M.D. Update Issue #83

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #83

SPECIAL SECTION

It’s All In Your Head

STRENGTH IN NUMBERS VOLUME 4, NUMBER 8

The association of Lexington Clinic and Kentucky Ear, Nose and Throat ensures otolaryngology patients receive maximum quality of care ALSO IN THIS ISSUE  PRACTICING PSYCHOANALYSIS  TRAUMATIC BRAIN INJURY AND THE MILITARY  PTSD IN VETERANS  MAYO CLINIC MODEL FOR BRAIN INJURY  TMJ DYSFUNCTION

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LETTER FROM THE EDITOR

Welcome to 2014 Another year has come and gone. 2013 was a good one for M.D. Update. We featured many faces new to our pages, as well as welcomed back many familiar friends.

Personally, I would just like to start the year by saying, THANK YOU! Thanks to those of you who make the magazine possible by participating in interviews, sharing your expertise, and supporting the magazine with advertising dollars. And thanks to those of you who read these pages – a publication is nothing without its audience!

As we begin 2014, there is much to anticipate on the health care horizon, including Medicaid expansion and the continuous working evolution of the health benefit exchange and the ACA. Our goal at M.D. Update remains steadfast: to keep you connected to what’s happening locally throughout the state, in your neighborhood, in your field, and across the board.

While we remain committed to providing you more of content you love, like many of you, we at M.D. Update have a few resolutions for the New Year: In the coming year, we resolve continue to improve and investigate our digital publishing options. We hear time and again that you enjoy our traditional hard-copy format. But we also know how vital and accessible technology is in our lives. Our goal is to offer you both. If you have any suggestions about the formats you’d like to see or have a particular “digital” skill you’d like to share, please drop us a line.

We also resolve to continue reaching out into the communities beyond Louisville and Lexington, to bring you a more complete picture of the state. Our challenge is finding the contacts in more rural areas. If you represent a community you would like us to feature or if you know someone in a rural community that would make a good story, please let us know.

In this issue, we feature all things “In Your Head.” From psychiatry to neurology to ENT, we’ve tried to give you a broad picture of body systems above the neck, including a unique dual-angle look at military service members and veterans, featuring traumatic brain injury treatment at Fort Knox and PTSD treatment at the VA Medical Center in Louisville.

On page 31, you will find a “working” editorial calendar for the coming year. As always, we welcome you feedback and suggestions on any topic. Our contact information is below.

WISHING YOU A HAPPY, HEALTHY, AND PROSPEROUS 2014!

Jennifer S. Newton, Editor-in-Chief: jnewton@md-update.com, jennewton01@gmail.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax 2 M.D. UPDATE

Volume 4, Number 8 ISSUE #83 PUBLISHERS

Gil Dunn PRINT gdunn@md-update.com Megan Campbell Smith DIGITAL mcsmith@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGNER

James Shambhu art@md-update.com

CONTRIBUTORS:

Jan Anderson, Melissa Avery, MD Larry Cunningham Jr., DDS, MD Robert Edwards Lisa English Hinkle Jeanette Miller James Patrick Murphy, MD Scott Neal Calvin Rasey William Smith III Susan Westrom

CONTACT US:

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CONTENTS

ISSUE #83

COVER STORY 4 HEADLINES 6 FINANCE 7 LEGAL 9 MEDICAL MANAGEMENT 11 INSURANCE 13 PHYSICIAN VIEWPOINT 14 COVER STORY

18 SPECIAL SECTION:

STRENGTH IN NUMBERS

The association of Lexington Clinic and Kentucky Ear, Nose and Throat ensures otolaryngology patients receive maximum quality of care

IT’S ALL IN YOUR HEAD

25 COMPLEMENTARY CARE 28 NEWS 31 EVENTS

BY TIM CORKRAN PAGE 14

SPECIAL SECTION  IT’S ALL IN YOUR HEAD 18 TREATING PEOPLE NOT SYMPTOMS: LEXINGTON CENTER FOR PSYCHOANALYSIS  20 Q&A ON TRAUMATIC BRAIN INJURY IN THE MILITARY: US ARMY  22 PTSD AND VETERANS: ROBLEY REX VA MEDICAL CENTER 

18

20

23

24

23 THE MAYO CLINIC MODEL: FRAZIER REHAB INSTITUTE  24 TMJ DYSFUNCTION: UK ORAL AND MAXILLOFACIAL SURGERY  22

ISSUE#83 3

HEADLINES

Health Care Issues for the 2014 Legislative Session [PART 1] I suspect my friends in the medical community will be doing all they can to survive the Healthcare Reform Act, medical record implementation, the flu season, and the 2014 Legislative Session, which begins on January 7, 2014 and ends on April 15. I sense the worry is not “what will they do FOR us, but what will they do TO us?”

There are several health issues on the boilerplate in Frankfort, and although it is a bit too early to predict challenges, changes, or outcomes of filed legislation, I will simply predict what may be on the medical front in the Kentucky Capital.

Medical Marijuana

There is no doubt that the topic of medical marijuana has been carefully avoided for years in Frankfort, since no legislator wanted to be labeled as a “drug promoter.”

We have recently watched other states legalize medical marijuana for people who suffer from chronic illness and pain, nausea from chemo therapy, seizure disorders, glaucoma, autism, and many more diagnoses.

You cannot imagine how little exposure Kentucky legislators have been provided on this vast and important issue. The first testi-

ties, as well as law enforcement, in any committee to which the bill might be assigned.

Legislators can learn much from other states who have already legalized medical marijuana, and they

BY By Susan Westrom could be available to share statutory language, court challenges or unintended consequences, illegal activities that have sprung from the legalization, and drug enforcement regulation and involvement.

The topic of legalizing medical marijuana has not been given an opportunity to clarify itself as an important topic in 2014, and the truth is, this being an election year would likely reduce the number of legislators willing to take a vote on such a controversial subject.

ARNPs

We have repeatedly listened to a one sided debate regarding the mandatory collab-

Until members hear from constituent doctors and patients willing to share their secondhand smoke stories, a critical number of legislators will run from a vote. mony in Frankfort was presented during the August 2013 special session. Unfortunately, the meeting was concluded abruptly due to a needed floor vote.

Public safety is a priority for those of us who serve in the General Assembly, so it would be critical to hear vetted scientific information, testimony from patients and parents, the medical and pharmaceutical communi4 M.D. UPDATE

orative agreements between doctors and advanced registered nurse practitioners (ARNP) for several years. The ARNPs were seeking more independence, and the KMA (Kentucky Medical Association) evidently felt no political pressure to address the issue and shut down any dialogue.

In 2013 a shift occurred when three senate bills addressed the issue of discontinu-

ing mandatory supervision of independent ARNPs by medical doctors. The legislative language included an amendment on a bill to eliminate the collaborative agreement that is currently in place and two individual bills doing the same. Once the topic became two-sided, it was imperative that all parties involved with this issue come to the table with an open mind to work toward a mutual agreement.

Over the 2013 interim, several meetings were held by the various stakeholders, and it now appears a bill will be drafted. The truth is, the General Assembly does not enjoy dealing with professional turf issues that leave most of the members confused and both sides of the argument difficult to deal with.

I predict the bill has a good chance of passing. I understand the meetings held were stressful and challenging, so I applaud the efforts made by the KMA!

Smoke-Free Kentucky

A bill number will be assigned to the 2014 Smoke-Free Legislation, which I will be filing for the fourth time in January. Let me take this moment to thank the KMA for endorsing and passing a resolution in support of Smoke-Free Kentucky during the 2013 state meeting.

Smoke-free legislation will prohibit smoking in enclosed workplaces or public places, however, smoking will still be legal.

Smoke-free laws are good for health, good for business, and popular with voters and the medical community. It reduces the economic toll on our state’s finances through Medicaid and employee health care costs.

A healthier workforce will entice out-ofstate businesses to consider Kentucky for relocation.

I am preaching to the choir when I reiterate that the United States Surgeon General has determined that the science is indisputable. Secondhand smoke is dangerous. It can cause serious or deadly illnesses from which people can be protected. Even with these facts, I still have far too many “Brethren” who are afraid to protect the public from secondhand smoke!

HEADLINES

How can you help?

You are one of the most influential people in your community. I can tell stories all day long, but I do not carry the lifechanging influence you do. Until members hear from constituent doctors and patients willing to share their secondhand smoke stories, a critical number of legislators will run from a vote.

Pulmonologists, cardiologists, pediatricians, family medicine, OB-GYNs, surgeons, and other specialties have been eerily quiet, yet their contact would force their representative to be accountable.

Please, have someone in your office e-mail patient stories without identifiers to susan.westrom@lrc.ky.gov. Encourage patients who have lost far too much as a result of secondhand smoke to email me or call (502) 564-8100 and ask for Amy Tolliver to connect us.

Please talk to your representative and senator and hold them accountable for public health. Let me know who you have connected with, so I can follow up.

I am hearing from far too many elected officials that they are receiving calls from people who are against this legislation.

It is hard to believe that 71percent of Kentuckians who do not smoke also do not talk!

Ongoing Critical Legislative Topics

Ongoing critical legislative topics include nursing home review panels, juveniles and e-cigarettes, and a greater need for rural medical professionals/expanding scopes of practice. Look for information on these topics in the next issue of M.D. Update.

Susan Westrom (D) was elected as State Representative of the 79th district in Lexington, KY in November 1998. Westrom sits on the House Standing Committee on Health & Welfare as well as Agriculture; Appropriations & Revenue; BR Sub-committee on Economic Development & Tourism; Natural Resources & Environmental Protection; Horse Farming (co-chair); Licensing and Occupations (Vice Chair). ◆

Health Care is a Pyramid Scheme

BY ROBERT L. EDWARDS LEXINGTON, KY On Tuesday, November 12, Mark D. Birdwhistell presented to the Lexington Medical Society, “Everything you want to know on the Affordable Care Act (ACA)

"Medicaid was never meant to be the largest payer of health care," says Mark D. Birdwhistell, UK HealthCare’s vice president of administration and external affairs.

in 20 minutes or less.” Birdwhistell, UK HealthCare’s vice president of administration and external affairs and former Secretary of Health for Kentucky’s Cabinet for Health & Family Services, addressed an audience of over 75 active and retired physicians on this daunting subject.

The public policy debate surrounding health care reform rages on now four years after the passage of the ACA (also known as Obamacare). Speaking to current events, Birdwhistell noted the highlights of Kentucky’s state-based health insurance exchange launch, in the face of the federal health insurance exchange’s troublesome rollout.

His remarks emphasized that the legislative intent of the ACA focuses on health insurance coverage and access to coverage, rather than transformative changes to the US health care delivery system.

While the political divides have only increased since passage of this bill, Birdwhistell discussed how health care systems have continued to prepare for the implementation of the ACA, sharing his insights into the machinations of state Medicaid Programs -- a payor of increasing scope and importance. Hospitals and physician offices are being forced to adapt to outright payment reductions, increased scrutiny over compliance with state and federal law, and significant workforce issues. State Medicaid programs are also tackling cost containment with renewed vigor.

“Medicaid was never meant to be the largest payer of health care,” said Birdwhistell. “But 80 percent of Eastern Kentucky will soon be on Medicaid, and that is significant.”

Birdwhistell compared the current trend of shopping for health care to “going on Amazon or Expedia to get health coverage. I never thought ‘Express Lanes’ would be part of Medicaid,” he said.

The benefit to health care consumers, said Birdwhistell, is closing the gap between the insured and the uninsured by improving outcomes and reducing costs.

The “Birdwhistell Pyramid” illustrates the progress with four components of improved health care delivery: 1) Health care information technology; 2) Chronic disease management, where 20 percent of the population consume 80 percent of the health care dollar; 3) Pricing based on value; and 4) Consumerism.

Birdwhistell ended on a positive note stating that the importance of the “art of medicine” has never been higher. His hopes included a desire to see physicians leading teams of providers to support disease specific models of care to improve patient outcomes and reduce the cost of complex patients. ◆ ISSUE#83 5

FINANCE

Investing in the New Year According to Daniel Kahneman, Princeton professor of psychology and the so-called father of behavioral economics, it is our “remembering self ” that makes decisions rather than our “experiencing self.” Of course, we are not two selves, but thinking this way gives us a good metaphor for discussion. In other words, we construct stories out of memories and those inform our decisions to a much greater extent than what we are experiencing in the present moment. We see this happening routinely as people make investment decisions. The stories that make up memories of risk and reward, past gains and losses ring loud and true in the psyche of most investors. Such thinking has caused many to miss the 2013 rally or to remain invested right through the two recessions of this century. Modern portfolio theory, espoused by the vast majority of advisors, holds that the market has no memory. That simply does not hold up to scrutiny or common experience.

Nevertheless, the turning of the calendar presents a good time to remember and to evaluate where you have been and to look to where you might be headed into 2014.

