Central and Southeastern Kentucky Edition
January 2011
Issue spotlIght:
Rural Medicine ThE buSinESS magazinE of KEnTuCKy PhySiCianS
and hEalTh CarE adminiSTraTorS
Addressing the Rural Physician Shortage VolumE 2, numbEr 1
pikeville College school of osteopathic Medicine expands in order to meet growing need for primary care physicians in rural Kentucky and Appalachia.
FeAtured physICIAns:
John belanger boyd buser bill Webb dennis Williams anthony yonts michael J. zackek
Rural Family Physician John Belanger Saint Joseph Mobile Health Service Kentucky Blood Center
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Central & Southeastern Kentucky Volume 2, Number 1 January 2011 Publisher
Gil Dunn gdunn@md-update.com editor in chieF
Megan Campbell Smith mcsmith@md-update.com
Contents Cover story
Feature story
PhotograPher
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12 Supply and Demand
Kentucky Blood Center Masters Logistics of Safe and Ready Blood Supply By megan C. smith
Addressing the Rural Physician Shortage pikeville College school of osteopathic medicine expands in order to meet growing need for primary care physicians in rural kentucky and appalachia. By Dan Dickson page 4
On the Cover:
pikeville College president paul e. patton (left) and Boyd R. Buser, DO, FaCOFp, vice-president and dean, pikeville College School of Osteopathic Medicine.
allieD health
20 Connecting Rural Kentucky Back to the Healthcare System By greg BaCkus anD megan C. smith
Departments 9 Financial 10 legal 16 Practice ManageMent 18 Physician ViewPoint 20 allied health 22 news 27 arts 28 adVertisers index
Cover story
Addressing the Rural Physician Shortage
pikeville College school of osteopathic medicine expands in order to meet growing need for primary care physicians in rural kentucky and appalachia. pikeville College president paul e. patton (left) and Boyd R. Buser, DO, FaCOFp, vice-president and dean, pikeville College School of Osteopathic Medicine. pHOtOS COURteSY OF pCSOM
4 M.D. UpDate
By Dan DiCkson Asked to name all of the medical schools in Kentucky and most people would quickly list the University of Kentucky and the University of Louisville, and then stop there. Many Kentuckians do not realize that a third medical school has been operating at Pikeville College since the fall of 1997, when Pikeville College School of Osteopathic Medicine (PCSOM) became the 19th osteopathic medical school in the nation. The school was ranked as one of the top 20 US medical schools for rural medicine in the U.S. News & World Report “America’s Best Graduate Schools” of 2009. PCSOM also ranked fourth in the percentage of graduates entering primary care residencies. The osteopathic medical education emphasizes primary care, and it encourages research and lifelong scholarly activity while producing graduates who are committed to serving the health care needs of communities in Eastern Kentucky and other Appalachian regions. Osteopathic medicine emphasizes the concept that the body has the ability to heal itself, that proper body structure predisposes appropriate body function and restoring normal circulation leads to better health. “Our medical students are taught how to use their hands to structurally diagnose and treat patients through osteopathic manipulative medicine or the manipulation of the musculoskeletal system,” explains Dean Boyd Buser, DO.
In May 2010, the School of Osteopathic Medicine graduated its 10th class of osteopathic physicians. the medical school accepted its first students in the fall of 1997.
the nine-story, $25 million “Coal Building,” scheduled for completion in March 2012, will house the School of Osteopathic Medicine and feature an expanded clinical skills center.
Osteopathic manipulative medicine (OMM) takes into account the physical, mental, emotional, and spiritual health of patients and how each might contribute to the disease. “Osteopathic medical education places more emphasis on disease prevention, wellness, and primary care. Osteopathic physicians practice in all medical and surgical specialties and subspecialties throughout the US,” says Dr. Buser. Doctors of osteopathic medicine enter family medicine at a higher rate than MDs. The training between the two is very similar in terms of length and material covered. The DO and the MD receive the same license, practice medicine in similar ways, and share equal medical rights and privileges. You can find doctors of osteopathic medicine in specialties ranging from emergency medicine to pediatrics, neurosurgery to psychiatry, and everything in between. Still, most PCSOM graduates work where they believe they are needed most
– rural areas. Pikeville College says that 32% of its medical school graduates practice in Kentucky and 62% in Appalachia as a whole. It says 44% of those graduates practice in federally designated medically underserved regions, and 36% practice in defined rural areas. PCSOM receives about 2,500 applications per year. “Our success has convinced the college board of trustees to expand the school from 300 to 500 students and thus, the need for a new building,” says Paul Patton, president of Pikeville College and former governor of Kentucky. The college broke ground last fall for a nine-story, $29M expansion project including a new educational facility and expanded clinical skills center. The new building, named the Coal Building, is due to open in the spring of 2012 and will house two lecture halls, a gross anatomy lab, two research labs, offices, small group classrooms and student study space. The clinical skills training and evaluation center will house 12 specially equipped examination rooms to train and test students in programs using standardized patients and high-fidelity robotic patient simulators. The expansion will allow college administrators to turn out more primary care physicians. “We’ll be able to take in 125 new students per year - up from 75 - and run them through the program,” says Patton. According to Patton, the PCSOM grew out of the observations that Eastern Kentucky students were not getting into the medical schools at UK and UofL as often JaNUaRY 2011 5
Cover story a Yonts
as other students in the state were. “We were not getting our fair share,” he says. Some mountain students who did enroll at Lexington or Louisville seemed reluctant to move back to rural areas after growing accustomed to city living. “We felt that if we could get students from rural areas into our own medical school, they would be more apt to stay here to provide better healthcare,” Patton says. “It was a two-fold approach. We get more of our young people into medicine and we have better health care from doctors from our own area, who understood us and with whom we feel comfortable.” As for the success of the medical school program, Patton adds, “It has obviously worked. There are few things in life that turn out better than you expected, and this is one of them.”
anthony Yonts, DO
After Anthony Yonts completed his bachelor’s degree at Alice Lloyd College, medical school at the PCSOM, and a dual residency in internal medicine and pediatrics at the University of Kentucky, he returned to the mountains of Eastern Kentucky to practice medicine. “There was never a doubt. The only reason I went into medicine was to get back home and help the folks who helped me all of my life,” says Dr. Yonts. A native of Bevinsville, Ky, population 250, in Floyd County, Dr. Yonts operates Quantum Healthcare, a clinic serving a
anthony Yonts, DO
rural community around Hazard, Ky. He feels he is exactly where he was meant to be. “There are very few things more rewarding than having someone you went to high school with come in or bring their kids to you. It is one of the most satisfying feelings I get. It means a lot,” he says. Doctors of osteopathic medicine see the chronic diseases that are common in the region, like hypertension, heart disease, diabetes, obesity, and cancer. Unfortunately, they are all diseases for which Kentucky ranks near the top among the 50 states. “We do see disease processes that are
32% of pCsom graduates practice in kentucky, and 62% practice in appalachia as a whole. 44% of those graduates practice in federally designated medically underserved regions, and 36% practice in defined rural areas. 6 M.D. UpDate
more advanced because, in this area, folks are later in presenting to doctors,” says Dr. Yonts. Reasons for the delay include poverty, lack of health insurance, and need for education about health habits. Dr. Yonts says he also sees a few rare diseases that are more common to rural areas of the state. He especially enjoys seeing old coal miners as patients, for personal reasons. “I worked with them for three years during the summers and Christmas break. My parents were in the coal business.” Dr. Yonts explains that in the rural settings, a physician may see a patient, discover a serious problem, and admit them to the hospital. The same doctor then continues to see the patient in the hospital setting, whereas hospitalists fill this role in urban settings. “It does spread you a little thin,” says Dr. Yonts. “You have to get up earlier in the morning to go to work and in the evening you have to go back to the hospital to make sure every patient is seen.” On the upside, Dr. Yonts says that practicing rural medicine “is one of the few jobs in this area where you can live comfortably and provide your family with a good life.”
