Nashville Medical News Sept 2013

By CINDy SANDERS

Between immunizations, primary care services, licensure and regulation of health facili-ties, analyzing health statistics and launching preventive care initiatives, it’s easy to think of the Tennessee Department of Health as more ‘Clark Kent’ than “Superman.’ Yet, as the recent multi-state fungal meningitis outbreak clearly reminded us, addressing emergency situations is a key part of the TDH’s core function.

In fact, the department was primarily established to combat life-threatening outbreaks of cholera, yellow fever and other deadly diseases in the late 1880s. Preventing or stopping public health threats remains a top priority. Sometimes those threats warrant local, state or national attention, but often the TDH staff quietly goes about that part of their workday without much fanfare.

“Our mission is to protect, promote and improve the health and well-being of Tennes-seans. The emergency preparedness aspect is all about protecting the population,” noted

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Scaling Cancer CareNashville Oncology Programs Expand, Spread

Metastatic cancer … not the best news a patient can receive, but ‘metastatic’ cancer care … that just might be a different story ... 5

The CHS, HMA Chess Match Continues Acquisition Would Create the Nation’s Largest For-Profi t Hospital Chain per Facility Number

Federal subpoenas, contract disputes, lower admissions, rising bad debt, and a reduction in surgeries contributed to a move that industry watchers now say was predictable ... 14

September 2013 >> $5

FOCUS TOPICS ONCOLOGY TRANSPARENCY

Morgan Wills, MD, MA, FACP

PAGE 3

PHYSICIAN SPOTLIGHT

ONLINE:NASHVILLEMEDICALNEWS.COMNEWS.COM

In Case of EmergencyTennessee Department of Health’s Role in Protecting the Population

(CONTINUED ON PAGE 16)

Shining a Light on Physician, Industry RelationshipsPhysician Payments Sunshine Act Now in Effect

By CINDy SANDERS

If you’ve recently enjoyed a golf outing with your friendly pharmaceutical rep or a nice dinner with a device manufacturer, that information will soon be available for all to see.

The Physician Payments Sunshine Act went into effect Aug. 1 of this year and requires applicable manufacturers to report certain interactions with physicians and teaching hospitals that are deemed to have value. ‘Applicable manufacturers’ are defi ned

as pharmaceutical, device, biologic and medical supply manufacturers whose products either require a prescription to be dispensed or for which payment under federal healthcare programs is available.

“The Sunshine Act generally applies when physicians or teaching hospi-tals receive transfers of value from applicable manufacturers, and the appli-cable manufacturers receive actual or potential value in return,” explained Tom Baker, a shareholder in the Baker Donelson Health Law group.

Baker, who practices in the fi rm’s Atlanta offi ce, pointed out the manufacturer doesn’t actually have to receive fi nancial benefi t

in exchange for the ‘value transfer,’ which can take a wide variety of forms, includ-ing donated items, payment to a physician for consulting services or expenditures for


Tom Baker

Early Diagnosis Greatly Improves Lung Cancer Survival RatesLearn more on page 7

The CHS, HMA Chess

2 > SEPTEMBER 2013 n a s h v i l l e m e d i c a l n e w s . c o m

That’s why the Tennessee Hospital Association and BlueCross BlueShield of Tennessee teamed up to create the Tennessee Center for Patient Safety. This program provides ongoing training and support to eliminate infections and help keep patients across the state healthy and safe.

So everyone who provides care can provide it better. BlueCross BlueShield of Tennessee is for Tennessee. See how BlueCross is impacting your community at bcbst.com/impact

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By LyNNE JETER

Throughout high school at Montgom-ery Bell Academy in Nashville and later at Princeton, Morgan Wills, MD, was encour-aged and challenged to broaden his focus globally.

Soon after the Berlin Wall fell in 1990, Wills did just that, heading to Eastern Eu-rope and then backpacking through Africa and Asia. While volunteering at a medical mission in Ghana in West Africa, he had a profound encounter involving a doctor he’d known in his hometown as an exchange stu-dent a decade earlier.

“I was really changed by that world-by-classroom approach,” said Wills, who took over Sept. 1 as president and CEO of Siloam Health Center. Wills knew he wanted to return to Nashville, where his family had roots since the early 1800s. His paternal great-grandfather was a doctor – Wills has his black bag – and a maternal great uncle, Hugh Jackson Morgan, MD, (1893-1961), was a professor and chairman of the Department of Medicine at Vander-bilt, as well as a brigadier general in the Sur-geon General’s office during World War II.

“It’s ironic and fascinating that I’ve returned to Nashville only to end up work-ing with the most marginalized, interna-tional population possible in this city,” he said of the faith-based health ministry that emanated from the Edgehill neighborhood of Nashville. When established in 1991, Si-loam was a volunteer-driven charity clinic on a shoestring budget. Nancy West joined the center as executive director and its first full-time employee in 1998, and was named president and CEO in 2006. For five years, Wills was the non-profit’s sole staff physician.

Now, Siloam has a staff of 35, and an annual budget of $3 million to care for the 5,000 uninsured patients representing 77 countries who annually seek care in the cen-ter’s 12,000-square-foot clinic near the Mel-rose Kroger Shopping Center off Franklin Road. A robust team of specialty volunteer health professionals helps out, treating ap-proximately one of every three patients seen onsite.

“When the opportunity arose to work at a place like Siloam, I was intrigued,” re-called Wills. “The patient population very quickly diversified from largely African-American to include many Vietnamese refugees and then other newcomers from around the world who happened to be re-settling in increasing numbers in cities like Nashville.”

Now, approximately one in six David-son County residents is foreign-born. Be-hind Spanish, the second largest language group at the clinic is Arabic.

“It’s been a fun and challenging place to develop a medical practice,” he said.

A few years ago, Wills took a sab-batical from medicine to pursue a mas-ter’s degree in theological studies at Regent College in Vancouver, Canada.

“When we returned to Nashville after a year, I continued to chip away and finally completed my degree this spring,” said Wills. “My overseas travels had given me an incredible thirst for spiritual and theo-logical formation, but I was also busy be-ginning medical training. The sabbatical afforded me the chance to take a longer, deeper drink and to further my journey. It has practical applications at Siloam, too, both in patient care and teaching the next generation of physicians.”

The Canadian venue gave Wills a unique vantage point in 2010 when Con-gress passed the controversial Patient Pro-tection and Affordable Care Act (ACA).

“In some ways, I was blissfully away from the rancor of it, but it was also very interesting to see it filtered through the Canadian experience,” he said. “It’s an ap-ples-to-oranges comparison, so it’s difficult to draw direct parallels, but as participants in the healthcare system in Canada on a minor basis, we were impressed with the way it functioned. We’re in such a volatile, complex healthcare situation in the U.S.; it would be impossible to replicate now what they did in Canada, but there are certainly lessons to learn.”

In 2011, Wills, a clinical faculty mem-ber in internal medicine at Vanderbilt, established the Siloam Institute of Faith, Health and Culture as an educational ini-tiative to bridge the gap between the faith community, medically underserved and academic medicine.

“It’s an expansion of a long-standing commitment to mentorship,” he said. “It’s given us a platform to do it in a more struc-tured and systematic way … not only with poverty medicine for different nationalities but also with our whole person approach to healthcare in general.”

The elongated sluggish economy has made fundraising more challenging so Si-loam is working to raise awareness of the need among individuals, corporations, and congregations during this changing time. “Thankfully,” said Wills, “Nashville is blessed

with lots of people of good will and healthcare institutions that want to give back.”

With uncertainty shrouding implemen-tation of the ACA, Wills pointed out that Siloam “will continue to be available for the significant number of people who will con-tinue to fall between the cracks. Even if the Affordable Care Act is fully implemented in Tennessee, there will be substantial need for a healthcare safety net.”

He emphasizes the importance of clari-fying common public misconceptions about the need for services offered by clinics like Siloam.

“Many people think the ACA will render charitable clinics for the uninsured

irrelevant,” he said. “But that’s far from ac-curate. The best estimates suggest that at least 340,000 Tennesseans will remain with-out an affordable option for health insur-ance. That doesn’t even take into account patients who will ‘churn’ in and out of the insured pool.

In many ways, Siloam is a medical foster home providing healing, hope and encouragement until patients can begin to function within the existing system on their own. We remain fully committed to our mission: to share the love of Christ by serv-ing those in need through healthcare.”

Wills practices cross-cultural relations at home, too. Before taking over the new leadership post, he and his family fulfilled a lifelong dream of his wife Heather, a native of Canada, by touring the Maritime Provinces.

“She grew up reading Anne of Green Ga-bles so it was a treat to visit that site, as well as Nova Scotia and New Brunswick,” he said. “It was an opportune time to get away for a little bit before the new role started.”

Between camping, soccer, softball, basketball and track activities, Wills and his wife, the parish nurse for St. Bartholomew’s Episcopal Church, have a thriving home life with their children, Isaac, 14, Jessie, 12, and Morgan Jr., 9.

Morgan Wills, MD, MA, FACPPresident and CEO, Siloam Health Center

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By KELLy PRICE

“You’ve got to be nim-ble and hit the ground run-ning,” Jim Baker, a former director of NeighborMD (now CareSpot), advised the overflow crowd at the annual investment forum hosted by the Nashville Health Care Council and Nashville Capital Network (NCN).

The meeting, dubbed “Developing Health Care Ventures: Investor and En-trepreneur Collaborations,” was designed to explore the opportunities and challenges that accompany venture capital investments in the constantly changing healthcare landscape.

More than 300 healthcare industry executives, entrepreneurs and investment professionals gathered at the new Music City Center on Aug. 8 to talk about ven-ture capital investments in today’s volatile healthcare sector. A panel featuring inves-tor and CEO combinations gave insider

perspectives on the opportunities and challenges that exist today.

The group included Baker; Greg Burns, founder and former CEO of O’Charley’s and NeighborMD; Craig Goguen, president and CEO of DSI Renal; and Mohamad Makhzoumi, the partner who co-heads the healthcare ser-

vices and healthcare information technology investment practice at New Enterprise Associ-ates (NEA).

Kevin Lavender, senior vice president and managing director, Fifth Third Bank, di-rected the conversation

as moderator.Caroline Young, president of the

Council, opened the meeting by pointing out, “Nashville’s history of entrepreneur-ship and access to capital is a primary reason why our healthcare industry has continued to thrive over the past four de-cades. It is important that new and expe-

rienced investors alike learn from recent collaborations, and for the healthcare community to understand the resources that are needed to continue moving in the right direction.”

Nashville Capital Network’s execu-tive director, Sid Chambless, observed, “There is a large network of healthcare en-trepreneurs and investors in the Nashville community that has produced numerous highly successful companies. It’s an excit-ing time to be an innovator in Nashville, and NCN and the Council are dedicated to supporting these partnerships.”

Last year, the Council and NCN re-leased a comprehensive report on the local venture capital marketplace that showed that more than $1.4 billion in venture capital funds had been invested in 215 different Nashville-based companies since 2001. Nearly $1 billion of this venture capital money was invested in healthcare companies.

When urgent care company Neigh-borMD was launched in Nashville in late 2010, the startup received a big boost through an investment by NCN’s Angel Group and Tennessee Angel Fund the fol-

Developing Healthcare Ventures with Investor, Entrepreneur CollaborationsNashville Healthcare Council & NCN Look Ahead

© 2013 Donn Jones

Panelists share insights about entrepreneurial investments during this era of healthcare transformation with the capacity crowd attending the Nashville Health Care Council and Nashville Capital Network’s venture capital event.



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By CINDy SANDERS

Metastatic cancer … not the best news a patient can receive, but ‘metastatic’ cancer care … that just might be a differ-ent story.

Recently, Nashville oncology pro-grams have initiated partnerships, pur-chased practices, and entered into collaborative agreements to enhance and improve cancer care in a rapidly changing landscape. Although the reasons vary, the bottom line for patients seems to be better care delivered closer to home.

