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TOA Expanding Footprint By MELANIE

KILGORE-HILL

Tennessee Orthopaedic Alliance (TOA) is already one of Middle Tennessee’s larg-est orthopaedic providers … and there’s no sign of slow-ing down. In January 2016, the 53-physician group will relocate its downtown offi ce to oneC1TY, an urban mid-town Nashville community catering to technology-enabled commercial, residential, research and retail activity.

More Services, More Space“We’re trying to ride the wave of innovation, not just within Nash-

ville but in healthcare in gen-eral,” said Steve Wade, chief executive offi cer of TOA. “We want to create an orthopaedic destination for individuals and employers in Nashville.”

TOA will serve as the anchor tenant of oneC1TY’s fi rst building, where they will occupy three fl oors - approxi-mately 50,000 square feet. Wade said the site will allow more space for MRI- and CT-

related services and also will house an orthopaedic walk-in center. “There are places in town with urgent or walk-in care that offer a

gambit of services, but we’ll be ortho only,” Wade explained. “The win is immediate access to all diagnostic treatment services at that location,

(CONTINUED ON PAGE 6)

Burton Elrod, MD

PAGE 3

PHYSICIAN SPOTLIGHT

(CONTINUED ON PAGE 8)

Feds Make Fraud Enforcement a Top Priority

By CINDy SANDERS

In fi scal year 2014, the Department of Justice (DOJ) racked up nearly $5.7 billion in settle-ments and judgments resulting from civil cases of fraud against the government. Of that number, $2.3 billion was recovered from false claims investigations and lawsuits involving federal health-care programs.

While the False Claims Act (FCA) has been in effect since the Civil War, alterations to the law in the 1940s had rendered it largely ineffective. That changed in 1986 with amendments to the FCA that encouraged more individuals to step forward and report fraud through qui tam law-suits. Although the modern incarnation of the FCA has been in effect for nearly three decades, it was a 2009 amendment passed by Congress – the Fraud Enforcement and Recovery Act (FERA) – that greatly ramped up DOJ activities. In fact, more than half of all dollars recovered since 1986 have happened in the past fi ve years.

Leading the way with the largest recoveries are the health-care and fi nancial industries. Brian Roark, a member at Bass, Berry & Sims PLC and head of the fi rm’s Healthcare Fraud Task Force, said the increased enforcement in the healthcare space keeps his team very busy.

“The FCA is the federal government’s primary civil enforcement tool. It’s

We’re excited to unveil our brand new online format designed to bring the news you use to your laptop, tablet or smartphone.

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The Times They Are a-Changin’

Undergoing transformative change, this industry has been tasked with fundamentally alter-ing delivery methods and asked to meet heightened consumer expectations and increased demands for interaction and engagement.

While the above statement is certainly representative of the healthcare industry … in this case, we are actually referencing the media’s role in the dissemi-nation of information.

The way we consume news has dramatically changed over the past decade. Yet, how, when and where we receive informa-tion is often a matter of personal choice. Some people love the feel of newsprint between their fi ngers. Others like to get information on their tablet. Still others want the highlights in 140 characters or less, giving them control of whether or not the topic is worthy of a click through to more information.

Recognizing our readers embody these varied prefer-ences, Nashville Medical News is excited to announce major changes to our product. If you love the monthly paper (and we certainly hope you do), no wor-ries … you’ll still receive it faith-fully each month in the mailbox.

However, we’ve long realized the static nature of our websites left much to be desired from both an aesthetic standpoint and the ability to adequately offer information be-tween print cycles. Additionally,

continued on page 6

2 > AUGUST 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

Orthopaedist Burton Elrod, MD … a Titan in the FieldBy MELANIE

KILGORE-HILL

Imagine a cross be-tween Mike Ditka and Steve Irwin and you’ve just conjured up an apt image of the man in charge of keeping the Tennessee Titans healthy on and off the fi eld. Orthopaedist Bur-ton Elrod, MD, wears countless hats … from head physician for the Tennessee Titans and founder of Elite Sports Medicine & Orthopae-dic Center to alligator hunter and skydiver.

Football Meets Medicine

A lifelong athlete with a passion for football, Elrod said medicine was an easy choice. When a player he was coaching became partially paralyzed, he decided to become a physician.

“Orthopaedics was a natural way to do both,” Elrod said of his two passions.

After receiving his undergrad at Lip-scomb University, Elrod attended medi-cal school at the University of Tennessee Health Science Center, where he also completed his orthopaedic residency. Moving to California, he continued his post-graduate studies in sports medicine at Kerlan-Jobe Orthopaedic Foundation and with the Los Angeles Rams.

“I went to L.A. because I wanted a pro team here in Nashville, and I said that within 15 years we would have one,” said the Middle Tennessee native. Sure enough, the Titans arrived 15 years later. and Elrod began a second job that’s since resulted in 70-hour work weeks packed with tryouts, camps, practices and games … but he wouldn’t have it any other way.

“I love the sport, and it’s the ultimate challenge because these athletes are under so much pressure,” Elrod said. “There’s a lot of money on the line with professional athletes, and it requires keeping up with the latest, newest technology. One game can make a difference for these guys.”

Elite SportsOff the fi eld, Elrod

can be found deliver-ing the same quality of care to patients at Elite Sports Medicine & Or-thopaedic Center, which fi rst opened as Southern Sports Medicine in the 1980s. Now a 10-phy-sician practice, Elrod insists the goal at Elite isn’t to become the big-gest ortho provider in Middle Tennessee but to treat all patients with fi rst-class care.

“While we treat ath-letes of all levels, youth through professional, we treat everyone with the same care that our pro-fessional athletes receive

and with the best providers around,” Elrod said. “When people are hurt, they’re stressed. They’re worried about their jobs and not being able to enjoy ac-tivities they usually do. We started Elite to create a truly integrated system to provide patients with as good or better care as they can get anywhere else in the world. We re-ally wanted a place where we could treat patients like family.”

Elite now boasts four locations in the Nashville area: Saint Thomas Midtown, TriStar Centennial, Franklin and Leba-non. In fall 2015, Elite also will open a new satellite offi ce in Green Hills. “The community has really honored what we’ve

been doing by supporting our growth,” he said.

Elrod, who was instrumental in bring-ing arthroscopic surgery from experimen-tal to the mainstream, stays well versed in industry trends and looks to scientifi c ad-vances to change the future of orthopae-dic care. Elite already offers Platelet-Rich Plasma Therapy (PRP), and Elrod expects the option to unveil even more potential in the treatment of injuries. He also awaits big things in the area of biologics, as well as surgical techniques and advances in non-operative care like PT and hyaluronic acid injections.

“We always try to be on the cutting edge with treatments we offer,” Elrod said. “Stem cell, for example, is a very new area in orthopaedics and more research needs to be done, but so far our experience has been positive.”

Another goal of Elrod’s is to build a sports medicine center in Nashville as good or better than anywhere in the world. When he’s not on the fi eld or in clinic, the self-professed adrenaline junkie can be found racing cars, hunting, skiing, sky diving, or engaging in a number of other death-defying acts that would land most mere mortals on the other side of the orthopaedist’s desk … but not Elrod.

MPOWER Performance InstituteFrom professional musicians and busy CEOs to world-class athletes, Nashville’s biggest and brightest fi nd a respite at the

MPOWER Performance Institute.A partner of Elite Sports Medicine & Orthopaedic Center, MPOWER is a concierge medicine and wellness program that helps

private pay clients reach optimum performance. Trainers, nutritionists, physicians and orthopaedists provide education, health and wellness services, physical therapy and other therapies as needed.

“MPOWER is really for anyone who wants to be the best they can be,” said Elite and MPOWER founder Burton Elrod, MD. “What sets it apart is the integration and coordination of these services, as well as the positive, high-energy environment that all of our team of specialists create for the patients and clients.”

