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ORTHOPEDICS: Beyond the Hype MARYLAND PHYSICIANS: Are You Ready for ICD-10? HIT & Painkillers for EHR www.mdphysicianmag.com
JULY/AUGUST 2011 VOLUME 1: ISSUE 2
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Contents 12
July/August 2011 Volume1: Issue 2
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F E AT U R E S
16 Orthopedics: Beyond the Hype Proper Procedure Selection is Key to Outcomes
D E PA R T M E N T S
Cases | 7 | Spinal Cord Stimulation: Managing Challenging Chronic Pain in Young Patients Solutions | 8 | Protecting Your Practice in a RAC Audit Environment Medical Beat | 10 | News and Notes in the Medical Field Healthcare IT | 12 | EHR Painkillers – Practical Advice for a Conversion or Upgrade Legacy | 20 | The Estate Planner’s Storybook of Everyday Tales and Unexpected Endings Compliance | 23 | Maryland Physicians,Will You Be Ready? Good Deeds | 25 | Raymond Wittstadt, M.D. – Making Music Pain Free Heritage | 26 | National Name, Local Roots
On the Cover: Dr. Ronald Delanois, M.D., orthopedic surgeon at the Center for Joint Replacement and Preservation at Sinai Hospital, at LifeBridge Health & Fitness
JULY/AUGUST 2011
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JACQUIE ROTH, PUBLISHER/EXECUTIVE EDITOR jroth@mdphysicianmag.com LINDA HARDER, MANAGING EDITOR lharder@mdphysicianmag.com
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CONTRIBUTING WRITERS Allison Eatough
N THE MAY/JUNE INAUGURAL Issue 2011 of Maryland Physician, I wrote that my passion and goal is to keep you - Maryland physicians and healthcare stakeholders – informed, intrigued and inspired with cuttingedge treatment information and practical advice for managing a clinical practice. Apparently, I’m on my way! Less than 24 hours after that first issue was delivered to the USPS, I received my first email from a Maryland physician. He applauded the content and design of the publication, both in print and online (www.mdphysicianmag.com). He suggested that we include pain management, a topic that has frustrated him as a primary care provider. I listened, thanked him and will be including this topic later on in our editorial year. I heard from another male physician who applauded the cover story of that inaugural issue, “Cracks in Maryland Medicine’s Glass Ceiling.” He plans to share the issue with his granddaughters, who are following his path into medicine, and felt that they would be inspired by the four outstanding female physicians we profiled. I’ve since received many more emails and comments – thanks to all of you and keep them coming! Every issue includes a clinical feature. This month, Maryland Physician Editor Linda Harder spoke with three Maryland orthopedists about the latest advances in this field, to guide your treatment and referrals. Not surprisingly, there was some difference of opinion – we’ve shared it with you beginning on page 16. We plan to present controversy where it exists, to bring you honest and meaningful content that facilitates your practice of medicine. Confused about RAC audits, ICD-10, EHR, EMR and Meaningful Use timelines and requirements? The goal of Maryland Physician’s regular department, Healthcare IT, is to keep you informed. According to our online poll, EHR technology is your practice’s biggest headache, no matter what the size of your practice. This issue’s HIT feature outlines tips to ease your EHR implementation pain, whether EHR is new to your practice or you’re upgrading an existing system. Maryland Physician is dynamic and organic. Tweaks to our website and online conversations with you and with our subject matter experts are occurring nearly daily. You may have noticed that we’ve changed our URL. You'll still be directed to us via the original URL too. Go online and reach out to all of us at Maryland Physician and to our subject matter experts – we’re waiting to hear from you. Wishing you all some relaxing and safe time this summer enjoying the splendor of our Chesapeake Bay or wherever your summer travels take you! To life!
Jacquie Roth Publisher/Executive Editor jroth@mdphysicianmag.com
aeatough@mdphysicianmag.com Tracy Fitzgerald tfitzgerald@mdphysicianmag.com CONTRIBUTING PHOTOGRAPHERS Tracey Brown, Papercamera Photography www.papercamera.com Mark Molesky, Molesky Photography www.moleskyphotography.com DIGITAL Andrei Palmer, Digital General Manager Aertight Systems andreip@aertight.com ADMINISTRATION Ginger Jenkins Maryland Physician Magazine™ is published bimonthly by Mojo Media, LLC. a certified Minority Business Enterprise (MBE). Mojo Media, LLC PO Box 1663 Millersville, MD 21108 410.987.6667 www.mojomedia.biz Subscription information: Maryland Physician Magazine is mailed free to Maryland licensed and practicing physicians and a select audience of Maryland healthcare executives and stakeholders. Subscriptions are available for the annual cost of $42.00. To be added to the circulation list, please email circulation@mdphysicianmag.com or call 410.987.6667 Reprints: To order reprints of articles or back issues, please call 410.987.6667 or email jroth@mdphysicianmag.com Maryland Physician Magazine Advisory Board: An advisory board comprised of medical practitioners and business leaders in diverse practice, business and geographic scopes provides editorial counsel to Maryland Physician. Advisory board members include: JOHN BARRY, M.D. Chesapeake Orthopaedic & Sports Medicine Center KAREN COUSINS-BROWN, D.O. Maryland General Hospital HOLLY DAHLMAN, M.D. Greenspring Valley Internal Medicine, LLC PAUL W. DAVIES, M.D., FACS Advanced Pain Management MICHAEL EPSTEIN, M.D. Digestive Disorders Associates STACY D. FISHER, M.D. University of Maryland Medical Center REGINA HAMPTON, M.D. FACS Signature Breast Care DANILO ESPINOLA, M.D. Advanced Radiology GENE RANSOM, J.D., CEO MedChi Although every precaution is taken to ensure accuracy of published materials, Maryland Physician and Mojo Media, LLC cannot be held responsible for opinions expressed or facts supplied by authors and resources.
