M.D. Update Issue #66 by Mentelle Media

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS NoVember/december 2011

ThE CaRE ConTinUEs Under new roof and with fresh leadership, Cardinal Hill Rehabilitation Hospital is poised to outshine its own legacy as a leader in rehabilitation care.

Special SectioN

Neuroscience

norton neuro & spine Rehab Turns one Frazier Rehab, UofL Join spinal Cord Program  new Brain aneurysms options at Central Baptist 

Volume 2, Number 10



alSo iNSide

 Merger Update with UofL’s Jim Taylor  Medicare Enrollment Revalidation Well Underway

We’re not here for the glory. It’s you, the patient, that’s at the center of everything we do. Based on feedback from you, the inpatient services in all seven of our hospitals have received the J.D. Power and Associates award for “An Outstanding Patient Experience”. Thank you.

Saint Joseph Hospital | Saint Joseph East | Saint Joseph - Berea | Saint Joseph - Mount Sterling Saint Joseph - London | Saint Joseph - Martin | Flaget Memorial Hospital For J.D. Power and Associates 2011 Distinguished Hospital Program SM info, visit jdpower.com.

Contents

November/December 2011 volume 2, Number 10

3 letters

Cover story

4 HeaDliNes 4 Jim taylor, Dman, president & ceo of Umc 5 Gary Payne, ceo of chrh 6 Governor Names KaSPer council 7 FiNaNce 8 accouNtiNg 10 Practice maNagemeNt 12 cover story 16 sPecial sectioN NeuroscieNce 22 News 29 eveNts 32 arts

tHe care coNtiNues

Under new roof and with fresh leadership, Cardinal Hill Rehabilitation Hospital is poised to outshine its own legacy as a leader in rehabilitation care. by megaN c. smitH P.12

oN the cover:

William J. Lester, mD Gary Payne, and russell travis, mD. Photo by Liz haeberLiN

speCial seCtion NeuroscieNce

16 Norton Neruro & Spine rehab turns one

18 Frazier rehab, UofL Join elite Spinal cord injury model System Program

20 New endovascular technologies offer hope for treating complex brain aneurysms November/December 2011 1

volume 2, Number 10 November/December 2011 PublisHer

Gil Dunn gdunn@md-update.com eDitor iN cHieF

Megan Campbell Smith mcsmith@md-update.com sales maNager

Bias Tilford bias.tilford@md-update.com geNeral maNager

Wesley Shears wshears@md-update.com PHotograPHers

to participate in M.d. Update, contact publisher Gil dunn. | gDuNN@mD-uPDate.com | (859) 309-0720

Kirk Schlea Liz Haeberlin

graPHic DesigNer

James Shambhu art@md-update.com

coNtributors:

advertisers index bluegrass oxygen ................................................9 www.bluegrassoxygen.com, 1-800-404-8838 boone creek creamery .......................................25 www.boonecreekcreamery.com, (859) 402-2364 D. Scott Neal, inc. ..............................................23 www.dsneal.com, 1-800-344-9098 Frazier rehab institute ...................................... c3 www.frazierrehab.org, 1-866-540-7719 henkle Denmark ...................................................6 www.henkeldenmark.com, (859) 455-9577 hospice of the bluegrass ....................................31 www.hospicebg.org, 1-800-876-6005 Jewish transplant care .......................................11 www.jhsmh.org/transplant, 1-800-866-7539

KohS ...................................................................3 www.kybones.com, (859) 278-3481 mcbrayer, mcGinnis, Leslie & Kirkland ................27 www.mmlk.com, 1-866-218-5040 maG mutual ........................................................28 www.magmutual.com, See ad for local agents Pain treatment center of the bluegrass .............26 www.pain-ptc.com, (859) 278-1316 x 258 Physicians Financial Services..............................26 www.physiciansfinancialservice.com, (502) 893-7001 republic bank .....................................................24 www.republicbank.com, (859) 266-3547 Saint Joseph hospital ........................................ c2 www.sjhlex.org,

Kentucky audiology & tinnitus Services .............23

Unified trust ....................................................... c4

rhotenwhite@windstream.net, (859) 554-5384

www.unifiedtrust.com, (859) 296-4407 x 202

For aDvertiSiNG iNFormatioN coNtact bias tilForD ď ľsales maNager (859) 539-2058 or biaS.tiLForD@mD-UPDate.com

Bill Henkel Patricia Cordy Henricksen Scott Neal L. Porter Roberts, Jr. Matthew S. Smith

Bias Tilford bias.tilford@md-update.com

iNtegrateD PHysiciaN marketiNg:

Gil Dunn gdunn@md-update.com

Mentelle Media, LLC

921 Beasley Street, Suite 210 Lexington, KY 40509 (859) 309-9939 phone and fax Standard class mail paid in Denver co. Postmaster: Please send notices on Form 3579 to 921 beasley Street, Suite 210 Lexington, Ky 40509 m.D. Update is peer reviewed for accuracy. however, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials. copyright 2011 mentelle media, LLc. all rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher. Please contact mentelle media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. thank you. individual copies of m.D. Update are available for $9.95.

2 m.D. UPDate

letters to tHe editor

Nurses respond to hinkle’s “Who is the Doctor, anyway?” Dear Ms. Smith: A recent article in the October 2011 issue of your publication by Lisa English Hinkle entitled “Who Is the Doctor, Anyway?” comes close to the classical definition of chutzpah. The practice of a profession, such as medicine or nursing, is regulated in Kentucky by a state regulatory board. Each profession has a defined scope of practice, which sometimes overlaps that of another profession. To imply, as Ms. Hinkle does, that the board that regulates medicine, KBML, should have authority over other professions, such as nursing, reinforces the often public perception that physicians are more concerned about control for reasons other than patient care. There is no evidence that care provided by others, such as Advanced Practice Registered Nurses (APRN), is in any way substandard. Just the opposite. As for the title “doctor”, while it is often used to identify a physician, it is a much broader term. There are a myriad of doctoral degrees and each allows the recipient to be addressed as “doctor”. It does not detract from the physician’s ability to provide care if an APRN with a doctoral degree is addressed as doctor. To think otherwise, seems somewhat like paranoia. APRNs have reported consistently that they identify themselves as Nurse Practitioners, not physicians. They are proud of being Nurse Practitioners, and not physicians. According to the recent Gallup Poll of professions, nurses are held in the highest esteem by the public. Ms. Hinkle’s article actually points out the problem of turf battles or attempts

to limit one profession’s scope of practice by another profession. As the Citizen Advocacy Center wrote in 2010, laws passed to limit the scope of practice of a profession, usually at the behest of another profession, “too often protect the economic interests of healthcare professionals by unnecessarily restricting other professions from providing competent, affordable, and accessible care” (“Reforming Scopes of Practice”, Citizen Advocacy Center, July 2010). We should trust the public to make informed decisions as from whom they wish to receive care. Just as each state regulatory board serves the public by regulating its defined professions, each profession could better serve the public by concentrating on its own members, and worrying less about others. Sincerely, Nathan Goldman Kentucky board of Nursing

Dear Editor: Ms. Hinkle’s recent article titled “Who Is the Doctor, Anyway?” contains two errors that merit correction. The first is the title APRN title in our state and the second, and more serious error is the status and her interpretation of the Kentucky Board of Medical Licensure’s (KBML) opinion statement regarding APRN/ MD collaborative agreements. The first error is minor and regards the change in title from Advanced Registered Nurse Practitioner (ARNP) to Advance Practice Registered Nurse (APRN). This change was a result of legislation enacted in order to update Kentucky statutes, making them consistent with the title that is becoming the national standard. This legislation became effective January 2011.

Then second error is more problematic in that if it is taken as fact, could affect the APRN/MD relationship. Ms. Hinkle incorrectly states that KBML will only allow a physician to enter into two collaborative agreements with APRNs. KBML issued their first “guidelines” regarding collaboration in 1997. The initial guidelines did indeed state that a physician could only enter into two collaborative agreements. In 2006 the KBML threatened disciplinary action if physicians did not adhere to these guidelines, thus treating them as if they were regulation. The Kentucky Board of Nursing had objected to the guidelines since they were initiated and its opposition had been largely ignored to this point. In 2007 the Administrative Regulatory Review Subcommittee (ARRS) charged with reviewing and approving Kentucky regulations determined that KBML could not enforce these guidelines as regulations without legislative approval. The ARRS also advised KBML that they could only issue opinions that clearly state that they do not have the effect of law. The old guidelines were pulled from the KBML website and have since been superseded by the opinion statement found here: http://kbml. ky.gov/NR/rdonlyres/195123EC-A98A42E0-8C3A-C6251936913A/0/arnp.pdf. Page 11, last paragraph of the opinion statement clearly states it is up to the physician to determine the number APRNs with whom he/she enters into without citing any restrictions. Sincerely, michael D. aines, aPrN murphy Pain center