SCRIDriving the Research ForwardAlmost from inception, what is today

known as Sarah Cannon Research Insti-tute (SCRI) was committed to partnering with community providers as a means of expanding clinical trials to drive research efforts. “From the very beginning, one of the premises was to take the research to the pa-tient … not making the patient come to the can-cer center,” said How-ard A. Burris, MD, chief medical officer and ex-ecutive director of drug development for SCRI.

Founded in its pres-ent format in 2004 in partnership with HCA, the roots of SCRI go back a decade before that to Tennessee Oncology. At the end of 2012, the practice stepped out of the ownership piece of SCRI, but the institute remains home base for all of Ten-nessee Oncology’s research endeavors. Additionally, noted Burris, six other of the largest oncology practices in the nation — located in Florida, Ohio, South Carolina, Texas and Virginia — also conduct their research through SCRI.

Today, noted Burris, “There are probably 60-80 unique sites where we’re doing trials with some (locations) just hav-ing one trial and others doing dozens. We’ve got trials on the West Coast and East Coast and in the middle part of the country. We also now have trials in the United Kingdom.” More than 700 physi-cians on two continents participate in clin-ical trials through the affiliated network.

“We know you’ll get better care all around if you can get it closer to home,” said Burris. He added that while oncolo-gists provide one part of a patient’s care, family members and friends provide the emotional support that is a critical compo-nent of the overall care plan. “We’re com-ing to appreciate that more and more.”

When cutting-edge care and clinical trials can be delivered within the commu-nity, then patients and physicians both benefit. In fact, Burris noted, the science has greatly expanded treatment options. “We’ve had dozens of new cancer thera-pies approved in the last seven to eight years,” he pointed out. “There are three

new melanoma therapies in the last year, six new therapies for kidney cancer in the last five years,” he continued. “We’ve personally been involved in more than 50 drugs that have been FDA-approved.”

Yet, Burris said, that success could have an unintended consequence. With more options for treatment comes the threat of complacency, but the newer therapies only go so far. “Part of our growth in infrastructure is we’ve got to empower, support, educate … do every-thing we can … to make sure the (com-munity) doctors have everything they need to be able to participate in clinical trials,” he said. “You have to keep the en-thusiasm high to keep pushing the science forward.”

Tennessee OncologyEconomies of ScaleWhen Tennessee Oncology’s CEO

Jeff Patton, MD, joined the practice in 1996, three years after it was founded, he was the 15th physician. “In the last 12 months, we’ve added 15 physicians,” he said.

Today, the large practice is home to nearly 80 physicians, 24 physi-cian extenders and 700 employees spread over more than three-dozen locations in Middle and East Tennessee. The prac-tice actually expanded across the border into Georgia when Tennessee Oncology acquired Chattanooga Oncology & He-matology Associates … including its Ring-gold, Ga. site … at the beginning of 2013.

“We want to be the oncology solu-tion,” said Patton. “And to be the oncol-ogy solution, you have to provide the best outcomes at the lowest price.”

Throughout healthcare, he contin-ued, we are seeing partnerships, collabo-rations and consolidation. “We’re quickly evolving away from fee-for-service to value-based payments, and you really need scale to do that.”

He added Tennessee Oncology is in-vesting in infrastructure and processes to make the practice more nimble in light of the changing reimbursement world. While market share matters from a finan-cial standpoint, he was quick to add it also makes a difference to patients. “Medical oncology is a very portable specialty,” he noted. “To deliver care closer to home is a great value to patients.”

Although the practice doesn’t have any imminent expansion announcements, Patton certainly didn’t rule out additional acquisitions in the future if it makes sense for the practice and for patients.

VICCExpanding the Population BaseBoth Vanderbilt-Ingram Cancer

Center and the larger Vanderbilt system have formed a number of partnerships and affilia-tions with other provid-ers and health systems over the past few years. Michael Neuss, MD, chief medical officer for VICC, noted there are different models for these relation-ships ranging from Vanderbilt physicians providing all services to working collab-oratively with community physicians to serving in more of an advisory capacity for research and operations.

“We really are looking at mutually advantageous relationships like we’ve found so far,” he noted. Vanderbilt’s part-

ners get access to some of the academic center’s clinical trials, data, and vast re-search and clinical infrastructure. VICC, on the other hand, gains access to a larger population base. That is increasingly important, Neuss said, in light of the ad-vances being made in understanding the pathology of cancer.

“We used to talk about lung cancer like it was one disease … and then like it was two diseases. Now, we talk about it like it’s 10 diseases, and as we understand more about the genetic alterations, we’ll soon look at it like it’s a hundred diseases,” he said. “As the entry criteria for trials get more and more specific because the treat-ments are targeted for specific genetic al-terations that are associated with cancer, we need a larger population base,” Neuss continued. “The law of small numbers is you need to have relationships outside of your own backyard.”

While VICC and their partners ben-efit from the collaborations, Neuss said he hopes the biggest winners are the pa-tients. “Patients get Vanderbilt care closer to home,” he said. “They get care in their own community. They get the friendli-ness of personalized care where they often literally know the people working in the office.”

Although VICC will continue seek-ing out smart partnerships and affilia-tions, Neuss said his ultimate hope is that one day they will no longer be needed. “We really are excited about our collabo-rations and the possibility of moving the knowledge of how to better treat cancer forward,” he stated. However, Neuss continued, “As a cancer center, we really would like to put ourselves out of busi-ness. We wish there were no cancers to treat.”

Scaling Cancer CareNashville Oncology Programs Expand, Spread

Dr. Howard A. Burris

Dr. Jeff Patton

Dr. Michael Neuss


$5.2 Million NIH Grant Bolsters Colorectal Cancer Research

Robert Coffey Jr., MD, Ingram Profes-sor of Cancer Research at Vanderbilt Uni-versity, recently received a five-year, $5.2 million grant from the National Institutes of Health (NIH) to study the role of extracellular RNA (ex-RNA) in colorectal can-cer. Coffey received one of 24 grants totaling $17 million awarded to 20 insti-tutions through the collaborative, cross-cutting Extracellular RNA Communication program.

While most RNA works inside cells to translate genes into proteins, recent findings show cells can release RNA in the form of exRNA to travel through body fluids and affect other cells. Researchers hope to use some kinds of exRNA as bio-markers, or indicators of the presence, ab-sence or stage of a disease, or to develop new molecular-based therapies.

Coffey’s project is entitled “Secreted RNA during CRC (colorectal cancer) pro-gression, biogenesis, function and clini-cal markers.” His lab will work with two teams of investigators from the University of California, San Francisco, and one team each from Massachusetts General Hospi-tal (Harvard) and Rockefeller University to

examine the mechanisms of exRNA bio-genesis, distribution and function. The Vanderbilt team will study the role that altered biogenesis of secreted RNAs in vesicles (exosomes) may play during the progression of colon cancer.

Increasing Colon Cancer Awareness

Last month, Nashville’s Norris Gas-troenterology Associates sponsored a giant inflatable colon exhibit as part of the Second Annual Nashville Undy 5000 5K Run/Walk. On Aug. 15, more than 400 colon cancer patients, survivors, caregiv-ers and advocates took to the streets in family-friendly, underwear-themed out-fits to raise awareness and funds to fight colon cancer. The 2013 event raised more than $40,000. During the weekend fes-

tivities, attendees had the opportunity to walk through the Colon Cancer Alliance’s larger-than-life inflatable colon, which is used to create a dramatic visual of various stages of the disease and alert partici-pants to risk factors. William Norris, MD, sponsored the inflatable as a fun twist to get people talking about a serious topic. Although colon cancer is one of the most preventable cancers, it remains the sec-ond leading cause of cancer death in the United States.

Tennessee Oncology Announces Participation in Breast Cancer CAPTURE Registry

Last month, Tennessee Oncology, PLLC announced participation in CAPTURE (Compliance and Preference for Tamoxifen

Registry) with DARA BioSciences, Inc., a specialty pharmaceutical company focused on oncology supportive care products. The CAPTURE registry is designed to gain valu-able insight into adherence to prescribed tamoxifen treatment; patient preference for a liquid formulation of tamoxifen; and prev-alence of difficulties in swallowing among breast cancer patients taking tamoxifen tablets. Tennessee Oncology is one of 10 leading oncology centers nationwide, and the first healthcare provider in Tennessee, to now enroll patients for this registry.

CAPTURE was initiated to support the recent launch of Soltamox® (tamoxi-fen citrate) oral solution, the only liquid form of tamoxifen available for patients who prefer or need a liquid formulation of tamoxifen. The American Society of Clini-cal Oncology recently updated its guide-lines, recommending tamoxifen (20mg per day for five years) should be discussed as an option to reduce the risk of estrogen receptor (ER) positive breast cancer.

“We are pleased to participate in CAPTURE as this registry explores breast cancer adherence issues and patient pref-erences relative to long-term tamoxifen therapy,” said Nancy Peacock, MD, medical oncologist of Tennessee Oncol-

ONcology Rounds


Dr. Robert Coffey Jr.

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As a Senior Manager in the Accounting and Assurance practice focusing in the healthcare industry, Meredith, also a CPA, serves as the Senior Manager on a number of healthcare engagements, including audit, consulting and due diligence engagements, for hospitals, both for-profit and not-for-profit, behavioral health providers, ASC’s, long-term care facilities and hospice care. With over nine years of experience, Meredith is familiar with the complex financial accounting requirements that healthcare companies typically face. She is actively involved in the Leadership Health Care and Nashville Health Care Council organizations, TSCPA, AICPA and serves on the Finance Committee for the YWCA of Nashville. In her spare time, Meredith enjoys traveling and spending time with family and friends.

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Dr. Nancy Peacock


Lung cancer is the leading cause of cancer death in men and women in this country. Smoking causes 80 to 90 percent of lung cancers.

The most treatable and curable lung cancers are discovered early. Although the five year survival rates of stage I and II non-small cell lung cancer are still unacceptably low at around 50 percent, survival becomes much worse with advanced stages of the disease.

Frequently early stage lung cancer is discovered incidentally, on a chest X-ray when a person is examined in an emergency facility, walk-in clinic or his physician’s office with an unrelated problem.

The hospitals of Saint Thomas Health have implemented a focused program to quickly direct patients with incidentally discovered lung lesions to the next step in evaluation and treatment. “Through this program, we can avoid some lung

cancer deaths by catching the disease in its early stages when it is more survivable,” said Dr. Susan Garwood, pulmonologist with Saint Thomas West Hospital.

If a patient in the emergency department has a chest X-ray or chest CT abnormality they are given written and verbal instructions about appropriate follow up. Once that patient returns home, they are contacted by a nurse navigator to ensure that they have followed up with their personal physician in a timely fashion. Over the past two years, this program has resulted in the referral of 320 patients with previously unknown lung abnormalities to physicians at Saint Thomas Midtown Hospital, Saint Thomas Rutherford Hospital and Saint Thomas West Hospital.

“Despite a very scary diagnosis, many people with early stage lung cancer go on to live a healthy, full life after treatment,” said

Dr. Brian Wilcox, thoracic surgeon at Saint Thomas Midtown Hospital. “The long term survival rate for cases detected when the disease is still localized is more than 50 percent.”

There are nearly 400,000 people diagnosed with lung cancer in the US each year, and only 15 percent of those are diagnosed at an early stage. The hospitals of Saint Thomas Health remain committed to improving survival rates from all cancers and to improving the processes to make certain this occurs.

Early Diagnosis Greatly Improves Lung Cancer Survival Rates

Dr. Susan Garwood is a pulmonologist with Saint Thomas West Hospital, and Dr. Brian Wilcox is a thoracic surgeon at Saint Thomas Midtown Hospital


ogy at Saint Thomas Midtown Hospital. “CAPTURE data could potentially help physicians better understand challenges faced by their breast cancer patients and develop ways to help tamoxifen patients stay on therapy to maximize its effective-ness.”

