Nashville Medical News January 2015

12
PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 Middle Tennessee’s Primary Source for Professional Healthcare News ON ROUNDS PRINTED ON RECYCLED PAPER Tennessee Falls in Health Rankings Heath data released in December ranked Tennessee 45th in the country for overall health ... 5 Financial Restructuring to Position VUMC for Growth Vanderbilt University recently announced plans to reconfigure Vanderbilt University Medical Center as a not-for-profit academic medical center that is financially distinct from the university ... 8 THA, TMA Outline 2015 Priorities For Craig Becker, president and CEO of the Tennessee Hospital Association, the top priority for 2015 is securing Medicaid expansion in Tennessee … now, it looks like that could happen this year. ... 9 January 2015 >> $5 FOCUS TOPICS PUBLIC HEALTH & INFECTIOUS DISEASE HEALTHCARE LAW ONLINE: NASHVILLE MEDICAL NEWS.COM Fighting Flu...and Misperceptions BY CINDY SANDERS During the recent Ebola scare, Americans became transfixed with the infectious disease that ultimately killed two individuals on American soil. To the frustration of many medical providers and public health officials, it has been extremely difficult to gain the same kind of attention and traction for another virus that has proven to be much more contagious and deadly in the United States … the flu. Now in the height of the annual influenza epidemic, the Centers for Disease Control and Prevention estimate on any given year, 5-20 percent of the U.S. popu- lation winds up getting the flu. In the best year between 1976 and 2006, flu was responsible for about 3,000 deaths … in the worst year, there were almost 50,000 flu- associated deaths. Additionally, more than 200,000 people are hospitalized each year (CONTINUED ON PAGE 10) David Aronoff, MD, FIDSA PAGE 2 PHYSICIAN SPOTLIGHT BY MELANIE KILGORE-HILL In today’s increasingly com- plex healthcare landscape, terms like “meaningful use” and “regulatory com- pliance” are the new normal. While it might not take a law degree to understand every new ruling or regulation, there’s no question it sure helps. To that end, we asked some of Nashville’s top healthcare attorneys their advice on navigat- ing healthcare law in 2015. Regulatory Compliance: Changes on the Horizon “The general theme in healthcare regulation is that it is continuously evolving and increasingly complex,” said Danielle Sloane, healthcare attorney at Nashville’s Bass, Berry & Sims. Driven significantly by the Affordable Care Act, increased costs, risks and regulations are chipping away at the healthcare model of yesteryear. Industry-wide consolidation and move- ment from acute to outpatient care will mean fewer new hospitals and heavier oversight of services seeing a boom in both volume and tech- nology. Laboratory, pharmacy, long-term care/hospice/home health, telemedicine and urgent care are among those facing the greatest regulatory changes. “The lab segment is really interesting right now, as we’re seeing sophisticated technology that’s making genetic and molecular testing widely available,” Sloane said, citing the simple DNA/ RNA blood test driving women to undergo pre- emptive mastectomy. “Labs now can test for biomarkers that can have a significant im- pact on patients.” While labs are regulated by CMS, the Food and Drug Administration hasn’t historically looked at test accuracy or its associated risks. In 2014 the FDA issued draft guidance describing its plan A Look Ahead: Healthcare Law in 2015 Local Attorneys Weigh in on Anticipated Changes, Advice for the New Year (CONTINUED ON PAGE 6) To promote your business or practice in this high profile spot, contact Tami Pearce at Nashville Medical News. [email protected] 615-844-9407

description

Nashville Medical News January 2015

Transcript of Nashville Medical News January 2015

Page 1: Nashville Medical News January 2015

PRSRT STDU.S.POSTAGE

PAIDFRANKLIN, TN

PERMIT NO.357

Middle Tennessee’s Primary Source for Professional Healthcare News

ON ROUNDS

PRINTED ON RECYCLED PAPER

Tennessee Falls in Health RankingsHeath data released in December ranked Tennessee 45th in the country for overall health ... 5

Financial Restructuring to Position VUMC for GrowthVanderbilt University recently announced plans to reconfi gure Vanderbilt University Medical Center as a not-for-profi t academic medical center that is fi nancially distinct from the university ... 8

THA, TMA Outline 2015 PrioritiesFor Craig Becker, president and CEO of the Tennessee Hospital Association, the top priority for 2015 is securing Medicaid expansion in Tennessee … now, it looks like that could happen this year.... 9

January 2015 >> $5

FOCUS TOPICS PUBLIC HEALTH & INFECTIOUS DISEASE HEALTHCARE LAW

ONLINE:NASHVILLEMEDICALNEWS.COMNEWS.COM

Fighting Flu...and MisperceptionsBy CINDy SANDERS

During the recent Ebola scare, Americans became transfi xed with the infectious disease that ultimately killed two individuals on American soil. To the frustration of many medical providers and public health offi cials, it has been extremely diffi cult to gain the same kind of attention and traction for another virus that has proven to be much more contagious and deadly in the United States … the fl u.

Now in the height of the annual infl uenza epidemic, the Centers for Disease Control and Prevention estimate on any given year, 5-20 percent of the U.S. popu-lation winds up getting the fl u. In the best year between 1976 and 2006, fl u was responsible for about 3,000 deaths … in the worst year, there were almost 50,000 fl u-associated deaths. Additionally, more than 200,000 people are hospitalized each year

(CONTINUED ON PAGE 10)

David Aronoff, MD, FIDSA

PAGE 2

PHYSICIAN SPOTLIGHT

By MELANIE KILGORE-HILL

In today’s increasingly com-plex healthcare landscape, terms like “meaningful use” and “regulatory com-pliance” are the new normal. While it might not take a law degree to understand every new ruling or regulation, there’s no question it sure helps. To that end, we asked some of Nashville’s top healthcare attorneys their advice on navigat-ing healthcare law in 2015.

Regulatory Compliance: Changes on the Horizon

“The general theme in healthcare regulation is that it is continuously evolving and increasingly complex,” said Danielle Sloane, healthcare attorney at Nashville’s Bass, Berry & Sims.

Driven signifi cantly by the Affordable Care Act, increased costs, risks and regulations are chipping away at the healthcare model of yesteryear. Industry-wide consolidation and move-

ment from acute to outpatient care will mean fewer new hospitals and heavier oversight of services seeing

a boom in both volume and tech-nology. Laboratory, pharmacy, long-term care/hospice/home health, telemedicine and urgent

care are among those facing the greatest regulatory changes.

“The lab segment is really interesting right now, as we’re seeing sophisticated technology

that’s making genetic and molecular testing widely available,” Sloane said, citing the simple DNA/

RNA blood test driving women to undergo pre-emptive mastectomy. “Labs now can test for biomarkers that can have a signifi cant im-pact on patients.” While labs are regulated by CMS, the Food and Drug Administration

hasn’t historically looked at test accuracy or its associated risks.

In 2014 the FDA issued draft guidance describing its plan

A Look Ahead: Healthcare Law in 2015Local Attorneys Weigh in on Anticipated Changes, Advice for the New Year

(CONTINUED ON PAGE 6)

To promote your business or practice in this high profi le spot, contact Tami Pearce at Nashville Medical News.

[email protected] • 615-844-9407

Page 2: Nashville Medical News January 2015

2 > JANUARY 2015 n a s h v i l l e m e d i c a l n e w s . c o m

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PhysicianSpotlight

By KELLy PRICE

What goes around, comes around. For David Aronoff, MD, FIDSA, that

means being in a position to give back to Vanderbilt University Medical Center, which played a key role in his medical train-ing.

After spending more than a decade with the University of Michigan, Aronoff was tapped as the new director of the Di-vision of Infectious Diseases in the Depart-ment of Medicine at Vanderbilt a little more than a year ago. He also holds a secondary faculty appointment in the Division of Pathology, Microbiology and Immunology.

When he was appointed, Nancy Brown, MD, chair of the Department of Medicine, noted, “David is a star in the fi eld of infectious disease. He has natural leader-ship instincts, and we are fortunate to have recruited him back to Vanderbilt.”

Aronoff is the third generation of physicians in his family, following in the footsteps of his father and grandfather. He and his twin brother were born when their father was a medical resident in Blooming-ton, Mich. and grew up in the state. After graduating summa cum laude from Indiana University with a degree in microbiology, Aronoff earned his medical degree from Tufts University Medical School in Boston.