sUbMit yoUr letter to tHe editor to MeGan CaMpbell sMitH  MCsMitH@Md-Update.CoM

November/December 2011 3

Headlines

Merger essential to University Hospital’s Continued Growth by gil DuNN

louisville Without a significant change and operate as one teaching hospital with one the addition of medical partners, University medical staff and one leadership group. Hospital is headed into decline. So reasons Community physicians who choose to ask Jim Taylor, DMan, president and CEO for UofL faculty status will be welcomed as of University Medical Center, Inc (UMC), the non-profit corporation which operates University Hospital in Louisville, on why the merger with Jewish Hospital & St. Mary’s HealthCare (JHSMH) and Saint Joseph Health System (SJHS) is necessary for University Hospital to continue to fulfill its mission of serving community needs in its role of academic medical center. “The status quo for University Hospital is not sustainable,” says Taylor. UMC took over operations of University Hospital after hospital management company Columbia HCA left Louisville for Tennessee in 1995. The original UMC board comprised appointees from Norton Hospital, Jewish Hospital, and the University of Louisville (UofL). In 2007 the current 17-member community based board replaced the representation from Norton and Jewish. Now UofL has 6 members on the board, including chairman Robert W. “Bob” Rounsavall, III. Jim taylor, PhD, has been president and ceo of The sub-standard facilities, low University medical center, inc (Umc) for over 15 patient volume, and poor public image years. he says the merger with Jewish hospital that Taylor inherited back in 1996 & St. mary’s healthcare and Saint Joseph health have been completely overhauled to System is necessary to avoid decline in the where now University Hospital has academic center’s fulfillment of its core services. competitive and contemporary facilities, better trained and a diverse staff, and well as the employed physicians.” robust patient volumes while becoming a Furthermore, states Taylor, “There is leading academic medical center. nothing in this merger that is going to force In our interview on November 7, Taylor a physician to change their practice. We are states his optimistic belief that the merger going to honor each physician’s decision.” of the three healthcare partners will occur and the benefits to the professional medical merger addresses Statewide staff and people of Kentucky are numerous. challenges These include expanded clinical research, Taylor emphasizes that the merged organizaincreased training opportunities for all med- tion has the potential of altering Kentucky’s ical professionals, and greater efficiencies physician shortage by vastly increasing the clinical research and training opportunities through improved healthcare delivery. “All physicians will access the merged for medical school residents. Even in the organization and we,” states Taylor, “will short term, the merger will add hundreds of 4 m.D. UPDate

new clinical research sites for cutting edge clinical trials. As medical schools are under pressure to increase their class size, seeking additional training sites is an imperative. “We’ll be adding a dozen new hospitals, including the CHI hospitals in Lexington and Southeastern Kentucky plus the Jewish sites in Louisville, to our teaching facilities,” says Taylor. Taylor adds that the merged organization will also increase the utilization of telemedicine and training opportunities for advanced practice nurses who often work in rural and underserved communities. Taylor points to the economic efficiencies that the merger will bring from both increased buying power and consolidation of expense. Electronic health records under the merged organization will present huge savings for University Hospital, and Taylor says University Hospital will tag along with the single platform employed by CHI for all clinical and business systems. “We will have the ability to do the unique things required for our academic setting,” he says. “This will allow us to seamlessly move patient data from hospital to hospital. Physicians will enjoy the advantage of having their patient data available throughout the entire system.” Among recent accomplishments under Taylor’s leadership are the University Hospital’s 30-year anniversary of the Level 1 Trauma Center; National Accreditation for the Breast Care Cancer Center at the James Graham Brown Cancer Center; a collaboration between UofL and Owensboro Methodist Hospital to produce a low-cost HPV vaccine derived from the tobacco plant; and the Regional Critical Care program at The Stroke Center. “Every day we are training the next generation of care givers,” says Taylor. “That is core to what we do and is very exciting to me.” ◆

Headlines

new Ceo is Fit to lead Cardinal Hill through ppaCa, Uncertain economic Climate by megaN c. smitH

outlasting crisis and Forging opportunity

Call it coincidence, opportunity, or fate, but it was not lost on the Cardinal Hill Rehabilitation Hospital Board of Directors that Gary Payne cut his administrative teeth on the PPS reimbursement crisis of the 80s and 90s. Back in Mexico, Missouri at Audrain Medical Center, the small community hospital where he launched his pharmacy career, the death of his supervisor led to Payne’s sudden promotion to department head. A few years later, he left Audrain for the Gary Payne is the new chance to head up ceo of cardinal hill the pharmacy of the rehabilitation hospital

metropolitan, tertiary care center Boone Hospital of Columbia, Missouri. At that time, the late 80s, Medicare rolled out its prospective payments system (PPS) which, Payne recalled, “scared us to death. We were wondering if we would be able to meet payroll.” One of Boone’s many responses to PPS was to reduce the number of middle managers in the hospital. Left standing, Payne had the opportunity then to take on additional responsibilities and gained his first exposure to inpatient and outpatient rehabilitation, cardiac rehab, radiology, housekeeping... “you name it.” During this time, Payne had the support of Boone Hospital president John O’Shaughnessy, who mentored Payne through his newfound responsibilities and helped him obtain what was called in 1990 the SmithKline Beecham fellowship at the Wharton School’s Leonard Davis Institute of Health Economics for directors of pharmacy who were looking to advance in their careers. Boone made its way through prospec-

Liz haeberLiN

leXiNgtoN For Cardinal Hill Rehabilitation Hospital’s new CEO patient care has always been his first priority. Gary Payne says his roots are in hospitals where he can work closer to patients and their families “in support of the staff and physicians in their work to help patients.” Payne began his career in a Missouri community hospital pharmacy in 1977, rose quickly through the ranks of healthcare administration and, with good fortune in circumstance and opportunity, found himself interviewing for the open leadership role at Cardinal Hill earlier this year. “My varied background was a compelling factor in the board’s decision to bring me here,” said Payne in an interview at the end of his first week on the job where his recent arrival was evident in the sparse appointment of the executive office. “The board and I believe that this is a great fit for all concerned.” His story of professional accomplishment and how he came to be selected as CEO of Kentucky’s largest freestanding rehabilitation hospital illustrates a mutual confidence in their ability to overcome the many challenges facing healthcare today.

tive payments, and Payne learned “that we were going to be able to survive and fulfill our mission of caring for patients.” One of the lasting outcomes of PPS was the alignment of hospitals into the healthcare systems of today. Boone became a member of the Christian Health System based in St. Louis, and soon thereafter Christian Health System joined in the newly formed Barnes Jewish and Christian (BJC) Health System, which ultimately became the largest health system in the Midwest. Payne’s mentor O’Shaughnessy became a senior executive with BJC, and a year later in 1996 recruited Payne from Boone to St. Louis to become a BJC corporate officer, where he served as a vice president for 10 years. “While I was with BJC,” said Payne. “I had the opportunity there to work with an occupational medicine system that we put together for St. Louis area employers, including the St. Louis Cardinals and McDonnell Douglas, which became Boeing.” Payne was instrumental in developing those contracts and overseeing the delivery of their workers’ injury, workers’ health, and general medical care services. Payne also administered BJC’s own self-insured workers’ comp program, which covered 28,000 employees, and he was responsible for the credentialing and verification organization (CVO) for the entire health system which, he estimates, employed about 3000 physicians and probably twice that many therapists and other professionals. It was also Payne’s first exposure to academic affiliation there with the physicians and administrators of Washington University of St. Louis. In 2006, a former colleague approached Payne about joining “a pretty renowned rehabilitation hospital” in Columbia, Missouri. Eager to get back to his roots, Payne accepted the position of CEO of Howard A. Rusk Rehabilitation Center, a joint venture hospital between HealthSouth Corporation coNtiNUeS oN PaGe 9  November/December 2011 5

Headlines

Governor names Kasper advisory Council

In a press statement made on Nov 4, Governor Steve Beshear announced the appointment of 11 health professionals to the KASPER Advisory Council. Made up of doctors, pharmacists, and professionals from the fields of nursing, dentistry and mental health, the panel will issue recommendations for flagging suspicious prescribing habits within KASPER, or Kentucky All Schedule Prescription Electronic Reporting, so that unusual records may be submitted to medical licensure boards for further review or criminal investigation. “While KASPER has been an excellent tool for tracking prescription drugs, this advisory group will fill a gap in the program’s effectiveness in targeting providers who are participating in criminal activity,” Gov. Beshear said. “The professionals I’m appointing know the difference between legitimate prescriptions and what constitutes a pattern of abuse. This is just another way for us to identify and investigate providers who may have become drug pushers.” Gov. Beshear issued an Executive Order creating the council on Oct. 14. The advisory council will work with law enforcement professionals and KASPER offiFraNkFort

cials at the Cabinet for Health and Family Services (CHFS) to create methods for identifying generally accepted prescribing practices among different medical disciplines. The panel’s criteria will be used to guide when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity. Those reports will be submitted to the Kentucky Board of Medical Licensure (KBML), Kentucky Board of Dentistry (KBD), Kentucky Board of Nursing (KBN) or Kentucky Board of Pharmacy (KBP). If prescribing patterns are not acceptable, further internal reviews will be conducted. If unlawful prescribing is identified, the report will be submitted to Kentucky State Police or the Attorney General for investigation. Gov. Beshear, Attorney General Jack Conway and Ky House Speaker Greg Stumbo have announced plans to hold multiple education summits on prescription drug abuse for medical professionals throughout the state. The leaders will also support legislation in the upcoming General Assembly to regulate and license pain clinics and to require use of KASPER among all medical professionals who can write prescriptions. ◆

Healing Growth 6 m.D. UPDate

the medical licensure boards submitted lists of nominees to the Governor to consider for the advisory council. the appointees to the panel are: pHysiCians: dr. Mary Helen davis, CHair, psychiatrist, louisville dr. laxmaiah Manchikanti, pain management physician, paducah dr. William Craig denham, general practitioner, Maysville dr. Corazon a. veza, oncologist, elizabethtown pHarMaCists: sandra p. thornbury, vice-chair, pikeville Jackson M. bray, Frankfort Kelly lynn Whitaker, Hickory nUrsinG: Julianne Zehnder ewen, advanced practice registered nurse, lexington dentist: dr. Katherine King, somerset sUbstanCe abUse and Mental HealtH proFessional: dr. Michelle lofwall, UK department of psychiatry, lexington CoMMUnity Mental HealtH Center representative: david b. Hayden, regional substance abuse program director, bluegrass regional Mental Health-Mental retardation board inc.