Participating patients currently on tamoxifen therapy for breast cancer are asked to complete an online question-naire. The key objectives are to:

• Understand patient preference for tamoxifen tablets or an oral tamoxifen liq-uid solution;

• Ascertain whether patient partici-pation in choosing their preferred dosage form may lead to better adherence;

• Correlate adherence to tamoxifen therapy with factors such as, age, ethnic-ity, history of smoking, alcohol intake, sur-gery, and radiation therapy;

• Understand patient adherence to long-term tamoxifen therapy and how it might be affected by swallowing difficul-ties; and

• Identify factors that might drive pa-tient preference for the oral liquid form of tamoxifen therapy.

Penson Wins $2 Million Prostate Cancer Research Grant

David Penson, MD, MPH, professor of Urologic Surgery at Vanderbilt Univer-sity Medical Center, has received a $2 million re-search award from the Pa-tient-Centered Outcomes Research Institute (PCORI) to study localized prostate cancer, the second lead-ing cause of death among American men.

“The goal is to find out what works best, in which patients, and in whose hands,” said Penson, who also directs the Vanderbilt Center for Surgical Quality and Outcomes Research.

Over the next three years, Penson and colleagues will study patient-reported outcomes and compare the effectiveness of treatment of prostate cancer in 3,691 men diagnosed with prostate cancer in five states in 2011. The new study builds on Penson’s recent success in developing a network of tumor registries that collect patient data, which may hold the key to more scientifically proven treatment plans that make the most sense for each patient. Penson’s Comparative Effectiveness Anal-ysis of Surgery and Radiation (CEASAR) study continues to collect critically impor-tant data such as treatment, complications and short-term cancer rates by following nearly 4,000 men diagnosed with prostate cancer.

Ultimately the hope is to better edu-cate men on the types of treatment avail-able, known complications and overall quality of life following treatment. Though men diagnosed with prostate cancer have a variety of treatment options, including surgi-cal removal of the tumor, radiation therapy and active surveillance, each of these comes with its own risks, side effects and impacts on overall quality of life, much of which is

known. What isn’t clear is how to take this information and personalize it for individual patients in a way that helps them make clini-cal decisions consistent with their own per-sonal preferences and values.

Lovly Wins Runyon Research Award

Christine Lovly, MD, PhD, an assis-tant professor of Medicine at Vanderbilt with a laboratory at the Vanderbilt-Ingram Cancer Center, has earned the 2013 Damon Runyon Clinical Investigator Award, which supports young phy-sician-scientists conducting patient-oriented cancer research. The three-year award will provide $450,000 for Lovly’s research efforts in lung cancer.

Lovly is investigating novel thera-peutic strategies for patients with non-small cell lung cancer (NSCLC) whose tumors are positive for ALK tyrosine ki-nase fusions. Initially identified in 2007 as a novel ‘driver mutation’ in lung cancer, genomic alterations in ALK are also found in subsets of lymphoma, sarcoma, neu-roblastoma, colon cancer, breast cancer, ovarian cancer and thyroid cancer. A small molecule inhibitor of ALK was recently FDA approved to treat ALK+ lung can-cer. However, as is consistent with other small molecule inhibitors in clinical use, disease progression after initial response … acquired resistance … is evident. Lovly is working to develop new therapeutic agents or drug combinations that delay or overcome acquired resistance.

Nashville Researchers on a National Stage

Researchers hailing from Middle Ten-nessee were highly visible at the 2013 American Society for Clinical Oncology (ASCO) meeting held in Chicago earlier this summer. Sarah Cannon Research Insti-tute investigators had 78 abstracts selected for presentation. Among the abstracts au-thored by SCRI researchers, 18 were chosen for oral sessions, three for clinical science symposiums, 16 poster discussions and 41 general posters (of which nine are trials still in progress). Additionally, eight of the accepted abstracts led or co-authored by SCRI investigators were selected for “Best of ASCO®.”

“SCRI’s presence reached a new high at this annual meeting, with our abstract acceptance rate doubling over the last four years,” said Dee Anna Smith, CEO of SCRI.

In addition to pre-senting at ASCO, Vanderbilt-Ingram Can-cer Center researchers have also garnered national attention from the American As-sociation for Cancer Research (AACR). Hal Moses, MD, director emeritus of VICC received the 10th Annual AACR Award for Lifetime Achievement at the orga-nization’s annual meeting in Washington, D.C. this spring. During the same meeting, Carlos Arteaga, MD, professor of Medi-cine and Cancer Biology at Vanderbilt, was chosen 2013/14 president-elect for

the national organization. Director of the Breast Cancer Research program at VICC, Arteaga will assume the position of AACR president in April 2014.

Vanderbilt Study Explores Race Differences of Lung Cancer Risk

Melinda Aldrich, PhD, MPH, assistant professor of Thoracic Surgery and Epide-miology at Vanderbilt, has been awarded a National In-stitutes of Health Academic Career Award to investigate some of the genetic se-crets behind a greater risk of lung cancer among Afri-can-Americans compared with other racial and ethnic groups.

Aldrich is studying the genetic ancestry of African-Americans to identify the genetic and environmental risk factors associated with a higher incidence of lung cancer in this population.

To date, this represents the largest study of African-Americans with lung cancer. Aldrich is using two existing epidemiology studies — the African American Lung Can-cer Consortium and the Southern Commu-nity Cohort Study.

“We have known for some time that African-Americans, particularly men, have both the highest incidence and mortality rates for lung cancer, but little research has been conducted among minority popula-tions,” said Aldrich. “By uncovering the genetic differences that might cause this increase in lung cancer, we can one day identify high-risk individuals and develop treatments that ultimately reduce its occur-rence and impact.”

ONcology Rounds, continued from page 6

Dr. David Penson

Dee Anna Smith

Dr. Carlos Arteaga

Dr. Melinda Aldrich

Dr. Christine Lovly

VICC, Maury Regional Open Spring Hill Center for Radiation OncologyThe latest partnership for Vanderbilt-Ingram Cancer Center is a joint venture between Vanderbilt Health Services and Maury

Regional Medical Center to provide radiation oncology services for cancer patients in the new multi-story Maury Regional Spring Hill facility located just off of Saturn Parkway

Opened to patients in July, the 8,900-square-foot center pro-vides access to advanced equipment and therapies. Representing an investment of approximately $7 million, the facility provides pa-tients access to a linear accelerator and CT scanner without having to drive into Nashville.

“This collaboration with Maury Regional Medical Center pro-vides both institutions the opportunity to bring leading-edge cancer therapies to more patients, marking the latest element in ongoing efforts to enable our patients to receive highly personalized care in a healing environment within the convenience of their own commu-nities,” said C. Wright Pinson, MBA, MD, deputy vice chancellor for Health Affairs and CEO of Vanderbilt Health System.

“For radiation oncology, typically a patient has to go to the center every day for eight weeks, Monday through Friday … so roughly 40 times,” explained David N. Franklin, administrator for clinical operations and finance for VICC Radiation Oncology.

“Vanderbilt truly believes in our expansion with affiliates,” he continued. “We have to strategically partner to determine where voids are. We’re trying to make it more convenient for patients.”

As a CON state, Franklin noted expansion and new facilities would only be approved with a demonstrated need and adequate population base. Spring Hill’s growth made it feasible to add the radiation oncology service line.

Although Vanderbilt has different partnership models, in this case staffing is split between radiation oncologists at Vanderbilt and Maury Regional. “It demonstrates to the community that we’re in their community, and we want their physicians to be a part of this venture, as well,” Franklin said.

He added the facility design incorporates Vanderbilt’s knowledge of workflow and patient and family satisfaction. The accelerator features ambient lighting. “You can pick the lighting, and it will wash the walls in that color,” Franklin said. He added patients could bring in their own MP3 player to customize their music or choose from a variety of genres at the center. Artwork with local ties adds to the community feel.

Franklin also noted family members are very much a part of the treatment plan. “We make sure once a patient is diagnosed that we bring their family members into the vault (accelerator) so they can see what their family member is going through.”


By CINDy SANDERS

In July, Sarah Cannon Research Institute (SCRI) and AstraZeneca (AZ) announced a collaborative partnership between the strategic research organiza-tion and the biopharmaceutical giant to support the development of new AZ oncol-ogy compounds in the field of personalized medicine.

Cindy Perettie, MBA, president of SCRI Development Innovations, said a relationship already existed with AstraZen-eca through the phar-maceutical company’s participation in SCRI’s molecular profiling pro-gram, which is part of Sarah Cannon’s broader personalized medicine initiative across the United States and United Kingdom. How-ever, this new announcement deepens the relationship with AZ outsourcing 60 per-cent of their oncology early development portfolio to SCRI.

While SCRI does take on the tradi-tional duties of a contract research organi-zation (CRO) to execute a clinical study, the relationship goes beyond that. “We essentially write the entire clinical plan on behalf of the pharmaceutical company,” Perettie explained. “It’s really a strategic relationship,” she continued.

Under the agreement, SCRI will work with AZ to identify potential patients for clinical trials and help explore biomarkers that predict response to specific treatments. Additionally, SCRI will provide clinical program development leadership and the medical expertise of practicing physician-scientists … what Perettie called a ‘soup to nuts’ approach all the way through proof of concept (PoC). On average, the SCRI model has been cost effective, reaching PoC in 15-18 months as compared to the typical 24-36 months reported by industry.

Perettie added Sarah Cannon offers many other pluses for partnering pharma-ceutical and biotech companies. “We get to those go/no go decisions quickly,” she said of SCRI’s nimbleness. “They (partners) can leverage our strong scientific expertise and leverage a team of practicing research phy-sicians,” she continued. Perettie pointed out that having practicing physicians is important to developing a pragmatic trial plan. “It makes the clinical trial designs much more innovative and much more efficient, which I think AstraZeneca really valued,” Perettie said.

For example, she noted, a pharma-ceutical company might design a study that required patients to come in several times a week for testing. “Practicing physi-cians would recognize that is rate limiting,” Perettie said of the likelihood of losing a fair number of participants who found the time requirement too difficult to sustain.

With the new AZ collaboration, Per-ettie said, “We expect to have an average three molecules a year enter, and we would do full programs around each molecule.”

Working together on molecular profil-

ing to classify tissue based upon genetic pro-files for the purpose of treating cancers and predicting response to therapy, Perettie said some molecules might be targeted to a very specific set of patients while others could take a much broader, ‘all comers’ approach.

“We’re excited at Sarah Cannon be-cause we have implemented a molecular profiling program both here and in Lon-

don which allows us to screen patients for actionable genes with the hope of putting them on phase 1 clinical trials,” Peret-tie said. In the solid tumor setting, SCRI already screens for 35 genes that account for about 1,000 mutations. “In the hema-tologic setting, we’re launching a panel in October that will cover about 75 actionable genes,” she continued.

“Screening these patients for action-able genes enhances enrollment to the clini-cal trial, as well as increases the probability that patient is going to have a response,” Perettie said.

With the enhanced AZ partnership, the hope is to move novel molecules into real world solutions in a safe, efficacious, timely, and cost-effective manner.

SCRI, AstraZeneca Launch Personalized Medicine PartnershipCollaborative Effort Supports Development of Oncology Compounds

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Dr. Yves Pommier

By CINDy SANDERS

How will this breast can-cer drug react in patients that are HER2 positive? Will this new lung cancer therapy work in a patient with multiple genetic variations?

Finding answers to those ques-tions just got a bit easier with the rollout of a vast data set of cancer-specific genetic variations by scien-tists at the National Cancer Institute (NCI). Yves Pommier, MD, PhD, chief of the Laboratory of Molecu-lar Pharmacology at the NCI, was one of three lead researchers on the study, pub-lished July 15 in Cancer Research, that pinpointed more than six billion connec-tions between cell lines with mutations in specific genes and the drugs that target those genetic de-fects. Paul Meltzer, MD, PhD, chief of the Genet-ics Branch at the Center for Cancer Research and James Doroshow, MD, director of the Division of Cancer Treatment and Diagnosis, were the other principal investigators.