His next stop was Nashville. Aronoff completed his internship and residency training, including a year as chief resident in Internal Medicine, at Vanderbilt. He stayed to complete a clinical fellowship in Infectious Diseases and a research fellow-ship in Clinical Pharmacology before leav-ing to join the faculty in Infectious Diseases

at the University of Michigan. “I was so fortunate that I was able to

complete the fi nal two years of my fellow-ship under Dr. John Oates, senior professor of Medicine (Clinical Pharmacology) and chair emeritus of the Department of Medi-cine,” Aronoff noted of working with the renowned researcher at Vanderbilt.

During his tenure at Michigan, Aronoff also completed a research postdoc-toral fellowship in Pulmonary and Critical Care Medicine. In 2011, he was named a Fellow in the Infectious Diseases Society of America (FIDSA).

Of returning to Nashville, Aronoff said, “The Vanderbilt culture is a very nurtur-

ing and highly collaborative environment, which had a major impact on my decision to accept this post.”

He added, “Vanderbilt put me in posi-tion to eventually become a leader. For me, being here is really giving back to the insti-tution that opened a lot of doors for me. I feel a deep sense of gratitude, and it feels great to be back.”

Although returning to Nashville in 2013 certainly held a lot of familiarity, Aronoff said he was stunned by how much Nashville had grown in the years since his departure. “The city had become a ‘destination city’ in the time I was gone … I was amazed at the transformation,” he observed.

He was also impressed by the growth in size and prestige that the Vanderbilt medical complex has undergone in the last decade. “The campus had evolved and the medical center itself was radically enlarged, especially by the addition of the towers,” he noted.

In addition to knowing the culture of the academic medical center, he said he was also drawn to return by Vanderbilt’s national leadership in infectious diseases training and research. In addition to the division’s leadership in HIV care and re-search, tuberculosis research, global health, infection control and hospital epidemiology and infectious disease pathogenesis, he has been struck by Vanderbilt’s commitment to addressing poverty-related disease burden.

Aronoff said he has also been pleased to work with William Schaffner, MD, chair-man of the Department of Preventive Med-icine, who Aronoff called a “charismatic national leader” in the fi eld of infectious disease … and one of the motivating fac-tors for his return to Nashville to lead the Division of Infectious Diseases.

He also enjoys his role helping shape future physician-scientists, while also ex-panding on his own research lines. Aronoff, whose research has primarily focused on reproductive immunology and specifi cally on infections that complicate pregnancy, has received numerous governmental and non-nongovernmental research grants and is widely published.

He hopes to develop additional av-enues for Maternal Fetal Medicine, Pediat-rics, Neonatology, and Pediatric Infectious Diseases to work with his department to address challenges in maternal and child health, as well as develop new technologies for studying human disease. He is especially excited about spearheading Vanderbilt’s Pre3 Initiative – Preventing adverse Preg-nancy outcomes & Prematurity – an inter-disciplinary group of faculty and trainees with a shared interest in reducing the bur-den of adverse outcomes through discovery, innovation, implementation and education.

Aronoff concluded, “I am excited to be able to give back to the program that has given so much to me.”

Aronoff Leads the Charge on Infectious Diseases

Page 3: Nashville Medical News January 2015

n a s h v i l l e m e d i c a l n e w s . c o m JANUARY 2015 > 3

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Dr. Ming Wang, Harvard & MIT (MD, magna cum laude); PhD (laser physics), is one of the few cataract and LASIK surgeons in the world today who holds a doc-torate degree in laser physics. He has performed over 55,000 procedures, including on over 4,000 doctors (hence he has been referred to as “the doctors’ doctor”). Dr. Wang currently is the only surgeon in the state who offers 3D LASIK (age 18+), 3D Forever Young Lens surgery (age 40+) and 3D laser cataract surgery (age 60+). He has published 7 textbooks, over 100 papers including one in the world-renowned journal “Nature”, holds several U.S. patents and performed the world’s fi rst laser-assisted artifi cial cornea implantation. He has

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Page 4: Nashville Medical News January 2015

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By CINDy SANDERS

A demonstrated need for an organiza-tion like the Tennessee Justice Center was the driving force behind founding the state-wide, non-profit, public interest law firm. Passion, mission … and a few miracles along the way … have kept the doors open for nearly two decades.

Michele Johnson, who helped launch the TJC along with col-league Gordon Bonny-man at the end of 1995, said new federal restric-tions at that time ham-pered legal aid programs across the country, mak-ing it nearly impossible to undertake certain activi-ties … even if using private funds for work that fell under the new restrictions. Because of that change, Johnson said, leaders in the Tennes-see Bar Association — many of them private attorneys at large corporate firms — stepped up to say they didn’t want see the poor re-ceive second class legal services.

“They wanted to have an entity that was unrestricted,” explained Johnson, who succeeded Bonnyman as TJC’s executive

director at the end of 2013. “It’s an amaz-ing story of people … our friends … who saw they wanted a system where ‘equal jus-tice under the law’ was real.”

With a mission to operate without government funding so that the TJC could advocate on behalf of low income Tennes-seans in civil matters that federally funded programs would be prohibited from han-dling, the doors opened in January 1996 with no funding. Johnson said the Legal Services directors across the state asked the Tennessee Bar Foundation to give less money to their organizations and instead provide some to this new entity. To this day, Johnson marvels at that act of gener-osity from another non-profit group that always struggles for funding, as well.

“That’s really been our story since our founding. There have been miracles all along the way like that,” she said.

Today, the vast majority of the TJC’s funding comes from three sources – the Tennessee Bar Foundation, Baptist Heal-ing Trust, and individual donors who con-tributed close to $275,000 in 2014. Johnson said there are also a number of smaller grants from multiple sources like the Frist Foundation and Memorial Foundation that are put to good use.

Initially, the staff was Johnson, Bon-nyman and a few volunteers. Now there are a little over a dozen employed, which is still small considering the great need that exists. “We’re constantly forced to inno-vate because of our size,” noted Johnson. “We’re pretty tiny for the impact we have,” she added with a laugh.

In fact, Johnson counts the TJC staff as another miracle. “We’ve been so fortu-nate to have our staff. They could really, truly be hired and work anywhere, but they choose to work here because they feel pas-sionate about the mission,” she noted.

Since the very beginning, much of the work has revolved around access to health-care and is now almost exclusively the focus. Picking up where Legal Services could no longer go, TJC took over as lead plaintiff in Grier v. Goetz (now Binta B v. Gordon) and won a landmark ruling in 1996 to allow TennCare enrollees to challenge denials by their insurance plan. Three years later, a settlement further expanded those rights and led to a stronger appeals process for enrollees. Johnson said the ongoing consent decree gives physicians the final say in medi-cal conditions and has resulted in lifesaving care for thousands of Tennesseans.

In one instance, a child needed heart surgery that was only being performed in Michigan at the time. Initially the fam-ily was told ‘no,’ but the TJC intervened. Today, that child is an active eight-year-old. In another case, a client found out she was pregnant the day after being di-agnosed with ALS. After she delivered a healthy baby, she wanted to go home to be with her family and newborn but required a vent. Her physician felt strongly that she would require home health, which wasn’t part of TennCare services at the time. “If she couldn’t go home, she would have had to go to a nursing home, and she said that would have killed her,” recalled Johnson. The TJC advocated on her behalf so she could return home. Not only is the woman still alive, the ‘newborn’ is now a healthy, happy college student.

Much of Johnson’s work has focused on the standards of care for children – the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit — which calls for children to receive what they need to reach their full potential. Yet at one point in Tennessee, children who were hearing im-paired couldn’t get hearing aids, managed care companies routinely refused speech therapy, and a child born with one eye was denied a prosthetic. “We went to the state and said, ‘Let’s breathe life into this law to protect children,’” said Johnson. “That brought about lots of positive outcomes for children across the state. From 1996 to 2011, it was my big work, and I’m really proud of the impact it has had on kids.”

The individual examples go on and on … one child with brain cancer was literally stopped while on the gurney on the way to surgery because he had lost his cover-

age. “His parents called us from the hospi-tal. We knew the law, and we had it fixed within four hours,” Johnson said.

She added most days are spent talk-ing to people in trouble. They call, John-son said, because they know the staff has “this freakish knowledge of the health law.” They also know TJC has a reputation for compassion and for treating clients with dignity and respect … as well as being te-nacious. “We won’t give up until we find an answer,” Johnson noted, adding that with nearly two decades of experience, the staff has developed friends, and a tremendous network of resources, all across the state.

