The Business Magazine of Kentucky Physicians and HealthCare Administrators April 2011
Issue Spotlight:
Orthopedics BREAK-THROUGH MENISCAL REPAIR
SPECIAL SECTION:
SPORTS MEDICINE new inside :
NEW EVENTS, IMPROVED INDICES
Ortho Kentucky Declares
Volume 2, Number 4
Independence
Four orthopedic group practices merge into Lexington-based Ortho Kentucky. While others wait for answers on managed care, the independent specialty group gains the competitive edge.
Saint Joseph Outpatient Rehabilitation PHYSICAL tHERAPY • oCCUPAtIoNAL tHERAPY sPEECH THERAPY At Outpatient Rehabilitation Services, our experienced physical, occupational and speech therapists work with a variety of diagnoses and collaborate with physicians to return patients to normal activity levels. Whether it’s an orthopedic injury, such as a strain or sprain, or rehab after surgery, our Outpatient Rehabilitation Services provide a comprehensive medical rehabilitation program. OUR LOCATIONS: Saint Joseph Park Physical Therapy Saint Joseph Office Park 859.313.1699 Saint Joseph East Medical Office Building 859.967.5737 Saint Joseph - Jessamine RJ Corman Ambulatory Care Center 859.887.6756 Saint Joseph - Berea 1st Floor Inside Hospital 859.986.6543
COMMON CONDITIONS TREATED: ORThOpEDIC CONDITIONS • Musculoskeletal Conditions of the Spine & Extremities • Generalized Weakness • Decreased Range of Motion Neurological Conditions • Cervical/Lumbar Radiculopathy • Stroke • Parkinson’s Disease pAIN DISORDERS • Fibromyalgia • RSD (Complex Regional Pain Syndrome) • Pelvic Pain • Headaches SpEECh LANgUAgE DEfICITS • Swallowing Disorders • Voice Disorders • Cognitive/Linguistic Deficits OThER DISORDERS • Open Wounds • Incontinence • Lymphedema
2011 EDITORIAL CALENDAR 2011 EDITORIAL CALENDAR APRIL
Or thopedics & Spor ts Medicin e
MAY
Women’s Health
JUNE
Derm atology, Plastic Surger y & Allergies
JULY *
Intern al Medicin e & Prim ar y Care
AUGUST *
Pediatrics & ENT
SEPTEMBER
Urology & Nephrology
OCTOBER
Oncology
NOVEMBER
Neuroscience
DECEMBER
Psychiatr y & Ment al Health
Submission Deadline: Second Friday of the month before issue
JOIN TH E CLUB! Cont act u s t o d a y.
Gil Dunn, Publisher (859) 309-0720 phone gdunn@md-update.com Megan Campbell Smith, Editor-in-Chief (859) 309-9939 phone mcsmith@md-update.com mcsmith@md-updat
Letters
FROM THE DESK OF Gil Dunn, Publisher
Innovation is the core messages in this month’s Orthopedics and Sports Medicine issue.
New technology, like the Sequent Meniscal Repair system, which was invented by University of Louisville professor Dr. David Caborn, has lifechanging potential for injured athletes. Inside, you will see two images of the breakthrough meniscal repair taken from Caborn’s arthroscope during the world’s first Sequent procedure on March 28. Innovation in healthcare IT defines Joe Sostarich, founder of ZirMed and MedX12. M.D. Update editor-in-chief Megan C. Smith sat down with the irrepressible Sostarich for his recollections on the development of medical industry IT products and his personal business philosophies. And innovation is how independent specialty groups are moving from surviving to thriving while dealing with managed care. In our cover story, Ortho Kentucky Declares Independence, physicians from four recently merged orthopedic practices describe their merger objectives and discuss how adapting to change allows specialists to retain their competitive edge along with their profesBY Gil Dunn sional autonomy. Important updates in sports medicine treatment and rehabilitation are the subject of two symposia coming up later this summer. Innovative rehab techniques will be the topic at the KORT / Norton Sports Health Sports Medicine Symposium taking place in Louisville on June 10. World leaders in shoulder injuries will present at the Shoulder Center of Kentucky’s 14th Annual Shoulder Symposium, organized by Dr. Ben Kibler, and held in Lexington July 29-30. While orthopedic surgeons can replace and repair aging or injured joints with artificial joint systems, major organ transplants depend on tissue donations. The Kentucky Organ Donor Registry, now five years old, has over one million Kentuckians registered. We wrap up national Donate for Life month with a message from Jenny Miller Jones, director of education for Kentucky Organ Donor Affiliates. We’ve added a new specialty for June’s M.D. Update: Allergists. Please contact us if your practice wants to be included in a future issue. Also, archived editions of M.D. Update are now available online at www. mdupdate.com. Until next month All the Best, Gil Dunn
Submit your Letter to the Editor to Megan Campbell Smith at mcsmith@md-update.com 2 M.D. Update
Kentucky Issue Volume 2, Number 4 April 2011 Publisher
Gil Dunn gdunn@md-update.com Editor in Chief
Megan Campbell Smith mcsmith@md-update.com Associate Editor
Greg Backus gbackus@md-update.com Photographer
Kirk Schlea kirk@ md-update.com Writers
Jennifer S. Newton Melissa B. Zoeller Graphic Designer
James Shambhu art@md-update.com
Contributors: Wallace Huff, MD Jenny Miller Jones Scott Neal Carol A. Quaif
Send your Letters to the Editor to: mcsmith@md-update.com
Mentelle Media, LLC
921 Beasley Street, Suite 210 Lexington, KY 40509 (859) 309-9939 phone and fax Mentelle Media, LLC is locally owned and operated. Mentelle Media strives to produce top quality referral and marketing resources for Kentucky’s professionals by welcoming the participation of our readers. For more information about how your business or medical practice can get involved, contact Gil Dunn at (859) 309-0720. Standard class mail paid in Denver Co. Postmaster: Please send notices on Form 3579 to 921 Beasley Street, Suite 210 Lexington, KY 40509 M.D. Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials. Copyright 2010 Mentelle Media, LLC. Contact Mentelle Media for information on obtaining reprints. Individual copies of M.D. Update are available for $7.95.
Contents
April 2011
2 LETTERS 5 HEADLINES 11 FINANCE 12 PRACTICE MANAGEMENT 14 Healthcare IT 16 Insurance 24 Physician Viewpoint 25 Allied Health 36 NEWS 44 Events 46 ARTS
cover story Four orthopedic group practices merge into Lexington-based Ortho Kentucky. While others wait for answers on managed care, the independent specialty group gains the competitive edge. Page 18
Ortho Kentucky Declares
Independence
On the Cover:
Mark E. Einbecker, MD, with the Kentucky Orthopaedic & Hand Surgeons Photograph by Kirk Schlea
special section
Sports Medicine
28 Norton’s Top Recruits
30 Lexington Clinic Champs
32 Pikeville Powers Forward
33 Heavyweight Frazier Rehab
34 Return Specialist Apex PT April 2011 3
Headlines Now Open:
the Generic Orthopedic Device Market DENVER, CO. Earlier this month, a privately held Colorado medical device company announced the launch of the industry’s first generic orthopedic implants and instruments. Emerge Medical, initially focused on cannulated screws and drill bits, is aiming at the $2B orthopedic trauma market. In a press release on April 4, Emerge Medical CEO John Marotta said “Our supply chain model offers hospitals and physicians high-quality products at a significantly lower cost, changing the way medical device sales are approached and empowering hospitals to improve efficiency.� The company also plans to introduce its generic devices into the larger orthopedic market, including sports and spine. Cannulated screws, being standardized and lacking strong physician presence, give Emerge Medical a stake at the entire $92B device industry. Company CFO Zach Stassen said that because years have passes with little innovation in many medical devices, the generic approach has the potential to unburden contemporary healthcare systems. The company estimates that hospitals could save between 40 and 50 percent by purchasing generic orthopedic devices.
WHAT DO YOU THINK?
Who benefits the most from generic orthopedic devices? Will generic orthopedics spur innovation or just drive up cost on name brand devices? Send your thoughts on generic orthopedic devices to mcsmith@md-update.com.
Dr. Tim Wilson of Central Kentucky Orthopaedics sizes up a knee injury. Photo by Kirk Schlea, 2007. April 2011 5
headlines
Breakthrough in Meniscal Repair
Jewish Hospital/UofL surgeon David Caborn invents, then performs world’s first Sequent Meniscal Repair procedure By gil Dunn LOUISVILLE On March 28, a groundbreaking surgery occurred that might rewrite outcomes and extend the playing careers of athletes with meniscal tears. David Caborn, MD, UofL clinical professor and orthopedic surgeon with Shea Orthopaedic Group (a Jewish Physician Group affiliate) performed the first Sequent Meniscal Repair procedure on a 17-year-old male high school athlete who had torn his ACL and lateral meniscus playing basketball. Caborn, who invented the Sequent system and, over the last 15 months, saw it though FDA trials and approval, says the
new repair procedure has the “potential to revolutionize the way we look at and consider meniscus repair or removal.” Torn cartilage, one of the most common knee injuries, is routinely repaired by arthroscopic meniscectomy, but many athletes face future ligament failure and osteoarthritis following the traditional repair. The new Sequent procedure saves and repairs the athlete’s meniscus tissue through
just one or two entries into the knee joint. The new procedure also reduces re-injury and protects the joint-lining cartilage. According to Caborn, the genesis of the Sequent Meniscal Repair system occurred
a few years ago during a conference of the Japanese Arthroscopy Association when discussions turned to the deficiency in the arthroscopic meniscectomy technique; specifically, when combined with ligament reconstruction of the ACL or PCL, developing arthritis of the knee is a near certainty. Japanese surgeons were the first to do arthroscopic meniscus repair, but the procedure involved stitching from outside of the joint through incisions in the back of the knee joint, and this risked damaging nerves
The Sequent Meniscal Repair system can implant multiple stitches in a nearly limitless array of configurations (1). This “all in side, stay inside” repair is accomplished using the Sequent delivery needle and handpiece (2). The implants are self-tensioned, and a sutures cutter releases the Sequent device from the joint (3). A YouTube video explaining the implant is available at www.youtube.com/watch?v=q4uPBhrEQP0.
6 M.D. Update
and blood vessels. Furthermore, the traditional technique involves the implanting of individual stitches one incision at a time. Caborn envisioned repairing the meniscus tissue through just one or two incisions with a stitching technique that resembles the hemming of a pair of pants. “There was nothing that could reproduce or was analogous to a sewing machine,”
says Caborn, “where multiple stitches could be put in multiple different configurations.” Addressing tears where the tissue could be damaged in various orientations is imperative in order to save the tissue, and changing the direction or orientation of the stitches would allow repair without damaging the tissue. Using the Sequent Meniscal Repair sys-
These images of the world’s first Sequent Meniscal Repair procedure were taken from Dr. Caborn’s arthroscope on March 28.
tem, which is manufactured by ConMed Linvatec, a surgeon can enter the knee joint, pass through the meniscus, come out, and pass through the meniscus again – all without leaving the inside of the knee joint. The Sequent device is loaded with multiple implants, each with suture locking technology, that allow for fixed, individually ten-
sioned stitches that create a knotless repair in any configuration. Describing the procedure, Caborn says, “Tension is applied between each of those implants, which locks the suture in place. The Sequent device is not removed, so you just keep going on down the line until you put your six stitches in tension.
“Each one is a separate locking mechanism. You have this intertwining of the stitching and sharing of the stitching without cutting into the tissue. Also, you are not damaging the tissue because the load is shared across that whole construct. You don’t have to keep going in and out of the knee. You are doing it all while watching it directly with your arthroscope. It is truly unique.” Meniscal and ligament tears often occur together. Currently, up to 55 percent of patients with an ACL tear will have some portion of their medial meniscal cartilage removed, and up to 67 percent will have part of their lateral meniscal cartilage removed. “Now,” says Caborn, “when we perform the ACL reconstruction, we can really give the orthopedic surgeon the option to repair a very high percentage of that meniscus cartilage that would have previously been removed.” Caborn specializes in meniscus repair with Shea Orthopaedic Group. “For years, he says, “when my partners saw a meniscus tear, they would refer it to me because I was the person who would repair meniscus tears. Now we all have a device that the other members of my group and other doctors can use to repair the meniscus without the excessive technical demands that were present before. Our message, our goal, is to ‘save the meniscus’.” ◆ April 2011 7
headlines
Sticking to It
Veteran healthcare administrator Jerry Dooley stays on to lead Georgetown Community Hospital By Megan C. Smith GEORGETOWN On February 24, Georgetown Community Hospital announced that Jerry Dooley, interim CEO since late October 2010, had accepted leadership of the LifePoint community hospital on a permanent basis. This is the first time Dooley has hung his hat for a while; in recent years, he has served five interim CEO positions in Kentucky, Indiana, and Virginia. Previously, Dooley served as CEO of Monroe Hospital in Bloomington for one year and CEO of Terra Haute Regional Hospital, Indiana, for 16 years. Dooley acknowledges that today’s economic conditions are a great challenge to hospital CEOs. Nationally, chief executive turnover is at about 18 percent per annum, demonstrating that the problems of healthcare are not quickly or easily resolved. Threats of deep cuts to Medicaid reimbursements put pressure on hospitals to spread their expense around, explains Dooley. Hospitals, which must accept Medicaid, are already being reimbursed at about 25 percent of cost. Adding to that burden are new patients being added to Medicaid through healthcare reform. Sure it means that hospitals will be reimbursed for some patients who were never reimbursed before, but hospital CEOs like Dooley need the state to meet their financial challenges. Governor Beshear’s plan to pay FY11 reimbursement rates on FY12 savings gained through managed care supposes that sufficient savings can be attained in just two years. While Governor Beshear has “every confidence” that managed care will keep Medicaid reimbursements stable, Dooley questions whether savings can be generated that quickly. “I hope it works,” he says. “It is a difficult problem that has not been experienced before, and certainly not in such difficult economic times.”
