Mercy Medical may join Cleveland Clinic 2 Colors of Advent 2 Does peer support counter burnout? 3 PERIODICAL RATE PUBLICATION
OCTOBER 15, 2019 VOLUME 35, NUMBER 18
By DALE SINGER
When you’re 10 years old and you have a rare bone disease causing problems inside your skull, you’d be forgiven for not getting excited over a new piece of medical equipment. But everyone is fascinated with their own bodies and Johnny Edenfield was no exception. He was wowed when he put on a virtual reality headset and saw exactly how Dr. Abilash Haridas, chief of pediatric Continued on 4
Dr. Abilash Haridas, chief of pediatric neurosurgery at St. Joseph’s Children’s Hospital in Tampa, Fla., uses virtual reality technology in pre-surgery consults to give his patients and their parents a clearer understanding of treatment options and risks.
Executive order spurs hope for improvements in kidney care By LISA EISENHAUER
For Nikki Love-McIntyre, the prospect of dialysis was more intimidating than the prospect of undergoing an organ transplant. “I think that’s one thing that just scared the bejesus out of me,” LoveMcIntyre says of being tethered to a blood filtration machine for hours at a time. Fortunately for her, a suitable kidney was found before the renal disease she had been diagnosed with a year earlier progressed to where she had to have dialysis. But just barely. She was a week away from her scheduled appointment for a fistula. Love-McIntyre, of Belleville, Ill., underwent a successful kidney and pancreas transplant at SSM Health Saint Louis University Hospital in October 2015. She says her new organs put an end to the misery of renal disease and the diabetes that triggered it. Now she is hopeful that an executive order signed by President Donald Trump on July 10 will spare others from having to suffer with kidney disease and that, if they do, it will mean more of them will be able to get a life-changing transplant like she did. “It’s going to give more people who are on the waiting list access to organs faster,” she says. “I think that’s awesome, because I think a lot of people don’t understand what someone who is waiting for basically a lifesaving organ goes through.” Dr. Holly Kramer, a nephrologist at Loyola University Medical Center in the
Chicago suburb of Maywood, Ill., sees much to applaud in the executive order. In fact, she sees it as “the most exciting thing that’s happened in the world of nephrology in the past 30 years.” The medical center is part of the Trinity Health system. “It’s very comprehensive,” says Kramer,
Services to: Launch a public awareness campaign to increase knowledge of chronic kidney disease. The agency says four out of 10 people with chronic kidney disease don’t know they have it. Reform the nation’s organ procure-
Courtesy Mid-America Transplant
Virtual reality takes patients on trip inside their own bodies
The kidney and pancreas transplant Nikki Love-McIntyre got in October 2015 at SSM Health Saint Louis University Hospital restored her health and made her an advocate for organ donation. She’s hopeful that a new federal kidney care initiative will aid others with kidney disease.
who is also president of the National Kidney Foundation. “It’s really trying to look at the whole spectrum of kidney disease and trying to incentivize better treatments for those patients and to increase organ transplantation and in-home dialysis therapies.” Specifically, the executive order calls on the U.S. Department of Health and Human
ment and management system to increase the supply of transplantable kidneys. Expand support for living donors through compensation for related expenses like lost wages and child care. Encourage development of wearable or implantable artificial kidneys, through cooperation between developers and the Continued on 5
Over-the-counter hearing aids on the way
PLEASURE CRUISE SSM Health St. Clare Meadows Care Center in Baraboo, Wis., has two electric “trishaws” to take residents on rides like this one on the Sauk Prairie State Recreation Area trail. Volunteers provide the pedal power. The tricycles are part of the center’s Cycling Without Age program. Story PAGE 8.
Americans suffering from mild to moderate hearing loss soon will be able to buy more affordable hearing aids over the counter once the devices meet federal safety, labeling and manufacturing standards under development now. The Food and Drug Administration Reauthorization Act of 2017 directs the FDA to make hearing aids available without a prescription or a visit to a physician or audiologist. Proposed regulations governing the devices must be issued by August 2020 and the public will have an opportunity to comment, said Alison Hunt, an FDA press officer. By law, the agency must finalize the rules within 180 days after the close of the comment period. The FDA is committed to “ensuring the proper guardrails are in place to make over-the-counter hearing aids a safe and effective option for consumers,” Hunt said. While the availability of overthe-counter, self-fitted hearing aids has been cast as a major breakthrough for consumers who can’t afford to spend thousands of dollars for traditional hearing aids, some clinicians are wary that people will sidestep audiologists
cost is not the optimal solution to this problem.”
Karen Elshout/ © CHA
Courtesy SSM Health St. Clare Meadows Care Center
By KEN LEISER
Kathleen Garavalia has her hearing aid programming validated at the audiology center at Mercy Hospital St. Louis.