Unless you have been hiding under a rock for the past few months, you know that the stock market has been “melting up” and that we are in the midst of the longest bull market ever. Lately, I have been asking our clients which risk presents them with the greater concern: 1) missing market gains in good markets? or 2) losing principal when the market falls? Confronted with the question, if you only think about the past few years, you might be looking at your annual returns and feeling some regret or remorse that you missed the rally in the stock market—if in fact, like many investors, you did miss at least some of it. Ask yourself if you have chosen to accept the wrong kind of risk. Wrong for you that is; not wrong in a universal sense. Alternatively, it could be that you are focusing on too short a time frame.

According to Morningstar, the 10-year average of the S&P 500 index has been 7.34% a year through December 13, 2013.

Even many who have adopted a wealth preservation or absolute return strategy have 6 M.D. UPDATE

done as well with their diversified portfolio. Doug Short reported on the same day that the S&P 500 was up by a grand total of 22% since January 1, 2000.

That, of course,

BY Scott Neal works out to be about 1.6% a year and includes the current bull market but also includes two very sharp and deep declines. Hardly anybody would be satisfied with those returns over such a long period but many buy-and-hold investors got what they bargained for and have either long forgotten the outcome or never bothered to look.

Given such a roller coaster ride as we have seen in the past 14 years, it would seem then that one need to remain invested so long as the market is trending up and have an exit strategy for getting out as it turns down. Nearly everybody appears to eschew market timing, however they still must admit to a deep desire to avoid the downturns but participate in the up-market. One way to have a chance of doing that is a) to be invested and b) to employ some sort of risk control so as to avoid the serious downturn as it begins to unfold.

Once the strategy is matched to objective, where then does one go with their money in the marketplace of 2014? A good place to look is the growing universe of exchange traded funds (ETF’s).

ETF’s come in a variety of sizes and types and there is surely one to address nearly every asset class today. In fact, there are ETF’s that move counter to the market. On days when the market is down, these instruments go up. Leverage can be served up in some ETF’s that have as their objective to double or even triple the daily movement of an index. Most ETF’s are extremely tax efficient and some have very low expense ratios. An added bonus is that they can be traded on the exchanges rather than having to be bought or sold at the closing

net asset value as do more traditional openend mutual funds. Sector ETF’s can be an effective way to rotate between sectors. One downside to ETF’s is that one usually has to pay a commission to buy or sell the instrument. However, some discount brokerage firms offer a pretty wide array of ETF’s that can be bought and sold without incurring transaction costs. Another downside can sometimes be the lack of liquidity. Some are so thinly traded as to make them impractical for an investment of respectable size.

Generally, asset allocators recommend that the more conservative your risk tolerance the more you should be invested in bonds. Presently however, bonds could present as much or more downside risk as stocks.

Recall that as interest rates rise, bond values fall. 2014 could be the year that the bond market says it has had enough of low interest and will start bidding up the rates. For that reason if bonds are to be included at all right now, only short term bonds would be indicated since the longer dated bonds will suffer more in a rising interest rate environment.

High quality U.S. stocks seem to present the best place to put equity investments as the New Year unfolds. Even that should be done cautiously.

Once a vehicle is chosen, the proper sizing of the position becomes imperative.

Decide going in how much downside risk you would be willing to accept should that investment not do what you expect it to do.

Purchase only that number of shares that will keep you from reaching your point of ruin should the price drop to that predetermined level. Set that as a stop alert and monitor it for a potential sale should that price, and therefore that amount of loss, be reached.

Resolve that a small loss will not ever become a big loss in your portfolio. Wishing you a very Happy and Prosperous New Year!

Scott Neal, CPA, CFP is President of D. Scott Neal, Inc., a fee-only financial planning and registered investment advisory firm that subscribes to the fiduciary oath. Offices are located in Louisville and Lexington. He can be reached by calling 800-344-9098 or via email: scott@dsneal.com ◆

LEGAL

Top 10 Health Law Issues for Physicians, Health Systems, and Providers in 2014 Change is the one constant that physicians, health systems, and other providers face in 2014 as the ACA and its myriad regulations become effective, along with increasing review and scrutiny from not just state and federal regulators but also private companies with state and federal contracts to review and audit claims, cost reports, and billing practices. So, listed below are the top 10 areas that physicians and other providers should watch in 2014.

MEANINGFUL USE AUDITS: Physicians, hospitals, and others that have received incentive payments to integrate electronic medical records into their practices will likely be subject to an audit from either Medicare or Medicaid to assess whether the providers have actually made meaningful use of these funds and systems. Auditors are likely to demand evidence of meaning-

ful use of incentive monies and repayment when providers cannot back up the attestations made for Stage 1 compliance. Providers should be on the lookout for audit request letters

BY Lisa English Hinkle sent via email by the contracted auditor. Make sure that whoever has the email address registered with CMS checks for an audit letter. In addition, providers should make sure that all meaningful use attestations are backed up and documentation is maintained for the six years that CMS requires. Some of the required evidence includes EHR

vendor agreements, attestation reports on clinical quality measures, statements from EHR vendors, information used to generate numerator and denominator values for reporting, etc‌ If an audit letter is received, contact should be made immediately. Providers need to pay attention to these responses; a failure to respond adequately could result in more than just a request for repayment.

ASSURING AND MEASURING COMPLIANCE WITH HIPAA AND HITECH: Increased audit and enforcement activities related to HIPAA and HITECH are coming, and providers should ensure that they have implemented required changes such as identifying business associates and executing compliant business associate agreements, as well as implementing security standards and testing for patient information and reporting

ISSUE#83 7

LEGAL

breaches. Also, expect increased enforcement activities from Kentucky’s Attorney General as HITECH granted enforcement authority to the Attorney General along with the opportunity to seek damages.

STARK LAW APPLICATION TO MEDICAID CLAIMS: While the Stark Law on its face applies only to Medicare, recent court decisions have found that a Medicaid claim filed in violation of the Stark Law also constituted a false claim. Courts have now found False Claims Act liability for Medicaid claims filed in violation of the Stark Law. Historically, the federal government had focused enforcement efforts on Medicare claims. Carving out Medicaid referrals and claims in health care transactions is no longer prudent.

All contracts and transactions should be reviewed for compliance with the Stark Law even if the contract only applies to services for private pay or Medicaid patients.

MEDICAID INTEGRITY CONTRACTOR AUDITS: As the Medicaid review auditors are finalizing their review of the big data to identify providers who fall outside billing standards, these reports are being released to Medicaid for provider audits and collection of overpayments. Challenging overpayments must be made through Kentucky’s Medicaid appeal process, which establishes important deadlines for requesting a dispute resolution meeting when an overpayment is identified.

If a DRM is not requested, then repayment is due in 30 days. Providers should pay close attention to these deadlines and exercise their ability to challenge overpayments.

MEASURING QUALITY: As CMS’ Physician Compare website joins the nursing facility and hospital compare websites, physicians must be ever mindful that quality scores will ultimately impact reimbursement for all payors, not just Medicare and its incentive payments. Physician groups, as well as all providers, should carefully develop their quality measures. As ACOs, hospital systems, and payors develop their own quality measures, individual physicians must be aware of those measures and how they affect them.

Participation in networks, ACOs, and even Medicaid may become tied to performance.

All physicians, even those who are employed by health systems, should be careful in their contracting and knowledgeable about their individual quality and performance.

8 M.D. UPDATE

MEDICAL STAFF MEMBERSHIP AND CREDENTIALING: Changes in Joint Commission for Accreditation of Health Care Organization’s requirements for medical staff credentialing have made evaluation of a physician’s quality of care an element of the credentialing and recredentialing process. How this evaluation takes place and the factors that are considered are left to the medical staff, which, in reality, usually means administration. The information about this evaluation becomes a permanent part of a physician’s records. Every physician should be aware of this, find out about evaluation results, and challenge them if necessary. A challenge does not mean that a physician impairs his/her privileges but rather seeks to maintain an accurate credentialing file.

RETENTION OF OVERPAYMENTS: Retention of a Medicare or Medicaid overpayment can create false claims liability and treble damages recovery when the overpayment is not returned within 60 days. The ACA created the duty to report and return known overpayments. While the law sounds simple, its application is anything but simple and creates a host of issues for providers, including determining when an overpayment is known to the provider. For example, is the billing clerk’s knowledge imputed to the physician owner of the practice? Also, when reporting an overpayment, does a provider have a duty to look back to see if there are other overpayments?

EXPANSION OF MEDICAID BENEFICIARIES: With Kentucky’s successful rollout of its Health Insurance Exchange and the possibility of 308,3891 new Medicaid beneficiaries, what is the health care provider’s duty to take on more Medicaid patients? Should a provider establish express limits on the number of Medicaid patients that a practice will accept as patients? Does this create liability under provider agreements with Medicaid Managed Care payors? These issues will become even more important as the number of beneficiaries increases.

PRESCRIBING CONTROLLED SUBSTANCES IN KENTUCKY: The war on prescription drug abuse has taken a terrible toll on physicians as House Bill 1 and the implementing regulations issued by the Kentucky Board of Medical Licensure have forever changed how and when a physician may prescribe controlled substances. While the regulations have been slightly tweaked, physicians

must take extraordinary efforts to build the procedures and processes required for prescribing into their day-to-day practice.

Physicians should be aware that the Drug Control Branch of Kentucky’s OIG routinely reviews KASPER data and reports the highest prescribers of controlled substances to the KBML for investigation. Physician responses to these investigations must be careful and complete with the understanding that there is little recourse if a violation is found.

GETTING PAID: All providers must take active steps to assure that they are paid, which includes keeping abreast of a myriad of payment issues and policies. A providers’ staff must be diligent in following up with insurance companies, Medicaid, and Medicare to seek payment. The squeaky wheel gets oiled first. Providers also need to be aware that preventive benefits such as cholesterol screenings and vaccinations are now free of charge through all Marketplace plans and many other insurance plans, including Medicare, Medicaid, and private insurance plans. Providers should be prepared that they will no longer be able to collect a copay from any member of these plans, regardless of whether that member has met his or her deductible. A list of preventive benefits covered by most plans under the ACA can be found at https://www.healthcare.gov/whatare-my-preventive-care-benefits/. Providers, particularly physicians, should pay attention to proposed federal legislation that will finally repeal the sustainable growth rate and replace it with payments that tie payments to quality and efficiency, incorporate alternative payment models, and improve the fee for service system by including value-based performance measures. This bill has the support of both Senate and House committees.

We will see…….

In conclusion, 2014 promises to be anything but boring.

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. ◆

MEDICAL MANAGEMENT

Are You Ready to Become a Physician Executive?

After learning biochemical pathways, memorizing notes as tall as yourself (my second year notes were measured to be one and a quarter times as tall as me), learning to become ambidextrous in the operating room, and taking the time to develop the social skills to have a calming bedside manner – you became a physician. Now you are considering becoming a physician executive in medical management. Being a physician executive means you will learn to become a coach and progress to being a mentor, read financial reports, quality surveys, discipline disruptive providers, and organize strategic long term organizational plans. With advanced training, you will strive to have staff members problem solve independently with assistance from your insight.

Some issues to consider:

1. Are you a self-starter and lifelong learner?

2. Are you accomplished at networking and using social media?

3. Are you willing to relocate, possibly often?

4. Are you good at wearing different hats? And adding new hats?

5. Are you ready to give up clinical medicine and wearing your white coat?

6. Are you ready to not be looked at the same by your peers?

How does a physician transition into becoming a physician executive? Some start by sitting on committees and boards within their facilities. Others perform part-time reviews of authorization requests and appeals. Typically, the career physician executive will initiate advance formal training in medical management from a resource such as the American College of Physician Executives (ACPE), Certifying Commission in Medical Management, or the American College of Healthcare Executives (ACHE). This training can be online or in person at meetings or concentrated tutorials. The ACPE, for exam-

ple, has legendary courses such as Physicians in Management, Fi n a n c i a l D e c i s i o n Making, and the Three Faces of Quality. Newer coursework is

BY By Melissa V. Avery, MD available such as High Reliability 2.0 and the Integrated Health Systems Series. Additional helpful resources are the ACHE, Medical Group Management Association, and the American Academy of Family Physicians to name a few.

Additionally, you will again need to learn a new language – this time it is the language of health care, managed care, reimbursement, claims payments, etc. Did I mention the new acronyms you will see like alphabet soup in your sleep? ROI, LOS, COC, ADK, MLR, NCQA, COB, DOI, IBNR – this list is continuing to expand rapidly now with the addition of health care exchanges.

Physician leaders that have the talent and courage to become the liaison between providers and administration while staying abreast with advances in medicine are a rare breed. The best in the field network constantly, read voraciously (think New York Times, Wall Street Journal, USA Today, Bloomberg Business, Forbes), effectively communicate orally and in writing, possess computer skills including Excel and PowerPoint, attend state and federal forums on health care, read company financial reports, patient census, contracts, organize quality improvement projects, credential/recredential providers, motivate staff members, facilitate shortterm and long-term strategic planning within local and corporate structure, and update policy regularly while managing to motivate stakeholders.

Becoming a part of an organizational family (whether hospital, insurance, private, government, academia, pharmaceu-

tical industry, or consulting) can be an enriching position for a physician executive.

These providers function by a defined set of expectations, responsibilities, objectives, and short- and long-term goals. Some manage from a distant location. Others literally manage by walking around interacting with staff members. These leaders are able to see the big picture for the organization and be judicious stewards for the state and federal trust funds.