FinanCe

end of year planning Do you agree that making money is not nearly as difficult as keeping it? Part of the financial planning process is to determine legitimate ways for you to hold onto more of your money. Since the end of the year is rapidly approaching, let’s take a look at some items that you may want to consider.

taxes

Most good tax planning begins at the beginning of the year, but it is not too late to look for ways to reduce the tax burden for 2011. Start by looking at the 2010 return for any carryover items, especially capital loss carryforwards. Those can be used to offset capital gains realized this year. In order to identify this year’s gains and losses, be sure to calculate your tax basis for any securities or property that was sold in 2011. The reportable gain or loss from the sale of an asset is the difference between the selling price and the tax basis. You should have your financial advisor or CPA prepare a tax projection that includes both 2011 and 2012 noting any opportunities to shift income or deduc-

currently own, but pay close attention to what each position is worth today and then set stop alerts to protect your profits or to keep small losses from becoming big. Reassess risk tolerance and risk BY Scott Neal capacity and be sure that your portfolio is in line with those.

cash Flow

Now is a great time to review your spending for 2011 and to set some goals for 2012. Recall that after you pay your taxes and debts, there are only three things that you can do with each dollar of income: save it, spend it, or give it away. Make informed choices. Have a system for tracking spending as you move through the year. We have developed such a cash management solution that we will be happy to share with you free

Have you maximized your retirement contributions this year?

tions from one year to the other and looking for any possible way to reduce the total tax bill. Use the projection to assist in the early collection of data for tax preparation. You don’t have to wait to collect W2’s, K1’s, and 1099’s. Use year-to-date data and add in assumptions for the remaining of 2011. Then consider projected changes for 2012.

investments

The recent market volatility may have you down in the dumps when it comes to investments; however, now is not the time to give up. Instead, seize the opportunity to re-establish your goals and objectives, to assess your current portfolio and to identify gaps between what you have and what you need in order to attend to your goals. Are you more concerned with beating the market or earning a non-negative return? Do not become overly concerned with what you paid for the asset that you

for the asking (see my email at the end of this piece).

insurance

Has 2011 been a year of change for you? If any part of your financial life has changed for better or for worse, now would be a great time to review your insurance coverage. Health, life, disability, property, and liability coverage should all be reviewed at least once every two years. Identify the cost of insurance, especially that of life insurance. Get competing quotes on health and property coverage. Determine that your beneficiary designations are what you want them to be. Review health savings account contributions to insure that you have contributed the maximum possible. Over 55? You may increase your contribution by $1,000. If deductibles have been met, consider having elective procedures performed this year. If

they have not been met, consider putting off the elective treatment until early next year. Be sure that you spend the balances in flexible spending accounts that you will lose if not used. Over 65? Review Medicare Supplement options each year?

retirement accounts

Have you maximized your retirement contributions this year? If you turned 50 this year, you can make catch-up contributions to some retirement accounts and IRA’s. Review Traditional IRA’s for possible conversion to ROTH. Did you become 70 ½ this year? If so, you have until April 1st 2012 to take the first required minimum distribution, but you will then have to take two RMD’s next year and pay the taxes on both in 2012. Carefully calculate which is best. Check beneficiary designations for each retirement account.

estates

Many people think that because the federal estate tax exemption is now $5 million, that planning is not necessary. Nothing could be further from the truth. It is every bit as important as ever in order to meet the needs of your survivors and to control the disposition of your estate. Conduct a year end review of all your legal documents to insure that they still contain your wishes. Prepare a road map for your heirs that let them know where important documents can be found. Insure that beneficiary designations are up to date and that each beneficiary is still capable of inheriting and managing the assets that you direct their way. Confirm that your chosen executors and trustees are still available and willing to serve. Don’t have documents, make the appointment with an estate attorney now. This list is by no means exhaustive, but should be used to stimulate thought. Get these things off your mind and enjoy the holidays. Scott Neal is President of D. Scott Neal, inc. a fee-only financial planning and investment advisory services with a presence in Lexington, Louisville, and cincinnati. contact him via email at scott@dsneal.com or 1-800-344-9098. ◆ November/December 2011 7

aCCoUntinG

employee theft and Fraud. Could this happen at your practice? Over the last few years, occupational fraud has increasingly made news headlines. This year, local headlines about employee thefts of cash at Big Brothers Big Sisters and prescription drugs at a business in Paducah show that employees steal from their employers right here in Kentucky. But it couldn’t happen to your practice, right? That’s what these organizations thought too. How could someone steal funds from your practice? Let’s consider the Fraud Triangle. Each corner of the Fraud Triangle represents something that must be present in order for an employee to commit fraud. The three corners are: Pressure: The financial strain or force causing a need. Rationalization: The ability of the perpetrator to justify their actions. Opportunity: The circumstances that allow the fraud to happen. Here is an example illustrating a fraud scheme at a private practice: An office employee’s spouse loses his job and her family is forced to live on only her salary (Pressure). When taking a co-pay collections deposit to the bank, she takes $100 cash from the deposit, telling herself she will repay it once her husband finds work (Rationalization). She has access to the accounting and billing software and she alters the information in both systems to adjust the $100 as an uncollectible adjustment (Opportunity). Eventually her husband finds work and at best, she stops without repaying, but more likely, she continues, as no one has noticed. At $100 per day, she is taking over $25,000 per year out of the owners’ pockets. As shown in this example, the corner of the triangle that you have the most control over is Opportunity. Fortunately, there are measures that can be put in place to combat the risk of fraud in even the smallest of practices.

basic anti-Fraud measures

Bank and credit card statements should not 8 m.D. UPDate

be mailed to the same location as the employee writing the checks, and the monthly bank account reconciliation should be outsourced or completed by BY L. Lisa Porter english roberts, hikleJr someone without check writing duties. This will prevent one employee from having complete control over the recording and reconciliation functions. Owners should take a few minutes to briefly review these statements each month for anything out of the ordinary. Employees handling cash or maintaining financial records should be bonded and insured. This insurance coverage reduces the financial strain on the practice if a fraud occurs and shifts the burden of collecting from the perpetrator to the insurance company. The employee opening the mail and collecting payments should stamp all payments “For Deposit Only”, and prepare a listing of all payments received for the day. This employee should not have access to the billing software. The deposit for the day should be reconciled to this listing and the billing reports. Deposits should be made daily by someone without access to the accounting and billing software. Payroll preparation services should be outsourced, and employee time should be reviewed and approved by management. These measures reduce the risk of fraud related to payroll and withholdings, and reduce the likelihood of employees padding their hours. In addition to these specific measures, smaller organizations should consider mandatory job rotations or vacations. Frauds are frequently uncovered by someone filling in for the perpetrator. Another common detection method is by management review. You, as the owner, need to set the tone at the top. Procedures,

including adequate oversight, should be standardized and followed by everyone. Blank check signing, approval of bills without adequate review, not requiring invoices for each credit card transaction, and failing to review financial reports are all behaviors that increase the opportunity for fraud. Employees who commit fraud exhibit many similar behaviors. These behaviors are referred to as red flags. Some of the red flags frequently observed are: Living beyond their means Financial difficulties Unwillingness to share duties Unusually close association with vendor Divorce/family problems The Report to the Nations on Occupational Fraud and Abuse published in 2010 by the Association of Certified Fraud Examiners highlights the pervasiveness of fraud in today’s environment. Based on over 1,800 reported cases, the median loss due to fraud for organizations with fewer than 100 employees was $155,000. Frauds lasted an average of 18 months before being detected, and small organizations are disproportionately victimized by occupational fraud since they are typically lacking in anti-fraud controls. Fortunately, when anti-fraud controls were in place, the duration and amount lost were drastically reduced. As you can see, the risk for occupational fraud is real and when it happens, it costs real dollars. To decrease your risk, you should determine what additional controls or improvements to existing procedures may be warranted. Medical practices, along with the rest of the business world, are always changing and there is no better time than now to examine your processes, systems and controls. You will be glad you did. L. Porter roberts, Jr., cPa and matthew S. Smith, cPa, cFe are with the medical Services Group of barr, anderson & roberts, PSc in Lexington, Ky. if you would like more information, they can be reached via email at lproberts@barcpa.com and msmith@barcpa. com and via telephone at (859) 268-1040. ◆