altogether and treatable medical conditions will go undiagnosed. “We really are glad that there’s more awareness of the importance of addressing hearing loss,” said Jennifer Main, a clinical audiologist with Mercy Audiology in St. Louis. “We just think that taking the professional out of the picture in order to drive down
Big ticket purchase Dr. Frank Lin, director of the Main Cochlear Center for Hearing and Public Health and a professor at the Johns Hopkins University School of Medicine Lin and Bloomberg School of Public Health, said that with an average price tag of $4,700, a set of hearing aids can reflect the third-largest purchase in a typical American’s life behind a house and a car. According to the FDA, about 37.5 million Americans aged 18 and older report mild to profound hearing loss. Hearing loss can result from aging, exposure to loud noises or certain medical conditions. Most insurance companies do not cover the cost of hearing aids or their fitting, nor does traditional Medicare. Age-related hearing loss usually affects both ears, meaning most sufferers Continued on 6
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CATHOLIC HEALTH WORLD October 15, 2019
Sisters of Charity system in talks to transfer Canton, Ohio, hospital to Cleveland Clinic The Sisters of Charity Health System of Cleveland is in talks to transfer ownership of its Canton, Ohio, medical center to the nonprofit Cleveland Clinic. The 476-bed Mercy Medical Center is one of two hospitals in the Sisters of Charity system. A nonbinding letter of intent signed by both parties says the transaction under consideration would result in Mercy Medical Center joining the Cleveland Clinic, a multispecialty academic medical center, under what the health systems are calling a “member substitution.” Mercy Medical Center would maintain its Catholic identity including by adhering to the Ethical and Religious Directives for Catholic Health Care Services. The facility would continue to be sponsored by the Sisters of Charity of St. Augustine through CSA Health System Ministries, the public juridic person of the Sisters of Charity system. Mercy Medical Center’s 10 outpatient health centers, which are in three contiguous Ohio counties, also would join Cleveland Clinic under the arrangement. Financial details of the transaction were not available as Catholic Health World went to press. The ownership substitution is pending due diligence review and regulatory and church approvals. The Sisters of Charity system said in late September that the deal could close in several months. In a release on the transaction, the Sisters of Charity system and Cleveland Clinic said the change in ownership should enable Cleveland Clinic to expand the hospital’s services, improve its technology, provide additional support and investment for community needs, build synergies among physicians at the organizations and improve care accessibility for patients. Sr. Judith Ann Karam, CSA, leader of the Sisters of Charity of St. Augustine congregation and chair of its PJP, said that by joining Cleveland Clinic the stand-alone Mercy Medical Center would become part of a clinically integrated network. Thomas J. Strauss, president and chief executive of the Sisters of Charity system, said in the release that the deal would “provide for the long-term sustainability of Catholic health care in Canton.” Currently, the Sisters of Charity system
Catholic Health World (ISSN 87564068) is published semimonthly, except monthly in January and July, and copyrighted © by the Catholic Health Association of the United States. POSTMASTER: Address all subscription orders, inquiries, address changes, etc., to Kim Hewitt, 4455 Woodson Road, St. Louis, MO 63134-3797; phone: 314-253-3421; email: khewitt@chausa. org. Periodicals postage rate is paid at St. Louis and additional mailing offices. Annual subscription rates: CHA members free, others $55 and foreign $55. Opinions, quotes and views appearing in Catholic Health World do not necessarily reflect those of CHA and do not represent an endorsement by CHA. Acceptance of advertising for publication does not constitute approval or endorse ment by the publication or CHA. All advertising is subject to review before acceptance. Vice President Communications and Marketing Brian P. Reardon
Associate Editor Lisa Eisenhauer leisenhauer@chausa.org 314-253-3437
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Associate Editor Julie Minda jminda@chausa.org 314-253-3412
Thomas J Strauss; Sr. Judith Ann Karam, CSA; and Dr. Tom Mihaljevic pose with documents related to the potential transfer of Sisters of Charity Health System’s Mercy Medical Center to Cleveland Clinic. Strauss is president and chief executive of the Sisters of Charity Health System and interim chief executive of Mercy Medical Center of Canton, Ohio; Sr. Karam is congregational leader of the Sisters of Charity of St. Augustine and is chair of the health system’s public juridic person; and Mihaljevic is chief executive and president of Cleveland Clinic.
includes two Catholic hospitals: St. Vincent Charity Medical Center in Cleveland and Mercy Medical; as well as grant-making foundations in Cleveland and Canton and Columbia, S.C. The Sisters of Charity system also includes other health and human services organizations and two continuum of care facilities. The system had previously transferred ownership at three additional hospitals to other organizations. All three hospitals maintain their Catholic identity. The buyer of two of the hospitals is a for-profit system, and the other, a nonprofit. Cleveland Clinic has a main campus in Cleveland as well as 11 regional hospitals and a network of outpatient locations in north and northeast Ohio. Cleveland Clinic also has locations in Florida and Nevada as well as in Canada, the United Arab Emirates and England. One of Cleveland Clinic’s hospitals, Union Hospital in Dover, is within 25 miles of Mercy Medical.
CHA taking orders for complimentary Advent coloring book CHA is extending an early holiday gift to its members in the form of an Adventthemed adult coloring book. The booklet, which comes with a small set of colored pencils, is a complimentary item that CHA members can order through Nov. 1. Custom designed by CHA, each coloring page features a mosaic sketch that illustrates the themes of four weekly Advent reflections and a Christmas reflection. The reflections were developed for those who work in the health ministry to connect their work to this season. Members can elect to co-brand the coloring book. The order form includes the option for adding a second corporate logo alongside the CHA logo on the booklet cover. Learn more and order copies at chausa. org/coloringbook.
The cover and an illustration from CHA’s booklet of Advent reflections.
Upcoming Events from The Catholic Health Association Ethics Webinar: A Discussion of Why Organized Medicine Must Maintain Its Opposition to Assisted Suicide
2020
International Outreach Networking Call
Diversity and Disparities Networking Call
Faith Community Nurse Networking Call
Critical Conversations 2020
Oct. 24 | 2 – 3 p.m. ET
Nov. 6 | 3:30 p.m. ET
Dec. 10 | 3 p.m. ET
Human Trafficking Networking Call
International Outreach Networking Call Feb. 5 | 3:30 p.m. ET
Feb. 19 | 1 – 2 p.m. ET
Feb. 12 – 13 Atlanta (Invitation only)
Dec. 12 | Noon ET
Sponsor Formation Program for Catholic Health Care Session Two: March 26 – 28 (Invitation only)
Ecclesiology and Spiritual Renewal Program for Health Care Leaders April 26 – May 1 Rome and Assisi, Italy (Invitation only)
International Outreach Networking Call May 6 | 3:30 p.m. ET
Graphic Design Les Stock
A Passionate Voice for Compassionate Care® chausa.org/calendar
October 15, 2019 CATHOLIC HEALTH WORLD
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CHI Health physician researcher works to reduce clinician burnout, improve well-being Approach aims to deepen doctors’ connections with patients, colleagues Research demonstrates that physician burnout is taking a toll not only on the physicians themCOMMONSPIRIT selves but also in HEALTH some cases on the patients they treat. CHI Health neurologist Dr. Prasanna Tadi believes that physician burnout has reached “public crisis” level, and he is looking for remedies that work. Tadi’s approach engages medical students, residents and physicians in a community of their peers to celebrate their accomplishments, talk about the issues they are facing, explore ways to improve Dr. Prasanna Tadi, left, talks with research co-investigators about protocols for his studies on reducing their well-being and adapt healthy rou- physician burnout. Shown from center to right are Creighton University medical students Emma Parks, tines that mitigate the impact of their Serenity McAndrews and Elizabeth Hartley. demanding, high-stress career path. He also is exploring ways to deepen the spirit- shortages. Tadi says that attending physi- side the medical profession. replenishing connections between physi- cians, residents and medical students sufHe has experienced periods of burnout, cians and their patients. Tadi is spearhead- fer from higher rates of depression, anxiety to the point that he once considered exiting a series of pilot studies and related and suicide, as compared with people out- ing the profession. “We became doctors to research to determine how well these interventions work. He’ll use the findings to refine and/or expand this approach. Tadi says, “Physicians are losing the sense of having meaning in their work. HI Health neurologist Dr. Prasanna Tadi and the groups switch. The researchers administer a My big hope is that we find his research teams are studying the impact of survey tool to assess wellness and burnout levels some solutions for this structured support on reducing stress responses prior to, halfway through and at the end of the burnout — some evidencein four separate groups: medical residents at CHI study. based solutions.” In addiHealth Creighton University Medical Center – The study of medical residents involves tion to his role at Omaha, Bergan Mercy, first- and second-year medical stu- patient participation. Residents in the research Neb.-based CHI Health, dents at Creighton University School of Medicine, cohort are part of a multidisciplinary team that Tadi is director of a neurolphysician leaders at CHI Health Immanuel and focuses on a particular patient with a complex ogy clerkship, director of neurologists practicing at CHI Health Immanuel. sociomedical background. The multidisciplinary wellness and an assistant These facilities are in Omaha, Neb. team will spend 30 minutes each day at the bedprofessor of neurology at The researchers this summer completed the side with the patient and family to talk about the Creighton University, a physician leader study with about 15 participants; patient’s personal and social background, hobbies the medical resident study is underway with and interests. During this time, the group also Jesuit school in Omaha.