“People can get pretty cynical, but if you hung out at TJC very long, you’d feel pretty hopeful about the world. It’s an over-whelming privilege to see all the good that is being done in this state,” she concluded.

To learn more about the work of the Tennessee Justice Center or to refer a pa-tient to them, go online to tnjustice.org or call (615) 255-0331.

Equal Protection Under the LawTennessee Justice Center’s Statewide Fight for Access to Care

HealthcareEnterprise

TennCare EligibilityThe Tennessee Justice Center

undertook several measures in 2014 to help people better understand TennCare criteria and receive a determination of eligibility.

Last year, TJC made headlines when the public interest law firm joined forces with the Southern Poverty Law Center and National Health Law Program to sue the state over delays in determining eligibility. At a preliminary hearing, a judge ruled TennCare has to provide fair hearings upon request to anyone who applied for TennCare more than 45 days ago (or 90 days ago for CHOICES) and who has not received a decision.

Following negotiations last summer, the state also implemented a newborn presumptive eligibility program to ensure the newest Tennesseans meeting certain criteria have access to care even before formal paperwork is filed. TJC also began training healthcare providers, social workers and volunteers on eligibility rules. Last year, the staff conducted more than 90 statewide trainings and webinars.

TJC is in the process of going high tech with the new AskJane software. The program is named for Jane Beasley, TJC’s senior paralegal who is known as the ‘eligibility wizard’ for her depth of knowledge about the complex enrollment criteria. Attorney Rob Watkins is turning that knowledge into an algorithm that will ultimately enable almost anyone to calculate eligibility after about an hour of instruction on the software.

Michele Johnson

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By CINDy SANDERS

What Nashville set out to do more than five years ago has finally become a federal mandate with the Food & Drug Adminis-tration issuing two final rules late last year requiring calorie information be listed on menus and menu boards in chain restau-rants, similar retail food establishments and vending machines with 20 or more locations.

Back in 2009, the Metro Board of Health — with the staunch support of Metro Public Health Department Direc-tor William Paul, MD — passed regula-tions to address the city’s climbing obesity rates by requiring caloric information be included on menus and sign boards for chain restaurants in Davidson County with 15 or more locations in Middle Ten-nessee or across the country. Set to go into effect at the end of March 2010, the regulations were withdrawn when similar national requirements were included in the 2010 Patient Protection and Afford-able Care Act to avoid having restaurants potentially implement local rules only to turn around and change signage again to meet the federal requirements.

As it turns out … it wouldn’t have been a very quick turn-around. In fact, in the ensuing years, a number of restaurants including Panera, McDonald’s and Au

Bon Pain voluntarily began posting calo-rie counts well in advance of federal regu-lations going into effect. The new federal final rules, which must be implemented by November 2015 barring legal and politi-cal challenges, are intended to replace the patchwork of local and state regulations that have sprung up over the past decade.

In announcing the new restaurant rule, which requires covered food estab-lishments to “clearly and conspicuously” display calorie information for standard items on menus and menu boards next

to the name or price of the item, FDA Commissioner Margaret A. Hamburg, MD, said, “Making calorie information available on chain restaurant menus and vending machines is an important step for public health that will help consumers make informed choices for themselves and their families.” She also noted Americans eat and drink a full one-third of their calo-ries away from home.

According to the FDA release, “The menu labeling final rule applies to res-taurants and similar retail food establish-ments if they are part of a chain of 20 or more locations, doing business under the same name and offering for sale substan-tially the same menu items.” The rule also includes some pre-packaged, prepared foods sold at grocery and convenience stores intended for takeout dining by indi-viduals. The rules don’t apply, however, to prepared items intended to feed multiple people like a rotisserie chicken or prepared meatloaf sold at the grocery. Still, both the National Association of Convenience Stores and the National Grocers Associa-tion have accused the FDA of going be-yond congressional intent.

In expressing his disapproval of con-venience stores being included in the menu labeling regulations, NACS Senior Vice President for Government Relations Lyle Beckwith said, “It is now up to the bipartisan, bicameral opponents of this regulatory overreach to enact legislation introduced in both houses of Congress that reasonably defines a restaurant as a business that derives at least 50 percent of revenue from prepared food.”

Also catching many by surprise was the inclusion of some alcoholic beverages

in the final rule. Although mixed drinks at a bar aren’t subject to the regulation, an alcoholic beverage included on the menu of covered food establishments is required to have calories posted. Originally ex-empted, the final rule also included menu items in entertainment venue chains in-cluding movie theaters and amusement parks. The federal agency did make some adjustments in light of more than 1,000 public comments, such as allowing pizza to be labeled by the slice to more accu-rately reflect an individual’s caloric con-sumption of a multi-serving dish.

In addition to the calorie counts on menus and boards, covered food estab-lishments also must provide nutrition in-formation about total calories, total fat, calories from fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrates, fiber, sugars and protein in writing upon consumer request.

Hamburg reiterated the rules only apply to those with 20 or more locations and do not impact independent restau-rants, bars or grocery stores and do not apply to food trucks, ice cream trucks, food served on airplanes or other trans-port vehicles.

The vending machine requirement, which pertains to those who own or oper-ate more than 20 vending machines, re-quires similar posted calorie information for items sold in each machine. Vending machine operators have two years to im-plement the new requirements.

Both the menu and vending final rules were published in the Federal Regis-ter on Dec. 1, 2014. To link to the details of each rule, go online to federalregister.gov/topics/food-labeling.

Meharry Population Health Grant Targets North, Northeast Nashville

In late November, officials with Meharry Medical College announced the medical school had been awarded $451,430 as part of the Racial and Ethnic Approaches to Community Health (REACH) grant program to launch Nashville REACH 2020, which targets African-American residents in the 37027 and 37208 zip codes of Nashville in an effort to improve health and decrease health disparities.

A main focus of the funding is on education, public policies, and evidence-based programming aimed at increasing the consumption of healthy foods and beverages. According to the United States Department of Agriculture, the target areas constitute a food desert because of the lack of full-service grocery stores and access to fresh foods.

Margaret Hargreaves, PhD, professor of Internal Medicine at Meharry, is the principal investigator of the project and believes focusing on African-American residents in this area of Nashville will yield the best attempt at reducing health disparities. “This is an excellent opportunity to impact risk factors, such as obesity, that predispose residents in 37207 and 37208 to diabetes, heart disease and some forms of cancer,” said Hargreaves, who also serves as director of Meharry’s Prevention Research Unit. “African Americans suffer disproportionately from these chronic diseases more than Caucasian residents of Davidson County.”

The grant, which is administered by the Centers for Disease Control and Prevention, runs for three years subject to funds availability. In addition to Meharry, other key stakeholders involved in the project include the Tennessee Department of Health and the Nashville Health Disparities Coalition.

The lead organizations will work to form partnerships with churches, neighborhood associations and other local groups to address the factors that impede access to healthy foods. Representatives from the two neighborhoods were involved in creating the grant proposal so there is already community buy-in to try to bring about change. The goal is to favorably impact policies, systems and environmental factors to improve nutrition, prevent a host of chronic diseases, and lower overall healthcare costs.

The REACH initiative was launched in 1999 by the United States Department of Health and Human Services with a specific focus on racial and ethnic communities experiencing health disparities. For fiscal year 2014, 49 REACH grants totaling $34.9 million were announced. The Meharry project was the only REACH grant funded in the state of Tennessee.

To learn more about Nashville REACH 2020 and the Nashville Health Disparities Coalition, call 615-327-6927.

FDA Finalizes Menu Labeling Rules

Health data released in December ranked Tennessee 45th in the country for overall health. After several years of im-provement, the state slipped three spots for 2014 (from a ranking of 42nd in 2013). Con-tributing to Tennessee’s results:

• A high prevalence of physical inactiv-ity, with 33.6 percent of adults inac-tive (an increase of 17 percent from last year);

• A high prevalence of obesity at 33.7 percent of adults;

• The highest rate of violent crime relative to other states in the country, ranking Tennessee 50th with 644 of-fenses per 100,000 population.

• On the plus side, the state performed well in several areas, including:

• A low prevalence of binge drinking (Rank: 1);

• Low incidence of pertussis infections (Rank: 10); and

• The state’s ready availability of pri-mary care physicians (Rank: 19).

