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Fibromyalgia a Game Changer for Rheumatologists, PCPsMore Patients Mean Better Understanding Needed within Medical Community

By MELANIE KILGORE-HILL

It’s estimated that more than 10 million Americans are affected by fibromyalgia, and the condition afflicts twice as many women as men. While the medical community has made strides in understanding the painful condition, misinformation still abounds on this perplex-ing diagnosis.

Chad Boomershine, MD, PhD, medical director of Boomershine Wellness Centers and assistant clinical professor of Medicine at Vanderbilt, said improvements in brain imaging have led to a much better understanding of fibromyalgia. Still, the board certified rheumatolo-gist and internist noted some physicians are reluctant to admit any such condition really exists. “Doctors will say they don’t believe in fibromyalgia, then they’ll diagnose patients with it and

(CONTINUED ON PAGE 6)

Keith G. Anderson, MD, FACC

PAGE 2

PHYSICIAN SPOTLIGHT

(CONTINUED ON PAGE 9)

Finding the Right Words Alive Hospice Simulation Lab Looks to Make Hard Conversations a Little Easier

By CINDy SANDERS

You only get one chance to make a first impression. This is es-pecially true when approaching family members to discuss end-of-life alternatives.

“There are certain moments in our life that are indelible … that we’ll never forget,” said Anna-Gene O’Neal, president and CEO of Alive Hospice. “Critical communications, particularly around mortal-ity, are conversations that stay vivid, that stay real, and that stay with us. We don’t really get a chance for a ‘do over’ if we don’t do it well.”

To help ease those conversations and make them less stressful and more productive for everyone involved, Alive Hospice is creating a simulation lab for advance care planning discussions. Made possible through a $150,000 grant from the Memorial Foundation, the lab is anticipated to open on or before this September.

“The Memorial Foundation is just an incredible organization and truly a gift to our community,” O’Neal said of the support that has been provided to nonprofits across Middle Tennessee for more than two decades. She added this latest gift would help Alive Hospice answer a critical unmet need in the community.

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MedTenn16: Meeting in the MiddlePhysicians and medical professionals from across Tennessee ‘met in the middle’ for MedTenn16. The annual conference, sponsored by the Tennessee Medical Association and a number of medical specialty societies, was held April 28-May 1 in Murfreesboro ... 3

Meharry Installs Hildreth as 12th President in Formal CeremonyOn Saturday, April 16, the Meharry Medical College Board of Trustees conferred the Office of the President upon James E. K. Hildreth, PhD, MD, during a formal Investiture Ceremony at Temple Church in Nashville ... 9

ON ROUNDS

Rep. Brenda Gilmore addresses those gathered in celebration of Dr. James Hildreth.

2 > MAY 2016 n a s h v i l l e m e d i c a l n e w s . c o m

By CINDy SANDERS

As the 2016 House of Delegates for the Tennessee Medical Association draws to a close on Sunday, May 1, outgoing president John W. Hale, Jr, MD, will of-ficially pass the gavel to cardiologist Keith G. Anderson, MD, FACC, to begin his year leading the 186-year-old statewide organization.

Growing up in Memphis, Anderson said his desire to follow in his father’s foot-steps and become a physician was more of a gradual process than an ‘aha moment.’

“My high school and undergraduate leanings were always in the sciences,” he recalled. “As I got toward the end of my undergraduate time, I decided to go into medicine.”

Finishing his degree in math and chemistry from Vanderbilt University, Anderson moved back to Memphis to at-tend medical school at the University of Tennessee Health Science Center. While some medical students begin with a spe-cialty in mind, Anderson noted, “I think for most people, it’s a matter of step-wise exposure. You find your interest.” That was certainly the case for him.

As he progressed through his educa-tion and training, Anderson said he re-ally enjoyed internal medicine and was fascinated by cardiology. “It’s a blend of the practice of medicine and procedural-based skills. You can learn something new every day,” he said.

Anderson remained at UT for intern-

ship, residency and fellowship. He is board certified in internal medicine, cardiovascu-lar disease, and interventional cardiology and practices with Sutherland Cardiology Clinic in Germantown and Memphis.

From the very beginning, Anderson has been interested and involved in the local and state medical associations. “I was interested in organized medicine even as a student,” he noted. “I’ve probably been involved at the committee level for 20 years … at least.”

Anderson credits a lot of his involve-ment to the strength of the Memphis Medical Society and TMA. He said the organizations do a great job fostering en-gagement and involvement. “I’d like to put a word in for the staff of the statewide

and local society. They work hard, and they’re very passionate about organized medicine,” he said.

Anderson served as president of the Memphis Medical Society in 2008. “Shortly after that, I was elected to the Board of Trustees at the state level,” he noted, adding he served as chair of that group for two years.

In his new role, Anderson said there are a number of issues at both a state and federal level that deserve particular at-tention. One of his goals is to continue to strengthen the membership and ensure different practice perspectives are rep-resented in light of a growing number of employed physicians.

“We want to make sure our mem-bership values and addresses the issues of those physicians, not just the independent physicians; but at the same time, we don’t want to weaken our value system so the in-dependent physicians aren’t represented, as well,” he said of the balancing act to meet all needs.

Anderson also looks to continue and to enhance collaborative efforts with other physician groups, incorporating specialty societies into the TMA meeting structure and educational offerings whenever it makes sense to pool resources.

On a broader stage, Anderson said physicians should have a seat at the table to discuss issues ranging from the logistics of caring for those at high risk of addiction to payment reform. While SGR is gone, it remains to be seen how the Medicare

Access and Chip Reauthorization Act (MACRA) will be implemented. As in-tended, the law opens the way for more alternative payment models, which An-derson said is great in concept … but, he noted, the devil is in the details. “It’s going to be a slow evolution, but we’ve got to be at the forefront of payment reform,” he said.

When he isn’t seeing patients or representing organized medicine, An-derson and his wife Kay enjoy traveling and spending time with their two grown daughters. Anderson also loves deep sea fishing and fly fishing when he can find the time.

Of course, he added with a laugh, “There’s not a lot of down time lately.”

Anderson Installed as TMA PresidentPhysicianSpotlight

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Shumaker Named TMA President-Elect

Nita Wall Shumaker, MD, of Chattanooga has been named president-elect for the Tennes-see Medical Association. When Anderson passes the gavel to her next year, Shumaker will become the second female president since the organization’s founding in 1830.

“TMA has put in a lot of time and effort to diversify our leadership,” said TMA CEO Russ Miller. He added Shumaker joins Board of Trustees Chair Michel McDonald, MD, and Speaker of the House of Delegates Jane Sie-gel, MD, in key leadership roles.

“We want our leadership to reflect the mix of physicians in the state,” Miller continued, adding “We’ve been training future lead-ers for the past decade through our Physician Leadership Col-lege.” He noted Shumaker, Mc-Donald and Siegel all participated in the program, which was re-branded the John Ingram Institute for Physician Leadership last year.

Shumaker, who is a pediatri-cian at Galen North Pediatrics in Hixson, is a current member of the TMA Board of Trustees and former president of the Chat-tanooga & Hamilton County Medical Society. She was one of only two female chiefs of staff at Erlanger Medical Center and now serves on the hospital’s Board of Trustees. Shumaker earned her medical degree from East Caro-lina University School of Medicine in Greenville, N.C.

