MD-UPDATE Issue #102

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #102 WWW.MD-UPDATE.COM

SPECIAL SECTIONS PLASTIC SURGERY DERMATOLOGY VASCULAR

Perseverance, Problem Solving, and a PatientFirst Philosophy

VOLUME 7 • #6 • SEPTEMBER 2016

Joseph Banis, MD, has built a 20-year legacy of reconstructive and cosmetic surgery in Louisville that defies stereotypes ALSO IN THIS ISSUE THE IMPORTANCE OF THE SKIN • PREVENTING STROKE IN ATRIAL FIBRILLATION • THE EFFECTS OF VENOUS DISEASE • FENESTRATED STENT GRAFTING AND • FULL-SERVICE VASCULAR CARE

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LETTER FROM THE EDITOR

Below the Surface On the surface, specialties such as plastic surgery and dermatology might seem to be all about that – our surface or how we appear to the world. But, time and time again, what we came across in this issue are experiences that go far beyond appearances.

In our cover story, Joseph Banis, MD, defies the typical Hollywood stereotypes of a plastic surgery practice, instead approaching patient care with a family practice perspective and a personal touch that takes the whole person into account. From dramatic reconstruction surgery to routine cosmetic procedures, Banis views his job as “psychosurgery,” helping people match their insides to their outsides.

Dorothy Clark, MD, Susan H. Wermeling, MD, and Therese-Anne LeVan, MD, of Bluegrass Plastic Surgery embrace a similar philosophy, noting that while cosmetic surgery can be trivialized, it can provide very beneficial emotional and psychological results.

Dermatology Consultants in Lexington continues to grow its practice on the premise that the skin is not only the body’s outer defense against the elements but also a window into overall health. When it comes to skin cancer, Joseph Bark, MD, founder of Dermatology Consultants, says assuming dark-skinned people are at lesser risk is a dangerous misconception. Cancer does not discriminate based on race or skin color, he says.

In our vascular section, we address disease states that often go undetected because they are not visible on the surface. Rakesh Gopinathannair, MD, with KentuckyOne Health in Louisville, introduces us to the WATCHMAN Left Atrial Appendage Closure device to prevent strokes in people with atrial fibrillation. Steve Lin, MD, with KentuckyOne Health in Lexington, underlines the importance of addressing venous disease that often goes untreated and the benefits of lifestyle programming. Noah Scherrer, MD, of Surgical Care Associates of Louisville, discusses fenestrated stent grafting for abdominal aortic aneurysms and screening that can prevent complications from these aneurysms that are silent but potentially fatal.

Getting to the root of the problem and identifying what each patient needs, no matter what things may appear, is what this issue is all about. I hope that you find it as enlightening as I have.

Sincerely,

MD-UPDATE MD-Update.com Volume 7, Number 6

ISSUE #102 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

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

Laura Doolittle, Provations Group

CONTRIBUTORS:

Jan Anderson, PsyD, LPCC Molly Nicol Lewis Donald Lovasz Scott Neal Shawn Stevison

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CONTENTS

ISSUE #102

4

HEADLINES

6

FINANCE

7

ACCOUNTING

8

LEGAL

10 Perseverance, Problem Solving, and a Patient-First Philosophy Joseph Banis, MD, has built a 20-year legacy of reconstructive and cosmetic surgery in Louisville that defies stereotypes 15 SPECIAL SECTION: PLASTIC SURGERY 17 SPECIAL SECTION: DERMATOLOGY 20 SPECIAL SECTION: VASCULAR 26 COMPLEMENTARY CARE 28 NEWS 31 EVENTS

SPECIAL SECTIONS PLASTIC SURGERY

DERMATOLOGY

VASCULAR

15 M ORE THAN SKIN DEEP: BLUEGRASS PLASTIC SURGERY

17 A LIFETIME DEDICATION TO THE BODY’S WINDOW TO WITHIN: DERMATOLOGY CONSULTANTS

20 T HE NEXT ERA IN STROKE PREVENTION: U OF L AND KENTUCKYONE HEALTH

22 F ROM CARDIO TO VASCULAR TO HEALTHY: KENTUCKYONE HEALTH

24 F ULL SERVICE VASCULAR CARE SPECIALISTS: SURGICAL CARE ASSOCIATES ISSUE #102 3

Headlines

KentuckyOne Health Partners Preparing Providers for MACRA

BY DONALD LOVASZ

LOUISVILLE Physicians across the United States

are preparing for a new payment system, as a result of the Medicare Access and CHIP Re-Authorization Act (MACRA). MACRA was signed into law in April 2015, and makes important changes to how Medicare pays those who give care to Medicare beneficiaries.

The MACRA legislation creates a Quality Payment Program (QPP), ending the previous Sustainable Growth Rate (SGR) formula for determining Medicare payments for healthcare providers’ services. The SGR formula has been used to control spending by Medicare on physician payments. As a result of MACRA, two new payment tracks will now be used: MeritBased Incentive Payment System (MIPS) and Alternative Payment Models (APM). The change moves physicians more toward a system where they are rewarded for quality, rather than a flat fee-for-service payment model.

Updates to Medicare provider payment take effect on January 1, 2019, but will be based on 2017 data. Nearly all providers who are reimbursed under Medicare Part B will be subject to either MIPS or APM. As a result, Damian P. (Pat) Alagia, MD, KentuckyOne Health chief physician executive and KentuckyOne Health Partners (KHP), says KHP is leading the way in Kentucky, prepar-

4 MD-UPDATE

ing physicians for the upcoming changes in advance of the official rollout.

Alagia added, “We are working with participants in our network – over 100 member organizations and 2,300 providers – to ensure they are ahead of the curve. We have created a MACRA resource center and are working directly with our physicians and their office staff to provide education. Our care management teams are rolling out the next version of our care management information system that helps physicians meet important quality metrics. In addition, we’re participating with national organizations that are shaping the roll-out of this program.”

Under the MIPS track, providers will be scored on four categories that will be used to calculate provider bonuses or penalties: quality, resource use, electronic health record (EHR) use, and clinical practice improvement (CPI). A provider’s performance will be weighted across the four categories and will change over time.

MACRA requires provider group practices to compete with one another. On an annual basis, providers will receive a MIPS performance score of 0 to 100. This score will then be compared to a performance threshold (PT) that will be used for all MIPS participants.

Providers who achieve scores above the threshold will receive bonuses, and those that fall below will face penalties.

Under the APM track, providers must participate in an eligible APM, such as KentuckyOne Health Partners, which is moving in that direction. Based on requirements, the model must incentivize providers to meet quality measurements comparable to those in MIPS; must require the use of certified electronic health record technology; and must bear more than nominal financial risk for monetary losses or be a medical home model expanded under Center for Medicare and Medicaid Innovation (CMMI) authority.

Under the APM track, providers must also have a minimum percent of revenue-at-risk under an eligible APM to be considered Qualifying Participants (QPs). By 2019, providers are required to have at least 25 percent of their Medicare revenue tied to an eligible APM, 50 percent of Medicare or 50 percent of all-payer payments in 2021, and up to 75 percent in 2023 and beyond. Qualifying Participants receive a five percent annual payment bonus from 2019 to 2024.

Stephanie Mayfield Gibson, MD, KentuckyOne Health vice president for population health and the KHP chief medical

Headlines officer, says, “It should be noted that under this law, expanded medical home models under the Innovation Center authority qualify as advanced APMs regardless of their ability to meet financial risk criteria. This special rule gives the primary care provider the opportunity to participate in advanced APMs.” KentuckyOne Health Partners is the largest Medicare Certified Accountable Care Organization (ACO) in Kentucky, and one of the 20th largest ACOs in the United States, with more than 100 provider group companies as members and nearly 2,000 clinical providers in Kentucky, Ohio and Indiana.

The group manages over 100,000 lives.

KentuckyOne Health Partners has earned a CAPG 4-Star “Exemplary” Standards of Excellence ACO status. The CAPG survey assesses the tools and processes an organization has in place to meet the escalating expectations of healthcare purchasers and patients. The survey helps set the bar for healthcare consumers to evaluate technical quality, responsive patient experience, and affordability.

While KentuckyOne Health Partners isn’t yet an eligible advanced APM at this time, we have applied for an advanced ACO status and are moving in that direction. Last year we applied and were approved as a next generation ACO, a more comprehensive organizational model that would move KentuckyOne Health Partners toward becoming an eligible advanced APM, however we deferred acceptance because we felt we weren’t quite ready. Now with another year and more quality success in the books, KentuckyOne Health Partners feels confident in moving forward with this pathway.

Due to availability of analytical information systems and quality improvement teams in larger organizations, the MACRA regulations predict that larger group practices and organizations, such as KentuckyOne Health Partners, will perform better than smaller organizations. “However, to the extent possible, MACRA aligns standards between MIPS and APM tracks,” said Stephanie Mayfield Gibson, MD, FCAP. “This alignment makes it easier for all providers to navigate the tracks, particularly those providers who may

She’s one reason Passport is the top-ranked Medicaid MCO in Kentucky.

not meet criteria for the most advanced APM models.”

Small practices can survive this change because it is primarily about providing the highest possible quality patient care. For smaller practices, it’s a question of how they can get support, education, and resources.

KentuckyOne Health Partners is already preparing for the upcoming changes and recommends physicians get ready for MACRA well in advance. The MACRA Resource Center on the KHP website was established specifically for providers in Kentucky.

Providers should review their own Physician Quality Reporting System (PQRS), Star Rating System, and Group Practice Reporting Option (GPRO) metrics and see where they have opportunity. The time to make quality change is right now.

Alagia says that although MACRA has changed the way Medicare will pay providers, the hope is that the system will improve the quality and efficiency of patient care.

Donald Lovasz is the president and CEO of KentuckyOne Health Partners.

We can give you 23,483* more.

Passport Health Plan is the only providersponsored, community-based Medicaid plan operating within the commonwealth. So, it’s no coincidence that Passport has the highest NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.

Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers.

Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information submitted by the health plans.

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5/2/16 PM ISSUE2:59 #102 5

Finance

Financial Planning Upgrades

BY SCOTT NEAL

For the past decade, we have advised that there is a better, more client-centric, method of financial planning than the one traditionally embraced by advisors. In a moment, I will talk about two new developments in our approach.

First, a brief review for newer readers.

For years planners have asked their clients about their goals and then calculated how much must be saved each and every year to fund each goal. The client is encouraged to dream big. In this method, how to reach “the number” almost always involved recommendations to save more, spend less. This kind of planning, while widely accepted, is often in the advisor’s interest over that of the client.