The statistics are part of the 2014 America’s Health Rankings®, an an-nual assessment of the nation’s health created by United Health Foundation in

collaboration with the American Public Health Association and Partnership for Prevention. America’s Health Rankings celebrated its 25th year as 2014 wound to a close.

Other highlights of the report for Ten-nessee include:

• A drop in infant mortality from 8.0 deaths per 1,000 live births to 7.3, moving Tennessee up six places in the rankings relative to other states;

• A decrease in preventable hospital-izations from 80.8 per 1,000 Medi-care beneficiaries to 73.1;

• An improvement in air pollution, measured in micrograms of fine par-ticles per cubic meter, from 16.1 to 9.5;

• An increase in high school gradua-tion (percent of incoming ninth grad-ers) from 80.4 to 83 percent; and

• A 10 percent reduction since 1990 of children living in poverty from 29.6 percent to 26.7 percent.

More information on Tennessee’s health rankings, trend data for the state, and rankings for other states is available at americashealthrankings.org.

Tennessee 45th in America’s Health Rankings

Panera voluntarily posted calorie counts long before the new FDA rule was finalized.

Page 6: Nashville Medical News January 2015

6 > JANUARY 2015 n a s h v i l l e m e d i c a l n e w s . c o m

Can this be resized to 1/3S InCharge size and the ap-plication deadline info be deleted?

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SHAPE THE FUTURE OF HEALTH CARE.

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to regulate lab-developed tests: those de-signed, manufactured and used within a single lab, often blurring the line between testing and medical device innovation. Those guidelines are now under review with the comment period to wrap Febru-ary 2015.

“The question is how to protect quality without stifling innovation,” said Sloane, who expects reg-ulatory changes to unfold over the next decade.

Pharmacology is seeing similar changes driven by sophistica-tion in medicine and the hands-on role phar-macists are adopting in patient care. Compound-ing pharmacies, for example, are under stricter guidelines in many states following a nationwide fungal meningitis outbreak from a Massachusetts drug-compounding firm that killed 16 Tennesseans in 2012. The following year, Congress passed the Drug Quality and Security Act in an ef-fort to improve medication standards and safety.

According to Sloane, regulations are underway in Tennessee to establish guide-lines defining how pharmacists could work collaboratively with physicians to help manage medication regiments with pa-tients, along with other important roles.

Consolidation among long-term care, home health and hospice organizations also is ramping up, due in part to gov-

ernment oversight of Medicare patient billing. The Office of Inspector General 2015 Work Plan referenced their 2012 re-port, which found one in four home health agencies had questionable billing, prompt-ing more fraud review.

“For small providers who service mostly Medicare patients, the risk of run-ning afoul of regulations can be high … not necessarily due to bad intent but be-cause it’s challenging to keep up with all the rules, documentation requirements and continual regulatory changes,” Sloane said.

Still a relatively young industry, ur-gent care is a booming service touting convenience, time and cost savings over traditional emergency rooms. But changes are on the horizon for this market seg-ment.

Freestanding and retail clinics are regulated, though not as tightly as more established industry segments. And some states do not require licensure, making it seemingly easier to operate. However, clinics still must navigate other regulatory issues, such as the federal Stark Law and corporate practice of medicine laws in various states.

The industry of telemedicine is evolving, as well. While Medicare reim-bursement of telemedicine remains quite limited, more state Medicaid programs and commercial insurers are reimbursing for telemedicine.

“Regulations are struggling a bit to keep up with the growing model of tele-

medicine,” Sloane said. In an effort to promote some uniformity across states, the Federation of State Medical Boards recently published a Model Policy for the Appropriate Use of Telemedicine Tech-nologies in the Practice of Medicine, which is aimed at helping state medical boards evaluate and develop state guidelines and regulations on the appropriate use of tele-medicine. “Medicare is still quite limited with telemedicine, but the ability to use technology to remotely monitor patients is a current topic of conversation and may become more prevalent,” Sloane said.

Meaningful Use in 2015While CMS mandates are nothing

new, the onset of Meaningful Use kicked the reimbursement game into high gear. The three-stage process provides elec-tronic health record mandates to im-prove the quality, safety, and efficiency of patient care. MU established specific objectives that eligible professionals and hospitals must achieve to quality for CMS Incentive Payments. Stage 1 (2011-2013) MU focused on data capture and sharing, while stage 2 (2014) addressed advanced clinical processes. Stage 3 (2017) focuses on improved outcomes.

“Right now many providers are tran-sitioning between stages 1 and 2, and there’s still a lot of con-fusion and frustration on the part of providers trying hard to get newly required technology,” said Michaela Poizner, healthcare regulatory attorney for Baker Do-nelson in Nashville. “There’s been a lot of vendor backlog and providers are doing the best they can given the quick turn-around.”

Providers were required to have 2014 technology in place by Jan. 1, 2015. Hos-pitals, which run on a fiscal year calendar, began the 2015 reporting year Oct. 1, 2014. That leaves two years to integrate new systems before the next MU stage begins in 2017. (CMS is likely to propose the next round of required technology as early as 2015.) However with pricey EHR equipment being adopted nationwide, CMS now is calling for interoperability between systems – a function not stressed earlier in the MU process.

“Technology companies have created great products that work with one group of hospitals but don’t talk to the hospi-tal down the street,” Poizner explained. “CMS is coming in on the back end say-ing they want these systems to talk to each other, and that’s frustrating for both pro-viders and vendors who are doing their best to check all the boxes.”

Reimbursement reductions are an-other concern for providers. Beginning in 2015, Medicare providers who are eligible to participate in MU but chose not to do so will be subject to downward payment adjustments of 1 to 5 percent.

Another very real challenge for 2015 is the threat of audits. Providers now face a 1 in 20 chance of being audited. Intro-

duction of prepayment audits in 2013 required providers to show detailed docu-mentation before receiving any incentive payment. And then there’s the interplay between MU and detailed fraud and abuse laws, i.e. anti-kickback and Stark Law issues. These issues are especially important where hospitals and physicians share equipment.

“There’s a very delicate balance, and it tends to get overlooked when providers are trying to meet other requirements,” Poizner said. “Sometimes all the respon-sibility for monitoring falls to one person, and it’s just a lot of work. It’s easy to slip up, and regulations can be gray in terms of what a particular measure actually re-quires. Providers are having to make their best guess about what they’re required to do.”

Poizner’s best piece of advice to pro-viders: Document everything.

“If you can’t turn over a file to CMS or a third party auditor explaining why you’re entitled to payment [in a prepay-ment audit], you won’t get paid,” she said.

Poizner urges clients to prepare now for a smooth audit experience including practical steps like printing and filing cop-ies of reports and keeping meticulous re-cords.

“Providers will live and die by their organization skills, and that saves so much time and stress,” Poizner said. She also assists clients in conducting mock audits, which gives them a better understanding of the documentation process. “We get a lot of questions from providers preparing for an attestation and questioning how to interpret a particular phrase. For ex-ample, what qualifies as a patient encoun-ter?” Poizner said. “I tell them to hang in there. There’s a lot to wade through, but it really is doable and ultimately a worth-while endeavor.”

Antitrust Laws vs. ACAAntitrust laws were designed to pro-

mote economic competition while pre-venting monopoly in the marketplace. Ideal? Yes … but how does that translate in today’s era of unprecedented health-care consolidation?

“Healthcare reform has encouraged more collaboration between providers, and as a result there’s more investigation and activity in healthcare,” said Beth Vessel, part-ner and antitrust attor-ney at Waller Law. “Just because you’re claim-ing efficiencies with the Affordable Care Act doesn’t mean that you’re safe from antitrust laws.”

She cautioned against using the “fail-ing firm” argument for a buy-out, which only works with hospitals or facilities in extremely dire circumstances. And it’s not only the billion-dollar deals garnering attention. While the Federal Trade Com-mission’s HSR (Hart-Scott-Rodino) Act notification thresholds for 2014 was $75.9 million, it’s not unheard of for smaller

A Look Ahead: Healthcare Law in 2015, continued from page 1

Danielle Sloane

Michaela Poizner

Beth Vessel

(CONTINUED ON PAGE 8)

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n a s h v i l l e m e d i c a l n e w s . c o m JANUARY 2015 > 7

Bonus EditorialGo online to www.