Bill Webb, DO
At age 39, when many people are in the middle of their professional careers, Bill Webb decided to do something he had wanted to do all his life, but kept putting off – he enrolled in medical school. After owning a plumbing supply business for several years, then an IGA grocery store for 16 more years, Webb too enrolled in PCSOM. Now a practicing physician near his hometown of Pikeville, Dr. Webb is finally living his lifelong dream of treating the needy in this rural part of Kentucky. “It gives me a sense of fulfillment to practice here. I am helping to fill a need in Eastern
Kentucky because of a shortage of physicians. I can relate to the patients because I know the background here.” Dr. Webb works in a rural health clinic in Stanville, Ky., located between Pikeville and Prestonsburg. He is also affiliated with Saint Joseph-Martin, a 25-bed hospital in Martin, Ky, which is part of the Saint Joseph Health System. He makes rounds every morning and pulls about four emergency room shifts per month. Dr. Webb performs frequent osteopathic manipulation and sees patients who have suffered back injuries from automobile and coal mining accidents. He sees many patients with hypertension and diabetes, which he says are “problems around the country, but they are especially bad in Eastern Kentucky.” Before nearby Pikeville Medical Center hired an endocrinologist, Dr. Webb sent many diabetic patients to Ashland or Lexington for treatment. “Many of my patients cannot afford to travel out of town to see doctors, so now there is someone here
for them. Diabetes is tough to manage, and you need a specialist to handle patients who have trouble getting it under control.”
addressing physician Shortages
President Patton has a message for Kentucky’s medical community concerned about physician shortages in rural areas. He says PCSOM will produce colleagues that will be of value to them in whatever practice they are in and will help lighten the shortage. “I’m sure a lot of physicians do not appreciate being dragged out in the middle of the night to handle a serious medical emergency because there is no one else available to do it. I’m sure they want the field to be adequately staffed, and our school is helping to alleviate the shortage,” he says. Not stopping there, Patton says students can expect a quality medical education at PCSOM. “We will equip them to be high quality physicians whether they want to specialize or become a family care physician. We will provide a medical education at least as good as any similar institution in the country.” Because of health reform, there should be plenty of work for new physicians coming to the area. “I Bill Webb, DO
pCSOM students learn to use osteopathic manipulative treatment (OMt) at the medical school’s free community clinic. OMt incorporates the hands to diagnose, treat and prevent illness or injury.
don’t think there is any question about that,” says Dr. Buser. “We already have a physician shortage in Kentucky, and it is expected to worsen. The health reform legislation will undoubtedly create an increased demand for primary care physicians. It is incumbent upon us to do everything we can to help address those needs.” Practicing medicine in rural areas has another added benefit, one that comes from deep within the hearts of a grateful population, says Dr. Yonts. “When you are with a patient and they don’t make it, well, I can’t remember a time when the family did not thank me for all I had done. That boggles my mind,” he says. “Here we were unsuccessful, we failed. Yet even during that hard time, families were kind and courteous enough to thank me. That is, without a doubt, the most rewarding thing.” ◆ JaNUaRY 2011 7
FinanCial
Qe2 is more than a Big Boat There has been a great deal in the news lately about QE2, the Federal Reserve’s second round of economic stimulus. QE stands for quantitative easing. While one can laugh a bit at the cartoon dialogue found on YouTube under the title “quantitative easing explained,” the subject really is not a laughing matter. YouTube aside, there are some very smart people surprisingly arriving at some very poor conclusions about what they believe is the inevitable effect of QE2. The principle complaint seems to be centered on the idea the Fed is “printing money” and that it will most certainly be inflationary, in the same sense of inflation that we experienced in the 1970’s. It could be inflationary, but it doesn’t have to be; and may, in fact, not be very likely. First of all, if you look closely at the fundamentals of the economy in the ’70’s you will find, not only OPEC, but the proliferation of collective bargaining and its result
The Fed only increases the currency outstanding by just enough to keep up with demand. It implements QE by increasing the amount of reserves available to the banks to scott neal lend. This does not turn into “money” until the banks actually lend it. Many banks who have suffered near collapse under the weight of bad loans are unable to lend the money and others are simply unwilling to lend it because they figure that they can make more on investments. The Fed can actually insure that that becomes the case by increasing the rate they will pay on those un-lent reserves. These are two brakes on inflation. Even if the banks are willing and able
Why am I telling you all this? What difference does it make anyway? For one thing, I want you to be able to tune out the noise that is blasted at us every day on radio and TV and is likely to be coming soon from the halls of Congress. Most of the noise is simply wrong, or at least incomplete. Second, it is generally thought that a certain amount of QE was priced into the financial markets in an expectation of growth long before the Fed made its first purchase. What if it doesn’t stimulate the economy the way it is designed to do? Will there be a QE3? Will we need permanent QE? As I write this (early in 2011), the stock market is experiencing a significant rally, optimism seems to be spreading, and many forecasters have increased their predictions of annual growth in the economy. However, we are on very tentative ground. I point you back to last month’s article on the validity of the forecasts. Now is not the time to resume business
the stock market is experiencing a significant rally, optimism seems to be spreading, and many forecasters have increased their predictions of annual growth in the economy. however, we are on very tentative ground. on increasing wages that led to an inflationary spiral. That is very different than the fundamentals of our economy today. Most pundits, and I fear many politicians, fail to understand how the Fed pays for its acquisition of the mortgages and treasury securities that it is purchasing in QE2. As we accountants know, when you put an asset on your balance sheet, debits increase. Correspondingly, credits must increase by the same amount. The credit (or liability) side of the Fed’s balance sheet is made up of two components: 1) currency and 2) bank reserves on deposit with the banks that make up our banking system.
to lend, we consumers must also be willing and able to borrow the money. Guess what? Compared to just a few years ago, there aren’t many borrowers out there today. Finally, the Fed truly holds a couple of trump cards that also act as a brake on inflation: 1) it can simply reverse its QE by reselling all the securities that it bought or 2) it can arbitrarily increase the reserve requirement placed on member banks. Typically, for each dollar of reserves, a bank can lend ten. If the Fed increases the reserves through open market purchases of securities and, at the same time increases the reserve requirement, no new money is created.