Photo coUrteSy oF barr, aNDerSoN & robertS, PSc

CoaUtHored by MattHeW s. sMitH

 coNtiNUeD From PaGe 5

new Ceo is Fit to lead Cardinal Hill through ppaCa, Uncertain economic Climate and the University of Missouri-Columbia. There resides the Physical Medicine and Rehabilitation (PM&R) department of the University of Missouri School of Medicine – precisely the same model as Cardinal Hill’s academic affiliation with UK. Howard Rusk was the New York physician who famously recognized that injured soldiers returning from WWII were losing their functional capacity as they laid about waiting to recover, the conventional recovery of the time. Rusk got those soldiers up and moving again, and his work with injured veterans defines Rusk as the father of PM&R. Seventy years later while heading up the Rusk Rehabilitation Center, Payne imbued his work with a personal mission to combine “patient care, significant outcomes for patients and their families, and the training up of new physicians, new therapists and nurses. “The educational component has always been something very close to my heart,” he said.

for policies that they believe are appropriate and fair. Ignoring rehab in its capitation equations, the Patient Protection and Affordable Care Act (PPACA) threatens the access to and the viability of rehabilitation care going forward. “As a corollary to that, whatever new policies or reimbursment plans are established, we will have to prepare ourselves to deal with that in a fiscally sound way,” said Payne. “Just like when PPS hit back in

the 80s, we really have to think about our response so that we can remain financially viable to continue our mission. “The role of accute care hospitals is to prepare the patient for their next level of care, which gets me back to why we do rehab in the first place. When a patient has suffered some malady that creates a physical disability, Cardinal Hill’s role and mission is to bring that patient to the place of maximum ability.” ◆

Fit to Lead

Just prior to joining Cardinal Hill, Payne had spent two years filling interim CEO positions across HealthSouth’s mid-Atlantic hospitals. This work, he recalled, entailed lots of air travel but never a day off. So, when he was contacted about the opening at Cardinal Hill, he recognized that both he and the job made a great fit and threw his hat into the ring. Now with his frequent flyer card retired, Payne is focused on achieving the goals set forth by Cardinal Hill’s board of directors in a manner that is financially sound because “the healthcare economic outlook is a very tricky thing right now.” Payne said one of his primary focuses would be on issues of policy, reimbursement, and making sure that “policymakers understand the implications that certain policies have on the organization.” Cardinal Hill is a strong advocate for persons with disabilities and is striving November/December 2011 9

praCtiCe ManaGeMent

Medicare enrollment revalidation Well Underway additional certification statement must be printed, signed, dated, and mailed along with the required supporting documentation. While the revalidation process extends to BY Patricia cordy henricksen March 23, 2013, it is important that you do not file prematurely. You must wait for the formal request from your Medicare contractor and then you must submit the new enrollment application within 60 days from the date of the letter, or face certain punitive action, e.g. loss of privileges for up to three years. It is also important to note that the notices are being sent via regular U.S. First Class mail, not Certified mail and also not electronically. When the Medicare contractor mails the request, it assumes receipt, therefore, you must be vigilant with respect to reviewing incoming mail from CMS between now and March 23, 2013, as notification can arrive at anytime up to that date and it must not be overlooked. HIPAA Covered entItIes requIred to In order to allow uPgrAde to HIPAA 5010 by JAnuAry 1, 2012 providers to be proacThe CMS Office of E-Health Standards and Services (OESS) tive and assure that a issued notification on November 17, 2011, that HIPAA 5010 revalidation request has enforcement would be delayed until March 31, 2012. This not yet been sent (or delay has been enacted because so many covered entities sent and not received), have notified OESS that they are still awaiting software CMS is posting a list updates and they would not be ready to comply with the of notified providmandated transaction standards by January 1, 2012. While ers as the requests are enforcement has been delayed, it is important to issued, listing the name note that the implementation date has not changed, and National Provider and providers must still meet the compliance Identifier (NPI), as deadline of January 1, 2012. Covered entities not well as the date on the ready by January 1st will have to provide evidence that they letter sent to the proare making a good faith effort to comply with the new HIPAA vider. This listing may standards. This conversion to 5010 will affect transmission be viewed at: www. of all healthcare transactions, including eligibility, claims cms.gov/Medicare processing, claim status inquiries, and remittance. Covered Provider SupEnroll/11_ entities will not be paid for services if they are not in Revalidations.asp where compliance by January 1, 2012, or do not provide proof of a a sample revalidation good-faith effort to be in compliance no later than the extension letter is also posted. If date of March 31, 2012. ◆ your name is on the list

More than 750,000 physicians nationwide who enrolled as participants in the Medicare program prior to March 25, 2011, will be receiving notices by mail from CMS to revalidate their enrollment records. Section 6401(a) of the Patient Protection and Affordable Care Act (PPACA) mandates that all providers and suppliers who provide medical services to Medicare and Medicaid beneficiaries revalidate their enrollment in the program under new screening criteria. This sweeping revalidation process, extending until March 23, 2013, is an attempt to purge the system of individuals who may illegitimately hold CMS billing privileges. According to CMS, physicians who entered the system after March 25, 2011, are exempt from revalidation, as their enrollment applications were processed using the new CMS criteria. As soon as the revalidation notification is received, an application should be submitted through the CMS PECOS, or Provider Enrollment, Chain, and Ownership System, on-line enrollment system at https://pecos. cms.hhs.gov. The revalidation application will be submitted electronically, but an

10 m.D. UPDate

but you have not yet received the revalidation request, you will need to immediately contact CGS Administrators, the Medicare contractor for Kentucky, at 1-866-276-9558. If you receive notification that your enrollment has been revoked, either because of failure to respond within the 60 day time-frame or because a notice for revalidation was not received from CMS, you do have two options. You may submit a corrective plan within 30 days of the revocation explaining why you did not respond to the revalidation notification or, within 60 days from the revocation, you must submit a request for reconsideration to Medicare asking that the revocation of enrollment in the CMS program be rescinded. Recent good news was issued on October 14 regarding two of the enrollment requirements. CMS Administrator, Donald Berwick MD, issued a statement that the field for answering the question, “Do you accept new Medicare patients?” and the field for listing advanced diagnostic imaging services that the physician might provide to Medicare patients (Section L – Advanced Diagnostic Imaging Supplies) are now optional, so applications will no longer be denied if these two fields are left blank. While this revalidation for enrollment proceeds, the American Medical Association has expressed concerns to CMS. According to AMA President, Peter W. Carmel MD, “We have very significant concerns with this revalidation effort in light of problems physicians have had with reenrollment and revalidation in the past, therefore, the AMA is making this a priority and urging CMS to reconsider this action.” For more information go to : www. ama-assn.org (search CMS revalidation) or to www.cms.gov/center/provider.asp. Patricia cordy henricksen, mS, chca, cPc-i, cPc, ccP-P, PcS, is senior vice president of Soterion medical Services and is a certified instructor of the Professional medical coding curriculum for the american academy of Professional coders. more information is available at www.soterionmedical.com and by calling (859) 233-3900. ◆

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November/December 2011 11

Cover Story

the Care Continues

Under new roof and with fresh leadership, Cardinal Hill Rehabilitation Hospital is poised to outshine its own legacy as a leader in rehabilitation care.

By Megan C. SMith featuring photography By Liz haeBerLin Lexington If you have been waiting to get your patients into Cardinal Hill Rehabilitation Hospital, then here is some good news: The wait is over. This past September, Cardinal Hill dedicated the brand new Patient Care Building and, for the first time in the hospital’s 61-year history, opened up 94 private rooms in the now 232-bed hospital. Hospital medical director William J. Lester, MD, is thrilled about the upgraded facility, which adds new gyms and a modern aquatic center. “It’s a big difference when we have a lot more treatment space for the patients and a good environment to help patients feel comfortable being here at the facility,” he says. Lester points out that the new patient rooms are also larger and easier to maneuver. “Larger room sizes improves patient services and care,” he says, and serve an important purpose for this hospital where inpatient clients participate in three hours of therapy every day and essentially spend each waking moment relearning how to perform activities of daily living (ADLs) according to their new functional capacity following an accident, injury, or illness.

Cardinal Hill Hospital medical director William J. Lester, MD, finds that the larger, private rooms in the new patient Care Building help more patients attain functional independence and a safe discharge back to the community.