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DR. YESH NAVALGUND / OWNER DNA ADVANCED PAIN TREATMENT CENTER CHRONIC PAIN MANAGEMENT PITTSBURGH, PA SINCE 2006 21 EMPLOYEES
LEARNING THE BUSINESS OF MEDICINE CHALLENGE: When Dr. Navalgund came out of medical school, he had all the right medical training. But when he decided to open his own practice, he needed something new — an education in the business side of medicine. SOLUTION: Dr. Navalgund had the Cash Flow Conversation with his PNC Healthcare Business Banker, who put his industry knowledge to work. Together, they tailored a set of solutions to strengthen his cash flow: loans for real estate and equipment along with a line of credit to grow his practice, plus remote deposit to help speed up receivables. ACHIEVEMENT: DNA Advanced Pain Treatment Center now has four private practices and a growing list of patients. And Dr. Navalgund has a place to turn for all his banking needs, allowing him to focus on what he does best. WATCH DR. NAVALGUND’S FULL STORY at pnc.com/cfo and see how The PNC Advantage for Healthcare Professionals can help solve your practice’s challenges, too. Or call PNC Healthcare Business Banker Les Pasternack at 1-866-356-6916 to start your own Cash Flow Conversation today. ACCELERATE RECEIVABLES IMPROVE PAYMENT PRACTICES INVEST EXCESS CASH LEVERAGE ONLINE TECHNOLOGY ENSURE ACCESS TO CREDIT
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Cases
Spinal Cord Stimulation: Managing Challenging Chronic Pain in Mid-Life Patients Paul W. Davies, M.D., FACS
CASE: Three patients have chronic pain issues. The first is a 47-year-old flight attendant with plantar fasciitis and tarsal tunnel syndrome in both feet, despite multiple surgeries. The second is a 45-year-old administrator who suffered bilateral patella dislocations as a child as well as chronic knee pain, leading to seven knee surgeries, including a total knee replacement in 2006. A 48-year-old school teacher with neuropathy, burning and numbness in the lower lateral area of her left foot, causing balance loss, is the third patient. Is there a common solution for all of these scenarios? DISCUSSION Managing pain can be challenging. Standard pain management treatments, including medication, injections and blocks, acupuncture, therapy and rhizotomies are often attempted, but when they fail to relieve pain, other options must be considered. Spinal Cord Stimulation (SCS) treats chronic neuropathic pain of the back,
trunk and/or limbs, through the transmission of electrical impulses that trigger selective nerve fibers along the spinal cord. The stimulation is provided by leads, inserted into the dorsal epidural space and connected to a generator. The patient experiences paresthesia in areas where they typically feel pain and their level of discomfort is reduced. The SCS procedure is performed by orthopedic physicians, neurosurgeons and trained pain specialists. The process begins with a thorough review of the patient’s medical history, including review of past treatment approaches, and a physical examination. An X-ray and MRI of the lumbar, thoracic and / or cervical spine are performed, as well as psychological testing to confirm if the patient can undergo the procedure. SCS is performed in two stages: the trial and the permanent implantation. In the first phase, using local anesthesia and mild sedation, one or two leads are placed into the epidural space. The final lead position is determined by testing the stimulation while the patient provides feedback. The lead(s) is then connected to an external trial stimulator, worn on a belt throughout the trial. A remote control allows the patient to control the intensity of stimulation over the course of several days, leading ultimately to a determination of how much pain relief can be achieved using this technology. Following a successful trial, the lead(s) and an implantable pulse generator (IPG) are placed, either percutaneously or surgically. Percutaneous lead placements are generally less invasive but tend to have a higher migration rate than those placed surgically. Surgical implants utilize paddle-type leads which are placed through a laminectomy. Both procedures
require tunneling the leads from the epidural entry site to the “pocket” where the IPG is implanted. The sites most often used for the IPG implant are posterior, above or below the belt line. SCS has positively impacted the three patients described in this case. The first patient reports that her feet no longer hurt in a constant manner. “It’s a saving grace when I need to be on my feet for an extended period of time,” the patient said. “I am a cycling instructor and I exercise regularly; I never would have been able to do this without the stimulator.” The second patient reported similar success. “Before, I could not walk without a cane, pick up my grandchild, walk my dog or leave the house. I was on the verge of total disability and despair.” Since receiving the stimulator implant, she has decreased her pain medications, lives an active lifestyle and has returned to work full-time. The third patient reported, “SCS reduces the amount of pain medication I need to take and allows me to sleep better – very important for the work I do in the elementary school system.” For these patients and others, SCS is utilized as a practical treatment method for chronic, intractable pain when other therapeutic measures have been exhausted. With proper patient selection, as well as correct device selection and positioning, SCS can be a highly successful, long-term solution for those with chronic neuropathic pain. Paul W. Davies M.D., completed his fellowship training at Johns Hopkins University and is board certified in Pain Management. He is the founder and Medical Director of Advanced Pain Management, where he institutes a multi-disciplinary approach to care. He can be reached at pdavies@mypainspecialist.com. JULY/AUGUST 2011
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Solutions
Protecting Your Practice in a RAC Audit Environment By Kathleen J. Young
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ORRIED ABOUT AN upcoming audit? Fortunately, there are a number of steps you can take to prepare for an audit, and protect your practice against findings that could end up costing you. RAC Auditors Are Incentivized Recovery Audit Contractors (RACs) have existed since 2005 and were originally established in Florida, New York and California, with South Carolina, Arizona and Massachusetts following sooner after, to help deflect fraud and abuse in Medicare claims. As of 2009, the recovery rate for claims has been a staggering $992 million, with inpatient hospitals representing the largest segment of funds recovered, including $19.9 million from physicians. Only 4.6 percent of RAC determinations have been fully or partially overturned on an appeal. RAC auditors are incentivized by the errors they discover. For this reason, systems have been put in place by the Centers for Medicare and Medicaid Services (CMS) to validate their findings, including appointment of AdvancedMed as the validation contractor for RAC claims. They perform accuracy audits and confirm valid reasoning or “good cause” for CMS to review a claim or a series of claims. A Compliance Plan Is Imperative Through educating providers about the presence of RACs and other entities, the goal of CMS is to help providers establish efficient coding and documentation guidelines, which will ultimately avoid future overpayments. Development of a compliance plan within the practice is also important, to address all of the laws and rules that apply to the healthcare 8 |
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environment: the Stark Law, Anti-kickback law, HIPAA, CMS and local laws. A compliance plan also guides the provider in making the correct tactical decisions each day. The Federal Register provides an outline of what a compliance plan should address, as well as guidance for your employees to address violations they observe. Document and Code Properly The best way for a provider to prepare for the arrival of a RAC auditor is to document and code properly. There are many consultants and private auditors who are capable of assisting you in this process. You may ask them to perform a pre-payment audit and document their findings. This will provide valuable insights in terms of how you can improve. Consider the cost associated with this service as an investment. The resulting possible savings for your practice could be very significant. Can you endure a take-back of $90K or more? Very few practices can; therefore, many consider paying a consultant or auditor an excellent use of resources. When you contract with a company to perform the audit, consider choosing the claims randomly. Perhaps you will focus on new patient codes or level 4 services. You may request an audit on the use of Modifier 25 or Modifier 59, as these are what the RACs are most often reviewing. Also, ask your consultant to review your procedure documentation to assure you are compliant according to American Medical Association (AMA) and CMS rules. Local Coverage Determinations (LCDs) offer another way to defend your practice and assure proper documentation or coding. The LCD will confirm the documentation requirement for a
procedure. They can provide insights on the level of history or exam that would be expected in the encounter prior to the procedure and will tell you how often a procedure can be performed in a designated period of time, as well as what diagnosis are payable. A Good Defense Another defense from the RACs is to hire an auditor or coding specialist under attorney/client privilege. This is recommended if you are receiving a significant number of coding requests for medical records from Medicare. In many cases, this is a sign that auditors are “fishing” and it is possible that you are being reviewed for an audit. If time will allow, hire an attorney/client privilege auditor to review all of the encounters you are sending to the payer. This will confirm if your coding procedures are accurate or require change in order to achieve ideal results, in the event that a RAC auditor is assigned to your practice. The current environment in healthcare is volatile for facilities and providers alike. Be proactive. Don’t wait to take the steps necessary to protect yourself and your practice, and assure that the results of an audit from an outside payer will be positive. Kathleen J. Young, CPC CMA is the CEO of Resolutions Billing & Consulting, Inc. She can be reached at kathy@resolutionsbilling.com
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Medical Beat
Doordan Retires from AAMC After almost 40 years at Anne Arundel Medical Center, CEO Martin L. “Chip” Doordan has retired. Anne Arundel Health System’s Board of Trustees announced Doordan’s retirement in June. Victoria W. Bayless, the health system’s former president, took over as CEO on July 1. Doordan joined the Anne Arundel Medical Center (AAMC) in 1972 as an administrative resident. In 1988, he became AAMC’s president and in 1994, the Board of Trustees named him president of Anne Arundel Health System. AAMC has more than doubled in size under Doordan’s leadership. The health system has also built satellite locations in Bowie, Kent Island and Waugh Chapel. “I never had a day where I didn’t want to come to work,” said Doordan. “It’s astonishing to think that nearly 40 years have flown by since I first joined Anne Arundel General Hospital. Today we’re a gleaming, modern expansive health system, touching hundreds of thousands of lives each year. It’s been a real privilege to spend my career here.”