as usual and go “all in” with your investment portfolio, especially without proper risk controls. GDP and the financial markets are likely to be very volatile; so let us participate wisely but not get overly excited when they go up. They can fall. When they do, they usually fall more quickly than they rise. Here’s to 2011 being your Best Year Yet! Scott Neal is president of D. Scott Neal, Inc, a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville KY. Reach him at scott@dsneal.com or by calling 1-800-344-9098. Scott is a Cpa and certified financial planner. ◆ JaNUaRY 2011 9
legal
aCos: an alternative to employment by a hospital? With a backdrop of rising health care costs, 50 million uninsured Americans, and a health care system that spends more per person but has lower quality than 37 other developed countries, Congress passed a comprehensive health care reform law with the vision of doctors and hospitals joining forces, coordinating care to hold down costs for the prospect of earning government bonuses for controlling costs.1 While no one can foresee exactly how all the provisions of the new law will mesh with the current system, four of Kentucky’s largest hospital systems are negotiating mergers and many of the smaller systems are buying up other providers or seeking to enter into controlling management arrangements. Not only are hospitals creating new healthcare systems, physicians and their groups are increasingly looking to hospitals as employers. It is a buyer’s market for
physicians must find ways other than employment relationships to align themselves as ACOs. The health reform law establishes a Medicare shared savings program for lisa english hinkle ACOs that is to take effect no later than January 2012. This is not a demonstration project; the law makes contracts with ACOs a permanent option under Medicare. Because the Health Reform Act left most of the details about what an ACO is supposed to look like to the Secretary of Health and Human Services (HHS) and the Federal Trade Commission (FTC), industry is eagerly awaiting the
physicians are the focal point for developing aCos because they are the gatekeepers for all healthcare services. integration of care must start at the physician level, but that does not mean that all physicians must be employees of a hospital. hospitals with the financial reserves to buy physician practices, but not every physician practice can be bought by a hospital nor does every physician want to be employed by a hospital. While this activity is being driven by decreases in reimbursement, it is also a product of the new health reform law, which encourages providers to create integrated health care delivery systems that can improve the quality of health care services and lower health care costs. Accountable Care Organizations (ACOs) are the vehicles through which shared savings are to be passed along when certain quality performance standards are met. Hospitals and 10 M.D. UpDate
implementing regulations that will impact how ACOs are structured and how they ultimately function. Complicating the scenario is the fact that shared savings arrangements have the potential to violate current fraud and abuse laws as well as antitrust prohibitions, particularly if physicians are not employed by the system establishing the ACO. Consequently, the AMA and other groups are actively lobbying the HHS and the FTC to waive requirements of existing laws and create new safe harbors regulations that give guidance to providers. Both the FTC and HHS are soliciting comments about ACOs prior to promulgating implementing
regulations. The Health Reform Act, however, gives enough guidance to motivate mergers and acquisitions of existing systems and hospital employment of physicians. Under the Health Reform Act, entities that may participate as ACOs must have a legal structure in place and can include physician group practices, networks of individual practices, arrangements between hospitals and ACO professionals, hospitals employing ACO professionals, and other groups of providers as the Secretary deems appropriate. Appearing to be motivated to develop an ACO, at least four of Kentucky’s large healthcare systems including Jewish Hospital & St. Mary’s HealthCare/Jewish Hospital Healthcare Services, Catholic Health Initiatives and its Kentucky based operations that include Saint Joseph Health System, and the University of Louisville announced intentions to establish an integrated system that partners with physicians to provide the full continuum of care. Likewise, UK HealthCare and Norton Healthcare recently announced an intention to form a partnership that is focused on improving patient care while emphasizing efficiency and accountability. With all this in mind, physicians are the focal point for developing ACOs because they are the gatekeepers for all healthcare services. Integration of care must start at the physician level, but that does not mean that all physicians must be employees of a hospital. Years ago, the FTC identified how to successfully achieve clinical integration without an employment relationship. In 1996, the FTC identified several requirements for integration including mechanisms to monitor quality and costs; selective choosing of network physicians; and the capital investment necessary to develop the infrastructure that has the capability to realize efficiencies.2 Serious obstacles currently exist to the integration of care that ACOs are supposed to achieve. Some physician specialties benefit directly from maximizing the
volume of services they provide and may not see possible shared savings as enough to offset the revenue they would lose from a reduced use of services. Solo practitioners and small physicians groups lack the data systems and organizational structure needed to form ACOs. Commentators agree that if ACOs are to achieve success, use of health information technology, including electronic health records, to coordinate care, communicate among network providers, eliminate unnecessary duplication of tests, and collect performance data will be critical. With the increasing need for investment in technology and for collaboration between physicians and hospitals to establish ACOs, implementing regulations should expand the types of new relationships providers may develop and permit a more free exchange of money. If cost efficiencies are to be
achieved, new models for delivery of health care services must evolve so that physicians have alternatives other than hospital employment. Older models of Independent Physician Associations (IPA) could serve as a springboard for ACO development. While many hospitals and physicians, through their IPAs, formed physician hospital organizations in the nineties, most of those organizations failed because of the lack of the ability to share clinical information due to the high cost of implementing technology systems. With better technology as well as the ability to be rewarded through shared savings, ACOs may be the answer if the regulating bodies give physicians and hospitals the flexibility they need to create new models of health care delivery other than hospital employment of physicians.
Lisa english Hinkle is a partner of McBrayer, McGinnis, Leslie & Kirkland, pLLC. Ms. Hinkle concentrates her practice area in health care law and is located in the firm’s Lexington office. She can be reached at lhinkle@mmlk. com or at 859-231-8780. this article is intended as a summary of newly enacted federal law and does not constitute legal advice. eNDNOteS 1 the Business Roundtable Health Care Value Comparability Study, executive Summary at 2 (2009) at Http://s73976.grindserver.com/ healthcarestudy.pdf. 2 US Department of Justice and Federal trade Commission, Statements of antitrust enforcement policy in Health Care; Network Joint Ventures. http://www.ftc. gov/bc/healthcare/industryguide/policy/ statement8.pdf. ◆
Pati truggling e with nts sght loss? wei Jason Rasmussen, M.D., a fellowship-trained board-certified general surgeon with a special interest in bariatric surgery, has joined the Central Kentucky Advanced Surgery & Medicine practice. He will practice bariatric and general surgery at Georgetown Community Hospital. Dr. Rasmussen received his medical degree from the Medical College of Wisconsin in Milwaukee. He went on to complete a general surgery residency as well as an advanced laparoscopic and bariatric surgery fellowship at the University of California, Davis. Dr. Rasmussen currently is accepting new patients and may be contacted at 502-867-3303. JaNUaRY 2011 11
Feature story
supply and Demand Kentucky Blood Center Masters Logistics of Safe and Ready Blood Supply
processed blood products are stored in the refrigerators in the hospital services department. pHOtOGRapHY: DaVID GReeNLee
By megan C. smith As the largest FDA licensed blood bank headquartered in the state, Kentucky Blood Center (KBC) plays an integral role in the healthcare of Kentuckians, providing life-saving blood products for patients at nearly 70 Kentucky medical facilities. “We are the stewards of the blood supply,” says KBC president and CEO William S. Reed. “We are supposed to provide a safe and continuous blood supply to the hospitals we serve. That’s really it. Safe means that the products meet FDA regulations, and continuous means that when they need it, we have it available for them. That guides everything we do.” Serving 68 counties, KBC supplies all of the hospitals in central and southeastern Kentucky, north to Bracken and Mason counties, and south and east to the Tennessee, West Virginia, and Virginia state lines. Hospitals served include Pikeville Medical Center, Lake Cumberland Hospital, UK Medical Center, Central Baptist Hospital, St. Joseph Hospital, and all the Kentucky Appalachian Regional Healthcare hospitals.
Donors for Life
To fulfill its life-saving mission, KBC has donor centers in 12 M.D. UpDate
ing at high schools, colleges, companies, churches – lots of different places. By seven o’clock at night, most of the blood is back here at the Beaumont Donor Center and Processing Facility. The second shift begins testing and component preparation. Tests are run overnight, so blood can be ready to release the next day.” Maintaining an adequate blood supply is paramount. “When it comes to supply, more is better,” says Reed. “We balance our supply, we outdate virtually nothing, and everything gets utilized.” Since joining KBC in 2008, Reed led the changeover from an importing center, meaning they had to look out-of-state for needed blood products, to a self-sufficient blood center with some exporting.
Components, testing, and Reference Laboratories
Recruitment and collection efforts also depend upon what blood products are needed most, according to KBC medical director Dennis Williams, MD, blood banking/ transfusion specialist who joined KBC in 2010. “Most of our donations are whole-blood,” explains Dr. Williams. “Once it is collected, we have to process it by separating it into its different components – platelets, plasma, and red blood cells. Each of these different products gets stored in different conditions, and each has its own shelf life. “Red blood cells are refrigerated, plasma is frozen, and platelets are kept at room temperature. We keep red blood cells for 42 days, plasma for a year, and platelets for 5 days.”