Dr. Nita Wall Shumaker

n a s h v i l l e m e d i c a l n e w s . c o m MAY 2016 > 3

By CINDy SANDERS

Physicians and medical professionals from across Tennessee ‘met in the middle’ for MedTenn16. The annual conference, sponsored by the Tennessee Medical As-sociation and a number of medical spe-cialty societies, was held April 28-May 1 in Murfreesboro.

The busy three days featured more than 30 hours of proprietary CME of-ferings, a range of speakers and sessions focused on key healthcare issues, vendor exhibits, networking opportunities, a poster competition for medical students and resident physicians, transition of TMA leadership, policymaking by the House of Delegates, and recognition of outstanding service.

Russ Miller, CEO of TMA, noted, “We increased educational offerings this year. There was probably 20 percent more than we offered last year.” He added MedTenn16 featured 32.25 hours of CME options, of which 19.25 hours were attainable for participants. Consider-ing the requirement is 40 hours every two years, Miller pointed out physi-cians could meet almost half of their ob-ligation in a ‘one stop shop’ setting. “We are continuing to grow the opportunities for physicians to get their educational requirements with relevant content at a great value,” Miller said of the meeting’s robust offerings.

Courses covered a wide range of top-ics from non-pharmacologic management of agitation in dementia, aging success-fully, and the death with dignity debate to updates on chronic care management, legal issues involved in treating minors and antibiotic stewardship. In addition, the conference featured two Maintenance of Certification courses – one for obstet-rics and the other for internal medicine.

MedTenn16 also saw the debut of the latest iteration of TMA’s proper prescribing course. “The biggest update this year is the continued discussion on opioid prescribing, proper use of opioid pain management, and an added section about medical marijuana,” Miller said. He added the course is now available online for those who were not able to attend in person during the conference but still need to fulfill the two-hour CME requirement from the Board of Medical Examiners.

Another topic of interest was physi-cian burnout. “The pressures and de-mands to practice medicine today are overwhelming our already thin supply of physicians. We are acutely aware of that,” Miller said. He continued, “We’ve got to clear the deck for more time on direct patient care and less on burdensome re-quirements. Doctors spend more time on

a computer or filling out forms than with patients.”

Lotte Dyrbye, MD, MHPE, FACP, led “Do You Smell Something Burning? Strategies to Reduce Your Risk of Burn-out.” The professor of Medicine at the Mayo Clinic, who is widely published on the subject of physician fatigue and satis-faction, covered the signs, prevalence and consequences of burnout, as well as sup-port strategies.

There were also sessions and discus-sion around telemedicine. “Done prop-erly, we see that as a very good solution to access and patient convenience,” Miller said. “But,” he continued, “you’ve got to marry up the capabilities of technology and the capabilities of healthcare provid-ers.” Miller added the regulations and requirements for the technology must en-sure that patient safety comes first. As an aside, properly implemented telemedicine protocols could have the potential to ease some of the pressures contributing to pro-vider burnout by taking travel time out of hectic days for physicians, while still giving patients in rural communities the access they need.

As for the House of Delegates’ poli-cymaking session, Miller said the biggest issue right now is tied to TennCare rate bump audits and recoupments. “They are retroactively going back to recoup the in-creases given to primary care physicians for treating TennCare patients,” he said of the battle brewing over the methodology used to determine eligibility for increased Medicaid payments as part of a provision in the Affordable Care Act.

Miller added most everyone in or-ganized medicine is anxiously watching the presidential race and the impact that might have on healthcare. “We continu-ally monitor the federal and state levels that dictate how the profession has to be carried out,” he said of the regulatory landscape. “Everything new that comes in that isn’t direct patient care affects ac-cess,” he pointed out.

While there were plenty of issues im-

pacting the practice of medicine to dis-cuss, MedTenn16 also was a celebration of the quality of patient care being deliv-ered across Tennessee and an opportunity to recognize outstanding physician lead-ers. John W. Hale, Jr., MD, wrapped up his year as TMA president and passed the gavel to Memphis cardiologist Keith G. Anderson, MD, FACC (see physician spot-light feature on page 2.)

The conference also included presen-tation of the organization’s annual awards.

Community Service Award• A Step Ahead Foundation, Mem-

phis• Tennessee Rep. Ryan Williams,

Cookeville• Safety Net Consortium of Middle

Tennessee, Nashville• Kathi Potts, CMPE, Administrator

at Siskin Spine & Rehabilitation, Chattanooga

Distinguished Service Award• James C. Gray, MD, Tennessee

Oncology, Nashville• Kelly Arnold, MD, Family Medi-

cine Practitioner and UTHSC Fac-ulty, Chattanooga

• Michel McDonald, MD, Vander-bilt, and Jane Siegel, MD, Tennes-see Orthopedic Alliance, Nashville

Outstanding Physician Award• Roland E. Gray, MD, of Middle

Tennessee• Jerre Minor Freeman, MD, of West

Tennessee• Nat Edens “Ed” Hyder, MD, (post-

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MedTenn16: Meeting in the MiddleTennessee Physicians Hold Annual Meeting, House of Delegates

Russ Miller

4 > MAY 2016 n a s h v i l l e m e d i c a l n e w s . c o m

By CINDy SANDERS

Oregon has done it. California is in the process of implementing it. Tennes-see, Colorado, Washington, Missouri and a number of other states are at least con-sidering it.

“It” is a pathway to allow women to receive oral and/or transdermal con-traceptives with a visit to the pharmacy rather than the physician’s office.

Addressing changes to prescribing and dis-pensing laws, Tim Tucker, PharmD, the former president of the American Pharmacists Association (APhA), noted, “The biggest, most important message here is patient access. Anything the provider – anybody who is part of the healthcare team: physician, pharmacist, nurse prac-titioner, physician assistant – can do to improve access is where we have to go in today’s environment.”

Tucker, who owns City Drug Com-pany in the small western Tennessee town of Huntingdon, continued, “I want every patient who can to have an OB/GYN.” However, he added, that isn’t always fea-sible as a matter of insurance, geography and other issues impacting access. “This is an alternative where pharmacists can help the OB/GYN or PCP.”

He added these new laws help women who are trying to be proactive in prevent-ing unintended pregnancies.

A similar mindset was behind a new prescribing law in Oregon that went live Jan. 1, 2016. Rep. Knute Buhler, MD, worked with colleagues and the Oregon State Board of Pharmacy to expand access to self-administered oral and transdermal birth control products by allowing phar-macists who meet mandated requirements to prescribe these hormonal contracep-tives.

Oregon State University College of Pharmacy played a key role in helping pharmacists meet those requirements through the creation of an education and certification program.

OSU Pharmacy Instructor Lorinda Anderson, PharmD, who was instrumen-tal in crafting and rolling out the certification pro-gram, said the Board of Pharmacy approached OSU even before the law was passed to ensure a robust educational plat-form would be in place. Physician members of the American College of Obstetricians and Gynecologists (ACOG) provided input for both the patient screen-ing tool and pharmacist coursework.

“Not only does the training program incorporate the guidelines for eligibil-ity criteria but also the Oregon Board of Pharmacy’s rules they put into place,” said Anderson, noting there is a procedural algorithm that walks through conditions and exclusion criteria that would require a patient be referred to a physician to obtain a prescription for contraceptives.

“I’ve been really happy with how the training has turned out,” Anderson said. “Mostly because pharmacists have come out of this feeling prepared and comfort-able to do this (prescribe), which is exactly what we had hoped.”