The Game Plan
For this Indiana fan, competition is welcomed challenge. In addition to problems with reimbursements and healthcare reform, Dooley says 8 M.D. Update
Georgetown by reducing outward migration of healthcare dollars to nearby Lexington. GCH is unique among Kentucky’s LifePoint hospitals for being integrated with a metropolitan marketplace. “If I had one wish,” jokes Dooley, “I’d move Georgetown Community Hospital 20 miles away.” On the other hand, being close to Lexington has proven very useful in the formation of care alliances. GCH, which will hire its first employed physician later this year, has agreements with UK HealthCare for cancer and obstetric services, and Central Baptist has three physicians on site providing primary care. Dooley says that each agrees that they want Georgetown Community Hospital Jerry Dooley, CEO of Georgetown Hospital, says he to be a “strong, complete, conveis focused on providing the community’s primary nient, and secure asset to the resihealthcare needs. dents of Scott County.” Plans for GCH include an importhat competition between hospitals and com- tant expansion of maternity services, says petition between physicians and hospitals is Dooley. Presently, Dr. Joe Haynes is the strongly influencing Georgetown Community only obstetrician at GCH, though there are Hospital (GCH) leadership today. about 1200 children born to Scott County Through its subsidiaries like GCH, residents each year. Fifteen children are LifePoint operates 52 hospital campuses in born at GCH each month, but at their 17 states. Every one is a community-based peak, they delivered between 500 and 600 enterprise, Dooley explains, with the goal babies per year. The loss of most of their OB of providing convenient, quality healthcare department, says Dooley, “has had signifiservices at a competitive cost. Also impor- cant impact on the pediatric and gynecoltant is supporting local physicians’ practices. ogy practices in Georgetown.” GCH does this, says Dooley, “by focusing Dooley understands that GCH canon what we do well. We make sure we are not be all things to all people, so he is marketing to the community the services focusing on core strengths while providthat are available here locally, for example ing for the community need. He reminds we have just sent out a mailer to the resi- us that community hospitals are typically dence of Scott County listing the services the largest employer in the community, that are available here.” and GCH alone pays over $1M in taxes Scott County, which was at one time each year. Being investor-owned, LifePoint Kentucky’s fastest growing population, is hospitals like GCH have an important today a young population with most resi- obligation to continue to work toward soludents under the age of 65. Focusing on tions for improved medical care, but the services such as primary care, ENT, OB/ responsibilities of fixing Medicaid, Dooley GYN, urology, general surgery, and bariatric warns, should not fall on hospitals and their surgery help Dooley keep market share in patients. ◆
headlines
New Law Reduces PT Copay By Greg Backus
Many consumers must pay specialty copays for physical therapy, which can limit compliance.
further surgery, imaging, and pharmacy.” Before SB 112, managed care companies restricted access to physical and occupational therapy services by charging “specialty” copays between $50 -75 per visit, jeopardizing compliance with physician-recommended frequency and duration of care. In their release, APTA says, “many consumers are forced to pay nearly $600 per month in out-of-pocket expenses to receive physical therapist services.” Continuing, Carper said that she hopes SB 112 will not only provide financial relief but will
June 10, 2011
8 am - 5 pm
allow patients to get “better, faster... We believe that SB 112 will lead to better outcomes as well as increased savings in the long run.” KPTA reports that this is the first time the organization has addressed payment issues through a state legislative effort. Again, in a release Dave Pariser, PT, PhD, legislative chair for KPTA, says that SB 112 was “truly was a team effort. Physical therapists, patients, and occupational therapists came together to advocate for this important legislation. It just goes to show what we can accomplish when we put our patients first.” ◆
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FRANKFORT On March 17, Governor Beshear signed into law new consumer protection legislation that reduces copays for physical therapy visits. The Kentucky Physical Therapy Association (KPTA) and the Kentucky Occupational Therapy Association successfully lobbied for swift enactment of Senate Bill 112, which was sponsored by State Senator Tom Buford (R) of District 22, comprising Boyle, Fayette, Garrard, and Jessamine Counties. According to a press release from the American Physical Therapy Association (APTA), “SB 112 limits a copayment or coinsurance amount for a physical therapist or occupational therapist visit to no greater than the copayment or coinsurance amount charged to a patient for a physician or an osteopath for an office visit.” Under the new law, insurance companies must clearly state the availability of physical therapies under their plans including all limitations. KPTA president Ramona Carper, PT, DPT, was quoted as saying “...For too long we saw the detrimental effects that excessively high copays were having on patient care. “The financial implication of excessive copay amounts results in disincentives for patients to participate in physical therapy, contributing to a lack of compliance for their care. This can result in significant recurrence and downstream costs including
April 2011 9
Financial
Probable Outcomes I am often asked, “Given one choice, which book on stock investments would I recommend to laypersons?” For years I recommended Andrew Tobias’ well-written, straight-to-thepoint paperbacks. Today, it would have to be the two far more substantial offerings of Ed Easterling - Unexpected Returns: Understanding Secular Stock Market Cycles and Probable Outcomes: Secular Stock Market Insights. If you only have time for one, go for the latter. Ed was formerly a professor of finance at Southern Methodist University where he taught alternative investments to MBA students. He has over 30 years of experience in investments and runs Crestmont Holdings, LLC, an Oregon-based investment management and research firm. His excellent research is available free of charge at www. crestmontresearch.com. Note: investment analysts often use the terms “secular” and “cyclical” to describe the markets. Secular trends refers to powerful, long-term directional moves that often extend a decade or longer. Cyclical moves are those that represent shorter-term swings around a primary trend. There seems to be a general consensus supported by very good historical data that a secular bull market existed between 1982 and 2000. Many believe that we entered a secular bear market at the turn of the millennium. Concurrent with that belief, the periods of 2002 to 2007, and now 2009 to the present would be characterized as cyclical bulls within the secular bear. This has wide-ranging implications on how your investment portfolio should be managed. As much as I simply like Ed’s writing style, it is his thought process that draws me to his books. He uses history to make meaningful inferences of the future, i.e., the following excerpt from Probable Outcomes. At this point, [2010] despite having been in a secular bear for a decade, the stock market has not made much progress, and remains on the front end of this cycle. There are no rules or restrictions about how quickly economic conditions, particularly the inflation
rate can change. This secular bear will end when the inflation rate rises significantly and peaks, or when deflation overtakes us and troughs. Note that it is not enough for bad conditions BY Scott Neal to arise; they must then be controlled and start to reverse before the next secular phase can begin. ...[T]here are only two courses out of this secular bear. The first is a slow, extended deterioration of inflation rate conditions, which could mean either high inflation or deflation. The result is a flat, choppy end to the secular bear market over another decade or longer, with few or no gains in the [stock] market. The second course is a rapid deterioration of inflation rate conditions. Earnings growth will not be able to offer much support, and the market will likely lose one-third or more of its value over a period of five years or so. Yet, unlike 2008, when the decline was
fully invested at all times, repeating the mantra, “buy, hold, and rebalance, and everything will be okay.” However, a very savvy advisor remarked to me recently, “In these kinds of markets, we can only tell clients to stay the course just so long.” Near the end of the book, in a couple of matrices, Easterling provides a model that is extremely helpful in plotting the interaction of economic growth and inflation-rate changes. In it, he gives us a method of seeing nine different scenarios and the probable return outcomes in both nominal and real, inflation-adjusted terms. The secret to successful investing is to discern how and when these trends develop and change in real time. Unfortunately, not many people, investors and advisors alike, want to take the time and energy to do this. In his first book, Easterling uses a boating analogy and points out that secular bear markets are the time for “rowing and not sailing.” We believe that this is a valid use of technical analysis—the daily and sometimes hourly re-evaluation of the price and volume trends of multiple markets in order to make more informed buy and sell decisions. That is how we have chosen to row the
A very savvy advisor remarked to me recently, “In these kinds of markets, we can only tell clients to stay the course just so long.” due to a financial crisis and not the result of inflation-rate problems, the recovery takes many years—often a decade or longer as inflation or deflation is battled into submission.
portfolio boat. This seems to put us very much in the minority of investment advisors. Another wise friend once told me, “Scott, running with the heard might just get you trampled.”
For many investors, these alternatives are grim and simply drive them out of the market altogether. They take a wait-and-see approach. Unfortunately, many advisors take the extreme opposite view and remain
Scott Neal is President of D. Scott Neal, Inc, a fee only financial planning and investment advisory firm. He can be reached at scott@ dsneal.com or by calling 1-800-344-9098. Scott is a CPA and Certified Financial Planner. ◆ April 2011 11
Practice Management
Which Way to Prosperity?
The answer may lie in your ability to navigate medical practice mergers and acquisitions. By Melissa B. Zoeller In the current state of health reform, practice management requirements and guidelines are intensifying and seemingly fluctuating on a daily basis. New rules, new coding changes, bundled payments – all of these are leading to major change, which can strike fear in physicians who have not changed with it. The major principles of health reform calls for a greater coordination of care and a higher level of communication through tracking, monitoring, and reporting on patients. Health information technology is one of the cornerstones of the ACO model. It is a significant investment, and independent physicians particularly need to make sure they are doing what is right for them in this regard. Many physicians are realizing that in order to prosper in the reformed healthcare marketplace, they have to be affiliated with an accountable care organization or patientcentered medical facility. To be part of that care team they must form some alliances. Physicians do not necessarily have to be involved in a greater IPA or a corporateowned practice. They can remain autonomous but they must understand the trend is toward affiliation. This is one realization that directs the desire to consider a practice merger or hospital-based employment. DoctorsManagement (DM) in Knoxville, Tennessee, manages both mergers and acquisitions for hospitals and medical practices, all with a central focus on never compromising patient care. Valora Gurganious is a senior consultant with the firm and specializes in helping practices and hospitals alike manage the many aspects of consolidation. The company has seen a good mix of both primaries and specialties forming IPAs 12 M.D. Update
and ACOs. Gurganious says their main goal is to assist the practices in determining what structure makes the most sense for them and how to manage the legal and credentialing aspects of the change, including any other details that might effect consolidation. “We help our clients understand how to begin in the world of mergers and acquisitions,” states Gurganious. “They come to us because they are wondering how best to handle negotiations, evaluate if offers are reasonable, what questions to ask and what they need to do to protect their own interests during the transactions.” Before healthcare reform passed, DM received eight to 10 M&A inquiries every week. A major pause occurred while physicians were observing the outcome of the reform, and many practices chose to wait it out, hoping to make better-informed decisions before giving up their autonomy. Whatever their reasons may have been, based on the stage of their own careers or their own personal goals, or based on fear or uncertainty, many physicians are now taking another look at the options. “Physicians are Valora Gurganious reconsidering because is a senior they want to be more consultant with efficient from an DoctorsManagement operations and finanof Knoxville. cial standpoint,” adds She is seeing increased activity in Gurganious, “We institutional inquiries really take a scalpel to into medical practice expenses, work flow, acquisitions. how practices spend their money and generate revenue, as well as recommending additional services to introduce, all while still keeping an eye on regulatory concerns, compliance issues and training and development of staff.” Gurganious notes that the currently, the trend is acquisitions over mergers, with institutional acquisitions of private practices making up an estimated 90 percent of inquiries and activity. The hospital’s goal is to get all of the premier providers in the area affiliated with them so they are not picked off by a competing health care sys-
tem or an outside corporate-owned health care organization that might be looking at their market. The bottom line is to secure practices as quickly as possible, in order to obtain referrals, ancillaries, laboratories, diagnostic testing, and surgical facility fees that are generated. If the physician goes elsewhere and becomes affiliated with a competing system, they will never have access to them. This gives physicians a start with some power, particularly if they have a large patient base in their local market. Sometimes having an advocate or spokesperson can also change the dynamic. Individuals feel better in dealing with corporate institutions when they have professional representation.
Taking Acquisitions Seriously
“The first question I ask when a practitioner calls concerning whether they should take an offer seriously is if they think that the hospital is the right partner for them,” says Gurganious. “Do they have a physicianfriendly orientation? Is their management and administration reasonable? Do they have a sound business strategy? It is amazing to me how often doctors will say that they do not like dealing with them.” If so, then why consider becoming an employee of an institution that does not share the same goals? Gurganious observes that joining, in that case, would likely leave the physician miserable. Other consideration include whether the hospital has experience in physician practice acquisition and management. If they do, then talk to their doctors and find out what their experiences have been. Did they feel like it has been a successful affiliation or do they feel like they wished they had not done it? Gurganious reminds physicians that hospitals are not acquiring practices for altruistic reasons; they are doing it strictly for business purposes. Physicians must remember that they have power in these dealings and must not discount that. Many physicians do want security, stability in their earnings, benefits, 401k plans, paid health and liability insurance, HR and much more. With all of that on the hospital’s side, doc-
tors must not forget their own value. Before a hospital is authorized to make an acquisition, they must have an evaluation performed by a certified valuation analyst, confirming that the valuation is a fair market calculation based on sound accounting principles, compliant with legal guidelines and rules. All of the calculations must demonstrate where they came from, how they were arrived at, what sources were used. The CVA is a recognized industry credential, and says Gurganious, the main reason why hospitals and medical practices are seeking her advice. “Hospitals must go through this process with a CVA and there are not many to choose from,” says Gurganious. “Physicians want to work with an organization that can tell them the ins-and-outs of the process, ultimately acting as their advocate. We offer both without fear of conflict of interest.”
It is certainly in the hospital’s best interest to secure the premier providers in their market, and to strengthen market share, positioning them to become an accountable care organization. Whether it is driven by insurance companies, large primary physician groups or multi-specialty practice groups, the situation is fluid and everyone is jockeying for the best possible spot. Hospitals are hoping to lead the charge if they can, so they are looking for the top
practices in each community. The dynamics are in place for it to happen in a big way and physicians need to make sure they are making a wise business decision that suits their own personal goals for their career. Future employment may come down to whether a practitioner is entrepreneurial or is more comfortable being an employee. In the end, Gurganious says that could be the driving factor in choosing between a merger and an acquisition. ◆
Merger opportunities
Practices looking to merge have many choices as well. Becoming one tax ID number may not always be the best option, says Gurganious. They may want to consider an IPA with a centralized administration, which helps with cost, benefits, and negotiation advantages when dealing with managed care plans. In some instances, practices can also qualify for federal incentives while forming an ACO, creating that patient-centered medical environment and meeting the necessary guidelines without losing complete autonomy. Administrative areas such as billing, HR, managed care and contracting become centralized, and practices will be unified into one electronic medical health record system. One that is part of a practice management system, or that can interface easily with a current system already in place. “We try to take advantage of scale economies where possible so each physician doesn’t have to give up everything that they have built as independent practitioner,” adds Gurganious.
Continue the Trend?
According to Gurganious, hospital acquisition of medical practices will continue to be the trend, largely because of the recession, which also increases physician interest. Physician income is declining generally and preference for an improved lifestyle has made them more receptive to the idea of consolidation.