KBC
Pikeville, Somerset, and Lexington, and operates numerous mobile blood drives every day. In addition, KBC staff focus on recruiting enough blood donors to meet the needs of the hospitals. People can begin donating blood at age 16 with parental permission. About 20 percent of donors are first time donors with the average donor giving only twice a year. A person can donate whole blood every 56 days. Because the blood supply is seasonal, and blood usage is typically predictable, KBC tracks donor data and plans ahead to offset periods of low donation. In fact, KBC has a forecasting system that compares projected blood donations to projected blood transfusions 14-weeks into the future. Historically, donations go down during summer months and winter holidays. During those periods, KBC plans promotions to help encourage people to donate. Martha Osborne, executive director of marketing and recruitment, oversees donor programs and promotions. Big Blue Crush, for example, is a competitive blood drive between football boosters of the universities of Kentucky and Tennessee. The popular Big Blue Crush helps to rebuild the blood supply just after summer reserves have dwindled and also ensures enough blood for the holidays. In 2010, the 23rd annual event raised over 6,000 units, with Kentucky collecting 3,503 units to Tennessee’s 2,954. By comparison, KBC collects about 1,700 units in a week. Osborne explains the logistics of blood collections. “On any given day, our four fixed sites are operating, two in Lexington, and one each in Somerset and Pikeville. At the same time, we will have 6 to 9 mobile units operat-
LeFt:
William Reed, KBC president and CeO RIGHt:
Martha Osborne KBC executive director of marketing and recruitment
pHOtOS COURteSY OF KBC JaNUaRY 2011 13
Feature story
RIGHt:
all blood is processed in KBC’s components lab, where whole blood is separated into red cells, platelets and plasma (shown on worktop). CeNteR:
KBC conducts more than 1,000,000 tests a year. these reagents are used in the reference lab.
14 M.D. UpDate
photography by David Greenlee
KBC has a fleet of bloodmobiles that travel the region, making it convenient for people to donate blood closer to home or work.
Depending on their blood type and if they meet the requirements, donors are invited to give platelets, plasma or red cells via automated collection process called pheresis in place of a traditional whole blood donation. Plateletpheresis is the process of removing whole blood, retaining the platelets, and returning the other blood components to the donor. This can be done every two weeks, up to 24 times a year. Plateletpheresis allows KBC to meet the very high demands for platelets that are necessary for cancer and anemia therapies. Double red cell donors can give the equivalent of two units of red cells in one sitting, allowing a much larger supply of transfusion products. Double red cell donors can give every 112 days. Plasmapheresis services are also available and help patients who require plasma exchanges. Dr. Williams emphasizes that safety is the number one priority in blood banking medicine. “We run over 1.5 million laboratory tests every year in Lexington’s Beaumont facility. We collect around 100,000 products in a year, and every product requires 15 different tests per FDA regulations. The majority of the screening tests are to detect diseases transmitted through blood, like HIV, hepatitis B and C, syphilis, West Nile virus, and others. We screen at many levels, beginning with the donor history and questionnaire. If a laboratory screening test comes up positive, we do a confirmation test.” Testing and processing occur simultaneously in order to expedite release of the final product. Bar-coding and proprietary software track every donation and testing sample until its final disposition. There are several levels of redundant checks in the system to ensure the security of the products. Local physicians, says Reed, expect the blood supply to be safe. With several area pathologists serving on the KBC Board of Directors and local physicians determining best practices via the KBC board’s medical advisory committee, KBC meets and exceeds federal safety regulations. For example, a test for Chagas disease and the method used to test for it was set up following review and recommendation from physicians who sit on the medical advisory committee. One of the critical services provided by KBC is
Units of rare blood are stored at KBC.
maintaining an adequate blood supply is paramount. “When it comes to supply, more is better,” says reed. “We balance our supply, we outdate virtually nothing, and everything gets utilized.” the reference laboratory. The reference lab, which is accredited by the American Association of Blood Banks, resolves blood typing problems, antibody identification, and antigen typing. “Some hospital transfusion services do not have the ability to do antibody testing,” says Dr. Williams, “so they send out to our reference lab. Other hospitals can do more testing, but if a particular case becomes too complicated, then we serve as a reference lab for more complex testing.” The KBC reference lab also provides continuing education for pathologists and blood banks at the hospitals they serve.
the Business of Charity
Because the blood is provided free of charge by volunteer donors, KBC has a special fiduciary responsibility. Reed explains that they are reimbursed by the hospitals for the
service fees, which cover the cost of recruiting donors, and collecting, processing, testing and distributing the blood products. “We are extremely proud of the fact that our service fees are the lowest in the region. We feel very strongly that when we are asking the hospitals to reimburse us for these service fees, that we have to do our job as efficiently and economically responsible as possible. Our service fees have not increased by more than 1% a year over the last three years.” KBC is a 501(c)(3) non-profit organization. CEO Reed reports to an all-volunteer board monthly, and the budget they approve determines the fees. Reed acknowledges that KBC functions as a healthcare entity, meeting supply and demand while assuring quality and safety means they operate with smarts and efficiency, “But at the end of the day, we are not able to do anything we need to do without our volunteer donors. Our donors trust that we are going to do the right thing with their generous gifts. We are a non-profit business and without blood donors we cannot fulfill our mission.” Reed encourages physicians to advocate for blood donation. “You’ll perform the surgeries and help on the traumas, but the more that people hear the message to donate, the more everybody will benefit – physicians and patients. It truly is a community resource. “We have some of the best staff around and the donation experience is great. Just give it a chance. Try it once and maybe you’ll become a donor for life.” ◆ KBC medical director Dennis Williams, MD, is a blood banking/transfusion specialist. KBC’s reference lab staff help area hospital blood banks that need more complex blood testing. JaNUaRY 2011 15
praCtiCe management
living with electronic health records By miChael J. ZaChek, mD Many physicians currently in practice have used computers for years in their private lives for email, internet access and multimedia, while relying on paper medical records at work. We scribbled notes or checked items on intake sheets, wrote illegible prescriptions, and answered call backs from our memory when we were away from the office. It is what we were brought up with and what we are used to! For some, contemplating the shift to electronic records conjures a nightmare of dual paper and electronic records, misplaced data, and countless hours of frustration for staff and providers throughout the transition. Does “I’ll retire before I go through all that” sound familiar? Recent changes in health care law virtually mandate that electronic medical records be used in medical practice. Currently, providers are financially incentivized to use EHR, and if used properly (Meaningful Use Requirements) much of the costs of the conversion to computer based health records will be borne by the federal government. However, for those that delay, the message is clear; penalties for failure to convert to EHR loom. At Graves-Gilbert Clinic (GGC), a 60+ physician multispecialty group practice in south central Kentucky, an EHR was instituted in 2005. The past 5 years have not been pain-free, but the benefits of putting a system in practice are now quite clear. We installed Allscripts Touchworks (now Allscripts Enterprise) EHR after much deliberation. In a medical group the size of GGC, we needed a flexible system that would allow communication between multiple departments and services. Our group has an active hospital practice at the Medical Center at Bowling Green, so transfer of hospital reports including laboratory, radiology, and pathology 16 M.D. UpDate
results was critical. Some physicians liked the idea of being able to dictate their thoughts using Dragon Speak; others liked a series of text templates, while others preferred the selection of findings from lists. The system we chose enabled GGC to give providers options in data input. The electronic record process was not implemented overnight; rather, it was rolled
out in a stepwise manner. The first aspect to be included was the creation of the problem, medication, and allergy list. Like most medical practices, we were already using these in our paper records (although, as you might imagine, not every list was up to date). The medical assistants and providers were all involved in this portion of the project and, by the end of the first 6-9 months, all departments had access to this information. The addition of an electronic medication list allowed practitioners to begin to electronically transmit prescriptions. This demonstrated the first tangible benefit to my practice; the calls from pharmacies to “clarify” my orders stopped. They could actually read what I was ordering! Many offices then realized that the EHR had more to offer. A complex (for new patients) and a simplified (for follow ups) review of systems was added. Individual specialties were able to customize these questions to make them more appropri-