Paige Clark, RPh, who leads profes-sional development efforts for OSU’s Col-lege of Pharmacy and is a member of APhA, said about 350 pharmacists had already completed the course and passed the certification examination. “We expect to have 1,200 pharmacists certified and prescribing by the end of June,” she added, noting that approaches the halfway mark of retail pharmacists in just six months.

While it’s too early for hard numbers, Clark said from anecdotal evidence, “We are seeing a 90 percent prescription rate and a 10 percent referral rate, which is ex-actly what ACOG physicians would hope to see.” She added individuals with an in-creased risk of stroke, high blood pressure or who simply want to explore other birth control options would be among those re-ferred to a physician.

“We found Oregon patients were so excited to be able to access this service,” said Clark. “This can dramatically in-crease the availability of hormonal birth control therapies to women in every county of Oregon.”

She added, “We’ve had such a smooth rollout due to a lot of folks pull-ing together in a robust way. Patients are happy. Physicians are happy, and our public health officials are thrilled beyond belief because we’re already making an impact.”

Clark called pharmacists an “un-tapped resource” and pointed to the five-fold increase Oregon has seen in im-munization rates since involving pharma-cists in the process. As for concerns that patients might skip physician visits for rec-ommended screenings with birth control now available at the pharmacy, Anderson noted the Oregon law tried to address this issue. She said pharmacists are routinely talking to patients about the importance of those visits.

“After three years, if the patient doesn’t have evidence of having a wom-an’s healthcare clinical visit, then the pharmacist can no longer write a birth control prescription for them,” Anderson

added.Although ACOG would much pre-

fer birth control pills be available over the counter, Tucker, who is also a past president of the Tennessee Board of Phar-macy, said he is opposed to that move. “I think it’s so very important with contra-ceptives that there is some oversight by a healthcare team member.” He added that without a prescription, it would be impos-sible to track usage habits and changes in health that might impact the effectiveness or safety of oral contraceptives. “If we fill a prescription, we have a profile and can have a patient history,” he pointed out.

Why ACOG Thinks Good Isn’t Great

ACOG’s opposition to pharmacy prescribing laws for birth control pills stems not from an effort to protect physi-cian territory but rather the belief that ac-cess to oral contraceptives should be even more open.

“I think it’s a mistake to go in that di-rection because it still creates a barrier,” AGOG President Mark S. DeFrancesco, MD, MBA stated of the cur-rent wave of state laws putting oral contracep-tive prescribing power in the hands of pharmacists.

In terms of the new Oregon law and oth-ers that might follow, DeFrancesco noted, “Although ACOG members participated in the development of the patient screening tool and the phar-macist training program, this should not be interpreted as ACOG support for this concept. Once the new law was a reality, ACOG members did assist with imple-mentation in order to assure that appro-priate guidelines were followed.”

However, he continued, “We’d like to see unfettered access. ACOG’s policy is we don’t want anybody to be between the patient and the pill. We feel like it is time for it to be available over the counter. The pill has been out long enough to be proven extremely safe.”

DeFrancesco added that many OTC options – ranging from medications for pain relief to those addressing gastric is-sues – have at least as much, if not more, potential to harm certain patients than hormonal contraceptives. As with current OTC medications, he said, “The things that are absolute contraindications for the pill could be outlined on the label.”

He also noted that his patients who have a condition that prevents taking oral contraceptives such as migraines or deep vein thrombosis (DVT) are typically keenly aware of the fact. In addition, the physician pointed out unintended preg-nancies can also carry health risks for patients, including those with high blood

pressure. Furthermore, DeFrancesco said he believed it was a fair assumption that if the number of unintended pregnancies was reduced, the nation would see a drop in the abortion rate.

As for the argument that requiring a physician visit to receive a birth control prescription is the impetus to get women through the doors for annual health screens, DeFrancesco said, “We shouldn’t be holding patients hostage to the pill pre-scription.”

While he said he recognizes the claim might have some limited merit and that a small percentage of women might, in fact, skip their annual OB/GYN appointment, DeFrancesco said, “That puts the onus on us to explain that the annual visit is more than just a pap smear and pelvic exam.”

And, he continued, ACOG is promot-ing that broader practice message not only to women … but to their own members, as well. “It’s time physicians and women separate the pill from the annual visit,” DeFrancesco stated, adding there are al-ready many women who no longer require contraceptives that continue to come for an annual exam.

DeFrancesco said he suspects laws al-lowing women to seek oral contraceptives and transdermal patches from pharmacists are well meaning in their intent to allow broader access to birth control. Whereas moving hormonal birth control options to OTC status would most likely require in-dividual manufacturers to apply for such a change with the U.S. Food and Drug Administration, state legislative action on prescribing laws broadens the reach with-out reclassifying the drugs.

Yet, DeFrancesco fears, this halfway step might unconsciously prove to be di-versionary, diminishing the push for truly barrier-free access. “In that sense, the good would be the enemy of the perfect,” he said. “We might settle … and that’s not good enough.”

Of Pills, Prescriptions, Pharmacists & PhysiciansThe Push to Remove Barriers to Oral Contraceptives

Tim Tucker, PharmD

Lorinda Anderson, PharmD

Paige Clark, RPh

Mark S. DeFrancesco, MD

Council Capital Fund IIILast month, Nashville-based

healthcare private equity firm Council Capital announced the closing of its third fund, Council Capital III, LP (“Fund III”) totaling over $150 million, exceeding its target of $125 million and hitting its hard cap, bringing total capital under management at the firm to approximately $300 million.

In related news, the company announced the Fund III CEO Council would have 34 members, including 16 who are new to the exclusive group of industry-leading CEOs.

n a s h v i l l e m e d i c a l n e w s . c o m MAY 2016 > 5

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6 > MAY 2016 n a s h v i l l e m e d i c a l n e w s . c o m

By MELANIE KILGORE-HILL

Saint Thomas Health recently re-branded all women’s services under the name Saint Thomas Women’s Care. The change includes a multi-million dollar re-model and renovation of Saint Thomas Women’s Care at Midtown to enhance the patient and family experience be-fore, during and after childbirth. Around 7,000 babies are born each year at Saint Thomas Midtown.

“Given that Midtown is the hos-pital of choice for so many mothers, we wanted to continue to make sure mothers have the best experience possible,” said Jennifer Elliott, RN, vice presi-dent of Clinical Opera-tions and CNO at Saint Thomas Midtown and Saint Thomas West. “The rebranding was perfect timing, and we just came together to call ourselves what we are. We take care of women for the entire course their lives.”

More Space for More ServicesObstetric unit enhancements will be

competed in two phases. The first phase of the project – to be complete by year’s end - will focus on the high-risk patients, prenatal, guest waiting, and education centers and will include a 29,000-square-foot renovation. The wing will undergo significant upgrades including 22 labor and delivery rooms with renovated bath-rooms and showers to provide enhanced accessibility for patients and comfortable sleeper sofas for guests staying overnight in patient rooms. Other improvements include an expanded guest and family waiting lounge with more seating, enter-tainment and a children’s activity area, plus new floors, lighting and wall cover-ings in neutral color schemes for a softer, more welcoming environment. The new design also will include ample resources for natural childbirth – something Elliott said more women are expecting from to-day’s medical centers.

“For obstetrics, we provide any ex-perience a mom may want,” Elliott said. Midwives, doulas and water births are available for more natural deliveries, while a high-risk OB unit and surgical services are on site if needed. Nearby, the Perinatal Cardiac Clinic at Saint Thomas Heart cares for antepartum and intrapar-

tum women at high risk for cardiovascular complications related to preexisting and/or current co-morbidities. Maternal-fetal medicine specialists and cardiologists work together to develop a systematic, stream-lined patient care protocol that offers each patient a comprehensive, individualized treatment and long-term education plan.