Pommier explained the new database builds upon the NCI-60 cancer cell line col-

lection, which is comprised of nine different tissues of origin – breast, ovary, prostate, colon, lung, kidney, brain, leukemia and melanoma. In their Cancer Research ar-ticle, the authors note the NIC-60 panel is the most frequently studied human tumor cell line in cancer research and has gener-ated the most extensive cancer pharmacol-ogy database worldwide.

“Most of the cell lines are from cancer tissues that are hard to treat and are usu-ally resistant to therapy,” he said. “The ge-nomic database is unmatched and enables researchers to mine all the gene expression in relationship to a drug.” Pommier con-tinued, “Each drug has a different profile in the cell line because they act on differ-ent targets.”

In this most recent study, the investigators sequenced the whole exome of the full NCI-60 cell lines to define novel cancer variants and deviant patterns of gene expression in tumor cells. “The whole genome for the cell line has never been done before,” he said. “Many, many genes had never been sequenced.”

The researchers cataloged the genetic coding variations, develop-ing a list of possible cancer-specific gene aberrations. The group then used the Super Learner algorithm

to predict the sensitivity of cells with vari-ants to more than 200 anti-cancer drugs … those approved by the FDA and those still under investigation. By studying the corre-lation between the gene variants – such as TP53, BRAF, ERBBs, and ATAD5 – and anti-cancer agents including vemurafenib, nutlin and bleomycin, the researchers were able to predict outcomes, showing one of the many ways the data could be used to validate and generate novel hypotheses for future investigation.

Access to the data is freely available through multiple sources including the CellMiner and Ingenuity websites. By opening up the scalable data on the whole genome sequencing and drug connectiv-ity, Pommier and his colleagues hope to

help other researchers connect cancer-specific gene variants with drug response to move the science forward. “It’s an evolving system,” he said, adding that pro-files on drugs in clinical trials will be added to the database as information becomes available to keep the data set current.

In explaining how the system works, Pommier said a researcher interested in a specific agent could plug that drug into the database. “You’ll get the profile activity of the drug, and then you can ask if there is any match to any specific gene muta-tions,” he said. From there, Pommier con-tinued, the researcher could query, “Are these cells more resistant or receptive to the drug?”

Getting those answers rapidly should help researchers move major lines of on-cology drug development toward per-sonalized medicine to achieve optimal outcomes in a safer, more efficient and effective manner. With the added knowl-edge provided by the data bank, Pommier said researchers might separate patients into groups based on their genetic profile and therefore be able to use specific drugs in a more rational manner.

“Between a targeted drug and a clini-cal application, you need a verification in the middle,” he stated. That’s just what this new database offers.

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By CINDy SANDERS

The word ‘transparency’ is used with increasing frequency in the healthcare space … most often in reference to physician and hospital pricing. But trans-parency is applicable across the healthcare spectrum as evidenced by Brentwood-based DXE Medical, a Sarnova Inc. company.

While it’s clear that run-ning a transparent operation is considered the ‘right thing to do’ by DXE President Matthew Spencer, it turns out that trans-parency is also a sound business decision for this national dis-tributor of AEDs, defi brillators, heart monitors and other small medical devices.

Founded in 1999, DXE started as a seller of recertifi ed AEDs and defi brilla-tors. As the company grew, DXE began picking up additional product lines from national manufacturers, including new acute care equipment. To enhance customer service, DXE then ex-panded its offerings to repairs and preventa-tive maintenance by manufacturer-certified biomedical technicians. Ultimately, the compa-ny’s depth of expertise and reputation for quality work attracted the attention of Sarnova, a large national specialty distributor for emergency medi-cine and acute care products. The deal between Dublin, Ohio-based Sarnova and DXE closed at the end of last year.

Spencer said DXE’s reputation as a trusted resource has solidifi ed over the years for a number of reasons. As a distrib-utor, rather than a manufacturer, DXE isn’t aligned with one particular brand. “We’re unbiased … we carry competitive

brands,” Spencer pointed out. “We try to carry every device a person might ask for over a particular line, like AEDs,” he con-tinued.

Another key to their success, he added, is that the company runs a trans-parent operation with a robust online presence to help clients — ranging from independent physician offi ces, hospitals and emergency responders to law en-forcement, schools and churches — sort through sales pitches to drill down to facts.

“We have an online presence that people refer to … they use it as a re-source,” he said of both the corporate site and www.AED.com, which has extensive information about all things AED.

Spencer noted purchasing agents take information with a grain of salt from direct sales reps. “Everyone is really savvy at this point. The minute you leave, they’re going to get online,” he said. In addition to checking out sales claims, purchasers are honing in on competitive pricing. “You want the best deal possible,” Spencer con-tinued, “but you don’t want to sacrifi ce quality because this is a lifesaving piece of equipment, after all.”

In the hospital sector, which often has

the resources to conduct in-house research on various brands and products, purchas-ing agents might not have much leeway if tied to GPOs (group purchasing organi-zations) or IDNs (integrated delivery net-works). For most everyone else, though, a trustworthy online source helps bridge the knowledge gap and provides a picture about price, quality and features of avail-able brands.

“If we could bring every customer into our building and let them walk through, meet with sales people, see our facility, see the service and refurbishing process, I don’t think we would lose a single deal,” Spencer said. “We can’t do that … but we do the next best thing. The trick is to do everything we can with the mediums available to help the customer understand exactly who they are dealing with.”

For example, he continued, it’s cru-cial to his company for clients to see the steps DXE undergoes to refurbish a piece of equipment. “We want people to know that not all used devices are the same,” he explained. “We want to show them exactly what we do to recertify it. We go through an 11-point checklist, and that’s all posted on our website. The testing pro-cedures we use before we would send the product back out the door strictly adhere

to the manufacturers’ service manuals,” he continued.

DXE is using videos to pull back the curtain on the detailed process and virtu-ally invite customers around the country to ‘tour’ their Middle Tennessee facility. Currently in the works, the 30-second vignettes outline not only the recertifi ca-tion and refurbishing process but also will highlight products and company philoso-phy. Additionally, the corporate website clearly outlines company policies, privacy and security measures, and contact infor-mation.

“If you are transparent, you’re giving the customers the information needed to make a purchasing decision, but you are also giving them the confi dence to know that if something did go wrong, you’re going to answer the phone.”

So does transparency actually give healthcare companies a competitive edge?

“It depends on if you have a good company or not,” Spencer said wryly. “If you’re not confi dent or comfortable with the products or services you’re providing, I’d say a lack of transparency is going to benefi t you.

“If, on the other hand, you have a company, product, or process you are proud of and stand behind, then the more transparency the better.”

Crystal ClearTransparency as a Daily Business Strategy

Matthew Spencer

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entertainment. “It’s enough that it might infl uence a physician,” he noted.

“The Sunshine Act is about transpar-ency in two different fundamental ways,” he continued. “First, there is the potential interference in medical judgment in clini-cal trials required for FDA approval of drugs or medical devices. Second, there is potential interference in medical judg-ment in terms of ordering an item or ser-vice for which federal reimbursement is available.”

Baker said the policy is to shine a light on interactions that could be construed to

unduly infl uence a physician or teaching hospital and to ferret out confl icts of interest. “It’s not saying that transfers of value are, per se, illegal but that the public has a right to know when medical judgment might be infl uenced by the value transfer,” he contin-ued. Relationships between physicians and industry will now be on display for patients, auditors, personal injury lawyers and others to see when the Centers for Medicare and Medicaid Services (CMS) begins publishing the reported data next fall.

The Back StoryChampioned by Sen. Chuck Grassley

(R-Iowa) and Sen. Herb Kohl (D-Wis.), the impetus behind the Sunshine Act came from mounting concern over poten-tial confl icts of interest within the industry. These confl icts were highlighted by sev-eral egregious incidents involving clinical trials and devices up for FDA approval where physicians received large payments from the manufacturers of the drugs or devices being studied.

Grassley publicly described a num-ber of academic physicians taking money from the National Institutes of Health when those physician-scientists had direct fi nancial interests in their own research. Among the worst offenders, the former chairman of the Psychiatry Department at Stanford University received an NIH grant to study a drug when he owned $6 million in stock in the company seeking FDA approval. Similarly, the former chair of the Psychiatry Department at Emory failed to report hundreds of thousands of dollars from GlaxoSmithKline while re-searching the company’s drugs. Harvard also had to discipline three researchers who received almost $1 million each in outside income while heading up several NIH grants.

Outside of these fl agrant examples, the concern persists that much smaller gifts might also infl uence medical deci-sions. Earlier this year, Pew Charitable Trust published Persuading the Prescrib-ers: Pharmaceutical Industry Market-ing and its Infl uence on Physicians and Patients, which stated the drug industry spent nearly $29 billion marketing their products in 2011 (Source: Cegedim Stra-tegic Data). Of that amount, $25 billion was spent directly marketing to physicians.

After unsuccessfully introducing the legislation in 2007, the Sunshine Act was incorporated into the Affordable Care Act. A couple of missed rulemaking dead-lines by CMS pushed the law’s effective date to Aug. 1, 2013 for the balance of this calendar year and requires annual report-ing going forward.

What is a Transfer of Value?

With 12 major exceptions (see box), any direct payment or transfer of value of $10 or more (or an aggregate of $100 or more in a calendar year) to a physician or teaching hospital must be reported. Addi-tionally, indirect transfers through an in-termediary or third party are also subject to reporting.

There are 14 main reporting cat-

egories. These include consulting fees, compensation for services other than con-sulting, gifts, entertainment, food, travel, charitable contributions, education, grants, research, royalty or licensing fees, current or prospective ownership or in-vestment interest, direct compensation for serving as faculty or a speaker for a medi-cal education program, honoraria.

Under the new rules, Baker said a physician could accept a ballpoint pen or pad of sticky notes from a manufacturer without it being included in the annual re-port, but most meals, tickets, or gifts prob-ably will fall under one of the reporting categories considering the $10 threshold.

“The days of the pharmaceutical company taking a group of physicians to the Super Bowl are over … or at least it will be disclosed and expose you to the risk of Anti-Kickback statute prosecution,” Baker said. “It’s the entertainment part of it that physicians would probably like to have exposed the least,” he added.

The law also requires applicable man-ufacturers and GPOs (group purchasing organizations) to report ownership inter-ests by physicians or their immediate fam-ily members. It should be noted, however, that purchased industry stocks and mu-tual funds that are generally available to the public are not reportable. If Dr. Smith buys 50 shares of ABC Pharmaceutical stock, which is publicly traded, it doesn’t have to be reported. If a representative of ABC Pharmaceutical gives Dr. Smith stock, then it does.

Ultimately, a patient whose doctor recommends a specifi c device or drug will be able to search the CMS database to see if there is a connection between the physician and the manufacturer. “You’re going to know when your physician has a personal fi nancial interest in your health-care beyond the physician’s professional services,” Baker pointed out.

Disputing a ReportSo what happens if your name ap-

pears on a report, and you disagree with the data? Baker said CMS is going to notify physicians of all their reported re-lationships. Once access is granted to the online portal housing the consolidated re-port, a physician should have at least 45 days to challenge the data and try to re-solve the dispute with the reporting entity.

Those who cannot agree will be given an additional 15 days to come to a resolu-tion before the information is made pub-lic. If no agreement can be reached, the data will be published but fl agged as dis-puted. Physicians cumulatively have up to two years to dispute reports even after the data is published.

“While physicians aren’t required to track transfers of value, they are encour-aged to do so,” said Baker. “How in the world are you going to be able to refute a report if you don’t have evidence to the contrary.”