Membership includes 24/7 access to a concierge primary care physician, same day primary care or sports medicine appointments Monday through Friday, an annual executive physical, regular physician review of personal training and nutrition programs, same day appointments at Elite when necessary, and coordination of appointments with the area’s top medical specialists as needed.

Located at South Springs Drive in Franklin, MPOWER’s Cool Springs facility also includes a unique indoor turf room and ergonomic, state-of-the-art equipment. A second location in Green Hills is slated to open fall 2015. The two-story, 20,000-square-foot facility will be located at the site on Woodmont Boulevard that previously housed the Green Hills Senior Health Center and Easter Seals Tennessee. An Elite satellite clinic also will be located onsite.

In addition, plans call for a third MPOWER Performance Institute to open in midtown in the summer of 2016. That location will be part of an expansion to the current Elite offi ce location at 21st and Church Street.

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

Dr. Andrew Shinar

By MELANIE KILGORE-HILL

Recent research from Vanderbilt Uni-versity could change the future of orthopae-dic treatment and training nationwide.

Andrew Shinar, MD, associate professor of Orthopaedics and Re-habilitation and chief for the Division of Arthritis and Joint Replacement, presented two studies at July’s Southern Ortho-paedic Association meet-ing in Asheville, N.C.

Pain Control & Knee Replacement

In one study, Shinar and his peers looked at the effectiveness of using local injections over (traditionally used) nerve blocks for knee replacements. The study, which included 82 patients, revealed those who received injections experienced less pain and faster recovery than those who received nerve blocks.

“Nerve blocks work well but come with risks,” Shinar said. “Patients can’t use their leg for a while after surgery, which increases the risk of falling, as well.”

Patients who received injections expe-rienced less pain following surgery, were able to walk longer distances, and left the hospital sooner. “The injections are good for 8 to 12 hours which is the most intense point following surgery, but patients can then get out of bed and walk five times fur-ther in the following 24 hours,” he said.

Narcotic Use among Ortho Patients

A second study presented by Shinar examined the number of patients taking narcotics prior to knee or hip replacement

surgeries. The study was spurred by a sur-vey that ranked Tennessee high among states with illegal narcotic use and the re-sulting Tennessee Prescription Safety Act of 2012.

“The whole problem of opiates is amazing,” said Shinar. “Restrictions came about because Tennessee is outpacing the U.S. in opiate-related deaths from over-dose.”

Shinar said the habit of treating com-mon back and other pains with narcotics had become so widespread that opiate-related deaths increased fourfold between 2000 and 2012. Of the people who misuse opioids, over half get them from friends or relatives for free, Shinar said.

The Prescription Safety Act established a database for prescribing providers to moni-tor drug use. Shinar looked at patients com-ing in for total joints to see what medications they listed. Comparing narcotic use among patients from the last two months of years 2011-2014, Shinar saw a 38 percent drop in patients taking narcotics in the years after regulations were implemented. “That means primary care providers aren’t prescribing narcotics as often, which means regulations are having a desired effect,” Shinar said.

Better Diagnosis, Treatment for Sarcoma

More than 9,000 soft tissue sarcomas are diagnosed in the U.S. each year, and another 2,500 patients are diagnosed with pri-mary bone sarcomas. Unfortunately, many of those patients are ini-tially misdiagnosed, said Ginger Holt, MD, or-thopaedic oncologist and professor of Orthopaedic Surgery and Rehabilita-

tion at Vanderbilt Orthopaedic Institute. As the third largest sarcoma facility in the nation, The Vanderbilt Sarcoma Center often sees patients who require much larger surgeries and longer treatments due to mis-diagnosis by primary care physicians or general surgeons.

Holt, whose team sees more than 300 sarcoma patients annually, found that one-third had to undergo a much larger surgery often due to incomplete excision of the mass. “Doctors often think it’s a benign fatty tumor and leave part of it behind,” Holt explained. “Without imaging, they usually only see the tip of the iceberg that’s pushed through.”

She then set out to find commonalities among misdiagnosed patients. Surprisingly, distance from a treatment center wasn’t a factor. “We have patients come to us from four hours away with a proper workup, while patients in our own backyard were being misdiagnosed,” she said. There also was no connection between misdiagnosis and a patient’s financial status, leaving Holt to conclude that perhaps the problem was tied to physician recognition and training. She then sent surveys to medical schools nationwide and soon discovered a gaping educational lapse.

“We looked at resident education and found that among general surgery programs, the educational process lacked training in the area of bumps, lumps and masses,” she concluded.

While training was included in 85 per-cent of orthopaedic surgery programs, only 35 percent of general surgery students were properly prepared. “Patients are poorly ed-ucated because this is a rare condition, but physicians also are poorly educated,” she said. “That’s where we want to make the biggest difference.”

To that end, Holt has partnered with American College of Surgeons to imple-ment physician-training programs. She is also working to supplement general surgery curriculum at Vanderbilt and is urging in-surance companies to provide educational training for physicians. That’s because a 2014 medical malpractice study showed the majority of lawsuits for primary care pro-viders stemmed from misdiagnosis, with the dollar amount for sarcoma-related lawsuits greater than most others.

“Many doctors see this so infrequently that they don’t know the proper mechanism for imaging and referral, but the problem can become serious because patients often end up with amputation or a nasty surgery,” Holt explained.

Her advice to physicians: If a lump is bigger than a golf ball, painful or growing, it needs an MRI scan or 3D imaging. “The biggest burden of misdiagnosis is to patients, who endure extra surgery and radiation,” said Holt. “However, it also becomes a bur-den to the entire healthcare system.”

Vanderbilt Hopes Findings Lead to Better Diagnosis, Treatment for Orthopaedic Patients

By MELANIE KILGORE-HILL

Personalized medicine is revolutionizing healthcare, and orthopaedics is no exception.

Orthopaedic surgeon William Kurtz, MD, said the “one size fits all” approach to joint replacement would soon be a thing of the past. “Individualized implants mean attaining a 3D bone scan, taking 3,000-4,000 data points that make up surface anatomy, and building the implant to match,” Kurtz explained. “Everything’s made to the shape of the patient’s bone before arthritis, according to their normal anatomy.”

A Tennessee Orthopaedic Alliance physician who is on the medical staff at Saint Thomas Midtown, Saint Thomas West, and TriStar Centennial Medical Center, Kurtz is among a handful of Middle Tennessee surgeons now implanting ConforMIS customized knee implants, and he currently sits on the company’s surgical advisory board. An active researcher, Kurtz presented a poster – Patient-Specific Knee Replacement Implants Preserve Bone and Decrease Blood Loss & Swelling – at the 2013 British Association for the Surgery of the Knee (BASK) annual meeting.

Not only is the implant specific to an individual patient, it also comes with custom-made tools to help facilitate bone cuts and set implants. The entire pack comes shipped in a box the size of a carry-on suitcase and contains everything needed for each surgical case.

“Traditional joint replacement requires five to six trays of instruments and loads of equipment and inventory to service every patient,” Kurtz said. “The customized approached uses CT scans taken ahead of time, and everything we’re using is the perfect size for that one patient. I know I have the right implant.”

Patients appreciate a shorter surgery (roughly 15 minutes faster), one-third less blood loss, and a new knee that moves like their own. Hospitals ultimately decrease the cost of care by lowering surgical times and behind-the-scenes equipment processing and sterilization. “There’s a ton of research behind it,” Kurtz said. “From a design perspective, it just makes sense that if you restore a joint to its natural anatomy, it will work better than new anatomy that doesn’t reflect what the patient had before.”