Baby-Friendly HospitalIn 2016, Saint Thomas Midtown

received international recognition as a ‘Baby-Friendly’ designated birth fa-cility. Baby-Friendly USA, Inc. is the U.S. authority for the implementation of the Baby-Friendly Hospital Initiative (BFHI), a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Saint Thomas Midtown is the only hospital in Middle Tennessee and one of only two hospitals in the state to have received the designation as of April 2016.

BFHI encourages and recognizes hospitals and birthing centers that offer an optimal level of care for breastfeeding mothers and their babies. Based on the ‘Ten Steps to Successful Breastfeeding,’ the award recognizes birth facilities that

offer breast-feeding mothers the infor-mation, confidence, and skills needed to successfully initiate and continue breast-feeding their babies. Currently there are only 331 active Baby-Friendly hospitals and birth centers in the United States. The coveted designation is given after a rigorous on-site survey is completed. The award is maintained by continuing to practice the Ten Steps as demonstrated by quality processes.

Also available is the Saint Thomas Breastfeeding Outreach Clinic, a free ser-vice offered to any nursing mother in the community. “It’s important that moms have all the education they need in how they feed their baby,” Elliott said. “There are so many options for moms to look at and determine what best fits their life-style, and what they want for their baby. As a facility, we’re educated in all aspects to make that decision and to honor that choice. We’ve invested in educating our staff so whatever mom chooses is really her choice.”

The second phase of the renovation project will begin summer 2016 and will include similar enhancements to the labor and delivery wing and obstetrics triage area.

refer them to me,” Boom-ershine said. “I compare it to where depression was 30 years ago when a lot of people didn’t be-lieve it was a disease and wouldn’t treat it.” He con-tinued, “It then became a typical disease that every primary care provider now treats. Fibromyalgia will get there too.”

New Name with a Long HistoryWhile the term “fibromyalgia” has

been around since the 1970s, the condi-tion has gone by a lot of names historically. Boomershine points as far back as the Old Testament in the Bible where Job’s descrip-tion of widespread pain and poor sleep are consistent with fibromyalgia. Neurasthenia was the diagnosis given to patients with similar complaints in the 1800s, followed by fibrositis. Still, the American College of Rheumatology didn’t classify fibromyalgia as a disorder until 1990.

In a Class by ItselfBoomershine is among a handful of

rheumatologists willing to treat fibromyal-gia patients. That’s because rheumatology involves treatment of inflammatory dis-eases. Patients with fibromyalgia present with widespread pain but without the in-flammation present in patients with arthritis and other inflammatory conditions.

While chronic body pain is the primary symptom of fibromyalgia, other signs can

include moderate to severe fatigue, sleep disorders, problems with cognitive function-ing, anxiety and depression, IBS, and more. Symptoms tend to be life long. It also affects half of lupus patients and a quarter of pa-tients with rheumatoid arthritis.

Fibromyalgia often presents following major physical or psychological trauma and is thought to be triggered by a distur-bance in a person’s pain processing system. “We believe it’s a neurological condition in which hypersensitivity of nerves cause pain,” Boomershine explained. “Over half of patients can identify a specific stressor that brought it on – emotional stress, illness, or something that happened in their lives. We think people are born with a propen-sity to develop fibromyalgia, but it may not manifest itself until a stressful event … and because of this abnormality, the body isn’t able to adapt to stress.”

A Learning Curve for PCPsSince less than 10 percent of the na-

tion’s 3,000 rheumatologists treat fibromy-algia, diagnosis and care typically falls to family doctors. “Primary care providers are doing the lion’s share of the work with these pa-tients, and the tricky thing is that this isn’t a disease that has a test,” said inter-nist Marilynn Michaud, MD, of TriStar Medical Group’s Frist Clinic.

Michaud said fibro-myalgia is a common

condition among her predominantly fe-male patient base. “Patients often present with fatigue, muscle pain and cognitive dysfunction, and it’s my job to makes sure they don’t have anything else,” Michaud said. Her first task – which can take mul-tiple office visits – is to rule out a handful of possible diagnoses that include rheu-matoid arthritis, lupus, statin myopathy, mono, Lyme Disease, thyroid or adrenal abnormalities and HIV. She also examines a patient’s psychiatric history. Half of fibro-myalgia patients have a history of depres-sion, and a quarter is actively depressed. Many suffer from sleep apnea or a lack of restorative sleep, or experience restless leg syndrome. Anxiety and PTSD also are common among patients.

“Fibromyalgia is complex, but it’s no more complicated than a diagnosis like dia-betes,” Michaud said. “There are so many co-existing problems that you have to take little bites out of it over many visits.” For many of Michaud’s patients, first steps often include improving sleep hygiene and seek-ing cognitive behavioral therapy. Regular exercise also is shown to improve muscle pain and releases endorphins to help com-bat depression. Massage and relaxation exercises like yoga and tai chi also can be beneficial.

No Magic Pill“People often want a pill to make the

pain go away, and it can be frustrating be-cause you can’t do to the work for them,” Michaud said. “We can guide them, but it

takes a lot of effort on their part to really fix it.”

Pharmacological treatment often in-cludes anti-depressants, which help de-sensitize pain receptors. Lyrica, Cymbalta and Savella have received approval from the U.S. Food and Drug Administration specifically for treatment of fibromyalgia, although Michaud estimates that only 30 percent of patients find relief in these.

And while neither Michaud nor Boom-ershine prescribes opioids for fibromyalgia patients, they say over-prescription remains a problem among providers. “If you look at any neurological pain disorder, you see that opioids don’t work well,” Boomershine said. “Unfortunately that’s the first line of treat-ment for many physicians. There’s a lot of education that still needs done.”

Hope for PatientsWhile diagnosing fibromyalgia is often

time-consuming, Boomershine said it’s not overly difficult and encourages providers to make an effort to reach an accurate diag-nosis.

“It takes a lot of patience on the part of providers because these patients can be dif-ficult to manage and can take a lot of time,” Boomershine said. “The point I make when I speak to providers is that fibromyalgia patients can get better because a lot don’t believe that’s true. Patients can be treated and go into remission. Many have been told they’re crazy or are never going to get bet-ter, and we can give them hope. That’s the biggest impact I can make.”

Saint Thomas Expands, Rebrands Women’s Services

Fibromyalgia a Game Changer, continued from page 1

Dr. Chad Boomershine

Dr. Marilynn Michaud

Jennifer Elliott

n a s h v i l l e m e d i c a l n e w s . c o m MAY 2016 > 7

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By MELANIE KILGORE-HILL

Menopause has long been synony-mous with hot flashes, poor sleep patterns and memory trouble. But these sometimes-laughable memory lapses aren’t quite so funny, researchers now say.

Recent studies have found low estrogen levels often cause notable memory prob-lems in the months following a woman’s last period. Understand-ing why is the mission of Vanderbilt University’s Paul Newhouse, MD, professor of Psychia-try, Pharmacology, and Medicine and director of the Center for Cognitive Medicine. Newhouse ar-rived in Nashville four years ago to establish the center where much of his work examines cognitive performance in women and the elderly.

Estrogen & the Aging Brain“I’ve been studying the effects of

menopause on memory and cognitive and intellectual function for many years and from many perspectives,” Newhouse said.