Research looks at whether, how structured peer support eases physician burnout
C
Broken connections Studies have shown that burnout can lead to physicians providing lowerquality care and it can be associated with reduced patient satisfaction, in– creased medical errors and more malpractice payouts as well as increased staff turnover, which can contribute to physician
about 80 participants; the medical student study is underway with about 60 participants; and the neurologist study is to start within the next half year. The physician leader study was not intended to produce publishable results. The other studies are structured to be statistically valid and the results will be published, Tadi says. The studies of medical students and neurologists will be “crossover” studies that begin with half of the study participants in each group taking part in the structured support intervention — the CHEER meetings — once every four or five weeks for five months and half not. At that point
will talk through the patient’s condition in-depth, hashing out any concerns or challenges. Patients in the study can be at any inpatient unit and are normally in the hospital for one or two weeks, though their lengths of stay can vary. Residents and patients taking part in this study will participate in the monthly CHEER meeting of residents. If the patient(s) have been discharged earlier, the researchers can arrange for and fund their transportation, if need be, says Tadi. — JULIE MINDA
Perfect alignment When Webster Square Day Care Center learned two years ago it needed to find a new location, a partnership with the nearby St. Mary Health Care Center presented a happy option. This summer, the day care relocated COVENANT to newly developed space at the Worcester, Mass., eldercare HEALTH facility. The organizations, both of which are Catholic, have developed programs so kids and elders can mingle and play on a regular basis. At left, with a pencil pillow on her lap and a fox puppet on her hand, St. Mary resident Vicky Kirby charms a young friend. Above, St. Mary resident Jeannette Sienkiewicz reads You Are Important to an appreciative listener.
Andrew Jackson
By JULIE MINDA
make a change” for the better in the lives of suffering people. But, he says, many physicians find once they begin to practice that they do not have much control over their schedule, and this can mean that they cannot spend as much time as they wish with each patient. Given the hectic pace of medical practice, Tadi says, “We can miss the personal touch and the caring” that provide professional fulfillment. Time is so short, he says, practitioners may find it difficult to determine the best treatment options for an individual patient. Another real concern for physicians is patients who can’t afford to follow doctors’ orders and take their prescription meds as directed. Elizabeth Hartley and Eric Villanueva are fourth-year medical students at the Creighton University School of Medicine, and co-investigators in some of Tadi’s physician well-being research. Hartley says medical students are susceptible to burnout because of the workload, career uncertainties, feelings of inadequacy and feelings of isolation that seem to be part and parcel of medical school. Villanueva says he has seen numerous peers suffering from exhaustion. He adds that physicians and medical students often are expected to demonstrate superhuman resilience, never letting their personal struggles interfere with their pursuit of perfection, and so they may resist seeking help when they feel burned out.
Creating community Tadi believes that encouraging physicians to create a community of support and a safe space to address burnout can be an essential part of the remedy. And so he has developed a model that links physicians and physicians-to-be in peer groups that meet on a regular basis. Tadi uses the acronym CHEER to represent the activities that are part of these gatherings. Participants: Celebrate their accomplishments Hear one another’s successes and challenges in a safe environment Invite the Expertise of wellness experts Engage in discussion about how to apply those experts’ advice Recharge by putting wellness routines into practice in their daily lives For more than a year, Tadi has been assembling research teams made up of physicians, residents and medical students to implement the CHEER model and to conduct research on its effectiveness. (See sidebar.) Expansion plans Tadi says he is optimistic that these pilot programs and studies of the CHEER model will encourage physicians to create their own support communities and that this will prompt them to talk about the stressors in their lives, improve the culture, form friendships and build trust with one another. He anticipates that increased trust among physician colleagues will help to reduce the stigma around medical providers seeking help for themselves. Hartley says, “On a systemic level, the problems within the medical system that lead to physician burnout are copious, convoluted, complicated, and will not be solved with our relatively simple research.” However, she says she hopes that the research team can show that building community, emphasizing the positives of the profession, enhancing relationships and nurturing healthful lifestyles can improve the well-being of individual clinicians. “I hope that this research is able to create a program or a set of guidelines that can be applied to medical schools and residency programs across the country,” she says. Find this story at chausa.org/chworld for more on the high incidence of physician burnout. jminda@chausa.org
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CATHOLIC HEALTH WORLD October 15, 2019
Virtual reality From page 1
neurosurgery at St. Joseph’s Children’s Hospital in Tampa, Fla., planned to enter his cranium, slice away bone and relieve his painful symptoms. “All he kept saying,” Haridas recalls, “was ‘That’s cool, that’s cool.’” The Surgical Theater Precision Virtual Reality system in use at the pediatric hospital lets pediatric heart and brain surgeons combine and enhance traditional medical images from CT scans and MRIs and create a 360-degree model specific to their individual patient’s anatomy and then navigate around inside the model. The technology was developed by Israeli fighter jet pilots for use in flight simulations. Surgeons can use it to try out various approaches to the case at hand, analyze the instant problem from different angles and map out the best tactics. Haridas was onboard from his first encounter with the technology when he saw just a little piece of its potential. “They brought this VR system into my office, to show me what it can and can’t do,” he says. “I was excited. I had never seen anything like it before.” Prior to Johnny’s operation on July 18, Haridas used the technology to show the boy — in stereovision — how he would resect a bony growth pressing on an optic nerve, causing discomfort and vision problems. Johnny’s parents followed along on a large flat-screened monitor mounted on the wall.