NashvilleMedicalNews.com

to read an extended version

of this article with additional

insights and information.

By CINDy SANDERS, ELISABETH BELMONT & JOEL HAMME

Already one of the most highly regu-lated industries in America, 2015 looks to be another active year across healthcare’s legal landscape. Two past presidents of the American Health Lawyers Associa-tion, Elisabeth Belmont and Joel Hamme, took time to share insights and predic-tions for the coming year.

Subsidies in the Health Insurance Exchanges

Under the Affordable Care Act, in-dividuals with incomes between 100 and 400 percent of the federal poverty level are eligible to receive federal tax credit subsidies for purchasing health insurance on the exchanges. Hamme noted that in King v. Burwell, the Fourth Circuit court ruled the IRS acted lawfully in interpret-ing such subsidies were permissible not only for state exchanges but also for fed-erally run exchanges and those that are a federal-state partnership. However, the Supreme Court has agreed to review this decision.

Hamme explained, “Of the 50 states and the District of Columbia, only 17 have state established exchanges; 7 have partnership exchanges and the remain-ing 27 are federally operated. Thus, if the Supreme Court were to overturn the Fourth Circuit’s decision, individuals in two-thirds of the 51 jurisdictions would be ineligible for subsidies for purchasing health insurance on the exchanges.” He added that while there was some debate as to how detrimental such a decision would prove to be to the ACA, certainly it would be a major setback. “The King case essentially represents the last major legal hurdle for the ACA. If the subsidies challenge fails, ACA opponents will be relegated to trying to repeal or signifi-cantly modify the ACA by legislative and executive branch actions.”

Medicaid Eligibility ExpansionSince the Supreme Court ruling that

mandatory Medicaid expansion wasn’t permissible, 29 states voluntarily have au-thorized Medicaid eligibility expansion or obtained federal approval of an alternate expansion plan to take advantage of gen-erous federal financial support tied to the program. However, Hamme pointed out, the 2014 election results impacting gov-ernorships and state legislatures seem to have strengthened the numbers of those opposing such expansion in several states that were still weighing the options. “In at least one state, it is conceivable that Medicaid eligibility expansion will be re-scinded after having been implemented,” he said.

Hamme continued, “For 2015, the key Medicaid eligibility expansion devel-opment will be whether the slow erosion of state opposition to expansion continues as states decide that they do not want to forego the financial advantages of expan-sion or whether this erosion is abated by

those fiercely opposed to the ACA.” He added it will be interesting to see how flexible the federal government might be with respect to work and work search re-quirements and beneficiary cost-sharing obligations for states that are seeking waivers for alternate expansion models.

ACA Going ForwardAs Hamme pointed out, the ACA

has already generated several legal deci-sions and navigated a number of political and operational obstacles in its relatively short life. However, a number of hurdles … including the decision on exchange subsidies and the law’s unpopularity among large swaths of the public … re-main.

“During 2015, interested observers should look to various barometers to as-sess whether the ACA is working … and equally important … whether it is gain-ing the public acceptance needed to as-sure its political survival,” Hamme said. He added some of those measures would include the administration of the ex-changes, whether offerings to consumers were deemed acceptable in terms of plan choices and affordability, a continued decline in the number of uninsured, and whether or not the ACA could continue to withstand legal and political assaults.

“Like 2013 and 2014, the coming year will witness numerous developments that will lead either to the ACA’s long-term viability or its premature demise,” Hamme concluded.

Fraud and AbuseOn Oct. 31, 2014, the U.S. Depart-

ment of Health and Human Services Of-fice of Inspector General (OIG) released the FY-2015 Work Plan. Always eagerly anticipated, the document gives insight into the OIG’s planned reviews and ac-tivities with respect to HHS programs

and operations. Belmont noted, “In the introduction to the Work Plan, OIG stated that, in the coming year, the agency plans to continue to focus on issues such as emerging payment, eligibility, man-agement, IT security vulnerabilities, care quality and access in Medicare and Med-icaid, public health and human services programs, and appropriateness of Medi-care and Medicaid payments.”

Belmont highlighted a few areas of interest for this year:

Hospitals: With 22 substantive areas under review, the OIG is deeply engaged with hospital reviews both on the billing and payment side, and quality of care is-sues, which are a particular priority for current Department of Justice (DOJ) and OIG enforcement efforts. OIG continues to scrutinize CMS contractors’ imple-mentation of outlier reconciliation (of which the OIG has been critical for many years) and remains intensely interested in inpatient versus outpatient payments, the “two midnight” rule for inpatient admis-sions, and cardiac catheterizations.

Hospice: Hospice billings for general inpatient care, a focus of relators and the DOJ, is under close review by the OIG.

Freestanding Clinic Providers: OIG con-tinues to examine certain payment sys-tems such as provider-based services and freestanding clinic payments, with an eye toward reducing disparity of payments based on site of service.

Laboratories: OIG added a review of independent clinical laboratory billing requirements, without further specifying the billing requirements at issue. This may coincide with increased local cover-age determinations by contactors, OIG enforcement against clinical laboratories under its Civil Monetary Penalties Law authority, and OIG’s general heightened scrutiny of technical billing and payment compliance by clinical laboratories, espe-

cially specialty laboratories.Accountable Care Organizations: OIG

intends to conduct a risk assessment of CMS’ administration of the Pioneer ACO Model.

Medicaid Managed Care: OIG added a review of state collection of rebates for drugs dispensed to Medicaid managed care enrollees.

Medicare Part D: This is an area where there will be continuing scrutiny of the quality of Part D data submitted to CMS. The OIG also plans to follow up on the steps CMS has taken to improve its over-sight of Part D sponsors’ Pharmacy and Therapeutics Committee conflict-of-in-terest procedure in the wake of the OIG’s critical 2013 report.

Health Information & Technology

“Data now is recognized as one of a healthcare organization’s most valu-able assets, especially as a result of the transition to a more analytically driven industry,” Belmont said. “Given the in-creasing importance of data to a health-care organization, it is advisable for the organization to implement appropriate data governance best practices.”

With the accumulation of data also comes an obligation to make sure pro-tected health information (PHI) stays protected. “In 2015, healthcare privacy and security compliance will continue to expand with respect to the scope, number of enforcement bodies and increased en-forcement activity, and overlapping sets of requirements,” Belmont said. “In ad-dition to the requirements of the HIPAA Privacy and Security Rules, healthcare providers also will need to navigate re-quirements promulgated by the Federal Trade Commission, Centers for Medi-care and Medicaid Services, Office of the National Coordinator, and state at-torney generals. Additionally,” she con-tinued, “increasing exposure for privacy and security breaches may occur as the result of state common or statutory law, despite there being no private right of action with regard to HIPAA violations. As a consequence, healthcare organiza-tions and practitioners need to manage the complex daily operational processes required to maintain appropriate privacy and security of protected health informa-tion and devote necessary resources to ensure regulatory compliance.”

Hot Button Legal Issues to Watch in 2015About the Experts

Elisabeth Belmont, Esq. serves as corporate counsel for MaineHealth, ranked among the nation’s top 100 integrated healthcare delivery networks. She is a member of the Board on Health Care Services for the Institute of Medicine and its Committee on Diagnostic Error in Health Care. Belmont is also a member of the National Quality Forum’s Health IT Patient Safety Measures Standing Committee. In addition to serving as a past president of the American Health Lawyers Association, she is also the former chair of

the organization’s HIT Practice Group and the current chair of the Inhouse Counsel Program. In 2007, Modern Healthcare named her to their list of “Top 25 Most Powerful Women in Healthcare.”

Joel Hamme, Esq. is a principal with Powers, Pyles, Sutter & Verville in Washington, D.C. He joined the firm in 1998 and focuses his practice on long term care, Medicare and Medicaid reimbursement issues, provider licensure and certification matters, and litigation in his areas of expertise. He is a member of the District of Columbia and Pennsylvania bars, as well as the bars of the Supreme Court of the United States and numerous federal appeals courts. A past president of AHLA, Hamme is a frequent speaker and lecturer on healthcare issues and has authored

numerous articles and book chapters relating to healthcare law.