Studies examine how estrogen alters the brain, potential benefits of estrogen on brain functioning, and how to test theories in a way that reveals the mechanisms be-hind it. And since estrogen doesn’t seem to

be a fit for every postmenopausal woman, he hopes to learn whom it benefits most.

Current studies focus on women who have noticed changes in memory function after menopause as opposed to those who don’t, with the former group at a seemingly higher risk of late life memory impairment. While no good epidemiological studies exist on the topic, smaller studies have found approximately one-third of women report cognitive changes during this stage of life.

Nicotine as a Memory Aid?

Newhouse’s memory studies aren’t limited to menopausal women. Last year, VUMC received a $9.4 million grant from the National Institute on Aging (NIA) to test the effectiveness of a transdermal nicotine patch in improving memory loss in older adults with mild cognitive impairment (MCI), a precursor to Alzheimer’s disease.

About 300 older individuals with MCI will be enrolled at about 20 different sites around the country, including Vander-bilt, in the two-year MIND (Memory Im-provement through Nicotine Dosing) study — the largest study of a nicotine patch in nonsmokers. The research is a continua-tion of Newhouse’s work into nicotine as a treatment for MCI. A 2012 study published in Neurology looked at 74 nonsmokers for six months at three sites.

Women, the Brain & Stress ResponseNewhouse also is examining the

link between menopause, depression and stress. “We’re looking at how women who are vulnerable to depression may differ in terms of how the brain responds to stress,” Newhouse said. “We have evidence that menstrual cycles and estrogen levels regu-late the body’s stress response. We want to extend that to older women after meno-pause because there’s preliminary evidence that estrogen can help stress before meno-pause but can exaggerate it after. The brain changes during and after menopause, and we want to understand why.”

MRIs and brain scans measure brain activity that occurs during psychosocial stress. The technique shows participants’ neurological signatures and demonstrates how the brain modulates the body’s stress response in real time activity.

“Women with prior depression may still get benefits from estrogen after meno-pause on the modulation of emotion,” New-house said. “We don’t fully understand the neurological mechanisms behind it but are beginning to explore it.”

He said the idea of stress response post-menopause is very interesting and that Vanderbilt researchers were among the first to discover and report it. “Estrogen can modulate stress response, and we didn’t know that till now,” Newhouse said of the fairly recent discovery. That’s because sex steroids like estrogen and testosterone aren’t traditionally thought of as stress modulators. Newhouse believes those sex steroids are de-

rived from the same cholesterol backbone as hormones like glucocorticoids.

“The brain seems to respond to sex hormones in a very specific way, and we’re trying to map that out in younger and older women,” he said. Newhouse hopes his work will lead to new treatment for memory loss and Alzheimer’s disease and is developing new molecules for mem-ory loss to address different aspects of the aging brain.

Menopause and the BrainVUMC Studying Estrogen Levels & Memory Loss, Depression

Postmenopausal Studies at Vanderbilt

Vanderbilt’s Center for Cognitive Medicine currently has three studies for postmenopausal women that focus on memory.

1. Ages 50-75: Women who have had a depressive episode(s) that was more than one year ago and no more than 10 years ago.

2. Ages 65-80: Women and men. This study examines the connection between memory and sensory differences.

3. Ages 50-60: Postmenopausal woman, memory, and hormones.  In this study postmenopausal women may not have been on any hormones (estrogen, etc.) for 1 year. Half of the participants will receive estrogen for four months and the other half will receive a placebo.

Each study has its own criteria. Please call Sally Ross, MS, for specific information: 615-875-0955.

Dr. Paul Newhouse

8 > MAY 2016 n a s h v i l l e m e d i c a l n e w s . c o m

HealthcareEnterprise

By MELANIE KILGORE-HILL

Tennessee Women’s Care, PC is a quiet leader in Nashville’s women’s health market. Founded as Women’s Health Alli-ance in 2003, the practice has grown from 20 practitioners in four locations to 34 doc-tors in 15 care centers across the midstate. TWC also offers bone density scans, lab services, a mammography center and a la-borist company that staffs hospitals 24/7.

Going it Alone – Together TWC’s ability to thrive independently

is something administrators don’t take for granted. In 2011, TWC was one of eight Nashville medical practice groups to create Health Innovation Specialists, a new col-laborative physician network that included Anesthesia Medical Group, Tennessee Or-thopaedic Alliance, Urology Associates and other thriving practices. “We all wanted to stay independent but work together,” said TWC CEO Tammy Pearson. “We created Health Innovative Specialists as a group of single specialties who wanted to make sure patient care remains our focus and not the bottom dollar.”

Smart Growth“Intentional” best describes TWC’s

steady growth. “Our goal is not to conquer an area so we concentrate on keeping our focus as a true women’s specialty,” Pear-son said. That means constantly looking at changes in Nashville’s market and some-times altering growth plans based on pa-tient requests.

In the past year, TWC’s market has expanded into Franklin and Cool Springs. Their physicians have privileges at Saint Thomas, TriStar Summit, TriStar Cen-tennial and Maury Regional. Altogether TWC providers see 1,200 patients a day.

“Provision of care is our focus, and providers are very good about listening to patients,” she said. “They understand that relationship is the most important thing and pride themselves on building those.”

Spend Where it CountsIn an era of practice consolidation and

provider buy-outs, Pearson said staying independent means establishing the right leadership that allows physicians to see patients and keeps them out of the billing, hiring and contracting game. “The business components consume so much these days that unless you have experts in that area you’ll fail,” said Pearson, a nurse and former hospital CFO. “Providers must be willing to pay good money for someone who knows what they’re doing and let that happen if they want to stay independent. Get the right administrators and pay them appropriately. They’re well worth their salt if they get you expense and revenue management.”

At TWC, providers can focus solely on patients because of smart financial practice management. Being a debt-free company also allows providers more flexibility and increased cash flow. “We want to make sure physicians get the most optimal return on their investment, which is their time,” Pearson said. “We want to be respectful about where and how they spend their time and eliminate as many conflicts as we can for them.”

Avoiding Practice Management Pitfalls

A veteran healthcare consultant, Pear-

son said there are several common mistakes she sees in practice management. Groups often grow for revenue enhancement, and the desire to grow is often one-sided, lack-ing the realization that revenue is two-fold – what you have coming in and expense management. “We plan deliberately,” Pear-son said of TWC. “There’s no business ven-ture we go into where we haven’t already decided worst and best case scenarios.”

Another common mistake is a lack of realization that give and take is necessary. That means not every physician will win exactly when they want to win, but they won’t lose either thanks to the cyclic nature of healthcare. Groups won’t always “win” either, and Pearson said it’s troublesome when administrators mistake “winning” for dominating the field. Winning takes on dif-ferent connotations, Pearson said, and all parties should have fair and equal balance. “If you think you always have to be aggres-sive to be on top, at some point you will not be solicited and will become the bully in the market,” she said. “Business needs to be fair to everyone because we’re all here for a par-ticular reason.” That means there’s value in every practice, from one provider to 100.

To Sell or Not to Sell?While the lure of a big-name buyout

might be enticing, the grass isn’t always greener. “One of the things we as admin-

istrators know about is how to get physi-cians to move, and many administrators will push them to be scared,” she said. Un-fortunately they often don’t realize that’s what is transpiring; and if they don’t have the right resources, they can make a deci-sion that’s not in their best interest. Pear-son noted if physicians are pushed to make decisions about selling quickly, they might be ready to file for divorce once the brief honeymoon period is over.