Custom Knee Implants Bring Personalized Medicine to Orthopaedics

Dr. William Kurtz

Aegis Sciences Names Sports Science Leaders to Expert Panel

In June, Nashville-based Aegis Sciences Corporation announced members of its Aegis Shield™ Expert Panel. Comprised of leaders in fields including sports medicine, nutrition and physiology, the panel provides Aegis guidance on its Aegis Shield mobile app and website, as well as its Aegis Shield CERTIFIED™ program, which are designed to protect athletes from inadvertently consuming banned ingredients. 

“We created our Aegis Shield products and services to give athletes and supple-ment makers, alike, resources to help them avoid complications associated with banned or prohibited substances,” said Bob Murray, PhD, scientific director for Aegis Shield.

Athletes subjected to sports drug testing can test positive for unknowingly consuming prohibited substances found in some of the products they use. The mobile app and website are designed to help identify the presence of banned substances on the ingredient labels of dietary supplements, over-the-counter drugs and prescription medications. The expert panel helps Aegis stay abreast of current science and practices related to supplement use.

Additionally, the panel will help guide the development of Aegis Shield CERTIFIED. Dietary supplement manufacturers whose products pass testing by Aegis and are found to be free of prohibited substances such as steroids, stimulants and diuretics can display the Aegis Shield CERTIFIED™ logo to reassure athletes.

 

Dr. Ginger Holt

n a s h v i l l e m e d i c a l n e w s . c o m AUGUST 2015 > 5

By CINDy SANDERS

Frequently viewed by parents and young athletes as more annoyance than necessity, it’s easy for the sports physical to devolve into automatic answers to a list of questions, a quick check of vital signs and then out the door with a signed permission slip for another year of organized activity.

But it doesn’t have to be … and really shouldn’t be … this way, stressed Chris Koutures, MD, FAAP, a board cer-tified pediatrician and sports medicine specialist who sits on the American Academy of Pediatrics (AAP) Council on Sports Medicine & Fitness.

Instead, he contin-ued, providers should look at the sports

physical as a prime opportunity to ad-dress important issues with children, teens and parents. “There are a host of things we can look at … both sports specific and medically in general,” he said. “Every op-portunity we get to sit down with a family is a chance to educate … whether with a sports physical or routine physical.”

Koutures, who is based in Anaheim Hills, Calif., is co-author of “Pediatric Sports Medicine: Essentials for Office Eval-uation” and served as medical team physi-cian for USA Volleyball and Table Tennis at the 2008 Beijing Summer Olympics. He pointed out providers have the opportunity to not only identify and fix current prob-lems but to delve deeper to discover and address underlying issues that could pre-vent or reduce the impact of future injuries or illness. “One thing that pediatricians and primary care providers do so well is

anticipatory guidance,” he said.Koutures said there are a host of

reasons families rely on retail clinics for a sports physical ranging from convenience to cost to the drop-in nature of such fa-cilities. However, he pointed out, seeing your regular provider has a value-added proposition that shouldn’t be ignored. “If we do our job right, we are providing such a higher level of care,” he said. “If you have a relationship with that family, you can look at past history. We can see a his-tory of asthma. We can look at a growth scale and see if there’s been a tremendous amount of growth. We can see immuniza-tion records,” Koutures enumerated.

He added the long checklist of issues, ailments and conditions on sports medi-cine forms makes it easy to simply an-swer ‘no, no, no’ to everything. However, those answers aren’t always accurate … whether by accident, oversight, or fear of being sidelined.

“You look at the sheet, and it says ‘no history of asthma.’ Really? There was an episode two years ago,” Koutures out-lined an example of the benefit of going to a provider who knows a child’s history. “If you know the child has asthma, they can actually have a better sports experience because you are addressing and control-

ling the issue.” He added, “Having that background

knowledge is one more checkpoint to making sure we’re giving the best care we can.”

As important as it is to use the time to educate young athletes and their fami-lies about issues ranging from nutrition and hydration to concussion and overuse, Koutures said a sports physical is also a great time to listen. Particularly with older adolescents where part of the appointment is without the parent, Koutures said it’s a great time to open dialogue about alcohol, drugs and supplements and to allow kids to ask questions. “We need to take the time to educate ourselves,” he added of hearing a patient’s thoughts and concerns.

Listening, he continued, also plays an important role in an area where he believes providers could do a better job – assessing and addressing mental health issues. “It’s a silent epidemic,” Koutures noted of the number of adolescents feeling overwhelmed, anxious or depressed.

“If you get that one time a year to sit down with a family and address these things, you can make a big impact,” Kou-tures concluded of the sports physical. But, he added, “That’s not going to hap-pen in 10 minutes.”

Why a Sports Physical Should Take More than 10 Minutes

Dr. Chris Koutures

Addressing Common Questions & ConcernsPediatric sports medicine specialist Chris Koutures, MD, FAAP, shared insights

and advice on several common questions and concerns parents might have regarding their active offspring.

How Much is Too Much?“The minimum the American Academy of Pediatrics recommends is one day

off a week from organized activity,” Koutures said. Furthermore, he continued, there are additional time limits on adult-directed

activity that should be considered. “If you take the age of a child, that’s the number of hours of organized activity they should not exceed in a week,” he said of recommendations based on new data. Therefore, a 12-year-old shouldn’t participate in more than 12 hours of organized sports and practices in a week. However, Koutures stressed, this time limit doesn’t apply to additional free play with friends.

Overuse“I think we’re seeing more overuse injuries,” Koutures said. In part, he thinks

the increase is due to more children becoming one-sport athletes, which leads to repetitive motion. He added that when a child plays a number of sports, different muscle groups are engaged, and children mentally learn different movement patterns.

While physicians might not be able to change a child’s activity preferences, they can help mitigate overuse injuries through evaluation and education. “With my throwing athletes, I look at the shoulder range of motion. There are great studies that show if we can make sure they have appropriate follow through, we can reduce the risk of injury,” he pointed out.

Hydration & NutritionKoutures noted the AAP released a statement on sports drinks several years

ago. “The belief is that for most times, water is sufficient,” he said. Koutures added that a sports drink might be appropriate when exercising for over an hour, particularly if it is hot and humid, or right after an activity to replace salt and sugar.

“We like to think of hydration as being a full time job,” he continued, noting proper hydration doesn’t occur during the small window of practice or playing. Instead, children should be drinking water regularly to prepare for … and recover from … activity.

He also tells young athletes to look at their urine to gauge their level of hydration. “If it’s really dark, that’s a sign of dehydration,” Koutures reminds them.

As for pre-activity nutrition, he said that somewhat depends on the child, time of day, and personal preference or tolerance. Recognizing some kids really can’t eat much shortly before competition, he suggested trying fruit because of the liquids and quick energy it provides.

“The most important meal of the day isn’t breakfast, lunch or dinner,” he continued, “It’s what you eat right after you exercise. Getting some sort of protein mixed with carbohydrates in that first half hour after you exercise is essential for recovery.” Koutures added chocolate milk has a great protein-to-carb balance. Greek yogurt and peanut butter are also good options.

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

the editorial and publishing teams have looked at vari-ous solutions to quickly alert our readers to major breaking news stories and to have a platform to put important information in your hands in the immediate fashion audi-ences have come to require.

To achieve these goals and meet your personal expectations, we are debuting our new website this month and offering you the flexibility of following us on social media platforms to receive updates. Knowing how many journals, magazines and e-mails you receive on a daily basis, we promise not to flood your devices with a constant stream of data. Instead, we will format key informa-tion into brief updates and breaking news alerts as warranted. We encourage you to follow us on Twitter (@NashMedNews) to receive these notifications and engage in an interactive dialogue.

For many of you, we already have your email addresses on file so you will automatically receive breaking news alerts. If you aren’t currently receiving electronic notifications from us, feel free to contact me at editor@nashvillemedicalnews.com with your email address, and I’ll see that you are added.