We believe that a more client-centric method is based on a century-old economic theory: consumption smoothing. Consumption, i.e. spending, is what determines one’s living standard. The basic premise of consumption smoothing is that we consumers prefer a smooth, growing standard of living to one that is disrupted when we retire or send our children to an expensive college. Of course, we will gladly accept upside disruption caused by a windfall. It is the downside disruption that concerns most of us and remains the focus of our analysis.

Up until a few years ago, it was nearly impossible to figure out a smoothed living

standard, adjusted for inflation, over the course of one’s lifetime. Around the turn of this century, modern and affordable computers in the hands of competent planners ushered in post-modern financial planning. The developer was Boston University’s Laurence J. Kotlikoff. If you haven’t read it, I highly recommend his book, Spend ‘til the End. His three commandments of economics are: maximize your spending power; smooth your living standard; and price your passions.

Consumption smoothing enables us to put a valid price on alternative choices: taking more call, buying a different house, changing jobs, choosing which college Junior will attend, working more or fewer years, choosing a start date for social security, etc. Using our modern tools, the effect of any current or future decision can be measured and illustrated on its impact to living standard, over a lifetime, adjusted for inflation.

The newer developments in the technology now offer even greater potential benefit to our clients using this method of financial planning. The first of these, Monte Carlo simulation, has been used for years to simulate stock market returns. Because market returns are probabilistic and not deterministic, Monte Carlo can be used to determine the impact of different investment portfolios on future

outcomes. Kotlikoff claims that his program is the only one available today that uses Monte Carlo to determine the impact on living standard, after taking into consideration social security and/or pensions.

The second development has to do with the evolution of our own thought process and builds on the consumption smoothing approach. Historically, in a strictly utilitarian manner, economists have simply measured rising living standard by the growth rate of the economy. More economic output in the aggregate equals higher standards of living and vice-versa.

With thanks to our economist Dr. Woody Brock, we have become convinced that there is a more correct way to measure changes in living standards. The theory is called Revealed Preference and was introduced by Paul Samuelson of MIT about 70 years ago.

Using our modern tools and that theory, we can index living standard and make desired adjustments today that affect a client’s future.

Doing so enables us to look for quantifiable ways to improve living standard, without regard to the published economic data.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Call 1-800-344-9098 or email to scott@dsneal.com.

Focus on what matters most.

We’ll handle the rest.

• Revenue cycle assessment and • Reimbursement optimization management • Accounting and financial • Physician coding and documentation outsourcing improvement • Compliance and risk • Managed care contract negotiations management services 6 MD-UPDATE

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Accounting

Why Should I Worry About a Compliance Program?

BY SHAWN STEVISON

Many individual and small group practices find themselves stretched thin trying to see patients and handle the day-to-day operations of the practice. Oftentimes, something slips through the cracks. More often than not, a compliance program is one of them.

You may be asking yourself, “Why is this so important? I have enough to do just addressing patient care needs.” With the passage of the Patient Protection and Affordable Care Act of 2010, Section 6401, physicians who treat Medicare and Medicaid beneficiaries are required to establish a compliance program.

What does a Compliance Program look like?

In October 2000, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS), issued Compliance Program Guidance directed at individual and small group physician practices. The recommendations from HHS OIG included the following: • Conduct internal monitoring and auditing; • Implement compliance and practice standards; • Designate a compliance officer or contact; • Conduct appropriate training and education; • Respond appropriately to detected offenses and develop corrective actions; • Develop open lines of communication; and • Enforce disciplinary standards through well-publicized guidelines.

The question then becomes “How am I supposed to implement this and keep it current?” The answer to that question is going to depend on the size of the practice, the type of specialty involved, and the compliance risks that are unique to each of the specialties. The following are the basic steps any practice can take:

1. Determine who is going to take the lead for the compliance program – a physician or office manager or other staff.

Designate that person as the compliance officer/compliance leader.

2. Develop new practice standards or update existing practice standards to address the following elements: HIPAA privacy and security; coding and billing; reasonable and necessary services; documentation guidelines; and improper inducements, kickbacks and self-referrals.

3. Provide education to all employees of the practice – both physician and non-physician – regarding the policies and procedures and disciplinary implications of non-compliance.

4. Develop a monitoring program which includes, at a minimum, the following risk areas: • Charge sheets are updated to agree to the most recent procedure codes.

• The appropriate provider code is billed for the service performed.

• Staff is practicing within their state-licensed scope of practice.

• Documentation templates include all the elements required to support the medical necessity of the services provided.

• Completed documentation templates for patient visits contain all the information necessary to support the charges (the requirements may differ based on the type of service and the specialty area).

• Physician DEA pins and NPI numbers are safeguarded appropriately to prevent provider medical identity theft.

• Processes to verify patient identity are performed to prevent medical identity theft.

• HIPAA monitoring to verify who is

accessing patient medical information and that conversation areas are HIPAA compliant – including exam rooms, etc.

• HIPAA security checks – patient medical information is not stored on hard drives, external hard drives or zip drives. All hardware is appropriately encrypted.

• A monitoring process for any gifts received by employees of the office, including the physicians, to determine if the gifts could be considered inducements or kickbacks to generate referrals.

5. Establish a consistent response to issues identified during monitoring and verify that corrective actions are taken.

6. Communicate early and often with staff.

Make sure that all employees are aware of the requirements and set a tone that encourages open communication of problems. Physician practices may consider working with a vendor to establish a compliance hotline to allow for anonymous reporting.

7. Routinely reinforce the importance of compliance within the practice through ongoing conversation and feedback to all staff. Publicize the disciplinary standards and follow through with enforcement when situations present themselves.

For those of you who are reading this and thinking you already have these elements in place, please remember that in the eyes of the government if it isn’t documented, it didn’t happen. Make sure you document your procedures, monitoring activities and outcomes. If you don’t have a process in place, now is the time to establish a compliance program.

Shawn Stevison, CPA, CHC, CGMA, CRMA, is the manager of Healthcare Consulting Services at Dean Dorton. She can be reached at 502.566.1066 or sstevison@ddafhealthcare.com.

ISSUE #102 7

Legal

Recent Supreme Court Holding a Mixed Bag for Healthcare Providers

BY MOLLY NICOL LEWIS

Beginning in 2004, teenager Yarushka Rivera, a Medicaid beneficiary, received counseling services at Arbour Counseling Services in Massachusetts. In 2009, she suffered seizures as an adverse result of a prescription for her bipolar disorder, and ultimately died.

An investigation revealed that very few of the employees at the treatment center were licensed to provide care. The individual who had diagnosed the bipolar disorder for which she received the medication was actually not a licensed psychologist, and her PhD had come from an unaccredited internet college.

This “doctor,” as she held herself out to be, had applied to Massachusetts to be a licensed psychologist and had been rejected. The individual who had prescribed the medicine to the teen, held out as a psychiatrist to the teen and her family, was actually a nurse without the authority to prescribe medications without supervision.

The United States Supreme Court, in the case of Universal Health Services v. United States ex rel. Escobar, found the owner of the counseling facility in violation of the False Claims Act (“FCA”) under the theory of ‘implied certification,’ and the result could cause severe headaches for practitioners.1 Under implied certification (also referred to as ‘implied false certification’), the theory is that, by submitting a claim for payment, the claimant is impliedly in compliance with all relevant laws, regulations, contract requirements, etc., that are material conditions of payment. Failure to disclose lack of compliance renders claims submitted with respect to these regulatory conditions false or fraudulent. This outcome keeps the floodgates open for FCA claims, but the result in Escobar isn’t a total loss for providers.

1 Universal Health Services Inc. v. United States ex rel.

Escobar, 579 U.S. (2016).

8 MD-UPDATE

Let’s start with the good news for healthcare providers first: the ‘implied certification’ theory espoused in Escobar is far more limited than originally envisioned in lower courts.

In Escobar, the First Circuit adopted a broad theory of implied certification, such that any claim presented for payment implicitly suggests compliance with all laws and regulations by the claimant. This theory would have resulted in broad attachment of FCA liability for every failure of compliance on the part of a claimant.

The Supreme Court instead couched its recognition of the theory in terms such that a representation about the goods or services as

to compliance must have been made by the claimant, and that the failure of the claimant to disclose noncompliance would have affected the decision to pay the claim. According to Justice Thomas in the majority opinion, “What matters is not the label the Government attaches to a requirement, but whether the defendant knowingly violated a requirement that the defendant knows is material to the Government’s payment decision.”2 The materiality language used by the court here is important in that it does put an onus on the qui tam relator to prove that the misrepresentation or omission at issue under 2 Escobar at 2.

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Legal

the implied false certification theory was or would have been material to the payment decision. This cuts against the automatic attachment of False Claims Act liability even if a claim submission misrepresents an express condition of the contract under which the payment is made. The materiality of the misrepresentation is the overriding factor.

The court did, however, explicitly reject the application of a much more stringent standard by other circuits. The Second Circuit, for instance, held that “implied false certification is appropriately applied only when the underlying statute or regulation upon which the plaintiff relies expressly states the provider must comply in order to be paid.”3 The Sixth Circuit, which includes Kentucky, held largely along these same lines, recognizing implied certification as a theory but only in certain 3 Mikes v. Straus, 274 F.3d 687, 700 (2d Cir. 2001).

explicit circumstances. The Supreme Court dismissed this higher bar to entry for implied certification claims, focusing instead on the representations made by the claimant over the explicit terms of the payment.

The adoption of the implied certification theory by the Supreme Court is not a particularly welcome development. The facts of the Escobar case are particularly egregious, but many implied certification claims will likely arise under far less dire circumstances, and this could result in an increase of FCA liability for providers as a result. A further consideration is that the new materiality test set out in the case will make the determination of liability more fact-intensive and less likely to be dismissed early in the proceedings, so not only may FCA claims increase in number, but they will also be harder to dispose of and costlier to litigate.

On the other hand, this holding produces

TOGETHER, WITH HOPE AN EVENING TO SUPPORT PEOPLE FACING CANCER

a far more exacting standard, curtailing liability and placing a larger burden on qui tam relators in the pursuit of False Claims Act violations. Courts will scrutinize such claims more severely from now on, and the high bar set for successful litigation of these claims may lead relators to think twice before pursuing a qui tam action. On the whole, the Escobar holding’s true legacy may be a mixed bag for all.

Molly Nicol Lewis is an associate of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Lewis concentrates her practice in healthcare law and is located in the firm’s Lexington office. She can be reached at mlewis@ mmlk.com or at (859) 231-8780.