So what should a provider look at when deciding whether to sell? “The pri-mary focus doesn’t need to be about cash, but what do you expect in your lifestyle, and what are you willing to compromise on to make 10 percent more income?” Pearson said. “If it’s about insurance reim-bursements, those can change tomorrow so providers need to figure out if that small margin in income is worth giving up au-tonomy. Don’t assume what someone else is telling you is correct. That’s the biggest misconception for practices.”

Finding the right business manager can help a provider stay independent as long as he or she desires. For many pro-viders, that extra expense is well worth the ability to maintain autonomy. “Being a provider is a service line business – it’s you someone wants to see,” Pearson said. “You can consolidate, but that doesn’t mean you’ll rob Peter to pay Paul.”

Tennessee Women’s Care: A Model in Independent Practice Management

Mission in MotionSTMP Receives Mobile Mammography Grant

Saint Thomas Medical Partners (STMP) has received a $75,000 grant for the Our Mission in Motion (OMIM) program. The amount is the largest monetary award given by the Greater Nashville Affiliate of Susan G. Komen®. 

OMIM provides screening mammography through a mobile health unit to 17 Tennessee counties, including the 11-county Susan G. Komen Greater Nashville Affiliate service area, eliminating both time and transportation barriers to increase the number of women having annual mammograms. 

The OMIM program supports the Komen and STMP objectives of increasing the availability and affordability of breast health services in Middle Tennessee communities and developing partnerships with health providers to reach uninsured, underserved, low income and minority women. OMIM also works closely with employers in many of the counties to deliver mammography to female employees on their work premises. 

“Saint Thomas Medical Partners and Our Mission in Motion is excited to continue our partnership with the Komen Greater Nashville Affiliate and bring this potentially life-saving service to many who might otherwise not be able to care for their health,” said Yvette Doran, COO of STMP.

Since its inception in June 2011, the OMIM program has screened 11,615 women, diagnosed 34 breast cancers, and visited more than 120 venues to bring screening mammography and breast health education to women. 

Tammy Pearson

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n a s h v i l l e m e d i c a l n e w s . c o m MAY 2016 > 9

On Saturday, April 16, the Meharry Medical College Board of Trustees conferred the Office of the President upon James E. K. Hildreth, PhD, MD, during a formal Investiture Ceremony at Temple Church in Nashville. Hildreth, who began his tenure as the school’s 12th president on July 1, 2015, also serves as the chief executive officer for the 140-year-old college that offers degree pro-grams in medicine, dentistry and graduate studies/research.

Delegates from academic institutions across the world at-tended the ceremony. Notewor-thy participants included the Honorable James H. Cooper, U.S. Representative, 5th Congressional District; Tennessee De-partment of Health Commissioner John Dreyzehner, MD, MPH, FACOEM, rep-resenting Governor Bill Haslam; the Honor-able Brenda Gilmore, State Representative, 54th District; and Debbie Dale Mason on behalf of Mayor Megan Barry. Those mak-ing presentations included Sir Andrew Mc-Michael, professor of Molecular Medicine and group head Nuffield Department of Medicine from the University of Oxford in Oxford, England; Valerie Montgomery-Rice, MD, president and dean of Morehouse School of Medicine in Atlanta; and Rev. Kim Cape, DMin, general secretary of the United Methodist Church and member of Meharry

Medical College Board of Trustees. Hildreth was introduced by Board of

Trustees Chairman and Meharry alumnus Frank S. Royal, MD, (Class of ‘68). During the ceremony, Hildreth was presented the seal, the mace and the medallion, official symbols of the office of the president. He then gave an inaugural address providing an overview of his dynamic vision for Me-harry, which includes expanding the campus footprint, increasing enrollment in all three schools, enhancing technology, adding new academic programs, and positioning the Col-lege for its sesquicentennial in 2026.

“The future is now, and Meharry is just nimble enough to evolve its culture and transform its operations for the future so more students who support our mission can come,

learn, and go out and serve,” said President Hildreth.

A full week of activities – in-cluding a Faith Walk, a Scientific Discovery Day, a Gospel Con-cert featuring Kim Burrell and a President’s Scholarship Golf Tournament – culminated with an Inauguration scholarship gala event featuring television star An-thony Anderson of ABC’s “Black-ish.”

Scholarship GoalDollars raised for scholarships

are part of a $75 million campaign goal. Initial efforts to reach this

historic scholarship objective have already begun. Frank S. Royal, Sr., MD, and Henry Moses, executive director of the Meharry National Alumni Association and professor emeritus of Biochemistry, have each commit-ted scholarship gifts of $1 million.

With a shortage of physicians nation-wide, the need for a diverse population of healthcare professionals and researchers is even greater, calling further attention to the sharp decline in the number of black men en-rolled in medical school. Hildreth has dedi-cated his Inauguration to raising scholarship funds for any student interested in upholding Meharry’s mission. Today, the historically black academic health science center has trained thousands of health professionals who answer the call to serve in rural and urban

communities with the greatest need. More than 80 percent of Meharry Medical College alumni provide healthcare services to the na-tion’s most vulnerable communities.

A Remarkable CareerIn 1979, Hildreth received his under-

graduate degree in chemistry from Har-vard University magna cum laude. A Rhodes Scholar, he earned his doctorate in immu-nology from the University of Oxford in England in 1982; and his medical degree from Johns Hopkins University in 1987. He is a renowned HIV/AIDS researcher and the recipient of numerous awards including the NIH Pioneer Award.

Hildreth is a member of the National Academy of Medicine (formerly the Institute of Medicine) and the Johns Hopkins Society of Scholars. Hildreth also serves on the Har-vard University Board of Overseers and the National Advisory Council on Drug Abuse at the NIH. An Arkansas native, he also has been inducted into the Arkansas Black Hall of Fame. Hildreth has been married to his wife, Phyllis Drennon King, for 35 years. They have two children: Sophia, a captain and at-torney in the U.S. Army, and James, a senior at the University of Oregon.

Immediately prior to becoming Mehar-ry’s president, Hildreth served as dean at the University of California Davis College of Bi-ological Sciences, where he made significant contributions to the university’s fundraising efforts and research programs.

“In an IOM report, more than 85 per-cent of those surveyed say they want to die at home surrounded by friends and fam-ily,” O’Neal said. Despite this desire, many individuals eventually die in the hospital. “We need an opportunity to do things differently,” she continued.

O’Neal added hos-pice services often are not activated until very near the end of someone’s life. Yet, research continues to show those in hospice care frequently live longer and with greater quality of life. “We’ve had so many patients who are late referrals to hospice,” O’Neal said. “But once we get them, we have so many clients who say, ‘If we had only known earlier the im-pact this could have made on our family.’”

Instead of just wishing people would consider hospice earlier, O’Neal said the team at Alive Hospice really began thinking about the barriers to earlier entry and ways to overcome those obstacles. One major issue is a dread of broaching the subject with families and a fear of mishandling such a sensitive topic.

The goal of the new simulation lab is to provide a safe place to hone skills and de-

velop a personal style to discuss end-of-life options, allowing providers to make missteps and corrections before facing patients and families who are already in a fragile state.

“If we create this environment to teach and to train in a way to be able to help healthcare providers, then that is going to set us all up for success with our patients and our families at the moment those con-versations should occur,” she said.

“We want to take them through very emotionally challenging discussions … and frankly medically and ethically challenging discussions … to be able to immerse them into all types of end-of-life conversations,” O’Neal added. “We’re using intentional adult learning theory as the model to make sure we have success.”