Baker pointed out you might not think you received an infl uential ‘gift’ from a de-vice manufacturer by grabbing a bite of lunch, but even a sandwich, tea, tip and tax is often over the $10 threshold. Short of

asking to see the bill, it would be diffi cult to gauge the cost per person at the table; and without a copy of the receipt, it would be diffi cult to dispute the reported item.

“As a practical rule, doctors probably aren’t going to be good at refuting the evi-dence,” Baker said.

However, he added, CMS has cre-ated a smartphone app with a version for industry and another for physicians to make it easier to keep track of reportable transfers. “Open Payments Mobile” is available at no charge through the Apple Store and Google Play Store.

TimelineData accumulation for 2013 has al-

ready begun. Below is a timeline of up-coming key dates in the process. • Jan. 1, 2014: Anticipated launch date for CMS physician portal where doc-tors can register to receive notice when their individual consolidated report is ready for review. This portal also provides a means for physicians to contact manu-facturers and GPOs about disputes in ac-curacy. • March 31, 2014: Partial year data (August-December 2013) must be turned into CMS. • June 2014: Anticipated access to in-dividual consolidated reports from 2013. Physicians have a minimum of 45 days by law to seek corrections or modifi cations to the information by contacting manufac-turers/GPOs through the portal.September 2014: Searchable reports are published and open to the public.

Be Prepared“The act itself is vexing,” said Baker.

Adding to the frustrations, he continued, is that CMS is interpreting the Sunshine Act very broadly.

“The applicable manufacturers are not going to take any chances,” Baker continued. He noted, those who acciden-tally fail to disclose required data will face penalties of not less than $1,000 and not greater than $10,000 per incident up to a cap of $150,000 annually. Those who knowingly withhold reportable informa-tion face penalties between $10,000 and $100,000 for each value transfer with an annual cap of $1 million.

“Physicians need to know other peo-ple are going to be talking about them,” concluded Baker. “One would hope everything reported is within the legal boundaries … but if you are testing those boundaries, you better stop.”

Shining a Light on Physician, Industry Relationships, continued from page 1

12 Key Exemptions to the Reporting Rule

Certifi ed and accredited CME.

Buffet meals, snacks, coffee breaks that are provided by a manufacturer at a large-scale conference or event when the items are generally available to all attendees.

Product samples that are not intended for sale and are for patient use.

Educational materials that directly benefi t patients or are intended for patient use.

The loan of a medical device for evaluation during a short-term trial period (not to exceed 90 days).

Items or services provided under a contractual warranty in the purchase or lease agreement for a device.

The transfer of any item of value to a physician when that physician is a patient and not acting in his or her professional capacity.

Discounts including rebates.

In kind items for use in providing charity care.

A dividend or other profi t distribution from, or ownership or investment in, a publicly traded stock or mutual fund.

Transfer of value to a physician if the transfer is payment solely for the services of the physician with respect to a civil or criminal action or an administrative proceeding.

A transfer of anything with a value of less than $10 unless the aggregate amount transferred to, requested by, or designated on behalf of the physician exceeds $100 in the calendar year.

More Information for Physicians

The American Medical Association has put together the “Physician Sunshine Act Tool Kit” with additional information on the new requirements, a webinar and links to the free mobile app. To access the kit, go online to www.ama-assn.org/go/sunshine.


The Vanderbilt Stroke and Cere-brovascular Service has received advanced certification as a Compre-hensive Stroke Center by The Joint Commission and the American Heart Association/American Stroke Association. To receive the advanced certi-fication, institutions must meet requirements for volume of cases, advanced imaging capabilities, post-hospital care coordination for patients, a dedicated neuro-inten-sive care unit, a peer review process, participation in stroke research and performance measures.

“There is no higher stroke certifi-cation. And no deeper commitment to stroke patient care,” according to the accreditors. “We in the Vanderbilt Stroke Center are very pleased to achieve this certification, as it recognizes what we do in acute stroke treat-ment, secondary stroke prevention and stroke rehabilitation. This is truly a team effort,” said Howard Kirshner, M.D., professor of neurol-ogy and director of the Vanderbilt Stroke Center. Accredited by the Joint Com-mission since 2005, the Vanderbilt

Stroke Center has been honored with a Gold Plus Award by the American Heart Association’s Get With The Guidelines Stroke program for excellence in stroke care. The center also participates in the Stroke Belt Consortium, the Delta Stroke Task Force, the American Stroke Association and clinical drug studies sponsored by the industry and the National Institutes of Health. The Vanderbilt Stroke Center strives to exceed national standards of care for stroke. The standard benchmark set by the Joint Com-

mission for the complication rate for carotid endarterectomy and carotid artery stenting (two surgical procedures used to prevent stroke) is below 6 percent. Vanderbilt far exceeds this standard with a com-plication rate of 2.9 percent.

Stroke Center Receives Elite Certification

“We in the Vanderbilt Stroke Center are very pleased to achieve this certification…This is truly a team effort.”

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Referrals: (615) 322-2318

Arvindh Kanagasundram, M.D.Specialty: General Cardiology/ElectrophysiologyMedical School: Vanderbilt UniversityResidency: Stanford UniversityFellowship: Weill-Cornell Medical Center

& Vanderbilt UniversityPractice Location: Vanderbilt University

Medical Center

Referrals: (615) 322-2318

Michael Kelley, M.D.Specialty: General & Invasive CardiologyMedical School: University of VermontResidency: University of VermontFellowship: Vanderbilt UniversityPractice Location: Vanderbilt Heart,

Columbia, TN

Referrals: (615) 322-2318

Daniel Munoz, M.D.Specialty: General CardiologyMedical School: Johns HopkinsResidency: Johns HopkinsFellowship: Johns Hopkins & Vanderbilt

UniversityPractice Location: Vanderbilt University

Medical Center

Referrals: (615) 322-2318

Thomas J. Wang, M.D.Specialty: General Cardiology & Heart Failure

Medical School: Harvard University

Residency: Massachusetts General Hospital

Fellowship: Massachusetts General Hospital

Practice Location: Vanderbilt University

Medical Center

Referrals: (615) 322-2318

Quinn Wells, Pharm.D., M.D.Specialty: Cardiology, Inherited Heart Disease

Medical School: Pharm.D. from Samford

University School of Pharmacy,

M.D. University of Alabama

Residency: Massachusetts General Hospital

Fellowship: Vanderbilt University


Medical Center

Referrals: (615) 322-2318

endoCrInology And dIAbetes

Nathan C. Bingham, M.D., Ph.D.Specialty: Pediatric and Adolescent

Endocrinology and Diabetes

Medical School: University of Texas,

Southwestern Medical School

Residency: Cincinnati Children’s Hospital

Medical Center

Fellowship: Pediatric Endocrinology,

Cincinnati Children’s Hospital Medical Center,

Practice Location(s): Monroe Carell Jr.

Children’s Hospital at Vanderbilt

and Vanderbilt Eskind Diabetes Clinic

Referrals: (615) 322-7842 (VEDC)

and (615) 322-7427 (MCCHV)

Irene Hong-McAtee, M.D.Specialty: Pediatric and Adolescent

Endocrinology and Diabetes

Medical School: Washington University

School of Medicine

Residency: Indiana University School of

Medicine

Fellowship: Pediatric Endocrinology, University

of Minnesota Medical School

Practice Location(s): Monroe Carell Jr.

Children’s Hospital at Vanderbilt and

Vanderbilt Health Edward Curd Lane

Referrals: (615) 322-7427

HemAtology

Name: Salyka Sengsayadeth, M.D.Specialty: Hematology

Medical School: East Tennessee State University

Residency: Vanderbilt University School

of Medicine


Medical Center, VA Medical Center

Referrals: (615) 327-4751

obstetrICs & gyneCology

Reesha Shah Sanghani, M.D., M.P.H.Specialty: OB/GYN

Medical School: University

of Alabama, Birmingham

Residency: Vanderbilt University

Practice location: One Hundred Oaks

Referrals: (615) 343-5700

Adam Huggins, M.D.Specialty: General OB/GYN

Medical School: University of

Alabama, Birmingham

Residency: Virginia Commonwealth University/

Medical College of Virginia

Practice Location: NorthCrest Medical Center

Referrals: (615) 343-5700

Name: Reesha Sanghani, M.D.Specialty: General OB/GYN

Medical School: University of

Alabama, Birmingham

Residency: Vanderbilt University

Practice Location: One Hundred Oaks

Referrals: (615) 343-5700

Name: Jessica Ritch, M.D.Specialty: GYN

Medical School: University of Chicago,

Pritzker School of Medicine

Residency: Columbia University Medical

Center and New York Presbyterian Hospital

Fellowship: Vanderbilt University

Practice Location: One Hundred Oaks

Referrals: (615) 343-5700

Xiaomang B Stickles, M.D.Specialty: Gynecologic Oncology

Medical School: University of Rochester

Residency: George Washington

University Hospital

Fellowship: University of South Florida

Practice Location: Vanderbilt-Ingram

Cancer Center

Referrals: (615) 343-5700

Molly M Cone, M.D.Specialty: Colon and Rectal Surgery

Medical School: Oregon Health

and Science University

Residency: Oregon Health

and Science University

Fellowship: Ochsner Clinic


Medical Center

Referrals: (615) 343-4612

ortHopAedICs

Kevin R. O’Neill, M.D.Specialty: Orthopaedic Spine

Medical School: Indiana University

Residency: Vanderbilt University Medical Center,

Fellowship: Spine, Washington University School

of Medicine


Medical Center and Vanderbilt Health

One Hundred Oaks

Referrals: (615) 875-5100

Brian Perkinson, M.D.Specialty: Orthopaedics, Joint Replacement

Medical School: University of Tennessee,

Memphis; Memphis,TN

Residency: Campbell Clinic, University

of Tennessee, Memphis

Fellowship: Adult Reconstruction, Anderson

Orthopaedic Clinic

Practice Location: Vanderbilt Bone and Joint

Referrals: (615) 790-3290

Gregory Polkowski, M.D., MSc Specialty: Orthopaedics, Total Joint

Replacement, Hip Preservation Surgery

Medical School: University of Arkansas

College of Medicine

Residency: Vanderbilt University Medical Center

Fellowship: Washington University School

of Medicine


Medical Center

Referrals: (615) 343-9430

otolAryngology

Benjamin J. Johnston, M.D.Specialty: Otolaryngology

Medical School: University of Louisville

Residency: Vanderbilt

Fellowship: Head and Neck, Skull Base

and Microvascular Surgery, Vanderbilt

Practice Location: Vanderbilt Health Highway 96

Referrals: (615) 791-0710

Edward Penn, M.D.Specialty: Pediatric Otolaryngology

Medical School: University of Kansas

Residency: University of Kansas Medical Center

Fellowship: Ann and Robert H. Lurie

Children’s Hospital

Practice Location: Monroe Carell Jr.

Children’s Hospital at Vanderbilt

Referrals: (615) 936-8176

VanDERbilt StRokE

(615) 936-0060 VanderbiltStroke.com

News from VANDERBILT UNIVERSITY MEDICAL CENTER * FALL 2013


The CHS, HMA Chess Match Continues Acquisition Would Create the Nation’s Largest For-Profi t Hospital Chain per Facility Number

Read Nashville Medical News Online:

NASHVILLEMEDICALNEWS.COM

By LyNNE JETER

Federal subpoenas, contract disputes, lower admissions, rising bad debt, and a reduction in surgeries contributed to a move that industry watchers now say was predictable.

On July 30, Franklin-based Com-munity Health Systems (Nasdaq: CYH) announced plans to acquire Health Management Associates Inc. (NYSE: HMA), a Naples-based hospital group that, ironically, had been on a spending spree ac-quiring struggling hospitals.