“Dealing with kids and their families, they want to know everything. For all of the
Dr. Abilash Haridas, chief of pediatric neurosurgery at St. Joseph’s Children’s Hospital in Tampa, Fla., wears a virtual reality headset that shows him a 3-D image as he navigates a 360-degree model of a human skull.
cess what you see, and what you don’t, it takes you to a new level of understanding. It’s that amazing. They can draw a picture and show you a model, but it’s nothing until you see this. “Everything about it was positive,” Edenfield says of the surgical consult
employing VR. “There was nothing really negative about it. It wasn’t that terrifying, really, once we were able to see what was damaged in there,” she says. “It made a big difference. This takes pictures to a whole different level. It’s hard to explain until people see it for themselves.”
Haridas says pediatric patients who are gamers are in their element with the VR technology. “It has all the features of a video game,” he says. “That’s the world they know. It’s the language they speak well. They gravitate toward it and feel more comfortable with it.” Medical personnel may not be as familiar with VR technology as some of their young patients are, but Haridas says most of his colleagues are gaining proficiency. He says there’s been a learning curve to figure out the best way to take maximum advantage of the VR tool. “We definitely started off slow, when we were first using the technology,” he says, “but now we can maximize the potential of the technology. It’s like riding a bicycle — the more times you use it, the more efficient you get.” “Any technology has limitations,” Haridas concedes. “It can take up a little more space and a little more time in the office. People tend not to put down the technology and keep asking questions and playing with it. But we found ways around that pretty quickly.” Edenfield allows that Johnny was so fascinated with what he saw tooling around inside his own skull, he would have sat and played with the technology all day if he could. Very cool indeed.
NEW END-OF-LIFE RESOURCE FROM CHA BY PROMINENT THEOLOGIAN FR. THOMAS F. O’MEARA, OP
questions they have, the answers are on the screen, and it keeps the conversation focused on what really matters.” — Dr. Abilash Haridas “We were very interested in it,” Sherry Edenfield, Johnny’s mother, says of the technology. It made it much easier for Johnny “to understand what was going on, instead of just drawing his own conclusions. The whole family got the bigger picture and a better understanding of what was going on.” That is one of the greatest advantages of the VR technology, Haridas says. “Sometimes we have to spend a lot of time explaining what is going on and why it’s serious,” Haridas says. Giving a patient and his or her parents the opportunity to see inside the patient’s body can provide a fuller understanding of complex anatomy and pathology, as well as treatment options and risks. “It takes some heavy medical terminology out of the conversation. The biggest benefit I found is the way technology can speak to a patient in a way a doctor cannot,” Haridas adds. “Being invested in your own health care,” Haridas says, “the more you know, the better informed you’ll be and the more confident you’ll be going into whatever treatment you get, surgery or no surgery. “Dealing with kids and their families, they want to know everything. For all of the questions they have, the answers are on the screen, and it keeps the conversation focused on what really matters.” When the subject of a surgical consult involves your child’s brain, Edenfield emphasizes, any tool that removes part of the mystery and increases understanding is welcome. Edenfield acknowledges that the intensity of VR is undeniable. “But I would say that once you sit down and actually pro-
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October 15, 2019 CATHOLIC HEALTH WORLD
Kidney transplant From page 1
Food and Drug Administration and support for KidneyX, a public-private partnership between HHS and the American Society of Nephrology. Like Love-McIntyre, Dr. Krista Lentine applauds the executive order. Lentine is medical director of living kidLentine ney donation at the SSM Health Transplant Center at SSM Health Saint Louis University Hospital. She sees the initiative as recognition of “the need to transform the way kidney care is delivered in this country.” Lentine cites statistics to make her point: Of the more than 40 million Americans with kidney disease, 700,000 have end-stage kidney failure that requires dialysis and/or transplant. Medicare pays about $115 billion annually caring for patients with chronic kidney disease. The cost to care for a dial-
Waitlist (11/30/2016)
Transplants 12/4/2014–12/3/2015
ysis patient is about $93,000 per year versus $36,000 per year to care for a patient with a functional transplant, after the cost of the transplant surgery. The average fiveyear survival rate after a living donor transplant is about 85 percent and about 75 percent after a deceased donor transplant but only about 45 percent for patients on dialysis. “We have a situation now where the therapy with the poorest outcomes, on average, is also the most commonly used and the most expensive,” Lentine says.
113,000
Kidney Foundation, in 2018, 21,167 kidney transplants took place nationwide. Of these, 14,725 kidneys came from deceased donors and 6,442 from living donors. In general, the median wait time for first kidney transplant is three to five years, a number that varies depending on health, compatibility and availability of organs.