Our mission … as it has always been …

is to make sure we get the latest clinical, busi-ness, research and regulatory news in your hands, in addi-tion to updating you on industry events and hap-penings among colleagues. The new format of the website makes it easier than ever for you to see the latest

information in each of these categories, find related content, and share articles on your own social media platforms. Additionally, the design was created to be scalable to desk-top, tablet and smartphone formats.

As Bob Dylan aptly noted – The Times They Are a-Changin’ – and we’re excited to embrace that change with enhanced capa-bilities to deliver the best possible product to you in a manner that suits your busy life. We hope you enjoy the new look, flex-ible formats, and ability to receive industry updates in between print cycles. Please feel free to share your thoughts and comments with us. As always, we’re open to sugges-tions on how to continue to improve our publication and our performance.

Sincerely,Cindy SandersNashville EditorNashvilleMedicalNews.comTwitter: @NashMedNews

The Times They Are a-Changin’, continued from page 1

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and since the clinic is embedded in our ortho surgery group, it will have expanded onsite treatment capabilities.” The walk-in clinic is expected to be open six days a week and after hours.

Physician LeadersTOA currently employs 430 support

staff and 53 physicians in 19 locations. Wade said becoming the region’s largest orthopae-dic provider doesn’t happen by chance and credits TOA’s solid physician leadership with continued growth. “To have physician practice growth, and in particular large phy-sician practice growth, requires extremely strong physician leadership, which we’ve been blessed with,” he said.

TOA board president W. Blake Gar-side Jr., MD, has been on staff since 2000 and said TOA physicians are constantly striving toward understanding and innova-tion. “We’re always learning better ways to do things, like customizable implants, that result in better clinical outcomes,” Garside said. “A lot of physicians are also actively in-volved in research.”

In May 2015, Alison Cabrera, MD, was published for her research on ACL surgery in Sports Health Journal. The same month, fa-ther/son surgeons Allen and Christian An-derson, MDs, were published in The American Journal of Sports Medicine for their research on ACL injuries in young athletes and the risks associated with delaying surgery. And just last month, the elder Anderson was inducted

as president of the American Orthopaedic Society for Sports Medicine.

Bending the Cost CurveThe group also works to stay ahead

in the ever-changing world of healthcare regulations and payments, as approximately one-third of TOA’s annual 4,500 joint re-placement procedures are Medicare-related. “All groups in general are continuing to ex-perience downward pressure on reimburse-ment and upward pressure on expenses,” Wade said. “Being able to understand what causes those pressures and to get in front of them is extremely important to survive.”

To that end, TOA is actively involved in Medicare’s Bundled Payment Care Initiative (BPCI), launched in 2013. Wade said they’re working to make significant headway in bending the cost curve associated with total joint replacement. “BPCI puts the doctor more actively involved in care management and cost control,” he noted. “It’s a major initiative, and we expect to save millions be-cause it tightens up the discharge process and helps eliminate waste.”

As for the future, Garside said TOA would continue to seek out innovation while providing services throughout all Middle Tennessee. “We’re a large ortho group that wants to maintain its independent focus and serve the community,” he said. “Fifteen years ago everyone drove downtown for me-dial care. As we’ve expanded our footprint through Middle Tennessee, we’ve brought in physicians with subspecialization, and we’ve brought care to the periphery, where patients are.”

TOA Expanding, continued from page 1

Dr. Blake Garside Jr,

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

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Something to Chew OnImplementing Innovation in Food Choices

HealthcareEnterprise

By KELLy PRICE

Spinach or kale … grilled or fried? When it comes to the war on weight,

you have to load up on as much food infor-mation and consume as much knowledge as you can hold. Helping Nashvillians navigate nutrition, NourishWise … a local company founded and led by Jason Denenberg … works with local restaurants to decode their menus.

Denenberg’s other ‘day job’ is as direc-tor of entrepreneurship for Launch Ten-nessee, which provides seed capital and support for start-ups. Currently, he oversees nine regional businesses at various stages in their evolution. He noted, “The three basic questions that any entrepreneur should ask before starting a venture are: What is the problem that needs to be fixed? How can we fix it? How can we all make money doing this?”

Denenberg believes NourishWise fits the criteria by offering an innovative, en-trepreneurial solution to a growing societal problem: how to eat in restaurants and not ruin your diet or eating plan.

The idea is to provide a local model here, saturate Nashville’s growing foodie scene, and then raise capital to move into other markets. The tone is informational without being ‘preachy.’ In fact, the website notes, “Our goal is to provide an accurate tool to help you make proactive decisions for healthy eating while at restaurants. But if today is hamburger and french fries day, go for it! We won’t tell anyone, and we’ll be here for your next restaurant visit.”

Finding the Sweet SpotDenenberg said, it’s all about helping

people find the sweet spot and realize there isn’t one right food plan that fits every per-son … but there is an opportunity to pro-vide people with the tools to make the best decision for themselves on any given day.

The NourishWise team of registered dieticians and licensed nutritionists isn’t afraid to take on popular trends, either. A recent blog post by Tim Olszewski, MS, RD, LDN, who heads up the company’s business development, was titled “Death to Kale and the Demonization of Foods.”

Olszewski wrote, “Let’s take kale for example. In isolation, kale is great. How-ever, kale isn’t the silver bullet that will turn around a diet, help someone lose a lot of weight, or eliminate a variety of health complications. Its advantages are that it is easy to grow, very versatile, and has pleas-ant nutritional benefits.

“Upon a closer look, though, kale isn’t a whole lot different from, say spinach. … They are pretty much equal, but what I do know is that spinach tends to cost less than kale. Also, I don’t see a lot of spinach snacks covered in oil and salt, dried out, and pro-moted to be healthy. It’s all about perspec-tive.”

How it WorksIf you’ve ever stared dejectedly at a

restaurant menu to see if anything could fit with your eating plan or notion of ‘healthy,’ NourishWise can open up new horizons. “The concept came from our own foodie frustration,” Denenberg noted, of trying to decipher any nutritional clues on menus. “We knew that there had to be a better way to marry our love of eating, technology and healthy living.”

NourishWise partners with restaurants that then submit their operating recipes to the company for a nutritional/caloric eval-uation that will give diners more accurate tools to make smarter choices when order-ing. Diners sign up for free at the Nourish-Wise.com site and receive weekly updates with information about local food options and delicious choices that fit dietary needs and preferences.

An email from mid-July broke down four healthy ‘must eats’ in Music City with calorie, total fat, protein and carb infor-mation on popular menu items from Blue Coast Burrito, City Fire, Deg Thai Food Truck, and Juice Bar. Another missive outlined four great options at Sole Mio, in-cluding the deliciously spicy Scegli Penne Arrabbiata, which comes in at 370 calories and 6g of total fat. Currently, NourishWise is working with more than 18 restaurant partners including The Perch, Wild Iris, Puckett’s Grocery & Restaurant, Taziki’s, Jonathan’s, Eastland Café, The Standard and 1808 Grille, among others.

Nutritional analyst Lindsey Joe, RDN, LDN, said, “For me, working on the NourishWise mission means an in-credible opportunity to positively impact the fuel (food) decisions of my friends, family and community. Everyday I work with individuals and groups who express one food frustration after another only to be left feeling defeated about this seem-ingly unattainable ‘healthy lifestyle’ we’re bombarded with 24/7.”

Through her work at NourishWise, she continued, “I can help relieve and relax some of those worries about making a ‘wrong’ choice for someone’s health and wellness goals. That means so much to so many who fight with food decisions each and every day.”

Eight days after the pediatric liver transplant program at the Monroe Carell Jr. Children’s Hospital at Vanderbilt was launched, 10-year-old Aubree Vanzant received her liver.