Page 8: Nashville Medical News January 2015

8 > JANUARY 2015 n a s h v i l l e m e d i c a l n e w s . c o m

Last month, the Nashville Health Care Council and former U.S. Senate Majority Leader Bill Frist, MD, announced the lat-est class of the Nashville Health Care Coun-cil Fellows. For 2015, 36 senior healthcare leaders were selected for the renowned pro-gram, which is focused on influencing and transforming the nation’s healthcare system.

“The 2015 Fellows include some of the industry’s best and brightest leaders with experience and industry focus spanning all sectors of healthcare,” said Frist, who co-directs the initiative with Larry Van Horn, PhD, a leading expert in healthcare management and economics and professor at Vanderbilt’s Owen Graduate School of Management. “These individuals have a challenging task ahead, and I look forward to the meaningful discussion and debate on our nation’s healthcare that will come from our rigorous curriculum,” Frist continued.

Now in its third year, Council Fellows engages industry leaders in clearly defining healthcare’s greatest challenges and explor-ing innovative business strategies to navi-gate the difficult issues facing the American healthcare system.

Members of the 2015 Fellows Class are:

Oran Aaronson, MD: Medical Di-rector, Vanderbilt Spine Center

Gregg Allen, MD: EVP & CMO, MedSolutions

Greg Allen: General Manager, Cigna-HealthSpring

Bill Baucom, MD: Summit Medical

AssociatesBill Brown: CEO, EntradaDave Caluori: Principal, Welsh,

Carson, Anderson & StoweNick Coussoule: SVP & CIO,

BlueCross BlueShield of TennesseeMike Cuffe, MD: President & CEO,

Physician Services, HCAMichael Dal Bello: Partner, Pritz-

ker GroupRebecca Dexter: VP, Market

Performance & Account Management, Healthways

Lisa Doyle: VP, Human Resources, HCA

Joel Galanter: Chief Legal Officer, General Counsel, Aegis Sciences Corpora-tion

Rachel Haithcoat: Director, Merg-ers & Acquisitions, DaVita HealthCare Partners

Mark Harris, PhD: Founder & CEO, NextGxDx

Darren Hodgon: VP, Strategy & In-novation, UnitedHealthcare

Rusty Holman, MD: CMO, Life-Point Hospitals

Debbie James: President & CEO, Vivere Health

Philip Johnston, PharmD: Dean, College of Pharmacy, Belmont University

Ed Jones: President & CEO, Health-Trust

Kris Joshi, PhD: EVP, EmdeonNeil Kunkel: EVP, Chief Legal &

Administrative Officer, Capella HealthcareMark Lamp: CEO, American

HomePatientJulie Lampley: Attorney, Butler

SnowHelen Lane: EVP & Partner, C3

ConsultingDarren Lehrich: Managing Direc-

tor, Deutsche BankWendy Long, MD: Deputy Direc-

tor & Chief of Staff, Bureau of TennCare/Health Care Finance and Administration

David Massaro, MD: Deputy CMO, VA MidSouth Healthcare Network

Ken Misch: CFO, MEDHOSTAnna-Gene O’Neal: President &

CEO, Alive HospiceBill Paul, MD: Director, Metro Pub-

lic Health DepartmentBeth Ratliff: SVP, Premise Health/

CHS Health ServicesSaurabh Sinha: CEO, emidsLloyd Smith: Partner, PwCPaul Smith: VP, Division VI Opera-

tions, Community Health SystemsHarsh Trivedi, MD: Executive

Director & CMO, Vanderbilt Behavioral Health

Erin Wilkins: President, Southeast Region, Press Ganey

Council Fellows is presented in part-nership with BlueCross BlueShield of Tennessee, Community Health Systems, HCA, Healthways, LifePoint Hospitals and Vanderbilt University Owen Graduate School of Management. For more informa-tion on the program or Class of 2015, go online to healthcarecouncilfellows.com.

By MELANIE KILGORE-HILL

Vanderbilt University recently an-nounced plans to reconfigure Vander-bilt University Medical Center as a not-for-profit academic medical center that is financially distinct from the university. While the change should have little effect on day-to-day operations, Jeff Balser, MD, PhD, vice chancellor for Health Affairs, said the restruc-turing would strengthen VUMC’s growing pres-ence in a rapidly evolving healthcare economy.

“The decision was based on our look into the future and our understanding that, as VUMC stretches its arms and be-comes more interactive with health systems throughout the southeast, it’s an endeavor that requires us to really utilize a different financial, government and board model than used in a university setting,” Balser explained.

New Model for a New EraCurrently the medical center is among

just a few facilities entirely embedded within a university’s legal and financial structure and utilizing the same governing board. Unlike most health systems, VUMC also functions under an AA university bond rating – the high investment grade rating of many top research universities.

Balser said the new model will allow for more flexibility in the types of capital and debt VUMC will be able to access, which will in turn help grow VUMC’s network of affiliate providers. Launched in 2011 with three partners, the network now includes more than four dozen hospitals, health systems and large practice groups in five states.

“It’s just very hard for a university to contemplate governing a multistate health system since it’s not a mission constant with the university’s activity,” Balser explained. “It’s not just about access to capital but being able to create government and man-agement systems necessary and supportive of a big healthcare facility.”

Same Name, Same FacesBalser said he expects no visible

changes short-term: VUMC will remain not-for-profit with academic arrangements,

faculty status and degree programs unaf-fected. In their November 2014 announce-ment, VUMC committed to continue full support of research and educational activities of the School of Medicine clini-cal departments, Graduate Medical Edu-cation (residencies and fellowships), and clinically related centers and institutes. At the same time, Vanderbilt University will play a greater role in supporting the MD and PhD-granting programs of the School of Medicine, its basic science programs, as well as the academic programs in the School of Nursing.

Moving ForwardHowever, the long-term impact will

be visible through VUMC’s growing net-work of affiliates, services and clinical trials. The move is consistent with the direction of healthcare in general where smaller orga-nizations are turning to larger systems for shared savings programs, quality improve-ment and more services in more locations.

“People are mobile and don’t want to hear that when they go 200 miles away they can’t access the same healthcare,” Balser said. “Patients want access to the best pos-sible care no matter where they are.”

The process is expected to take 12-18 months and will include appointment of a new board for the separate financial entity. The news came a year and a half after the announcement of VUMC’s “Evolve to Excel” initiative – a two-year plan to cut $250 million from its $3.3 billion operating budget. E2E also cut 400 VUMC employ-ees and eliminated 1,100 open positions. With difficult changes now behind them, Balser said VUMC is in “very good shape” to continue their transition.

“The chancellor [Nicholas Zeppos] and I are entirely committed to this work,” Balser said. “The best thing we can do is re-spond to what we can see in the future, and the best time to do this is when we’re doing well and not under stress. Right now we’re in very good shape, and the ideal time to go through this process is when we are all strong.”

Council Fellows Announces 2015 Class

Financial Restructuring to Position VUMC for Growth

Dr. Jeff Balser

A Look Ahead,continued from page 6

transactions to warrant second requests for information.

When contemplating a buy-out, com-panies must consider the real rationale for the transaction and know their market share. Taking a community from three healthcare providers down to only two could quickly send up flags. Keeping a close eye on email and other internal com-munication also matters. Vessel warned against discussing market domination or increased prices, focusing instead on ef-ficiencies and improved quality of care while specifying benefits of the transac-tion. She also cautioned against sharing competitively sensitive information.

Addressing physician practice acqui-sitions, she said less is often more. She advised considering network affiliations rather than full-blown acquisitions.

Companies often make the mistake of thinking smaller deals will avoid scrutiny. In reality, any complaint from an insur-ance company could get the ball rolling on possible antitrust violations. Last year, a district judge in Idaho sided with the Fed-eral Trade Commission and ordered the unwinding of a merger between one of the state’s biggest hospital systems and its big-gest independent network of doctors.

“This case points to the principle that they are looking at physician practices and not just hospitals and hospital systems,” Vessel said. “This is a very fact-specific inquiry, and investigators will interview competitors and payers to see how easy it is for a competitor to enter the market and what competitive effects are likely to be,” she explained. “In this case, the judge acknowledged the transaction would help with efficiencies but said there were less competitive ways to achieve that. Efficien-cies under the ACA aren’t enough,” she noted.

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is ensuring the state’s Certificate of Need program stays in tact. “There is no looming threat right now, but it’s always a concern,” Becker noted, adding the CON process lev-els the playing field for facilities across the state.