This article is intended as a summary of federal and state law and does not constitute legal advice.

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Friday, October 7, 2016 Starting at 7 pm FOR MORE INFORMATION & TICKETS, VISIT US ONLINE AT: W W W. H O P E S C A R V E S . O R G

ISSUE #102 9

Cover Story

Perseverance, Problem Solving, and a Patient-First Philosophy Joseph Banis, MD, has built a 20-year legacy of reconstructive and cosmetic surgery in Louisville that defies stereotypes

BY JENNIFER S. NEWTON LOUISVILLE If you have preconceived notions

about plastic surgery, you should check those at the door before stepping into the practice of Dr. Banis Plastic Surgery. This is not one of those glitzy, high-gloss, Hollywood nip-and-tuck practices often portrayed on TV. Joseph Banis, MD, admittedly, is not a showman. In fact, at the heart, he is a family practice man who was drawn to the precision and problem-solving of reconstruction and microsurgery.

Having practiced the whole of his career, some 30+ years, in Louisville, Banis’ longevity is, in part, attributable to his ability to adapt.

At a time when many of his colleagues are retiring, Banis continues to operate and take on difficult cases because no one can or is willing to do it quite like he can.

Ironically, Banis grew up in southern California, the unofficial plastic surgery capital of the United States, intending to pursue family practice. “Once I got going, I realized I really needed to be a surgeon,” says Banis.

He attended medical school at the George Washington University School of Medicine in Washington, DC, and did an internship at Los Angeles County/USC Medical Center, one of the busiest in the country. He intended to pursue his residency in ear, nose, and throat surgery at UCLA but changing program

requirements meant his “rotating” internship did not meet the surgical internship requirement.

So, Banis followed the advice of a friend and went to the University of Hawaii in Honolulu to do a year of general surgery training under Dr. Thomas Whelan. “My first rotation was in plastic surgery, and I absolutely fell in love with it,” says Banis. At the end of his year, Whelan asked him to stay on for four years, and he did and completed his general surgery residency.

Banis then traveled to Eastern Virginia Graduate School of Medicine in Norfolk, Va., for his plastic surgery residency. “Midway through my plastic surgery training I had an opportunity for a fellowship with world-renowned microsurgeon Dr. Robert Acland at the University of Louisville (who recently passed away) and learned the technique of microsurgery, a field that at that time didn’t exist. I was right on the frontline of this brand Although she refuses the title of office manager, Abbey Helton is the “nerve center” of Dr. Joseph Banis’ office, having adapted her role over 17 years to meet the practice’s needs. Says Helton of Banis, “You don’t always get the talented, technical surgeon with the great bedside manner, and I think that contributes to his longevity. He’s a great surgeon but he’s a great guy too.”

10 MD-UPDATE

PHOTOS BY ROBERT DENSMORE

Cover Story

new superspecialty,” says Banis. After completing his residency in Virginia, Banis returned to Louisville to work in the new microsurgery program. He was on staff at U of L from 1981 to 1995, when he left to start his own private practice. He has had several partners over the years, but has been on his own since 2010.

Adapting for Survival Banis describes plastic surgery as “two totally separate but integrated spheres” – reconstruction (for congenital defects, trauma, cancer, and functional repair) and cosmetic surgery. In the early days, Banis’ practice was almost solely focused on reconstructive and microsurgery. “I love problem solving. The older I get, the more I realize why I’m in this specialty. It’s all about figuring things out in real time,” he says. “Every other specialty works with situations where they open a wound, and they can close it. In our specialty, we are asked to close things that previously

In 1988, Dale Klaber was a 50-yearold heavy machinery operator when he was impaled face-first on rebar at a construction site. In a series of multiple surgeries over years, Dr. Joseph Banis was able to transplant his own nose back on and rebuild his face.

could not be closed.”

However, over the last decade Banis’ practice has transitioned from reconstruction to the aesthetic. Abbey Helton, BSN, RN, a plastic surgery nurse and Banis’ de facto office manager, estimates, “When I joined him 17 years ago, he was probably 90 percent reconstructive and 10 percent cosmetic.” Today the practice is 80 percent cosmetic and 20 percent reconstruction. This is the trend in plastic surgery and not unique to Banis. “You can barely sustain yourself with the economics of what the reimbursement on reconstruction is,” says Banis. While only 20

percent of his revenues are from reconstruction, he estimates it takes 40 percent of his time.

One thing that has remained constant is Banis himself, says Helton. “Our whole team works really well together. There’s a very good synergy. We see how much his patients mean to him and how much he means to them,” she says.

ISSUE #102 11

Cover Story

Perseverance is Paramount If Banis could name the most important trait that has contributed to his success, it would be perseverance. “One thing my dad taught me, and my mom, is you don’t have to be sharpest tack in box, but if you have a lot of tenacity and perseverance, you’ll beat most problems,” he says. It’s a trait he believes all great physicians have, and it’s something he looks for in patients as well.

In November of 1988, 50-year-old Dale Klaber was a heavy equipment operator. He always ran the remote-controlled tower crane from a small four-foot-by-four-foot cabin set high up on the edge of the building. On this particular day, the wind was gusting 30-35 miles per hour. Klaber had a big elevator panel on the hook and was waiting for someone to come get it off, but a strong gust of wind picked the panel up and launched it into the cabin above Klaber’s head. “I was on the ninth floor. It knocked the cabin and me off of the building. I was falling headfirst 90 feet to the concrete,” he says.

Although it sounds unthinkable, Klaber’s life was saved by 1 1/8-inch rebar sticking out of a column. Banis, who was on-call in the emergency room, remembers the case vividly.

12 MD-UPDATE

“He fell at an angle where it went through his face first and then went underneath the skin of the chest and then exited his groin, missing the internal chest – heart, lungs, abdomen – which would have been critical. He used up five of the seven feet of the rebar. That friction stopped him. If he had gone another two feet, his skull would have been crushed against the concrete,” says Banis.

Klaber’s nose, part of his lip, and his jaw bone were torn off by the rebar, but part of the tissue was recovered at the scene and brought to the hospital. Banis proposed something experimental – burying the facial tissue in his arm and reattaching it to his blood supply so they could transplant it at a later date. Klaber says Banis initially told him there was only a 10 percent chance it would work, but Klaber replied, “Now listen, for some people it may only be 10 percent but with me it’s 90 percent at least.” The tissue stayed in Klaber’s arm for six weeks, and, sure enough, it survived.

Banis knew it would take years and numerous surgeries to repair Klaber’s face. “I

tell the family the biggest thing is persistence, not losing heart, and the determination to get through it,” says Banis.

Following the accident, Klaber was in the hospital for 28 days and went back to work on the same crane within 90 days. In the first three years, he had an uncounted number of procedures. He would have surgery on Friday and go back to work on Monday. Banis credits Klaber’s attitude for his successful healing.

Of Banis, Klaber says he always asked his opinion on what should be done and followed through. “I think that goes a whole lot to the trust. You have to trust your physician that he can do what he says he can,” says Klaber.

The Puzzle of Problem-Solving Mary Romelfanger is a gerontological nurse and the associate director of the U of L Institute for Sustainable Health and Optimal Aging. In fact, Romelfanger was interviewed for the cover story of MD-UPDATE Issue #97 on the Institute, but here, she is the patient.

Mary Romelfanger sought out Dr. Joseph Banis for a rare orphan disease called Brooke-Spiegler syndrome.

She says removing the most disfiguring type of tumors it causes “requires pretty deft surgical technique in order to preserve the scalp as much as possible around the tumors.”

Cover Story

Romelfanger was referred to Banis six years ago for a very rare genetic problem called Brooke-Spiegler syndrome, a condition where tumors grow on skin and skin appendages, such as hair follicles or sweat glands. There are three types of tumors: spiradenomas and trichoepitheliomas, which can be removed by laser, and cylindromas, which must be removed surgically. The tumors most commonly occur on the head and neck, and while typically benign, they can become malignant if not removed. Cylindromas are the most aggressive and disfiguring of the three types.

For 25 years, Romelfanger had surgery once or twice a year to remove the cylindromas from her scalp at the earliest stage possible, but each surgery created more scar tissue, making it more difficult to find healthy scalp tissue to close the wounds. This year, when Romelfanger visited Banis, he proposed a radical approach – “to resect the scalp or remove down to a certain layer, below where the hair follicles start. Ostensibly, you remove the tissue from which cylindromas arise,” says Romelfanger. After Romelfanger got over the initial shock, she researched the procedure and got a second opinion, all of which supported Banis’ proposal.

“Mary gets into the problem-solving aspect of plastic surgery. I’ve never seen the problem Mary presented with. I’d barely even heard about it. There’s no written standards for this,” says Banis. Romelfanger’s first surgery was the resection on February 19, 2016. Three days later she went back into surgery for a tissue graft from her buttock. However, Banis was not able to get enough tissue to cover the entire scalp, so a week later he performed a tummy tuck to complete the graft.

Banis says Romelfanger is a good example of the interconnectedness of everything in plastic surgery. During her scalp resection, Banis actually performed a formal brow lift, something she had been considering. “It was dealing with the physiology, the psychology, the aesthetic, how the aesthetic merges with the reconstructive, and wound healing,” he says.

Romelfanger, whose grafts have healed almost completely, says, “It’s been a partnership with Dr. Banis to work this through with the endpoint being I can go back to my work and

function normally and nobody will know what has transpired.”

Putting Patients First, Always Patient-centered care is one of the buzzwords of 21st century medicine. For Banis, putting patients’ needs above all else has long been his guiding principle, and one that spans both sides of his practice. “Contrary to what the popular thought may be, for me, plastic surgery is not about procedures. It’s basically about identifying what the patient really wants and needs – those are two different things – and it’s about satisfying the patient,” he says.

her 80-pound weight-loss journey, she went to Banis for help.

“One of the things that I appreciate so much with him as a doctor is he really gets to know you as a patient and really understands what it is you’re looking for, what you need, what your capacity is, and helps you understand it. I was still 40 pounds overweight, but liposuction spurred me on and really gave me the motivation to tackle the rest,” says Day. Banis cautions that performing liposuction before patients reach their ideal weight is not the best approach for everyone. Again, it’s all about an individual approach.

Day is also a client of Banis’ medical skin care practice and returned to him when she was ready for surgical intervention to lift the skin on her chin and neck.

For Day, plastic surgery has simply been a means to get her outside to match her inside.

“To me, my appearance did not represent how I felt internally, and that was part of that journey,” she says. “I wish as a society it was championed to do the things that make you your best, whatever that is for that person.”