Source: Donate Life America
Prospects for better outcomes Among the aspects of Trump’s order
Transplants 12/4/2015–12/3/2015
Source: United Network for Organ Sharing
that she especially welcomes are its efforts to bring more dialysis services into patients’ homes and to move patients off dialysis entirely by giving them kidney transplants. The advantages to moving dialysis treatment to the home include restoring patients’ independence and reducing the cost of treatment. The benefits of transplantation versus dialysis are more transformative, Lentine says. That is, studies show that untethering patients from dialysis not only improves quality of life but also gives them a longer life span. Of course, the key to giving more patients transplants is finding more donors. HHS says that as of Jan. 1, there were 100,791 Americans waiting for kidney transplants. According to the National
Kidney Foundation’s leader cheers HHS’ bold kidney care goals
Courtesy Loyola University Medical Center
D
r. Holly Kramer was in the audience at the Ronald Reagan Building and International Trade Center in Washington, D.C., when President Donald Trump signed an executive order in July establishing a bold timetable for improving care of U.S. patients with kidney disease. Based on the order, the Department of Kramer Health and Human Services laid out several goals, including, by 2025, having 80 percent of new end-stage renal disease patients either receiving dialysis at home or receiving a transplant. Right now, only about 12 percent of dialysis patients undergo the treatment at home and more than 100,000 people are awaiting kidney transplants. “Whether or not they’re going to be able to make the big goal … remains to be seen, but I think setting a really big goal like that brings a lot attention and energy to the problem,” Kramer says. Kramer is a nephrologist at the Loyola University Medical Center, a Trinity Health facility in the Chicago suburb of Maywood, Ill., and president of the National Kidney Foundation. HHS also set a deadline of 2030 for doubling the number of organs available for transplant and reducing the number of Americans developing end-stage renal disease by 25 percent. To get the kidney disease prevention and shift in care of kidney disease that federal officials envision will require hiring more nurses and educators for tasks like teaching patients how to prevent or address kidney disease through diet or how to do their own dialysis treatments in their homes, she says. “This is a great thing for patients,”
Anthony Gonzalez hugs Lynne Snyder, who had anonymously donated a kidney to him, at the pair’s first meeting last month. The successful transplant took place at Loyola University Medical Center in Chicago. Gonzalez’s wife was not a match for her husband, but she donated a kidney for someone else on the waiting list.
Kramer says. “I think the doctors are concerned about how are we going to achieve this because the Department of Health and Human Services and Medicare, they’re not saying OK here’s $40,000 for your dialysis unit to figure out how to increase transplantation education.” Kramer points out that Medicare picks up the cost of caring for patients with kidney failure and that bill is hefty. Care for the 726,000 people in the U.S. with end-stage kidney disease alone accounted for roughly 7 percent of Medicare claims, or $35 billion in 2016, according to federal statistics. (An additional 12.5 percent of Medicare claims, or $79 billion, was paid for treatment of chronic kidney disease that same year.) Meanwhile, the number of people with endstage renal disease is increasing in the U.S. by 5 percent each year. Figures like that are alarming, Kramer says, but so is the lack of advancements in kidney care. She is hopeful that the executive order will be accompanied by more
investment from the federal government in technologies that improve care, such as better dialysis systems, and more funds for disease prevention programs, especially dietary counseling. Everything in the executive order, which includes calls for more prevention efforts, more transplants and the development of artificial kidneys, is not only welcome but overdue, in Kramer’s view. “The nephrology community wants to move forward,” she says. “We’re tired of working in a dialysis unit that looks the exact same as 1982 and we’re tired of transplantation and organ procurement that looks pretty much the same as for the past several decades. We want change. We want to make things better for our patients and we want better prevention.” — LISA EISENHAUER
5
Financial assistance The president’s order targets the organ shortfall in several ways. One is to make it less onerous for more people to become living donors by helping to cover related expenses, such as the previously mentioned lost wages and child care costs. Sr. Patricia Talone, RSM, views that assistance as poten- Sr. Talone tially particularly helpful for African Americans, a segment of the population that is especially hard-hit by kidney disease and by lower incomes. The National Kidney Foundation says African Americans constitute more than 35 percent of all patients in the U.S. on dialysis for kidney failure, about three times their representation in the overall U.S. population. “I am very much against paying for organs, but I think we can ease financial challenges for living organ donors,” says Sr. Talone, retired vice president for mission services for CHA and board member emeritus of Mid-America Transplant, an organ procurement organization. Organ procurement revisions Another way the executive order aims to ease the donation shortfall is to revise the rules on federally designated organ procurement organizations so that more “transparent, reliable, and enforceable objective metrics” are used by HHS to evaluate their performance. While the specific revisions of rules for organizations like hers are still Brockmeier being written by HHS, Diane Brockmeier, president and chief executive of Mid-America Transplant, is hopeful that the result is more donated kidneys and fewer rejections of them by hospitals and transplant centers. Brockmeier says the number of kidney donations has been on the upswing for eight years, but that increase is dwarfed by the increase in need for kidney transplants. Brockmeier would like to see HHS revise regulations to encourage hospitals to take so-called high-risk kidneys, including organs from older donors that could be lifesaving for older recipients and organs from HIV-positive patients for transplant into HIV-positive recipients. Loyola’s Kramer says revisions to rules for organ procurement organizations, such as on how they go about contacting treatment centers when they have transplantable organs and when and how biopsies must be done to detect diseases or injuries to organs, could increase the organizations’ efficiency. Vigor restored Love-McIntyre is doing what she can to get the word out about kidney disease and the need for more organ donors. In the four years since her kidney and pancreas transplant, she has accepted many invitations to speak at events where she tells people how the surgery ended her insulin dependency and restored the vigor that kidney disease had stolen. “I’m blessed to be here,” she says. “I’m blessed to have the opportunity to tell my story.” leisenhauer@chausa.org
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CATHOLIC HEALTH WORLD October 15, 2019
Hearing aids From page 1
Loneliness, depression and fall risk During a presentation at the Bloomberg School of Public Health in May, Lin cited research that shows people suffering from hearing loss are at higher risk of dementia, depression and hospitalization. Other potential consequences can include social isolation, injury from falls, and inability to work, travel or be physically active. Lin testified in support of the Over-theCounter Hearing Aid Act before the House Committee on Energy and Commerce’s health subcommittee in May 2017. During his testimony, he told lawmakers that only 20 percent of Americans suffering from significant hearing loss actually use hearing aids. Dr. William Luxford, an ear, nose and throat specialist on staff at Providence Saint Joseph Medical Center in Burbank, Calif., said there are apps that allow consumers to administer their own hearing tests, which can provide reasonably accurate results. While the over-the-counter hearing aids have not yet been developed, they are on their way and “it’s not something that
Photos by Karen Elshout/ © CHA
would benefit from having two devices at roughly $2,350 apiece. Out-of-pocket cost is not the only impediment to correcting hearing loss. The President’s Council of Advisors on Science and Technology reported in October 2015 that in European countries, where people with hearing loss can obtain free or low-cost hearing aids, many don’t use them because of the social stigma or the association of the devices with old age. But that decision may carry risks.