Most enter medical management as an Associate Medical Director. These physicians have chaired some committees, volunteered in their community, managed a practice, lead a task force at the hospital or private group. Eventually, some became (or entered medical management) as a Medical Director. Be careful, as this is a very loosely held term and could mean many different things such as: you practice 95 percent medicine and manage the call and vacation schedules as your management duties or you manage 225,000 lives for one state for a national Fortune 100 company with no clinical involvement. In short, before you give up clinical practice, remember these two important caveats: 1) It is very difficult to go back; and 2) You will never be looked at the same again (colleagues will want to assume you don’t understand their plight as you are no longer a practicing clinician) As you grow your knowledge base as a Medical Director, you may advance to a Senior Medical Director position and begin to be involved with the Senior Management team of the organization. At this level the ability to create and manage successful change within the organization is paramount.

With these accolades comes an opportunity to expand your knowledge base and comfort zone to the entire C-suite (Chief Medical Officer (CMO), Chief Quality Officer, Chief Medical Information Officer or Chief Clinical Integration Officer.)

ISSUE#83 9

MEDICAL MANAGEMENT

Sometimes these positions are with new organizations in different locations. If you have a spouse and/or children, deep consideration will occur whether or not this transi-

HOW DOES A PHYSICIAN TRANSITION INTO BECOMING A PHYSICIAN EXECUTIVE? SOME START BY SITTING ON COMMITTEES AND BOARDS WITHIN THEIR FACILITIES. tion is the best choice for your family as a whole. As a CMO, you often will be tasked with managing the entire medical operations of your organization and be account-

able for production, quality, grievances, cost savings, and growth. Some systems are corporate enterprises and have multiple CMO’s that feed into one centralized corporate CMO. If you are in this position you might lobby at the level of Washington, DC or for a national organization or branch of the military either promoted or elected.

Many times you may cross into the political arena as you navigate your physician executive landscape. For some, they are able to side with a political party – others may choose to be bi-partisan.

Opportunities to be at the forefront of health care delivery and utilization are expanding as our health care climate is continually changing. You may want to consider or reconsider becoming a physician executive as you start your career or as a mid career change. Good physician execu-

tives are becoming increasingly sought after domestically and worldwide. For some, these roles can lead to an exciting and challenging transition for the next segment of your medical career.

Melissa V. Avery, MD, MMM, FAAFP, CPE has been an entrepreneurial physician executive for 14 years with roles for government programs and private insurers, including health care systems. She is a recertified family physician with a master’s of Medical Management from Tulane University, fellow from the American Academy of Family Physicians, diplomate from the American College of Physicians Executives and is a certified physician executive. Dr. Avery may be contacted at Bluegrass Family Health, 651 Perimeter Drive, Suite 300, Lexington, KY 40517, (615) 818-1967. ◆

Would you rather be here?

Or HEAR?

Engineered for performance.

10 M.D. UPDATE

INSURANCE

Disability Plays No Favorites Are You Prepared and Protected?

As a physician, every day you see your patients suffering from unexpected injury or illness, which may require them to miss work that could substantially reduce their income.

Often I find that many physicians have the mentality of being invincible, that somehow they can avoid the same ailments that plaque your patients. When was the last time you thought about the chances of a major disability interrupting your career and possibly your future income stream? How long could you make it without that pay check? Could your mortgage or rent get paid?

The fact of the matter is disability is all too common. According to the social security administration, 30 percent of the US working population that are 40 years old or older will become disabled before they reach the age of 65. If that is uncomfortable, think about it this way: The chances of you using your homeowners insurance

is about one in 88. The odds of using your auto insurance is about one in 47, but the odds of a disability are one out of every eight people.* Your home is insured, your car is insured, but

BY Calvin R. Rasey are you, as your Greatest Asset, properly insured? As long as you have the ability to see patients, the home can be replaced, the car can be replaced. Do you protect the goose or the golden egg?

Many physicians may feel that purchasing adequate disability protection is just too expensive. Is that a myth or reality? Assume that the average physician earns $250,000

per year, would it be wise to spend approximately two percent of that annual income to protect the other 98 percent? While this may be more expensive than other insurances, it also accounts for a much greater risk.

Disability plays no favorites and accidents do happen, but illnesses like cancer equate for 14.6 percent amount of disability, musculoskeletal/connective tissue 28.5 percent, cardiovascular 8.2 percent, disorders of nervous system and sense organs 14.2 percent, and mental disorders 7.7 percent, making up the majority of long term claims.** If you seek the protection and peace of mind that disability insurance could provide, how do you find the correct plan for you and your specialty? Disability income insurance is becoming increasingly vague, and the need for having a professional review or creating a policy is more important than ever. A trained professional, who understands the legal lan-

Sturgill Turner’s health care legal team is committed to providing comprehensive legal services to health care professionals, institutions and managed care organizations.

Serving health care providers with integrity.

LEXINGTON â—† STURGILLTURNER.COM

THIS IS AN ADVERTISEMENT ISSUE#83 11

INSURANCE

WHEN WAS THE LAST TIME YOU THOUGHT ABOUT THE CHANCES OF A MAJOR DISABILITY INTERRUPTING YOUR CAREER AND POSSIBLY YOUR FUTURE INCOME STREAM? guage insurance companies employ and can spot the subtle details that can alter the entire nature of a policy, is crucial in making an informed decision. Furthermore, an individual who is not beholden to a specific insurance company can typically determine the best possible plan for the client’s specific needs.

One specific aspect of disability insurance the can be unclear is the definition of “Total Disability” and “Own Occupation.”

My research has found that many companies are stating “Own Occupation” provisions when, in fact, it’s almost a misrepresentation. Insurance companies define “Own Occupation” in a myriad of ways.

1. Unable to perform substantial and material duties of regular occupation, meaning no matter what in this world one is qualified to do, if they cannot continue their current occupation in the same manner they did yesterday due to a disability, they would be viewed 100 percent disabled and collect 100 percent of the benefit.

2. A loss of earnings of at least 20 percent and unable to perform duties. This type of contract is very vague due to the words “perform duties.” Are those the specific duties that one performs to earn a living? Are those the duties another individual in the same specialty may do to earn a living? Or are those any duties that a person with a medical degree is qualified to execute?

12 M.D. UPDATE

3. Unable to do material and substantial duties of own occupation and not gainfully employed. The words “gainfully employed” are scary. Who makes that call? Typically not the insured.

4. Unable to perform main duties of regular occupation and not employed in any occupation. Again the words “any occupation” are vague. For example, one may not be able see patients in the practice but may be able to manage the office. That’s an occupation, and the contract would not pay a benefit.

5. Unable to perform substantial and material duties of regular occupation for the first 12 months (or 24 months) of total disability, thereafter not gainfully employed. This is a great contract for one or two years, but after that period of time an individual may lose their benefits if they are able to work somewhere somehow.

The contracts that have included “not gainfully employed” within their definitions are now written “Own Occupation” without too much emphasis on that one little – very important – caveat. The companies that have changed their definitions imply that their responsibility is to insure one’s income, not occupation. Unfortunately, most disabled physicians know they need more than simply income coverage.

Interpretations of definitions are far more stringent when viewed by the claims and legal departments than by the marketing department. Claim filing time is by far the worst time to debate with the claims personnel, and the legal department has no sympathy for “well, I thought…”

“Own Occupation” is not the only clause in insurance policies that has an indistinct definition; phrases such as “NonCancelable, Guaranteed-Renewable” are

finding new meaning in the small print of some disability plans. It is imperative that individuals seek the help of a disability specialist that is completely independent, representing only the client’s needs and interests, someone who can analyze and interpret the often-confusing definitions employed by all of today’s disability insurance contracts. A disability plan needs to fit one’s needs and occupation, a plan that will be 100 percent intact when and if it is in need.

Calvin R. Rasey is President of Physicians Financial Services II, LLC. You can reach him (502) 893-7001 or 1-800-928-8834.

Securities Offered Through Securities America, INC.*Member FINRA/SIPC • Calvin R. Rasey • Registered Representative Advisory Services offered through Securities America Advisors, INC.• A registered Investment Advisor Calvin R. Rasey • Investment Advisor Representative Physicians Financial Services II, LLC and Securities America Companies are NOT UNDER Common Ownership Representatives of Securities America do not offer tax or legal advice FOOTNOTES: *Source: US Census Bureau. For more information go to www.census.gov. ** Source: 2012 Long-term Disability Claims Review, Council for Disability Awareness. For more information go to www.disabilitycanhappen.com. ◆

PHYSICIAN VIEWPOINT

Be a Good Samaritan & Pass the Good Samaritan 911 Law

Overdoses kill more people in Kentucky than car wrecks Kentucky has the third highest drug overdose mortality rate in the United States (REF 1). The chance of surviving a drug overdose depends on how fast one receives medical assistance. Too often, witnesses to an overdose delay or fail to call 911.

Research confirms that the most common reason is fear of police involvement (REF 2). Fourteen states and the District of Columbia have enacted policies (e.g. “Good Samaritan 911”) to provide limited immunity from arrest or prosecution for minor drug law violations for: (a) people who summon help at the scene of an overdose and (b) for the overdose victim.

Background

Deaths from drug overdose have been rising steadily over the past two decades and have become the leading cause of injury death in the United States (REF 3). Accidental overdose deaths are now the leading cause of accidental death in Kentucky. In 2010, for the

THE NUMBER OF DRUG OVERDOSE DEATHS – MOST OF WHICH ARE DUE TO PRESCRIPTION DRUGS – IN KENTUCKY HAS QUADRUPLED SINCE 1999 WHEN THE RATE WAS 4.9 PER 100,000

first time, there were more deaths in Kentucky due to unintentional drug poisonings than motor vehicle collisions (REF 4).

Kentucky’s overdose mortality

BY James Patrick Murphy, MD, MMM rate is third highest in US (i.e. 23.6 per 100,000 people suffering drug overdose fatalities). The number of drug overdose deaths – most of which are due to prescription drugs – in Kentucky has quadrupled since 1999 when the rate was 4.9 per 100,000 (REF 5).

Many of these deaths occur because no one, not even family or friends, is willing to call 911 due to the fear of arrest. The best way to encourage overdose witnesses to seek medical help is to exempt overdose witnesses from arrest and prosecution for minor drug and alcohol law violations. This is the basis of the “Good Samaritan 911” law (REF 6).

Currently, fourteen states and the District of Columbia have passed immunity or sentence mitigation laws to encourage calls for help in the case of an overdose. It is important to note that the existence of an immunity law (e.g. “Good Samaritan 911”) does not protect people from arrest for other offenses, such as selling or trafficking drugs, or driving while intoxicated.

“Good Samaritan 911” protects only the caller and overdose victim from arrest and/ or prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence. “Good Samaritan” laws can encourage bystanders to summon medical assistance by mitigating negative legal outcomes (REF 7,REF 8).

Multiple studies show that most deaths occur one to three hours after the victim has

initially ingested or injected drugs. The time that elapses before an overdose becomes a fatality presents a vital opportunity to intervene and seek medical help (REF 8). The chance of surviving an overdose depends greatly on how fast one receives medical assistance. “Good Samaritan 911” can save lives by allowing timely emergency care for overdose victims – i.e. advanced cardiac life support and reversal of drug effects by antidote.

“Good Samaritan 911” has few negative effects, can be implemented at little or no cost, and has the potential to save both lives and resources (REF 9).

Recommendation

Legislature should pass a law (e.g. “Good Samaritan 911”) providing – for an overdose victim and the person requesting medical assistance – immunity from arrest and/ or prosecution for simple drug possession, possession of paraphernalia, and/or being under the influence.

James Patrick Murphy, MD, MMM, Murphy Pain Center, President of Greater Louisville Medical Society can be reached at (502) 7363636 and at dr.m@mpcky.com (Reprinted by permission from jamesmurphymd.com) REF 1: http://www.tfah.org/reports/drugabuse2013/release. php?stateid=KY REF 2: Tracy_Circumstances of Witnessed Drug Overdose in_2005 (2).pdf http://www.researchgate.net/publication/7742372_Circumstances_ of_witnessed_drug_overdose_in_New_York_City_implications_ for_intervention/file/d912f50ef220035400.pdf?ev=pub_ext_doc_ dl&docViewer=true REF 3: http://www.cdc.gov/homeandrecreationalsafety/overdose/ index.html REF 4: http://www.healthy-ky.org/sites/default/files/KHIP12%20-%20 Rx%20Drug%20Deaths.pdf REF 5: http://www.tfah.org/reports/drugabuse2013/release. php?stateid=KY REF 6: http://www.drugpolicy.org/911-good-samaritan-fatal-overdoseprevention-law REF 7: http://lawatlas.org/files/upload/Final%20GoodSam%20 Essential%20Information.pdf REF 8: Davidson, Peter J. et al. “Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco,” Addiction 97 (December 2002): 1511. https://ufo.epi-ucsf.org/ufostudy/pdfs/ Davidson_2002.pdf REF 9: http://www.aslme.org/media/downloadable/files/links/j/l/jlme41_1-davis-supp.pdf How To Contact Your Elected Officials http://www.usa.gov/Contact/Elected.shtml

◆

ISSUE#83 13

COVER STORY

STRENGTH IN NUMBERS

FROM LEFT TO RIGHT:

Keith J. Alexander, MD Wayne B. Colin, DMD, MD Michael T. Cecil, MD, FACS K.V. “Tad” Hughes, III, MD, FACS Alberto N. Laureano, MD Gregory V. Osetinsky, MD, FACS Ray M. Van Metre, MD

The association of Lexington Clinic and Kentucky Ear, Nose and Throat ensures otolaryngology patients receive maximum quality of care

BY TIM CORKRAN

PHOTOS COURTESY OF LEXINGTON CLINIC

When the partners at Kentucky Ear, Nose and Throat (KY ENT) began considering association with a larger medical system in early 2012, they found an eager and capable partner in Lexington Clinic. Almost two years later, the symbiotic relationship has produced positive results for all parties: Lexington Clinic’s ENT department has gained five accomplished colleagues; KY ENT’s seasoned physicians have seen the administrative side of their workload decrease considerably; and the patients of both practices have access to expertise in all aspects of the specialty on a shared EHR system.