Diagnosed on May 27 with autoim-mune hepatitis, the Maryville resident underwent a 12-hour surgery to remove her grossly oversized organ and replace it with a healthy, deceased donor liver on June 25. Just three weeks post-transplant, Vanzant was out of the hospital and recu-perating in a nearby hotel.

Her mother, Nikole Sellers, said there have been a multitude of blessings throughout the entire journey, includ-ing having the director of the Vanderbilt Transplant Center as the lead surgeon on their case. “I am so thankful for the entire team,” said Sellers.

No stranger to building nationally recognized liver transplant programs — he has three under his belt — Douglas Hanto, MD, PhD, professor of Surgery and director of the Vanderbilt Transplant Center, said starting the pediatric program will allow children in the region with liver disease to receive world-class care close to home.

“We have a goal of identifying the Monroe Carell Jr. Children’s Hospital at Vanderbilt as a comprehensive transplant center,” said Hanto, who along with De-partment of Surgery Chair Seth Karp, MD, will serve as the two pediatric liver

transplant surgeons. “With the addition of the liver transplant program, our abil-ity to care for some of the more complex pediatric medical conditions is greatly ex-panded.”

Children’s Hospital now offers liver, heart, kidney and stem cell transplanta-tion. “The program we are starting is new, but our medical, surgical and transplant teams are very experienced. This is a very exciting time for us and we are looking for-ward to getting started,” Hanto said.

As the pediatric liver transplant program is unveiled, Hanto expects to integrate the newest innovative and tech-nological solutions, including:

An immunocompromised host con-sult service for all pediatric transplants. Established by Infectious Diseases, it is designed to offer input into the care of patients whose immune systems are sup-pressed or impaired.

Monroe Carell Celebrates First Pediatric Liver Transplant

8 > AUGUST 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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how they recover money in fraud cases,” he said. “The government continues to increase the resources it directs toward healthcare fraud detec-tion and enforcement,” he continued. “There-fore, hospitals and other healthcare providers are under more scrutiny than ever.”

Roark, who also teaches healthcare fraud as an adjunct professor at Vanderbilt Law School, added this at-tention isn’t surprising on two fronts – 1) healthcare spending represents a large portion of government outlay, and 2) the return on investment is noteworthy when comparing resources spent to recoveries gained.

“As what the federal government pays for healthcare continues to grow, in particular with the passage of the Afford-able Care Act, the federal government has made clear that it will continue to make healthcare fraud enforcement a top prior-ity,” Roark said of the first point. As for the second issue, he added, “The government estimates it returns over $7 for every $1 it invests in healthcare fraud enforcement.”

A significant part of the enforce-ment efforts comes from qui tam cases, which allow private individuals to bring

civil claims on behalf of the government. Whistleblowers, also known as relators, have a financial stake in the recovery ef-forts. Changes made to the FCA in 2010 that make it easier to file qui tam cases and harder to get those cases dismissed have led to a spike in qui tam cases, with more than 700 filed last year alone.

“Since a private individual can bring these qui tam cases, it allows a current em-ployee, former employee, competitor, busi-ness associate or a patient to file,” explained Roark. “Then, the federal government has to investigate the allegations and see if they think it merits moving forward … but, even if the government declines to take the case, the individual can maintain it on his or her own.” He added that on average, the gov-ernment intervenes in approximately 20 percent of the qui tam cases that are filed.

Historically, Roark noted, if the gov-ernment declined intervention, individuals often would drop the case at that point. Now, however, the stakes are so high that individuals and law firms, often working on contingency, are willing to proceed on their own. And, Roark continued, there is little downside for the individuals filing such ac-tions unless the suit is proven to have been frivolous.

Roark said the whistleblower stands to collect up to 25-30 percent of the total

Feds Make Fraud Enforcement a Top Priority, continued from page 1

By CINDy SANDERS

Ignorance might be bliss in some situations, but for those in the healthcare industry, it makes for a poor defense. Un-fortunately, it can be extremely difficult (if not seemingly impossible) to stay on top of the ever-changing rules and regulations that govern the industry.

While there isn’t enough ink at the printer’s to cover all the pressing regula-tory problems, Keith C. Dennen, a member in the Nashville office of Dick-inson Wright, sat down with Medical News to dis-cuss what he considers one of the biggest issues that continues to plague the industry … HIPAA compliance.

“It used to be that doctors worried about malpractice. Thanks to tort caps,” Dennen said, “that issue is practically gone. Now they worry about HIPAA.”

He continued, “The reason is, of course, that all you have to do is make one little mistake, and suddenly it’s 1) national news, and 2) everyone and their brother is fining you.”

Despite all the focus given to HIPAA and HITECH rules and regulations at the federal level and in the media, compli-ance continues to be problematic … and

non-compliance continues to be extremely costly.

Last spring, Dennen continued, the Department of Health and Human Services levied the largest HIPAA monetary fine to date on New York-Presbyterian Hospital and Columbia University for the release of protected health information. The $4.8 million fine was for a breach that occurred in September 2010 when a physician tried to deactivate a personally owned computer server on the NYP network and accidentally made PHI – including vital signs, medica-tions and lab results – accessible on Internet search engines.

In a statement announcing the settle-ment, Christina Heide, acting deputy di-rector of health information privacy for the Office of Civil Rights said, “When entities participate in joint compliance arrange-ments, they share the burden of addressing the risks to protected health information. Our cases against NYP and CU should re-mind healthcare organizations of the need to make data security central to how they manage their information systems.”

The interesting thing, Dennen noted, is that there was no evidence that anyone actually made use of the data or that the patients were adversely impacted. Also of note, the breach didn’t affect hundreds of thousands of patients … or even tens of thousands. Instead, the $4.8 million fine was levied for the disclosure of PHI for 6,800 in-dividuals.

Now, he continued, “New York-Presbyterian and Columbia are big enough to do a thorough risk analysis, but how about a small physician office in Columbia, Tenn.?”

Certainly, it would have cost far less for the New York facilities to proactively search for the technical gaps blamed on the breach than to pay the massive fine. That, said Dennen, is the real takeaway message.

Can a small practice afford the costs associated with insuring electronic files are secure? “You can’t afford not to,” he said. “Let’s say they fine you $200,000 … can you afford that?”

While updating firewalls and computer systems can be costly, Dennen said even sim-ple, inexpensive steps often still aren’t taken. “We still have the lost laptops that aren’t en-crypted. We still have the mobile phone, lost or stolen, that doesn’t have a password or fingerprint recognition enabled.”

Just last month, officials with the UCLA Health System announced cyber-criminals accessed a computer network that contained an estimated 4.5 million patients’ unencrypted personal and medical records. Even when a practice or medical facility has done everything in their power to secure their information flow, Dennen said they still aren’t out of the woods.

“The greatest opportunity for a HIPAA violation is with people who don’t even real-ize they are covered by HIPAA … the busi-ness associate,” Dennen said. “Every night

I have to close my door and lock it because not only do I have client information, I have protected health information.”

While individuals do not have private right of action in the case of HIPAA viola-tions, Dennen said he expects to eventually see a different type of lawsuit hit Tennessee courts.

“Thanks to Elvis, we have some of the strongest privacy protections in America,” he said of state laws that were enacted de-cades ago to protect the legendary singer and numerous other artists based in Ten-nessee. “I keep waiting for that lawsuit to occur and not be HIPAA but be a privacy right issue,” he noted of leaked patient in-formation.

The most frightening part of HIPAA violations, he continued, “is you don’t know you’re not compliant until something hap-pens.” Dennen said it’s far too easy for Dr. Jane Doe in Hartsville, Tenn. to be lulled into a false sense of security and think no one would ever hack into her computer. But if she has 2,000 files in the databank, then that’s 2,000 credit cards that could be opened. While bigger organizations might yield higher numbers of identities, security is often more lax at smaller practices.