ate to the patient and practice. Medical assistants were trained to input the data, often from a questionnaire that the patient had filled out in advance. Providers simply reviewed this data at the point of service. The next step was the introduction of a complete electronic office note, new patient evaluation, and consultation note. Here, the job fell directly on the shoulders of the individual providers. For my practice (pulmonary, critical care, and sleep disorders), a wide variety of patients and disorders had to be considered. I found that the pulmonary patients were best served by a list of symptoms (e.g. Dyspnea, at rest? On exertion? How far and at what speed?) while sleep patients really required a series of narrative text templates ( “Mr. Jones gets into bed at __ hour and is out of bed by __”). The physical examination was rather simple. Most physicians perform essentially the same examination on every patient although they spend more time and give greater attention to areas of concern raised by the patient. As a consequence, the physical examination was built as a series of normal/abnormal inputs. Individual practices would expand on their areas of expertise (for pulmonary breath sounds diminished, expiratory wheezing, etc.) The assessment turned out to be easy. It included the problems addressed during the evaluation, perhaps with a brief modification. Obstructive Sleep Apnea, 327.23, mild, well controlled or Chronic Obstructive Pulmonary Disease, 496, Severe, FEV1=38%. The problems were a click away. The treatment plan was also straight forward. Laboratory tests were ordered from a dropdown list as well as instructions to the patient (lose weight, stop smoking, follow up). Sometimes, for more complex instructions (detailing my discussion of risks and benefits of bronchoscopy or explaining sleep hygiene) a template paragraph would be inserted. Even before the first office went live on the EHR, we converted thousands of paper charts
the addition of an electronic medication list allowed practitioners to begin to electronically transmit prescriptions
to digital images. This allowed medical assistants and providers to transition more quickly to the EHR since we were eliminating our old paper record system and the labor that accompanied it. The task was too laborious for our chart room personnel, so the job was outsourced. We decided to scan these into the system for all active patients, which totaled 60,000 charts. Once the paper chart was scanned into the system, it was destroyed. Approximately 1,800 paper images are scanned daily and indexed into the EHR by the company that initially converted our paper charts to digital images. Now, in 2010, much of the hard work is done. We are starting to realize the benefits of having an EHR. At the GGC we converted 3,000 square feet of “chart room” into two physician practice areas. Transcription of dictated documents has virtually disappeared, saving an estimated $600,000 per
year. Additionally, documents are faxed directly to referring physicians’ offices at the point of service, so there is no time or money spent mailing information. In the pulmonary department, we used to employ two full-time assistants just to file paper work, and GGC had 23 people in the chart room whose job was to pull, distribute, and collect charts. These people now have more constructive jobs in other areas of the clinic. From a physicians’ standpoint, there is a clear improvement in the quality of care rendered. Being able to review office records while caring for patients in the ER or the ICU is a significant advantage. In the office, I no longer have to see a patient “without the old chart”.
One Friday afternoon at about 5 pm, just after the office closed when I was on call for my partners, I received a call from someone who stated that he was a patient of my colleague and was just about to leave town when he realized that his narcotic prescriptions had run out. “I need you to refill them for me,” he said. I replied, “Just a moment, please, while I pull up you records on the computer.” After a short pause, I heard the “click” of the line going dead on the other end. At that moment, I knew we had arrived at the full benefit of EHR. Dr. Michael J. Zachek practices at the Graves-Gilbert Clinic in Bowling Green, Ky. He is board-certified in internal medicine, pulmonary medicine, critical care medicine, and sleep medicine. Dr. Zachek may be reached at 270-783-3323. ◆
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JaNUaRY 2011 17
physiCian vieWpoint
rediscovering primary Care By John Belanger, mD When I graduated from medical school in 1986, some doctors still kept patient records on 3 by 5 index cards. Now, when I make a referral, I receive a five page progress note with a complete history and physical for each visit; and that’s just from the physical therapist. During the ‘90s, managed-care happened and patients no longer knew the costs for services and medications, only their co-pays mattered. Even the doctors were unsure what many of these costs were. Meanwhile, patients without insurance saw the actual costs skyrocket out of their realm of possibility. These are the folks that I worry about. After years of seeing patients turned away by doctors’ offices (including where I worked) because they were short on cash, I realized that the system was too big for me to change. So I decided to strike out on my own. In the year 2000, with the help of many community members, I opened the Paint Lick Family Clinic in the heart of Paint Lick, KY. My goal was to provide high-quality care and never turn a patient away for financial reasons. I did this by lowering my overhead, hiring a small but very competent staff, opting out of Medicare and private insurance, and getting rid of the billing department. Unfortunately, this was not enough. Some patients could not even afford our regular fee of $20 for an office visit. This is when I talked to one of the older physicians in our community who told me that if our fees are reasonable, patients will try very hard to pay us when they are able. Contrary to my practice management journals, he felt that it was not necessary to make patients pay their fees up front. I strongly feel that stress, including financial stress, can delay the healing process. Since patients frequently are experiencing deep financial troubles at the same time that they are suffering from illness, it made sense to me to trust patients to pay us when they are able. So, in Paint Lick, when our patients check out after a visit, the receptionist hands them their bill and asks them to pay what they can, when they can. We 18 M.D. UpDate
never send them a bill and absolutely do not send anyone to collections. At the end of the day, we have found that about 30% of our fees have been paid. However, by the end of the year, about 80% of our fees have been paid. To me, this has been a huge success! Patients do not have to wait until they have cash to see me, so illnesses can be treated promptly and we are still able to pay our bills. But what about patients who need outside services such as labs? For these patients we have found that if the clinic agrees to pay the lab fees, we get the Medicare rate which is usually much less than the fee charged to cash paying patients. We then ask the patients to pay us back when and if they can. This has worked so well that we have extended this program to cover many outside services including x-rays, urgent medications, and urgent referrals to specialists, counselors, and dentists. Even though these costs add up quickly for patients with com-
plicated medical problems, patients usually attempt to pay us back when they can. We also raise money from grants and donations to help us cover the portion that some patients will never be able to pay. Whenever we offer to front a medical cost for a patient, we remind them that it will be added to their bill and they can pay us when they are able. This way, patients are included in the financial decision to proceed. Meanwhile, we steer our patients towards more long term assistance such as hospital based programs and pharmacy assistance programs. In my opinion, the care of my patients is improved because they do not have to wait until they have cash to see me. But my patients are not the only ones to benefit from this system. The other beneficiary is me. The joy of practicing medicine has been returned to me. In the past, if a patient urgently needed an expensive medicine, I would have to spend a lot of time and energy on the phone, despite a full waiting
room, to hopefully locate resources to buy the drug. Now I just ask my assistant to call the pharmacist and write them a check. The patient knows that although this is a good deal, it is not a handout and that they can pay us back as they are able. The result is less embarrassment for them and less frustration for me. The patient gets the care they need, and the experience is actually pleasant for both the patient and myself. We both feel better at the end of the visit, and to me that is worth a lot. Clearly, what I am doing in Paint Lick is not the answer to fixing our healthcare system. I see myself as one strand in a safety net that has a lot of holes. I do wish that all patients could receive primary care services at a reasonable cost and that patients could pay as they are able instead of being turned away for lack of cash. The opportunity to provide care to those in need is a privilege that requires healthcare providers to remain focused on service and compassion as we create new solutions to improve our healthcare system for everyone. â—†
JaNUaRY 2011 19
allieD health
Connecting rural kentucky Back to the healthcare system
Mission-driven Saint Joseph Mobile Health Services uses NP-facilitated clinics and telemedicine consults to heal the hard-to-reach patient. By greg BaCkus anD megan C. smith
ing its electronic medical records.