12 M.D. UpDate

Building Blocks of Independence

The design of the new Patient Care Building not only addresses some longstanding challenges for Cardinal Hill, but it also lays the foundation for continued improvements in patient outcomes. “One of the big issues we have in healthcare right now is the infection rates in the acute care setting,” says Lester, a physiatrist and admired provider among the hospital’s clientele. Lester says the challenge is “to provide a safe environment for patients to transfer here and start their rehabilitation care.” The new, private rooms permit isolation of patients with hospital-acquired infection, such as MRSA (methicillinresistant staphylococcus aureus), while allowing them to get started on rehab right away. Similarly, Cardinal Hill’s new vetilator program makes an enormous difference in the functional independence that a person with traumatic brain or spinal cord injury can attain as it supports patients requiring respirators without delaying the start of therapy. “We can now get these people started on the road to recovery much sooner,” says assistant medical director Russell Travis, MD, a neurosurgeon turned towering advocate for persons with disabilities. Meeting the rehabilitation needs of persons who have suffered traumatic brain injury, traumatic spinal cord injury, and even non-traumatic injuries such as MS, Parkinson’s, and cerebral palsy, requires the coordinated effort of at least a dozen specialties providing round-the-clock care. According to Travis, Cardinal Hill’s commitment to a large staff of physical therapists, occupational therapists, speech therapists, respiratory therapists, neuropsychologists, school teacher, social workers, and 24-hour nursing and physician care. “We have this multi-specialty group here to teach people to function with what they have,” says Travis, “and to accept what they have.” Comparing the discharge to commu-

russell travis, MD, assistant medical director of Cardinal Hill Hospital, is a towering advocate for persons with disabilities. He believes that Cardinal Hill must advocate for healthcare policy that protects access to rehabilitation care for a population that, “besides Cardinal Hill, has no organized lobby.”

nity rates of rehabilitation hospitals to discharges to community in nursing homes or extended care facilities, the impact of rehab is evident. “The end result is that about 87% of our patients go home, back to the community, as opposed to institutional care where only 35% of nursing home patients go home,” says Travis. He also points out that rehab, under the proposed Patient Protection and Affordable Care Act (PPACA), is under direct threat. He says that the accountable care organization (ACO) model incentivizes primary care to refer to nursing homes over rehabilitation hospitals in an effort to save money. “I’m afraid that primary care doctors and the government with their ACOs are going to miss the boat if they don’t realize how much more expensive it is in the long run if the patient is sent back to a nursing home rather than going home,” Travis cautions. On the job for a few weeks now, Cardinal Hill Rehabilitation Hospital’s new CEO Gary Payne recognizes that advocating for policy that benefits people with disabilities will be essential to enabling the hospital to fulfill its mission in a financially sound way. “That’s always going to be a top priority for us,” he says. “Rehabilitation in my estimation provides the best outcome measures and the best database of any other segment of healthcare,” he says. “At the rehab level, we

Cardinal Hill Home Care program manager pam Heissenbuttel, MSpt, makes sure that patients can function independently once they return home.

NoveMBer/DeCeMBer 2011 13

Cover Story

M.D. UpDate

Sara Salles, Do, is the medical director of the spinal cord unit. Salles believes that the UK-Cardinal Hill affiliation heightens the expertise of both organizations.

academic affiliation

“People don’t really understand what we do at Cardinal Hill,” says Sara Salles, DO, medical director of the spinal cord unit and a physician with the UK Department of Physical Medicine and Rehabilitation housed at CHRH. “Personally, I find pleasure educating my peers, wherever they are, about the complement of services that we are able to provide at Cardinal Hill.” The UK PM&R program, which brings four new residents to Cardinal Hill each year, is involved in numerous research programs on stroke, brain injury, and spinal cord injury recovery. Some of the latest research investigates the use of transcranial magnetic stimulation (TMS) in conjunction with the Lokomat to improve gait and mobility in chronic spinal cord injury. The Lokomat assists walking movements of gait-impaired patients and is an effective inter14 M.D. UpDate

M.D. UpDate

can determine what to do based on the patient’s functional status upon admission.” Following that progress throughout the course of therapy and beyond discharge, Cardinal Hill can input innovative changes into their protocols and see immediately the effect of innovation on the desired outcome.

vention for improving over-ground walking function in neurological patients. Cardinal Hill is fortunate to have a Lokomat, which was provided by an anonymous donation on behalf of one of Salles’ patients.

Continuum of Care

If you think of the continuum of rehabilitation care as a journey from a life-altering, acute injury to maximum functional status with independence in daily living, then think of Cardinal Hill’s rehabilitation programs as steps along that journey of recovery. For most, post-acute rehab begins as an inpatient in one of the hospital’s condition-specific units: stroke, traumatic brain injury, spinal cord injury, general rehab (amputations, wounds, multi-trauma, and burns), pulmonary, and orthopaedic/ general surgery. The largest of these units – stroke – provides intensive therapy for nearly 500 patients each year. According to David Jackson, MD, a physiatrist who has been on the stroke unit for over 25 years, helping patients in stroke recovery begins at the acute care center before transfer to Cardinal Hill. Each day, Jackson makes rounds to central Kentucky’s acute care hospitals to provide rehab consults for physicians and families,

t. J. richardson, MD, internist and medical director of Cardinal Hill’s skilled rehabilitation unit, provides medical management of patients’ comorbidities. this permits patients to stay on their course of therapy and get home faster.

a highly personalized service, home care continues the multi-therapy recovery and nursing of Cardinal hill inpatient but attuned to the challenge of mastering activities of daily living in the real world. advocate for transfers to rehab care, and prepare the seamless transition for individual patients entering post-acute care. Seeking excellence in coordination of care, Jackson says, keeps rehospitalizations low and accounts for his esteem among referring physicians. “From what I understand about healthcare law, rehabilitation is not part of ACOs,” he says. “That is why it is so important for us to make sure the physicians and hospitals are knowledgeable enough about what rehabilitation does.” Sub-acute unit medical director T.J. Richardson, MD, sees a similar conflict between short-term cost and long-term independence when advocating for patients to get the rehab care they need. This level of care is a unique rehab platform that is especially beneficial for older patients presenting with comorbidities – diabetes, hypertension, congestive heart failure - who need more time to recover before returning to the community. It is also appropriate for orthopaedic patients who do not require three hours of therapy a day. As an internist, Richardson manages these patients medically and keeps them on their course of therapy. “Our goal is to make sure that the patient is as independent as they can be when they return home,” says Richardson. “We want them comfortable, we want them confident, and we want them independent.”

Home Care and outpatient therapy

For some patients, inpatient therapy is not the most ideal level of care. They may be more appropriate for home care or outpatient services. Cardinal Hill Home Care program manager Pam Heissenbuttel, MSPT, makes sure that patients can function independently in their own homes. A highly personalized service, home care continues the multitherapy recovery and nursing care of Cardinal Hill inpatient but attuned to

the challenge of mastering ADLs in the real world. Providing safety consults, in-home physical, occupational and speech therapy, nursing and tele-monitoring, home care has the unique mission of “helping patients who are homebound remain in their home safely, improve their func-

Helping parkinson’s patients speak in a louder, functional voice that others can understand, Nancy Nickerson, SLp, guides a patient through the LSvt LoUD outpatient voice therapy protocol.

tional independence, and get back into the community,” says Heissenbuttel. “Being more functional in their home reduces the burden on caregivers and improves quality of life.” Cardinal Hill’s Outpatient Program is another service in their continuum of care, treating the same diagnoses as inpatient or home care. The Parkinson’s Program is one of many specialized programs Cardinal Hill offers in their outpatient continuum. Physical therapist Jessika McCowan works with all types of neurological patients and is especially enthusiastic about the newest physical therapy protocol for Parkinson’s patients called LSVT BIG. BIG is an intensive therapy that recalibrates Parkinson’s patients’ sense of normal movement through repeated movements of the arms, trunk, and legs that are wider, swifter, and larger than

patients would otherwise perceive as normal. “What happens in Parkinson’s is that patients’ world becomes smaller,” says McCowan. “We have to get them to think big and move big.” The counterpoint therapy, LSVT LOUD, retrains Parkinson’s patients to speak in a manner that enables them to be understood by others. Speech therapist Nancy Nickerson emphasizes the intensive nature of the therapy. “We are working in a loud voice that is a very functional voice. It is not to be confused with shouting,” she says, adding that “one of the mysteries behind Parkinson’s disease is that over time, a break down in sensory processing and feedback causes a person with Parkinson’s to be unaware that their voice is getting weaker and more difficult to understand. They think they are speaking at a normal loudness, which is why all LOUD therapy is recommended when the slightest decline in vocal function is noticed.” LSVT LOUD and LSVT BIG are very effective therapies with one caveat: to maintain the protocol’s gains for the next 1-2 years, patients must stick to their home program of exercises twice a day, every day. When patients need additional retraining or have new movement or speech goals, Cardinal Hill Outpatient Therapy can tailor a booster program to help them reach their independence objectives. In every component of this highly integrated system of rehab care, Cardinal Hill’s new CEO Gary Payne finds “a very evident, heartfelt commitment to the work that we do here for the patients and families that have the unfortunate circumstance to need our services.” Says Payne, “I get the distinct sense that everyone involved, whether a nurse or physician, administrator, housekeeper, or a person from foodservice, that they really consider it a privilege to be here delivering the special care that occurs here.” ◆ NoveMBer/DeCeMBer 2011 15

SpeCiaL SeCtion neurosCienCe

Director of operations and rehab services for Norton Hospital Deeann Clark, pt, HCM; NSrC director Mark Sheridan, MSSW; and elizabeth Ulanowski, pt, Dpt, NCS, program manager of the NortonBellarmine Neurological physical therapy residency program.