Newly named AAMC CEO Victoria W. Bayless with newly retired AAMC CEO Martin L. "Chip" Doordan
BWMC Doctor Named Emergency Physician of the Year
September/October 2011 Issue
Clinical Feature Maryland Physician focuses on the latest cancer developments. We talk with top Maryland specialists to get their take on the effectiveness of the latest treatments for prostate, breast and blood cancers.
Healthcare IT In every issue, Maryland Physician explores a different facet of the race to implement EHRs to meet Meaningful Use and other e-health government incentives. Don’t be left behind – read what Maryland physicians and healthcare IT experts have to say that eases the pain of transition to an electronic world.
Imaging Update Maryland Physician delivers the latest advances in diagnostic imaging from Maryland radiologists – including when 3T MRI is proving most valuable and when it is not meeting early expectations - to get more from your imaging referrals.
In Every Issue and Online Cases x Solutions x Compliance x Medical Beat x Heritage x Legacy x Policy Space Reservation Deadline August 5, 2011 x Ad Materials Deadline: August 10, 2011
Jacquie Roth x Publisher/Executive Editor 410.987.6667 x jroth@mdphysicianmag.com www.mdphysicianmag.com
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The Maryland chapter of the American College of Emergency Physicians recently named Neel Vibhakar, M.D., an emergency medicine physician at Baltimore Washington Medical Center, as its Emergency Physician of the Year. Vibhakar, chairman of the Department of Emergency Medicine at BWMC, was honored during the college’s annual meeting in Baltimore along with his co-worker Lynn Brown, R.N., who was named Emergency Nurse of the Year.
University of Maryland Doctor Leads Trial on Breast Cancer The University of Maryland Marlene and Stewart Greenebaum Cancer Center is leading a multicenter clinical trial to evaluate a new approach in treating triple-negative breast cancer – an often aggressive type of cancer that is more common in African-Americans and young women. The trial, led by Saranya Chumsri, M.D., an oncologist at the Greenebaum Cancer Center, will help researchers see if the experimental drug entinostat can reprogram tumor cells to express a protein that would make them sensitive to hormone therapy. It is based on lab studies by Angela H. Brodie, PhD., a University of Maryland breast cancer researcher, and her colleagues. Doctors will treat newly diagnosed postmenopausal patients with entinostat and an aromatase inhibitor called anastrozole (Arimidex) before they have surgery to remove their cancer. Researchers will then analyze tissue from the tumor and blood samples to evaluate whether the treatment is effective. After surgery, patients will receive standard treatment, such as chemotherapy and radiation. Researchers hope to enroll 41 patients at 20 sites, including the Greenebaum Cancer Center.
Upper Chesapeake Named Cardiac Interventional Center
Howard County General's Spine Center Earns Distinction
The Maryland Institute for Emergency Medical Services has designated Upper Chesapeake Medical Center as one of 23 cardiac interventional centers in the region. The designation signifies the medical center meets state standards to receive patients transported by ambulance who are experiencing an ST-elevation myocardial infarction (STEMI) – the most common type of heart attack. Emergency medical providers who identify patients with this kind of heart attack must take them to the nearest designated cardiac interventional center, bypassing non-designated hospitals.
CareFirst BlueCross BlueShield has designated Howard County General Hospital’s (HCGH) Spine Academy as a Blue Distinction Center for Spine Surgery®. CareFirst BlueCross BlueShield, an independent licensee of the Blue Cross and Blue Shield Association, awards the designation to hospitals that meet evidence-based thresholds for clinical quality, including patient results and treatment expertise, and safety developed with input from expert clinicians and leading professional organizations. HCGH is a member of Johns Hopkins Medicine.
GBMC Doctor Receives Caregiver Award Greater Baltimore Medical Center recently awarded Hmu Minn, M.D., with its fourth annual Nancy J. Petrarca Compassionate Caregiver Award. Dr. Minn, an internal medicine physician and associate program director of GBMC’s internal medicine residency program, received $1,000 as part of the honor, created in 2008 to honor caregivers who display extraordinary compassion in caring for patients and their families. He has worked at GBMC for five years.
From left, John B. Chessare, M.D., president and CEO of GBMC HealthCare, and Hmu Minn, M.D.
Freischlag Named Vice President of National Vascular Society The Society for Vascular Surgery® recently elected Julie Freischlag, M.D., chair of the Department of Surgery at Johns Hopkins, as its vice president. In her new role, Dr. Freischlag will help lead the professional vascular medical society, which seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. Dr. Freischlag, a vascular surgeon and one of only six female surgical chiefs in U.S. history, was featured in the May/June 2011 issue of Maryland Physician magazine as a female physician leader cracking medicine’s glass ceiling.
Along with her position at Johns Hopkins, Dr. Freischlag is the editor of the Archives of Surgery and the associate editor of the American Journal of Surgery. She serves on the editorial boards of the Annals of Vascular Surgery, the Journal of the American College of Surgeons and the Journal of the American Medical Association. She is also involved with the American College of Surgeons, American Medical Women’s Association, Association for Academic Surgery, Association of Women Surgeons, Chesapeake Vascular Society and Society of Surgical Chairs.
Send news and announcements for publication consideration with high res photo (300 dpi) to news@mdphysicianmag.com
JULY/AUGUST 2011
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Healthcare IT
EHR
Painkillers
Practical Advice for a Conversion or Upgrade BY LINDA HARDER
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Whether your practice is small or large, and whether you’re implementing a new EHR or upgrading an existing one, it’s a huge undertaking. We spoke with a number of IT professionals, practice managers and EHR vendors for tips to ease your conversion pain.