Providing healthcare to the underserved populations in rural Kentucky is challenge which defies singular solutions. In the rural setting, problems of access to healthcare or compliance with physician recommendations are compounded by the psychological and social issues unique to the mountain lifestyle. Here, a greater disease burden is caused in part by the environmental hazards of coal mining, and increased anxiety and depression caused by poverty and work life strains on the family unit create hurdles to health that are difficult to appreciate until one has experienced them first hand. Two area women who have earned local acclaim for their dedication to meeting the healthcare needs of Kentuckians are Sister Dorothy McDougall of the Sisters of Charity of Nazareth, Kentucky – the founding order of the Saint Joseph Hospital whose mission work is now supported by Saint Joseph Health System’s (SJHS) parent company Catholic Health Initiative –and Rose Rexroat, RN, MSN, a 30-year veteran in community nursing and primary care who has managed the Mobile Health Services (MHS) for SJHS since its inception in 1995. According to Rexroat, McDougall created MHS because “she felt a calling to help the uninsured, the underinsured and other marginalized people in need of health care. She wanted to take the care to them.” McDougall and the SJHS Mission Committee handpicked Rexroat to oversee MHS. “I was director of Orthopedics, Neurology & Neurosurgery nursing services at the time and had done my entire undergraduate work in community nursing and primary care. When Sister Dorothy and the SJH Mission Committee came to me and shared their vision, I hesitated at first. I was about to go on vacation, so I took that time to think it through. I came back and told Sister McDougall that I would do it for her. To me, she was the epitome of mission and service, of
Medication assistance program
20 M.D. UpDate
One of the most impactful ways that MHS has shaped positive health outcomes for rural Kentucky is through the Medication Assistance Program. Using software that connects MHS to pharmacies and pharmaceutical company resources, MHS staff apply for pharmaceutical programs for indigent people. Each company has its own criteria, applications, and credentialing to qualify people for their program, which Rexroat says is often difficult for indigent people to complete due to Rose Rexroat, RN, MSN a lack of formal record keeping. “We started the Medication Assistance Program in 2003,” says Rexroat, “but we being a leader, of caring about other people, only had 73 visits that year – we were just barely and being called to mission before business.” Rexroat, McDougall, and the Mission starting. By the end of 2010 we had obtained Committee met with different community nearly $8 million of free medicines for 12,473 groups including pastors of churches and patient visits. This figure is an indicator of lay leaders, business people, and employers chronic disease and the complexity of what to define areas of need. They selected sites people are trying to manage. You think about in Fayette county, and they designed and 8 million dollars in just this small, isolated area built their mobile healthcare coach “from (3 counties with a population of around 5000) the axel up”. When the certificate of need and you are looking at an average of $641.38 was at last issued in August 1997 (there was in medications per person per visit. The disease a brief moratorium under Governor Jones burden in eastern KY is very significant.” until this time), MHS sprung into action connecting rural and remote populations to telemedicine Specialty Care quality healthcare. In 2003, we were able to Anxiety and depression is prevalent among replicate the model by initiating the Eastern rural women, says Rexroat, who struggle Kentucky Mobile Health Service serving with additional family responsibilities following employment strains on the famMorgan, Wolfe, and Lawrence counties. While the Fayette county mobile health ily unit. MHS’s utilization of telemedicine moved to a fixed site near the SJHS main began with mental health consultations campus in Lexington in 2007, the Eastern with public mental health service providKentucky MHS continues to serve its rural ers. Patients who came to the clinic for communities. Until July 2010, there was primary care could also have a consultation a service provider contract between SJHS with a mental health specialist. Rexroat says and the Commonwealth of Kentucky to that patients appreciated that they did not aid to subsidize the service. Operating have to go into a building that was labeled as an outpatient clinic of SJHS, MHS is mental health, “so other people never knew staffed and administered by SJHS, includ- why they were going to the clinic. This was
the starting point from which telemedicine became very productive avenue for us.” Patients can see other specialists through the Kentucky Tele Health Network, including dermatologists at UK and UL or cardiologists at St. Claire Regional Medical Center in Morehead. For certain chronic conditions, telemedicine can enhance the continuum of care while significantly reducing the number of trips to urban centers for tertiary care. Rexroat believes that “the future of telemedicine in serving rural and remote areas is something that will be developed and replicated internationally. Our philosophy is to serve and provide quality care for people as close to home as possible. To really impact transportation and access needs you have to have facilities in reasonable proximity. There are going to be a certain amount of patients that are going to have to go to other facilities - the big heart cases, big surgery cases, and that kind of thing. Telemedicine can be used very effectively to ‘fill the gaps’.”
could develop a high trust relationship with and who could perform independently. We have an NP, RN, social worker, and driver. Our driver is cross-trained and maintains the telemedicine equipment.”
access to primary Care
Morgan, Wolfe, and Lawrence counties are isolated and sparsely populated, so their tax base is small. Rural counties tend not to have sufficient population to allow a physician to afford to practice there. This is one
or Medicaid qualified. “What is happening,” she explains, “is that the administrative overhead per patient for Medicaid reimbursement is often not what a small family practice physician wants to spend his time doing. The return does not cover the cost. The other simple option is just to not take these patients. In these cases, either the physician will suffer, or people who need medical care will go without. Somebody will be suffering.” Practices may have to balance Medicare/ Medicaid patients with insured patients in terms of balancing reimbursement to overhead and meet state &/or federal regulations. “We are looking how to deal with this problem. This is why we are moving toward providing for Medicare and Medicaid patients in our clinic.”
it is an exceptional county that can sustain a physician in the community and enable that physician to have sufficient income.
Np-facilitated Clinic
A main reason why physicians have difficulty opening and operating primary care clinics in rural settings is the conflict between smaller patient population and high malpractice insurance costs – some doctors simply cannot see enough patients to cover their risk. Nurse Practitioner facilitated clinics offer several opportunities to coordinate care with rural populations. Rexroat notes that NPs have a decisive advantage in the rural clinic setting. “As an NP,” she says, “you have a long experience to draw on.” NPs at MHS have a collaborative practice agreement with our medical director, who is available 24/7 by phone and internet. “When I looked at developing this service, I realized that all of the staff must live in Eastern Kentucky. I knew that I had to have people that could practice independently and know their boundaries very well. I had to trust them to be able to know when to resource assistance from an administrator or from the medical director for a clinical decision. It took individuals that I knew I
reason why there is a significant allocation of funding through the health care reform for federal qualified health centers or rural health centers. These rural health centers have to serve multiple counties and have to be able to recruit and retain physicians. “It is an exceptional county, however, that is able to sustain a physician in the community and have the physician be able to have a sufficient income,” says Rexroat. “Another hurdle to providing access to primary care is that the market has driven this condition. Many students in medical school look at the earnings potential of a primary care physician and compare that to the income they would earn by going into, say, CT surgery. It is a big difference. In a way, we are our own worst enemies in this case, because we have allowed that kind of disparity in valuing different varieties of medical education. The reality is that it has driven us into issues of access because not everyone can afford the care they need.”
More Reimbursable Services
Fewer physicians are taking new Medicare or Medicaid patients due to regulations, paperwork, and oversight requirements, making another access issue. Rexroat explains that MHS is exploring to expand their mission at the Lexington free clinic to be able to care for patients as they become Medicare
public-private Collaboration
“Many people are in the habit of looking to government for answers, but some of the best solutions can come from the private sector. Solutions to the problems that come from our changing health care environment are going to have to come from people coming together and doing things in different ways,” says Rexroat. “The state has to change too, as we bump up against regulations that need to change due to delivery of care issues. To meet the needs of the future we all have to be open to change, and to allow new ideas to be tested. If these ideas fail, they fail, but trying a change should be allowedwithout suffering punitive results/ actions that would stifle a new strategy in caring for patients or developing a model of care.” Rexroat says that managing MHS has been a “dream come true. This makes me feel very fortunate, that I was able to make Sister Dorothy McDougall’s vision a reality and that I am able to serve the poeple of my birthplace, Morgan county. When I was given the project , I was told to ‘just go do it’. It took me a long time to get a handle on it, but what an opportunity it is to work for an organization committed to caring for all people, regardless of their ability to pay. It has kept me here for 30 years.” ◆ JaNUaRY 2011 21
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senD your neWs items to m.D upDate > news@md-update.com
New physicians at the pain treatment Center of the Bluegrass
Roy Durrett, MD has joined the physician practice at The Pain Treatment Center of the Bluegrass (PTC), where he will serve as assistant medical direc-
he also attended medical school. Dr. Durrett will practice injective therapy and medication management at PTC.