norton’S innovative neuro & Spine rehaB prograM turnS 1 the neurosciences & Spine rehabilitation Center strives to define what a 21st Century outpatient rehab clinic can achieve. By Megan C sMith LouisViLLe It’s just an observation, but when winding our way through healthcare environs, we tend to find the most fascinating programs housed deep within the architecture of hospitals. Typical, windowless corridors lead us to program offices, and - once in - we are suddenly immersed in the cosmos of healthcare innovation. Each built with the purpose of making manifest one provider’s vision of excellence in the delivery of their service, it is truly amazing to emerge into these small worlds of healing and realize, as our discoveries reveal time and again, a certain singular 16 M.D. UpDate

truth about healthcare: That which is worth showing off is most certainly hidden from public view. Like, places where people go to learn to walk again. That’s what we found at the Neurosciences & Spine Rehabilitation Center down in the lower level of the Norton Healthcare Pavilion in Louisville: a rehabilitation facility targeted to the recovery of persons with neurological spine conditions, including brain injury, stroke, Parkinson’s, MS, spinal cord injury, and orthopaedic spine injury. This is one of those remarkable places of healing

where dedicated professionals provide tools to people who have suffered a life-altering injury and who are rebuilding their capacity to function independently again. Moreover, this is the kind of place where people dedicated to their profession seek innovative ways to deliver that care more effectively than has been done before. The Neurosciences & Spine Rehabilitation Center (NSRC) is a new program launched just over one year ago and with great excitement for bringing the first Lokomat to the region. Focused on more than just gadgets (and this place has awesome gadgets), Christopher B. Shields, MD, president of Norton Neuroscience Institute (NNI) emphasizes that the success of NSRC will grow from his commitment to recruit the best and the brightest into the Norton system. In his view, rehabilitation care is too often overlooked in the overall management of the patient. “The excitement seems to occur as the ambulance rushes to the emergency department,” Shields says. “But perhaps even more impor-

tant is what happens to the patients after they leave the hospital and they get into a rehabilitation center.” As a multi-therapy outpatient center, NSRC employs physical, occupational, and speech-language therapy, along with the support of neuropsychology and counseling services. “We are the only dedicated neurologic and orthopaedic spine rehab center in the region,” says center director Mark Sheridan, MSSW. “That is all we do.” Sheridan organized the center’s clinicians into two teams, orthopaedic spine and neurologic therapy, and he believes that allowing therapists to specialize in their area of interest allows them to work to their maximum capacity.

elevating the Standard of Care

Part of Shields’ vision for NSRC is elevating the standard of care for neurologic rehabilitation one person at a time. This ambition is demonstrated in the fact that NSRC will welcome in January its first resident in neurologic physical therapy. This collaboration between NNI and Bellarmine University to establish a Neurological Physical Therapy Residency Program will place NSRC among an elite group of educators providing the highly sought-after neurologic specialist certification (NSC) accredited by the American Physical Therapy Association. According to residency program manager Elizabeth Ulanowski, PT, DPT, NCS, the Neurological Physical Therapy Residency Program will give new graduates and young clinicians a chance to spend an entire year seeing only neurologic patients. The residents, who will gain experience in teaching, research, and outreach through Bellarmine, will gain clinical expertise by working in the neurologic rehab units at Norton and at Cardinal Hill in Lexington. “You learn the best by doing it,” says Ulanowski. DeeAnn Clark, PT, HCM, director of operations and rehab services for Norton Hospital, says that’s where Norton comes in. “It’s very important for our program to back up what these clinicians are trying to learn. Being the best means that our poli-

cies, procedures, the way we look at things objectively, the way we are structured operationally – all of these things have to be the best so that these residents can take their experiences from our center and make an impact throughout the country.”

the objective Gym

measure the efficacy gait patterns through pressure, time, length of stride, among other parameters. It replaces subjective visual assessment, and Sheridan says he has found it especially useful in Parkinson’s therapy. The BioDex Gait Trainer is a treadmill based therapy and assessment tool that measures gait speed length to track fatigue over time. In fall prevention therapy, NSRC employs the BioDex Balance System that strengthens patients’ core strength and coordination. Both systems utilize a touch-screen biofeedback interface that includes training programs to help users achieve their therapy goals. Sheridan predicts that in the next 10 years, all outpatient therapy centers will move toward the objective measurement standards that the NSRC uses today. Ulanowski says that these tools help her in the role of recovery educator as patients and their physicians are given concrete data

NSRC’s grand opening gained a lot of attention for bringing the Lokomat to Louisville. Like many therapies, the Lokomat’s automated locomotion therapy is based on the principle of neuroplasticity, which means if you repeat the activity often and frequently enough, then your brain will relearn how to do it. The Lokomat is the machine that helps people learn to walk again. It is not the only therapy nor is it even considered the best therapeutic modality for relearning gait: the TheraStride (of which NSRC has two) is considered the gold standard in this arena. However, the TheraStride is also labor intensive and requires four therapists to operate compared to the one or two needed on the Lokomat. Therefore, the biggest advantage of the Lokomat, among its myriad of benefits to persons seeking locomotor training, is the opportunity to provide more treatment time to more patients. It is also an icon for modern, objective gym. As director of NSRC Sheridan procured equipment that would both treat and assess patients in their prog- Christopher B. Shields, ress toward recovery goals. MD, president of “Historically,” he says, “PT, Norton Neuroscience depicting therapy goals and OT, and speech have been Institute (NNI). the progress. subjective in the way they Lokomat behind him is Not only is the objective an icon of the modern measure progress. Maintaining assessment of patients useful for rehabilitation gym. objectivity was an imperative tracking progress, she says. It is for us we, so we put tools in also useful in the coordination the gym that treat and assess.” In fact, he of care. “For example, many physicians are says, assessment is so important to the referring MS and Parkinson’s patients to us center’s objectives that for some new piec- for gait analysis,” she says. “We also provide es of equipment, assessment is all they do. referring physicians with a plan of care every One of those, she says, is the GAITRite 30 days to make sure that outcomes measures mat. This assessment tool allows PTs to are being appropriately assessed.” ◆ NoveMBer/DeCeMBer 2011 17

SpeCiaL SeCtion neurosCienCe

By Megan C. sMith

UofL and Frazier Rehab Institute have joined the elite National Institute on Disability and Rehabilitation Research (NIDRR) Spinal Cord Injury Model System Program. Administered by the Office of Special Education and Rehabilitative Services of the U.S. Department of Education, NIDRR’s network of research grants supports the development of individual disability and rehabilitation research projects across the country. Researchers at Frazier Rehab Institute and the University of Louisville have been awarded $2.2 million for five years to establish a Spinal Cord Injury Model System. The new research program - Frazier Rehab and Neuroscience Spinal Cord Injury Model System (FRNSCIMS) - will focus on spinal cord injury (SCI) populations of Kentucky, Indiana, Ohio, and Tennessee. The award will support FRNSCIMS in the delivery of comprehensive SCI rehabilitation, and it will establish new locomotor research that has potential to translate rapidly into patient care. According to a joint statement from UofL and Frazier Rehab, FRNSCIMS has three objectives: Provide an integrated, mul-

LouisViLLe

18 M.D. UpDate

tidisciplinary system of rehabilitation care specifically for individuals with spinal cord injury. The FRNSCIMS will broaden the current scope of care provided by Frazier Rehab and UofL by addressing the comprehensive rehabilitative and reintegration needs of patients with spinal cord injury. Conduct an active research program that moves evidence-based approaches to treating spinal cord injury to the clinical setting. In addition to participating with other Spinal Cord Injury Model System centers in at least one collaborative research proj-

ect, a site-specific study of the antispasticity drug baclofen and its impact on locomotion in chronic spinal cord injury patients will be conducted. Enroll at least 30 patients per year – 150 total from the four-state area served by the five-year grant – in the national Spinal Cord Injury Model System database. Sharing data on patients with spinal cord injury with the other 13 Spinal Cord Injury Model System centers will help standardize and improve the methods essential to treatment and rehabilitation of people living with spinal cord injury. FRNSCIMS’s principle investigators are Daniel E. Graves, PhD, Darryl L. Kaelin, MD, and Susan J. Harkema, PhD. Kaelin, who serves as medical director of Frazier Rehab Institute, just joined UofL faculty in June of this year. There, he is chief of the Division of Physical Medicine and Rehabilitation, UofL Department of Neurosurgery. Harkema is a professor with UofL Department of Neurosurgery; director of research at Frazier Rehab Institute; and director of the Christopher & Dana Reeve Foundation’s NeuroRecovery Network. Graves, who joins UofL and Frazier Rehab in December as principal investigator on the grant, previously served as associate professor of physical medicine and rehabilitation at Baylor College of Medicine and the Texas Institute of Rehabilitation and Research in Houston.

testing the efficacy of Baclofen Darryl L. Kaelin, MD

Susan J. Harkema, PhD, who will lead the site-specific baclofen study, explained that the drug has been used for

pHotoS CoUrteSy of UofL

frazier rehaB, uofL Join eLite SpinaL Cord inJury ModeL SySteM prograM

Susan J. Harkema, phD

decades to reduce spasticity in people with SCI. “It’s sort of like ‘Spinal cord injury? Here’s your baclofen.’” She explained that while the baclofen is indeed helpful in stopping the spasms of SCI and makes it easier to care for these patients, the drug has never been tested for efficacy. Locomotor training, she said, involves “driving the nerve system to recovery by using its natural intrinsic capacity.” Harkema and her team now hypothesize that administering baclofen, although it will stop spasm, may stop the potential of an individual with SCI to recover. “We are going to test the drug,” said Harkema. “We’re going to test locomotor training as a way to drive functional recovery with and without the drug of baclofen... If we find out that it’s effective, there will be some strong rationale to give the drug.” Harkema emphasized that the focus of the model systems is to create research that will “impact clinical practice now.”