She continued, “We’ll have trained actors who portray individuals at different emotional states in the understanding of their disease to be able to create as lifelike, real world discussions as possible,” O’Neal said. “This is way beyond the classroom di-dactic. The intent of this is really immersing individuals into their verbal language and their non-verbal language.”

The simulation lab is located at Alive Hospice’s Training Center on 18th Avenue North in close proximity to a number of hospitals, universities, medical practices

and clinics, and faith communities. The space is being set up to look like a patient’s room with a hospital bed and equipment emulating the sights and sounds encoun-tered in an acute care setting.

O’Neal added the conversation simu-lations would be videotaped to allow for de-briefing and to reset areas that might need more work. She noted the stages of grief don’t follow any direct order or timeframe so providers have to be prepared for vari-ous emotions and responses. “Grief doesn’t happen in a neat line,” she said. “Grief is a scribbly mess.”

With practice and preparation, how-ever, providers can get past feeling intimi-dated and uncomfortable. “Our goal when they leave is that they feel confident and se-cure and know they also have a resource if they have questions down the line,” O’Neal said, adding she anticipated a two-hour time commitment should give participants really good exposure to numerous scenarios.

One of first people planning to take advantage of the new resource is Dan Hogan, president and CEO of Medalogix, a Nashville-based, post acute predictive analytics and population health manage-ment firm. If all goes as he expects, Hogan said, “I will not only put my entire staff through the training, but I’m going to make

it part of our onboarding process so when we hire new employees, they’ll go through it, too.”

A l though the Medalogix staff will never have end-of-life conver-sations with a family, the company’s Bridge tool uses analytics to identify the right patients to link to hospice care at the right time. “It’s a vic-tory when we identify patients early on who will benefit from hospice care,” Hogan said. However, he continued, “It’s important to me and for everyone on the Medalogix staff to remember that whenever our software works well, there is a conversation at the end of it that someone will never forget.”

He added that because his team is so data driven, “It’s very easy for us to get lost in the 1s and 0s.” Hogan continued, “I’m constantly looking for ways to drive home the patient impact.”

O’Neal said the hope is that the lab will benefit a broad spectrum of healthcare industry professionals and ultimately be ac-cessible to the community at large

“We feel it’s critical for us, with what we do, to make the best of something that’s really tough and hard – and we’re commit-ted to that upstream,” she concluded.

Meharry Installs Hildreth as 12th President in Formal CeremonyTelevision Star Anthony Anderson Hosts Inauguration Scholarship Gala

Anna-Gene O’Neal

Finding the Right Words, continued from page 1

Dan Hogan

Meharry President & CEO Dr. James Hildreth and his research team.

10 > MAY 2016 n a s h v i l l e m e d i c a l n e w s . c o m

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Dr. Michael Warren

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Mark Your CalendarMay 10: NMGMA Presents Susan

Childs, FACMPE8 am-noon • Millennium Maxwell

HouseAn interactive session looking at

best practices for revenue cycle man-agement. For more information or to register, go to NMGMA.site-ym.com.

May 12-13: Mental Health Mar-keting Conference

12th: 1-6 pm, 13th: 9 am-4 pm • Ezell Center, Lipscomb University

Designed to help marketers in the mental health space learn about effec-tive ways to reach those in need of ser-vices. This conference brings together speakers from around the country and here locally to share information and tools to lead others to treatment and de-stigmatize mental health. For infor-mation or to register, go online to MH-Marketing.org.

Warren Appointed TDH Deputy Commissioner

Michael Warren, MD, MPH, FAAP has been appointed deputy commis-sioner for Population Health for the Tennessee Department of Health. He previously served as as-sistant commissioner for Family Health and Well-ness. Warren will provide leadership for various of-fices and divisions within TDH including Family Health and Well-ness; Policy, Planning and Assessment; Rural Health; Minority Health and Dis-parities Elimination; Health Planning; Grants Coordination and Strategic Alignment and Workforce Develop-ment.

Prior to TDH, Warren served as an assistant professor in the Department of Pediatrics at Vanderbilt and as medi-cal director in the Governor’s Office of Children’s Care Coordination. A board-certified pediatrician, Warren received his undergraduate degree from Wake Forest and his medical degree from the Brody School of Medicine at East Caro-lina University. He completed his pedi-atrics residency, chief residency and fel-lowship in academic general pediatrics at Vanderbilt University, where he also obtained a master’s degree in Public Health. He is a fellow of the American Academy of Pediatrics and currently serves as president-elect for the Asso-ciation of Maternal and Child Health Programs.

Pietenpol Named EVP for Research at VUMC

Jennifer Pietenpol, PhD, director of the Vanderbilt-Ingram Cancer Center, has been named execu-tive vice president for Re-search at Vanderbilt Uni-versity Medical Center. She will take on this new role while continuing to lead VICC.

Pietenpol, who is an active researcher, will as-

sume a portion of the responsibilities held by Larry Marnett, PhD, as he tran-sitions to the newly created position of dean of Basic Sciences in the School of Medicine for Vanderbilt University.

In her new role, Pietenpol will re-port to Jeff Balser, MD, PhD, vice chan-cellor for Health Affairs and dean of the School of Medicine. A professor in several disciplines, Pietenpol will sup-port the basic science programs in clini-cal departments, centers and institutes that will be housed in the new VUMC after the reorganization. She will be re-sponsible for leading the infrastructure that will advance much of the Medical Center’s basic research enterprise and broadly promoting research discoveries and strategic planning.

TwelveStone Health Partners Adds Three

Murfreesboro-based TwelveStone Partners, a new post-acute care pharma-cy and medical supply service provider has recently announced three additions to the company’s leadership team.

Cannon Loughry has been named COO. Previously, he was vice president of information services for TwelveStone’s predeces-sor company, Reeves-Sain Family of Medical Ser-vices. Loughry joined the organization in 2012 from Microsoft, where he was a healthcare technology strategist for Tennessee. He also has a banking background and served as CIO for Cavalry Bank and Pin-nacle Financial Partners.

Chad Boyd has been named CFO. Also part of the predecessor company, Boyd stepped away from Reeves-Sain from 2013-14 to serve as CFO and in-terim COO for the Nash-ville Symphony. His eye for detail not only serves him well as a financial leader, but Boyd is also a skilled artist. He has been named one of the ‘Top 10 Artists in Tennessee’ by the Portrait Society of America.

Dave Carter has joined the com-pany as chief business development officer. Previously, he owned venture capital company, CV&M, an in-vestor in healthcare and media companies. Addi-tionally, he doubled the size of Integrity Solutions & Healthcare, an interna-tional sales and leader-ship consulting firm, in four years. Prior to healthcare, Carter served as a region-al vice president for both Comcast and AT&T. Carter is a retired military veteran with 20 years of service. He is also an ad-junct professor of business at Lipscomb University.

Centerstone’s Ella Hayes Clinic Moves

Mental health and addiction ser-vice provider’s Germantown-based Ella Hayes Center outpatient clinic has re-located to nearby renovated property in MetroCenter at 230 Venture Circle. Clients began receiving treatment in the fully renovated facility on April 4. The new location offers more treatment space and has been remodeled spe-cifically to meet the needs of a modern mental health clinic.

Law Retires from Premier Orthopaedics

Recently, Premier Orthopaedics & Sports Medicine, PLC announced well-known orthopaedic spine surgeon, Melvin Law, MD, retired on April 22. A partner and former board member at Premier’s Centennial Care Center, Law served patients, his practice and the medical community with distinction during his long career.