Kristy Greco, a clinical audiologist at Mercy Hospital St. Louis, conducts a hearing test on Ashley Weilbacher, at the Mercy Audiology and Hearing Aid Center on the hospital’s campus in suburban St. Louis. Weilbacher works at the hospital.
device. Hearphones include noisereduction technology and retail for about $500. Although consumers will be able to fit, program and control the Bose hearing aid without assistance from a health care provider, the FDA said Bose “must comply with applicable state laws that might require hearing aids to be purchased from or dispensed by a licensed hearing aid dispenser.” In approving the Bose hearing aid, the FDA referenced clinical studies of 125 patients that demonstrated that consumers preferred the hearing settings they selected over those set by professionals. The Bose device label must inform the consumer when to consult a hearing professional.
Perils of self-diagnosis Main said that defining mild or moderate hearing loss is one of the shortcomings of the 2017 law authorizing the FDA Kathleen Garavalia has her hearing tested at the Mercy Audiology and to create the new category Hearing Aid Center. of over-the-counter hearing aids because “people either physicians or audiologists are going are not very good at self-identifying if they to prevent.” Clinicians should be prepared have a hearing loss and how much hearing to work with the consumers, he said. loss they have.” “I think it’s going to be there and we According to the Hearing Health Founhave to learn to work with it because that’s dation, people with mild hearing loss may the best way to prohave difficulty hearvide the patient with ing soft-spoken people “When you obtain the best care,” he said. and children. People “You really want to devices directly without with moderate hearapproach this as what the hearing health care ing loss have more difis best for the patient.” ficulty understanding speech. Without the professional involved, First in class use of hearing aids, there’s also the concern someone with moderIn October 2018, the FDA gave the audio ate hearing loss may that you’re missing company Bose the gonot be able to folahead to market the out on some important low a conversation or first self-fitting hearhear a phone ring, for ing aid for people age counseling and support in instance. 18 and over with mild In a traditional the interim.” to moderate hearing hearing evaluation, — Jennifer Main loss. The product is an audiogram — or a not yet available. Margraph showing someket watchers expect it to be comparable one’s hearing pitch by pitch — can reveal a to Bose Hearphones, a sound-amplifying mild hearing loss indicated by thresholds device not categorized as a medical of the softest sounds the person can hear
at each pitch in the range of 30 to 40 decibels, Main said. The Hearing Health Foundation defines moderate hearing loss as difficulty hearing sounds in the 41 to 55 decibel range.
The test is run first by air conduction to see how the sound transfers through the entire auditory system starting at the ear canal. Audiologists also look at the measures by bone conduction, bypassing the outer and inner ear and directly stimulating the cochlea. A standard set of audi– ology tests also includes speech testing and middle ear assessment. When patients try to self-diagnose their condition, they may miss types of hearing losses that can be improved by medical intervention — perhaps as simple as removing a ball of earwax or as complicated as repairing a hole in the eardrum. Catherine Palmer is president-elect of the American Academy of Audiology and an associate professor at the University of Pittsburgh. She said about 10 percent of adults with hearing loss have a medical problem, and an audiologist would be able to guide them to the appropriate medical care. Main added, “When you obtain devices directly without the hearing health care professional involved, there’s also the concern that you’re missing out on some important counseling and support in the interim.” Counseling can include discussions of the functional limitations of the patient’s hearing loss and the opportunities to supplement amplification with other devices or communication strategies that can optimize the use of a hearing aid. Despite their reservations, audiologists who spoke to Catholic Health World joined Main in expressing appreciation for the heightened awareness that the over-the-counter hearing aid law is bringing to hearing loss and its implications for patients’ quality of life and health.
A Palliative Care Prayer in honor of Pastoral Care Week, Oct. 20 – 26
Let us together lift up our needs to our God, who is ever-present and always loving. God of all comfort, be with those who are sick and suffering. May they receive the medical, spiritual and psychological care they need; may they be supported in love by their family and friends, enabled to live well. We pray, ALL: GRACIOUS GOD, HEAR US.
God of all companionship, be with those who care for others in their infirmity. Strengthen them with the graces of patience, love, joy and peace. Surround them with communities of care. We pray, ALL: GRACIOUS GOD, HEAR US.
God of all people, move in our hearts that we may affirm the value of all human life through our action and advocacy on behalf of those who suffer. Open our eyes to see you in the faces of those affected by serious illness that we may care for them as we would care for you. We pray, ALL: GRACIOUS GOD, HEAR US.
Visit chausa.org/pastoralcare/resources to download mobile apps to assist in pastoral and spiritual care.
October 15, 2019 CATHOLIC HEALTH WORLD
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KEEPING UP
Forney
Dumont
PRESIDENT/CEO Jason M. Adams to president of Saint Joseph East and chief operating officer of Saint Joseph Hospital. The facilities are located in Lexington, Ky., and are part of CommonSpirit Health’s CHI Saint Joseph Health. Adams was system chief operating officer for CHRISTUS Good Shepherd Health System in Longview, Texas.
ADMINISTRATIVE CHANGES Covenant Health of Tewksbury, Mass., and one of its facilities has made these changes: Steven Forney to senior vice president and chief financial officer of Covenant
EXECUTIVE REFERRAL Chief nursing officer/vice president of patient care services — A 350-bed Catholic hospital in northern New Jersey seeks a chief nursing officer. Master’s degree required, MAGNET and nursing school experience preferred. Send resume or call: Tom Benoit 732-284-6517; tom@allenthomas.com.