CorreCtion
in December, we incorrectly identified Dr. marian Bensema as the president of the Central Baptist Board of Directors. her correct position is president of the Central Baptist medical staff, and she is a member of the Board of Directors. We regret our error.
YMCa of Central Kentucky and CDC Offer Diabetes prevention program
Dennis Northrip, MD
Roy Durrett, MD
tor of the Center’s surgery center. Dr. Durrett is board certified in anesthesiology and pain medicine. He did his residency in anesthesiology and earned a PhD in pharmacology from the University of Texas Medical Branch at Galveston School of Medicine, where
22 M.D. UpDate
Dennis Northrip, MD has also joined the physician practice at PTC. Dr. Northrip is board certified in anesthesiology and fellowship trained in pediatric anesthesiology from the University of Louisville. He did his residency at the University of Missouri and attended the College of Medicine at the University of Oklahoma. Dr. Northrip will practice injective therapy and medication management at PTC.
The YMCA of Central Kentucky was recently awarded a grant from YMCA of the USA, as part of the CDC’s National Diabetes Prevention Program, to help expand the YMCA’s Diabetes Prevention Program and help reduce the burden of chronic disease in communities across the nation. This announcement comes on the heels of a recent CDC report that projects that one in three adults in the United States could develop diabetes by the year 2050 if current trends continue. The YMCA’s Diabetes Prevention Program is a group-based lifestyle intervention designed especially for people at high risk of developing type 2 diabetes, and has been proven to cut high-risk peoples’ chances of developing the disease by more than half. YMCA of the USA, the national resource office for the nation’s 2,687
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YMCAs, is working with CDC and other organizations to expand the program to as many communities as possible nationwide as part of CDC’s National Diabetes Prevention Program. The program will be available to community members in central Kentucky beginning in March. “Providing support and opportunities that empower people to be healthy and live well is part of the YMCA’s charitable purpose,” said Gail Glasser, president and CEO of the YMCA of Central Kentkucky. “The lifestyle choices learned through the YMCA’s Diabetes Prevention Program not only reduce risk for type 2 diabetes, but also create lifelong changes in the way that individuals approach health and well being.” “A prevention program is outstanding because it will be able to dovetail with
other diabetes management programs such as ours to try to get the focus out there at an earlier age and stage,” said Amanda Goldman, director of the Outpatient Diabetes Treatment and Nutrition Center at Saint Joseph Hospital. “As a diabetes educator, I know that simple changes in lifestyle can make a huge difference in preventing diabetes for those at risk,” said diabetes nutrition expert Patti Geil. “Although the steps to preventing diabetes are small- 7% weight loss and 150 minutes of exercise a week- it’s often difficult for us to make permanent changes in our behavior. Members of our community are fortunate to have access to the new YDPP, which is based on proven research and practical advice. The YDPP is another weapon in the war against diabetes, whose
impact and incidence is a serious threat to the health of Kentuckians.” The YMCA’s Diabetes Prevention Program is based on the landmark Diabetes Prevention Program (DPP) led by the National Institutes of Health (NIH) and supported by CDC, which showed that with lifestyle changes and modest weight reduction, a person with prediabetes can prevent or delay the onset of type 2 diabetes by 58 percent. Researchers at Indiana University School of Medicine were able to replicate the successful results of the national DPP with the YMCA of Greater Indianapolis. Unlike the national DPP research study, which was conducted with individuals one-to-one, the Y’s program is conducted in a group setting. The research by the Indiana University
JaNUaRY 2011 23
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researchers also demonstrated that the Y could effectively deliver a group-based lifestyle intervention for about 75 percent less than the cost of the original DPP. This research also highlighted the ability of the Y to take the program to scale nationally. “We now have proof that lifestyle interventions delivered through communitybased organizations such as the Y can save lives and health care dollars,” said Glasser. The goals of the YMCA’s Diabetes Prevention Program are to reduce and maintain individual weight loss by at least 7 percent and to increase physical activity to 150 minutes per week. In a group setting, a trained lifestyle coach helps participants learn skills for healthier lifestyles by healthy eating, increasing physical activity and other behavior modifications over the course of 16 core sessions. After the initial sessions, participants meet monthly for up to a year for added support in maintaining their lifestyle changes. The historic health care reform legislation passed earlier this year authorized the National Diabetes Prevention Program. If funded, the program would allow CDC to expand its work to train and recognize community-based diabetes prevention programs like those being offered by the Y. The YMCA is committed to making the program available to everyone in the community. All individuals with a BMI of 25 or greater and who have two additional risk factors or have a diagnosis of prediabetes are eligible. Contact Debbi Dean at 859254-9622.
$6.5M Grant to UK prevention Research Center to Study Cancer Disparities in appalachia
Cancer prevention experts at the University of Kentucky are joining a network of academic and community partners in six states to target cancer in Appalachia, where cancer incidence and mortality are notably higher than the rest of the United States. The UK Prevention Research Center (UK PRC), based in the Department of Internal Medicine at the UK College 24 M.D. UpDate
of cancer, occurs in epidemic proportions in Appalachia. The intervention, to be developed in collaboration with community partners, will focus on changing health behaviors to help individuals lose weight and increase physical activity. “This is community-based participatory research,” Dignan said. “We will be working directly with the community to identify strategies that they think will be effective. When we have communities as partners, we get better results. We have also found that projects are more likely to continue when the community is involved in developing them.”
UK Held Metals toxicity Conference in Lexington Mark Dignan, professor of internal medicine at the UK College of Medicine and director of the UK pRC, is principal investigator of the appalachian Community Cancer Network.
of Medicine, has received a 5-year, $6.5 million grant from the National Cancer Institute to implement the Appalachia Community Cancer Network (ACCN). Mark Dignan, professor of internal medicine at the UK College of Medicine and director of the UK PRC, is principal investigator for the project. The network, headquartered at UK, serves the Appalachian regions of Kentucky, New York, Ohio, Pennsylvania, Virginia and West Virginia. Regional partner institutions include The Ohio State University, Pennsylvania State University, Virginia Tech and West Virginia University. Plans for the ACCN have been developed in collaboration with community partners and will include programs in research, training and community outreach. The research program includes a project testing a “faith-based” intervention to reduce cancer risks by addressing obesity and physical activity. Obesity, which is a significant risk factor for many types
The University of Kentucky hosted a scientific meeting of researchers studying the toxic and cancer-causing effects of metals in Nov 2010. The Sixth Conference on Molecular Mechanisms of Metal Toxicity and Carcinogenesis is the only meeting of its kind in the world, says Xianglin Shi, professor in the UK Graduate Center for Toxicology. Around 100 researchers, from institutions around the United States and eight foreign countries attended. “This is not a narrow field,” says Shi, who holds the William A. Marquard Chair in Cancer Research and is the Markey Cancer Center’s associate director for cancer chemoprevention and environmental toxicology. “Metals are literally everywhere, and all kinds of metals — metals such as arsenic, chromium, nickel and cobalt — have the potential for toxicity and carcinogenesis.” Research into the molecular mechanisms of metals toxicity has value both in terms of risk assessment (figuring out where the significant sources of contamination are) and abatement (figuring out how to contain contamination and reduce exposure). Accordingly, the conference attracts researchers from a variety of different disciplines, including toxicology, nutrition, epidemiology, chemistry, public health, and engineering.
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In Eastern Kentucky, surface mining activities are a major source of contamination of groundwater and soil by heavy metals, which are believed to contribute to higher-than-average rates of cancer in the region, particularly lung cancer and colorectal cancer. Shi initiated the first “Metals Meeting,” as it has become known, back in 2000. However, this was the first time that the meeting, held every two years, took place in Lexington. Contact Xianglin Shi by phone at 859-257-4054 or e-mail atxianglin.shi@ uky.edu.