“The Office of Civil Rights has said their primary focus right now is HIPAA en-forcement,” he stated.

Not knowing you were out of compli-ance won’t get you very far if the OCR comes calling.

‘I Didn’t Know’ Isn’t a Defense in HIPAA Violations

Keith C. Dennen

Brian Roark

(CONTINUED ON PAGE 9)

n a s h v i l l e m e d i c a l n e w s . c o m AUGUST 2015 > 9

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By CINDy SANDERS

With the King v. Burwell ruling up-holding the validity of tax credits on federal exchanges, the Supreme Court removed one of the last hurdles to full implementa-tion of the Affordable Care Act. Now, large employers – generally defined as 50 full-time equivalent employees or more – must move forward with coverage and reporting requirements in effect for 2015.

B. David Joffe, a partner with Bradley Arant Boult Cummings and head of the firm’s Employee Benefits and Executive Compensation Group said there really shouldn’t be anything new here be-cause employers should have been planning for the play or pay mandate. However, he continued, a ‘wait and see’ attitude might have left a signifi-cant number of employ-ers scrambling to catch up to this year’s requirements.

“Frankly, a lot of employers probably aren’t as far along as they should be for this year keeping track of their full time em-ployees. I suspect towards the end of the year, it’s going to hit,” Joffe said.

“If you are an employer that is re-quired to provide coverage, you’re going to be reporting for 2015 in 2016. This is the first time it happens. There was an optional reporting (for last year), but I don’t know anyone who did that,” he added.

In a brief following the Supreme Court decision in late June, Joffe said the important data points for employers to monitor are:

• Identifying and tracking full-time employees who must be offered coverage under ACA;

• Offering minimum essential cover-age that is affordable and provides mini-mum value to substantially all full-time employees (70 percent in 2015 and 95 per-cent in 2016 and thereafter) and providing such coverage;

• Continue preparing for required IRS information reporting applicable to employer-sponsored health coverage;

• Continue preparing for the Cadillac Tax, including analyzing whether coverage changes will be required to avoid the tax when it becomes effective in 2018.

The reasons employers are lagging be-hind in this process are multifactorial. Joffe pointed out the history of the ACA has been a lot of delays so there was probably some wishful thinking involved. Also, ven-dors are at varying levels of preparedness so it has been difficult for some employers to update software to help keep track of com-pliance mandates.

“Some people are just waiting to do this at the end of the year like other year-end reports, but this one is a little more difficult to reconstruct what happened throughout the year,” Joffe noted. “If you don’t have a way of tracking how many full-time employees you have and who you are offering coverage to every month, then you’re going to miss somebody; and if you miss somebody, then you have the penalty issue,” he continued, adding those penalties could be quit substantial.

The general rule, Joffe explained, is that if an employer didn’t offer coverage to enough of their employees, they would be subject to a penalty based upon the total

number of full-time employees less a pre-set threshold number. This is the A penalty.

The B penalty, he continued, is ap-plied when you offer coverage to the cor-rect percentage of people but didn’t offer it to someone who is a full-time employee and eligible for the subsidy. “If that person goes to the exchange and gets certified for the subsidy, you get penalized,” Joffe said. In this case, the employer is only penalized for the employees in question and the time-frame the company was out of compliance. In 2015, the penalty is $260 per month or $3120 for the year per employee.

While there was a lot of initial talk of employers simply dropping coverage and paying penalties, Joffe said he hasn’t really heard of anyone who plans to do that. “The health insurance is deductible, the penalty is not,” he pointed out. Further, he ques-tioned, “From a competitive standpoint could you really get away with it (dropping coverage)?” And, he continued, there is also a moral obligation many ... if not most ... employers feel toward their employees.

The net effect, Joffe said, is that most large employers will continue to provide coverage so they must be prepared to play or pay.

With ACA Ruling, Exchanges Stay … As Does Play or PayLarge Employers Need to Stay on Top of Requirements

David Joffe

recovery in these cases. A relator and his or her representing law firm look to be awarded $2.5-$3 million in a $10 million fraud allegation. Last year, Franklin-based Community Health Systems paid out nearly 10 times that amount to settle seven qui tam cases stemming from allegations re-garding inpatient billings from 2005-2010.

“Our firm has seen a huge increase in FCA cases we work on compared to five or 10 years ago,” Roark said. He added, this increase has “led to more hospitals and healthcare providers having to respond to government investigations and having to defend these qui tam lawsuits.”

Even if innocent of willful fraud, the process is costly and time consum-ing. “You can’t be held civilly liable for a mistake or even negligence,” said Roark. “You have to show a company knowingly submitted false claims.” The three indica-tors of ‘knowing submission’ are: actual knowledge, deliberate ignorance, or reck-less disregard.

However, he continued, there are cer-tainly gray areas that need to be better de-lineated, especially regarding under what circumstances providers can be held liable under the FCA for failing to return known overpayments to the government. For ex-ample, Roark asked, is there an obligation to audit? If a provider doesn’t conduct audits and is accidentally … but wrongly … charging for services, could that be con-sidered deliberate ignorance? If a hospital finds a biller has consistently coded a pro-cedure incorrectly and doesn’t document set steps to re-train that employee, is that reckless disregard? The hope is the Centers for Medicare & Medicaid Services will bet-ter define what actions could be linked to liability in a final rule expected later this year.

The financial impact isn’t the only worry in such cases, though. Roark said he is also seeing heightened efforts by the gov-ernment to hold defendants criminally lia-ble in certain circumstances. “In late 2014, the DOJ announced that every qui tam law-suit that is filed is going to be reviewed by the DOJ to see if a criminal investigation should be opened,” he said. “A trend is an increase in the number of parallel pro-ceedings in the healthcare fraud space,” he added of the simultaneous review by both civil and criminal specialists within the De-partment of Justice.

“Due to the increase in government enforcement activities, providers need to undertake efforts to be prepared in the event they are investigated. They need to proactively respond to issues or problems as they arise,” Roark stated.

“If a provider receives a subpoena or civil investigative demand or is other-wise contacted by the government about a healthcare fraud matter, it’s important to engage counsel promptly to conduct what-ever internal investigation is necessary to be able to respond to the government’s inquiry,” he continued. “Government in-vestigations should never be taken lightly.”

Feds Make Fraud Enforcement a Top Priority, continued from page 8

UnitedHealthCare BonusIn late July, UnitedHealthcare

announced it is awarding $1.9 mil-lion in bonus payments to Tennessee physicians for achieving quality goals while treating Medicare Advantage Members. More than 100 providers across the state were recognized with performance-based 2014 PATH Excel-lence in Patient Service Awards.

10 > AUGUST 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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By CINDy SANDERS

A word to the wise should be suffi-cient. Recently, the Office of the Inspec-tor General has released a fraud alert on physician compensation arrangements and updated guidance for healthcare governing boards.

Michelle B. Marsh, partner at Waller Lans-den Dortch & Davis, said all such communiqués from the OIG deserve special attention. Marsh, who is the practice leader for Waller’s Healthcare Compliance & Opera-tions group, said the June 9 alert reiterated the need to make sure physicians are being paid only for work they are actually doing and at a rate that reflects fair market value.

Red flags, Marsh noted, include “pay-ing physicians as medical directors when

they didn’t really provide the services, or when services weren’t necessary, or where payment was not related to the value of their services but to the volume of refer-rals.”

She continued, “Not that this is break-ing news … these arrangements were al-ways wrong.” However, Marsh added, the difference is that the OIG has previously appeared to focus most of their attention on the non-physician partner in these cases.