In late March, For-tune magazine had named HMA among the ‘World’s Most Admired companies in Health Care: Medical Facili-ties’ for the second consecutive year and fi fth time in seven years. HMA has also been named the leading company for two subcatego-ries in 2012: ‘Use of Corporate Assets’ and ‘Social Responsibility.’

Yet, soon after HMA CEO Gary Newsome announced retirement plans in May to preside over a Uruguay mission with the Church of Jesus Christ of Latter-day Saints, rumblings swept through Wall Street that the fi scally struggling public company might be the target of a take-over.

In a May 31 note to investors, Chris Rigg, an analyst with Susquehanna Finan-cial Group, was cautiously optimistic that CHS might be pursuing HMA, estimating the company could be acquired for $18.50 a share, a premium to HMA’s shares that had recently traded near $14.

“We would be surprised if a transac-tion were announced in the very near-term,” he noted. “We don’t believe CEO Gary Newsome would be leaving the com-pany in July if a formal auction process, which we expect HMA would conduct, were currently underway. That being said, we believe Community is the best-posi-tioned name in the hospital group to oper-ate HMA rural focused hospital assets.”

The EngagementIn a power play, the move became

offi cial when CHS announced plans to acquire HMA for $3.9 billion in a deal valued at $7.6 billion, creating the na-tion’s largest for-profi t hospital chain in terms of number of facilities.

“This is the second biggest hospi-tal deal announced this summer,” said healthcare industry consultant George Paul, antitrust partner with White & Case. In June, Dallas-based Tenet Healthcare Corp. (NYSE: THC) announced its ac-quisition of Nashville-based Vanguard Health Systems (NYSE: VHS) in a pact valued at $4.3 billion.

“This deal is part of a growing wave of hospital consolidation, as hospitals seek ways to diversify and lower costs in anticipation of a sea change occurring in

the healthcare industry with the imple-mentation of the Affordable Care Act, uncertainty over how states will handle Medicaid coverage and reimbursement, and Medicare changes,” he said.

Paul emphasized that under Obam-acare, scale will matter greatly as hospitals seek to cope with reimbursement changes and as consumers become increasingly price sensitive. “Insurers will pressure hos-pitals to become more effi cient than ever, and as a result, it’s not surprising to see these two companies merge,” he added.

With a similar focus on non-urban locations, CHS leases, owns or operates 135 hospitals around the country. With HMA’s 71 hospitals, CHS would have 206 acute-care hospitals.

The antitrust review will focus on highly localized markets, Paul pointed out.

“While the two parties overlap in 29 states, it doesn’t appear that they have substantial overlaps on a localized level,” he explained. “The Federal Trade Com-mission (FTC) will focus on how many pa-tients in an area would likely view the two operators as substitutes for each other in terms of location, quality and specialties. Where the two are close substitutes, the FTC could seek divestitures if it were to fi nd that patient choice may be limited.”

The new CHS would be rivaled only by its across-town neighbor, Hospital Corporation of America (HCA), which has fewer hospitals (162), yet reports higher revenue. Last year, HCA raked in $33 billion; CHS and HMA had a com-bined $18.9 billion.

“This compelling transaction pro-vides a strategic opportunity to form a larger company with a diverse portfolio of hospitals that is well-positioned to real-ize the benefi ts of healthcare reform and to address the changing dynamics of our industry,” said CHS CEO Wayne Smith. “Our complementary markets and the ability to form networks in key states, along with the synergies that will be avail-

able to us, can create value for the shareholders of our companies, the communities we serve, our em-ployees and medical staffs.”

Both companies’ boards of directors unanimously ap-

proved the definitive merger agreement.

The deal would give HMA shareholders a 16 percent stake in the new company. Before the market

opened on July 30, the day of the announcement,

HMA shares fell 6.9 percent to $13.89; CHS stock rose 2.4 percent to $48.35.

The UnravelingThe relationship between HMA and

its largest shareholder (14.6 percent), Glenview Capital Management, a hedge fund managed by billionaire Larry Rob-bins, had soured in recent months. Glen-view, a private investment management fi rm established in 2000 with more than $6 billion of assets, also owns nearly 10 percent of CHS. Robbins had been criti-cal of HMA’s sluggish fi nancial results and “unconstructive” executive behavior, pointing to HMA CFO Kelly Curry.

Glenview had previously tried to re-place HMA’s entire board of directors with eight candidates in a Fresh Alternative cam-paign to revitalize the company. In June, Glenview had written HMA about “signifi -cant room for improvement,” which it said had fallen short in its fi nancial performance for more than a decade.

“Under the supervision of the sitting board, HMA lacks the fi nancial acumen to deliver on its projections,” Glenview released in a July 30 statement. “Unfortu-nately, this continues to be the case.”

By mid-August, Glenview announced it had enough votes to oust the HMA board in place when the CHS offer was accepted. The hedge fund operator won a majority stockholder vote to replace the ousted board with its own slate of eight directors.

“Several months from now, with greater board and management engage-ment and greater transparency, Glenview and other shareholders will consider the [CHS proposal] with an eye towards max-imizing shareholder value and positioning HMA to best serve the healthcare needs of its local communities,” Glenview said in a recent statement.

Another Nashville-based hospital group, LifePoint Hospitals (NASDAQ: LPNT), had also expressed interest in ac-quiring HMA.

Smith said he considered keeping CHS an independent company and ex-plored partnerships with other compa-nies but decided acquiring HMA would “create value for the shareholders of our

companies, the communities we serve, our employees and medical staffs.”

Despite the board shakeup, CHS of-fi cials say they remain committed to the HMA deal. Vice President of Corporate Communications for CHS Tomi Galin said in a statement following the HMA board vote, “Our defi nitive agreement to acquire HMA remains unchanged. We look forward to working constructively with the new board of directors at HMA to complete this strategic transaction.”

The Next StepHow these latest developments will

impact the target date of March 31 to complete the merger is unclear.

In the meantime, HMA’s projected second-quarter earnings show a drop of .05 percent in net revenue to $1.46 bil-lion. Company offi cials attributed the dis-couraging fi scal picture to low admissions, increases in observation stays, higher bad debt, a reduction in surgeries, and the fed-eral government’s sequestration. Same-hospital admissions were predicted to fall 6.7 percent, compared to the second quar-ter of 2012.

In its fi rst-quarter fi nancial fi ling, HMA reported it had received a subpoena from the U.S. Securities and Exchange Commission (SEC) for documents in-volving accounts receivable, billing write-downs, contractual adjustments, reserves for doubtful accounts, and revenue. In May and June, HMA received three more subpoenas from the HHS’s Offi ce of In-spector General related to the process by which the company admits people from its emergency department. The new sub-poenas supplemented ones the company received in 2011. Another subpoena was issued on physician relationships. In De-cember, a CBS “60 Minutes” segment fo-cused on HMA’s aggressive policies aimed at increasing admissions and “disgruntled former employees.” No stranger to the federal pressure-cooker, CHS recently re-ceived a new subpoena for similar allega-tions from the Department of Justice.

Editor’s Note: In other CHS news, it was announced at press time that CHS and Cleveland Clinic are in exclusive talks regarding a joint ven-ture ownership of Akron General Health System in Ohio. This would be the fi rst major deal since the two formed a strategic alliance earlier this year.


HealthcareEnterprise

Aspirational Care for the Seriously IllAspire Health Closes the Gap on Palliative Medicine

By CINDy SANDERS

On July 1, Aspire Health — the com-pany envisioned by Sen. Bill Frist, MD, and co-founder Brad Smith to provide an extra layer of support to those facing seri-ous illness — made its debut in Nashville.

The palliative medicine company, noted Frist, has the potential to revolu-tionize advanced illness care in the United States … much the way hospice did for terminally ill patients nearly 40 years ago. Launched in Nashville, the plan is to cre-ate outpatient palliative care clinics and a physician network across the nation to better manage symptoms associated with life-threatening illness and chronic dis-ease to improve outcomes and decrease costs associated with hospitalizations and Emergency Room visits. As Frist noted on the corporate website, “Advanced ill-ness management is one of the few areas in healthcare where patients, caregivers, physicians, and health plan’s incentives are well aligned.”

To oversee clinical operations, Aspire recruited Andrew Lasher, MD, as chief medical offi-cer. Lasher, who is board certified in both internal medicine and hospice and palliative medicine, relocated to Nashville from San Francisco. Prior to his new role at Aspire, Lasher was director of palliative medicine for California Pacific Medical Center and regional director for the specialty for the hospital’s parent orga-nization, Sutter Health.

The decision to relocate with his fam-ily was an easy one. Lasher noted, “There are very few things in medicine that help people live longer, feel better and at a lower cost. This job allowed me to spread the gospel.”

Typically, he continued, palliative care has happened in the hospice setting or in a limited, home-based setting. He was intrigued by the idea of taking that highly personalized care and replicating it on a national scale.

“The idea is we will start in Nashville, take wonderful care of vulnerable patients in this community, learn what works and what doesn’t — in terms of physician outreach, in terms of quality of care pro-vided, in terms of measurement — and then partner with other providers in other communities to build a network of pallia-tive care practices,” he said.

Lasher continued, “The primary focus of palliative care is to relieve pain and suffering. We help patients live as long as they can, as well as they can.” Un-fortunately, he continued, “For patients with an advanced, serious illness, there is very little out there until close to the end of life.” Unlike hospice, he pointed out pal-liative care allows physicians and nurse

practitioners to meet the patient wher-ever they are in their journey … including working with those still actively seeking curative or experimental treatments for their disease or illness.

The need to expand palliative medi-cine, Lasher continued, is great. A major void exists in outpatient care for the seri-ously ill who are not yet ready for hospice services. Typically, palliative medicine serves three major patient populations: 1) those who need symptom management but are not eligible for the hospice benefit as defined by a diagnosis of ‘six months terminal,’ 2) those who have life-threaten-ing conditions who are still seeking aggres-sive therapies to address the root illness, and 3) those who are hospice appropriate based on their diagnosis but are not philo-sophically or emotionally ready.

“People live with cancer and heart disease or after stroke for years after the

diagnosis or event. They need a lot more care over the last chapter of their life … no matter how long,” Lasher said. “Right now there is no system to care for them outside of a hospital setting,” he added, noting the much higher costs associated with inpatient care.

Despite the cost effectiveness and evidence-based improved outcomes as-sociated with such care, reimbursement remains a tricky proposition. By docu-menting and demonstrating those out-comes, Aspire hopes to help drive the conversation regarding a federal payer mechanism. “We all believe Medicare rec-ognizes the value of palliative care and will ultimately find a way to pay for that care,” he said. In the meantime, reimbursement for many patients is made under the fee-for-service system, which doesn’t fully cover the care dispensed.

“But we’re working very closely with

payers who recognize the value of what we do in terms of quality of care to identify more creative ways to reimburse for our services,” Lasher said. He added that Mis-sionPoint has stepped up with a contract that more fully recognizes the depth and breadth of services provided under the palliative umbrella. Lasher said a number of other payers are also looking at similar incentives around value-based medicine.

Many patients seen by Aspire ulti-mately qualify for the hospice benefit so the plan is to help patients make that tran-sition at the appropriate time. In Nash-ville, the palliative practice was launched as a joint venture with Alive Hospice to form Aspire Health Medical Partners of Middle Tennessee. However, Lasher stressed that patients are free to select any hospice provider they choose when … or if … the time becomes right.

Dr. Andrew Lasher

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‘‘

’’

We’ll do everything we can to treat problems before they spiral out of control, helping you avoid long nights in the Emergency Department and unneeded weeks in the hospital. … Facing a serious illness doesn’t have to be this hard, and you don’t have to do it alone,

— Aspire Chairman Sen. Bill Frist, MD


lowing year. In April 2013, the company and its seven local urgent care locations were acquired by a joint venture of HCA Holding’s TriStar Health and CareSpot Express.