Why Start Now As we went to press, CMS indicated it may modify some Meaningful Use deadlines in response to provider concerns. However, delaying EHR implementation will still squeeze your timeframes in future years. Pamela McNutt, Senior VP and CIO at Methodist Health System in Dallas, wrote in “Roadblocks on the Path to Meaningful Use,” a June 6, 2011 article in Modern Healthcare, “…. Starting in 2012 or later compresses your time frames to move from Stage 2 to Stage 3. Everyone must be at Stage 3 in 2015, regardless of their start date. Some 70% of your Medicare incentive funds come during the first two payment years, and those two years will be in Stage 1 only if you start in 2011 or 2012.”
5 Implementation Stages The 5 implementation stages, and advice for each phase of the journey, are:
1
Planning Identify your goals and the entire scope of work that the EHR system must address – is there more than one practice location, will you want patients to access forms in a kiosk or online, will you add or lose physicians? As much as possible, anticipate growth in the practice over the next five to 10 years. Even with Meaningful Use deadlines looming, the upfront investment is worthwhile.
2
Evaluation Evaluate the most likely certified vendor packages available and select two finalists. Make sure that you try out the software online and that you talk to several references from practices that are similar in size and scope to yours. “Ideally, visit these practices and also have your IT people talk to the reference’s IT people because they’ll speak the technical language,” says Triplett.
Rick Greenberg, regional sales manager, Greenway Medical, says, “The return on investment for existed long before the government provided federal stimulus dollars. EHRs allow you to better capture your procedures and code more accurately, and they save you all of the costs associated with paper charts.” PART A: Tips for EHR Implementation IT professionals Andrei Palmer and Gordon Triplett, co-founders of Aertight Systems, have helped more than 30 physician practices implement EHR systems over the past six years. They have formulated a list of recommendations for each of the five key stages of implementing or upgrading an EHR system.
“When discussing the functionality and usage of the EHR system with the potential vendors, be forthright and comprehensive in your explanation of current and future needs,” adds Palmer. “The more understanding the EHR vendor has of your practice, the better the system can be set up to meet your needs. Also, it’s much better to learn the limitations of the EHR system early on before you’re expecting the system to do something that it cannot be configured to do.” Greenberg concurs that the evaluation stage is critical. He suggests that,
in addition to checking with other healthcare providers you trust, you should check your vendor’s ranking on KLAS (www.klasresearch. com), an independent service that rates companies based on customer surveys. “Make sure a product supports your specialty, but beware of highly specialized EHR vendors because they may not be around in five years,” he notes. “Also select references where more than half of the providers are using the EHR.” He counsels physicians to consider the following factors when evaluating a company: (continued on page 15)
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PAPERCAMERA PHOTOGRAPHY
Aertight Systems Co-founder and Vice President Andrei Palmer with Michelle Housley, HR/IT manager, and Jackie Goldberg, practice administrator, for Digestive Disorders Associates (DDA)
“Ideally, even before you select a vendor, involve the local IT professionals you already use and trust in the EHR process,” says Palmer. “Very few vendors are actually based in Maryland and this is a life-changing operation. The out-ofstate vendor provides training for a short time, then is gone. Your in-house or contracted IT professional can help you assess vendors and become an active part of the process early on, minimizing headaches.” PART B: Tips for an EHR Upgrade Jackie Goldberg, practice administrator, and Michelle Housley, HR/IT manager, for Digestive Disorders Associates (DDA) went through an EHR conversion a decade ago, long before most practices were on the HIT bandwagon. Goldberg attributes the early start to the practice founder, Michael Epstein, M.D. “Dr. Epstein is very forward thinking and was ready to jump on board back in 2001,” Goldberg says.
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Fast forward 10 years to June, 2011. The practice is embarking on a major upgrade to their EHR system, using the same vendor but gaining significant new functionalities, and most importantly, making them compatible with HIPAA Version 5010. “We’re going to a virtual environment, where our servers have been redone, with one physical box that can store five to seven servers,” comments Housley. ‘We have a firewall and our servers are behind that. We also have redundancy in our servers and secure back-up.” Housley continues, “The look of the updated application will change dramatically for the staff and they will use a totally different approach,” she notes. “We're about to employ a new EMR where our patients will also have online access to schedule appointments, request prescription refills and download patient forms from the website. They’ll even be able to email questions to physicians.”
PART C: Tips for an Upgrade or Install In addition to concurring with much of the advice from Greenberg and Aertight Systems, Goldberg and Housley recommend the following: z Recognize that many vendors have a growing backlog of clients now – even after you’ve signed a contract, it could take several months or more to begin conversion. z Determine whether you want to host the data onsite or off. Onsite may provide more control but also carries the onus of managing HIPAA compliance and providing redundancy. z Ensure that your CMS electronic transactions are submitted using Version 5010 of HIPAA by January 1, 2012, the deadline for compliance. Until then, Version 4010/4010A or Version 5010 standards are acceptable. z Expect staff to resist change and for some of them to be unhappy. Frequent communication can alleviate
(continued from page 13) z The company’s viability – number of employees, financials, longevity and growth z Product usability z Technology z Support z Price “Price should be the last and perhaps least important factor to consider,” Greenberg adds. “A cheaper price isn’t worth it if the product doesn’t do what you need it to.”
3
Demonstration Rather than selecting one system that you impose on your staff, invite the two finalists to conduct detailed demonstrations of their systems and let all of the staff that will be impacted by the EHR provide input. “For
example,” says Palmer, “one system might provide more functionality but take five clicks to get data. And beware – if a vendor promises to make a change from five clicks to two, make sure they can actually deliver on that promise.” Since many EHR systems come in modules, make sure you’re buying all the functionality you need. Also determine what the user licensing or cost model is and whether that model will accommodate your practice if you add another physician or office. McNutt’s article cautions, “We now know that you must possess all the modules that a vendor used to achieve its certification even if you are not using them to demonstrate meaningful use. This is further complicated by the fact that many major vendors certified
“Patients will also have online access to schedule appointments, request prescription refills and download patient forms from the website. They’ll even be able to email questions to the physicians.” — Michelle Housley HR/IT manager, DDA
z
z
z
z
their products only as complete EHRs, and their modules do not inherit the certification when those modules are used separately.”
4
Prepare for Conversion Triplett recommends preparing for the actual conversion to paperless by taking non-active charts and “practicing” the conversion on them. He says, “That lets you “stress test” the system to detect issues such as needing more RAM because the conversion is too slow. Or you might find that non-standard forms, such as allergy reports, were not included in your initial planning. Make sure that everything is in synch and get the staff used to it before implementation day.” Triplett and Palmer also
the stress. Hold staff meetings to prepare them for what will happen, including a period of lower productivity. The AMA’s website recommends providing incentives for staff, such as a special lunch. Help doctors in the practice prepare for how different electronic charts are from paper ones. “There’s a cascade of information that’s hard for some doctors to adjust to,” notes Goldberg. Keep patients informed. When they call to schedule their next appointment, let them know about the new system and that it may slow down their first appointment. Cut patient volumes during the first week of conversion to reduce stress and frustration for patients, staff and physicians alike. Ensure that your contract requires the vendor to be onsite during the first business week of conversion and to provide ready support offsite after that time.
recommend getting college students or interns to help scan existing patient data and speed the conversion.