For Lexington Clinic’s Wayne Colin, DMD, MD, “The net result has been very positive. We are able to see a broader range of patients working together than would be possible separately.” KY ENT founder Keith Alexander, MD, is equally appreciative: “With such rapid changes in the delivery of healthcare in the last two to three years, a partnership like that with the Lexington Clinic empowers us. It’s very hard for a small group practice to have the expertise that the Clinic has when it comes to contract negotiations, HR, and IT.” KY ENT, founded in 1989, has five physicians, a nurse practitioner, and five audiologists.

Alexander is joined by partners Alberto Laureano, MD, Gregory V. Osetinsky, MD, FACS, K. V. “Tad” Hughes, III, MD, FACS, and Ray M. Van Metre, MD. Lexington Clinic’s ENT department is comprised of two physicians, Wayne Colin, DMD, MD, and Michael Cecil, MD, as well as one 14 M.D. UPDATE

audiologist.

Both practices agree that the variety of otolaryngology is what attracted them to the field, both in body systems covered and patient population served. Alexander calls it a “specialty that is not so narrow,” and while each of the seven practitioners is trained in all aspects of the profession, each also has developed specific areas of expertise. Though the association of the two practices is not a daily presence in the lives of the physicians, their resource sharing is an anchor for all in this complex and multifaceted field.

The Players

Colin has been a fixture at Lexington Clinic for over 12 years. His adult-only practice focuses on obstructive sleep disorders; head, neck, and skin cancer treatment; and reconstructive surgery for head and neck cancer patients. Trained as a dentist at Harvard School for Dental Medicine, he did his first residency in oral and maxillofacial surgery (OMFS) and a second residency in ENT when head and neck cancer piqued his interest. The OMFS training is a rare attribute among ENT physicians and serves the two associated practices well. Colin’s most notable contribution, however, has been his work on sleep apnea, and the KY ENT physicians send their patients with obstructive apnea directly to him.

Sleep apnea affects two to four percent of the general population, but Colin says there is a dearth diagnosis, with “only about 20 percent of the cases” being detected.

This means that many people are feeling the effects of sleep apnea without receiving treatment. Those effects, says Colin, are fundamental and potentially profound: “Each obstructive event interferes with our brain wave pattern. This results in psychological and physiological stress.” He continues, “Nighttime sleep disruption is a prime risk factor for hypertension, cardiovascular disease, congestive heart failure, and diabetes.” Colin is active in trying to convey this connection to other physicians. “Sleep is intrinsic to our well-being. If it is being perturbed, it’s going to affect all aspects of our well being,” he says.

Cecil handles adult and pediatric ENT cases that come to Lexington Clinic. He was drawn to the field because he “enjoyed the complex anatomy of the head, neck, and

ear.” Cecil trained at UK and was recruited to Lexington Clinic after a few years in Pikeville as they sought another physician to join Colin. Cecil developed a particular interest in sinus issues in residency and has focused on non-invasive surgeries the last few years. He particularly values this aspect of his practice, noting, “It’s very gratifying to be able to treat patients surgically without the disfiguring effects we might have seen years ago.” Looking to the future, Cecil currently is working with balloon sinuplasty. While it is only appropriate for about five percent of patients he sees with sinus issues, he is actively following whether it emerges as financially feasible.

Cecil also performs tonsillectomies. The reasons for these have changed, however.

“Most tonsil and adenoid removal these days are done because kids are having more sleep disorders, and tonsil and adenoid removal can help this,” he says. His pediatric work has been bolstered by the association with KY ENT, as this brings him valuable collegial input. “If I have a difficult case, someone in the group has likely had this case before. Sharing of information has been the biggest advantage of this large group,” he says.

Having evolved as a stand-alone practice, Kentucky Ear, Nose and Throat seeks to serve all ENT needs for the general population. In addition to physician appointments – hearing aids, allergy shots, and hearing tests are some of the services available in their Lexington, Richmond, and Frankfort offices. The practice has gradually grown, adding physicians and audiologists steadily. The latter is a key to the practice.

Each has six years of training and an AuD degree. Alexander says, “We really rely on our audiologists a lot. It’s a team effort here with them.”

The KY ENT physicians are all trained to do the full-range of ENT, but each has developed some areas of interest and focus. Alexander was drawn to the specialty because he liked the combinations of surgery and primary care, adult and pediatric.

“It has a great variety of things to treat, including the sensory elements of hearing and olfactory,” he notes. He treats allergy and sinus patients of all ages and specializes in functional and cosmetic nasal surgery, including rhinoplasty.

Drawn to surgery in medical school,

ASSOCIATION RELIEVES A BIG BURDEN REGARDING NON-MEDICAL HEADACHES. CHANGES IN HEALTH CARE MAKE IT SENSIBLE TO ALIGN WITH BIGGER ENTITIES. ISSUE#83 15

COVER STORY

Laureano’s mentors showed him the appeal of ENT. He too enjoys the variety of patients and systems he engages with every day. He sees patients of all ages, for all maladies, and only sends out the most complicated head and neck cancer cases. In addition, Laureano treats thyroid and salivary gland disorders and places ear tubes. He also has interest in hearing problems/hearing aids

Dr. Michael T. Cecil performs surgery at Lexington Clinic Ambulatory Surgery Center.

16 M.D. UPDATE

and cosmetic rhinoplasty.

Many people come to ENT with a complaint about sinus problems or with nasal, sinus, or ear congestion, but Alexander notes, “It could be any number of things causing their complaint – allergies, obstruction – so we must dissect the problem in order to determine which factors are causing the underlying symptoms.” KY ENT sees patients from all over central Kentucky, so allergy treatment is an integral part of their services.

The three other physicians also have areas of focus: Osetinsky has a special interest in head and neck cancer; Hughes is their voice specialist; and Van Metre focuses on pediatric care. KY ENT considered adding a neuro-otologist at one point, however, given

the practice’s excellent working relationship with UK’s neuro-otologists, there was no need to add such a subspecialist.

Advances in the Field

Endoscopic sinus surgery was innovated in the early 1990s as standard practice. “It really was one of the first minimally invasive surgical techniques,” notes Laureano.

External incisions and drilling through bone are no longer necessary. This is all done intra-nasally with small telescopes and special instruments with no external bruising or swelling. Digital image-guided sinus scans that allow ENTs to “peel back the layers” are now a standard tool also. As balloon sinuplasty increases in popularity, time will tell if it is good business. It is not paid for by many health plans, as it is still considered experimental.

Non-surgical advancements are being developed also. Utilization of culture-specific antimicrobials applied through irrigation to treat sinus infections is increasingly accepted. They are covered by insurance more so than they were even a few years ago. Treatment of nasal polyps through bio-film removal is increasingly employed. These biofilms are a protein matrix that bacteria secrete to protect themselves from the outside, making them antibiotic resistant. Scrubbing this with an irrigation of a simple soap makes the bacteria vulnerable again. Immunotherapy to treat allergies – essentially a slow vaccine – is helping many patients. Long-lasting allergy shots are on the horizon also. “These are cheaper and easier treatment that maximize efficacy and minimize costs,” Laureano says.

Self-administered sub-lingual drops, long popular in Europe, are gaining ground here too.

Misconceptions abound about ENT. Alexander finds that many referring physicians do not realize that otolaryngologists are trained extensively in allergy as part of their overall ENT training and are well versed to treat allergy symptoms. “It’s very hard to practice our specialty well without

doing good allergy work,” he says. “Its part of the ENT training.” Allergies often obscure a bigger problem that only an ENT can properly diagnose. Colin wants GPs to consider gastroesophogeal reflux before referring some patients on to ENTs. “I have patients each week who are alarmed about throat issues – hoarseness, for example – only to learn they have reflux, and this is what is causing their discomfort,” says Colin. Cecil is concerned that some GPs may assume that ENTs are inclined toward surgery and may steer patients away. “The sentiment is that they need to ‘protect them from the surgeon,’” Cecil says. “Surgery is not our primary mode of treatment: we try to treat medically first and use surgery as a last resort.”

The Association Advantage

When KY ENT began considering association in 2012, Lexington Clinic seized the opportunity as it fit a larger vision of theirs.

Lexington Clinic has been bringing associate practices into their fold for a few years, with a total of eight practices currently.

According to Lexington Clinic, affiliation creates opportunities that will help each organization remain competitive in patient care and technology as health care continues to undergo massive changes.

Lexington Clinic seeks practices with which they share similar values, philosophies, and goals and that will allow them to “provide better patient care through expanded locations and services, an increased number of physicians, and better continuity of care.” The Clinic is not buying up practices. They help manage them; handle negotiations with insurance, technology, and equipment providers; and facilitate use of a system-wide EHR. The only evidence of the association at KY ENT’s Lexington office is a small addition to their insignia.

By all accounts, Lexington Clinic’s association with KY ENT

has been a win-win for patients. Lexington Clinic patients have more pediatric ENTs and audiologists, and Colin and Cecil have more colleagues with whom to confer. KY ENT patients have access to Colin’s sleep apnea expertise and, as Laureano says, the EHR that enables “a seamless transition to send him all patients who might benefit from his care.” Most notably, the physicians at KY ENT can devote more of their daily energy to patients. For Alexander, association with Lexington Clinic, “Relieves a big burden regarding non-medical headaches; the stress of the practice was running the business side of it.” Laureano concludes, “Changes in healthcare make it sensible to align with bigger entities. We are proud of our association with the Clinic.”

With over 120 years of practice amongst them, the ENTs of Lexington Clinic and Kentucky Ear, Nose and Throat provide a strong service to the patients of central Kentucky. The Clinic’s association model is allowing physicians to do what they do best, and while that association may not be visible to patients, they are certainly the beneficiaries of it. ◆

Dr. Gregory V. Osetinsky examines a patient using Kentucky Ear, Nose and Throat’s video otoendoscope.

ISSUE#83 17

SPECIAL SECTION  IT’S ALL IN YOUR HEAD

Treating People, Not Symptoms:

The Lexington Center for Psychoanalysis enables deep change for willing patients BY TIM CORKRAN Oft misunderstood, psychoanalysis is a viable and vital option for Kentuckians who seek lasting relief from their neuroses. At The Lexington Center for Psychoanalysis, Drs. Jeff Tuttle and Beth Housman facilitate patients’ close examination of their own stories to help empower

LEXINGTON

them to deeper understanding of the causes of plaguing stress and uncertainty. Unlike Cognitive Behavioral Therapy (CBT), psychoanalysis is cause, not symptom, focused, so revelation of personal stories, and patient understanding of them, is integral to the treatment. It is a highly collaborative, and usually gradual, process in which, as Housman says “Patient and doctor work together to find the best course of therapy.” For Tuttle, the goal of psychoanalysis is simple: “To make people less vulnerable to stress in the future.”

Why Practice Psychoanalysis?

Both Tuttle and Housman began training as psychiatrists without plans to practice intensive psychotherapy, but each found that the limited doctor-patient interaction precluded the familiarity and understanding they needed to best serve patients. Having

observed the shortcomings of the trend towards medication management, their revelations were fundamental for their career paths. For Tuttle, “the value of getting to know patients was lost when I was limited to 15 minutes per patient. This led me to consider training in psychotherapy.”

Housman, who planned to be a family practice doctor when she started medical school, observed that “During my outpatient rotations in psychiatry, I became frustrated very quickly with just a medication approach – and noticed that my patients were also. I found that I was drawn to their stories, so I did more training in psychotherapy.”

Their inclinations led both to the Advanced Psychotherapy Program at the Cincinnati Psychoanalytic Institute. The two-year program is available to medical professionals who have an advanced professional degree in their field, a minimum of two years supervised clinical experience, and a valid license to practice in their state.

As part of their training, all psychoanalysts Beth Housman, MD, UK College of Medicine and residency at UK Dept. of Psychiatry. Post-graduate training in psychodynamic psychotherapy and psychoanalysis at the Cincinnati Psychoanalytic Institute. Board certified in General Psychiatry.