The Safety Clause

Tammy York Day, chief operating officer of Delta Dental, says she went to Dr. Joseph Banis during her weight loss journey because, “To me, my appearance did not represent how I felt internally, and that was part of that journey.”

Rather than always being procedure-oriented, Banis believes in taking the time to listen to patients. On the cosmetic side in particular, he describes what he does as “psychosurgery,” satisfying a psychological need.

“Cosmetic surgery is often trivialized. Breast augmentation is probably the most trivialized operation, and yet it is extremely important psychologically to women,” contends Banis.

Tammy York Day, chief operating officer for Delta Dental, had been friends with Banis for years before turning to him for help on her weight-loss journey. Day had always been athletic but went through a period where she became very overweight. Halfway through

As much as Banis prioritizes patients’ needs and wants, he will not sacrifice safety to meet them. “I’ve known Dr. Banis to turn patients away if it’s not the right thing to do,” says Helton. One example is smoking, which Banis uses to barter with patients to get them to quit. He’ll tell them, “I can’t do your facelift, because it is too dangerous if you’re smoking.”

For Banis, his practice is a perfect world.

“I think I’ve merged my family practitioner personality with plastic surgery because we’re always talking about fitness and weight loss and health. … So much of life is motivation and self-confidence, and for me, this is where it all comes together in this office,” he says.

At that convergence of tenacity, technical prowess, and helping people be their personal best, Banis has set the bar for plastic surgery with a real-world purpose, and he isn’t going anywhere anytime soon. “That’s why I can’t stand the thought of retiring. I do think I’m as good as I’ve been. I do think I’ve gotten better, and I don’t want to waste that,” he says.

ISSUE #102 13

Register TODAY to run or walk

October 15, 2016 ● 9 a.m.

(rain or shine) at R.J. Corman Railroad Group Headquarters 101 R.J. CORMAN DRIVE NICHOLASVILLE, KY 40356

The Yes, Mamm! 5K will offer additional fundraising to accommodate the demand and help supplement funds to allow for more mammography screenings. Every dollar raised will be used for Yes, Mamm! in Lexington and Nicholasville which serves individuals in 15 counties.

REGISTER ONLINE ● KentuckyOneHealth.org/YesMamm5k

QUESTIONS: 859.313.1705 KentuckyOneHealth.org SaintJosephFoundation.org SaintJosephHospitalFoundations

SJHF_KOH_YM5K_AD_7.375x10.indd 1

6/27/2016 8:33:45 AM

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Plastic Surgery

More Than Skin Deep Bluegrass Plastic Surgery helps heal all kinds of scars, even emotional ones

BY JIM KELSEY LEXINGTON Technically speaking, plastic surgery,

whether cosmetic or reconstructive, is elective.

That can have a negative connotation, making it seem vain or frivolous. For many patients, however, that characterization is dismissive of their genuine motives for improved quality of life.

“Cosmetic surgery and plastic surgery can provide very beneficial emotional and psychological changes. For example, men seek breast surgery for gynecomastia. Something like that can be life changing,” says Susan H. Wermeling, MD, of Bluegrass Plastic Surgery.

Wermeling and her partners, Dorothy Clark, MD, and Therese-Anne LeVan, MD, are all board certified by the American Board of Plastic Surgery, Inc. Clark initially founded the practice in 1985, with Wermeling joining in 1990 and LeVan coming aboard in 1999. Clark, who received her medical degree from the University of Mississippi School of Medicine, received her post-graduate training in general surgery at the University of Kentucky Medical Center. She completed a fellowship in plastic surgery at Indiana University Medical Center, and then moved back to Lexington with her husband, Woodford Van Meter, MD, a native of Paris, Ky. In the early days of the practice, the majority of the patients were there for breast reconstruction. A few years ago, the partners agreed

Dr. Dorothy Clark founded Bluegrass Plastic Surgery in 1985. The practice now performs both operative and nonoperative cosmetic procedures, including Botox, lasers and injectable fillers.

that they would no longer take new breast reconstruction patients, focusing instead on cosmetic surgery. “In the early 2000s, we were so overwhelmed with breast reconstructions that we hardly had any time to do anything else,” Clark says. “It’s very satisfying, but it’s extremely time-consuming. A breast reconPHOTOS BY GIL DUNN

struction patient is probably going to have 20 more office visits than a cosmetic patient or even a breast reduction. We have so much more time to see patients now.”

Another deciding factor in the change was that there was an influx of plastic surgeons in the Bluegrass area, meaning that those in search of breast reconstruction would still have an ample number of options and resources. Bluegrass Plastic Surgery now handles cases such as skin cancer, facial mole and cyst removal, breast augmentation, face lifts, tummy tucks, breast lifts, liposuction, eyelids, and nonoperative procedures such as Botox, lasers and injectable fillers.

Nearly 95 percent of the patient population is women, with men most commonly coming in for breast reduction related to gynecomastia or for cosmetic work on their eyelids. In all cases, understanding the patient’s expectations ISSUE #102 15

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Plastic Surgery

and motivation is essential. “I do my best to understand what their expectations are and to let them know if those expectations are realistic or not and whether their request is advisable or not,” says Wermeling, who attended the University of Michigan School of Medicine.

She went on to become the first female to complete the general surgery program at UK in five years and the first woman accepted to the plastic surgery residency at the University of Cincinnati. “It’s not uncommon that we may say, ‘that’s unrealistic.’ It’s just as important for them to know what the surgery can’t accomplish as what it can,” says Wermeling.

Educating the patient is a key component of patient care at Bluegrass Plastic Surgery.

Generally, their patients have two consultations with their physician before moving forward with any procedures. They are shown before and after pictures of others who have had similar procedures, so they can get a good idea of what their own results will look like.

The idea of being able to see positive results almost immediately is one of the things that drew LeVan to plastic surgery. LeVan attended Rush Medical College in Chicago, followed by a five-year general surgery residency at the University of Miami/Jackson Memorial Hospital. She then completed three years of plastic surgery training at Duke University Medical Center.

LeVan notes that one of the big changes she’s seen in recent years is fat grafting, where fat is taken from one area of the patient’s body and then injected to fill out a deficiency in another area. Bluegrass Plastic Surgery started performing fat grafting about five years ago.

Dr. Susan Wermeling was the first woman to be accepted to the plastic surgery residency at the University of Cincinnati.

“Breast reconstruction with fat graftDr. Therese-Anne LeVan is a member of the American ing requires multiple stages to be able Society of Plastic Surgeons and the American Society for to get there,” LeVan says, noting that Aesthetic Plastic Surgery. saline and silicone implants are the most popular methods of breast reconstrucWhile the procedures may differ between tion and augmentation. “The implants don’t augmentation and reconstruction, the goal is always fill out all the areas that need to be always the same. Neither is considered to be filled out. Fat grafting is an excellent adjunct a more important procedure than the other. to implant reconstruction to improve the “Whether it’s reconstructive or cosmetic in shape and soft tissue deficiencies.” name, our goal is the same, to achieve the best While LeVan says the fat grafting proce- cosmetic result,” Wermeling says. dure is very effective, Bluegrass Plastic Surgery That’s because only the patient knows will not use it for breast augmentation due to how truly valuable – even life-changing – a the potential confusion it can cause during cosmetic procedure might be. “Sometimes breast exams. “The biggest risk with fat grafting people think cosmetic surgery is done purely is fat necrosis,” LeVan says. “It’s an area of fatty for vanity,” LeVan says. “In many ways, just tissue that doesn’t take as well so it can become like reconstructive surgery, cosmetic surgery is an oil cyst. It can feel like a nodule and it can done for restoration. You’re restoring back to take years for it to get smaller. On a mammo- what you had.” gram it looks like an oil cyst, so we don’t use Technically elective. Emotionally imperait for breast augmentations due to the risk of tive. Regardless of the motive, it’s always more making it more difficult to examine a breast.” than skin deep.

1707 Nicholasville Rd. Lexington, KY 40503 bluegrassplasticsurgery.com

859.276.5577 Dorothy Clark, M.D.

::

Susan Wermeling, M.D.

::

Therese-Anne LeVan, M.D.

BOARD CERTIFIED BY THE AMERICAN BOARD OF PLASTIC SURGEONS

16 MD-UPDATE

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Dermatology

(l-r) Joseph P. Bark, MD, founder of Dermatology Consultants, with managing partner Erika N. Music, MD, and W. Patrick Davey, MD, MBA, FACP, in the new location of the long-established dermatology practice.

A Lifetime Dedication to the Body’s Window to Within

Dermatology Consultants in Lexington grows to meet patient needs.

BY BOB BAKER AND JENNIFER S. NEWTON

LEXINGTON Doctors tell some very novel stories

about how they chose their particular specialty, but never before or since has someone roller skated their way into a residency and their life’s work. Joseph P. Bark, MD, dermatologist and founder of Dermatology Consultants, tells the abbreviated story this way: “As a teenager I took up roller skating and became very good at it, so good that I started winning competitions. I won two national championships in a row and was embarking on defending my title when a problem developed on the skin of one foot. A dermatologist solved the problem, and I did indeed win an unprecedented third national title. I thought about that dermatologist’s treatment, and I began to think that dermatology might be something I would enjoy as a career.”

Bark pursued medical school at the University of Kentucky, and it was there he

attended a series of lectures on dermatologic conditions with Dr. Glenn Marsh. “At that point, I was hooked. I did a mentorship with Dr. Marsh during medical school, and I was sure dermatology was for me,” says Bark.

After an internship in internal medicine, Bark completed a residency in dermatology at the Medical College of Georgia in Augusta, Ga. Since Bark and his wife had common roots in Lexington, they returned to the Bluegrass in 1976 where he began what has become a remarkable 40-year career as one of the most prominent dermatologists in the country and one of the most recognized doctors in Kentucky.

Educational Broadcasting Bark’s passion for his specialty and his drive to take medical education directly to the PHOTOS BY GIL DUNN

public soon led to his reputation and recognition transcending the area of dermatology.

This aspect of his career began simply, “I was invited to be a guest on Dr. Talk, a local television show that featured physicians from various fields coming on air to discuss the current status of their specialty. I ended up doing 48 episodes on dermatology.” Soon he was asked to host his own show called Ask the Doctor.