Biersack
Pena
and René Dumont to chief patient experience officer of St. Mary’s Health System of Lewiston, Maine. Trinity Health of Livonia, Mich., and organizations within Trinity have made these changes: Marcus Shipley to Trinity senior vice president of innovation and chief information officer and Cassandra Willis-Abner to Trinity senior vice president, diversity and inclusion and chief experience officer. Dr. Matt Biersack to chief medical officer and Michelle Pena to chief nursing officer, both of Mercy Health Saint Mary’s of Grand Rapids, Mich. Stephanie Meade to chief nursing executive of the mid-American group and the Cincinnati area for Bon Secours Mercy Health of Cincinnati. Dr. Hijinio Carreon to interim chief medical officer of MercyOne Des Moines and West Des Moines medical centers in Iowa. Regina Peterson to chief nursing officer for HSHS St. Elizabeth’s Hospital of O’Fallon, Ill. Dr. Travis Sewalls to chief medical officer for Saint Joseph Hospital and Saint Joseph East of Lexington, Ky. Dr. Kevin Post to chief medical officer of Avera Medical Group of Sioux Falls, S.D.
Share the joy of the season with a Christmas message to the ministry
Meade
Carreon
ANNIVERSARIES The Alexian Brothers’ Immaculate Conception Province is marking 150 years since the establishment of its Chicago ministry, its first ministry in the U.S. CHRISTUS Santa Rosa Hospital – Westover Hills, San Antonio, 10 years.
GRANTS Marian Regional Medical Center of Santa Maria, Calif., has received a
Peterson
Sewalls
$2.7 million building donation from The Sierra Land Group. The funding will allow Marian to expand behavioral health services at Santa Maria’s Marian West campus by establishing a crisis stabilization unit. Essentia Health – St. Joseph’s Foundation of Brainerd, Minn., has received a gift of more than $700,000 from the Marilyn Covey Estate to support the work at the Marilyn Covey Heart & Vascular Center.
CHA Chief Operations and Finance Officer CHA is seeking a strategic executive aligned with the association’s mission to serve as its chief operations and finance officer. A member of the CHA president’s advisory council, this individual will be accountable for leading key financial and operational functions during a pivotal time for the association, with a recently appointed president and chief executive officer and a new strategic plan under development that will be in effect beginning July 1, 2020. Based in St. Louis and reporting directly to the president/CEO, the chief operations and finance officer will be responsible for the financial and operational vision, and alignment of operations to advance CHA’s strategic priorities and ensure the financial, technology, production and business intelligence functions remain efficient, effective and service-oriented. Strong financial acumen and demonstrated fiscal stewardship are top priorities as this person will be the key staff liaison in support of the association’s finance committee, co-staff for the organization’s audit and compliance committee, and its corporate treasurer. In addition, this person must have a proven ability to build relationships and collaborate effectively with other leaders. Excellent verbal and written communication skills are imperative as well as the ability to maintain integrity, establish credibility, and earn trust and respect. Requests for additional information or nominations should be directed to the consultants supporting this search: Donna Padilla, Jim King, and Wendy Brower c/o WittKieffer 7733 Forsyth, Suite 725 St. Louis, MO 63105 Phone: 314-754-6072 Email: wbrower@wittkieffer.com CHA is an equal opportunity employer.
U.S. Postal Service STATEMENT OF OWNERSHIP, MANAGEMENT, AND CIRCULATION (Required by 39 U.S.C. 3685) 1. Publication title: Catholic Health World 2. Publication number: 8756-4068 3. Filing date: Oct. 15, 2019 4. Issue frequency: Semimonthly except monthly in January and July. 5. No. of issues published annually: 22 6. Annual subscription price: free for members, $55 for nonmembers and foreign subscriptions 7. Complete mailing address of known office of publication: 4455 Woodson Rd., St. Louis, MO 63134-3797 8. Complete mailing address of headquarters or general business office of publisher: The Catholic Health Association of the United States, 4455 Woodson Rd., St. Louis, MO 63134-3797 9. Full names and complete addresses of publisher,
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15. Extent and nature of circulation: a. Total number of copies printed (net press run) b. Paid and/or requested circulation (1) Paid/requested outside-county mail subscriptions stated on Form 3541. (2) Paid in-county subscriptions (3) Sales through dealers and carriers, street vendors, counter sales, and other USPS paid distribution (4) Other classes mailed through the USPS c. Total paid and/or requested circulation [Sum of 15b(1), (2), (3), and (4)] d. Free distribution by mail (Samples, complimentary, and other free) (1) Outside-county as stated on Form 3541 (2) In-county as stated on Form 3541 (3) Other classes mailed through the USPS (4) Free distribution outside the mail (Carriers or other means) e. Total free distribution [Sum of 15d(1), (2), (3), and (4)] f. Total distribution (Sum of 15c and 15e) g. Copies not distributed h. Total (Sum of 15f and g) i. Percent paid and/or requested circulation (15c/15f x 100) 17. T his statement of ownership will be printed in the Oct. 15, 2019, issue of this publication.
editor, and managing editor: Catholic Health Association, publisher; Judith VandeWater, editor; Julie Minda and Lisa Eisenhauer, associate editors; 4455 Woodson Rd., St. Louis, MO 63134-3797 10. Owner: The Catholic Health Association of the United States, 4455 Woodson Rd., St. Louis, MO 63134-3797 11. Known bondholders, mortgagees, and other security holders: None. 12. The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes have not changed during the preceding 12 months. 13. Publication name: Catholic Health World 14. Issue date for circulation data below: Sept. 15, 2019
Average No. Copies Each Issue During Preceding 12 Months
No. Copies of Single Issue Published Nearest to Filing Date
15,656 13,210
14,530 12,201
420 0
414 0
0 13,630
0 12,615
1,671 65 0 0
1,522 65 0 0
1,736 15,366 290 15,656 88.70%
1,587 14,202 328 14,530 88.82%
I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions and/or civil sanctions. Judith VandeWater, editor.