His practice continues in the hands of his partners and fellow spine sur-geons, Robert W. Lowe III, MD, and L. Brett Babat, MD. Lowe is a graduate of Vanderbilt School of Medicine and served his Spine Fellowship at Rush Uni-versity in Chicago. Babat is a graduate of Yale University School of Medicine. His Spine Fellowship was completed with the Cleveland Clinic Foundation.

Cumberland Consulting to Offer Legacy System Data Management

Nashville-based healthcare advisory firm Cumberland Consulting Group has announced the launch of legacy system data management services powered by Trinisys, a healthcare data automation and integration solutions platform. “As organizations implement or inherit new HIT systems, they must determine what to do with the data in a legacy system – that’s where we come in,” said Brian Cahill, CEO of Cumberland Consulting Group. “Our legacy data management service offering meets the growing needs of our clients to cost effectively manage the migration, retention and access of legacy data in enterprise environments.”

In other news, the company recent-ly announced the acquisition of Little Rock-based Oleen Pinnacle Healthcare Consulting

GrandRounds

Dr. Jennifer Pietenpol

Cannon Loughry

Chad Boyd

Dave Carter

Dr. Mel Law

n a s h v i l l e m e d i c a l n e w s . c o m MAY 2016 > 11

GrandRounds

Let’s Give Them Something to Talk About!Awards, Honors, Achievements

Modern Healthcare’s annual list of “50 Most Influential Physician Ex-ecutives and Leaders” includes Middle Tennessee’s Jonathan Perlin, MD, of HCA and Lynn Simon, MD, of CHS.

Riverview Regional Medical Cen-ter in Carthage recently announced it has been named a Duke LifePoint Quality Affiliate. This designation rec-ognizes hospitals within the LifePoint Health system that have enrolled in the LifePoint National Quality Program and succeeded in transforming their culture of safety and achieving high standards of quality care, performance improve-ment and patient engagement.

Brentwood-based predictive ana-lytics firm WPC Healthcare recently announced their TapRootTM Cloud So-lution Suite has been named a finalist for the 2016 SIIA CODiE Awards in the Best  Healthcare Technology Solution category. The Taproot Cloud Platform was designed to deliver fast, affordable access to advanced predictive analytics across all core functions – clinical,  op-erational and financial – in healthcare organizations of every size.

David Morgan and Mike Cain have been awarded the esteemed “Legend” award from LEA Global. They were hon-ored for their outstanding contributions to LBMC, their clients, and their com-munities over the span of their careers. 

BlueCross BlueShield of Tennessee has designated multiple TriStar Health hospitals a Blue Distinction Center+ or Blue Distinction Center for cardiac care, maternity care, knee and hip replace-ment, and spine surgery programs as part of  the Blue Distinction Specialty Care program.

In recently released results, the CMS Five-Star Quality Rating System recognized Home Care Solutions with a 5-star rating in patient satisfaction. Ac-cording to the data, the Nashville home health provider achieved the highest rating possible in the patient satisfac-tion category.

Belmont’s Masters of Science in Nursing program for Family Nurse Practitioners has achieved a 100 per-cent pass rate with all graduates passing the nursing certification exam on their first attempt. The most recent class of 22 graduates passed the exam this spring, making this the 12th consecutive year of 100 percent first-attempt success.

After analyzing HCAHPS scores, Healthgrades has honored 448 hos-pitals across the country with the 2016 Outstanding Patient Experience Award. Honorees in Middle Tennessee

are Maury Regional Hospital, Saint Thomas Hospital for Spinal Surgery, and Williamson Medical Center.

Saint Thomas Midtown Hospital has received a 2016 award of excellence in Stroke Care from Healthgrades. Saint Thomas Midtown Hospital is the only hospital in Tennessee to receive Health-grades awards of excellence in two key areas this year: Stroke Care and Cranial Neurosurgery. Additionally, Saint Thom-as West Hospital received the designa-tion of a five-star recipient for treatment of Stroke for seven years in a row.

Lipinski Named CEO of Lee Medical

Franklin-based Lee Medical, Inc. re-cently announced Bryan Lipinski, BSN, MBA has joined the vas-cular access insertion and management provider as chief executive officer. Founded in 1993, Lee Medical is a leading pro-vider of outsourced vas-cular access services to acute, post acute, skilled, outpatient and home providers.

Lipinski has more than 25 years ex-perience leading small and large distrib-uted clinical workforces in both regional and national settings. He has served at a senior executive level with Special-tyCare, Fresenius Care North America and Renal Care Group. He also has ex-tensive experience scaling public and private healthcare delivery enterprises though organic growth, joint venture formation, and strategic acquisitions. Lipinski is on the board of Healthcare Resources of America.

Brian Lipinski

Surgical Trends and BreakthroughsThe Surgical Clinic, PLLC, is a specialty practice that provides the latest in medical technology

with an emphasis on patient care, convenience and satisfaction. Now over 30 surgeons strong,

we offer 14 clinic and outreach locations with specialists in general, vascular, breast, bariatric

and reconstructive surgery as well as surgical oncology. Our nationally known surgeons not only

deliver the highest quality healthcare but also focus on the newest trends in their specialties to

give patients the very best in individualized treatment – in a setting that’s close to home.

Experience. Tailored to the Patient. TSC.com

ADAM A. RICHTER, MD, RPVIBoard Certified Vascular SurgeryMedical School - University of Texas Residency - University of Texas Southwestern Fellowship - Vanderbilt University Medical Center

ASHLEY A. HENDRIX, MD Board Certified General SurgeryMedical School - University of TennesseeResidency - University of TennesseeFellowship Trained in Breast Surgery - University of Texas Southwestern

Trends in Breast Surgery Trends in Vascular Surgery

Breast health is more than cancer screening. It is a wide

spectrum of diseases that starts at any age of life. Talking

with a specialist helps navigate the complex and conflicting

advice that may be given in the treatment of non-cancerous

problems such as breast pain, infections, mastitis and cysts.

Breast cancer screening is more than just mammograms.

Clinical breast exams, advanced imaging, personalized risk

assessments and discussions of family history are all essential

steps when looking at both individual risk and treatment of

breast cancer. Breast cancer care evolves constantly. Breast

surgeons combine both surgical oncology principles with

plastic surgery techniques for better outcomes. When scars

are hidden, patients move past the cancer more easily with-

out a constant reminder. Surgeons at The Surgical Clinic are

committed to staying on the cutting edge to not only effec-tively treat cancer, but also help our patients survive cancer.

Aneurysm ruptures carry a mortality rate of 78% making

detection critical. Ultrasound poses little risk to the patient

and can diagnose a potentially fatal disease when it can eas-

ily be treated. Since the advent of endovascular abdominal

aortic aneurysm repair (EVAR) and thoracic aortic aneurysm

repair (TEVAR), the management of aortic aneurysm repair

has evolved rapidly. This leap in technology has enabled

vascular surgeons to perform complex repairs in a fraction of

the time and send their patients home as early as the next

day. As new generations of aortic stent grafts have been

developed, complication rates have decreased and more

patients with complex anatomy have become candidates for

a minimally invasive repair. Newer adjunctive technologies

such as endovascular screws and fenestrated grafts have

expanded the number of patients who can benefit from

endovascular aneurysm repair with lower mortality and

morbidity rates realized through the application of these

technologies. It is an honor and privilege to care for these

patients and participate in the evolution of the treatment of

this lethal, yet treatable, disease.