Daniel e. Graves, phD

Spinal Cord Injury in Context

According to Kaelin, “There are about 12,000 traumatic spinal cord injuries that occur in a year. Most of those occur from different types of accidents, and there are hundreds of thousands of individuals living

the drug baclofen has been used for decades to reduce spasticity in people with spinal cord injury. “it’s sort of like ‘Spinal cord injury? here’s your baclofen,’” said harkema.

in the United States today with the sequelae of spinal cord injury. “When you look around within your own neighborhood, you will see people getting around in wheelchairs. Not all of them have spinal cord injuries, but many of them do. So, this [research] certainly impacts our families, our friends, and the people who are so important to the community of Louisville and the surrounding area.” Kaelin observed that the costs in caring for a person with SCI could be daunting. “The numbers can mount and to the millions of dollars over a lifetime for a person with quadriplegia,” he said. “The services can render everything from a very expensive wheelchair to different types of assistive technology... in some cases ambulatory support and additional caregiver support since you have somebody who now has to give up their livelihood to care for a loved one.” A pressure wound, he said, can run up to $70,000 to repair. Other individual medical incidences, such as recurring urinary tract infections that lead to sepsis or, ultimately, death, result in a higher mortality rate for individuals with SCI. “This kind of research will ultimately lead to healthier people,” said Kaelin. “People who still have spinal cord injury, but people who have better hearts, better lungs, better bellies, better urologic system, and better quality of life.” ◆

NoveMBer/DeCeMBer 2011 19

SpeCiaL SeCtion neurosCienCe BILL StraUSS

Neurosurgeon Dr. Christian ramsey (left) and neurointerventional radiologist Dr. Curtis Given II perform most endovascular brain aneurysm treatments together as a team at Central Baptist Hospital.

new endovaSCuLar teChnoLogieS offer hope for treating CoMpLex Brain aneurySMS By Brenda KoCher

Lexington Neuro interventionalists at Central Baptist Hospital (CBH) have added one more tool in their evergrowing repository of technologies to help patients with complex brain aneurysms. Dr. Christian Ramsey, neurosurgeon, and Dr. Curtis Given II, neurointerventional radiologist, began using the new Pipeline Embolization Device this past summer, shortly after its FDA approval in April. Pipeline is a flow diverter, a stent-like device implanted across the opening to an aneurysm, diverting blood flow into a normal vessel. “Pipeline is exciting because it allows us to treat aneurysms that 20 M.D. UpDate

before were deemed untreatable because of their size, location or other factors,” explains Given. “The advantage of Pipeline is that, with treatment, the aneurysm shrinks in size so that the mass effect of it is relieved, and it can no longer cause symptoms.” CBH was the first facility in Kentucky to offer treatment with Pipeline. The device’s manufacturer, ev3, provided rigorous training on Pipeline to only a select group of experienced endovascular physicians who practice in facilities that do a significant volume of brain aneurysm treatments. Together, Ramsey and Given treat about 100 brain aneu-

rysm patients a year. Both believe volume may grow for surgical treatments because newer technologies have opened up treatment options to patients who were previously told their aneurysms were untreatable.

evolution of treatment

Since the 1930s, surgical clipping has been the most traditional method to treat brain aneurysms. Under general anesthesia, a neurosurgeon performs a craniotomy and the brain is retracted to locate the aneurysm. A small clip is placed across the base, or neck, of the aneurysm to block the normal blood flow. Clipping is still an effective treatment for some patients, but those who are in poor health or those who have large aneurysms that can be difficult to clip may not be good candidates for open surgery. Coil embolization, also called endovascular coiling, was approved by the FDA in 1995, offering the first minimally invasive method of treatment. A catheter is inserted into the patient’s femoral artery and it is navigated through the vascular system, into the head and into the aneurysm

using fluoroscopic imaging. Tiny platinum coils are threaded through the catheter and into the aneurysm, blocking blood flow into the aneurysm and preventing rupture. Another endovascular treatment, liquid embolic embolization, was introduced within the past decade. The procedure to access the aneurysm is similar to coiling, but instead of coils the aneurysm is filled with Onyx HD-500, an embolic material in liquid form that gradually solidifies, blocking blood flow into the aneurysm and reducing pressure and the likelihood of rupture. Both coiling and liquid embolic embolization represented breakthroughs in brain aneurysm treatment that allowed patients to recover more quickly and experience shorter hospital stays. But large (10 to 25 millimeters in diameter), giant (greater than 25 millime-

the pipeline embolization Device, the first flow diverter device approved by the fDa, is made of a flexible braided cylindrical mesh that is placed across the aneurysm neck to impede blood flow to the aneurysm.

ters in diameter) or wide-necked aneurysms still proved challenging to treat until Pipeline was introduced. Additionally, both coiling and liquid embolic embolization involve filling the aneurysm, leaving its mass intact and the

pipeline allows the treatment of aneurysms that before were deemed untreatable because of their size, location or other factors. with treatment, the aneurysm shrinks in size so that the mass effect of it is relieved, and it can no longer cause symptoms such as headaches or visual changes. possibility for it to cause symptoms such as headaches or visual changes.

How pipeline works

During the Pipeline procedure, the aneurysm is accessed similarly to the other

endovascular treatments. The braided, cylindrical mesh device is implanted across the aneurysm neck and blood flow into the aneurysm slows. Over time, blood no longer enters the aneurysm, and the body’s natural healing process works to shrink the aneurysm. Clinical trials in the United States and Europe on the Pipeline device have shown

promising results – no recurrences of aneurysms and low occlusion rates. “Up until Pipeline, patients with large brain aneurysms or patients whose aneurysms had been treated but had recurred didn’t really have a surgical treatment option available to them,” explains Ramsey. “Yes, we could cite statistics that the chance of the aneurysm rupturing over the next five years would be minimal, but it still takes a psychological toll on someone to think that they have something inside them that could rupture and kill them or leave them severely disabled.”

forward thinking

Ramsey and Given perform most endovascular brain aneurysm procedures together. Patients with brain aneurysms who are referred to their practice, Baptist Neurointervention Service, receive both open surgery and endovascular surgery consults when appropriate. “The key is that the patient gets the most appropriate treatment for their unique situation,” says Given. “That’s why it’s important that they are referred to a facility that offers all therapies so that the best option for them is available.” CBH was not only the first in the state to offer Pipeline treatment, but it is the only facility in Kentucky to offer Onyx HD-500 liquid embolic embolization. “We appreciate the forward thinking and commitment of Central Baptist to invest in new technologies in order to offer its patients the latest care for aneurysms,” says Ramsey. Both Ramsey and Given feel it is important that patients who have aneurysms or those who have aneurysms that have been treated should have a neuro consult on a regular basis. “If a patient was told their aneurysm was untreatable as recently as five years ago, we may now have a treatment that’s suitable for them,” says Ramsey. “Patients who had an aneurysm treated 10 or more years ago may want to revisit it because it was treated with older technology. Because people are living longer, we want to make sure their old treatments are intact and will serve them for the rest of their lifetime.” ◆ NoveMBer/DeCeMBer 2011 21

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“extremely well-trained, respected experts in their respective subspecialties within pediatric cardiology/CT surgery/research which allows better care and advances the field,” says Bezold. Outreach efforts and telemedicine links, particularly ECG and echocardiography allow some patients to receive some or much of their care closer to home, states Bezold, which “allows us to care for Eastern Kentucky’s children and adults with congenital heart disease here in Kentucky, avoiding unnecessary transfers and sometimes lifesaving care can be started prior to a patient being transferred.”

physiatrist Joins Kentucky orthopaedic and Hand Surgeons Multispecialty Congenital Heart Clinic opens at Kentucky Children’s Hospital

22 M.D. UpDate

defects, including diagnosis even before birth. The PFEL is also fully accredited in all 3 pediatric areas by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Their website is ICAEL.org. Dr. Mark Plunkett, medical co-director of the Congenital Heart Clinic at Kentucky Children’s Hospital, states that the clinic has performed over 600 surgeries in the last four years on Kentucky children and the heart catherization program has nearly tripled. “Our diagnostic ability is remarkable,” says Plunkett. “We can now prepare parents for the heart surgery that their unborn child will need. We couldn’t do that when I started performing pediatric heart surgery.” Dr. Louis Bezold, medical director of Kentucky Children’s Hospital believes that the Congenital Heart Clinic represents the largest collaborative subspecialty pediatric program at KCH and is one of the most high-profile pediatric programs at the children’s hospital. We have attracted

George P. Boucher, MD has joined Kentucky Orthopaedic and Hand Surgeons. Boucher is a diplomate of the American Board of Physical Medicine and Rehabilitation. Dr. Boucher graduated from The State University of New York at Buffalo (UB) School of Medicine, where he also completed his residency. He held academic appointments in the Department of Physical Medicine and Rehabilitation at UB. As a physiatrist, Boucher specializes in the diagnosis and nonsurgical treatment