Jeffrey Tuttle, MD, UK College of Medicine & residency at UK Dept. of Psychiatry. Post –graduate training in psychodynamic psychotherapy and psychoanalysis at the Cincinnati Psychoanalytic Institute. Board certified in General Psychiatry and Fellow of American Psychoanalytic Association.

18 M.D. UPDATE

maintain a long-term relationship with an experienced analyst who regularly sees them as a patient. For Tuttle, “A psychiatrist’s experience in their own therapy has probably the most profound impact on the direction of their practice.”

How It Works and For Whom it Works

Psychoanalysis is a gradual, but intense and dynamic, process. Doctor and patient typically meet one-to-five times per week, as Housman says, “to work together to determine the best course of therapy.” Although many psychoanalysts are psychiatrists, medications are not always incorporated in the

notes, “The first few sessions are spent trying to get a feeling for what the problems are and what kind of treatment will be most helpful.” Tuttle estimates that, “About a quarter of patients decide this long-term approach is not for them.”

With its time-intensive demands and self-exploratory nature, psychoanalysis is not for everyone. Housman says that many people who end up in psychoanalysis “feel guilty about feeling depressed or anxious because they ‘have it all.’ These are people who are not satisfied emotionally and cannot seem to understand why – despite their success in other realms of life.” Tuttle summarizes typical psychoanalysis patients

TYPICAL PSYCHOANALYSIS PATIENTS ARE ‘FUNCTIONING NEUROTICS,’ WHO HAVE SIGNIFICANT PROBLEMS RELATED TO WORK, RELATIONSHIPS, OR SEX. treatment. Nor is psychoanalysis focused on symptom management, as CBT is. Rather, Housman continues, “it is focused on where symptoms are coming from and why they exist, because the symptoms are there for a reason.” Thus, looking closely at stories – one’s past and how it is understood – is key.

The general population’s conception of psychoanalysis is rife with outdated clichés.

While some patients do take their therapy in a reclined position, most converse face-to-face with the analyst. Rather than explaining how archetypal relationships and neuroses are manifest in a patient, modern psychoanalysts spend abundant time getting to know specifics of the individual life being examined. Tuttle finds that many people do not know what to expect when they first come to see him. “I am yet to have a patient come in asking for psychoanalysis.

Most people come looking for a combined treatment – therapy with the availability of prescriptions,” says Tuttle. So there is a “getting to know the therapy” period. Housman

as “functioning neurotics, who have significant problems or frustrations related to work, relationships, or sex.” Another group ends up in psychoanalysis either by choice or requirement: people with characterologic problems and multiple severe symptoms for whom CBT has failed. Housman says, “These are challenging patients, but it is very rewarding to see them change.”

Value Added for Lexington

Tuttle opened his Lexington practice in January of 2010, and Housman joined him that October. They work out of a discrete office near downtown with separate entrance and exit that keeps patients from crossing paths. Their patients range in age from 18-75, with most referred by their GP or word of mouth. Their services work best for people who want to take an active role in the understanding and resolution of their mental and emotional misgivings.

Housman and Tuttle are excited to be

part of this dynamic field. Psychoanalysis is seeing increased interest due to abundant disappointment with pharmacological results for emotional and mental health issues and some ebbing of the immediategratification culture. There is available data about psychoanalysis’ effectiveness, despite it being so highly personalized. While both Housman and Tuttle are certified by and members of the American Psychoanalytic Association, there is no formal maintenance of certification, so self-regulation is encouraged in the field. Both doctors note the culture of mentoring, professional support, and self-awareness as integral to this selfregulation. A strict code of doctor-patient conduct is also advocated.

The Lexington Center for Psychoanalysis offers an enduring form of therapy that has been extremely valuable to many individuals. It’s predicated on the type of doctor-patient interaction both Tuttle and Housman long sought. As Housman says, “People come to us because they are struggling, they want help. They are not sure just what kind of help they want.” Tuttle concludes, “Our goal is to collaboratively foster positive psychological development in our patients.” ◆

FOR PATIENT REFERRAL INFORMATION Jeffrey Tuttle, MD (859) 537-7332 drtuttle@jtuttlemd.com Beth Housman, MD (859) 221-2276 bthousman@insightbb.com 225 Walton Ave Suite 100 Lexington, KY 40502 ISSUE#83 19

SPECIAL SECTION  IT’S ALL IN YOUR HEAD

Q&A on Traumatic Brain Injury with Army Lt. Colonel Thomas Hair Lieutenant Colonel Thomas J. Hair (MD LTC, MC USA) is Department Chief for Medicine at Ireland Army Community Hospital in Fort Knox. He’s spent 25 years in the U.S. Army, including tours as a combat physician in Iraq and Afghanistan and as the primary care physician in a clinic that treats soldiers who’ve experienced Traumatic Brain Injury (TBI). Ireland Army Community Hospital also houses a Warrior Transition Battalion, a unit which, according to the hospital’s website “provides leadership, complex case management, and primary care to enable wounded, injured, and ill ...Soldiers to return to the fight or successfully transition to civilian life as a Veteran.”

M.D. UPDATE: How has the military’s treatment for TBI evolved over time, particularly the last few years?

LT. COLONEL HAIR: TBI is as old as war itself, but what’s happened lately is that battlefield medicine has improved so much that we’re saving soldiers who once

Lieutenant Colonel Thomas J. Hair, MD, is chief of the Department of Medicine at Ireland Army Community Hospital in Fort Knox. He has been with the Army for 25 years, serving as a combat physician and a primary care physician treating TBI.

would have died from these injuries. As a result, when the Iraq and Afghanistan wars were both underway, the number of TBI patients started to overwhelm the system.

In 2007, the leadership of the U.S. Army 20 M.D. UPDATE

basically declared that we were going to do whatever it took to take care of these people. We’re going to give them respect and dignity. These are our brothers and sisters and we’re not going to tolerate anything less than first-rate care for their injuries. The Army decided to set up TBI clinics nationwide and that included our facility here. Now, with the wars winding down, we’ve had less demand, which I’m quite happy about, so we’re starting to open our doors to some retired military as well as spouses, children and other military dependents.

Talk about the comprehensive nature of the team that’s assembled here to deal with TBI patients.

TBI can be really insidious and as a result, patients need more than any one doctor can provide. They need surgeons, they need psychiatrists. We also have a Licensed Clinical Social Worker (LCSW) and a case management team because there are patients who could have case management both inside and outside our facility, so we have to coordinate care. We also do EEGs (electroencephalography) and ENGs (electronystagmography ). We need that because patients who’ve been exposed to concussive force can sustain damage inside the eyeball. Those patients have headaches and trouble focusing their eyes and need customized glasses that can cost thousands of dollars a pair. We also have a neuropsychologist on staff.

What does a neuropsychologist do?

It’s a relatively new addition to the program of treatment for TBI, though it uses some old-school techniques. The neuropsychologist asks the patient a series of questions about what his or her symptoms may be. Based on the answers, the neuropsychologist administers a series of standardized tests. These tests take hours, unfortunately, and by the end, the patient is just exhausted, but this helps us identify the precise nature

TBI can cause neuro-cognitive problems, the ability to think and how fast. Simple video game exercises are used in rehabilitation.

of what the patient is facing. The tests are also useful, because they can help us identify the small percentage of people we see who are faking symptoms, and we can give the same test to a patient a few months after treatment and get an objective picture of their progress.

What kind of success rate have you seen with TBI patients here?

In general, we’re able to help about 70 percent of patients move forward and continue serving in the military. Most of the remaining 30 percent receive a medical severance and full V.A. benefits.

Assuming the patient is functioning, what do you treat first?

With true TBI, the first thing we have to get under control is sleep. Fix the sleep, or nothing else will work. The numbertwo problem is headache. After that, we’re looking at body aches and pains, and then mood/behavioral problems and neurocognitive problems, which is your ability to think and how fast you think.

What’s the relationship between TBI and PTSD? Often they go handin-hand. I’d say about 40 percent of TBI patients I’ve seen also have PTSD. Some studies say 70 per-

cent, others say 30 percent. Also, it’s difficult because PTSD can look like TBI because they have a lot of the same symptoms. One distinction is that TBI patients usually have physical problems that PTSD patients don’t tend to have. TBI also doesn’t typically lead to the kind of vivid nightmares that wake you up in the night the way PTSD often does.

What are the biggest misconceptions about TBI that you see in the medical community?

The biggest TBI misconception is the old-school notion that you don’t have to take it seriously. When I was young and played football and did martial arts, I got concussed and my coaches and whoever basically just told me to shake it off. That said, another important aspect of TBI that people need to understand is that it gets better. If you suffer TBI but don’t die, you’re going to get better. The brain is plastic in a sense; it’s flexible. It’s also smart; it reroutes neural pathways. It finds workarounds. The healing process takes time and not everyone experiences 100 percent full recovery, but TBI does get better. Even PTSD, for that matter, gets better with time.

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What do you see as the next big breakthrough in this area?

There’s a lot of money on the table for the next great thing, which could likely come in the area of diagnosis and early detection. Somebody is going to find the next biomarker or cluster of biomarkers that help doctors understand exactly what a patient’s problem is and shorten six months of diagnosis, testing and treatment to two weeks. I’m looking forward to that. ◆

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ISSUE#83 21

SPECIAL SECTION  IT’S ALL IN YOUR HEAD

PTSD and Veterans

Robley Rex VA Medical Center offers specialized PTSD program for veterans BY JENNIFER S. NEWTON experiences, sexual violence, severe physical assault, or witnessing something violent.

Military sexual trauma (MST) carries a high-risk for the development of PTSD, and the VA has a MST coordinator to assist Veterans with arranging for specialized care.

At the VA, all Veterans are screened for PTSD. A positive screen must be confirmed with a diagnosis, which can only be made by a trained provider who interviews the Veteran to determine the occurrence of a trauma, the presence of associated symptoms, the level of distress caused, and the symptom’s effects on functioning.

Certain clinical scales, such as the Clinician Administered PTSD Scale (CAPS), may also assist with diagnosis. Once diagAvoidance, Intrusion, Arousal, and Negative nosed, Veterans Cognition are invited to join a highly strucPTSD is a mental health disorder tured, traumacaused by a severe trauma , and it focused treatment is manifested by a specific sympprogram. tom cluster, including: avoidance, PTSD has a which involves avoiding people high co-morbidor situations (and often contribity with other utes to a hesitancy to seek treatDr. Nicole Luddington is an mental health ment); intrusions, such as recurdisorders such as rent nightmares or troublesome outpatient psychiatrist at the Louisville VA Dupont depression and memories; negative cognitions or Community Based Outpatient substance abuse mood states; and arousals, such as Center, where she serves as and with trauheightened startle responses, irri- the primary psychiatrist for matic brain injutability, hypervigilance, and dif- the Louisville VAMC’s PTSD ficulty maintaining sleep. These program. She is also an assistant ry (TBI). In fact, symptoms of a symptoms carry with them dis- professor in the University of Louisville’s Department TBI may overlap tressing and disruptive effects on of Psychiatry and Behavioral with symptoms of people’s lives. According to Nicole Sciences.

PTSD. “Typically Luddington, MD, a member of when a Veteran the PCT, “PTSD can affect many returns from active duty and begins treatareas of a person’s life, including their socialment with the VA, he or she will be ization, intimate relationships, job or school screened for TBI,” says Luddington. If the performance, and physical health.”

Who PTSD will affect and why is some- screen is positive, psychiatrists often colwhat of a mystery, as every person subjected laborate with members of the VA Hospital’s to a severe trauma does not develop PTSD. polytrauma team and other specialists to Trauma does not have to be combat-related; ensure that all facets of a Veteran’s care are types of trauma can include near-death managed simultaneously.

According to the US Department of Veterans Affairs (VA) website, an estimated 5.2 million Americans have Posttraumatic Stress Disorder (PTSD) during any given year. The website also states that in 2011 alone, over 476,000 veterans received treatment for PTSD in VA medical centers and clinics across the US. In Louisville, the Robley Rex VA Medical Center (RRVAMC) houses its program for PTSD treatment at a community clinic on Dupont Circle in St. Matthews.

There, the Posttraumatic Stress Clinical Team (PCT) consists of a coordinator, a psychiatrist, and several therapists who specialize in the treatment of PTSD. Currently, RRVAMC has over 100 veterans enrolled in this outpatient PTSD program.

LOUISVILLE

22 M.D. UPDATE

Getting Unstuck

Therapy for PTSD includes both individual and group treatments. VA medical centers employ two types of evidence-based psychotherapy: 1. Prolonged Exposure therapy and 2. Cognitive Processing therapy. Prolonged exposure therapy encourages Veterans to talk about traumatic events, repeatedly exposing them to the painful memories in order to help reframe them. “In the process of doing that, a Veteran may experience a temporary increase in anxiety, but we are helping them to restructure their cognitions in so far as their beliefs about what happened and normal reactions to stress,” says Luddington.

Cognitive processing therapy helps Veterans examine negative or distorted beliefs about a traumatic event that has prevented them from moving forward. “This kind of therapy helps people get past some of the ‘stuck points’ they have in their mind, which have prevented their recovery,” she says.