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April 2011 13
healthcare IT
Infamous IT Leader Joe Sostarich
A quintessential entrepreneur, Sostarich is the man behind many of today’s practical and financial healthcare transactions. M.D. Update editor-in-chief Megan C. Smith had a unique opportunity to sit down with Joe Sostarich, the self-proclaimed “infamous” founder of healthcare IT companies ZirMed and MedX12. Sostarich, who has a reputation for living to his fullest capacity, has in years past has led his staff to take the Polar Bear Plunge in support of the Special Olympics. We asked Sostarich how this year’s Plunge went, and he said he didn’t go. M.D. Update: What happened, did you get scared? Sostarich: They had pools this year – where’s the danger in that? In the past they did the Plunge in the river, and you actually had to swim. This year they had pools. I will go back next year, but I was disappointed that you just jump in and out. The Plunge is part of your business legacy on how to be a charismatic leader. What exactly is your leadership philosophy? (Sostarich, demonstrating that he has answered this question before, picks up a large, prop starfish and points at its center.) That’s me, in the center. These legs are the company. For a starfish, if a leg is damaged or breaks off, the starfish grows a new one. In business, what I am doing is serving here at the center. These legs, they are the company’s departments. They are autonomous teams. I ask, ‘What can I do to be a catalyst to help others get their job done?’ They all do their jobs and I am only here to help them do that. That’s the kind of leader I am, like a starfish. It is unlike a spider, with its big head and the legs that are dependent upon
Joe Sostarich, who founded ZirMed and MedX12, is famous for his business acumen and notorious for his sense of humor.
it, and where if you cut the head off the spider the whole organism dies. Today you are known as a quintessential entrepreneur. Tell us about the first business you started? My interest in business developed during high school, a time when I felt driven to do things. My first entrepreneurial venture was a contract to build a small cistern. I ended up making ten cents an hour. I misjudged the time but gave him a price, so I learned from that experience the value of knowing the details of the job you are going to do. After I got out of college, I worked for Brown-Forman and became their tax director. I graduated from Bowling Green University with both business administration and accounting degrees. Then, after my retirement from Brown-Forman, I started a
“I ask, ‘What can I do to be a catalyst to help others get their job done?’ They all do their jobs and I am only here to help them do that. That’s the kind of leader I am.” 14 M.D. Update
venture with a former IRS agent, and we set up a tax system for the country of Ecuador. This was in 1985. We bid against all the big accounting firms and won. We were successful in winning the contract because my partners were brilliant; they really knew what they were doing. They were bilingual, and they were very kind and generous. Also, I think we won this contract because we were interested in the outcome of the project for the client, not in the amount of pay that we would receive. That is a huge starting point – developing the tax system for an entire nation. What made you think you could do it? I always felt really comfortable with launching ventures. I never doubted that I could do anything. If other people are doing it, why can’t I? At about the same time in 1985, I partnered with a guy who had a concept to etch the vehicle identification number directly onto the glass of the car. Sometimes a thief will pry this VIN tag off a junk car to replace the one on a stolen car, and suddenly the stolen car has disappeared. But, it is very expensive to replace glass, so doing etching the VIN on the door glass deterred theft. My business partner had an idea to
prevent theft and asked me how to do it. I knew how to generate the business, and he had the idea of what to do. Our primary client was Farmers Insurance Group, and we cut car theft for their California clients by 85 percent. We turned districts that had been losses and turned them into profits. We got a patent on the gel – that was the first thing I patented. Then I got the idea that there are a lot of medical transactions, tons of them. So I was thinking about ways of making money and I thought about subscriptions, because that is recurring revenue. I was reading an article about how many billions of transactions take place with doctors and medical facilities, and at the time, about 1998, this was mostly on paper. You are talking about the beginning of ZirMed? Yes. My partner in this venture was an insurance company executive, and we decided to make an Internet-based claim filing system. We brought in Doug Fielding to be our product development director. He was perfect for the job, so he came to Kentucky. We started ZirMed in January of 99, had our first product and our first customer in place by April of that same year. We did this with a quarter-million dollars. We would get 25 cents per claim at that time, though the amount has gone down since then. We sold subscriptions for the service. The doctors’ offices put all the information about the claim into the computer and send it to us electronically, and then we send it to the proper payers. The payers paid us about 10 cents a claim. Brilliant – you were selling to the buyer and to the payer. For a while that worked pretty good, then the payers got smart and said ‘we are going to allow you to go through us, but pay you diminishing amounts’ while they took the service we provided and did it for themselves. It lasted about 2 or 3 years. When we got really big, they had already cut that part out. How did you come to leave ZirMed? We were going to go public with Prudential insurance company in September of 2000. Then the stock market collapsed,
NASDAQ collapsed, and 500 start-up companies similar to ours went broke. Those were interested in developing a base, but they did not have a profit like we did. That is how Amazon did it – way before the market crash of course. Amazon lost money for years before they ever made a dime because they focused at first on building a large client base instead of turning a profit. If you capture the client base of the market then you have loyal clients. So, at the time we were acquiring clients and getting revenue in, but we were growing and developing the infrastructure to go public. We were 24 hours away from total oblivion because when the stock market collapsed we had too much overhead – too much invested in going public. Bob Kirchner, vice president of ZirMed, had a friendly contact who ended up funding the company until it became selfsufficient. We were in a growth curve, but we had not got o the point that we could sustain our own operations. So October 13, 2000, they came in and started putting money into the company. They immediately cut the staff back, but later re-hired most everyone they had cut. They downsized, but the employees continued without pay for a month while we were reorganizing. They were very loyal. That core really built the company. Even the ones that were let go during the downsize and came back – many of these people are still there today. So your heavy investment in an IPO was nearly your ruin? We were going to be in the big leagues. We were planning on mergers and acquisitions. We were servicing future needs out of capital – but with the collapse, the capital was gone. The employees really ran the departments. The way they operated was not top down – each department was running itself. So, after the investment, ZirMed never went public. It stayed private, and has remained very profitable. Everybody had a role there and knew what they were doing. John Freeman and I were the founders. My title was CFO, and John’s was Marketing VP. He had a phenomenal sense of how things fit together. But when the people came in to fund the business, they wanted to manage it. They we in effect Continues on page 26> April 2011 15
Insurance
Merging Practices: Protect Yourself
Prior Acts Coverage and Other Insurance Considerations for Changing Employment Many practices are considering mergers with, or selling to, another practice as a way to reduce overhead expenses and take advantage of economies of scale. If your practice is moving down that path, along with all the other details, please don’t overlook how you will insure and protect the physicians’ medical professional liability in this new organization. If both practices use the same insurer, the process of combining the policies is simple, and may even result in a larger group discount. Notify your carrier, and they will walk you through the process. If the practices currently use different carriers for medical professional liability insurance, or are seeking a new carrier for the new entity, there are some important factors to consider: 1) Prior Acts coverage (also called “nose” coverage). It is essential that you confirm that any new policy covers prior acts for all of the physicians included in the new entity. This means that the new insur-
BY
Carol A. Quaif
If both practices use the same insurer, the process of combining the policies is simple, and may even result in a larger group discount. Notify your carrier, and they will walk you through the process. ance company will assume responsibility for claims that arise, reaching back as far as each physician’s retroactive date (or original inception date) of coverage. If Prior Acts coverage is not available from the new carrier, seriously consider purchasing an Extended Reporting Endorsement (tail coverage) from the current insurance companies. While these can prove expensive, they give the newly merged practice the opportunity to start over with the new insurer for less premium. Without the purchase of either an Extended Reporting Endorsement or Prior Acts coverage, there will be no insurance protection available for any patient care delivered prior to the new effective date (and new retroactive date). 16 M.D. Update
For example, consider Dr. Lincoln. He has purchased new coverage effective 3/1/2011 and the retroactive date with his previous insurer is 3/1/1997. If Dr. Lincoln’s new insurance company agrees to provide Prior Acts coverage, they will now be responsible for any future claim arising back to 3/1/1997. If the new company cannot provide, or is unwilling to provide, Prior Acts coverage, they will give him a new retroactive date, 3/1/2011, and will only cover claims incurred after this date. Dr. Lincoln must then purchase an Extended Reporting Endorsement from his old insurer, or go without coverage for any future claims from his practice arising between 3/1/1997 and 3/1/2011. Before making any changes, make sure that all known or potential claims have been
reported to your current carrier. 2) Coverage trigger. Check policies from both the old and new insurance companies for what is considered a claim, or the “coverage trigger”. Look for a policy that considers a claim to be reported on the date you report an incident to the insurance company (incident reporting or incident sensitive), whether or not a lawsuit has been filed. 3) Financial strength. You want to know that the company selected will be there when you need them, to protect your livelihood and reputation. AM Best ratings are a good source of independent information on insurance companies. You can also inquire about a company’s total assets and surplus and review prior annual reports or financial statements. If your practice is being acquired by a hospital, insist on individual physician coverage with a company you know and trust. This may be pivotal if a lawsuit arises against you and the hospital-employer. The entity paying the premiums usually has some say in the decisions about the lawsuit. Also, in a hospital, all physicians’ medical professional liability insurance is often lumped together and applied to overhead – making it possible that your rates could increase greatly over time. There are many important factors to consider when merging practices with or selling your practice to a hospital. Prior to making such a significant decision, do your due diligence by reviewing your current and potential insurance policies and other contracts. Thoroughly evaluate the pros and cons of the opportunity along with the assistance of legal counsel and other professionals who specialize in such sales or mergers before you finalize your decision. Carol A. Quaif, CIC, RPLU is president of MAG Mutual Insurance Agency, with more than 30 years experience in the insurance industry. For the last 20 years, Carol has focused exclusively on insurance solutions for the healthcare marketplace, and completed her Registered Professional Liability Underwriter (RPLU) designation in 2007. She can be reached at 404-842-5559 or cquaif@ magmutual.com. ◆
April 2011 17
Cover Story
Ortho Kentucky Declares
Independence
By Megan C. Smith Photography by Kirk Schlea Four orthopedic group practices merge into Lexington-based Ortho
Kentucky for the purpose of maintaining professional autonomy during this tumultuous period of regulatory change. Chances look good that
independent specialty group mergers will gain competitive advantage while we wait for answers on accountable care organizations.
James Ritterbusch, MD, performs a shoulder consultation at Ortho Kentucky’s Lexington Orthopaedic Associates office.
18 M.D. Update
Kaveh Sajadi, MD, with the Kentucky Bone & Joint Surgeons division, is fellowship-trained in shoulder and elbow surgery.
Thomas E. Menke, MD, orthopedic surgeon with the Orthopedic Consultants division is fellowshiptrained in spine surgery
While declining reimbursements prompt many specialty physicians to align with hospital-based health networks, at least one recent report suggests that physicians preferring to hold out for professional autonomy have a good chance to remain competitive in the future healthcare environment. The Health Care Services Acquisition Report recently released by Irving Levin Associates, Inc. shows that physician medical group merger and acquisition deals increased 54 percent last year, making 2010 the biggest year for M&A activity in the past five years. Nationwide, there were 63 deals comprising 2,370 physicians and $425.4M, a year-over year dollar volume increase of 330 percent. These figures help to quantify the trend of hospitals building ACOs through acquisition of physician practices, which, many suppose, will enable hospitals to win the LEXINGTON
reimbursement contest by negotiating the best rates and achieving the highest efficiencies. However, according to report editor Sandy Steever, in the 2010 M&A data only “31.25 percent of all specialty practices were acquired by hospitals or integrated delivery systems.� The 2011 data is not available, yet there is room still for a strong majority of specialists to remain independent through the year. If they do, how can independent specialists retain their competitive advantage over the hospital-based health networks?
Specialty group practice mergers turn Collaborative Environment into Competitive Advantage
In order to survive independently from entities like hospital networks and multi-
april 2011 19
Cover Story
Mark E. Einbecker, MD, with the Kentucky Orthopaedic & Hand Surgeons division, treats conditions of the upper extremities, including overuse syndromes, rheumatoid arthritis and carpal tunnel syndrome.
20 M.D. Update
specialty groups, four orthopedic specialty practices in Lexington, Ky. merged in July 2010. to form Ortho Kentucky, PLLC. Ortho Kentucky owns and administers its four divisions (the individual specialty group practices) in accordance with the physicians’ desires to adapt to the changes in the healthcare environment while allowing practitioners to retain their professional autonomy. “The practice of medicine is going through some big changes right now with health care reform, creating financial pressures on the healthcare system itself and on insurance carriers,” says Thomas E. Menke, MD, a fellowship trained orthopedic spine surgeon in Ortho Kentucky’s Orthopedic Consultants division. “In the face of change, our main goal was to maintain as much independence as possible. We wanted to continue to compete in the marketplace and still provide the high level of customer service and personal medical care that is the hallmark of a small practice.” Before merging, the partners in Ortho
Kentucky had long enjoyed a positive working relationship and often shared strategies in grand rounds or in consultation on difficult cases. The merger, observes Menke, is a culmination of the group’s collegiality and respect for one another’s professional accomplishments. Mathew A. Nicholls, MD, PhD, orthopedic surgeon with the Kentucky Orthopaedic & Hand Surgeons division, adds that the partners’ autonomy is “contractually structured so that we have a fair amount of independence within our own divisions and a larger framework agreement that we all follow. We manage the group through a committee comprising one representative from each division.” The committee, says Nicholls, debates and discusses ideas, formulates opinions, and disseminates actionable items to the larger group for a vote. The four divisions have maintained their original practice sites, their original compensation structure (collections minus expenses), and their original philosophy that each of the surgeons has only themselves to answer to regarding their practicality and efficiency. Among the practitioners at Ortho Kentucky, there is no sense that someone is looking over one’s shoulder at their clinical care. “That is why we went into private practice to begin with instead of becoming employed physicians,” says Kaveh R. Sajadi, MD, orthopedic surgeon with the Kentucky Bone & Joint division. “There is a national trend towards employed physicians, but we wanted very much to maintain being our own bosses. There is freedom in that.” Autonomy, according to Sajadi, means the practitioner is accountable to himself and has the flexibility to deal with office staff in the manner of his choosing. “You have the autonomy to bring in people to work with you that agree with your personality, as opposed to a large corporation where these things are not in your control.
Andrew Ryan, MD, general orthopedic surgeon with the Lexington Orthopaedic Associates division, practices under the motto, “Saving the world one limb at a time.”
We can foster a much more collaborative environment, one in which everyone is part of a team working toward the goal of taking care of the patient.”