Rural teens More Likely to Use prescription Drugs
Rural teens are more likely to use prescription drugs for non-medical reasons than teens in urban environments, according to a study conducted by researchers at the University of Kentucky. The study, led by Dr. Jennifer R. Havens, professor of epidemiology in the UK College of Medicine Department of Behavioral Science, was released online and will appear in the March 2011 issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Researchers analyzed data from 17,872 12- to 17-year-olds participating in the 2008 National Survey on Drug Use and Health. There were no differences between urban and rural youth in rates of any illicit drug use, including marijuana, cocaine, heroin and hallucinogens. However, 13 percent of rural teens reported ever having used prescription drugs for non-medical purposes, compared with 10 percent of urban teens. When the researchers assessed specific medication types, they found rural teens were more likely to have used pain relievers (11.5 percent vs. 10.3 percent) or tranquilizers (3.5 percent vs. 2.5 percent) nonmedically. Rural teens were more likely to misuse prescription drugs if they reported poorer health, episodes of depression or other substance abuse. Residing in a house-
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JaNUaRY 2011 25
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hold with two parents was associated with a 32 percent reduction in the odds of non-medical prescription drug use. Enrollment in school was also a protective factor.
Commonwealth Urology Joins Lexington Clinic
Commonwealth Urology, PSC, serving Central Kentucky since 1927, is joining the Lexington Clinic. This association is expected to take effect on April
1, 2011, at which time Commonwealth Urology physicians will become members of Lexington Clinic’s Associate Physician Network. Comprised of American Board of Urology certified physicians, Commonwealth Urology, which includes Urologic Associates, has nine primary offices in Lexington, Frankfort, Danville, Somerset, Richmond, Mt. Sterling, and Winchester. “We are very pleased to be a part of this alliance. By combining our efforts with Lexington Clinic, we are better positioned to meet and exceed the challenges of a changing healthcare system and to provide the best care for our patients,” said K. Eric Ruby, MD, president of Commonwealth Urology.
Lexington Clinic Receives aCR accreditation
The Lexington Clinic John D. Cronin Cancer Center has been awarded a threeyear term of accreditation in radiation oncology as the result of a recent survey by the American College of Radiology (ACR). The ACR, headquartered in Reston, Virginia, awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation of the practice. Evaluations are conducted by board-certified physicians and medical physicists who are experts in the field. They assess the qualifications of the personnel and the adequacy of facility equipment. The surveyors report their findings to the ACR’s Committee on Accreditation, which subsequently provides the practice with a comprehensive report. “We are very excited to have earned this accreditation. We have a wonderful staff dedicated to patient care, and this accreditation is a great way to show our patients our commitment to providing the best in healthcare delivery,” said Lexington Clinic chief executive officer Andrew H. Henderson, MD. ◆
26 M.D. UpDate
arts
Lipizzaner Stallions
Lipizzaner Stallions at Rupp arena
sunDay January 30, 2pm & 6pm The “World Famous” Lipizzaner Stallions proudly presents their 41st anniversary presentation of the “Dancing White Stallions” at two shows, Sunday January 30 at Rupp Arena. Over the years, more than twenty-six million people throughout North and South America, Europe, Australia and Hawaii have seen this internationally acclaimed spectacle. The Lipizzaner Stallions preserve horsemanship as a work of art, performing a unique equine ballet that has no rival. Harkening back to a time when the horse was a symbol of grace and majesty, the Lipizzaner Stallions are a great experience to be enjoyed by the entire family. Tickets are $25, $22, and Gold Circle seats are $30 each. Children 12 and seniors tickets are half price (no Gold Circle discounts), and all tickets are available at the Arena Box Office and Ticketmaster. To charge by phone call 1-800-745-3000.
Can (BOAC), founders Michael Gordon, David Lang and Julie Wolfe recognized that their new and open approach to presenting required new and open performers. They had to be able to cross musical boundaries, and be at home with many styles and technologies. Clarinets, cello, keyboard, electric guitar, bass and drums – it is part rock band and part amplified chamber group. Freely crossing boundaries between classical, jazz, rock, world and experimental music, this six member amplified ensemble from New
York defies categories, plays music from uncharted territories, and has shattered the definition of what concert music is today. BOAC was awarded Musical America’s Ensemble of the Year in 2005 and have been heralded as “the country’s most important vehicle for contemporary music” by the San Francisco Chronicle. Tickets prices are $32/$28/$25 depending on seat location. Tickets can be purchased by calling the Singletary Center ticket office at 859-257-4929, visiting online at www.singletarytickets. com, or in person at the venue.
Fiddler on the Roof at the Lexington Opera House
FeBruary 11-13 “Without our traditions, our lives would be as shaky as... a fiddler on the roof,” announces Tevye, a humble milkman from the Russian village of Anatevka. And so begins a tale of love and laughter, devotion and defiance... and changing traditions. Broadway Live and Blue Grass Airport present Fiddler on the Roof, the Tony Award winning musical that has captured the hearts of people all over the world with
Bang On a Can all-Stars at Singletary Center for the arts
sunDay January 30, 7:30pm UK alumnus and Wilco drummer, Glenn Kotche, who recently made the Gigwise list of “The Greatest Drummers Of All Time!” will be joining the Bang On A Can All-Stars at the Singletary Center on Sunday, January 30 at 7:30pm. At the very beginning of Bang on a
Bang On a Can all-Stars
JaNUaRY 2011 27
arts
its universal appeal, February 11 -13 for five performances at the Lexington Opera House. In what is a huge theatrical feat, audiences will have a once in a lifetime opportunity to see Jerome Robbins’ original Broadway direction and choreography, starring veteran actor John Preece. Preece has performed in Fiddler on the Roof over 3,100 times, 1,500 of which were in the role of Tevye the milkman. Tevye’s wrestling with the new customs of a younger generation is punctuated by an unforgettable score that weaves the haunting strains of “Sunrise, Sunset” and the rousing “If I Were A Rich Man.” When his daughters choose suitors who defy his idea of a proper match, Tevye comes to realize, through a series of incidents that are at once comic and bittersweet, that his children will begin traditions of their own. At the story’s
Be OUR GUeSt:
Lexington art League 4th Friday M.d. update will provide the first 5 respondents with 4 free passes to lexington art league’s Fifth third bank 4th Friday on January 28. this sociable evening of art, hors d’oeuvres, music, and performance is now in its 15th year and has become one of the visual art community’s most well-attended events. January’s event on Jan. 28 from 6-9pm features the art QX.net nude, henna by red lotus henna, music by DJ miss Cass, and barbecue by Billy’s Bar-B-Q. We’d love to see you there – email editor in chief megan C. smith at mcsmith@md-update.com or call 859-309-9939. more informationon the lexington art league at www.lexingtonartleague.org. close, the villagers of Anatevka are forced to leave their homes and even the sturdy mores that have guided everyday life begin to crumble. Paradoxically, it is the enforced loss of the rigid traditions and home life that Tevye has tried so tenaciously to pre-
serve that leads the family to reconcile and draw closer still. Tickets range from $25 - $80 and are available by calling the Lexington Center Ticket Office and all Ticketmaster locations. ◆
aDvertisers inDeX Cane Manor ........................................................22 859-309-9939 Central Kentucky audiology ................................23 859-277-5090 Community trust Bancorp.....................................1 1-800-422-1090 D. Scott Neal.......................................................25 1-800-344-9098 Georgetown Community Hospital ......................11 502-867-3303 Kirk Schlea photography.......................................8 859-332-7562 Lexington art League ......................................... C3 859-254-7024 Lipizzaner Stallions .............................................28 1-800-745-3000 McBrayer, Mcginnis, Leslie & Kirkland ................17 859-231-8780 physicians Financial Services..............................19 502-893-7001 Saint Joseph Center for Weight Loss Surgery ... C2 859-967-5520 Singletary Center for the arts .............................25 859-257-4929 Soterion Medical.................................................19 859-233-3900 Unified trust ....................................................... C4 859-296-4407 ext. 202
28 M.D. UpDate
ut c | M d up date | 8 .2 5 X 10.7 5 | 7/29/10 | M edical
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