At this time, Bark also did a guest spot on a regionally syndicated TV show in Cincinnati, which unexpectedly led to another outgrowth of his career. During a commercial break, Bark and the host, Bob Braun, discussed doing a Q&A show where doctors answered questions sent in by listeners. “When we came back on the air, Bob really surprised me when he said I was going to write a book based on questions from the listeners. Well, I did write ISSUE #102 17

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Dermatology

that book and ultimately, two more books. It was all great fun,” says Bark. Partly through the promotion of these books, Bark became a national crusader for protection from the sun’s ultraviolet radiation. He encouraged other physicians to embrace mass media by teaching radio and television technique at the AMA annual meeting as a member of the National Association of Physician Broadcasters.

Building a Practice Legacy After a few years in solo practice and with a group practice, Bark established Dermatology Consultants. The group has grown to the point of needing more space and is now located at 2424 Harrodsburg Rd. One half of the space is dedicated to medical and surgical dermatology and the other half is cosmetic dermatology. The practice now has four dermatologists – Bark, Erika N. Music, MD, Kelli G. Webb, MD, and W. Patrick Davey, MD, MBA, FACP – as well as three physician assistants – Ryan Filiatreau, PA-C, Samantha Stratton, PA-C, and Lauren Curry, PA-C. Davey, a Mohs surgeon, is the newest physician in the practice, having joined last fall, and James LaGrew, MD, will be joining in the summer 2017, bringing their total to five physicians. The cosmetic dermatology division, Skin Secrets, is also adding a third esthetician.

Dr. Erika Music joined Dermatology Consultants six years ago and is now the managing partner. She grew up in Ashland and Lexington and graduated from the UK College of Medicine in 2006. She completed an internship in general surgery at UK and did her dermatology residency at Cook County Hospital in Chicago.

“We are growing and were simply out of space,” says Music of the practice’s new location. “Dr. Bark started our practice 40 years ago and has established a very successful, well-respected business. We are fortunate enough to have the problem of needing a larger space as we add new providers and services.”

Davey was born in Sioux City, Iowa.

He attended medical school at Washington University in St. Louis, went on to a full residency in internal medicine at the University of Indiana and is board certified in internal medicine. This was followed by a residency in dermatology at University of Iowa School 18 MD-UPDATE

W. Patrick Davey, MD, is a fellow of the American Academy of Mohs Surgery.

His practice is almost entirely surgical.

of Medicine and a dermatologic surgery fellowship at the same institution. He is board certified in dermatology and is a fellow of the American Academy of Mohs Surgery. Davey spent 20 years in Lexington with Dermatology Associates of Kentucky before moving to Arizona for four years of solo practice. When the opportunity arose to join Dermatology Consultants, he happily returned to Lexington.

Don’t Underestimate the Skin According to Bark, the importance of the skin cannot be underestimated. “Skin is the

first defense against everything harmful that may contact the body – bacteria, viruses, parasites, all kinds of infectious agents and also toxins man-made and natural, and of course radiation from the sun,” he says. The skin also participates in eliminating toxins from the body, is “the body’s air conditioning unit” via perspirational cooling, and is an indicator of the dysfunction and disease of other organs.

What Bark considers the biggest advancement during his 40-year career may surprise you. “The most significant technological discovery in dermatology in my career is better

SPECIAL SECTION sunscreen,” he says. “I have been a very strong advocate of sun protection my whole career, and I remain so. There are some misconceptions about sun exposure, such as that you get all the damage you are going to get by the time you are 18. Where did that come from? It’s totally wrong. Another is that dark skinned people from equatorial areas don’t get sun-induced skin tumors. Again, not true.

Bob Marley died of metastatic malignant melanoma. Many people have been taught that African Americans just don’t get malignant melanoma. Cancer really does not discriminate, and it becomes much more dangerous when healthcare workers think it does.”

An area of special concern to Davey, and one where he believes we can strongly impact the incidence of skin cancer, is tanning beds.

Davey posits, “The purchase of one series of tanning bed visits increases the risk of developing malignant melanoma by 65 percent.

I was among a group advocating legislation that mandated parental consent for tanning bed use by anyone under 18 years of age. Last session the legislation passed both the State House of Representatives and the State Senate but was lost in the negotiations for a state budget. We will be looking to find a sponsor for the next session.”

When it comes to skin cancer, many people, including physicians, do not realize that the majority are removed by dermatologists.

“Mohs surgery was designed as a way to minimize the risk of recurrence and leave as much tissue for reconstruction and as little scarring as possible,” says Davey. “Dr. Frederic Mohs developed the technique named after him in the 1930’s, but it wasn’t until 1971 when frozen

section margins were added that Mohs surgery became the benchmark method for removing skin cancers. By taking small specimens from marked sites of the edges of removed tissue and examining them under the microscope we’re able to make a map of the tumor. If cancer cells are seen in an area, additional tissue is removed only in that area. This saves as much normal skin for reconstruction as possible.”

Cancer really does not discriminate, and it becomes much more dangerous when healthcare workers think it does. – Dr. Joseph Bark As the practice’s Mohs expert, Davey’s schedule is almost entirely surgical, usually consisting of eight to 10 skin cancer procedures a day. And while Davey handles some reconstruction himself, he says, “I do not hesitate to call on my colleagues in oculo-plastic, facial plastic, and plastic surgery to handle defects that are outside my scope.”

As is the national trend, cosmetic dermatology is a burgeoning business that dovetails nicely with the tenets of protection and preservation of healthy skin. Bark spends two days a week on the cosmetic side of the practice because he is passionate about physician administration of these treatments. “I like the effects of Botox, fillers, and topical antioxidants, but I want to stress that all of these procedures must be performed by a welltrained and experienced doctor. There is no place for these procedures being handed off

Joseph P. Bark, M.D. Erika N. Music, M.D. Samantha R. Stratton, P.A.-C Lauren A. Curry, P.A.-C

Dermatology

to a technician,” says Bark. “The face has 43 muscles, and only with a detailed knowledge of the dynamic interactions of these muscles can an intelligent plan be made for using Botox to stop dynamic wrinkling.”

Up Next for Skin Disease Beyond improved surgical techniques, one of the most promising advancements in all of medicine, including dermatology, is the advent of immunobiological agents. “In this category, we naturally think of cancer, but psoriasis, a life-altering disease, has been found to result from one small side chain anomaly in an enzymatic cascade that regulates the proliferation of scaly tissue on the skin. Correction of this side chain defect will eliminate the disease,” says Bark.

In the future Davey predicts, “The creation of biologic and immune therapies will be custom constructed to each patient’s genome for the eradication of each specific tumor type.”

For now, Music says, “It is my hope to continue to build on the legacy Dr. Bark began in 1976. I am humbled he chose me as his partner and will continue providing excellent patient care for our general, surgical, and cosmetic dermatology patients in our Lexington and Richmond offices. We have just started a clinic in Georgetown, and I would like to see that become a permanent location in the next few years.”

As for Bark, “I have no plans to retire, ever. The truth is I enjoy what I do so much that I feel I have really never worked a day in my life. So I want to keep doing what I’m doing. I love it.”

W. Patrick Davey, M.D. Kelli G. Webb, M.D. Ryan P. Filiatreau, P.A.C

2424 Harrodsburg Road, Suite 200, Lexington, KY 40503 859.278.9492 - www.dermconsultants.com ISSUE #102 19

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Vascular

The Next Era in Stroke Prevention The WATCHMAN LAAC Implant makes its debut in Kentucky, ready to fight stroke-causing blood clots

BY MELISSA ZOELLER LOUISVILLE Five million people in the United

States suffer from atrial fibrillation (AF), a heart condition where the upper chambers of the atrium beat too fast and with irregular rhythm. Individuals with AF have a five times greater risk of stroke, and 20 percent of all strokes are caused by the condition.

With that number expected to double in the next 20 to 25 years, Rakesh Gopinathannair, MD, MA, FHRS, director of cardiac electrophysiology, University of Louisville Physicians and KentuckyOne Health, is excited to be heading up the medical team that is bringing the newly approved WATCHMAN Left Atrial Appendage Closure (LAAC) Implant to Jewish Hospital, one of the first hospitals in Kentucky to offer the device.

Atrial fibrillation can cause blood to pool and form clots in the left atrial appendage (LAA). For the vast majority of patients with non-valvular AF, the LAA is the source of the stroke-causing blood clots. If a clot forms in the LAA, it can significantly increase one’s risk of having a stroke.

“AF-induced strokes are more devastating than other strokes because the clot can be much larger and travel through the bloodstream to the brain and other parts of the body, which causes the death rate to be almost double that of a regular stroke,” states Gopinathannair. “The risk of these strokes depends on associated conditions, including elderly age, heart failure, high blood pressure, diabetes, and prior strokes. For patients with non-valvular AF who have reasons to seek an alternative to blood thinners such as warfarin, the WATCHMAN Implant offers a potentially life-changing treatment option that could free them from the challenges of long-term anticoagulation.”

20 MD-UPDATE

Rakesh Gopinathannair, MD, MA, FHRS, is the director of cardiac electrophysiology with University of Louisville Physicians and KentuckyOne Health.

Because lifelong blood thinner use has many limitations, including excessive bleeding, falls, inability to keep the blood thinned adequately, and the general risks of being on a medication for an extended amount of time, the WATCHMAN is a solid solution for AF patients. “The device truly provides physicians with a breakthrough stroke risk reduction option for patients that are fighting AF,” says Gopinathannair.

The WATCHMAN Implant is designed to close the LAA in order to keep harmful blood clots from entering the blood stream and potentially causing a stroke for higher-risk patients. The WATCHMAN Implant has been approved in Europe for several years and has just recently been FDA-approved in the United States. It has been implanted in more than 10,000 patients and is approved in more than 70 countries around the world.

Gopinathannair and his team will perform the implant of the new device in the cardiac electrophysiology (EP) lab with the patient

PHOTO PROVIDED BY KENTUCKYONE HEALTH

under general anesthesia. An IV is placed in the groin through the femoral vein and a transseptal puncture makes a small hole through the membrane that separates the upper chambers of the heart, allowing entry into the left atrium or left upper chamber of the heart. The device can be threaded in through that IV. A transesophageal echocardiogram is then used to measure the size of the appendage.

“Appendages are like the lines in our hands – everyone’s are different and come in various sizes and shapes,” states Gopinathannair.

“Once the size, dimension and depth of the appendage is confirmed, we select the particular size of the device and use a catheter to deploy the mechanism.”

The one-time procedure takes about one to one-and-a-half hours to complete, and patients typically need to stay in the hospital for 24 hours. Patients are able to be completely free of blood thinner medication three to six months after the implant is put in place. Research has shown that the WATCHMAN is as effective as or more effective than blood thinners in preventing AF-induced strokes. “Bleeding and falling issues associated with warfarin therapy are taken out of the equation, and that is life-altering for these patients,” adds Gopinathannair.