Managed Care Mandates and the Cost Paradox
One of the important motivators for today’s specialty practitioner is reducing administrative and overhead expenses so that healthcare dollars can be more effectively spent on patient care. From his perspective, Andrew Ryan, MD, orthopedic surgeon with Lexington Orthopaedic Associates division, believes physicians must strive to raise patient awareness of the cost of healthcare. Patients are not necessarily to blame for their ignorance of how much is being spent on their behalf; insurance companies now pay physicians directly. Ryan says he has been trying to make patients aware of costs throughout his career, “but they tend to look at them as abstract things. If they are not aware of the actual costs they do not
have as much incentive to be more efficient as health care consumers.” Reimbursements may have changed during Ryan’s tenure in medicine, “but not as much as for my retired partners, like Dr. Bill Wheeler, who joined our group in 1968. He was the first in the city to do hip replacement – back in the days when patients paid out of pocket and insurance companies reimbursed the patients. I remember those days very well because I was doing the books in my father’s office during summers off from college. I think patients were better consumers in Wheeler’s day because they were more aware of the actual costs.” Ryan and his colleagues at Ortho Kentucky, like many practitioners who are making hard choices in the face of healthcare reform, grapple with the cost paradox in which not paying out of pocket drives up the cost of care. Over care, observes Menke, occurs when patients pursue having a test “just to know” the cause of a problem. While it may seem
Mathew A. Nicholls, MD, PhD, practices general orthopedic surgery at the Kentucky Orthopaedic & Hand Surgeons division.
april 2011 21
Cover Story
“There is a national trend towards employed physicians, but we wanted very much to maintain being our own bosses,” says Kaveh R. Sajadi, MD. “There is freedom in that.”
Kooros Sajadi, MD, orthopedic and sports medicine specialist, performs a hip consult at Ortho Kentucky’s Kentucky Bone & Joint Surgeons office.
22 M.D. Update
reasonable to the patient who does not have to pay for the test, Menke says, “It puts a lot of pressure on the doctor to provide a service that may not be completely necessary. If you talk to the patient and they start asking how much an MRI costs and how much of that they will have to pay, they will start to ask if it is necessary. Are the results going to change their care? They will ask if they have a problem for which I would recommend surgery, or is the test just for peace of mind.” Nicholls adds that one of the reasons the four practices came together is that they think along the same lines on subjects like this. “We are in a situation where our reimbursement is fixed by commercial insurance companies and Government payers like Medicare.” He notes that as a large entity, Ortho Kentucky is better able to negotiate
reasonable reimbursements with insurance companies, but that alone will not make healthcare more affordable. Reducing over care, practice expense, and patient cost are necessary strategies. Ortho Kentucky’s plans for reducing expense include distributing large fixed-price procurements like EMR and digital x-ray across an increased number of practitioners. “For investments like a digital x-ray system,” says Nicholls, “we do not know whether a system will work well with our practices until we have used it for two or three years. A $250,000 investment for an untested system would be incredibly high-risk for one surgeon or a small group to handle. Spreading that kind of cost out makes the risk less daunting.” Less risk, less expense, and better reimbursements mean specialty group mergers will allow doctors to concentrate more on what matters most – patient care. Summing up these days of rapid change, Menke says that in discussions of mergers and pooling resources, we usually speak of financial resources. “However, more important than that are the intellectual resources. “One of the problems that we face today is that we physicians are being asked to make changes that are not in our intellectual comfort zone, like the electronic medical health records and digital x-ray. We are being asked to function more like businessmen and women in dealing with all of these changes. “Joining this group has not been about helping us see more patients with back pain and sciatica. Instead, it has been about helping us deal with the business changes that the practice of medicine is facing - whether we want them or not.” ◆
John J. Vaughan, MD, spine and orthopedic surgeon with the Orthopedic Consultants division, performs a spinal neurological examination.
The Four Divisions of Ortho Kentucky, PLLC
After their merger, the orthopedic specialists and staff of Ortho Kentucky are experiencing greater flexibility in staffing and improved performance in the areas of billing, coding, and collecting. Their bigger size means improved negotiating power in all business matters and provides a better safety net when required. Important to patients is the complete range of interests and subspecialization among the practitioners, making the group capable of caring for virtually every aspect of orthopedics.
Orthopedic Consultants:
John J. Vaughan, MD, fellowship trained orthopedic spine surgeon G. Chris Stephens, MD, fellowship trained orthopedic spine surgeon Thomas E. Menke, MD, fellowship trained orthopedic spine surgeon
Kentucky Bone & Joint Surgeons:
Kooros Sajadi, MD, hand, hip, knee, and shoulder surgery; sports medicine; fractures Kaveh Sajadi, MD, elbow and shoulder surgery; sports medicine Sam Coy, MD, general orthopedics ; sports medicine
Kentucky Orthopaedic & Hand Surgeons:
Mark E. Einbecker, MD, fellowship trained in hand, upper extremities and nerve compression syndromes. Paul J. Nicholls, MD, complex reconstruction of the lower extremity; total joint hip and knee Lisa T. DeGnore, MD, fellowship trained in orthopedic surgery of the foot and ankle Mathew A. Nicholls, MD, PhD, hip, knee, shoulder surgery
Lexington Orthopaedic Associates:
William Wheeler, MD, office general orthopedics Gary Bray, MD, hip and knee replacement surgery; sports medicine; arthroscopic surgery; missionary medicine James Ritterbusch, MD, arthroscopic surgery; ; ; hip and knee total joint replacement, fractures hip and knee; total joint replacement; sports medicine; fractures Andrew Ryan, MD, general orthopedics, hip and knee replacement and revisions, anterior hip replacement Michael Kirk, MD, sports medicine; arthroscopic surgery; joint replacement; reconstructive surgery; fractures april 2011 23
Physician viewpoint
Overuse Injuries to the Shoulder and Elbow in Young Athletes LEXINGTON Millions of kids in the United States participate in sports activities this spring from soccer fields and baseball diamonds to tennis courts and track and field events. Sports activities are more than just having fun. Participation in athletics improves physical fitness, coordination, self-discipline, and gives youngsters valuable opportunities to learn about teamwork. Unfortunately, despite our best efforts to prevent them, these activities can result in injuries. Many of these injuries are minor, some are serious, and some can result in lifelong problems. Each year, over 3.5 million sports related injuries in children under age 15 are treated. These young athletes are not merely small adults. Their bones, tendons, and ligaments are still growing, which makes them more susceptible to injury. In addition, young athletes of the same age can differ greatly in size and physical maturity. Some kids may be physically less mature than their peers and try to perform at levels for which they are not ready. We advise parents and coaches to group players according to skill level and size rather than chronological age, especially in contact sports like football. When injury occurs, it can be acute from sudden trauma or a series of small injuries which eventually leads to a problem. “Little League Elbow” describes a group of common overuse injuries in young throwers involved in many sports, not just baseball. Because their bones and muscles are growing, children and teens normally experience some discomfort with sports. Inability or decreased ability to play, a visible deformity, or pains that prevent the use of an arm or leg are signs that warrant a visit to an orthopedic surgeon. Prompt treatment many times prevents a minor injury from becoming worse or causing permanent damage. Some combination of strengthening exercise, physical therapy, and bracing may be necessary as part of treatment. Successful treatment requires cooperation and open communication among the patient, parents, coaches, and doctors. A disturbing evolving trend in the field of sports medicine has been teenage athletes 24 M.D. Update
BY
Wallace Huff, MD
suffering from injuries requiring surgical treatment, especially in the shoulder and elbow. The cause of this appears to be overuse and overexposure. The overhead throwing motion generates significant forces in the shoulder and elbow joints. These extreme forces subject the tissues in and around the joints to stresses sometimes greater than their normal capacity. Fortunately, we have newer advanced techniques for repairing these injuries. The most common injury I see in young throwers in the shoulder requiring repair is a tear of the labrum and in the elbow a tear of the ulnar collateral ligament. After surgery, I rely on an excellent team of physical therapists to help these patients get their motion and strength back safely. I like to bridge their recovery to competitive throwing with a sports specific conditioning program for throwers which also focuses on proper technique to avoid re-injury. The majority of these patients are back to competitive throwing at one year. I am a firm believer that many of these injuries can be avoided, and I focus a lot of my time with patients on education. Many of the shoulder and elbow problems we see develop in stages. With appropriate treatment in the early stages, we can prevent progression to the need for surgical repair. Early on, the athlete may
only be stiff and slow to warm up, but without pain. A brief rest period, appropriate strengthening, correction of bad throwing mechanics and style can solve the problem. Ultimately, the best way to avoid injury is to learn proper mechanics early and engage in physical conditioning, especially approaching high school age. The conditioning should focus on core strengthening, flexibility, upper and lower body strengthening, and cardiovascular endurance. Pitchers are encouraged not to participate on more than one team per season, as coaches tend to use better pitchers more often, leading to excessive pitches. I also recommend pitchers rest from throwing for three months out of every year to allow the arm to rest, recover, heal, and undergo normal maturation and development. I always remind parents and coaches to listen to their athletes and remove them from the game if their arm or shoulder hurts. If pain persists more than a few days, or returns at the next game, those injuries should be evaluated and treated by someone with experience in treating these injuries. As an orthopedic surgeon specializing in sports medicine and total joint replacement, it is always gratifying to effectively treat a patient young or older in order for them to pursue a desired activity or sport that may provide them with an education, livelihood, or simple enjoyment and a healthier quality of life. Dr. Wallace Huff earned his medical degree from Eastern Virginia Medical School. His postgraduate residency and fellowship were from the University of Virginia in 1999. He is certified by the American Board of Orthopaedic Surgery and the American College of Surgeons. Huff also has a Subspecialty Certificate in Orthopaedic Sports Medicine. Huff joined Bluegrass Orthopaedics in 2010 after ten years in practice, most recently in London, Ky. His hospital affiliation is Saint Joseph East, and he offers outpatient surgery in Lexington & Somerset. ◆
Allied Health
Donor Registry Enables Individuals to Save Lives With over 110,000 men, women and children currently waiting for a life-saving organ transplant in the United States (www. unos.org), it is imperative that health care providers understand the process and need for organ donation. Since patients often look to their personal physicians regarding healthcare decisions, physicians and staff need to be aware of the significance that donor registries have in helping to save lives. From local communities to the federal government, efforts are continuous in creating awareness about the vital need. Still, demand continues to far outweigh the supply of organs. The national “Organ Donation Breakthrough Collaborative”, sponsored by the Health Resources and Services Administration (HRSA) from 2006-2010, brought transplant centers, trauma centers and organ procurement organizations together to help ease the donor shortage by working together and sharing best practices to increase donation. Organ donation increased up to ten percent annually (www. organdonor.gov), based on initial baseline data. However, more needs to be done
BY
Jenny Miller Jones
Registry. Donor registries are secure, electronic databases that record the wish of an individual to be an organ and/or tissue donor upon one’s passing. The Uniform Anatomical Gift Act (UAGA) acknowledges that donor registries are a legal format in which to honor a person’s wish to help save
Organ donation and transplantation is a medical crisis with a cure. The crisis is the lack of available organs and the cure is more people documenting their wishes by joining the donor registry. to try and save lives through donation and transplantation. Twenty nine thousand organ transplants occurred in 2010, but seventeen individuals die every day due to the lack of a donated organ. Donor registries have been implemented in 44 states over the past fifteen years, with Kentucky passing legislation to create a registry in 2006. Since its inception in 2006, over one million Kentuckians have joined the Kentucky Donor Registry. This represents 23% of the Kentucky population 16 and over who have chosen to join the
or enhance lives through organ and tissue donation. A person who willingly joins the donor registry is exercising First Person Consent, insuring that their wish to donate will be carried out because this is what they documented. In circumstances where the next of kin does not know the wishes of the deceased regarding donation, the donor registry can be instrumental, as it allows the family to know what their loved one wanted. There are three ways to join the registry in Kentucky, but most have joined the
Registry while obtaining or renewing their driver’s license or state identification card, making the support of the circuit court clerk crucial in increasing the donor designation rate. Individuals are also encouraged to go online and join the Registry, by logging on the Registry website www.donatelifeky.org. Registry forms are also available at donor awareness venues around the state throughout the year. Up to eight lives can be saved with the donation of the heart, liver, lungs, kidneys, pancreas, and small bowel. Additionally, up to fifty lives can be enhanced with cornea and tissue donation, including restoring sight, helping burn victims and enhancing mobility through spinal and other surgeries. There is no cost to a donor’s family with donation, and an open casket funeral is possible. With the ability of surgeons to successfully transplant organs, and the improved drugs that help with immunosuppression and anti-rejection, transplant recipients have an opportunity to live for many additional years. The success rates have greatly improved over the years, with transplant patients living anywhere from one to thirty years post transplant, depending on the organ transplanted. The main problem remains the lack of donated organs. Organ donation and transplantation is a medical crisis with a cure. The crisis is the lack of available organs and the cure is more people documenting their wishes by joining the donor registry. To be part of the solution, doctors can educate their patients about the existence of the donor registry, and make sure that people understand that signing the back of one’s driver’s license is no longer enough to help others. Taking five minutes to join the Donor Registry could possibly result in saving countless lives. “If it is given me to save a life, all thanks.” Even in death, lives can be saved. Jenny Miller Jones is the director of education for the Kentucky Organ Donor Affiliates. ◆ april 2011 25
Pain Medicine:UPdate
Governor Beshear Testifies on Prescription Drug Abuse Tells Congressional panel that prescribers of controlled substances should be required to educate patients about addiction. On April 14, Gov. Steve Beshear testified before a congressional panel on prescription drug abuse . During his testimony, Gov. Beshear urged Congress to continue funding the Harold Rogers Prescription Drug Monitoring Grant Program, which works toward data sharing among states. Gov. Beshear also presented evidence for the need to mandate training for prescribers of controlled substances so they can bring awareness to patients on the disease of addiction, and he requested that more federal resources be focused on ceasing Florida’s illegal prescription drug flow. “The fastest growing, most prolific substance abuse issue facing our country is the abuse and diversion of prescription drugs,” said Gov. Beshear. “In Kentucky alone, 82 people die every month from drug overdoses,
a number that has now surpassed car crashes as the leading cause of accidental death in our state. Since faced with this horrific epidemic, Kentucky has acted aggressively in ramping up law enforcement, policy initiatives and prescription drug monitoring efforts.” “KASPER has proven successful in Kentucky’s battle against prescription drug abuse,” stated Gov. Beshear. “However, the full effectiveness of this powerful weapon is limited by the fact that some states still do not have similar systems.” Florida, and especially South Florida, represents a significant population of unmonitored controlled prescription drug pain clinics and prescribers. In February 2011, Gov. Beshear sent a letter to Florida Gov. Rick Scott urging him to reconsider his decision to not implement a state drug monitoring system previously approved
by the Florida legislature. Recent news reports confirm that, at least in part due to outside persuasion, the drug monitoring project is moving forward and will be operational later this year. Finally, Gov. Beshear stressed the importance of increasing resources to federal, state and local law enforcement and prosecutors in Florida to address the threat that drugs obtained there will be diverted and abused on a regional scale. “Kentucky is not an island,” said Gov. Beshear. “We live in a mobile society and that mobility limits the ability of any one state to be entirely successful in addressing substance abuse issues. My testimony today calls on several strategies that have a higher probability of success when implemented on a national level.” SOURCE www.governor.ky.gov/media ◆
< Healthcare IT Interview with Joe Sostarich Continued from page 15
So, we had the core of the product, but it took some time and effort to modify it to do what we needed. We found out when we were selling that people wanted more than claims. They wanted other products, too, so we decided to look for the best possible sources of these products. It takes a long time to develop EHR and practice management systems – we did not have time to do that – so we wanted to partner with someone who already had that. We shopped around and found what we thought were the best products available and got a national sales contract.