“Physicians should keep in mind it’s a violation of anti-kickback laws to receive a payment for referrals, as well as to make a payment for referrals, so it’s both the payer and the recipient,” Marsh said. “Both sides of a transaction subject to kickback scrutiny are at risk … not just one side. The alert shows nobody is getting a free pass.”

Inappropriate arrangements extend past the major red flags, Marsh added, of other, more subtle infractions. The June alert noted the agency “recently reached settlements with 12 individual physicians

who entered into questionable medical di-rectorship and office staff arrangements.”

In a physician-lab agreement, for ex-ample, Marsh said it is perfectly appropriate for the lab company to have someone at a physician office to draw or pick up samples. However, that lab employee cannot answer phones at the practice or provide general office work at no charge to the physician. When an affiliated healthcare entity pays salaries for the physician’s front office staff, the OIG said it relieves that physician of the financial burden they would normally incur and therefore constitutes improper remuneration to the physician.

If deemed guilty of committing fraud, both the physician and affiliated health entity are subject to possible civil, crimi-nal and administrative sanctions. How-ever, Marsh added, “The other thing the OIG highlighted in that fraud alert is the resources the OIG and others are making available to help with compliance.”

Marsh said the OIG does a good job of providing education on this and other issues through their site at oig.hhs.gov. Specific to this issue, the fraud alert directed physicians to their “Compliance Program Guidance for Individual and Small Group Physician Practices,” which is available at oig.hhs.gov/authorities/docs/physician.pdf.

Marsh also underscored the need to document actions in any type of compen-sation arrangement. A physician and part-ner could be found guilty of fraud despite appropriate compensation if the actions performed were not supported by writ-ten data. “The rule in healthcare is if it wasn’t documented, it wasn’t done,” stated Marsh. “It’s important to accurately docu-ment any arrangement and then act in ac-cordance. You can appear to be crossing the line if you don’t document … even if the services were provided.”

The OIG released another piece of news earlier this spring providing updated guidance for healthcare governing boards on compliance oversight.

“If you’re accepting a board position, we would certainly recommend you look at this guidance and that you are comfortable with all the responsibilities,” Marsh said of her firm’s advice.

It’s a mistake, she explained, to think of a board appointment as an honorary title rather than as an executive leadership position. “In particular,” she continued of the guidance document, “it discusses the expectations that the board be involved in identifying and monitoring risk areas and that the board is expected to pull together many different functions within the orga-nization including quality, compliance, au-dits, legal and human resources.

“It’s clear the OIG’s expectations for the board is that it is responsible for mak-ing sure all the pieces come together and that the compliance program, as a whole, addresses those risk areas at an appropriate level for the organization. Ultimately, the compliance of the organization all rolls up to the board,” Marsh concluded.

A Word to the WiseOIG Cues Areas of Interest with Recent Alert, Guidance

Michelle Marsh

By CINDy SANDERS

During the 109th General Assem-bly, state lawmakers approved HB0143/SB0811 … more commonly known as the Tennessee Right to Try Act. The legisla-tion is intended to provide terminally ill patients access to experimental drugs and devices that could have potential life-sav-ing benefits.

“Right to Try was an idea that was created by the Goldwater Institute in Arizona,” said Lindsay Boyd, director of Policy at the Beacon Center, a non-profit, nonpartisan organization focused on public policy. “So the credit goes to the Gold-water Institute for com-ing up with this really patient-driven reform that curbs the emphasis of protecting the industry and puts the emphasis back on protecting the patient.”

In 2014, five states passed Right to Try laws. As of late June 2015, Tennessee and 21 other states now have some ver-sion of Right to Try laws, another 18 states have introduced bills, and legislation also has been introduced nationally.

The law affords protections for phy-sicians, pharma companies and medical manufacturers while loosening the regula-tions on terminally ill patients. “We believe this strikes the perfect balance,” Boyd said.

Insurers can cover the cost of treat-ment but don’t have to do so. Phar-maceutical companies can provide the experimental drugs for free or at cost, and manufacturers also retain right of refusal if

they believe a patient isn’t an appropriate candidate.

“We wanted to make sure this was a ‘mandate light’ piece of legislation,” Boyd explained. “It’s a free will bill. It’s designed to open the access and open the conver-sation between the pharmaceutical com-pany, patient and doctor.” She added the law extends to medical devices, as well.

Just as there are potential benefits to patients, Boyd said there are also benefits to manufacturers. “As we know, the ap-proval process takes on average 10 years … and now it is jumping up toward 12 years,” she said of moving through the Food and Drug Administration cycle. Boyd said an ancillary hope of these laws is to open a dialogue about reforming the FDA process.

In the meantime, by allowing patients who have exhausted other options early access to treatments that have already passed the Phase I clinical trial stage, man-ufacturers might be able to show efficacy more quickly and ultimately help expedite FDA authorization.

Boyd concluded, “Ideally, we hope the law might save a life. That’s our ul-timate goal. We don’t want to promise anyone false hope … but we do want to give patients hope where there was none before.”

The Right to Try

Lindsay Boyd

Go online to NashvilleMedicalNews.com for information on other new laws impacting the healthcare industry in Tennessee.

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

Mark Your Calendar: Sept. 21-23 Policy Immersion Trip to D.C.

Join the University of Tennessee’s Haslam College of Business faculty and Executive MBA in Healthcare Leader-ship students for an intensive three-day immersion on healthcare policy, busi-ness and government. The itinerary in-cludes insights from current and former legislators and regulators, corporate and industry public affairs officials and government relations executives. The trip is certified for 19 CME credits or 1.9 CEUs. For more information, contact Kitty Cornett at kpcornett@utk.edu or (865) 974-1705. Program fees are due by August 14th to secure your attendance for this exclusive experience.

Saint Thomas Buys Out Capella … Then MPT Does the Same

In a flurry of signatures in late July, Saint Thomas Health agreed to buy out Capella Healthcare’s interest in their four joint venture hospitals in Tennes-see. Saint Thomas Health’s parent com-pany, St. Louis-based Ascension, signed a definitive agreement to solely acquire River Park Hospital (McMinnville), High-lands Medical Center (Sparta), DeKalb Community Hospital (Smithville) and Stones River Hospital (Woodbury).

A few days later, it was announced Capella’s parent company and sole stockholder, Capella Holdings, Inc., had signed a definitive agreement with Medical Properties Trust, Inc. for the ac-quisition of Capella for $900 million in cash. The plan is for Birmingham-based MPT to acquire and oversee Capella’s real estate interests while Capella’s cur-rent senior management team will own, with MPT, hospital operations and will continue to manage current properties while expanding the footprint.

In MemoriamLast month, Nashville lost two ti-

tans of philanthropy and advocates for health and well-being.

J.D. Elliott, founding president of The Memorial Foundation, passed away after a brief illness at age 78. More than two decades ago, he helped launch the Hen-dersonville-based non-profit organization using money from the sale of the former Nashville Me-morial Hospital. Over the past 20 years, The Memo-rial Foundation has supported numer-ous nonprofits in the area, providing $135 million in grants to more than 775 organizations so far. Nearly one-quarter of their grants have supported health-related missions. For more information, go to memfoundation.org.

Francis Guess, who died at home at the age of 69, was a renowned civil rights advocate and hu-manitarian. He was the first African-American commissioner for the Tennessee departments of Labor and General Services under then-Gov. Lamar Alexander. He also served 30 years as a member of the Ten-nessee Commission on Human Rights and worked as a vice president with The Danner Corporation. Most recently, he served as executive director of The Dan-ner Foundation, which has contributed millions to state programs addressing health and education. The immediate past president of the Community Foun-dation of Middle Tennessee, the orga-nization has created a fund to continue his legacy. Donations can be made by visiting cfmt.org or mailed to: CFMT-The Francis Guess Fund, 3833 Cleghorn Ave., Suite 400, Nashville 37215.