Patients with a moderate or high risk of stroke from AF who are unsuitable for longterm anticoagulation are the best candidates for the WATCHMAN, and risk of the procedure is very low. “The overall risk of the

The device truly provides physicians with a breakthrough stroke risk reduction option for patients that are fighting AF. — Dr. Rakesh Gopinathannair

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The WATCHMAN is not just the new era of stroke prevention, it is the next level of stroke prevention. I believe LAAC will change how we manage atrial fibrillation.

— Dr. Rakesh Gopinathannair WATCHMAN procedure is about one to two percent. Anytime you work with IVs inserted into the groin area and in the left atrium, especially with the patient on blood thinners, there is a higher risk of bleeding and blood collection around the heart, but it’s very lit-

tle,” states Gopinathannair.

Gopinathannair’s WATCHMAN team includes Jeffrey Stidam, MD, KentuckyOne Health Cardiology Associates (electrophysiologist); Michael Flaherty, MD, PhD, U of L Physicians (interventional cardiologist);

Vascular

Naresh Solankhi, MD, KentuckyOne Health Cardiology Associates (interventional cardiologist); Marcus Stoddard, MD, FACC, FAHA, (echocardiographer): and Matthew Bessen, MD, (echocardiographer).

KentuckyOne physicians will implant the first WATCHMAN device in mid-September, and it couldn’t come sooner.

“The WATCHMAN is not just the new era of stroke prevention, it is the next level of stroke prevention,” says Gopinathannair.

“I believe LAAC will change how we manage atrial fibrillation.”

ISSUE #102 21

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Vascular

From Cardio to Vascular to Healthy KentuckyOne Health cardiovascular physician Steve Lin, MD, adapts his practice to meet the varied needs of patients

BY MEGAN WHITMER LEXINGTON For Steve Lin, MD, cardiovascular

disease physician in Lexington, Ky., becoming a doctor was in his veins. As the son of a cardiologist with several siblings and other family members with medical degrees, he always had a passion for becoming a cardiologist.

Originally from Taiwan, Lin grew up in Los Angeles, where he earned his undergraduate degree from UCLA before going on to medical school at Loyola University in Chicago, completing his residency in internal medicine at the Mayo Clinic, and obtaining further training in cardiovascular disease at the Cleveland Clinic Foundation.

In 2000, Lin moved with his family to Lexington and began working with Cardiology Associates of Kentucky, now KentuckyOne Health Cardiology Associates. “It was a great practice opportunity and Lexington is a great place to raise a family,” he says. “As a new physician, I had plenty of opportunities to build my practice and focus on the type of care I was trained to do.”

Like many cardiologists, Lin began his practice focusing primarily on cardiology.

Over time, his focus broadened. “Many patients with heart disease also have vascular disease,” he says. “I spent additional time at the Cleveland Clinic learning about vascular ultrasound. It was a natural extension for me to expand towards vascular care to serve the needs of the patients in our practice.”

Venous disease is the most visible and most prevalent vascular disease, but also the most overlooked, because the vast majority of patients do not have clearly defined or acutely threatening symptoms. Many have symptoms that can interfere with their lifestyles, but they do not seek treatment or have been neglected in their venous care.

“In the US, 100 million people have pri22 MD-UPDATE

Dr. Steve Lin, FACC, RPVI, FASE, is a cardiovascular disease physician with KentuckyOne Health and the medical director for their Healthy Lifestyle Centers and Ornish Reversal Program.

mary venous disease,” says Lin. “That doesn’t mean they all need medical or procedural care. However, venous disease can progress over time, and both patients and providers should be better educated about that.”

Venous disease can increase with age, in terms of prevalence and severity. Many people think venous disease is a cosmetic issue, but it can involve much more than varicose veins. Some patients with venous disease do not present with prominent varicose veins; in fact, many with advanced complicated venous hypertension may simply have dependent swelling with skin changes such as discoloration or ulceration. Women have a higher incidence of venous disease than do men.

Most of the patients in Lin’s practice are middle-aged or older with symptomatic venous disease and complications.

A significant portion of Lin’s patient referrals come from the wound center, primary care physicians, podiatrists, or cardiovascular colleagues for evaluation or unexplained limb PHOTO BY GIL DUNN

swelling, many involving advanced venous disease. They often have multiple comorbidities, including heart disease, peripheral arterial disease (PAD), and some type of refractory swelling or wound. “My goal is to optimize the venous care of these patients by combining my training in cardiology, imaging, and interventional techniques,” he says. “Many times, it doesn’t involve procedural care, but a combination of conservative management and lifestyle change such as compression stockings, weight loss, and leg exercises.”

When assessing his patients, Lin typically utilizes venous duplex to establish a detailed venous roadmap of the problem. “We do a full reflux ultrasound that is not typically done as part of most hospital venous ultrasounds,” he says. “The reflux ultrasound is done with the patient in an upright position.

In some patients with advanced skin changes or unusual varicose vein locations, we would image the proximal deep venous system looking for obstruction or compression.”

Left untreated, venous disease can lead to other complications, including thrombophlebitis, cellulitis, edema, and a variety of skin changes that come with venous hypertension.

For some patients, it can decrease quality of life and force them to limit physical activity because it can be very uncomfortable with prolong standing. Patients with careers that involve chronic sitting or standing, such as hair stylists, commercial drivers, fast food workers, and even healthcare staff in operating or interventional suites, can be affected in their job performance.

When it comes to ranking the three major risk factors for venous disease, Lin names family history as the highest contributing factor. Lifestyle comes in second, for people who spend a lot of time either sitting or standing. Lastly, it is very prevalent in patients that are obese. “Just about all patients that are

SPECIAL SECTION

morbidly obese have some degree of venous hypertension,” he says.

Complementing Procedures with Lifestyle Programming Lin is also the medical director for the Healthy Lifestyle Centers at KentuckyOne Health, a lifestyle medicine program fully staffed by clinical providers, exercise physiologists, social workers, and dieticians.

This is the only center in Central Kentucky that offers the Ornish Program for Reversing Heart Disease, the only program scientifically proven to undo atherosclerotic heart disease.

“This is a game changer that compliments best medical and procedural care. This has become one of the most gratifying aspect

of my practice to see the transformational improvements patients achieve with this program,” he says. In addition to reversing the progression of their atherosclerotic disease burden, the participants are spiritually and emotionally fulfilled through group support and stress management while achieving remarkable improvements in weight reduction, blood pressure, glucose, and lipid parameters despite reductions in their medication regimen.

The patients who come into the Ornish Reversal Program are patients who have had prior heart attacks, bypass surgery, coronary stenting, or prior valvular surgery, but some of them also have primary venous disease in addition to their heart disease. For those

Vascular

patients, as they reduce weight and improve their calf pump function as they become physically active, their venous hypertension symptoms improve.

“The level of patient satisfaction is beyond any program I’ve been involved with,” says Lin. “They basically go through a lifestyle transplant, but with the amazing team we have, patients feel like they are going to lifestyle spa.” Some providers were astonished to find out how much their patients enjoyed and looked forward to attending the “sessions.”

Lin praises the fantastic team involved at the Healthy Lifestyle Centers. “If you attend an Ornish graduation ceremony, you will see that Coach Calipari does not even have the best team in Lexington!”

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ISSUE #102 23

SPECIAL SECTION

Vascular

Full-Service Vascular Specialists The vascular specialists at Surgical Care Associates of Louisville offer comprehensive treatment for every vascular condition in their office and at Baptist Health Louisville

BY JENNIFER S. NEWTON LOUISVILLE Unlike some vascular practices that

specialize solely in vein care or minimally invasive interventions, Surgical Care Associates of Louisville is one of the most experienced teams in Kentucky, offering a comprehensive range of medical, endovascular, and surgical treatments for every type of vascular disease in their offices on Kresge Way and at Baptist Health Louisville.

“Traditional vascular surgery is the care of any blood vessel – arterial, vein, or lymphatic – that occurs outside the ones intrinsic to the heart and intrinsic to the brain,” says Noah Scherrer, MD, the newest vascular specialist at Surgical Care Associates, who joined the practice in early August 2016. For Scherrer, the practice’s philosophy matches his own ideals. “One of the reasons I chose vascular surgery was the opportunity to treat all aspects of vascular disease with all different modalities,” he says.

A native of Fort Thomas, Ky., Scherrer graduated from the University of Louisville School of Medicine and also completed his general surgery residency at U of L. He did his vascular surgery fellowship at the University of Kentucky. Another reason Scherrer was drawn to vascular surgery was the constantly advancing technology. “The vascular surgery that we’re practicing today is completely different than the vascular surgery we practiced even 10 years ago, and this is leading to better outcomes for our patients,” he says.

Each of the seven vascular surgeons at Surgical Care Associates practices general vascular surgery, while some do have special areas of interest. The group also employs one interventional radiologist and one nurse practitioner. While the practice has its own in-office vascular diagnostic center accredited by the 24 MD-UPDATE

Noah Scherrer, MD, is the newest vascular specialist to join Surgical Care Associates of Louisville.

American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF) and vascular laboratory certified by the Intersocietal Accreditation Commission (IAC), the group also works closely with Baptist Health Louisville, serving as the medical directors of Baptist Health’s noninvasive vascular laboratory and performing surgery at the hospital. Procedures are performed in Surgical Care Associates’ office-based Outpatient Endovascular Center or at Baptist Hospital Louisville, depending on the complexity of the intervention.

Addressing Arterial Disease When it comes to arterial disease, the main conditions Scherrer and his colleagues see are arterial aneurysms, arterial occlusive disease (blockages in the extremities due to peripheral artery disease), and carotid artery disease.

Arterial aneurysms, such as abdominal aortic aneurysms, often go undetected, but once they reach a certain size they must be treated to prevent rupture. Arterial aneurysms can be treated endovascularly and surgically.

PHOTO BY ROBERT DENSMORE

Endovascular stent grafting is a minimally invasive approach that utilizes a fabric tube and metal mesh stent to seal off the aneurysm and strengthen weak sections of the artery.

In some cases the anatomy of the aneurysm precludes surgeons from using an endovascular approach and surgery is warranted.

“The old aneurysm repair is very durable, but patients have a longer recovery, usually staying in the hospital for five to seven days. With endovascular repair, if the anatomy is suitable, patients can leave the next day and are almost back to normal within a week,” says Scherrer.