These guys give the doctors their money, so the connection between a doctor and their billing service company is very close. So, by acquiring a billing company, we acquire a group of doctors associated with them whom we can upsale to.
managing an already seasoned staff that didn’t really need to be managed. They preferred that the prior management vacate and leave that role to them, so we left. So then you and Freeman form MedX12 and become their biggest competitor? We are what I call “co-opetitors” because we are not really competing. We have good relations with ZirMed. They do a super job with servicing claims. We do claims too, but our primary focus is on practice management software, EHR, and electronic prescriptions – things that they do not have. And, it is a huge market, so competition does not need to be fierce. How did you come to found MedX12? My partner John Freeman had moved to Phoenix in 2005 and found some software similar to ZirMed’s, and after a year we acquired the intellectual software called Noteworthy, which we still use today. It is a practice management and EHR system, and it handles electronic prescriptions as well. 26 M.D. Update
That’s an important point – you have a software business, but you are not a software developer. We consider ourselves a selling machine, not a development machine. Now your sales plan now entails the acquisition of physician billing companies. Tell us about that. We are acquiring billing companies – that is our focus now, and it will stimulate much more rapid growth. You get a lot of doctors who are serviced by a billing group that provides them with their revenue.
Of course it doesn’t hurt your business plan that doctors have adopt EHR by 2014 or face reimbursement losses or that there are government subsidies for many providers to switch. Still, there are doctors who say they are not going to do EHR, are not going to take Medicare, and there will be a number of them who do not. There are a number of doctors who are maybe a few years from retirement, for example, so they do not want to make this transition and let the new doctors pick it up. Others will take the hit before they adopt EHR, but I would say that a minimum of two-thirds will have EHR in place when it is necessary. And if we see another company come along with better technology, we will adopt that. We are always looking for more opportunities. There is the possibility that we would acquire a company that is already public; check back in a few months. ◆
Special Section
ORTHOPEDICS & SPORTS MEDICINE 28 Norton Brownsboro’s Ryan Krupp and Sam Carter 30 Lexington Clinic’s Ben Kibler and Steve Umansky 32 Pikeville Medical Center’s Keith Hall and Kevin Pugh 33 Frazier Rehab’s Scott Baker 34 Apex Physical Therapy’s Patrick Meyers
Scott Baker, PT, MPT, ATC assists a patient with manual therapy following exercises at Frazier Rehab’s Springhurst location.
april 2011 27
Norton’s Top Recruits
From the opening tip to the final buzzer, Drs. Ryan Krupp and Sam Carter take an aggressive, comprehensive approach to sports medicine based orthopedic care By Jennifer S. Newton
Dr. Ryan Krupp’s energy
and tenacity have fueled his vision of building a cutting-edge, patient-centric program at Norton Orthopaedics Specialists.
28 M.D. Update
Ask any athlete and they will probably tell you that simply staying in the game is the most basic and most important need they have, although winning is never far behind. A lifetime athlete and orthopedic surgeon specializing in sports medicine, Ryan Krupp, MD, is well acquainted with the physical rigors of athletics. Krupp’s energy and tenacity have fueled his vision of building a cutting-edge, patient-centric program. “I wanted to build a practice that was not just doing the everyday – seeing patients, taking care of them – but one that included all of the facets from beginning to end,” he says. Krupp is the founder of the sports medicine based orthopedics program at Norton Brownsboro Hospital and also serves as director of Sports Health for Norton Healthcare. From athletic event coverage to injury prevention education to community partnerships to research to the evaluation, surgery, and rehab of all types of orthopedic injuries, Krupp’s vision has taken shape, in part, due to the comprehensive sports medicine training he sought out during his fellowship at Steadman Hawkins Clinic of the Carolinas. Under the leadership of Richard Hawkins, MD, a titan in the field of shoulder reconstruction and sports medicine, Krupp learned not only arthroscopic techniques for the knee, shoulder, and elbow, but also open shoulder procedures. Sam Carter, MD, joined the practice last year and brings a like-minded aggressive, but intelligent approach to patient care. Carter, also an orthopedic surgeon specializing in sports medicine, trained in Virginia under Dr. Bill Beach in the program founded by Dr. Richard Caspari. For Carter, the regional differences in the two physicians’ training gives their practice a broader knowledge base, and that, coupled with their sports
medicine focus, is what he believes sets their practice apart. But, Carter is quick to acknowledge that sports injuries are not the only ones they treat, and those techniques have many implications for the general population, such as rotator cuff tears and arthritis. For two practitioners who have always been in some sort of game themselves, working to get athletes back on the field, the court or the track is a natural extension of their personal interests. The physicians’ primary goal is always to get people back into action as quickly as is safely possible without risking further injury. Education inherently follows as a secondary goal. One key component of Krupp’s comprehensive vision is the athletic trainers network. By partnering with Kentucky Orthopedic Rehab Team (KORT), they have developed a network of 25 to 30 athletic trainers who are in schools on a daily basis and can get access to the physicians in a timely fashion. “We are just finishing our second year in the partnership and it has really expanded,” says Krupp. Beyond the task of treating injuries, the physicians are making it their mission to connect with the community. Krupp works with Eastern High School, Kentucky Country Day (KCD), St. Catharine College, and the Louisville Lightning indoor pro-
The idea that everything is intertwined, always pushing the envelope and expanding into new techniques, using cutting-edge technology, but also doing research to bring forward the next generation of treatments are the principles Dr. Krupp modeled the practice on.
Special Section: Orthopedics & Sports Medicine
fessional soccer team. Carter works with Waggener High School and KCD as well. “That has been a rewarding thing for me, getting to know the athletes and experiencing their season with them. I’ll be there when the freshmen I treated this year are graduating,” explains Carter. Additional educational opportunities they provide include an athletic symposium for trainers, physical therapists, and primary care physicians and evening lectures at the hospital on various topics. Another of Krupp’s community service initiatives is the Saturday Sports Injury Clinic. Krupp describes the program as “basically Saturday office hours as a kind of walk-in clinic.” No appointment is necessary, and patients are seen on a first come first served basis. The clinics typically run from August through November.
CLINICAL RESEARCH AND A MODERN APPROACH
According to Krupp, a critical component of staying on top of cutting-edge treatments and providing the best outcomes possible is analyzing your own effectiveness. “Are the things we are doing effective? How can we improve? That is a big part of not becoming stagnant,” he says. Krupp just completed a clinical trial on an anterior cruciate ligament (ACL) fixation device in conjunction with John Nyland, EdD, at the Department of Orthopedic Surgery, University of Louisville School of Medicine. The study compared ACL interference screws from several different companies and utilized porcine bone and mechanical testing to determine pullout strengths on each. Two other multi-center trials currently underway include one on reverse total shoulder arthroplasty and another on standard total shoulder arthroplasty. Crediting a fantastic biomechanics lab in the Department of Orthopedic Surgery at UofL, Krupp says his clinical expertise and Nyland’s research background are the reason they are chosen to participate in many studies. One hallmark of these surgeons’ modern approach to medicine is participation in online forums. “The bottom line is that we can always learn from others,” explains Krupp. He participates in what he calls the Hawkins Society – a chat room comprised of approximately 160 fellows who trained
Dr. Sam Carter acknowledges that sports medicine techniques have many implications for the general population, such as rotator cuff tears and arthritis.
under Hawkins and are now some of the top sports medicine specialists in the country. The site can be used to post scans and a patient’s case, for instance, so the treating physician can get feedback on what other specialists have experienced with similar cases in terms of what works and what does not. Carter also participates in online learning resources. “I am doing arthroscopies now around the hip joint that I never did in fellowship. A lot of times you learn about things like that by going to national meetings, watching other surgeons do them. Now there are sites online just for surgeons to post new techniques,” he says. Carter says arthroscopy is particularly suited for this type of learning because a camera is already in use during the procedure, but cautions that physicians should research published data before copying someone’s techniques.
PATIENT CARE AND MINIMALLY INVASIVE SURGERY
What could be more important than community service, education, research and online resources? Good patient care. “It is not like everything is a nail just because you are holding a hammer,” contends Krupp.
“Every patient that comes in is unique. What works for one may not work for another.” This patient-centric approach is the cornerstone of their practice. Surgery may not be in the best interest of every patient. “We have the whole package here, not just one or two aspects of things,” says Krupp, who built an infrastructure of physical therapists and rehabilitation specialists because rehab is critical to patient success, whether post-surgery or on its own, and these physicians believe an aggressive approach can greatly benefit athletes when executed prudently. The group works with a wide range of patients, both children and adults. If surgery is warranted, the physicians apply minimally invasive techniques whenever possible. According to Carter, arthroscopy has revolutionized shoulder surgery over the last 20 years. Almost everything that used to require a large open incision – rotator cuff tears, labrum repair, and shoulder dislocations – can be managed arthroscopically now. The same is true for the knee, including ACL reconstruction and meniscal repairs. “All this is saving the patient from larger incisions, more tissue damage, and decreasing rehab time, so they are feeling better faster,” he says.
Continues on page 35 > april 2011 29
Special Section: Orthopedics & Sports Medicine
Wire-to-Wire Leaders in Sports Medicine Care Lexington Clinic’s orthopedic and sports medicine physicians first define, then deliver cutting edge treatment through integrated patient care. By Megan C. Smith This summer, fifteen of the world’s leading experts in shoulder injuries will convene in Lexington to participate in the Shoulder Center of Kentucky’s 14th annual Shoulder Symposium. This year’s discussions will focus on injuries of the throwing shoulder, including updates on the latest in surgical, non-surgical, physical therapy, and rehab techniques. Hosted by Dr. Ben Kibler of the Lexington Clinic Orthopedics – Sports Medicine Center and founder of the Shoulder Center of Kentucky, the 2011 Shoulder Symposium will cover current knowledge in five key areas of throwing shoulder injury. The seed for this year’s discussions came when the editors of Arthroscopy, the Journal of Arthroscopy and Related Surgeries approached Kibler about publishing a 10-year update on the renowned series of articles Kibler co-authored on “The Disabled Throwing Shoulder” in 2003. Kibler recalls that it took him a year to write those articles the first time, so for the update he conceived of a consensus panel of the W. Ben Kibler, MD, FACSM world’s experts to headline There is a tendency to think of this as this year’s symposium. “It’s an elite athlete injury, but this is not great,” Kibler enthused. true. Recovering from a shoulder injury can mean four months of rehab for “We will have the pros workers and a year for players, making together on the Thursday this a population with a large economic night before the symposium and treatments. impact. to discuss the latest research Symposium and care for players. We will attendees include record the discussions and write it up for the orthopedic surgeons and non-orthopedic ten-year update for Arthroscopy. Then, the physicians who treat orthopedic problems, next day, attendees will get hot-off-the-press PAs, PTs, and certified athletic trainers, updates from the world’s leading researchers who are responsible for preventing injury on throwing injuries.” and overseeing an injured athlete’s return to The topics to be covered in the consen- play. According to Kibler, the return-to-play sus update are biomechanics and the kinetic statistics on shoulders are “not so good.” chain; the SICK scapula and scapular dyski“What is it?” he asks. “Is it the treatnesis (SICK stands for scapular malposition, ment? The rehab? If you ask the baseball inferior medial scapular winging, coracoid pitcher, he says that he ‘just can’t bring it,’ tenderness, and scapular dyskinesis); labral which means that he can’t throw hard and tears and SLAP lesions (superior labral ante- that the joint is too stiff to rotate. So we will rior posterior tears); glenohumeral inter- discuss the latest in treatment and rehab so nal rotation deficit (GIRD), and other injuries that athletic trainers and PTs can restore the
LEXINGTON
30 M.D. Update
range of motion of the shoulder, which is the hallmark of successful care.” After fourteen years, what more is there to learn about throwing shoulder injuries? Kibler identifies biomechanics as a leading area of research. What makes the ball go, he says, is a matter of the whole body and its adaptation to throwing mechanics. “Interestingly,” Kibler notes, “about half of the players with elbow injuries have tight or weak hips.” Studying the relationship of body mechanics to injuries helps researchers compare normal and abnormal conditions, which in turn can provide clinical predictability of where injuries may occur. Also, says Kibler, there is a need for continued improvement in treatment and rehab. “There is a tendency to think of this as an elite athlete injury, but this is not true,” he says. “Recovering from a shoulder injury can mean four months of rehab for workers and a year for players, making this a population with a large economic impact.” Kibler believes that all orthopedists would benefit from attending the Shoulder Symposium. He says that current journal articles point to diagnostic modalities increasing the number of labral tear diagnoses. “According to the American Board of Orthopaedic Surgery, when doctors report their clinical history to qualify for their boards, they indicate that arthroscopic labral repair is the second most common surgery of the shoulder. In my practice, I see many labral tears but only a third of them need surgery.” There is a difference between a condition and an injury, Kibler asserts. “MRIs are being over-read for the labral tear diagnosis, but we don’t operate on diagnosis. We operate on function. At the same time we are under-treating when we do not perform a
Our practice philosophy is based on integrated patient care for the treatment of orthopedic and sports injuries. Clinicians, therapists, PAs, and radiologists must attain a complete understanding of complex orthopedic conditions in order to meet that goal of high quality care.
complete physical exam in search of a functional diagnosis. It’s a paradox,” Kibler says, “and there is a lot of room for improving understanding.”