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

Kelly Wolgast, DNP, MSS, RN, FACHE, a faculty member at Vander-bilt University School of Medicine and a com-mittee chair and board member of the Tennes-see Action Coalition has been named a Fellow in the American Academy of Nursing and will be in-ducted as part of the 2015 class on Oct. 17 in Washington, D.C.

Two Nashville-area residents, H. Newton Williams and Keith Wolken, have been named to the American Heart Association Greater Southeast Affiliate (GSA) 2015-16 Board of Direc-tors. Williams, a longtime volunteer ad-vocate for the AHA, served as president & CEO for Hoechst-Roussel Canada. Wolken, who served as chair of the Greater Nashville board, is chairman and CEO of SMA Holdings, Inc.

George A. Hill, MD, a reproductive endocri-nologist and infertility spe-cialist at Nashville Fertility Center, has been elected treasurer of the American Society for Reproductive Medicine (ASRM).

U.S. News & World Report ranked Vanderbilt University Medical Cen-ter as the top hospital in the state for a fourth straight year. Saint Thomas West was also recognized as one of the top five hospitals in Tennessee.

Life Care Center of Centerville, a skilled nursing and rehab facility, re-cently received the 2015 Bronze Na-tional Quality Award from the American Health Care Association and National Center for Assisted Living.

Springer Named Saint Thomas Health CEO

Karen Springer has been named president and CEO of Saint Thomas Health and senior vice president for As-cension Health/Tennessee Ministry Mar-ket Executive. Previously, she served as STH’s president and chief operating officer with responsibility for opera-tional success and effec-tiveness of Saint Thomas Health hospital facilities, physician practices and numerous joint ventures.

Springer was named COO in 2011, joining Saint Thomas Health after serv-ing in the same role at Lutheran Hos-pital of Indiana for four years. She was named president of STH earlier this year. Prior to that, she held a number of nursing and administrative leadership positions, primarily in Indiana and New Mexico.

She takes the reins from Mike Schatzlein, MD, who has been named senior vice president for Ascension Health/Group Ministry Operating Ex-ecutive. In this new position, he will be responsible for overall senior leadership of the Tennessee/Indiana Ministry Mar-kets. In addition, he will have oversight, with accountability for operational and financial performance, stewarding qual-ity, strategic growth, and experience and safety outcomes of multiple other Ascension Ministry Markets.

Wishes GrantedResearch at Vanderbilt University

Medical Center aimed at develop-ing potential new treatments for major depressive disorder, general anxiety disorder and post-traumatic stress dis-order got a big boost recently from The William K. Warren Foundation, which announced it would increase its support of the research by $2.25 million over the next two years. That is in addition to a three-year, $5 million commitment made last year as part of a research col-laboration agreement signed by the two non-profit institutions.

Marco Davila, MD, PhD, assistant professor of Medicine and of Cancer Bi-ology at Vanderbilt University Medical Center, has been named a recipient of the Damon Runyon Clinical Investigator Award. The grant will provide $450,000 over three years to help fund his re-search on therapies for several types of blood disorders, including various forms of leukemia and non-Hodgkin lymphoma.

Amedisys Opening Nashville Executive Office

In late July, Baton Rouge-based home health and hospice giant Amedi-sys announced the opening of an exec-utive office in Nashville. Calling the city the “epicenter” of the healthcare in-dustry, company officials said the office would allow them to create strategic relationships and draw from the strong talent pool located in the city. The ma-jority of the executive team, including the CEO and COO, will be based in the new downtown Cummins Station office.

“Nashville is the place to be if you’re in healthcare, and we’re ex-tremely excited to be opening an of-fice here,” said Paul Kusserow, CEO of Amedisys. “Our vision is to be more than a homecare and hospice company – we see the future of healthcare as de-livered without boundaries, in the home setting. Our presence in Nashville will help us engage with the leading health systems, health technology and health services companies.”

Health Care Council Announces Board

The Nashville Health Care Council recently announced the appointment of the organization’s 2015-16 board of directors led by William Gracey, presi-dent and CEO, BlueCross BlueShield of Tennessee, who will serve as chair-man of the board for a two-year term. C. Wright Pinson, MD, deputy vice chancellor for Health Affairs and CEO, Vanderbilt Health System, was selected to begin a two-year term as vice-chair-man of the board. William F. Carpen-ter III, chairman and CEO of LifePoint Health, is immediate past chair. A full list of board members is available at healthcarecouncil.com.

The Surgical Clinic at Skyline Welcomes Richter

The Surgical Clinic PLLC welcomed vascular surgeon Adam A. Richter, MD, RPVI to its surgical prac-tice effective Aug. 1. He is seeing patients at The Surgical Clinic’s TriStar Skyline Medical Center clinic.

He graduated with honors from Vanderbilt with a degree in psychology and then received his medical degree, also with honors, from the University of Texas Medical Branch in Galveston. Richter completed his general surgery residen-cy at the University of Texas Southwest-ern Medical Center in Dallas and his fel-lowship in Vascular Surgery at Vander-bilt University Medical Center.

More Grand Rounds: www.nashvillemedicalnews.com

GrandRounds

Francis Guess

J.D. Elliott

Dr, Kelly Wolgast

Dr. George Hill

Karen Springer

Dr. Adam Richter

I am proud of my work as an oncologist, and I feel there is no higher calling than assisting the seriously ill. My patients inspire and teach me—it’s an honor to serve them. I also believe we can serve our patients’ needs by working at the societal level, and I do this through volunteerism. I’ve had the good fortune to work at the state and national level on issues of importance to oncologypatients and physicians, and I believe this has made me a better physician.

Locally, I’ve been a member of the Tennessee Oncology PracticeSociety since the early 1990s and on the board of directors formany years, serving as president in the late 1990s.

Nationally, I have held many volunteer positions with the American Society of Clinical Oncology (ASCO). I’ve served for many yearson the Clinical Practice Committee and chaired it in 2008-2009. I’ve also served on the Government Relations Committee aschair in 2012-2013. This work has given me the opportunity toparticipate in policy making and implementation and see oncologyfrom a different perspective. I’ve been privileged to meet talented,dedicated professionals, all striving to improve the care ofcancer patients.

Since 2005, I’ve had the pleasure of serving on the Board of Directorsof ASCO’s Conquer Cancer Foundation (CCF). As ASCO’sphilanthropic arm, this nonprofit funds breakthrough cancer research,shares cutting-edge knowledge, improves quality of and access to careand enhances quality of life for those touched by cancer. I’ve beenhonored to serve as chairman of the CCF Board of Directors sinceJanuary 2013. Our vision is “A World Free from the Fear of Cancer,”and we strive daily to realize that vision.

ASCO is physician-driven. The society is deeply rooted in science and education. ASCO is engaged in public policy, healthcare delivery and improvement of the quality of cancer care, as well as it is always lookingtoward the future. I am proud to be a part of this vital organization.

Presently, I am also honored to serve on the Association of Community Cancer Centers (ACCC) Board of Trustees. ACCC promotes multidisciplinary, quality cancer care for all. This nonprofit also addresses the challenges of cancer care delivery, developing innovative solutions for practices and healthcare systems. ACCC is a great mix of oncology professionals.

It is rewarding to know the volunteer work I do will have an impact locally and nationally. I am pleased to have served Nashville for almost 30 years. When I’m not in Washington, D.C., you can find me caring for patients at Tennessee Oncology’s Midtown Clinic.

Volunteerism in OncologyTENNESSEE ONCOLOGY’S Charles Penley, M.D.

CHARLES PENLEY, M.D.

1.877.TENNONC | www.tnoncology.com

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