Russ Miller, CEO of the Tennes-see Medical Association, is also eager to see more Tennesseans be able to access the healthcare system through a commonsense Medicaid expansion plan. Additionally, the TMA has a full slate of activities pertaining to professional development, member-ship resources, and advo-cacy planned for 2015.

Among some of their key priorities for the year are preparing members for ICD-10, finishing the work on payer accountability, looking at issues pertaining to graduate medical education and physician sustainability, and helping TMA members, in partnership with other healthcare professionals, navigate new payment models and collaborative care ar-rangements.

A major push for the TMA over the next 18 months is becoming recertified as a CME provider. Miller said the orga-nization served as the state accreditor for

By CINDy SANDERS

For Craig Becker, president and CEO of the Tennessee Hospital Association, the top priority for 2015 is securing Medicaid expansion in Tennessee … now, it looks like that could happen this year.

On Dec. 15, 2014, Gov. Bill Haslam intro-duced his Insure Ten-nessee voucher plan to provide an alternative coverage option to low-income Tennesseans who don’t qualify for either TennCare or fed-eral subsidies. It’s estimated nearly 200,000 employed Tennesseans at or below 138 percent of the federal poverty level would be impacted by the pilot program designed to help them participate in employer-offered plans.

In responding to the plan’s announce-ment, Becker stated, “For the past two years, THA’s number one priority has been securing Medicaid expansion in our state, and today marks the beginning of this goal becoming a reality. I applaud the governor’s thoughtful approach to this vi-tally important issue and am grateful for his hard work with the Department of Health and Human Services in recent months.”

Becker added the Insure Tennessee plan is a meaningful alternative to tradi-tional expansion. He continued, “I also believe Insure Tennessee helps provide a solution to the financial challenges hospi-tals across Tennessee have faced for the last several years as a result of extreme cuts in healthcare reimbursement.”

However, he recognizes there is still more work to do on behalf of the THA membership. Getting the plan through the Tennessee Legislature is the next chal-lenge. “It’s most needed,” Becker said. “We’ve lost several hospitals in the last year. It’s going to be much tougher, es-pecially for our small and rural hospitals to survive … and for our urban safety net hospitals to provide the level of services they do … if we don’t get expansion.”

Still, having the Insure Tennessee plan approved by HHS is clearly an im-portant first step.

Other priorities for 2015 include pas-sage of the hospital assessment, which al-lows Tennessee hospitals to put up $452 million to help fund the TennCare pro-gram and draw down federal match dollars at a 2:1 rate. Although passage has been fairly routine the last few years, there was initially some skepticism when hospitals first broached the subject of funding the state’s portion so Tennessee wouldn’t ulti-mately lose out on $900 million in federal funding support. “Hospitals have taken that on for the last five years,” Becker said. “The dollars used to come from the gen-eral fund.” Becker added he is hopeful the general fund might again pick up some of state’s portion of Medicaid funding down the line as the economy continues to sta-bilize.

Another ongoing priority, Becker said,

THA, TMA Outline 2015 Priorities

THA’s New LeadershipDuring the annual meeting this past November, the Tennessee Hospital

Association membership elected and installed the 2015 board of directors.

Mark Medley, senior vice president and president of hospital operations for Franklin-based Capella Healthcare, was installed as chairman. A Fellow of the American College of Healthcare Executives, Medley is responsible for the operations of 14 acute care and affiliated Capella entities throughout the United States. Previously, he served as a hospital CEO and division CFO for LifePoint Hospitals and began his career with HCA. Prior to his current THA role, Medley served as chairman of the

state association’s Council on Government Affairs and received the THA Small or Rural Hospital Leadership Award in 2013. He has also served on the boards of the THA Solutions Group and the Tennessee Rural Partnership.

Keith Goodwin, president and CEO of East Tennessee Children’s Hospital in Knoxville, was installed as chairman-elect and will step into the chairman’s role at the 2015 annual meeting in Nashville this coming November. Goodwin has served in his current position with ETCH since 2007. Prior to that, he spent more than 28 years at the Nationwide Children’s Hospital in Columbus, Ohio and also served as CEO at the Children’s Hospital of Austin for three years. In addition

to being a member of the boards of THA, Children’s Hospital Alliance of Tennessee and Hospital Alliance of Tennessee, Goodwin serves on the boards of the East Tennessee Foundation, Metropolitan Drug Commission and Knox County Imagination Library.

Reginald Coopwood, MD, president and CEO of Regional One Health in Memphis, handed the gavel over to Medley and stepped into his new role as immediate past chair. He also will serve as speaker of the THA House of Delegates in 2015. Coopwood received his medical degree from Meharry in Nashville and previously served as CMO for Nashville General Hospital and later as CEO of the Metropolitan Nashville Hospital Authority before accepting his current position in

March 2010. Coopwood serves on the boards of March of Dimes, QSource and Mid-South e-Health Alliance, among others.

Craig Becker

Russ Miller

continuing medical education until around 2005 but dropped that function for various reasons. “We thought it was time to bring it back,” he said.

The TMA already has a strong edu-cational component within the staff and offers online CME courses alongside lead-ership development and training on the latest issues. However, going through the recertification process will allow the state association to provide more clinical content to physicians and other providers. “It will give us the ability to create more original content to meet the needs of the market and to get it to them faster without having to use a third party,” Miller explained.

Staying on an education theme, Miller said another issue is graduate medical edu-cation. “The Medicare program funds resi-dency programs in every state,” he pointed out. Looking at concerns over physician sustainability and shortages in a number of areas, Miller continued, “You can get more doctors through medical school, but if resi-dency positions don’t exist, you can’t finish training them.”

A cap of $50 million for GME has been in place in the TennCare waiver with-out any increase since the 1990s. “We’re asking the state to seek out more funding for graduate medical education,” he said of a hope the cap could be raised by $25 mil-

lion. Miller was quick to add that doesn’t mean $75 million would be automatically funded, but at least there would be room for growth that doesn’t currently exist.

“Taking the long view, doctors often stay where they do residency. We want to keep doctors in Tennessee so we don’t have access issues for our citizenry.”

On the advocacy side, Miller said, “First and foremost is the continuation of the work we started last year on payer ac-countability.”

He expects legislation to be introduced in 2015 that addresses an issue he said has been an ongoing problem regarding com-mercial insurers making changes, often to fee schedules, mid-term in a contract cycle rather than waiting until the end of the con-tract and re-negotiating with all parties at the table.

“What we heard from our doctors is they just needed more predictability,” Miller said. He added it’s difficult to plan for the year when contracts could be uni-laterally changed with little notice. “We spent almost every week with the insurers this (past) summer to tweak (the proposed legislation) it to make sure we don’t have unintended consequences,” Miller noted of working earnestly to get insurer’s input.

The TMA has also played a part in addressing some of the larger societal issues facing Tennesseans, including prescription drug abuse. Noting limited resources make it difficult for any one organization to make a big impact, Miller said this has led to more statewide collaboration. “It takes a lot of or-ganizations working together to move the needle a little bit,” he pointed out. In addi-tion to creating classes on the subject to help providers appropriately diagnose and treat patients with powerful opioids, TMA has also joined colleagues in educating the public and Tennessee Legislature about the issue.

Miller said much of the coming year’s work is an investment in the future to en-sure Tennessee continues to have realistic rules and regulations, a good practice en-vironment, fairness in reimbursement, and improved population health. “We want to make our state a great place to be a doc-tor,” he said of TMA’s ongoing mission.

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Page 10: Nashville Medical News January 2015

10 > JANUARY 2015 n a s h v i l l e m e d i c a l n e w s . c o m

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from seasonal flu-related complications.Typically, the death toll exceeds

35,000 annually … and, unlike Ebola, influenza is contagious before symptom onset in a significant number of people. Also unlike Ebola, there is a vaccine read-ily available to the public to prevent the deadly virus or lessen its severity. Yet, mil-lions of American will once again skip get-ting vaccinated.

Chris Taylor, director of Community Health for the Metropolitan Public Health Department, said Nashville is well stocked with the full range of flu protection from the regular shot to the high-dose vaccine to the nasal mist at the three public health centers — Lentz, East, and Woodbine. While an appointment isn’t required, he said individuals should sign in by 3:30 p.m. for the walk-in service.

Although there is a $25 fee for the flu shot, Taylor noted many insurance com-panies, including TennCare, cover the im-munization. For the uninsured, he said a sliding scale is available that reduces cost depending on income and ability to pay. For many, the fee slides all the way down to zero, especially when factoring in programs such as the federal Vaccines for Children.