Multiple PTSD groups are available at the RRVAMC. While the RRVAMC does not have any inpatient PTSD programs, staff can make referrals to specialized residential programs in other cities.

Pharmacology is another aspect of PTSD treatment. First-line treatment typically involves the use of a SSRI (selective serotonin re-uptake inhibitor) antidepressant. Also, “VA treatment guidelines, which are based on PTSD studies, note that Prazosin, a medication commonly used to treat benign prostatic hypertrophy, can be effective in treating nightmares in some individuals,” says Luddington. Physicians may prescribe medications to treat insomnia too, another big problem in PTSD. During follow-up visits, members of the PTSD team depend on a Veteran’s self-report of symptoms and utilization of a PTSD checklist (PCL) to help quantify the severity of symptoms and to measure the success of treatment in reducing those symptoms. “PTSD can be chronic, but with treatment there may be enough recovery where someone is productive and can function day-to-day without much distress and interference in their life. And that’s what we hope for,” says Luddington. ◆

SPECIAL SECTION  IT’S ALL IN YOUR HEAD

The Mayo Clinic Model

Frazier Rehab Institute employs an interdisciplinary approach to brain injury care

BY JENNIFER S. NEWTON

LOUISVILLE Interdisciplinary is perhaps one of the new health care buzzwords of the 21st century. Championed by the Mayo Clinic in Rochester, Minnesota, the interdisciplinary model requires the medical team to work in collaboration to best serve the patient’s needs.

The model is catching fire across the medical spectrum, but according to Darryl

Kaelin cites the necessity of their expertise in the field. “We developed one of the first community-based brain injury programs for stroke and brain injury patients, which focuses on reintegrating back into the community and increasing a person’s independence in the home,” he says.

While their connection to UofL provides an inflow of traumatic brain injury (TBI) patients, Frazier is also adept at treating non-traumatic brain injury patients, which, loosely defined, can encompass brain tumors, hypoxic or anoxic events, stroke, Parkinson’s disease, and brain lesions in multiple sclerosis patients. The integration of the team is crucial, as neurologists, neurosurgeons, and other specialists are involved in the patient’s medical care.

Frazier’s brain injury program includes inpatient and outpatient rehab options. When subacute rehab is in the best interest of the patient, the team relies on UofL physicians who visit those locations and can oversee care.

Inpatient care provides intenDr. Darryl Kaelin is the medical sive rehabilitation and “allows director of Frazier Rehab Institute patients with some medical instaand chief of the division of bility to remain in the hospital Physical Medicine & Rehab for the while recovering from non-trauUniversity of Louisville. matic brain injury,” says Kaelin.

L. Kaelin, MD, medical director of Frazier Not only is the team interdisciplinary – Rehab Institute and chief of the division including a physician, nurse, case manager, of Physical Medicine & Rehab for the physical therapist, occupational therapist, University of Louisville (UofL), “Frazier’s speech therapist, psychologist, nutritionist, interdisciplinary approach [to brain injury and chaplain – the physiatrist’s approach care], where physicians come together to is holistic, encompassing body systems treat patients in one place and interact with beyond the musculoskeletal. each other about what the plan of care will The outpatient options are twofold: be, is unique to Louisville and Kentucky.” a comprehensive day program and traFrazier’s brain injury and stroke pro- ditional outpatient therapy administered grams constitute almost half of its over- several hours per week. “The comprehensive all admissions. Considering the sheer vol- day program is designed for people with ume of patients, Kentucky’s location in cognitive deficits that result in a loss of the “stroke belt,” and Frazier’s connection independence. They may have weakness, to the level one trauma center at UofL, gait problems, or vision problems resulting

from brain injury but most share a common deficit in thinking or behavior,” says Kaelin.

The diverse physical and cognitive aspects of brain injury are yet another component necessitating a multi-specialty team.

Community reintegration takes therapy from the gym into the patient’s community environment, preparing them for skills like crossing streets and navigating architectural barriers.

Therapy alone is not the only tool in the physiatrist’s arsenal. “It is very clear there are certain medications that can help protect the brain, speed recover, and ultimately improve the thinking ability of both people with TBI and non-traumatic BI,” says Kaelin. While there are no medications FDA-approved specifically for brain injury, physicians often borrow medicines intended for ADD, Parkinson’s, and Alzheimer’s to help rebalance neurochemical pathways.

Where Therapy Meets Technology and Research

One of the more exciting and innovative programs underway at Frazier is the EMERGE program for TBI patients, which began in April 2013. An acute rehab proCONTINUES ON PAGE 24

FOR PATIENT REFERRAL INFORMATION For inpatient admissions (502) 582-7476 For post acute admissions NeuroRehab Program (502)-429-8640

ISSUE#83 23

SPECIAL SECTION  IT’S ALL IN YOUR HEAD

Temporomandibular Joint Dysfunction

UK Oral and Maxillofacial Surgery BY LARRY L. CUNNINGHAM, JR, MD, DDS, FACS Oral and maxillofacial surgery is an exciting field that encompasses complex clinical problems ranging from the removal of teeth and placement of dental implants, to repair and reconstruction of difficult traumatic facial injuries. The variety of clinical problems affecting the jaws and face is the primary reason I entered my chosen specialty, and what keeps me enthusiastic. The Division of Oral and Maxillofacial Surgery and The University of Kentucky offer specialty service in the areas of trauma and reconstruction, orthognathic surgery, and pathology of the face and jaw. One of my areas of interest, the treatment of patients with temporomandibular joint dysfunction, will likely be relevant to many providers.

Facial pain and temporomandibular joint (TMJ) dysfunction are clinical problems seen with relative frequency in our population.

Benign TMJ pops or clicks affect up to 30 percent of the population; only five percent of those people will have a problem that requires surgical intervention. The typical patient is female and from 30 to 50 years of age. Symptoms can include pre-auricular pain, joint sounds, limited mouth opening, headaches, ear pain, and pain on chewing.

The type of treatment provided for the facial pain patient depends first on an accurate diagnosis. Facial pain can be associated with inflammatory conditions of the TMJ, myofascial pain, and neuropathic pain.

Etiologies can include trauma, parafunctional habits (e.g., night-time grinding, nail biting, mandibular posturing), malocclusion

Larry L. Cunningham,

LEXINGTON

The Mayo Clinic Model

CONTINUES ON PAGE 23

gram designed to help patients “emerge” from a coma or nearcoma state to a more interactive and participatory level, EMERGE has been quite successful so far in helping patients return home with their families and reducing health care costs.

Rehab therapists also have 24 M.D. UPDATE

Jr., DDS, MD, FACS is professor and chief of the Division of Oral and Maxillofacial Surgery at the UK College of Dentistry.

(abnormal jaw relationship), muscle tension (tension headaches), osteoarthritis, rheumatoid arthritis, and idiopathic conditions.

Degenerative joint disease can be progressive, passing through five stages, ending in variable chronic pain, TMJ crepitation, and painful function. Our evaluation of these patients includes a history and physical exam, a screening radiograph of the jaws (panoramic radiograph), and usually an MRI of the joints in open and closed mouth views.

The interaction between myofascial pain and joint dysfunction, as in other areas, can sometimes be a diagnostic dilemma, and often patients have elements of joint disease as well as muscular pain. Most frequently, trials of non-surgical therapeutic modalities are attempted prior to surgical intervention, which can include counseling, medications, trigger point injections, splint therapy, or physical therapy. At The University of Kentucky, we are fortunate to have an active and well-known facial pain group with which we collaborate, particularly on patients who have challenging diagnoses or are in need of extensive non-surgical therapy.

Surgical intervention may be indicated

the benefit of constantly improving technology.

Functional electrical stimulation to excite arm and leg strength is a part of daily therapy. Locomotor training manually moves limbs to regain neuroplasticity and encourage neurorecovery. While not yet the standard of care, Kaelin predicts in the next five years transcranial magnetic stimulation will be used on a daily basis. “If you stimulate

when non-surgical therapies have failed to result in significant improvement and when facial pain is associated with significant dysfunction in the joint (disc or ligamentous injury or displacement), a chronically dislocating joint, a neoplasm, a significant malocclusion, or neuropathic pain associated with a peripheral nerve injury.

Surgical therapies may include joint lavage, arthroscopic surgery, or open disc repair. In more severe cases, such as advanced arthritic disease or post-traumatic joint ankylosis, a total joint replacement may be required.

With correct diagnosis and treatment, the majority of patients can have good function with minimal pain. There are unfortunate patients who will require chronic pain management. In these situations we work with patients to find appropriate pain specialists for referral. ◆

University of Kentucky College of Dentistry 800 Rose Street, Lexington, KY mc.uky.edu/dentistry For referrals or appointments: (859) 323-6080 Larry Cunningham, Jr., DDS, MD, FACS Ehab Shehata, MBChB, MSc-GS, BDS, MD Joseph Van Sickels, DDS William Curtis, DMD (starting July 2014)

the brain while doing therapy, patients actually recover faster than with just therapy alone,” he says.

In addition, its affiliation with the university means Frazier is involved in leadingedge research and training the next generation of PM&R physicians. Kaelin currently is involved in several studies, including pharmacology research looking at medication

to reduce emotional lability after neurologic injury, evaluating a new bracing system for neck and limb contracture, and researching agitation after brain injury with residents.

With Frazier’s rich 60 year history and the collaborative expertise of its partners, Frazier’s brain injury patients do not have to travel to Minnesota to receive one-stop comprehensive care. ◆

COMPLEMENTARY CARE

Difficulties Experienced by the Hearing Impaired

BY WILLIAM F. SMITH III, MS, HEUSER HEARING INSTITUTE LOUISVILLE First, here is a quick description of the types of hearing loss to preface the discussion of the resulting difficulties.

Types of Hearing Loss

1. SENORINEURAL hearing loss occurs when there is damage to the cochlea or auditory nerve (VIII). Typically, the hearing loss is permanent and there are no correctible procedures or treatments. This type of hearing loss is most commonly caused by aging and noise exposure, but it can also be caused by genetic abnormalities, inner ear infections, and ototoxic medication.

Hearing aids are the most common treatment for sensorineural hearing loss.

2. CONDUCTIVE hearing loss occurs when there is a problem in the outer and/or middle ear that causes the intensity of the sound to be reduced by the time it reaches the inner ear. Cerumen impaction, middle ear effusion, and tympanic membrane perforation are just a few sources of conductive hearing loss. In many cases, the problem can be fixed by a simple procedure or a surgery. However, some conductive hearing losses are not correctible and, in those cases, traditional or bone conduction hearing aids are often used.

3. MIXED hearing loss occurs when there is a combination of sensorineural and conductive hearing loss.

rineural hearing loss. Frequency resolution is the ability of an individual’s ear to detect a signal at one frequency in the presence of another sound at a different frequency. Human speech is a sequence of complex sounds across a broad spectrum. So, when there is a reduction in frequency resolution, even when speech is audible, it can be difficult discriminating one speech sound from another. Hearing aids can help discriminate speech sounds, but cannot fully correct this problem.

3. TROUBLE IN BACKGROUND NOISE The “cocktail party effect” refers to the physiologic phenomenon allowing individuals to focus on a desired auditory signal in the presence of background noise. This ability is drastically reduced with sensorineural hearing loss. Trouble understanding speech in background noise is by far the most common complaint of the hearing impaired individual. Hearing aids can help with this problem but cannot fully correct it.

4. EMOTIONAL EFFECTS Hearing loss can stir up

many negative emotions for the patient and his/ her family, such as embarrassment, frustration, anger, paranoia, etc. When an individual experiences these negative emotions long enough, they will begin to withdraw socially, which is alarming. One of the main duties of an audiologist is counseling the patient to reduce these negative emotions and encourage coping skills.

When to Refer to an Audiologist

An audiologist specializes in the assessment and treatment of hearing loss and other ear-related disorders. Any patient who experiences the difficulties discussed above should be closely monitored audiologically.

Audiologists also specialize in testing and treating vertigo, which can often be corrected by simple maneuvers performed in office. There have also been many exciting improvements in treatment options for patients experiencing tinnitus. ◆

Difficulties as a Result of Hearing Loss

It is well documented that hearing impairment can significantly reduce an individual’s perceived quality of life, as well as that of the spouse. Because hearing loss is so prevalent in the aging population, it is important to be familiar with the major difficulties associated with the impairment.

1. REDUCED AUDIBILITY Simply put, they cannot hear soft sounds. Increasing TV volume and asking people to “speak up” are often the reaction. The easiest way to combat this problem is with hearing aids. For most hearing losses, hearing aids do a fantastic job of making inaudible sounds audible.

2. REDUCED FREQUENCY RESOLUTION This is one of the physiologic ramifications of sensoISSUE#83 25

COMPLEMENTARY CARE

Staying Connected, Socially and Technologically

Lexington Hearing & Speech Center emphasizes the importance of identifying hearing loss in adults BY JEANETTE MILLER, AUD Untreated hearing loss in older adults is a growing national epidemic.