Burns noted, “From the early stages of our company, we had tremendous sup-port from our investors, which allowed us to execute our strategic vision of building a leading urgent care company in Nash-ville.” He added, “In addition to provid-ing capital, our investors were a valuable resource as we considered selling our cen-ters to CareSpot and TriStar.”

Baker observed, “If you look at Nash-ville’s history, a significant number of our largest companies are the result of great collaboration between investors and entre-preneurs. This is especially true in health-care where many of the most successful entrepreneurs contribute capital and guidance to the next generation of startup companies.”

Craig Goguen of DSI Renal, who is in the process of moving to the city from Dallas, said he feels a dynamic energy level as he gets into what Nashville has to offer. He commented on how tight the networks are, observing that in other cit-ies, industries are much more “siloed.”

He also noted the major financial ex-changes are trying to figure out where the oncoming implementation of the Afford-able Care Act is going and what that means for business. “If anyone says they know, I’d like to talk to them,” he added wryly.

Over the past two years, DSI Renal

has become one of the fastest-growing di-alysis companies in the United States. The company, formed in 2011, today operates 88 dialysis centers in 23 states, providing care to more than 6,500 patients.

“Because Nashville is the leading market for healthcare ventures, we are able to attract numerous sources of invest-ment capital to our community. DSI was fortunate to find venture capital partners like Frazier Healthcare and New Enter-prise Associates. These investors bring a global perspective to our local economy,” said Goguen.

Makhoumi added, “Successful ven-ture investments require innovation and access to funding. New Enterprise Associ-ates strives to partner with entrepreneurs and management teams who have the ability and the vision to transform indus-tries. We believe in staying at the forefront of innovation in the dialysis community.”

Chambless closed the meeting by saying, “There is a great history of inves-tors and entrepreneurs collaborating in Nashville, and this is especially true in the healthcare sector. The success of these col-laborations is evidenced throughout the Council’s Family Tree. The companies that were discussed today and their inves-tor partners are contributing to that great legacy.”

The meeting was sponsored by Brad-ley Arant Boult Cummings LLP with Earl Swensson Associates, LBMC Healthcare Services, and Revive Public Relations serving as supporting sponsors.

TDH Commissioner John Dreyzehner, MD, MPH.

The types of emergencies range from natural or manmade di-sasters to addressing or preventing communicable and infectious diseases to investigating outbreaks. “We take an all hazards approach,” explained Dreyzehner. “We never know when the next event will be … but we know it’s coming.”

With the State Public Health Labora-tory in Nashville and additional labs in east and west Tennessee, the TDH has approx-imately 130 staff members who perform close to 1.5 million lab tests annually. Not only do the labs have the ability to run a broad spectrum of health assays, the staff also is called upon to analyze substances of concern, such as an unidentified powder, that might come to the attention of law en-forcement officials. “This occurs more fre-quently than people realize,” Dreyzehner noted.

While biohazards are a small part of the overall lab workload, the state labs also play an integral role in analyzing en-vironmental samples, conducting newborn screening panels, and identifying West Nile and other arboviral diseases. Equally im-portant is the state’s work in preparing for threats that haven’t yet arrived.

“Right now we have spent a good bit of time and resources on MERS-CoV — Middle East respiratory syndrome corona-virus — and H7N9, a new strain of flu,” Dreyzehner said. “I hasten to add that nei-ther of those have come to our shores.”

Being ready, however, has set Tennes-

see apart. When H1N1 did strike America several years ago, the State Public Health Lab was on the forefront of running tests. At one point, Tennessee was doing testing for other states that didn’t yet have the capacity to analyze incoming samples.

Since health threats come from many different arenas, it’s difficult to anticipate every scenario. “A key lesson is we never know where the next hazard is going to come from. We have spent a lot of time cre-ating the infrastructure, relationships, tools, and capacity to respond to any hazard,” ex-plained Dreyzehner.

That was made abundantly clear in the recent issues with preservative-free methyl-prednisolone acetate (MPA). He noted that in the fungal meningitis outbreak, the TDH relied heavily on the relationships and part-nerships that were put in place well in ad-vance of the crisis to effectively work with victims and to communicate information both internally and externally.

“We were able to use some existing ca-pacities in some very innovative and novel ways to great success,” Dreyzehner said. One example, he noted, was using pre-paredness software developed for another purpose to track patients who had been ex-posed to the tainted MPA.

The team also relied on their capac-ity to collect and analyze data to predict the most effective treatment protocols and to identify those at risk. As Dreyzehner pointed out, going into this crisis there was virtually no literature on the particular type of fungus involved in the meningitis out-break. “We were dealing with a situation that no one had ever encountered before.” Calling on relationships with federal agen-cies, national experts, and academic centers, Dreyzehner said the team quickly gathered

and disseminated information to local pro-vider resources across Tennessee — includ-ing public health nurses and county public health staff — who have regularly reached out to inform and update those impacted by the tainted MPA.

Dreyzehner was quick to add this work is ongoing. “More than 13,500 people were affected by this … ranging from disconcert-ing to catastrophic,” he said. “This is still affecting more than 700 people around the country — 749 cases have currently been identified, and 63 people unfortunately lost their lives.

The need for a rapid and accurate information loop has spurred the state to enhance communication tools. “We need to be able to push our information to our healthcare partners and receive information from them in a more real time and coop-erative space,” explained Dreyzehner. To that end, he said Tennessee is creating the Health Joint Information Center, which is a concept derived from the National Inci-dence Management System.

“In order to provide the best informa-tion to the public and media partners, we cre-ate a place where partners and entities can pool information to make sure we are provid-ing the right answers in a rapid fashion.”

Ultimately, it all comes down to build-ing a scalable infrastructure, and a big part of that infrastructure comes from creating and maintaining relationships. “An emer-gency is the last place you want to be meet-

ing people for the first time,” Dreyzehner pointed out wryly.

The smooth interaction between local providers, the TDH staff, and federal of-ficials during the meningitis outbreak un-derscored just how important it was to have previously developed relationships in place when it came time to act. “Just like com-munity health providers and centers are our eyes and ears, the state health depart-ments are the eyes and ears for the CDC,” Dreyzehner said.

“We in public health rely on a variety of surveillance tools to detect concerns and to protect health,” he continued, adding the TDH relies on local healthcare person-nel, hospitals and health departments to draw attention to concerns. “We’re always thinking of the continuum of reporting,” Dreyzehner continued. The first call, he added, should be to the local health depart-ment to report the incident. “They are cer-tainly able to escalate that rapidly if there is a need,” he said, adding each department has a medical director and direct access to the state’s subject matter experts.

Dreyzehner said the best defense to protect against or respond to public health threats is working together.

“To the healthcare community, we appreciate you … we depend on you … and we will make every effort to keep you informed and work with you to protect life and health before, during and after an event.”

In Case of Emergency, continued from page 1

Dr. John Dreyzehner

Developing Healthcare, continued from page 4

For Alive Hospice, partnering with Aspire made perfect sense to strengthen the continuum of care. John L. Shuster, MD, chief medical officer for Alive, noted, “This part-nership really was attrac-tive, and it’s exciting. I’ve been doing this for a long time … hospice and palliative care are really all one piece … and they ought to be.”

He also sees a great kinship between the founders of Aspire and those who launched Alive in 1974 … a full decade before the hospice Medicare benefit came into play.

“The pioneers at Alive were willing to step up and meet the need and start from scratch and test new models even when there wasn’t a funding mechanism,” he pointed out.

Shuster, who is double board certified in psychiatry and in hospice and palliative medicine, said the Medicare benefit was both the “best thing and worst thing for hospice care.” At issue is the definition of terminal illness embedded in the leg-islation. “The intention was really, really

good and solid, and this has done much, much, much more good than harm,” he stressed of the 1984 provision.

However, he continued, “I think the six month eligibility criteria for hospice created this gap … this chasm … between acute care and hospice care.” Shuster added, “Americans don’t want to choose between quality of life vs. quantity of life.”

The beauty of palliative care, he con-tinued, is that it takes so many of the posi-tive elements of hospice care and makes it available to people who fall in the gap.

“What’s exciting about this partner-ship is I think it really honors the spirit and the vision of the founders of this institu-tion. Guess where we are with palliative care? We’re exactly where we were with hospice care when Alive Hospice was founded,” he pointed out.

Shuster continued, “We’ve been look-ing for a way to contribute to the field of palliative care the same way we did for hospice 38 years ago.”

He is confident that together Aspire and Alive will fill the gap in care to bring comfort to patients, improve symptom management, and increase a patient’s quality of life while ultimately lowering costs to the system.

Aspirational Care, continued from page 15

Dr. John L. Shuster


More Grand Rounds Online

nashvillemedicalnews.com

GrandRounds

Save the DateSept. 24-26 • Infocast’s Healthcare

Deal Making Summit 2013 • Nashville Music City Center

Healthcare executives come to-gether with leading investors and finan-cial service providers to explore business strategies, models and investments in a post-ACA world. For more information, www.informationforecastnet.com/events/healthcare13.

Oct. 6-9 • MGMA Annual Conference • San Diego

More than 5,000 attendees are ex-pected at the annual conference focusing on practice success in a changing land-scape. This year, educational sessions will be offered in a variety of new formats, including point-counterpoint, rapid fire, deep dives and a live Twitter session about HIT. For registration or information, www.mgma.com/mgma-conference.

Oct. 12 • American Heart Association Nashville Heart Walk • Vanderbilt University Campus Sports Field

Join co-chairs Ken Harms, president, UPS Mid-South District and Gregg Mor-ton, president, AT&T Tennessee, for the year’s largest fundraiser to combat Amer-ica’s number one killer. The Nashville edi-tion of the Heart Walk is one of the largest in the country. Last year’s walk drew more than 12,000 participants and raised $1.75 million. This year’s fundraising goal is $2 million. For more information or to regis-ter, www.nashvilleheartwalk.org.

Oct. 26 • Nashville Walk to End ALS • Centennial Park

Take steps to beat ALS at the annual fundraiser. Check-in begins at 9 am with the walk starting at 10 am. For more infor-mation or to register, http://web.alsa.org.

Nov. 4-6 • Hospital of Tomorrow • Omni Shoreham Hotel • Washington, D.C.

U.S. News & World Report is conven-ing a forum of top hospital executives and renowned healthcare visionaries to ad-dress the critical challenges facing health systems today. This collaborative, solu-tions-driven examination of best prac-tices and the lessons of pioneers will in-form strategies for thriving in tomorrow’s health landscape. For details, go to www.usnewshospitaloftomorrow.com.

Optimal Radiology Relocates Headquarters to Nashville

Optimal Radiology, a national radiol-ogy practice and leading provider of on-site and teleradiology coverage to hos-pitals, has relocated its corporate head-quarters to Nashville.

The move, which follows Optimal’s partnership with Nashville-based radiol-ogy practice Advanced Diagnostic Im-aging (ADI) last year, is expected to add up to 15 new positions at the company’s White Bridge Road office. Formerly head-quartered in Birmingham, Ala., Optimal opened its Nashville office in November 2012.

With more than 100 radiologists who

interpret over 2 million exams annually, Optimal provides radiology staffing and management services to national and re-gional health systems, as well as indepen-dent radiology groups.

Dillard Named Board of Pharmacy Executive Director

Reginald Dilliard, DPH, has been ap-pointed executive director of the Tennes-see Board of Pharmacy.

Previously Dillard worked as a pharmacy man-ager for Walgreens where he he managed multiple pharmacies in the Memphis and Nashville areas with responsibilities for budget-ing, personnel and opera-tions as well as patient care programs and prescription processing. He received his degree from the University of Tennessee College of Pharmacy in Memphis, and is licensed as a pharmacist in Tennessee. He is a member of the Tennessee Pharmacists Association, and is both a past president of the organization and former member of the TPA Board of Directors.