At the time Taylor spoke to Nashville Medical News in early December, the city and state were still in the ‘green zone,’ meaning there was minimal flu activity. However, Taylor noted, “My expectation is that we’re looking exactly like the pattern last year, which means heavy flu activity in late December, early January. That’s when

I expect our flu season to really peak.”Typically seasonal flu remains

through the cold weather months and be-gins to lessen in March or April as temper-atures rise. “You really want to get your flu shot before the meat of the flu season, but it’s never too late,” Taylor stressed. He added that even though it takes a couple of weeks to get the full immune response, most people are afforded some benefit from the vaccine well before that.

Although plenty of vaccine is avail-able, it remains to be seen how many will take advantage of this year’s protec-tion. Complicating matters was a Dec. 3, 2014 health advisory to clinicians noting that one of the four strains included in the 2014/15 vaccine had mutated. In the advisory, the CDC stated:

“Influenza viral characterization data indicates that 48 percent of the influenza A (H3N2) viruses collected and analyzed in the United States from October 1 through November 22, 2014 were antigenically “like” the 2014-2015 influenza A (H3N2) vaccine component, but that 52 percent were antigenically different (drifted) from the H3N2 vaccine virus. In past seasons during which predominant circulating influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed. However, vaccination has been found to provide some protec-tion against drifted viruses. Though re-duced, this cross-protection might reduce the likelihood of severe outcomes such as hospitalization and death. In addition,

vaccination will offer protection against circulating influenza strains that have not undergone significant antigenic drift from the vaccine viruses (such as influenza A (H1N1) and B viruses).”

Taylor said that even though the H3N2 strain didn’t match as well as it would have without the antigenic shift-ing, the hope is that the vaccine still offers partial protection for that strain. Further-more, he continued, the vaccine has thus far shown to be effective against the other three strains in this year’s dose – H1N1 and two B strains.

The purpose of the CDC health alert, Taylor added, was to remind clinicians to discuss supportive care and antiviral medication options with patients, espe-cially those in high-risk groups, should the vaccine not offer optimal protection. By reporting symptoms soon after onset, the use of neuraminidase inhibitor antiviral medications could help lessen the duration or severity of the flu.

Taylor’s hope is that Middle Tennes-see providers will help explain the news stories circulating around the CDC advi-sory and remind patients that the vaccine is still the best way to protect against flu.

“Tell them it’s still important to get a flu shot,” he said. Taylor added it’s also a good time to share other preventive mes-sages including the need to wash hands frequently, cover coughs, stay away from people who are sick … and perhaps most importantly, stay home and take care of yourself if you get sick.

Fighting Flu...and Misperceptions, continued from page 1

Last summer the Metropolitan Public Health Department moved into a state-of-the-art facility with the opening of the new Lentz Public Health Center lo-cated at 2500 Charlotte Ave. in midtown.

Named after John J. Lentz, MD, who served as health director in Nashville and Davidson County from 1920-1964, the three-story building features 106,000 square feet of space and houses more than 300 Metro Public Health Depart-ment employees. Developed in agreement with HCA as part of a public-private part-nership, the hospital company developed the new facility on its property for Metro. In turn, Metro gave HCA ownership of the former Lentz property on 23rd Avenue North.

In the much larger new facility, the number of exam rooms in the preventive health clinic nearly doubled. The new den-tal clinic, which provides services for chil-

dren up to age 21 and some limited adult emergency care, features an open bay design and x-ray suite for more efficient patient flow. Other onsite services include immunizations, birth and death certifi-cates, Women Infants and Children (WIC) nutrition services, family planning, food protection services, a tuberculosis clinic and a sexually transmitted disease clinic.

The light-filled building was designed to pursue LEED Silver Certification and

has multiple features that support sustainabil-ity and promote healthy lifestyles. There is an indoor walking track, soaring staircase to en-courage climbing, and an outdoor quarter-mile walking track for both employees and the com-munity. The WIC dem-onstration kitchen on the first level will be used to showcase healthy fam-ily recipes. Two public art installations, funded by Metro’s One Percent for Art Fund, add to the facility’s beauty. The

center also offers improved access with sidewalks, a bus stop and a B-cycle kiosk, making it easy to arrive by foot, motor or pedal power.

Gresham Smith and Partners served as the architecture, interior design and engineering lead on the project with Sup-portive Design, LLC providing additional planning and procurement services. Bell/ICF was general contactor on the project, which broke ground in June 2012.

A Look at the New Lentz Public Health Center

The beautiful new facility on Charlotte Avenue replaces the original Lentz Public Health Center, which was built in the late 1950s.

Page 11: Nashville Medical News January 2015

n a s h v i l l e m e d i c a l n e w s . c o m JANUARY 2015 > 11

the firm in May 2014 after serving as vice president and associate legal coun-cil at LifePoint Hospitals. Lewis has been engaged in healthcare legal work for more than 25 years and is a past chair of the Ten-nessee Bar Association Health Law Section. Currently, Lewis serves as vice chair of the Physician Organizations Practice Group of the American Health Lawyers Association. He received his undergraduate and law degrees from the University of Tennessee.

Wishes GrantedThe V Foundation for Cancer Re-

search, one of the nation’s leading can-cer research funding organizations, re-cently announced nearly $15 million in awards for the 2014 Translational and V Scholar Grant recipients, who are trans-forming lab discoveries into clinical ap-plications. In Nashville, Dineo Khabele, MD, of Vanderbilt University Medical Center, is one of the cancer researchers receiving a 2014 Designated Grant.  

The Tennessee Department of Mental Health and Substance Abuse Services has been awarded two federal

grants totaling nearly $5 million dol-lars to reduce the rate of suicides in the state. The funds, from the U.S. Depart-ment of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA), will be focused on preventing suicides statewide.

In other TDMHSAS news, a $1.5 million federal grant has allowed the state agency to increase funding to Veterans Court in Shelby, Montgomery and Davidson counties. The grant will allow all three courts to nearly double their capacity.

Dave Lewis

More Grand Roundsnashvillemedicalnews.com

GrandRounds

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TriStar Southern Hills Files CONIn December, TriStar Southern Hills

Medical Center filed a Certificate of Need application for a free-standing emergency room to be built on 14 acres at the intersection of Old Hickory Bou-levard and American General Way, just east of I-65. The filing follows a CON application submitted by the hospital in November to relocate an outpatient surgery center from the Southern Hills campus to its new satellite campus at the former AIG property, which HCA purchased in early 2014.

According to a statement from of-ficials, the need for emergency services and outpatient surgical services in com-munities served by TriStar Southern Hills continues to grow. In the past 5 years, the hospital has seen emergency room visits increase by 24 percent, while overall ad-missions increased by 19 percent. The proposed emergency room is estimated to be an $11 million investment and in-cludes a medical office building to ac-commodate physicians who plan to use the proposed relocated surgery center.

HSDA Approves New Alive Hos-pice Facility

In late November, the Tennes-see Health Services and Development Agency approved Alive Hospice’s plan to build a $10.8 million, free-standing hospice facility in Murfreesboro. The 10-bed, 21,300-square-foot facility, which will be located near Saint Thomas Ruth-erford Hospital, will be the company’s first inpatient facility in that county and will offer both adult and pediatric hos-pice care. Groundbreaking will occur later this year with a projected opening in June 2016.

Medalogix Named a Finalist in National Challenge

Nashville-based health technology company Medalogix, which provides analytic solutions in the post-acute care market, has been named a finalist in the Health Acceleration Challenge. Of near-ly 500 applicants – including institutions like the Cleveland Clinic, Mayo Clinic, Kaiser Permanente, MD Anderson and more – Medalogix was chosen as one of only four finalists and has won $37,500 from the Harvard Business School, the administrator of the challenge.

The company will have a case study written about its innovative approach to end-of-life care by Harvard Business School, will present to senior healthcare execs at the Forum on Health Care Innova-tion conference in April and will compete for a $50,000 grand prize that is slated to be awarded at the end of the year.

Lewis Tapped to Lead Miller & Martin Health Law Practice

Miller & Martin recently announced Dave Lewis would head the firm’s health-care practice for all three offices – Chatta-nooga, Atlanta and Nashville. He joined

Page 12: Nashville Medical News January 2015

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