While the increase in hearing loss is troubling in itself, the ramifications of untreated hearing loss potentially reaches further than an inability to communicate and interact within ones environment. Such inability can cause a much deeper issue, as more and more studies are showing alarming trends with the association between hearing loss and dementia in older adults.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), one-third of Americans between ages 65 and 74 and nearly half of Americans over the age of 75 have hearing loss1. Discouragingly, only 20% of those who could benefit from treatment actually seek help2. With the ‘baby boom’ generation reaching this age range within the next 20 years, the number of adults with hearing loss is expected to increase dramatically. According to recent studies, this could produce disturbing results.

A recently released John Hopkins study followed 639 individuals who initially underwent cognitive and hearing testing between 1990 and 1994. They were followed for the development of dementia and Alzheimer’s disease through May of 2008.

The study found that those who suffered from hearing loss at the beginning of the study were more likely to develop dementia, and the greater the hearing loss, the more chance there was. A noticeable trend for Alzheimer’s was evident too. For every 10 decibels of hearing lost, the extra likelihood of development of dementia increased by 20 percent. The risk was worst for those participants who were aged 60 or older, with 36 percent of the dementia risk recorded as being associated with the hearing loss3.

A similar study of 1,984 individuals in the Journal of American Medical Association (JAMA) showed that hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. It was discovered that people who suffer from hearing loss would typically LEXINGTON

26 M.D. UPDATE

Jeanette K. Miller, AuD, CCC/A, is the Audiology Program director for the Lexington Hearing & Speech Center.

experience a loss of memory and thinking capabilities an estimated 40 percent faster than those who have no hearing problems4.

These studies raise the question of why the two are associated with one another. Social isolation that results from hearing loss is a common theory. Communication plays a critical role in ensuring independence, stimulating thinking, maintaining social networks, enhancing well being, facilitating adaptation to change, and participation in activities of life. As a communication disorder, hearing loss can lead to isolation – which can lead to loneliness, depression, cognitive decline, and is a known risk factor of dementia. Social connection is crucial to maintaining health and a sense of well-being, which is threatened in adults with hearing loss due to a lack of independence and mobility.

While the association between the two has yet to be solidified, one fact is certain, early identification and treatment of hearing loss with hearing aids and other technology is key in an attempt to curb any adverse effects to one’s cognitive state. A 1999 study by the National Council on Aging reported that untreated hearing loss in older persons can have a significant negative impact on quality of life, including a higher likelihood of depression, anxiety, and paranoia to those who wore hearing aids5. Hearing loss can be treated through current technology with not only the help of hearing aids, but also amplification phones and other Bluetooth technology.

Lexington Hearing & Speech Center (LHSC) is a quality healthcare provider for persons of all ages, providing hearing and speech services last year to over 1,000 individuals from 69 counties across the Commonwealth of Kentucky. Founded in

1960 as an educational and healthcare provider for children with hearing loss, LHSC audiologists at the Lexington Hearing & Speech Center’s Audiology clinic now provide comprehensive hearing healthcare for persons of all ages. LHSC employs four doctors of audiology to provide the quality of service our community deserves. With a new, bigger location in the heart of Lexington at 350 Henry Clay Blvd., LHSC is able to provide even more services to the Commonwealth.

As the previously discussed studies are now showing, hearing loss should be included in a physician’s medical model when treating adults with potential cognitive health issues, like dementia. With the information available today about the association between dementia and hearing loss, it is ever important for physicians to discuss hearing with patients and to be proactive in addressing any possible hearing decline. If hearing loss could impact treatment of any physician’s patient, a direct referral to LHSC for a complete audiometric hearing evaluation is recommended.

The make-up of the test battery is determined by the patient’s individual needs and is designed to assess specific symptoms and their causes. LHSC audiologists help the patient and their family understand the test results from their hearing evaluation, the impact of any hearing CONTINUES ON PAGE 30

FOR PATIENT REFERRAL INFORMATION www.lhscky.org 859-268-4545 350 Henry Clay Blvd Lexington, KY 40502 info@lhscky.org

COMPLEMENTARY CARE

Mindfulness-Based Therapy:

How it helps with food, eating, and body image problems BY JAN ANDERSON, PSYD, LPCC In my private practice, I find mindfulnessbased therapy a powerful approach to treating problems with food, eating, and body image. I primarily work with a sub-clinical population and was curious if this evidencebased modality is also efficacious with fullblown eating disorder patients. I recently participated in an interview with Dr. Lesley Williams, a UK graduate and now on the medical staff of Remuda Ranch, a residential eating disorder treatment facility located in Wickenburg, Arizona.

Dr. Jan Anderson is a Licensed Professional Clinical Counselor with a doctorate in Clinical Psychology. Her private counseling practice includes over 15 years of grief counseling experience.

bodies, numb out, and cope with underlying issues. One aspect of eating disorders that is unique when compared to substance What is mindfulness? abuse is the inability to completely abstain ANDERSON: “Mindfulness” simply from the substance of choice – food. The means paying attention, in a relaxed way, to eating disorder patient must navigate use what is happening in the present moment. of their “drug of choice” up to six times The cultivation of minda day. The challenge is fulness involves the heart like asking an alcoholic to as well as the mind — a drink six cocktails daily non-judgmental awareand maintain control. ness that is friendly, curiANDERSON: MBSR ous, and compassionate. and MBCT are useful in Mindfulness-Based Stress dealing with the need to Reduction (MBSR) is a eat and yet maintain conpowerful way to take trol at the same time. For a break from stressful example, the slowing down thoughts and gain perspecof the eating process that tive before you react or happens in mindful eating respond. It helps you keep allows the food to be fully from ruminating about tasted and savored. My the past or dwelling on observation is that evinegative thoughts, and can Dr. Lesley Williams, a graduate dence-based therapies like decrease anxiety about the of UK College of Medicine, is a MBSR and certified eating disorder specialist MBCT also future.

WILLIAMS: A 2011 and has been with Remuda Ranch create a state since 2004. meta-analysis of MBSR triof sufficient als found it to be a useful method for improv- calm, strength, and receptiving mental health and reducing symptoms of ity to unfamiliar feelings and stress, anxiety, and depression. Mindfulness- experiences. Food is no longer Based Cognitive Therapy (MBCT) has spe- needed to numb or distract. cifically been found to be helpful for problems with food and body image.

What is

How do mindfulness-based therapies help with problems with food and eating?

WILLIAMS: Food is an amazing drug – it decreases pain. Overeating, bingeing, and even starving are tools that eating disorder patients use to disconnect from their

Mindful Eating?

ANDERSON: From my own mindfulness meditation practice, I was delighted to discover this relaxed, fully present “here and now” mindset is available in many everyday activities of life,

including eating. Mindful Eating is not about dieting, deprivation, or giving up the foods you enjoy. It’s about limiting distractions while eating and experiencing food more completely. It’s rather paradoxical in that by slowing down and enjoying your food more, you end up eating less. I enjoy sharing this approach with my clients that may not have full-blown eating disorders but overeat from emotion, stress, and tension. I also appreciate how these therapies cultivate a more functional and less ornamental view of the body, which can be quite healing for women with body image issues.

Are MBSR and MBCT efficacious treatments for patients with a clinical diagnosis of anorexia, bulimia, or compulsive eating disorder?

WILLIAMS: During the acute phase of anorexia, mindfulness doesn’t work across the board. The bodies and brains of patients with anorexia are so starved that they cannot integrate sensory data. However, with weight restoration the brain begins to fire on all cylinders. At that point, mindfulnessbased therapy can be very helpful, for example, in somatic experiencing of the food, such as identifying how the food feels and tastes, and in post-meal processing. For the treatment of bulimia and compulsive overeating, mindfulness practices can be helpful from the beginning, as a way to help the patient relax, slow down and really taste their food, expose the patient to normal eating habits during treatment, transition into the “real world” after treatment, and to help maintain the lifestyle change.

As the new year brings attention to your patients’ concerns about their weight-related health issues and healthy weight goals, mindfulness-based therapy can be a helpful adjunct to medical therapy. ◆ ISSUE#83 27

NEWS  EVENTS  ARTS

Robert Salley, MD, executive director of Cardiovascular Services at Saint Joseph Heart Institute, part of KentuckyOne Health, with Doris Vastine, first patient in the state to undergo MitraClip procedure.

Saint Joseph Performs Firstin-State MitraClip Procedure

LEXINGTON The Saint Joseph Heart Institute, part of KentuckyOne Health, has successfully completed a new life-saving heart procedure that can present an alternative for patients who are too ill for open-heart surgery. Part of a clinical trial, it is the first time in Kentucky the minimally invasive MitraClip procedure has been completed.

The MitraClip is a small metal clip that helps patients with mitral regurgitation (MR), a condition where the heart’s mitral valve leaflets do not close tightly, causing blood to leak into the heart’s left atrium and can lead to advanced heart failure.

This new treatment expands the options for selected patients with MR, especially

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those who are not candidates for invasive open-heart surgery. The procedure allows doctors to use catheter-based technology to repair the mitral valve, without the need for patients to undergo cardiopulmonary bypass.

The MitraClip procedure shortens recovery time and ultimately improves quality of life for those experiencing life-altering symptoms like fatigue and shortness of breath.

With MitraClip and the recently introduced Trans Catheter Aortic Valve Replacement (TAVR) procedure, Saint Joseph physicians like Robert Salley, MD, executive director of Cardiovascular Services, are now able to treat a number of serious heart conditions with minimally invasive methods. “This is the first time that we’ve had an ability to manage this problem for patients too ill to undergo open heart surgery,” said Salley. “In the past, the only option to help patients with congestive heart failure was to band-aid the symptoms with medication. This is a huge opportunity to increase the health and quality of life for many patients.”

During the MitraClip procedure, a physician will use traditional catheter methods to guide the clip into the left atrium. The clip is lowered and attached to the valve to repair or reduce MR. Before final placement, the clip can be moved and rotated to ensure optimal fit.

MR is the most common type of heart valve insufficiency in the United States, affecting approximately 4 million people.

This condition cannot be medically treated,

and previously could only be repaired with open-heart surgery on patients who were otherwise physically healthy. 

Bolli wins AHA Achievement Award for Cardiovascular Research

The American Heart Association has presented its Research Achievement Award for 2013 to Roberto Bolli, MD, of the University of Louisville, “for the profound and lasting impact of his extraordinary contributions to cardiovascular research.”

“Over the past 40 years, Bolli has gained deserved recognition as a world leader in his field,” said American Heart Association president Mariell Jessup, MD, of the University of Pennsylvania in presenting the award. “He has advanced our understanding of the mechanisms responsible for injury to the heart during ischemia and reperfusion, opening the way for developing novel protective strategies in patients with ischemic heart disease.”

Bolli is professor of Medicine, Physics and Biophysics, chief of the Division of Cardiovascular Medicine and director of the Institute of Molecular Cardiology at the University of Louisville. He received the DALLAS, TX/LOUISVILLE, KY

2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com

28 M.D. UPDATE

award, a citation, and $2,500 honorarium, during the opening of the American Heart Association’s Scientific Sessions 2013 at the Dallas Convention Center.

In early studies Bolli established a primary role of oxygen-free radicals in development of reversible heart dysfunction, or “myocardial stunning.” His research further delineated at the molecular level how cardiac muscle adapts to stress, Jessup said.

More recently, Bolli has emerged as a leader in regenerative cardiology, the pioneering use of patient-derived cardiac stem cells to repair heart muscle damaged during a heart attack. The Kentucky scientist currently is directing the first major study to test the potential healing effect of patients’ own stem cells.

“Seamlessly melding basic experiments with patient-oriented studies has been a hallmark of Dr. Bolli’s research,” Jessup noted.

“He has made great strides in solving the mysteries of ischemic heart disease and developing effective new approaches in the attack on this worldwide problem afflicting millions.”

Jagger Named 2014 SEC Team Physician of the Year

The University of Kentucky’s Dr. James Jagger has been named the 2014 Southeastern Conference Team Physician of the Year. Jagger is an assistant professor in the UK Department of Orthopaedic Surgery and Sports Medicine and serves as the UK chief of athletic medicine and head team physician for all UK sports.

LEXINGTON

The Team Physician of the Year award is chosen by the athletic training staffs at SEC member institutions and is given annually to recognize a team physician who has contributed greatly to both his or her school’s teams and to the SEC sports community. Voting criteria includes both reliability to the physician’s athletic department and noted involvement in the field of sports medicine.

Jagger’s award this year makes back-toback wins for UK physicians -- Dr. Darren Johnson, chair of the UK Department of Orthopaedic Surgery and Sports Medicine, and head orthopaedic surgeon for UK Athletics, received the award in 2013.

UofL Physicians-Pediatrics Opens Pediatric MultiSpecialty Office in East Louisville

LOUISVILLE University of Louisville PhysiciansPediatrics has opened a pediatric multispecialty office in Brownsboro Crossing shopping center, in Norton Medical Plaza II, across from Kosair Children’s Medical Center-Brownsboro.

The office, which was partially funded with a $325,000 WHAS Crusade for Children grant to the University of

Louisville Department of Pediatrics, will house seven UofL Physician’s pediatric subspecialty practices: Acupuncture, Endocrinology, Gastroenterology, Ophthalmology, Neurology, Pulmonology, and Sleep Medicine.