Integrated Patient Care
Dr. Steven C. Umansky, head of section for Lexington Clinic Orthopedics, believes that bringing global leaders in shoulder repair to the annual Shoulder Symposium is an integral part of the Lexington Clinic’s practice of driving cutting-edge research and delivering the highest standards of care.
and elbow conditions. He is enthusiastic about the new Xiaflex treatment for adults with Dupuytren’s contracture of the hand. Not associated with any risk or trauma, Dupuytren’s contracture affects mostly men of northern European heritage between the ages of 50-70 when the collagen of the palms thickens and causes the telltale curling of fingers from tightened musculature. “Traditional surgery for Dupuytren’s contracture is followed by significant scarring and 6-9 months of therapy. The Xiaflex injections, which contain a collagenase that ruptures the thickened bands, deliver similar outcomes to surgery at a similar cost,” says Umansky, “but results are achieved in just three weeks. There are obvious economic benefits in delivering the more efficient treatment.” Going forward, more providers are needed with expertise in hand, shoulder, and lower extremity joint repair to meet the needs of an aging population. In response to increased demand, Dr. Trevor Wilkes joined Lexington Clinic and the Shoulder Center of Kentucky in August 2009 adding advanced shoulder replacement, including reverse shoulder arthroplasty, to the line of service. Future developments at Lexington Clinic – Orthopedics Sports Medicine Center, notes Umansky, will continue to focus on Lexington Clinic’s mission to provide the highest standards of orthopedic care to meet the needs of the athletic, working, and general populations. ◆
Visit www.kort.com for location information and to download the FREE KORT Simple Stretches iPhone app for yourself or to share with your patients.
800‐645‐KORT www.kort.com
Stephen C. Umansky, MD
The practice philosophy, he says, “is integrated patient care for the treatment of orthopedic and sports injuries. Clinicians, therapists, PAs, and radiologists must attain a complete understanding of complex orthopedic conditions in order to meet that goal of high quality care.” In addition to shoulders, the Lexington Clinic is well known for the research of Dr. Christian P. Christensen in complex revision and primary hip and knee replacement, including minimally invasive total joint replacement. Generally, joint replacement research shows the best surgical techniques and methods for improving individual patient care. Umansky points out that payers, patients, and surgeons are constantly demanding greater efficiency and excellent outcomes. Individualized post-operative treatment plans are also important in achieving these goals. The Lexington Clinic’s strong position on orthopedic research serves an essential function enabling providers to review the national body of outcomes research, identify the highest available standard of care, and deliver the best to their patients. Umansky, who is fellowship-trained in hand and upper extremity surgery, is versatile in the treatment of hand, wrist,
april 2011 31
Special Section: Orthopedics & Sports Medicine
Pikeville Powers Forward
Now in a larger facility, Drs. Keith Hall and Kevin Pugh are helping more rural patients return to work and play By Megan C. Smith PIKEVILLE Workers, athletes, and an aging population place tough demands on the two-surgeon practice at Pikeville Medical Center’s Orthopedic Surgery department. Here, Dr. Keith Hall, an orthopedic sports medicine specialist, and Dr. Kevin Pugh, whose specialty is joint replacement, see over 80 patients a day in their new, larger facility on Mayo Road in Pikeville. The practice move has helped the doctors accommodate more patients, says Dr. Pugh, “But really, it’s the staff that enables us to see that many patients each day.” Pugh and Hall each have a dedicated PA and RN who assist them with patient evaluations and histories, follow-up for established patients, and injections when needed. Both physicians describe themselves as “very aggressive” in the treatment of orthopedic and sports medicine cases. While the total joint patients have to be followed throughout their lives, Pugh allows them to begin therapy right away and places no restrictions on their activities. Similarly, Hall says he wants his athletes to return to play as soon as possible following an injury.
Sports Medicine
Keith Hall, MD, who is the only sports medicine orthopedist in Pikeville, typically sees younger athletes between the ages of 16 and 35 who “twist their knee playing sports or injure their shoulder and have a
torn rotator cuff.” About 70 percent of his practice is sports injuries, he says, with the balance being fractures and other sportsrelated cases in older persons. Hall works with all of the Pikeville College athletic teams – baseball, football, basketball. “Every now and then I see a bowling injury,” he jokes, “and I work with any of the local high school teams. We also have an ABA basketball team – the East Kentucky Energy – and luckily they haven’t had any big injuries yet.” Physical therapy is available at either PMC’s outpatient facility in downtown Pikeville or in one of several new clinic opening across the county. “There are private groups in town whose offices are scattered across the county,” says Hall. “That helps a lot because this county is somewhat isolated, and some people can live in this county but are an hour away from where we are.” Hall has a particular interest in rotator cuff surgery, which emerged during his fellowship at Emory University when he observed the difference that surgery can have in a person’s life. “Patients come in here in severe pain. They can’t sleep at night because of their rotator cuff tear, and they can’t raise their arm,” he says. “I fix it, and a few weeks later they are using their arm again and sleeping through the night.” Hall also sees patients who acquire an injury at work, and he says their goal is to repair the injury so the patient can heal and return to work full duty without having to experience pain from the injury going forward.
Total Joint Replacement
Kevin Pugh, MD, performs the less invasive, muscle sparing anterior approach to hip replacement. 32 M.D. Update
Dr. Kevin Pugh’s practice is centered on joint replacement for treatment of arthritis. He performs about twelve joint replacement cases a week and mostly of the hip and knee. He also performs shoulder replacements, handles fractures, and does an occasional scope for arthritic tears of the knee. Pugh says that sometimes he sees a patient with arthritis “who is 55 years old, who still wants to work or who needs to work for ten more years. So we try to provide the joint replacement and get them
Keith Hall, MD, is
Pikeville’s only orthopedic sports medicine specialist.
back to work as quickly as we can.” About once a month, Pugh sees a patient who may qualify for a partial knee replacement. However, he says, “Most of the patients around here will let these things go until they can’t go any further.” Pugh says, “Some people don’t want joint replacement surgery or they are not quite to the point of joint replacement, so we do different types of injections to give them pain relief and prolong the point when they will need joint replacement. We provide steroid injections, or we use viscosupplementation, where we inject Hyalgan or Synvisc into the joint, and that gives patients a temporary cushion or lubrication.” One of Pugh’s recent cases involved a male patient with hip pain for many years and whose joint was completely worn out with bone-onbone arthritis. He had a hip replacement done, he was on a walking device in two weeks, and he went back to work as a coal miner in eight weeks. Pugh used the anterior approach in this case, which is a newer method for hip replacement that is less invasive and muscle sparing. “I make an incision that is about 10 cm in length, occasionally longer, and gain access to the hip between muscle intervals instead of cutting across muscles,” says Pugh. “I just go right between the muscles without disturbing them and replace the hip that way. Three hours after surgery, patients are walking around. Four hours later they go home, some are on their canes, some are on nothing. Then two weeks later they are back to driving or doing what they want to do.” ◆
Special Section: Orthopedics & Sports Medicine
Heavyweight Frazier Rehab
Physical therapy powerhouse treats sport and work injuries of all types By Greg Backus Louisville Our health-conscious society means people are exercising more and staying active as they age. As the retirement age increases, people work longer and play sports later in life. Even children are playing more, starting sports at younger ages than ever before. The active lifestyle means that doctors are treating more injuries among a greater variety of people and that physical therapists are busier than ever. In the key role of helping patients get back to their desired activities, Scott Baker, PT, MPT, ATC, with Frazier Rehab sees patients from three to 100 years of age. “I love seeing fast results,” he says. “Like having a patient come in who cannot move their arm and enabling them to do so by the time they leave, or having a patient walk in on crutches and walk out without them. I love seeing that kind of thing.” Baker and his colleagues at Frazier Rehab treat a wide spectrum of injuries; neck, back, knee, and shoulder conditions resulting from work injuries, sports injuries, and automobile accidents are common. Weekend warriors need treatment just as often as wide receivers, and Baker notes that with the economic downturn over the last year, “we have been seeing more workers compensaScott Baker, PT, MPT, ATC, tion cases as people who still have jobs of Frazier Rehab enjoys helping patients are expected to work harder and do recover from injury quickly. more than normal. Sometimes they overdo it.” “Something is restricting movement at the Treatment Techniques joint level,” he explains. “So I do a lot of Helping patients recover from inju- pushing, pulling, and twisting. We compare ry requires attention and adaptability. the results to a range of clinical knowledge, Treatment modalities depend on the spe- and we employ a variety of techniques for cific case of the patient, and they change pain management. Depending on the case over time. Baker says that gentle methods and the results we are trying to achieve, we are required with post-op patients due to use hot and cold packs or electrical or ultratissue healing and the need to reduce re- sound stimulation.” injury, but soon the therapist must decide Every patient at Frazier has been referred how aggressively to focus on regaining range there by a doctor, and like patients, every of motion or rebuilding the injured joint or doctor is different. Some doctors send their muscle. Aggressiveness often depends on patients in to begin rehabilitation the day after the nature of the surgery. surgery, others will wait weeks to allow more Baker says that for a patient with healing to take place. First time patients are decreased range of motion but without a loss given a thorough evaluation so that a treatof strength, the problem is in the joint. For ment plan can be created. The evaluation is this, aggressive manual therapy is a mainstay. important because different orthopedic cases
require different approaches. It is important to determine what the initial injury was and which surgical procedures were undertaken. Assessing pain levels, range of motion, and current strength establishes a baseline and allows the therapists at Frazier to pace the treatment plan to meet the patients goals. Once a treatment plan is established, Baker has the patient warm up on a bike or treadmill. Exercise, stretching, and manual therapy follow to improve movement. Manual therapy can take place before or after the exercises, and if the patient is in pain, Baker says it is always important to reduce it. On return visits the patient is asked whether the previous session helped, and this information is entered into Frazier’s practice management system. “This really helps us, so we can know whether to continue the same plan or adjust it to better treat the patient. Every day that the patient comes in, we are assessing their strength and range of motion and watching for improvements.” Younger persons heal from injury and surgery faster, yet at whatever age, the healing process has to take its course. A person who is used to rigorous exercise might be trusted to follow an exercise plan during their recovery. Furthermore, patient expectations and pain tolerances vary widely. Some people, athletes especially, might be less likely to say that they are experiencing pain because they want to get back to playing and are used to “playing through it”. One part of providing physical rehabilitation, says Baker, is to be aware of and watch out for patients who might push themselves too hard, along with the ones that might not have the discipline to follow their recovery recommendations. ◆ april 2011 33
Special Section: Orthopedics & Sports Medicine
The Return Specialist
Patrick Meyers of Apex Physical Therapy By Megan C. Smith After working eleven years in a large physical therapy and rehabilitation setting, Patrick Meyers, PT, OCS, MS, COMT, decided that he couldn’t suppress his independent nature any longer. Calling himself one “who doesn’t take direction well,” Meyer founded Apex Physical Therapy in 2004 and grew it into a fourlocation, return-to-play specialty boutique, proving that sometimes striking out on your own is the best way to get the job done. Meyers has attained what is probably the region’s only dual-credential in orthopedic clinical specialist (OCS) and certified orthopedic manual therapist (COMT). The designation indicates above all else that Meyers is a passionate about getting patients back into the lives they desire. Louisville sports enthusiasts may recognize Meyers from his presence on the Drew Deener radio program, but despite the shared enthusiasm over sports, area physicians may be less familiar with Meyers’s COMT designation and what it means to them. The certified orthopedic manual therapist is a trained practitioner of manipulative physiotherapy. Manipulative physiotherapy, also known as the Maitland Concept, was developed by Australian physiotherapist Geoff Maitland (1924 - 2010), who cofounded the International Federation of Orthopedic Manipulative Therapists (IFOMT). It is called a concept, not a technique, because it emphasizes a pedagogical approach of continuous evaluation and assessment. Evidence based practice and clinical expertise are essential components of the manipulative physiotherapist’s work. The Maitland Concept utilizes manual therapy techniques, which include mobilization, manipulation, neural mobilization, muscle energy techniques, myofascial release, and massage. It is not an empirical, or trial-
LOUISVILLE
normal range of motion, relieve pain, decrease spasm, and promote healing. Patient assessment is essential in determining which manipulative therapies should be administered, though therapists are not dogmatic in their approach. Meyers says his COMT and OCS training give his clinic a boutique-style technique that provides patients with instant results. “With manual therapy, a patient’s back or neck pain can be reduced in one session, which gives them instant buy-in to therapy. They go back to their doctors and say, ‘I love therapy. It works!’” Sometimes, Meyers observes, physical therapy is simply a progression through exercises that leads a patient to reject therapy for the simple fact that patients reject exercise. Manipulative therapy uses stability exercises following manipulation to help the therapy “stick,” but does not constitute the whole of the treatment. Meyers says he will even send a patient home to rest. Meyers says that he is teaching all of his staff the Maitland Concept because it is essential to integrate it into the entire practice method. For example, the Maitland Concept is integrated into patient documentation where the computer-based treatment record automatically references appropriate manipulative therapy. Meyers is an active advocate for Patrick Meyers, PT, OCS, MS, COMT, improved access to physical therapy. He serves as federal liaison for KPTA founder of Apex Physical Therapy. and was among the member-advoand-error approach, but rather a didactic cates for Senate Bill 112 (page 9 this issue) method that asks the practitioner to evaluate that lowered physical therapy copays from when, how and which technique to perform. the specialist level. Meyers likens access to The goals of manipulation are to restore healthcare like waterslides. He says access to healthcare today is like a theme park waterslide with tunnels and turns that lead a patient unwittingly through potentially unnecessary MRIs and specialist visits. The other option, he says, is a lower copay – direct access model like a straight waterslide “that discharges patients into the healing waters.” ◆
Manipulative therapy is called a concept, not a technique, because it emphasizes a pedagogical approach of continuous evaluation and assessment. Evidence based practice and clinical expertise are essential components of the manipulative physiotherapist’s work. 34 M.D. Update
<Continued from page 29
For their younger population, new evidence is showing it is better to reconstruct the ACL sooner to prevent further damage to the knee, rather than waiting until patients are skeletally mature, as conventional wisdom stated. Carter prefers to use an autograft from hamstring tendons in young people but sometimes uses donated tissue for an allograft in older patients. Arthritis is another condition that plagues a large portion of their population. Total knee replacement is an appropriate treatment for someone with acute arthritis, but it is not a minimally invasive option. So, Carter tries to focus on partial knee replacements, which may be a good option for patients who only suffer from arthritis in one part of their knee. “When you can only replace
that section of the knee and leave the rest of the knee intact, it is a smaller surgery and leaves the knee in a more natural state. Patients can usually stay more active after a partial replacement than they can after a full replacement,” asserts Carter. He prefers the Oxford partial knee system from Biomet because of its mobile bearing, which helps restore the natural motion of the knee and has a much lower wear rate than fixed bearing options. For both surgeons, the support of the Norton network and access to its infrastructure for things like MRI have been instrumental in the success of their practice. Krupp credits the Norton Healthcare Foundation with getting the grant to fund the athletic trainers
network and is appreciative of Norton’s marketing efforts for things such as the Saturday Sports Injury Clinic. Carter adds that the large network of physicians and Immediate Care Centers aids in “finding these injuries when they show up to the ER or Immediate Care Centers and getting them to an orthopedic specialist sooner, so we can start our treatment sooner. It saves patients time and money.” Krupp concludes, “The biggest thing we want our colleagues to know is that if someone refers a patient here, they are going to get our full attention and the benefit of every resource we have available. If someone needs to get in ASAP, if there is a major issue, we will get them in – call me.” ◆
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april 2011 35
news
David Laird
Laird Named CEO for JHSMH
LOUISVILLE On March 25, 2011, the Jewish Hospital & St. Mary’s HealthCare Board of Trustees announced that David Laird has accepted the position of president and chief executive officer of Jewish Hospital & St. Mary’s HealthCare (JHSMH). Laird had served as senior vice president of Strategy and Business Development since 2008. He has also been JHSMH’s lead negotiator in the partnership discussions with the University of Louisville/University Hospital and Catholic Health Initiatives/ Saint Joseph Health System. In addition, he has served as the senior officer for strategic planning, marketing and communications and the organization’s property division. “I’m delighted that David has agreed to lead our organization as we move forward. Given David’s rich history of hospital management, particularly in this market, the board strongly believed that he is the right person for this position,” said LouAnn Atlas, JHSMH Board Chair. “David has spent many years in Louisville and has deep relationships within the health care community.” Janice James, who has served as transition CEO since July 2009, remained with the organization through April 15 to ensure a smooth transition. “I want to recognize and thank Janice for 36 M.D. Update
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all of her contributions to our organization. Under her leadership, we achieved over $70 million in documented cost savings that has positioned the organization for growth in the future,” Atlas stated. “We’re grateful to Janice for agreeing to lead our organization for a longer period than originally planned. This offered us the opportunity to work through the initial partnership discussions. We’re now at the point in the discussions where we need a permanent CEO to lead our organization into the future as we work toward our partnership,” said Atlas. Laird has extensive experience in hospital and health system management and leadership, having worked as senior vice president at Norton Healthcare from 1998 until 2006, including a two-year term as CEO of Norton Hospital. Laird held a number of senior executive positions at Humana for 18 years, including the management of Suburban Hospital (currently Norton Suburban) and University Hospital in the 1980’s. While at Humana, he also served as vice president of European Operations for six years. In addition, he has been involved in a number of entrepreneurial companies. “I’m humbled that the JHSMH Board has asked me to serve in this role as we move forward with our partnership discussions,” said Laird. “I’ve lived in Louisville for many years and have long standing relationships with many physicians throughout this community. I’m looking forward to working collaboratively with our physician partners to build upon the clinical expertise within our organization.”