5
Go Live Jackie Goldberg, practice administrator, and Michelle Housley, HR/IT manager, for Digestive Disorders Associates (DDA) recommend cutting your patient visits back by about 50% for the first week of conversion and making sure your vendor has contracted to be onsite for at least a week during the actual “go live” period. After that time, having a local IT professional and remote access to the vendor will help to smooth the transition. Greenberg, however, says that his company builds in enough advance training that patient volumes need be cut only slightly the first week.
z Consider how the software will interface with the practice management software you may already have, and with other locations, such as a surgi-center. “I’ve heard from many primary care practices that they’ve had to abandon their EHR system because the financial and patient care systems don’t interface well,” says Goldberg. Other experts recommend that physicians take into account any inter face with other providers in the practice's "network" (e.g. IPA or PHO) in anticipation of global payment contracts & ACOs. Jackie Goldberg, administrator, and Michelle Housley, HR/IT manager, Digestive Disorders Associates (www.dda.net). Andrei Palmer, Vice President, and Gordon Triplett, president, Aertight Systems (www.aertight.com). Rick Greenberg, regional sales manager, Greenway Medical (www.greenwaymedical.com).
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Dr. Ronald Delanois, M.D., orthopedic surgeon at the Center for Joint Replacement and Preservation at Sinai Hospital
BY LINDA HARDER • PHOTOGRAPHS BY TRACEY BROWN
Orthopedics BEYOND THE HYPE Proper Procedure Selection is Key to Outcomes MEDIA HYPE ASIDE, ORTHOPEDIC
procedures have made some true gains in recent years. We spoke with three Maryland orthopedists – Ronald E. Delanois, M.D, from Baltimore’s Sinai Hospital, William J. Sadlack, M.D, from Suburban Hospital in Bethesda, and Alex C. Speciale, M.D., from Anne Arundel Medical Center (AAMC) – about the latest advances, to help guide your treatment and referrals. Younger and Growing Joint Replacement Population The typical patient getting a knee or hip replacement used to be in his or her 70s or 80s. Now, with baby boomers wanting to stay active and new products potentially offering greater durability, patients are often in their 50s to 60s or even younger. That trend, accompanied by the burgeoning and increasingly obese baby boomer population entering “old” age, is expected to lead to increased demand for viable replacement. Ronald Delanois, M.D., orthopedic surgeon at the Center for Joint Replacement and Preservation at Sinai Hospital, notes, “I’m seeing a lot more younger patients wanting joint replacements. The average age for a knee replacement in our practice is now approximately 58 years, down from the national average of about 72. Heavier people who are active – such as one patient who is a
39 year old former football player previously weighing 500 pounds – are often seeking this procedure.” Advances in Hip Repairs Metal-on metal (MoM) hip replacements have received some negative press this year due to the potential for ion debris, hypersensitivity, and pain. However, a small number of patients have reported problems and only two devices have been recalled – the ASR ™ XL Acetabular System and the ASR ™ Hip Resurfacing system, with many other systems still on the market. On May 6, 2011, the FDA issued a post-market surveillance study of total MoM devices. Dr. Delanois comments, “The true rate of revision of these MoM hips is unknown. I’m not revising them very often, so I can’t say that
“The gold standard is still a total hip replacement, and not a hip resurfacing, which has strict criteria and is subject to metal on metal wear.” — William J. Sadlack, M.D.
they’re bad. We’re participating in a clinical trial for ceramic on metal hips – a new alternative bearing surface that may be the best of both worlds; great durability with lower risk. In my opinion, the new plastics are as good as they say they are, but it takes years to really know what is the best design and material. “Most patients with the old plastics had hip replacements lasting greater than 10 to 15 years; but the newer ones have the potential to significantly decrease osteolysis,” Dr. Delanois notes.“Polyethylene hips may very well prove to last for 30 years or greater. Stryker’s new MDM X3 offers two large heads that are more stable and show less wear. That has become my hip of preference for older women and those who need stability.” The multi-center clinical research trial for ceramic-on-metal hip implants is still recruiting patients, with preliminary results not expected until 2013. William J. Sadlack, M.D., chairman of Orthopedics at Suburban Hospital, states, “The gold standard is still a total hip replacement, and not a hip resurfacing, which has strict criteria and is subject to metal on metal wear.” Advances in Knee Treatments Weekend warriors tend to suffer more joint and ligament problems JULY/AUGUST 2011
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“A lateral approach to back pain has revolutionized our ability to treat many patients, especially for those with degenerative scoliosis involving four or fewer segments.” — Alex Speciale, M.D.
when they are not physically fit. “Muscle strengthening during the week is most important in lessening weekend injuries,” says Dr. Sadlack. “Stem cell implants may be the solution in the future for regenerating damaged cartilage, thereby decreasing the need for joint replacements.” Dr. Sadlack advises primary care physicians, “If a patient comes in with knee pain, the first joint to examine is the hip, as often the hip is the culprit for the knee pain. Also examine the entire extremity, because flat feet and other foot/ankle issues can affect the knee, too.” The vast majority of baby boomers with knee injuries have torn menisci, according to Dr. Sadlack, but this is usually superimposed on articular cartilage damage. He notes, “Unless the knee has mechanical symptoms of locking or giving way, arthroscopic surgery may not be as valuable as physical therapy, NSAIDs or hyalgan and cortisone injections.” “Joint replacement surgery should only be performed when all conservative
Alex C. Speciale, M.D., medical director of the AAMC Spine Center.