“We opened this office to extend our reach down the I-71 corridor, making critical pediatric specialty care more easily available to children and families from Oldham, Shelby, and Carroll Counties,” said Gerard Rabalais, MD, chairman, University of Louisville Department of Pediatrics.

The 7,500-square-foot office has 17 exam rooms, two intake rooms, a lab, a procedure room, and a large waiting room with a quiet area for anxious children. There is an administrative area, as well as space where providers can access electronic medical records and teach UofL medical students and residents.

The exam rooms are intentionally larger than typical exam rooms to accommodate families who often accompany children on pediatric visits. Two exam rooms are outfitted for exclusive use by pediatric acupuncture specialists and three rooms are dedicated to pediatric ophthalmology.

“As we developed this new office space we were able to consider the unique needs of children, especially those whose condition requires them to see multiple specialists, like a child with diabetes who needs ongoing ophthalmology care,” Rabalais said. “We are grateful to the WHAS Crusade for Children for helping us create this special place for children.”

TAKE CONTROL TODAY If you are at high risk for developing type 2 diabetes, the YMCA’s Diabetes Prevention Program can help you make lifestyle changes to improve your overall health and well-being and reduce your chances of developing the disease. Take the first step in controlling your health. Find out your risk for prediabetes.

FOR MORE INFORMATION CONTACT Dave Peterson at dpeterson@ymcaofcentralky.org or call 859-258-9622 ISSUE#83 29

NEWS

TeamHealth Acquires MESA Medical Group

TeamHealth Holdings Inc. (NYSE:TMH), one of the nation’s largest providers of outsourced physician staffing solutions for hospitals, announced the acquisition of the operations of Marshall Physician Services, LLC, operating as MESA Medical Group or “MESA.” Based in Lexington, Ky., MESA manages and staffs emergency medicine and hospital medicine programs for 24 facilities in Kentucky, Indiana, Ohio, and West Virginia. A physician-founded and physician-led organization, MESA is a recognized regional leader in providing emergency medicine and hospital medicine staffing services for hospitals. Through the management and staffing of 23 emergency departments and 10 hospital medicine programs, MESA cares for more than 600,000 patients annually.

“When evaluating partnership opportunities, we determined that TeamHealth is a natural fit,” said James Foster, MD, MESA co-founder and president. “TeamHealth offers extensive resources in both emergency medicine and hospital medicine management and provides unparalleled support for physicians and other clinicians. We are excited to join an organization that offers clinical and operational support with an emphasis on exceptional patient care.”

KNOXVILLE, TN/LEXINGTON, KY

CHI Joins National Specialty Pharmacy Network – Will Open Site in Louisville

LOUISVILLE Catholic Health Initiatives has joined Fairview Health Services and Intermountain Healthcare as investors in Excelera Corp., a national specialty pharmacy network based in Minneapolis. The three health systems all have committed resources, expertise, and investment capital to support Excelera’s model of integrated care for patients who require specialty drugs.

KentuckyOne Health, part of the Catholic Health Initiatives community, will be a part of the new specialty pharmacy network with a location in Louisville at 5111 Commerce Crossing. Construction of the new pharmacy will be completed by March 1, 2014 and opened by July 1, 2014.

Excelera Corp., a network of specialty pharmacies based at health systems and academic medical centers, was formed in May 2012 to enable member organizations to gain 30 M.D. UPDATE

access to limited-distribution drugs and provide continuity of care for patients with complex conditions who require specialty drugs.

“This partnership is designed to help us develop a national specialty drug network that is focused on better outcomes for our patients who so desperately need these medications,” said Kevin Lofton, president and chief executive officer of Englewood, Colo.-based CHI, one of the nation’s largest health systems. “The Excelera network gives our doctors access to a comprehensive, integrated network, including limiteddistribution drugs, which enables them to manage the full spectrum of patient care.”

Specialty pharmaceuticals are expensive drugs that may require special handling and administration and are often used to treat the most ill and clinically complex patients.

“We have already been doing many of these types of pharmacy services through our own Pharmacy Plus and University of Louisville outpatient pharmacy in Louisville, said Mark Milburn, vice president, Oncology Service Line, KentuckyOne Health. “Our patients will benefit from our expansion of services and access to medications. We serve a large population of patients with cancer, transplanted organs, HIV, and other conditions that require expensive types of medications. With the specialty pharmacy as part the patient’s care team, this integration will enable ongoing optimization of therapy and prevent interruption or delay in the initiation of their needed drug therapy.

Most health plans now require patients to obtain specialty drugs from an outside specialty pharmacy that has no direct relationship with the patient. The health system does not have control as to when the patient initiates therapy and is not able to manage or monitor it. As a result, health systems and payers may STAYING CONNECTED, SOCIALLY AND TECHNOLOGICALLY CONTINUED FROM PAGE 26

loss, and recommend appropriate steps for further management, including advice on how to stay connected with their environment with the most appropriate technology.

The professionals at Lexington Hearing & Speech Center are commit-

incur higher medical costs, lower patient satisfaction, and suboptimal health outcomes as care plans are not fulfilled as intended.

The Excelera network will negotiate on behalf of its member organizations to remove barriers to specialty drug access and monitoring. Patients and providers of health systems in the Excelera network will benefit by working with a specialty pharmacy that is a member of their care team, can easily access specialty pharmaceuticals, and knows the patient’s care plan.

Baptist Health Lexington, Richmond & Corbin Recognized for Organ Donation Outreach

LEXINGTON Baptist Health Lexington, Richmond, and Corbin were among a select group of hospitals nationwide recognized by the U.S. Department of Health and Human Services (HHS) for its outreach efforts for organ donation and registration.

The hospitals conducted awareness and registry campaigns to educate staff, patients, visitors, and community members about the critical need for organ, eye, and tissue donors and, by doing so, increased the number of potential donors on the state’s donor registry. The hospitals earned points for each activity planned between September 2012 and May 2013. Baptist Health Corbin was awarded gold recognition and Baptist Health Lexington and Baptist Health Richmond were awarded silver recognition.

Hospitals were recognized through the Workplace Partnership for Life Hospital Campaign, a program launched in 2011

by HHS’s Health Resources and Services Administration (HRSA). Of the 924 hospitals and transplant centers participating in the campaign, 322 were awarded recognition. ◆

ted to providing excellent hearing healthcare in our community, and strive to ensure that no one becomes defined by their communication delay or disorder.

1 “Quick Statistics”. National Institute on Deafness and Other Communication Disorders. June, 2010. Nov. 2013.

2 Oyler, Anne L., AuD, CCC-A. “Untreated Hearing Loss in Adults—A Growing National Epidemic”. American SpeechLanguage-Hearing Association. Nov. 2013.

3 F. R. Lin, E. J. Metter, R. J. O’Brien, S. M. Resnick, A. B. Zonderman, L.

Ferrucci. “Hearing Loss and Incident Dementia”. Archives of Neurology, 68. 2 (2011): 214. JAMA. Web. Nov. 2013.

4 Frank R. Lin, MD, PhD; Kristine Yaffe, MD; Jin Xia, MS; Qian-Li Xue, PhD; Tamara B. Harris, MD, MS; Elizabeth Purchase-Helzner, PhD; Suzanne Satterfield, MD, DrPH; Hilsa N. Ayonayon, PhD; Luigi Ferrucci, MD, PhD; Eleanor M. Simonsick, PhD; for the Health ABC Study Group. “Hearing Loss and Cognitive Decline in Older Adults”.

JAMA Intern Med.173. 4 (2013):293299. JAMA.Web. Nov. 2013.

5 Kochkin, S. PhD, & Rogin, C.,MA. “Quantifying the obvious: The impact of hearing instruments on quality of life”. Hearing Review. Jan. 2000. Better Hearing Institute. Nov. 2013. ◆

EVENTS

Healing Garden at Markey Cancer Center

A former concrete canyon at the Markey Cancer Center is being transformed into a healing garden. Located on the east side of the Ben F. Roach Cancer Care Facility, the garden was designed by Bill Henkel and Wendy McAllister of Henkel Denmark of Lexington and will be called the Lexington Cancer Foundation Healing Garden.

The concept had its roots in 2011, but the work began in December 2012 when the Lexington Cancer Foundation announced funding for 100% of the design and installation. Ground was broken on Oct. 7, 2013, after 10 months of meticulous preparation to ensure that all materials used in the garden area are safe for patients with compromised immune systems.

The Healing Garden is roughly 4,500 LEXINGTON

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS

square feet. Low Kentucky limestone sit walls enclose the healing garden, which will be visible 24 hours a day, 365 days a year with lighting for safety, as it is in a high-traffic area.

No annuals will be planted. All annual will be in pots because planting necessitates digging up soil and releasing dust in the air. Artificial mulches and sterile soil are used, but no bark mulch. Native Kentucky perennials like Solomon’s Seal and Lenten Rose are grown offsite and are delivered in sleeved planters.

Because the healing garden’s soil cannot be disturbed, anything with soil will be wet down before transporting and planting. No fountain will be installed, because water contributes to the possibilities of infectious disease.

“Once the garden is planted, we will weed by hand, without using chemical sprays,” said Henkel who is donating five years of care to the garden. Henkel is certified in healing garden design, the only registered landscape architect in Kentucky with

that distinction. He earned certification in “healthcare garden design” in May 2011.

The healing garden is designed for patients to get sunshine and fresh air, and for their families, physicians and staff.

Lexington Cancer Foundation has funded a number of patient support and education projects at Markey Cancer Center.

Vicky Myers is the chief development officer at UK HealthCare and the College of Medicine. She and Henkel looked around the medical campus before they settled on the site at the Markey Cancer Center.

“I think it’s an excellent addition to the kinds of projects we’ve taken on here to improve the environment of patient care,” Myers said. “It is also a place supportive of the staffs who work here.” ◆

AND HEAlTHCARE PROFESSIONAlS

CALL fOR PARTICIPATION 2014 Editorial Opportunities * Issue #84 - February Cardiology, Pulmonology / Smoking Cessation, Travel Medicine

Issue #87 - May Women’s Health, Pediatrics / Dental Health

Issue #90 - October Oncology, Radiology, Imaging / Hospice, Home Health

Issue #85 - March Gastroenterology, General Surgery, Bariatrics, Surgery Centers / Nutrition

Issue #88 - June/July Dermatology, Plastic Surgery, Hand & Foot Surgery / Men’s Health

Issue #91 - November Neurology, Pain & Addiction / Mental Health

Issue #86 - April Public Health & Rural Health, Endocrinology / Physician Extenders

Issue #89 - August/September Orthopedics, Physical Medicine, Rheumatology / Acupuncture

Issue #92 - December/January 2015 Nephrology, Urology, Pathology / Organ Donation *EDITORIAl TOPICS ARE SUBJECT TO CHANGE.

TO PARTICIPATE, PLEASE CONTACT: Gil Dunn, Publisher / gdunn@md-update.com / (859) 309-0720 Jennifer S. Newton, Editor-in-Chief / jnewton@md-update.com / (502) 541-2666 SEND PRESS RELEASES TO: news@md-update.com ISSUE#83 31

EVENTS

EVENING WITH THE STARS The Saint Joseph Hospital Foundation hosted its 25th annual Evening with the STARS Gala on Saturday, November 16, 2013. STARS stands for Saint Joseph Associates for Renowned Service. The 2013 STARS Gala recognized some of the area’s most innovative and caring doctors and community leaders.

This year’s award winners were Neal Steil, MD, hospitalist at Saint Joseph Hospital with Kentucky Inpatient Medicine Associates, winner of the “Nurses’ Choice” award for Saint Joseph Hospital; Timothy Anderson, MD, Emergency Medicine physician at Saint Joseph Hospital East, winner of the “Nurses’ Choice” award for Saint Joseph East; and Andrew (Andy) H. Henderson, MD, Internal Medicine, CEO of Lexington Clinic, winner of the “Outstanding Community Volunteer” award.

Proceeds from the event support the Saint Joseph Hospital Foundation, a part of KentuckyOne Health. The Foundation invests in outstanding patient care facilities and services, the education of health caregivers, advanced clinical research, and improved access to quality medical care.

Ruth Brinkley, CEO, KentuckyOne Health and Barry Stumbo, president/CEO Saint Joseph Hospital Foundation

32 M.D. UPDATE

Dr. Andy Henderson, Outstanding Community Volunteer with wife Peggy Henderson

Dr. John Stewart and wife Dr. Magdalene Karon

Dr. Bruce Belin and Joe Gilene, president Saint Joseph Hospital

(L-R) Dr. Richard & Anita Matter with Sally and Dr. Richard Blake

(L-R) Melanie and Dr. Dermot Halpin with Karma and Dr. David Cassidy

Esther and Dr. Thomas VonUnrug

(L-R) Pat Tritschler, Laura Boison, US Bank market

president, and Ron Tritschler, CEO, The Webb Companies

Julie and Dr. Richard Floyd

RICK D. ISERNHAGEN, MD

JOHN W. KITCHENS, MD

ANDREW A. MOSHFEGHI, MD

THOMAS W. STONE, MD

WILLIAM J. WOOD, MD

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