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CATHOLIC HEALTH WORLD October 15, 2019
Back in the spin: Seniors relish pedal-powered adventures Cycling programs popular at SSM Health and Benedictine Health continuum-of-care facilities By LISA EISENHAUER
program’s mission. The front of the cycles has a seating compartment with room for two adult passengers. The seat for the “pilot” who does the pedaling is in the back. “We quite literally say we put our passengers first,” Talcott says. “They are the first ones you see. They become approachable, they become visible, they reconnect with the community. It’s about a lot more than just giving nice people rides outside. It’s really about creating and strengthening and developing connections with your community.” Talcott says he connected with the program while visiting his daughter, who lives in Copenhagen. He was coaxed by Cycling Without Age founder Ole Kassow, whom he got to know socially, to try piloting a rickshaw. He picked up a woman living at a care center who was from Poland, had run her own business and spoke several languages. The plan was to go across the city to a Polish grocery so the woman could buy some candy. “What was supposed to be a 45-minute ride went for like three and a half, four hours,” Talcott recalls. “It was great. She was wonderful.”
Joyride Connections like that between riders and pilots aren’t unusual
Benedictine Living Community resident Marie Anderson and wellness aide Katrina Prestegord enjoy an afternoon ride this summer in Ada, Minn.
Konen says it wouldn’t be possible to get the trishaw and its human cargo up the hills of Baraboo. Konen says that while the passengers are the focus, the pilots benefit from the program, too. “It’s just fun for me to watch people enjoy themselves,” he says.
Movement is growing Cycling Without Age started in Copenhagen in 2012 and has since spread across the globe, including to more than 40 U.S. states. Talcott says that dozens of chapters started just this year. Cycling is proving popular at other continuum of care facilities that don’t have connections to the Cycling Without Age program too. The Benedictine Living Community of Ada, Minn., a member of the Benedictine Health System, bought a side-by-side tandem electric adult tricycle in July and has a wheelchair-accessible rickshaw on order. Both are built by a Netherlands-based company called Van Raam. Cassie Visser, wellness director at the care center that has 49 beds and 18 assisted-living apartments, says she was surprised at how quickly the donations rolled in to buy the cycles after she asked. Together, the cycles cost about $21,000. Even in its infancy, Visser says the cycling program is big hit with residents. “They get to be outside, to have a sense of independence, to exercise, and to do something they never thought they’d get to do again,” she says. The care center plans to keep the cycles in use on the quiet streets of Ada (population 1,620) for outings and appointments while the weather is nice and offer inside rides once cold weather sets in. In Baraboo, the Meadows has a core group of about a dozen people who volunteer as pilots for its cycles, including Machovec and Fichter, but Machovec says the rides are so popular among the 118 residents who are either getting skilled or assisted-living care that she could always use more pedalers. Smith is among the residents who never pass up a chance for a spin through town. “I think it’s the greatest,” she says of the program. leisenhauer@chausa.org
Courtesy SSM Health St. Clare Meadows Care Center
Putting passengers in front To officially be part of Cycling Without Age, chapters must purchase cycles that have been reviewed and approved by the program. Those cycles were specially designed to promote the
SSM Health St. Clare Meadows Care Center residents Gen Meyer, left, and Verna Boll stop for a pumpkin during a September 2017 spin on one of two electric “trishaws” that are used in the center’s Cycling Without Age program.
Courtesy Benedictine Living Community of Ada
On the town Machovec says the rides have transforming effects on residents. “So many of our residents are in wheelchairs and when you get on the bike, the wheelchair, the cane, the walker, any of that equipment is gone,” she says. “You see people open up in a way that you might not see otherwise.” The residents greet and chat with people out on the streets and those people most often respond in kind to the friendly overtures. “It changes how people look at our residents when we’re in the community on the bike,” Machovec says. Instead of seeing an elderly and perhaps frail care center resident, she says, the community sees a lively and active senior. Kelly Talcott is the U.S. captain for the nonprofit Cycling Without Age. He says the reaction that residents of St. Clare Meadows get is exactly what the program’s founder was hoping for. One of the program’s guiding principles is that people should be out in their local community no matter their age. “You take people who are sometimes forgotten, and they go out and they feel important, they feel noticed, they feel welcome,” Talcott says. “That’s a great feeling to share and to be part of.”
Courtesy SSM Health St. Clare Meadows Care Center
W
hen the weather is nice, Jean Smith likes to get out and see the sights in her hometown of Baraboo, Wis. “I’ve been to the county fair twice,” Smith says. “I’ve been to the river walk here at least three times and last week I went somewhere that I didn’t know existed here in Baraboo, an arboretum, and that was really neat.” When she goes, the 92-year-old goes in style at the front of one of two three-wheeled rickshaws that the SSM Health St. Clare Meadows Care Center has to ferry her and other residents around town. The care center acquired its first “trishaw” in spring 2017, when it formed a chapter of a program called Cycling Without Age. Samantha Machovec, director of organizational advancement and activities at St. Clare Meadows, and her colleague Teri Fichter, volunteer coordinator, got the program rolling after hearing about a chapter of Cycling Without Age in Oshkosh, Wis. The care center bought its first rickshaw and brought the founder of the program to Baraboo from Denmark to launch its chapter through a donation from the family of a woman who had spent many years working at what is now SSM Health St. Clare Hospital in Baraboo. The rides were so popular the St. Clare Foundation, the hospital’s charitable arm, funded the purchase of a second cycle later that same year. The cycles range in cost from $7,500-$9,500.
in the program. In fact, Smith, the St. Clare Meadows resident, has formed a similar bond with Bob Konen, a retired dentist who has been volunteering with the Meadows’ chapter in Baraboo since it launched. Konen calls Smith — one of his most frequent passengers — “a very special lady.” “When I first started, I was like, ‘What I am going to talk about?’ but we’re always yakking about something,” he says. The 65-year-old devotes a few hours each week to piloting one of the Meadows’ trishaws and takes any Meadows resident who signs up for a spin. Among his other memorable passengers have been a couple celebrating their 70th anniversary, who he cruised over to the home where they used to live and behind home plate of the baseball diamond where the husband used to play. Konen chauffeured a woman celebrating her 100th birthday. She was serenaded at one of the concerts on the square while she sat in the trishaw and gleefully soaked in it. In addition to the two-person passenger compartment, all of the trishaws have electric motors the pilots can use when they need a power boost. Without them,
Ole Kassow, founder of Cycling Without Age, gives SSM Health St. Clare Meadows Care Center resident Eunice McCoy and her daughter, Bonnie Braun, a ride at the launch of the care center’s chapter of the program on a snowy day in April 2017. McCoy has since died.