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measures fail and the pain compromises the activities of daily living,” Dr. Sadlack states. Computerized knee and hip replacements provide a true advantage in obtaining the correct alignment in joint replace- ments. Dr. Sadlack says, “The use of a computer guides the surgeon and is similar to having a guardian angel in the operating room.” In the knee, Dr. Delanois uses techniques that include high tibial osteotomies, unicompartmental (partial) knee replacements, and cartilage transplantation procedures. Surgical reconstruction of torn ACL ligaments is typically advised when other structures in the knee have also been damaged. Otherwise, conservative (nonoperative) measures may prove sufficient for most patients, especially those who don’t participate in high-risk sports. Patients undergoing surgical reconstruction have long-term success rates of 85% to 95%, with about 8% experiencing recurrent instability and graft failure. More controversial treatments include "low intensity laser therapy" for ligament tears, prolotherapy in which a glucose type substance is injected, and hyperbaric oxygen, which is highly controversial at this time. Advances in Spinal Treatments Most of the advances in spinal surgery have revolved around less invasive surgery techniques as well as implants and bone grafts to improve fusion rates and outcomes. Despite these advances however, “Patients with axial back or neck pain and even most of those with neurological symptoms, treatment is usually conservative and most people get better with physical therapy and NSAIDs,” says Dr. Speciale, medical director of AAMC Spine Center. “For those patients who fail to improve with non-operative treatment, laminectomy with or without fusion can be highly successful. Red flags for urgent surgical evaluation include profound weakness, acute bowel or bladder dysfunction and intractable pain.” Laminectomies and discectomies for radicular pain are highly successful procedures with patient satisfaction rates in the 80 to 90% range. Controversy abounds, however, on the topic of fusions, especially for the treatment of neck and back pain. Dr. Speciale notes,
William J. Sadlack, M.D., chairman of Orthopedics at Suburban Hospital
“There’s a misconception among many patients and some physicians that fusions don’t work – they’ve gotten a lot of negative press. But some studies now show that fusions have a similar success rates to hip replacements. “Proper patient selection appears to be the key,” states Dr. Speciale. “Patients with multi-level disc disease (more than two involved discs) are often poor surgical candidates.” Smoking and obesity are also risk factors for poor outcomes with surgical procedures. If initial conservative measures don’t improve their symptoms, the next step often is to refer them to a pain management specialist for procedures such as fluoroscopically guided injections. Spinal cord stimulation can be highly effective for those patients who fail to respond to advanced pain management techniques and are not considered candidates for surgery. For those patients that are deemed to be surgical candidates, the decision as to whether they need a laminectomy and/or a fusion can be complex and revolves around the degree of stenosis and instability. For those with instability and /or severe axial pain, fusion is still the gold standard. Less invasive techniques are tipping the risk/benefit ratio in favor of surgery. One of the most significant
advances in spine surgery is a lateral approach to treating lower back pain. ‘This has revolutionized our ability to treat many patients, especially for those with degenerative scoliosis involving four or fewer segments,“ observes Dr. Speciale. ‘When more than four segments are involved, the posterior approach is still best, though we’re working on less invasive hybrid approaches that involve percutaneous screw fixation, which does less damage to muscular tissue. Motion-preserving devices include flexible rods and disc replacements. Initial enthusiasm has been dampened by the difficulty in getting insurance coverage for many of these devices. Limited indications and a greater risk of vascular or urological dysfunction for lumbar disc replacement procedures that require an anterior exposure have also slowed its adoption. Cervical disc replacement procedures are likely to gain acceptance more rapidly as the approach and cost profile is similar to fusion for the same indications. Dr. Speciale continues, “The effectiveness of vertebroplasty and kyphyoplasty, which have become very popular over the last decade, was questioned in a recent New England Journal of Medicine article. This article, however, was seriously flawed due to selection bias. For patients with back pain caused by osteoporotic compression fractures that happened within the past 12 weeks, we get excellent results in most cases.” Advances in Shoulder Treatments “In the shoulder, arthroscopic surgery has come into vogue, but it is not the answer for all patients. Sometimes a mini open
Ronald E. Delanois, M.D., is a boardcertified, fellowship-trained orthopedic surgeon who brings more than 20 years of experience with complex hip, knee, and shoulder reconstructive surgery to the Rubin Institute for Advanced Orthopedics at Sinai Hospital. William J. Sadlack, M.D., is a board certified, fellowship trained orthopedic surgeon who is chairman of orthopedics at Suburban Hospital. He is a member of Johns Hopkins Community Physicians and has over 25 years experience in joint replacements and sports medicine. Alex C. Speciale, M.D., a board-certified, fellowship-trained orthopedic surgeon, is medical director of the AAMC Spine Center. Dr. Speciale has a special interest in spinal deformity surgery. In addition to traditional techniques, he performs minimally invasive spine surgery, balloon kyphoplasty, disc replacement and dynamic stabilization.
procedure offers the best option. Synthetic grafts for rotator cuff injuries are being developed now, but the jury’s still out,” Dr. Sadlack notes. With the baby boomer population increasing the demand for more and longer-lasting orthopedic procedures, the developments in stem cell research and surgical techniques are occurring at an auspicious time. Careful selection of the appropriate procedure for each patient’s clinical situation is critical in achieving a positive outcome.
Chlorhexidine Wash: An Easy, Low Cost Way to Reduce Infection The number one cause of hip revisions is infection and instability. In the U.S., 17% of joint replacements are revisions. A revision takes two to four times the OR time as the original procedure. Interestingly, Sinai Hospital's Ronald E. Delanois, M.D., has found that a low-tech approach first documented in 2009 by a study he participated in at Sinai provides one of the most effective ways to reduce post-op infection rates in joint replacement patients. As a result, his practice has patients scrub with chlorhexidine gluconate the night before and the morning of their surgery. Using this approach costs a bit more, but has been proven to significantly reduce the infection rate.
JULY/AUGUST 2011
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Legacy
THE Estate Planner’s STORYBOOK OF Everyday Tales and UNEXPECTED Endings
BY JANE FRANKEL SIMS
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CHAPTER 1: The Busy Doctor and her Devoted Daughter DR. MONICA GREEN WAS becoming increasingly busy managing her burgeoning practice in the face of cumbersome and ever-changing Medicare, Medicaid and insurance regulations. She sometimes neglected to check her mailbox and feared overlooking a bill or missing a credit card payment and incurring penalties. When a teller at the branch of her local bank suggested adding her daughter’s name to her bank accounts so that her daughter, Cindy, could help her manage her finances, Dr. Green thought this was a perfect idea, a welcome relief. As she approached retirement, Dr. Green began worrying about where her assets would go upon her death. She had three wonderful children, Cindy, John and Delia. Lucky for Dr. Green, Cindy lived close by, and Dr. Green depended on her for help with financial matters. When Dr. Green contacted her lawyer, Ralph Barnes, to see if her will needed to be updated, Mr. Barnes assured her that her will divided everything equally among her three children. Confident that her affairs were in order, Dr. Green turned her attention back to her hectic medical practice. Cindy had the time to focus on her mother’s affairs because her husband, Greg, supported Cindy and took care of the couple’s finances. Greg was a serial entrepreneur and though none of his businesses ever took off, he managed to make a comfortable living. When Dr. Green died suddenly at the age of 64, it came as a shock to Cindy and her siblings. Greg, however, was secretly relieved. He was counting on a substantial inheritance from Dr. Green as he had been funding his latest venture on his personal credit card and the bills were mounting. Dr. Green’s bank statements had been coming to their address these past few years and Greg took notice of the fact that his wife’s name was listed on the account. When Cindy alerted Ralph Barnes of her mother’s passing, he informed her that she was named personal representative of her mother’s estate and asked her to make a list of her mother’s assets
and gather statements of her various accounts. When Cindy presented Mr. Barnes with a recent statement of her mother’s bank account, he was surprised to see Cindy’s name next to her mother’s on the account title. “Well, Cindy,” Mr. Barnes stated, “it looks like the bulk of the assets are already owned by you.” Cindy looked confused. “The only assets that pass pursuant to your mother’s will are those owned solely in her name at the time of her death. Because the bank accounts were owned jointly with you, they passed to you by title automatically at your mother’s death.” “Do you mean John and Delia don’t get anything other than a few sticks of furniture? Mom thought everything would be divided equally among my siblings and me. This is not at all what she would have wanted.” “Cindy, don’t worry. Even though the bank accounts are legally yours, you can write checks to each of your siblings for their shares.” Thankful that the situation could be ameliorated, Cindy went home. Over dinner she informed Greg of the joint bank account situation and her intention to write a check for 1⁄3 of the value of the accounts to each of her siblings first thing in the morning. Normally calm and slow to speak up, Greg surprised Cindy with the alacrity of his response: “No, that’s not at all a good idea.”