The newest iteration of stent grafting is the fenestrated graft, which allows physicians to treat a larger patient population endovascularly.

“One of the big restraints of doing a standard stent graft repair of an aneurysm is the stent graft has to seal below the level of the renal arteries,” says Scherrer. However, the Zenith Fenestrated AAA Endovascular Graft by Cook Medical offers an alternative. The fenestrated grafts, which are custom made for each patient in Australia, incorporate openings for the renal and superior mesenteric arteries, allowing surgeons to seal off aneurysms higher up in the aorta. The fenestrated grafts expand the endovascular treatment population of AAA by 15 to 20 percent. Surgical Care Associates was one of the first vascular specialist teams in the nation to offer these fenestrated grafts.

Other common conditions, such as arterial occlusive disease and carotid artery disease, can be treated medically, endovascularly, or surgically. Of medical therapies, Scherrer says, “Statin medicines, like Lipitor and Crestor, have really shown benefit for not only heart circulation but our peripheral vascular circulation.” Endovascular repair of blockages in the extremities includes balloon angioplasty with stent placement to open up the artery. Surgical Care Associates also offers laser arthrectomy,

SPECIAL SECTION

which cleans out the blockage rather than just pushing it aside. Again, the anatomy plays a role in whether an endovascular approach is an option. If not, surgeons perform surgical bypass using a piece of vein or an artificial graft. Surgical treatment of carotid disease is called a carotid endarterectomy.

Another large area of concentration for the practice is the creation and management of hemodialysis access for the dialysis-dependent renal failure patient. This involves surgery, usually on the arm, called an arterial venous fistula creation or arterial venous shunt placement, where blood is re-routed close to the skin surface. This allows the dialysis center to access the patient’s blood on a regular basis and connect to the dialysis circuit, providing the lifesaving renal replacement that the patient needs.

The Varied Nature of Venous Disease

The vascular surgery that we’re practicing today is completely different than the vascular surgery we practiced even 10 years ago, and this is leading to better outcomes for our patients.

— Dr. Noah Scherrer of tPA (clot-busting medicine) to break up clots more quickly. “EKOS® has shown that by applying the ultrasound waves versus just the tPA, you can actually reduce the amount of medicine you give and reduce treatment time,” says Scherrer.

Vascular

Detecting Disease and Developing Treatments With diseases that can result in fatal consequences, vascular treatment alone is not enough. A large part of Surgical Care Associates’ practice is diagnostic screenings to detect conditions early, including abdominal aortic ultrasound to detect aneurysms, carotid duplex for stroke prevention, and ankle-brachial index (ABI) to detect peripheral artery disease.

The practice is also active in clinical research trials for the management of peripheral vascular disease, allowing them to be on the leading-edge of new treatments and technology.

Whatever the vascular concern, Surgical Care Associates has an approach tailored to fit the patient’s anatomy and individual needs.

Surgical Care Associates treats all types of venous conditions, from varicose and spider veins to life-threatening conditions such as deep vein thrombosis (DVT) and pulmonary embolism. For varicose and spider veins, outpatient sclerotherapy is performed. Saphenous vein ablation is used to treat increased pressure in leg veins caused by venous insufficiency.

DVT, when a blood clot forms in a deep vein, can cause complications in the leg that can lead to amputation, as well as pulmonary embolism, which can be life-threatening. “We have a number of products at our disposal in the operating room to suck the clot out physically or break it up through other mechanisms,” says Scherrer. Among the most effective techniques is catheter-directed lysis. “If it’s a significant DVT, we can access the vein in a number of locations and put a catheter through the clot that secretes a clot-busting medicine that works to reduce the clot much faster than traditional methods.”

Another new technology, the EkoSonic® Endovascular system with Acoustic Pulse Thrombolysis™ treatment, combines ultrasound waves with the administration ISSUE #102 25

Complementary Care

How to Succeed in the Business of Medicine

BY JAN ANDERSON, PSYD, LPCC

As a baby boomer, mine is the last generation to approach our careers, financial prospects, and life in general with the assumption that we will do better than our parents. These days, we not only worry about outliving our retirement nest eggs, but also about the very real possibility that our children – whether they be GenXers or millennials – may not be able to do as well, much less reach or surpass the standard of living that we have enjoyed.

For those who do try to better themselves through education, will they be able to make it pay off? After the student loans are paid off?

Most doctors go into the practice of medicine because they feel a calling to help, to heal, and to serve. But it’s gotten more complicated.

Whether they’re in private practice or working for a hospital, it’s increasingly important for physicians to understand the big picture and the business side of the industry, so they can do their parts to help their institutions be successful in a delicate and often volatile economy.

My son just started medical school. Right now, he’s just worried about making it through the next eight weeks. Me? I’m thinking about his longer-term prospects. So when I was invited as a representative of MD-UPDATE to sit in on “The Business Side of Medicine,” a non-clinical course in the U of L School of Medicine curriculum for all residents, I jumped at the chance. The course, designed and developed by Dr. Bonnie Mason, founder and CEO of Beyond The Exam Room™, is designed to help residents make the transition easier by focusing on practical topics such as how to analyze and negotiate an employment contract, personnel and practice management, financial planning, debt management and elimination, and the newest implications of healthcare reform.

The “Other Side” of Medicine Mason developed the course to give res-

idents something she didn’t get in medical school – the business skills needed to maintain financial viability as they transition into an increasingly complex industry. Mason is now in the process of expanding her CMEaccredited program into partnerships with universities like her alma mater, Morehead School of Medicine, as well as hospitals and physician groups and associations.

I can relate. I had to learn the “other side” of behavioral health the hard way. I graduated into the middle of a recession, so out of expediency, I entered the corporate world — and found myself better off from learning to live in the bottom-line, results-oriented world of commerce and business. It helped me avoid becoming a bobble-head therapist and gave me the entrepreneurial skills I needed to start my own private practice. It also made me more effective with my clients, most of whom are professionals or executives themselves, because I’ve lived and worked in their world.

When Mason’s surgical practice was derailed by rheumatoid arthritis, she “repurposed” herself with a stint at the Kellogg School of Management that resulted in a graduate certificate in executive education.

The result is an ability to communicate business concepts in a way that physicians can understand, digest, and apply, so they can understand financial reports, budgeting, and managing revenues and expenses as well as deliver excellent patient care.

the terms of the contract, such as termination, malpractice, noncompete, benefits, and compensation.”

The Greater Louisville Medical Society (GLMS) has been an official partner with U of L since the course was started four years ago. “We’ve learned a few things since the program’s inception,” says Bert Guinn, CEO of GLMS. “The art of contract negotiation has been the most popular aspect of the program.

Having seasoned physicians and attorneys teach our residents what to watch out for and what to fight for when negotiating is really important.” For example, residents can roleplay negotiating a higher base salary, a more robust sign-on bonus, more vacation weeks,

Relationship and Life Strategist Counseling for Executives and Professionals Private, Discreet Setting No Sign, No Waiting Room

Show Me the Money Business skills, even for hospitalists, are relevant because many physicians sign their first contracts without consulting a financial or legal advisor and leave that job within two years. U of L Vice Dean for GME and CME John Roberts says, “We give the residents a sample employment agreement and have an expert panel of attorneys help them analyze

Available for Speaking, Training & Workshops

502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC

26 MD-UPDATE 1904_16_UpdateMD_Update_Ad.indd 1

8/10/16 5:23 PM

Complementary Care

or the ability to moonlight within or outside of an organization.

Deron Bibb, MBA and vice president of Practice Management Services at iHealth Solutions and a volunteer expert panelist observes, “Eager to get out from under their student loans or caught in the crosshairs of government intervention, I see a ‘run for shelter’ mindset to employment by hospital systems, but it rarely is. I find myself reminding physicians that they are the primary revenue producers for the hospital system. My message is ‘Don’t expect the hospital system to make your best interest or job satisfaction a priority.’”

Money Isn’t Everything Mason emphasizes that it’s important to cover all the bases in an employment contract so the focus on compensation is balanced by taking into account key contractual items, such as the noncompete clause, the termination clause, and liability insurance – things that can make your life miserable if you don’t pay attention to them up front.

For physicians experiencing burnout, who wish they had been more in touch with what was important to them when they were first starting out and are now exploring how to reinvent themselves so their jobs better reflect their priorities, the main concern may be negotiating time off or more flexibility and the ability to manage the total number of work hours.

“Business skills to understand the other side of the industry are crucial, and I think it really gives our residents a leg up on residents from schools that do not provide such training,” says School of Medicine Dean Toni Ganzel. “We are now working with our CME unit to see how we can expand to include practicing physicians. Whether you’re transitioning into or between practices, it’s really about being better informed so you make better decisions.”

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ISSUE #102 27

News

Trager Transplant Center Relocates and Expands Services LOUISVILLE KentuckyOne Health announced

the relocation of the Trager Transplant Center, one of the leading providers of organ transplantation in the country. The center, a joint program with the University of Louisville School of Medicine and KentuckyOne Health, has moved from its previous location at Jewish Hospital to the newly-renovated third floor of the Frazier Rehab Institute building to allow for expansion and improved patient care.

The transplant department previously resided in approximately 10,000 square feet of space at Jewish Hospital, and only had six exam rooms. According to KentuckyOne Health officials, the move to Frazier Rehab Institute allows for better patient flow, improved patient satisfaction, and will alleviate congestion. Construction of the new space began in January 2016.

The new space provides a larger area for the transplant department, including 16 exam rooms, four consultation rooms, and additional space for the department staff and transplant doctors. The project involved the

Habimana Joins Floyd Memorial’s Pain Management Center NEW ALBANY, IND. Floyd Memorial Hospital’s Pain Management Center has added a new physician to its staff to aid those patients suffering from chronic and acute pain.

Patricia Habimana, MD, a pain management specialist and board certified anesthesiologist, earned her medical degree from the University of Louisville. She completed both her anesthesiology residency and pain management fellowship at the University of Kentucky. Habimana’s professional experience comes from a background in emergency and nuclear medicine, and she has participated in both anesthesiology and 28 MD-UPDATE

Surgical oncologist Kelly McMasters, MD, PhD, addresses the crowd on behalf of Organ Transplant Surgery Director Christopher Jones, MD.

Steve Trager, chairman and CEO of Republic Bank, cuts the ribbon for the expanded Trager Transplant Center.

renovation of 18,000 square feet of space, and will allow the solid Health transplant Jewish Hospital and U of L Director of organ transplant programs to be Cardiovascular and Thoracic Surgery team physicians Mark in one place.