LifePoint Names Murphy CFO, Hill CCO

LifePoint Hospitals, Inc. recently an-nounced Leif Murphy has been appoint-ed chief financial officer, effective Sept. 14. Murphy succeeds Jeffrey S. Sherman, who is leaving the company to pursue an-other opportunity in Dallas.

Murphy brings nearly 20 years of healthcare finance and development ex-perience to LifePoint. Before joining Life-Point in 2011, he served as president and CEO of DSI Renal, Inc., and prior to that he was senior vice president and treasurer at Caremark, Inc. He received his under-graduate degree from Furman University and his MBA from The College of William and Mary in Williamsburg, Va.

The hospital company has also named J. Reginald Hill to the po-sition of chief compliance officer. He had been serv-ing in this position on an interim basis for the past several months. He will lead the company’s ethics and compliance depart-ment, overseeing initiatives for LifePoint and its nearly 60 hospitals nationwide.

Hill joined LifePoint following an es-teemed 30-year career in healthcare law at Waller Lansden Dortch & Davis. As a partner at Waller, Hill focused his practice on healthcare legal matters related to compliance, acquisitions and divestitures of facilities, development, financing, joint ventures and syndication of facilities. Ac-tive in professional and community orga-nizations, Hill received his undergraduate degree from the University of Tennessee – Martin and his law degree from the Uni-versity of Tennessee College of Law.

Vanderbilt Finds Infant Vaccine for Pneumonia Helps Protect Adults, Elderly

Results of a new Vanderbilt study, funded by the Centers for Disease Con-trol and Prevention (CDC) and published in the July 11 issue of the New England Journal of Medicine, show infant vaccina-tion against pneumococcal bacteria since 2000 has reduced pneumonia hospital-ization by more than 10 percent across the board, with the most significant re-ductions at the extreme ends of the age spectrum.

“Pneumonia is a leading cause of hospitalization in the United States. The protective effect we saw in older adults, who do not receive the vaccine but ben-efit from vaccination of infants, is quite remarkable. It is one of the most dramatic examples of indirect protection, or herd immunity, we have seen in recent years,” said the study’s first author, Marie Griffin, MD, MPH, professor of Preventive Medi-cine and Medicine.

James Powers, MD, associate pro-fessor of Medicine in Geriatrics, said the study suggests this herd immunity is an even more effective prevention for elders than the vaccine currently recommended to prevent pneumonia in older adults.

Griffin, along with co-author Carlos Grijalva, M.D., MPH, assistant professor of Preventive Medicine, and their col-leagues, examined a large national data-base for hospitalization from pneumonia from 1997 through 2009. The result is a long-term snapshot of how pneumococ-cal conjugate vaccine (PCV7 or Prevnar) has impacted pneumonia rates since it was added to the childhood vaccine list in 2000.

Results show children under age 2 experienced a 40 percent reduction in pneumonia hospitalizations. Reduction in hospitalizations of older children and adults — who did not receive the vaccine — while less dramatic, was still impres-sive. But researchers said what began as a slow decline in 2000 in the rate of pneu-monia hospitalizations for adults over the age of 65 appeared to accelerate over the last decade. By 2009, more than half the nationwide decline in pneumonia hospitalizations could be attributed to older adults, with some 70,000 fewer an-nual hospitalizations for those age 85 and older.

“Humans are the only reservoir for the pneumococcus. This group of bac-teria can live in the nose and throat of healthy people, especially children. From young children, these bacteria may be transmitted to older age groups. Over time, the vaccine is causing a change in types of pneumococcus carried and transmitted nationwide. These huge indi-rect effects on the adult population don’t happen very often,” said Grijalva.

Recent Certifications, Accreditations & Commendations

Heather Greene, senior coding and compliance consultant with Kraft Health-care Consulting LLC, has earned the AAPC Certificate of ICD-10-CM Proficien-cy. She was asked by the AAPC to take the beta ICD-10-CM exam in advance of opening the exam to all members this fall.

Sarah Cannon Cancer Center at TriStar Centennial Medical Center has received a three-year/full accreditation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons.

TriStar Southern Hills Medical Center has earned full accreditation with percutaneous coronary intervention (PCI) from the Society of Cardiovascular Pa-tient Care. TriStar Southern Hills is the first hospital in the state of Tennessee to have achieved chest pain accreditation with PCI, as well as receiving certification with The Joint Commission

Asherbranner Joins TriStar Centennial as Director of Respiratory Services

TriStar Centennial Medical Center recently announced Laura Asherbranner, BS, RRT has joined the medical center as director of respiratory services. Previously, she was with TriStar StoneCrest Medical Center where she had been in leadership positions since the hospital’s opening in 2003.

Asherbranner earned her associate’s degree in respiratory care from Volunteer State Community College and a bach-elor’s in healthcare administration from Columbia Southern University where she is also pursuing her master of science in organizational leadership.

Dr. Reginald Dilliard

Reggie Hill

Alive Hospice Celebrates Re-Opening of the Skyline Madison Inpatient Unit

Nashville Mayor Karl Dean cuts the rib-bon to mark the grand reopening of Alive Hos-pice at Skyline Madison Campus. Pictured (L-R): Alive Hospice Adminis-trator of Inpatient Units Darlene Rutledge, May-or Dean, Alive Hospice President & CEO Anna-Gene O’Neal and Vice President of Community Development Sally Smallwood. The unit was closed for eight weeks while TriStar completed construction in adjacent areas.


TriStar StoneCrest Welcomes Internist Donald Patterson, MD

Last month TriStar StoneCrest Medi-cal Center announced the addition of Donald P. Patterson, MD, internal medicine physi-cian, to the medical staff and to the new Blackman Internal Medicine Prac-tice, part of TriStar Medi-cal Group. He is a board-certified internal medicine practitioner with 10 years experience in Rutherford County.

Patterson received his medical de-gree from University of Alabama School of Medicine in Birmingham and complet-ed his internship and residency at the Uni-versity of Tennessee at Baptist Hospital in Nashville.

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

Jonathan Perlin, MD, president of clinical and physician ser-vices and chief medical of-ficer for HCA, has been se-lected as chairman-elect of the American Hospital As-sociation. He will assume the chair position in 2015.

Capella Healthcare and Cumberland Consult-ing have made Modern Healthcare’s list of fastest-growing healthcare companies as part of the magazine’s “Healthcare’s Hottest” feature. The program recog-nizes the 40 fastest-growing healthcare companies that are headquartered in the U.S., had at least $20 million in revenue 2012, and have been in business for five years or more.

Allen Anderson, MD, of Tennes-see Orthopaedic Alliance has been ap-pointed to serve on the executive committee of Herodicus, an elite society of sports medicine veter-ans, and to serve as vice president of the American Orthopaedic Society for Sports Medicine. Ander-son is the first Nashvillian ever to be appointed to the presidential line of the AAOSM, the leading provider of orthopaedic sports medicine educa-tion, research, and fellowship.

Becky Harrell, a member with KraftCPAs, is among the seven dynamic Nashville women who have been select-ed as inductees into the 2013 Academy for Women of Achievement (AWA). They will be honored at the 22nd annual AWA celebration and induction dinner on Oct. 15. The event is presented by the YWCA of Nashville & Middle Tennessee and First Tennessee.

The Tennessee Hospital Associa-tion recently was awarded the highest patient safety and quality recognition by the Ameri-can Hospital Association for its work in reducing pa-tient harm.

The award for lead-ership and innovation in quality improvement and

contribution to national healthcare im-provement was accepted by THA Presi-dent Craig A. Becker in San Diego in July.

LBMC Technologies has been ad-mitted to the 2013 President’s Club for Microsoft Dynamics. The designation puts LBMC Technologies in the top five percent of Microsoft Dynamics partners worldwide who reach key business goals while maintaining a commitment to achieving exceptional levels of customer satisfaction and an active pursuit of prod-uct and technological innovation.

Lancaster Named Medical Director at Cigna-HealthSpring

Cigna-HealthSpring recently announced Jim Lancaster, MD, as medi-cal director. From 1997 to 2012, Lancaster served as an internist/primary care physician with the St. Thomas Medical Group.

Montgomery Joins Sumner Regional Medical Center

Sumner Regional Medical Center an-nounced that Brandon Montgomery, MD, has joined its staff and will be offering obstetrics and gynecology services to pa-tients throughout Gallatin and the surrounding com-munities. He is the second OB/GYN to join the hospi-tal’s medical staff this year and will see patients through Sumner Women’s Associates.

A Louisiana native, Montgomery graduated from LSU and completed his internship and residency at LSU Health Sciences Center School of Medicine in Shreveport, where he was chief resident. He is trained in da Vinci robotic surgery.

Bernard Health Adds Third Middle Tennessee Retail Store

Bernard Health, the healthcare advi-sory firm that raised $1.9 million earlier this year to expand its network of retail stores, has signed the lease for its third Middle Tennessee store opening this month near the Cool Springs Galleria Mall.

“We continue to improve the way health insurance is purchased in our country, and our solutions save clients an average of $2,000 a year. Our team is excited to help Cool Springs-area clients realize similar savings by implementing the right healthcare strategy,” said Alex Tolbert, founder of Bernard Health. A new retail store in Austin, Texas is planned for later this year.

Stat Solutions Adds Senior Coding Auditor

STAT Solutions has added Donna Baker as a senior coding auditor. She brings more than 15 years of medical coding and bill-ing experience to the po-sition. Baker is a Certified Professional Coder (CPC) and received her associ-ate’s degree in medical administration from the Southwest Florida College of Business.

Poole Joins Carter Lankford CPAs Lindsey Poole has joined Carter

Lankford CPAs as a staff accountant. Experienced in the healthcare industry, Poole will primarily assist with audits, re-views and compilations; process payables and maintain fixed assets for various cli-ents. Additionally, she will handle the preparation of client tax returns. A gradu-ate of Penn State University with a degree in accounting, Poole previously served as a staff accountant at Hertzbach & Com-pany in Maryland.

UL Workplace Health and Safety Names Libardi SVP

UL Workplace Health and Safety has announced David Libardi has joined the company as senior vice president of sales and marketing.

Libardi joins UL from Emdeon (formerly Web-MD), where he served in the top sales leadership role. Prior to Emdeon, he worked for 24 years at Ceridian where he held the position of senior vice president of field operations. He received his MBA from Columbia University and a bach-elor’s degree from Williams College.

UnitedHealthcare Community Plan of Tennessee Appoints CMO

Joel Bradley, MD, has been named the chief medical officer for the United-Healthcare Community Plan of Tennessee. Since 2007, he has served as the health plan’s associate medical director. Prior to that, he was the founding partner of Premier Medical Group in Clarksville. For seven years, he served as the medical director for the Cumberland Pediatric Foundation for patients.

Bradley, who serves as associate clini-cal professor of pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, received his medical degree from Wake Forest.

Seebach Joins TriStar Southern Hills Medical Staff

`zxzzczxzHe received his medical degree from University of Kentucky Col-lege of Medicine in Lexington and then completed a general surgery residency at Walter Reed Army Medical Center in Washington, DC

Atchley Joins Dental Bliss Franklin/Cool Springs

Michael Atchley, DDS, general and cosmetic dentist, has joined Randal Gar-ner, DDS, in the Franklin/Cool Springs of-fice of Dental Bliss. With the addition of Atchley, who has been voted Nashville’s top dental practitioner for five consecu-tive years in The Tennessean’s “Toast of Music City,” the Williamson County office will expand its hours to include Monday-Friday appointments. Atchley, who grad-uated from the University of Tennessee College of Dentistry, will also continue to see patients at his office in the Old Hicko-ry/Hermitage area..

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GrandRounds

Dr. Donald P. Patterson

David Libardi

Dr. Jonathan Perlin

Dr. Allen Anderson

Craig A. Becker

Dr. Jim Lancaster

Dr. Brandon Montgomery

Donna Baker

Dr. Joel Bradley


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Nashville Medical News Sept 2013