with Gene Woods to ensure a smooth transition of leadership before Woods’ departure on May 2. Klockars has extensive history with Saint Joseph. Most recently, he has served as president of both Flaget Memorial Hospital (recently receiving their fifth recognition as one of Thomson Reuters’ 100 Top Hospitals) in Bardstown since 2000, and Saint Joseph - Mount Sterling (since 2009), who will open the doors for their new replacement hospital on June 16. “I am honored and excited to lead SJHS during a monumental stage in our history,” said Klockars. “I have tremendous respect for our heritage and founding Sisters, and know that we will continue honoring their legacy by delivering our award-winning and compassionate care for generations to come.” “Bruce has more than 30 years of healthcare leadership experience, and has served as an interim leader three times previously, so he is the obvious choice for this important role,” said Mike Fiechter, chair of the SJHS Board of Directors. “He will have the full support of the Board, and we welcome his historical knowledge and expertise to lead SJHS.” Klockars was also chief operating officer at Saint Joseph Hospital from 1990 to 2000, and has more than two decades of knowledge of Saint Joseph, CHI and the central
Klockars to lead SJHS through transition
LEXINGTON Bruce Klockars, FACHE, has been appointed interim chief executive officer of Saint Joseph Health System and senior vice president of Divisional Operations for Catholic Health Initiatives (CHI), effective May 3. In his new role, Klockars, 64, will lead SJHS’s daily operations and serve as the representative for Kentucky on both the CHI Operations Team and OLG (Operations Leadership Group). Over the next few weeks, Klockars will work closely
Bruce Klockars, FACHE
news
and eastern Kentucky market. Klockars has extensive experience in strategic operations, financial planning, recruiting physicians, and has now led the construction planning and opening of two master facility plans (replacement hospitals). SJHS and CHI continue discussions with potential Louisville partners, University Medical Center and JHSMH. Moving forward, Gary Ermers, chief financial officer, and Dan Varga, MD, chief medical officer, will represent SJHS in the statewide strategy process.
Roberts named Chair of Orthopaedic Surgery at UofL
Craig S. Roberts, MD, MBA, professor of orthopaedic surgery at the University of Louisville, is the new chair of the department. “Dr. Roberts will build upon a firm foundation of the Department of Orthopaedic Surgery laid by former chairman John Johnson of providing excellent care to our patients and quality education to our future physicians,” said Dr. Edward Halperin, dean of the UofL School of Medicine. “Dr. Roberts’ expertise in graduate medical education, orthopedic trauma, and sports injuries is invaluable to our patients and residents. “Search committee chairman Dr. Sheldon Bond, professor of pediatric surgery, committee vice-chair Dr. V. Faye Jones, and the entire search committee, LOUISVILLE
Craig S. Roberts, MD, MBA
evaluated an exceptional pool of candidates for this very important position within the School of Medicine.” Roberts has served as the department’s residency director since 1997. Since 2008, Roberts has been a member of the Residency Review Committee for Orthopaedic Surgery for the Accreditation Council for Graduate Medical Education (ACGME). Roberts’ clinical and research efforts focus on knee and shoulder conditions, sports medicine, fractures, orthopaedic traumatology, post-traumatic deformities, bone infections and arthritis. He has authored more than 100 scientific writings and made scientific presentations throughout the United States and internationally.
He serves as a peer reviewer for the journals Arthroscopy and the Journal of Orthopaedic Trauma. Additionally, he is on the editorial board of the Journal of Orthopaedic Trauma and is deputy editor for upper extremity for Injury. He also serves as the chair of the Sports Medicine Evaluation Subcommittee of the American Academy of Orthopaedic Surgeons and as the chair of the Public Relations and Branding Committee of the Orthopaedic Trauma Association. Roberts’ has served as team physician for numerous high school, college, and professional organizations. He currently serves as the team physician for the UofL field hockey team.
U.S. News ranks Metro Area Hospitals
LOUISVILLE The first-ever U.S. News & World Report’s Best Hospitals Metro Area – including Louisville hospitals - is now available online (www.usnews.com/hospitals). The new rankings recognize 622 hospitals in or near major cities with a record of high performance in key medical specialties, including 132 of the 152 hospitals already identified as the best in the nation. There are nearly 5,000 hospitals nationwide. U.S. News created Best Hospitals more than 20 years ago to identify hospitals exceptionally skilled in handling the most difficult cases, such as brain tumors typically considered inoperable and delicate
april 2011 37
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pancreatic procedures. The new metro area rankings are relevant to a much wider range of healthcare consumers. They are aimed primarily at consumers whose care may not demand the special expertise found only at a nationally ranked Best Hospital. Patients and their families will have a far better chance of finding a U.S. News-ranked hospital in their health insurance network and might not have to travel to get care at a highperforming hospital. To be ranked in its metro area, a hospital had to score in the top 25 percent among its peers in at least one of 16 medical specialties. U.S. News & World Report’s Best Hospitals Louisville Rankings are: 1 - Jewish Hospital (12 high-performing specialties) 2 - Norton Audubon Hospital (11 high-
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performing specialties) 3 - Baptist Hospital East (10 highperforming specialties) 4 - Floyd Memorial Hospital and Health Services (7 high-performing specialties) 5 - Clark Memorial Hospital (1 highperforming specialty) 5 - University of Louisville Hospital (1 high-performing specialty)
Laboratory partners with SJHS
Pathology Associates Medical Laboratories (PAML) announced on March 1, 2011, its intention to enter into a joint venture agreement with SJHS to enhance laboratory outreach services for physicians in Kentucky and the patients they serve. PAML, a full-service medical reference laboratory located in Spokane, WA, is owned by two of the nation’s largest healthcare systems
LEXINGTON
– Providence Health & Services (PH&S) and Catholic Health Initiatives (CHI). The joint venture will operate under the name of Kentucky Laboratory Services (KLS). This new LLC combines the highquality laboratory testing capabilities of three of the seven community-based SJHS hospitals with the esoteric testing capabilities and nationally renowned laboratory outreach services offered by PAML. The rapid turnaround times delivered by each of the SJHS’s hospital-based laboratories, and the advanced physician connectivity, logistics and client support services for which PAML is known, will improve the level of testing services available to physicians in Kentucky. These combined healthcare services will result in better choices for local physicians. As an added benefit, approximately 90 percent of the testing completed by Kentucky Laboratory Services
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will be performed in Kentucky. This maintains jobs and the provision of healthcare services within the state. “We are delighted to be partnering with Saint Joseph Health System,” said Dr. Tom Tiffany, PAML’s president and CEO. “This new company is the next step forward in a healthcare partnership that combines the complementary expertise and capabilities of PAML and Saint Joseph to accelerate the development of quality laboratory services.” “This joint venture enhances our capabilities to provide more affordable access to basic health care closer to home for more Kentuckians,” said Mark Streety, SJHS chief innovations officer. “Through this joint venture with PAML, we gain an experienced and respected management team and an ambitious growth plan to build our outreach laboratory services.”
SJHS inpatient experience awarded
LEXINGTON All seven SJHS hospitals have been recognized for service excellence under the J.D. Power and Associates Distinguished Hospital Program. This distinction acknowledges a strong commitment by these hospitals to provide an outstanding inpatient experience. The service excellence distinction was determined by surveying recently discharged patients about their perceptions of their hospital visit and comparing the results to the national benchmarks established in the annual J.D. Power and Associates National Hospital Service Performance Study. The telephone-based research conducted among SJHS patients focuses on the five key drivers of patient satisfaction with their overall inpatient experience. These drivers, which were identified in the national
study, are speed and efficiency; dignity and respect; comfort; information and communication; and emotional support. All seven facilities exceed the national benchmark study score for inpatient satisfaction. “This recognition from J.D. Power and Associates is meaningful because it reflects how our patients feel about the care we provide them,” said Gene Woods, CEO of Saint Joseph Health System. “It demonstrates a strong, ongoing commitment by our nurses, physicians, and entire staff to provide person-centered care – treating patients and their families with dignity and respect and partnering with them to achieve the best outcomes.” Nongovernmental, acute-care hospitals throughout the nation are eligible for the J.D. Power and Associates Distinguished Hospital recognition for inpatient, mater-
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news nity, cardiovascular, emergency, and outpatient services. Distinction is valid for one year, after which time the hospital may reapply for this recognition.
Baptist Hospital Foundation hires top development officer
LOUISVILLE Scott Childers has been named executive vice president and chief development officer for the Baptist Hospital Foundation. He most recently served as vice president, Department of Philanthropy, for Ochsner Health System in New Orleans. A
helping others feel better by overseeing fund-raising efforts to provide new equipment and services for Baptist Hospital East in Louisville and Baptist Hospital Northeast in La Grange. “I am honored and excited to help advance the mission of Baptist Hospital East and Baptist Hospital Northeast through the alignment and realization of fundraising goals,” said Childers. Childers will lead the Foundation in all areas of development, including strategic planning, special events, and donor relations. “Scott brings extensive development experience to this new role, which is a particularly crucial one in light of the changing healthcare industry,” said Susan Stout Tame, Baptist Healthcare System Louisville market president. “Philanthropy is becoming increasingly important as a source of additional revenue for providing new technology and services needed to enhance our patient care.”
Hanlon to head UK Sports PT Clinic
Scott Childers
Louisville native, he holds a master’s degree from North Texas State University and is a Certified Fund Raising Executive (CFRE). In his new role, Childers will assist in
LEXINGTON UK HealthCare announces the appointment of Dean Hanlon to the role of supervisor of the UK Sports Physical Therapy Clinic. Hanlon will oversee the daily operations of the Sports Physical Therapy Clinic while also actively treating patients at the Perimeter Drive clinic location. “I am excited to join such a dedicated
Dean Hanlon
team here at UK Sports Physical Therapy,” Hanlon said. “With the close interaction among all our staff in conjunction with input from the sports medicine physicians and athletic trainers, the care our patients receive is second to none.” Hanlon comes to UK from Central Baptist Hospital in Lexington, where he was the manager of outpatient therapy services for three years. While there, he practiced the ASTYM methodology as a certified provider. This augmented soft tissue mobilization technique is an evidence-based rehabilitation process designed to effectively treat chronic tendon disorders and scar tissue. Prior to that, he worked at KORT Physical Therapy in Lexington. He was also a senior staff physical therapist for more
CBH launches iPhone App LEXINGTON Central Baptist Hospital (CBH) has developed an iPhone app that allows users to search the hospital’s Web site, find a CBHaffiliated physician, or keep track of their health. The app is available for download off the hospital’s web site (centralbap.com). The CB app includes
40 M.D. Update
PhysicianLink, which allows a user to look up a physician, locate the office and call to ask a question or make an appointment; floor plans of CBH’s on-campus buildings; a medical library; first aid information; and health trackers for monitoring weight, blood pressure, and blood glucose.
news than five years at Yampa Valley Medical Center’s SportsMed in Steamboat Springs, Colo., where he worked in outpatient physical therapy and in the emergency department, focusing on acute orthopedic and sports injuries. Hanlon earned a bachelor’s degree in psychology and his master’s degree in management and policy with an advanced certificate in health care management at the State University of New York at Stony Brook in 1994. He earned his bachelor’s degree in physical therapy at the State University of New York at Buffalo in 2001. His clinical interests include sports rehabilitation and treatment utilizing his manual therapy skills.
New associate dean for Veterans Affairs
LEXINGTON Dr. Robert Means has been appointed associate dean for Veterans Affairs with the UK College of Medicine. In this new role, Means serves as the College’s primary liaison to Lexington VA Medical Center, coordinating research, education, and clinical activities between the medical center and the University of Kentucky.