Mark Slaughter, MD, spoke about the Slaughter, MD, and A ribbon-cutting and growth of the Trager Transplant Center. Kelly McMasters, unveiling of the new Trager MD. Transplant Center at Frazier Rehab Institute Since 1964, the Jewish Hospital Trager was held on Tuesday, August 2. On hand Transplant Center has transplanted thousands were Steve Trager, chairman and CEO of of organs. The Center is nationally recognized Republic Bank, and family, KentuckyOne for performing Kentucky’s first adult heart, Health executives Joseph Gilene, president pancreas, heart-lung, and liver transplants, of Jewish Hospital and downtown market as well as the first minimally invasive kidney leader, and Leslie Smart, division vice donation in Kentucky. president of development, and KentuckyOne

physiology clinical research projects. In her practice, her focus is on treating pain using a comprehensive, integrative approach – offering both non-invasive therapies and innovative minimally invasive interventional pain procedures. Habiman is also fluent in English, French, Spanish, and Swahili.

Together with James Brent, MD, and Christian Clasby, MD, the Center operates as a patient-centric program, comprised of a team of physicians with specific area of expertise when it comes to treating pain.

Floyd Memorial Medical Group Adds Rheumatology NEW ALBANY, IND. Floyd Memorial Medical

Group - Rheumatology is now among the list of comprehensive service areas the medical group offers to its patients.

PHOTOS PROVIDED BY KENTUCKYONE HEALTH

Fellowship-trained rheumatologist Mohsen Ehsan, MD, and nurse practitioner Natalie Lane, FNPC, make up the former Arthritis Associates of Southern Indiana, now Floyd Memorial Medical Group - Rheumatology. Another provider will be joining the practice this fall.

Ehsan has been serving Kentuckiana’s patients for quite some time. His experience is vast, most notably working as a research physician for the World Health Organization from 1971 – 1972. Ehsan’s fellowships in rheumatology and clinical immunology and connective tissue disease fellowships at Alton Ochsner Medical, New Orleans, and the University of Louisville, respectively, have made him

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com an expert in the care of rheumatic diseases.

Ehsan later became a clinical instructor at the University of Louisville’s Arthritis Clinic. With more than 33 years in private practice, Ehsan is well versed in the area of rheumatology.

James Leads Clinical Trial of Therapy for Brain Hemorrhage LOUISVILLE A Louisville patient is the first to be enrolled in a national clinical trial to test a new treatment for patients who have suffered a ruptured brain aneurysm.

The trial, based at the University of Louisville under principal investigator Robert F. James, MD, associate professor in the Department of Neurosurgery at U of L, will include eight other medical centers in the United States.

James, chief of neurosurgery at University of Louisville Hospital, part of KentuckyOne Health, and chief of the Division of Cerebrovascular and Endovascular Neurosurgery at U of L, is leading the ASTROH study, a phase II, randomized clinical trial to determine whether a continuous 14-day, low-dose intravenous infusion of heparin is safe and effective in patients with ruptured brain aneurysms.

The ASTROH study will examine whether the use of intravenous heparin for 14 days following the repair of the ruptured aneurysm will control neuro-inflammation and improve clinical outcomes. Patients who enter University of Louisville Hospital or one of the other participating medical centers having experienced a ruptured brain aneurysm may be evaluated for participation in the trial.

GOING ABOVE AND BEYOND FOR EVERY PATIENT HAS ITS AWARDS. FOR 2016-17, BAPTIST HEALTH LOUISVILLE HAS BEEN RECOGNIZED as the Best Hospital in the city by U.S. News & World Report – earning High Performance ratings in 9 categories, from orthopedics to cardiology. We would like to extend our gratitude and congratulations to the physicians, staff and volunteers who made this possible.

To learn more about our nationally recognized care, visit BaptistHealth.com.

Corbin | La Grange | Lexington | Louisville | Madisonville | Paducah | Richmond

BaptistHealth.com

* EDITORIAL TOPICS ARE SUBJECT TO CHANGE

Issue #103 | October CANCER CARE Oncology, Hematology, Radiology

2016

Editorial Opportunities

Issue #104 | September IT’S ALL IN YOUR HEAD

Issue #105 | Dec/Jan. 2016 PRIMARY CARE AND PEDIATRICS

Neurology, Ophthalmology, Pain Medicine, Mental Health

Primary Care, Internal Medicine, Family Medicine, Pediatrics

TO PARTICIPATE Gil Dunn, Publisher • gdunn@md-update.com • 859.309.0720 CONTACT Jennifer S. Newton, Editor-in-Chief • jnewton@md-update.com • 502.541.2666

SEND PRESS news@md-update.com RELEASES TO ISSUE #102 29

You’re Invited!

Please join us!

Presented by PNC Bank

Saturday, October 29, 2016 Lexington Convention Center Cocktails | 6:30-7:30 p.m.

Silent Auction | 6:30-9:30 p.m.

Dinner | 7:30 p.m.

Performance by Mercy Men following honoree recognition Reservations are limited!

Proceeds benefit the Saint Joseph Hospital Foundation’s mission and outreach programs that build healthier communities.

To Reserve Tickets or For More Information Contact Stephen Clatos Saint Joseph Hospital Foundation P 859.313.2014 | E stephenclatos@kentuckyonehealth.org KentuckyOneHealth.org

Events

Lexington Medical Society Foundation holds 27th Annual Golf Tournament Twenty-two teams and 88 players enjoyed a picture perfect day for golf during the 27th Annual Lexington Medical Society Foundation’s (LMSF) Golf Tournament on Wednesday, August 24, 2016 at the University Club of Kentucky in Lexington.

The first place team, playing for UK HealthCare’s Markey Cancer Center, was Jeff Reynolds, Craig Rogers, Mark Filburn, and Dave Gosky. The second place team, from Quantrell Auto Group, was Billy Gatton Jones, Bill Bridges, Bill Shouse, and Dan Terrell. The third place team, representing Traditional Bank, was Carter Offutt, Tim Schuler, John Reynolds, and Shawn Woolum.

According to Dr. John Collins, chair of the LMSF Golf Tournament, the goal of the LMSF is to support broad based community activities that focus on illness prevention and maintenance of health. LMSF was instruLEXINGTON

John Stewart, MD, teed off to support the LMSF goal of providing financial help to Central Kentucky community health organizations.

LMS Alliance members pitched in to get golfers off to a fast start. (l-r) Julie Nichol, Betty Nolan, LMS Alliance president, and Tracy Francis, Alliance membership chair.

mental in the founding of the Blood Bank of Central Kentucky and providing CPR training courses for the public.

“Our golf outing is presently the major fund raiser for LMSF. The tournament has raised $30-35,000 for the past few years. Our outing has grown from 40 players the first year, to as many as 92,” says Collins. “With this money, the Foundation is able to support organizations such as Ronald McDonald House, Surgery on Sunday, Camp Horsing Around, and several free medical clinics. We have many more deserving organizations each asking for help. We hope to grow our golf outing to be able to fulfill our mission.”

The LMSF also supports medical education and the preservation of Kentucky’s medical history. The Lexington Medical Society is the oldest medical society west of the Allegheny Mountains.

Handling the registration table at the LMSF tournament were (l-r) Chris Hickey, LMS executive director, Cindy Madison, golf tournament coordinator, and volunteer Anna Taylor, executive director, Surgery on Sunday.

A golfing group that always seems to have a good time was (l-r) Tad Hughes, MD, Michael Kirk, MD, Hameed Koury, MD, and Alberto Laureano, MD. PHOTOS BY GIL DUNN

Representing presenting sponsor BB&T Bank and handling the chipping contest were (l-r) John Maher and Susan Potter.

ISSUE #102 31

Events

2016 Lexington Medical Society Foundation Golf Tournament

The first place team, representing UK HealthCare and the Markey Cancer Center, was (l-r) Jeff Reynolds, David Eperson, Mark Filburn, and David Gosky.

A strong team of big hitters was (l-r) Bradley Youkilis, MD, John Voss, MD, David Hawse, MD, and Harold Dennis, PA-C.

(l-r) LMSF president and Golf Tournament chairman John Collins, MD, with Carl Smith, MD, Wendy Cropper, MD, and her husband Sam Cropper.

Playing for the UK HealthCare Transplant Center were (l-r) Tom Waid, MD, Jon Webb, MD, Robin Bradley, and Rob Evans.

32  MDUPDATE

Obviously enjoying a round of golf was the team of (l-r) L. Porter Roberts, Anjum Bux, MD, Matt Smith, and Bruce Kostelnik, DO.

(l-r) David Bensema, MD, Beverly Games, SVMIC, Derek Weiss, MD, and Lisle Dalton, MD, teamed up to support the goals and work of the LMSF.

The Pathology & Cytology Labs team closely examined their scoring opportunities. (l-r) Mike Shepherd, Marian Bensema, MD, Charley Merritt, and Jack Jansen, MD.

Presented by

LEXINGTON MEDICAL SOCIETY FOUNDATION

27TH ANNUAL GOLF TOURNAMENT WHITE TEE SPONSORS

HOLE SPONSORS

BEVERAGE CART SPONSORS

LUNCH & DINNER SPONSORS

Proceeds from the tournament go to care-giving organizations throughout Central Kentucky, including Baby Health Services, Inc, Bluegrass Council of the Blind, Bluegrass Ovarian Cancer Support, Inc, Camp Horsin’ Around, Children’s Advocacy Center of the Bluegrass, God’s Pantry Food Bank, Lexington Medical Society Physician Wellness Program, Ronald McDonald House, Mission Lexington, Radio Eye, Inc, Surgery on Sunday and many more.

The Doctors’ Ball

“

Dance stars till the

come down Rafters. from the

”

Saturday • October 15th 2016 Marriott Louisville • Downtown

6:30 pm • Cocktails & Silent Auction 8 pm • Dinner & Awards Ceremony Black Tie Optional For more information and to purchase tickets go online to KentuckyOneHealth.org/DoctorsBall or call 502-587-4596.

2016 honorees Ephraim McDowell Physician of the Year

Sponsors Presenting

Kelly McMasters, MD

COMMUNity leaders of the year

George and Mary Lee Fischer

Diamond platinum

EXCELLENCE IN education Ronald Levine, MD

Gold

Excellence in community service Erica Sutton, MD

Compassionate physician award Manuel Grimaldi, MD

silver

Business First Cull & Hayden, P.S.C. H&H Design-Build ID+A KentuckyOne Health

Louisville Market Medical Staff

Kindred Healthcare Louisville Magazine PNC Bank Seiller Waterman TEAMHealth