“What do you mean?” Cindy asked, in deference to Greg’s experience in financial matters. “Am I doing something wrong?” This was not the way Greg had envisioned breaking the news to Cindy of their financial straits but the prospect of losing this windfall frightened him into action. “Cindy, we’re in trouble. A few big deals I was counting on fell through. It’s impossible to get business loans these days and we have maxed out the equity in our house. I have been purchasing business equipment on my personal credit card and taking cash advances on the card to pay rent and salaries. The interest alone is killing me.” Cindy was silent. “These joint bank accounts from your Mom are a godsend. We can get back on our feet again.” “But what about John and Delia? Mom wanted them to be treated equally, and they have kids to put through school.” “Cindy, you took care of your mother’s finances for years. Don’t you think you deserve a little extra as compensation? John and Delia will be fine. They don’t need this money like we do.” Overwhelmed and more fearful of disappointing her husband across the table than her siblings across the country, Cindy acquiesced. “Well,” she said. “I suppose we could give John and Delia their shares in a few months once we get our finances in order.”
MORAL OF THE STORY: Titles trump wills! Do not add someone’s name to your bank account as a co-owner as this could significantly disrupt your estate plan and unintentionally disinherit children or other family members. Instead, add the person to the account “for convenience purposes” only. Alternatively, sign a power of attorney allowing someone to manage your finances for you. Be wary of relying on the generous nature of your devoted child. Accounts titled jointly with one child are often not shared with siblings due to gift tax exemption limitations or pressures from third parties like spouses and creditors. Having a will with the proper terms is not sufficient. You need to inform your estate planning attorney of how each and every asset you own is titled. Remember, that assets pass by title before they pass by will. Jane Frankel Sims is founder and managing attorney of the Law Office of Jane Frankel Sims, LLC. She can be reached at janesimslaw.com. Excerpted from The Estate Planner’s Storybook of Everyday Tales and Unexpected Endings, her as yet unpublished book. JULY/AUGUST 2011
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Compliance
Maryland Physicians,Will You Be Ready? By Denise Buenning
A
RE YOU PREPARED for the U.S. health care system’s change from ICD-9 to ICD-10 diagnosis and procedure codes? The switch to ICD-10 takes effect on October 1, 2013. Leading up to the October 1, 2013, compliance date, Maryland physicians should also keep the following in mind: z January 1, 2012, the date for Version 5010 compliance; a pre-requisite for ICD-10 implementation z Testing of Version 5010 transaction standards is underway; you should be testing with trading partners now The Centers for Medicare & Medicaid Services (CMS) says it is important to prepare now to avoid potential reimbursement delays. The compliance deadlines are not changing and while they may seem far off, the transitions require a number of business and system changes that will take some time to plan. At CMS, we encourage physicians to take advantage of the many resources on our website that can help them get started, especially on the transition to Version 5010 since it is just about six months away. If you do not use Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards starting January 1, 2012, and ICD-10 codes when submitting claims with dates of service on or after October 1, 2013, payment of your claims may be delayed. What’s Changing and Who Is Affected? Unlike ICD-9 codes, ICD-10 diagnosis codes are alphanumeric, have 3 to 7 digits, and are much more descriptive. ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by HIPAA, not just those who submit Medicare claims. This change does not affect Current Procedural Terminology (CPT) coding for outpatient procedures. In addition to the code set changes, standards for electronic administrative
transactions (such as eligibility inquiries and remittance advices) are being updated from the current Version 4010/4010A1 to Version 5010 on January 1, 2012. Version 5010 accommodates both the ICD-9 and the ICD-10 code set structures. To allow adequate time to meet the January 2012 implementation date, CMS says that providers should have begun testing Version 5010 with their trading partners starting in January 2011. Providers who use practice management software, a clearinghouse, third-party biller, or some other way to transmit information between themselves and a health care plan, will need to upgrade their software or work with a clearinghouse or billing service whose systems can accommodate both the Version 5010 standards and the ICD-10 code sets. Get Ready for the Version 5010/ ICD-10 Transition Start with a gap analysis to determine the impact on your organization of both Version 5010 and ICD-10. Use that information to develop an implementation plan, with a detailed timeline, and estimate of costs. CMS suggests Maryland physicians take the following steps to prepare now: z Check with your billing service, clearinghouse, or practice management software vendor. Your third-party biller and clearinghouse need to make sure that you will be compliant by the deadlines. Software vendors should be developing and testing products that will enable Version 5010 testing with your payers and billing services. Testing with ICD-10 should start sometime after Version 5010 implementation in January 2012, to allow for full ICD-10 implementation on October 1, 2013. z Start planning your transition to ICD-10. Meet with your professional and support staff. Discuss where codes are used within your organiza-
tion to help you assess impact. Assign roles and responsibilities for addressing the transition. z Identify needs and resources. Consider changes that might be required. Develop a budget and timeline that take into account specific workflow needs, vendor readiness, and staff knowledge and training. Version 5010/ICD-10 Resources There are many professional, clinical, and trade associations offering a wide variety of Version 5010 and ICD-10 information, educational resources, and checklists. Check the websites of your associations and other industry groups, or call them, to see what resources are available. Denise Buenning is Director of the Administrative Simplification Group in the Office of E-Health Standards and Services at the Centers for Medicare & Medicaid Services (CMS). The CMS website, www.cms.gov/ICD10/, has official CMS resources to help prepare for Version 5010 and ICD-10.
Don’t Wait, Prepare Now Here are the important dates to keep in mind for the Version 5010 and ICD-10 transition: January 2011 Medicare began accepting Version 5010 electronic claims; providers should be testing Version 5010 transaction standards with their trading partners. January 1, 2012 All electronic claims must be submitted using Version 5010. October 1, 2013 You must submit claims with ICD-10 codes only for services provided on or after this date.
JULY/AUGUST 2011
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Good Deeds
Raymond Wittstadt, M.D. – Making Music Pain Free COURTESY OF RAYMOND WITTSTADT, M.D.