Dr. Robert Means
“The affiliation between the Lexington VA and UK benefits both institutions,” Means said. “It is a privilege to be asked to help enhance this relationship.” For two years, Means served as interim director of Markey Cancer Center, ensuring its progress during a time of transition. In addition to having previously served as Chief of Medical Services at Lexington april 2011 41
news
VA Medical Center, Means has held various appointments at VA Medical Centers in Nashville, Cincinnati, and Charleston, S.C., as well as at Vanderbilt University, University of Cincinnati, and Medical University of South Carolina. He will continue in his role as professor and associate chair of Internal Medicine, an appointment that he held since he arrived at UK in 2004. “Dr. Means has a longstanding relationship with VA Medical Centers throughout this region, which is of great benefit to UK. As a faculty member at UK, he has contributed a great deal to our academic community,” said Dr. Emery A. Wilson, interim dean of the College of Medicine and vice president for clinical academic affairs. “His extensive knowledge of the two organizations will greatly benefit the advancement of our education, research, and clinical collaborations.” Means earned his medical degree at Vanderbilt University School of Medicine, completed his residency in internal medicine at Baylor College of Medicine, and completed his Hematology fellowship at Vanderbilt University School of Medicine.
Honors for volunteer director at Ephraim McDowell DANVILLE
Linda Tillman,
director
of
Linda Tillman 42 M.D. Update
Robert Copley, MD
Amy F. Davis, PA-C
L. Joseph Dunaway, MD
James O. O’Brien, MD
James E. Wheeler, MD
James Wright, MD
Jeffersontown Family Practice joins BMA LOUISVILLE The
members of the group previously known as Jeffersontown Family Practice have joined Baptist Medical Associates. Robert Copley, MD, family medicine, a 1978 graduate of the UofL School of Medicine. He completed his residency at St. Mary’s Hospital in Evansville, Ind., in 1979. L. Joseph Dunaway, MD, family medicine, a 1983 magna cum laude graduate of the University
of Louisville School of Medicine. He completed his pediatrics/family medicine internship and residency at University of Louisville Hospital in 1984 and 1985, respectively. James O. O’Brien, MD, family medicine, a 1976 graduate of the UofL School of Medicine. He completed his internship at St. Joseph’s Hospital in Louisville in 1977. James E. Wheeler, MD, a 1998 graduate of the
Volunteer Services & Senior Programs for Ephraim McDowell Health (EMH), was recently awarded the Southeastern Directors of Volunteer Services in Healthcare Organizations (SDVSHO) DVS award. Tillman received the award on March 20 during the SDVSHO’s Annual Leadership
UofL School of Medicine. He completed his family medicine residency at the Trover Foundation in Madisonville in 2001. James Wright, MD, a 1986 graduate of the UK College of Medicine. He completed his family medicine internship and residency at St. Mary’s Medical Center in Evansville, Ind., in 1989. Amy F. Davis, PA-C, a 1993 graduate of the UK physician assistant program
Conference in Louisville. This prestigious award is presented annually to a SDVSHO member who is considered a role model in the profession. The award recognizes a member for efforts that have made a significant impact to their healthcare organization and/or their com-
news
munities, upheld high standards for volunteer engagement and effectiveness through a professionally managed volunteer program and/or multiplied community resources available through the DVS’ organization. Tillman was selected among award nominees from 13 states that make up the Southeastern Division. “While we have all known that Linda exhibits outstanding leadership qualities on a regular basis and is a role model in our organization, it is gratifying to see her recognized by her professional peers through this award,” says Rick Smith, vice president & chief marketing officer, EMH.
Prestigious fellowship for Tu
LOUISVILLE Thomas Tu, MD, FSCAI, a cardiologist with the Louisville Cardiology Group, has been chosen as one of 10 national fellows by The Society for Cardiovascular Angiography and Interventions. Dr. Tu
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was selected for the Emerging Leader Mentorship program for up-and-coming physicians, which includes six training sessions over the next two years plus assignment to a professional mentor. He is director of cardiac catheterization for the practice, which is part of Baptist Medical Associates. ◆
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events May 17, 1:30 to 6:00 pm, at Southern Indiana Rehab Hospital in New Albany
Dr. Kerri Remmel and Dr. John C. Shaw will present information on advances in acute stroke care and rehabilitation, featuring the latest in acute care, innovative rehab treatment interventions for stroke recovery, and provide the opportunity for one-on-one demonstrations. The educational conference is open to anyone interested in stroke care and rehabilitation. Remmel is the director of the UofL Stroke Program and the associate dean for Clinical Development and Regionalization in stroke care. She serves on the board of the Kentuckiana American Heart Association and National Stroke Association, and is a member of the NetGain Technologies’ EHR Madness Stroke Belt Consortium. Dr. John Borders, Candy Le’Oso, practice administrator, and Dr. Larry Maguire, Shaw is a board certified orthopedist and serves all with Borders and Associates in Lexington, answered questions about the as the Medical Director for Southern Indiana Rehab transition to electronic health records at the NetGain Technologies’ EHR Madness event March 28 at the Crowne Plaza, Lexington. Borders and Hospital. He presents with over 36 years experience in Associates implemented Greenway’s EHR solution in 2008 and provided insights rehabilitation and has made national and international into their experience. presentations on rehabilitative medicine. Participants can register by contacting Linda Moore at 812-941-6154 or Linda.moore@sirh.org. Space is limited so treatments, and rehabilitation. Through presentations, exhibits and advanced registration is preferred. There is a $10 registration fee for Q-and-A sessions, this symposium will work to help bridge the gap the course. Proceeds from the event will benefit the 16th Annual between the playing field and emergency departments, urgent care SIRH Stroke Camp and the Kentucky and Southern Indiana Stroke centers, primary care physicians and orthopaedic specialists. Association. This symposium will work to help bridge the gap between the playing field and emergency departments, urgent care centers, Sports Health Symposium: Building the Bridge primary care physicians and orthopaedic specialists. Continuing June 10, 7:30 – 4:45 pm, at Spalding University’s Egan Leadership Education Credits available for physical therapy, athletic training, Center in Louisville and physician education. The KORT and Norton Sports Health symposium is designed to Advance registration ends June 1, 2011. Visit the following provide the latest scientific and clinical information about sports website for more informaiton or to register online: http://kort.com/ medicine care, including injury management, medical and surgical services/Sports-Medicine/Sports-Medicine-Symposium.aspx.
44 M.D. Update
greg rodgers
Advances in Stroke Recovery Conference
events
Central Kentucky Heart & Stroke Ball Sets Records
Honoring Sister John Miriam
Tom Gessel, president and CEO of Sts. Mary & Elizabeth Hospital, and Sister Maria Brocato, Sisters of Charity of Nazareth, unveil a portrait honoring Sister John Miriam, Beloved Administrator, March 14, 2011 at Sts. Mary & Elizabeth Hospital. The portriat is part of the Sisters of Charity of Nazareth bicentennial celebration in 2012. Sister John Miriam McMahon, Sisters of Charity of Nazareth, was a native of Hyde Park, Mass. She was a registered nurse and pharmacist, counselor, speaker and scholar. In 1953, she became superior and administrator of Sts. Mary and Elizabeth Hospital, a role she maintained for six years. She sparked the building of the current hospital at Bluegrass Avenue and worked to raise funds for the $4 million project. Thanks to her dedication and efforts, the new hospital –a six-story, 200-bed structure—was completed in 1958.
A record amount of supporters attended the American Heart Association at the 23rd Annual Central Kentucky Heart & Stroke Ball in Lexington on March 26, 2011. The event had multiple high profile features including tributes to Sam Barnes, former 5th/ 3rd Bank President who died last summer of a heart attack and to Ralph Hacker, former broadcast “voice of the University of Kentucky Wildcats,” who survived heart disease in 2006. Over 520 guests attended the event which was held at the Lexington Center. “In-room donations were a record for cities of our size,” states Dr. Sylvia CerelSuhl, president of the Board of Directors, Central Kentucky Division American Heart /Stroke Association. “We set a National benchmark for ‘Open Your Heart’ donations. Our overall net for the Ball was up over 40 percent from last year. We are so grateful for this tremendous community support.” Photography by Neil Sulier
Former Governor Dr. Ernie Fletcher, Glenna Fletcher, Ellen Karpf, and Dr Michael Karpf, executive VP, UK HealthCare.
Melanie Halpin and Dr. Dermot Halpin, cardiothoracic surgeon with Surgical Associates of Lexington.
Dr. Preston Nunnelley, vice president and chief medical officer at Central Baptist Hospital and president of KBML, and Lucille Nunnelley.
Dr. Jeremiah Suhl, Dr. Sylvia Cerel-Suhl, president of the Board of Directors of the Central Kentucky Division American Heart /Stroke Association; Sheila Zwischenberger and Dr. Jay Zwischenberger, chair, UK Dept. of Surgery.
Stephanie Sarrantonio, marketing manager with Saint Joseph Health System, and Robert Sarrantonio.
Dr. Magdalene Karon and Dr. John Stewart. april 2011 45
Courtesy of the Kentucky Museum of Art and Craft
arts No Cliché
LOUISVILLE The Kentucky Museum of Art and Craft presents “David Sharpe: Re-Defining Sunsets” April 2 through July 23, 2011. The exhibition is presented in collaboration with the Carl Hammer Gallery in Chicago, Illinois and features works depicting the imagination of Owensboro, Kentucky native David Sharpe’s palette of experimental landscapes and figurative forms. Sharpe has successfully fine tuned his way of looking at the real world, painting it in a new and personal way. Whether looking at a sunset or creating a study of a still-life scene, Sharpe’s experimentation does not end up cliché-like. His unending inventiveness and the void of stylistic sentimentality result in a vision full of incisive humor, yet permitting us to better “see” the human experience in a marvelously unique way.
The exhibition includes landscapes, still-lifes and portraits rendered in oil on canvas, pencil and watercolor on paper, and mixed-media (pencil, oil and collage) on board.
DS – 54, by David Sharpe. Oil, pencil and collage on watercolor paper, 2000. 18” x 14”
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Homenaje a Maria Isavel, by Diane Kahlo.
Travesías/Crossings
LEXINGTON The Latino/a community is the largest immigrant population in Kentucky, and many aspects of Latin-American culture (food, music, traditional celebrations, and dance) are embraced state-wide. Yet, contemporary Latino/a art is rarely seen in central Kentucky. The Lexington Art League aims to bring more visibility to this sector of contemporary art through its latest exhibition, Crossings, their first exhibit focusing solely on Latino/a and Chicano/a artists living in America. Artworks explore issues of immigration and trans-border crossing experiences as well as the points at which gender, labor, race, class, sexuality and cultural identity intersect. Crossings runs through May 15 at the Lexington Art League’s Loudoun House.
Governor’s Derby Exhibit Thru May 10, Capitol Rotunda FRANKFORT A collection of spring-themed artwork by artists from across the Commonwealth, the Governor’s Derby Exhibit is presented by Gov. Steve Beshear and First Lady Jane Beshear as part of the Governor’s Derby Celebration. More info at artscouncil.ky.gov.
april 2011 47
Featured Professionals Scott Baker................................... 27, 33
Thomas E. Menke.......................... 18-23
Gary Bray....................................... 18-23
Patrick Meyers.....................................34
David Caborn..................................... 6-7
Scott Neal............................................11
Sam Carter..................................... 28-29
Mathew A. Nicholls........................ 18-23
Scott Childers .....................................40
Paul J. Nicholls.............................. 18-23
Robert Copley......................................42
James O. O’Brien.................................42
Sam Coy ....................................... 18-23
Kevin Pugh...........................................32
Amy F. Davis.........................................42
Carol A. Quaif.......................................16
Lisa T. DeGnore.............................. 18-23
James Ritterbusch......................... 18-23
Jerry Dooley..........................................8
Craig S. Roberts...................................37
L. Joseph Dunaway..............................42
Andrew Ryan.................................. 18-23
Mark E. Einbecker.......................... 18-23
Kaveh Sajadi ................................. 18-23
Valora Gurganious......................... 12-13
Kooros Sajadi . .............................. 18-23
Keith Hall.............................................32
Joe Sostarich................................. 14-15
Dean Hanlon........................................40
G. Chris Stephens.......................... 18-23
Wallace L. Huff, Jr................................24
Linda Tillman.......................................42
Jenny Miller Jones...............................25
Thomas Tu............................................43
W. Ben Kibler................................. 30-31
Steven C. Umanski......................... 30-31
Michael Kirk................................... 18-23
John J. Vaughan............................ 18-23
Bruce Klockars.....................................36
James E. Wheeler................................42
Ryan Krupp.................................... 28-29
William Wheeler............................ 18-23
David Laird . ........................................37
James Wright......................................42
Robert Means......................................41
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D. Scott Neal........................................43
Lexington Art League...........................47
Parkway Rehab....................................15
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DCx: the Design Commission..............10
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McBrayer, McGinnis, Leslie & Kirkland........38
Unified Trust........................................ C4
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www.unifiedtrust.com, (859) 296-4407 x 202
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KODA....................................................37
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For advertising information contact Gil Dunn, Publisher (859) 309-0720 or gdunn@md-update.com 48 M.D. Update
NATIONAL LEADER. LOCALLY AVAILABLE. Congratulations Steven McCabe, M.D. – elected by some 700 of your peers as president of the American Association for Hand Surgery. In addition to offering a full range of arm and hand services, Dr. McCabe specializes in treating distal radius fractures, arthritis, Dupuytren’s contracture, carpal tunnel and cubital tunnel syndromes, as well as peripheral nerve surgery. To refer a patient or for more information, call (502) 629-HAND (4263) or visit NortonHealthcare.com/ArmandHand.
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WHO UNDERSTANDS THE FINANCIAL NEEDS OF A MEDICAL PRACTICE MORE THAN A DOCTOR?
Dr. Gregory Kasten, Founder/CEO Unified Trust
In the early 1980â&#x20AC;&#x2122;s Dr. Gregory Kasten was a successful, practicing anesthesiologist. He began exploring ways to achieve successful financial outcomes for both himself and his fellow physicians and his innovative ideas lead to the creation of Unfied Trust. Today, Unified Trust is a national trust company. Weâ&#x20AC;&#x2122;re located in Lexington, Kentucky and are one of a handful of companies in the country that offer true fiduciary responsibility. We also have more experience and expertise in dealing with the unique issues facing physicians, medical practices and groups than anyone in the area. To learn more about our innovative and systematic approach to helping doctors and medical practices reach their financial goals, call Gregory Kasten at 859-296-4407 x 202 or visit unifiedtrust.com.
W E A LT H M A N AG E M E N T
R E T I R E M E N T P L A N C O N S U LT I N G A D V I S O R S E R V I C E S
Not FDIC Insured | No Bank Guarantee | May Lose Value