By Tracy M. Fitzgerald
O
NCE A MONTH, A GROUP of musicians come together at Union Memorial Hospital’s Curtis National Hand Center. They bring their instruments along, but their purpose is not to practice. Instead, their goal is to allow Raymond Wittstadt, M.D., to observe them in action, and ultimately, help them understand why they experience pain while playing. For the past 11 years, Wittstadt has offered this free monthly clinic, helping musicians as they battle pain and medical issues resulting from overuse of their hands and arms. Participants undergo a medical history review and complete body assessment, followed by an evaluation of body composure as they are playing their musical instruments of choice. In some cases, issues with posture are a contributing factor. In other scenarios, weakness or over-development of muscles can be causing the pain; often the case for those who began training at a young age and are spending as much as four to five hours a day, or more, with their instruments in hand. “There are not many people who use their hands more than musicians,” Wittstadt said. “Our goal is to look deep and understand what is causing their pain. If their hand hurts, it might be because their hand is injured. Or, it might be because their shoulder is weak. We can figure out a solution once we can see where the problem stems from.” Over the years, musicians from near and afar have taken advantage of Wittstadt’s clinic, traveling from as far away as Florida and California, and even Spain, to attend. An average of five to six musicians participate each month; a number that has steadily increased as
Sixteen-year-old Sheila Graves, a bass guitar player who practices up to three hours per day, began experiencing severe pain in both wrists. She has participated in Raymond Wittstadt’s monthly clinic for musicians to learn more about her injury and the steps that should be taken to resolve her pain.
awareness about the clinic and the positive impact it is having on so many people has grown. Tendinitis, carpal tunnel and nerve entrapment conditions are the most common issues diagnosed,
from neighboring medical institutions as ad hoc participants in the monthly meetings, and has written and published numerous articles on the prevalence of injury among musicians. Trained in
“We try to help people realize that the ‘no pain no gain’ philosophy isn’t always in their best interest.” with medication and therapy prescribed as appropriate and surgery considered when necessary. “We try to help people realize that the ‘no pain no gain’ philosophy isn’t always in their best interest and that there are ways for them to continue doing what they love, without the pain,” said Wittstadt, who works collaboratively with certified hand specialist Lauren Valdata and certified Alexander Technique therapist Karen Geurtler to evaluate clinic participants. A piano player as a child and recreational guitar player today, Wittstadt has a personal passion for music and is happy to volunteer his time to make this resource available to his patients and the community at large. He welcomes physicians
orthopedic medicine, he appreciates the opportunity the clinic gives him to merge the practice of correcting repetitive use injuries with sports medicine. “Musicians are athletes of the small muscles,” he said. “It’s rewarding to help them and know that we can positively impact their lives.” For further information or to refer a patient to an upcoming musician’s clinic meeting, call 410-235-5405. Maryland Physician would like to hear about your “Good Deeds.” Please share your ideas with us by contacting us via email at gooddeeds@mdphysicianmag.com.
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Heritage
National Name, Local Roots By Tracy M. Fitzgerald
I
T IS RECOGNIZED AS THE largest surgical hand practice in the United States. But the Raymond Curtis National Hand Center, based at Union Memorial Hospital, has built a reputation that accounts for much more than size. Here, it’s about a strong and stable foundation and history, over three decades of quality care that has revolutionized patient experiences and outcomes, and an outlook for the future that makes the most advanced techniques for treatment of upper extremity injuries available. Upon his return from World War II, Dr. Raymond Curtis identified a need for specialized care for upper extremity injuries and disorders, resulting in the 1975 establishment of a center focused on prevention and treatment of hand, wrist, arm, elbow and shoulder ailments. Approximately twenty years later, in recognition of its singular experience and expertise, the 103rd Congress designated the practice as the National Center for Treatment of the Hand and Upper Extremity. Today, 14 board-certified orthopedic and plastic surgeons are part of this nationally-acclaimed practice, offering treatment of carpal tunnel, arthritis, tendonitis and other congenital problems, as well as a wide range of emergency and non-urgent surgical procedures that can repair injury and restore functionality of the upper extremities. Under the leadership of James Higgins, M.D., Chief of the Center, there is a constant focus on innovative technique and the introduction of new procedures. One of his areas of clinical and research expertise is vascularized bone transfer surgery. “This procedure allows us to move bone and its associated blood vessels from one part of the body to another,” Higgins said. “We have presented some of the new techniques for treatment of wrist and hand 26 |
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A recent event was held to celebrate the lifetime achievements of Shaw Wilgis, M.D., one of four physicians credited with founding the Curtis National Hand Center. (Left to right) Current Chief James Higgins joined founders Gaylord Clark, M.D., Shaw Wilgis, M.D., and Frederik Hansen, M.D., at the event.
injuries on the national and international stage, and are sharing our research and undertaking clinical collaboration with physicians around the country and world.” Collaboration is key for Higgins and his colleagues as they identify strategic priorities for the future of their practice. A new partnership is underway with Operation Smile, best known for their mission work to help people in underprivileged parts of the world with cleft lip and palate conditions. Their new partnership with the Curtis National Hand Center expands the scope of their services, to include treatment of hand injuries. More work is being done with the Walter Reed Army Medical Center, to provide care to soldiers returning from war with hand and arm injuries. And through a partnership with Johns Hopkins Hospital, Curtis Hand Center surgeons are currently collaborating as part of a new hand transplantation team. “A hand transplant will give a patient the ability to experience sensation and function in their upper extremity that they could not achieve through a prosthe-
sis,” said Dr. Kenneth Means, a partner in the practice since 2006. “It takes a massive team of clinicians to do this, and we are honored to be part of this collaborative effort with Johns Hopkins.” The Curtis National Hand Center is designated as the official treatment site for upper extremity trauma cases in the state of Maryland. Physician referrals for non-urgent care cases can be arranged by calling 1-877-UMH-HAND.
Raymond Curtis, M.D., realized a need for a specialized practice to treat upper extremity injuries upon his return from World War II. Patients have benefited from his vision and expertise since the early 1970’s.
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24-Hour Concierge Valet Parking Housekeeping †
RCR-Baltimore.com
Valet Laundry & Dry Cleaning † Travel & Vacation Planning † Pet Sitting †
801 Key Highway, Baltimore, Maryland 21230
The Ritz-Carlton Residences, Inner Harbor, Baltimore are not owned, developed or sold by The Ritz-Carlton Hotel Company, L.L.C. An affiliate of RXR Realty LLC uses The Ritz-Carlton marks under license from The Ritz-Carlton Hotel Company L.L.C. This is neither an offer to sell nor a solicitation to buy to residents in states where registration requirements have not been fulfilled. MHBR No. 4096. An RXR Realty development. †Services provided by third-party companies are paid a la carte by the resident who requests the service.
“ I was worried about a long recovery from heart surgery. Thanks to a minimally invasive valve repair by the team at Washington Adventist Hospital, I was home the day after surgery and back to work in just three weeks.” —John Kearns, 52, Silver Spring Minimally Invasive Valve Surgery Patient
The Cardiac Surgery team at Washington Adventist Hospital offers the most advanced techniques in heart surgery including:
Minimally invasive aortic and mitral valve repair and replacement
Minimally invasive CABG
For a minimally invasive cardiac surgery consult, call 301-891-6101. For priority transfer of your cardiac admissions, call Cardiac One-Call at 866-684-8460.
www.trustedheartcare.com