Lexington

CoUrteSy of KoHS

Lexington On Monday, Oct 3, the Congenital Heart Clinic opened at Kentucky Children’s Hospital (KCH) in the UK Chandler Medical Center. The Congenital Heart Program provides care in the subspecialty areas of pediatric heart management including outpatient care, diagnostics, echocardiography, interventional catheterization, electrophysiology, cardiac surgery and perinatal cardiology which interfaces with the UK Women’s Health programs and research. Dr. Doug Schneider, medical director of the KCH Congenital Heart Clinic states that “both patient convenience and co-ordinance of care are the outcomes of the move to one location. From in utero through adult patients, we provide seamless, multidisciplinary diagnostic and surgical care.” The Pediatric and Fetal Echocardiography Laboratory (PFEL) at Kentucky Children’s Hospital Congenital Heart Clinic has attained national accreditation by the American Registry for Diagnostic Medical Sonographers in all three pediatric areas: transthoracic, trans-esophageal and fetal echocardiography. This diagnostic tool is effective for assessing congenital heart

Dr. Louis Bezold, medical director of Kentucky Children’s Hospital joins Drs. Doug Schneider and Mark plunkett, medical co-directors of the KCH Congenital Heart Clinic, in celebrating the grand opening of the clinic’s new home in the UK Chandler Medical Center.

Dr. George p. Boucher

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Sekela ranks High in robotic valve procedures

Lexington According to Intuitive Surgical Incorporated, manufacturers of the da Vinci surgical system, Michael Sekela, MD with Surgical Associates of Lexington, has been identified as eleventh in the nation in patient volume for robotic valve procedures. Sekela is quick to praise his team and Saint Joseph Hospital for his successes with the da Vinci platform. “The successes we have had with the da Vinci are the result of the commitment of everyone in the operating room,” he said. Sekela also credits the unique model

of his practice and his partner Theodore Wright, MD, as reasons for his high patient volume. “In most robotic surgeries, there is a surgeon on the robotic console in the corner of the room and a physician assistant at the patient’s bedside. In our practice, we have Dr. Wright, who is also a surgeon, at the patient’s bedside,” Sekela said. With this model in place, Sekela and Wright can work quickly and efficiently with minimal communication. In a da Vinci surgery, Sekela operates from a console translating surgical movements to the robotic arms of the da Vinci system, while Wright operates at the patient’s side, using the images on the monitor.

Second oBGyN Joins Georgetown Community Hospital

georgetoWn Georgetown Community Hospital welcomed a new OB/GYN, Dr. Craig Tilgman, on August 15. Tilghman is a board-certified University of Kentucky obstetrician and gynecolo-

CoUrteSy of GCH

of patients whose quality of life is affected by pain, amputation, musculoskeletal conditions, stroke, brain injury, spinal cord injury and other disorders of the central and peripheral nervous systems. His clinical interest also involves electromyography (EMG) to help evaluate patients with conditions such as carpal tunnel syndrome, peripheral neuropathy and sciatica.

Dr. Craig tilgman

gist. As a member of the UK HealthCare Community-Based Practice located in Georgetown, he will perform routine deliveries and surgery exclusively at Georgetown Community Hospital. He is seeing women for pre-natal, post-natal and gynecological care. Tilghman received his medical degree from the University of Alabama at Birmingham School of Medicine in Birmingham, Ala. He completed a residency at the University of Florida College of Medicine in Gainesville, Fla.

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Bariatric Surgeon returns to Georgetown Community Hospital georgetoWn Georgetown Community Hospital announces that G. Derek Weiss, MD, FACS, FASMBS, of Bluegrass Bariatric Surgical Associates, has rejoined

Georgetown Bariatrics as medical director and bariatric surgeon as of Sep 1. Weiss brings with him many years of experience as one of Kentucky’s premier bariatric surgeons, completing over 6,000 weight loss surgery procedures with his partners. For more information, call Georgetown Bariatrics at (502) 570-3717.

CoUrteSy of GCH

oBfCC-Medical Center South Brings Cancer Care to Bullitt County

Jewish Hospital & St. Mary’s HealthCare has expanded its cancer treatment services with the opening of a new Owsley Brown Frazier Cancer Center (OBFCC) Bullitt County Clinic. The clinic is located in the at Jewish Hospital Medical Center South medical office building at 1905 W. Hebron Lane in Shepherdsville. OBFCC board-certified oncology physicians Drs. Michael Carroll, Subhash Sheth, Vijay Raghavan, and Mohammad Khan will provide patient care that will initially include patient office visits, laboratory

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Dr. Derek Weiss

testing, CT scans, digital mammography and other cancer screenings. The clinic’s regular operating hours are Thursday and Friday from 9am-5pm. “We’re pleased to expand cancer services for patients in Bullitt County,” said Mark Milburn, vice president, OBFCC. “It’s important to us to offer comprehensive outpatient care in convenient locations throughout our entire service community.” OBFCC-Medical Center South will provide patient-focused care to individuals facing a cancer diagnosis. The program is accredited through the American College of Surgeons Commission on Cancer Accredited Program. Doctors and clinicians provide specialized treatment options for all types of cancer, including breast, prostate, colorectal, gastrointestinal and lung. “A cancer diagnosis is taxing on mind, body and soul,” said Sheth, who will offer oncology services at Medical Center South. “It’s important to us to be close to our patients to make cancer treatment as easy as possible.” For more information, call (502) 361-8496.

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Spanish Language Interpreter Joins Lexington Diagnostic Center

Danielle Maggs joins Megan Snellen as a trained medical interpreter at the Lexington Diagnostic Center and OPEN MRI (LDC). In October, Maggs successfully passed “Bridging the Gap,” a forty-hour course designed to prepare bilingual speakers to interpret for medical staff. Maggs and Snellen are both bilingual Spanish and English speakers on staff at LDC. Deborah Winslow, the administrator of LDC said, “There is great need for medical interpreter services in the Bluegrass. It is essential for all patients to be able to communicate effectively with medical staff. The more understanding there is between patients and medical staff, the more accurate the diagnosis. We find that using children or friends of patients to interpret is

vided by The Cross Cultural Health Care organization. To find out more about this group, go to this link: http://www.xculture. org. More information on LDC is available online at www.LDCMRI.com.

Lexington

97 year-old free Medical Clinic to Help More Children

Danielle Maggs and Megan Snellen are trained medical interpreters, bilingual Spanish and english, on staff at Lexington Diagnostic Center and open MrI.

not as effective and can leave gaps in understanding. We utilize telephone interpreting services when a patient speaks another language besides Spanish.” According to Maggs, “The training was helpful. I learned how to better improve the quality of my interpreting with Spanish-speaking patients. It’s important to interpret with accuracy, especially in medical situations.” “Bridging the Gap” is a course pro-

Lexington Baby Health Service, the Commonwealth’s oldest free medical clinic for children, held a open house on Nov 15 to announce changes to Baby Health Service’s age requirement. Nellie Wilkinson, president of the Baby Health Service board, announced that Baby Health Clinic will extend its age limit of birth to 12 years to the new age requirements, birth to 17 years of age, effective immediately. The age requirement has been changed in an effort to help more children. In 2010, Baby Health Service had over 2000 children come to the clinic for free quality medical services. The value of this free medical care was over $228,000. The event also marked the dedication

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Nellie Wilkinson, president of the Baby Health Service board introduces the newly refurbished exam rooms in Carole’s Corridor.

of Carole’s Corridor, the newly refurbished examining rooms and public spaces made possible through donations “in memory of Carole Eastland,” past president of Baby Health Service. Volunteer physicians and medical staff were recognized for their devotion to providing the highest quality medical care to the most vulnerable members of our community, children. Baby Health Service patients are children age birth to 17 years in families without any form of health insurance and whose families do not qualify for Medicaid. All services are free for children and include: well child visits, sick visits, medications, lab tests, and immunizations. Services are paid by Baby Health Service. Started in 1914, the non-profit Baby Health Service has a 50-members board of directors with who serve as volunteers in the clinic and at fundraisers. The board consistently meets its fundraising goals and has not had to turn away families who qualify for services. The clinic, located at 1590 Harrodsburg Road in Lexington, is open Mon-Fri from 7:30 am until noon. For information call (859) 278-1781 or visit babyhealthlexington.org.

New Location for palliative Care Center

Hospice of the Bluegrass’ Palliative Care Center has relocated to 2407 Member’s Way in Lexington. The Center was previously located at the St. Joseph Office Park.

Lexington

26 M.D. UpDate

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ephraim McDowell Health employee recognized

A prestigious statewide honor was recently given to an Ephraim McDowell Health employee. Joan Haltom, Pharm. D, FKSHP, director of Pharmacy and Respiratory Therapy at Ephraim McDowell Regional Medical Center, was awarded the Kentucky Society of Health-System Pharmacists (KSHP) President’s Award. Dr. Haltom was presented the award by Amey

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as the Chairperson for Hugg, past president the KSHP Executive of KSHP, on October Vice President Search 18 during a surprise Committee. ceremony at Ephraim “At Ephraim McDowell Regional McDowell Health, we Medical Center. The President’s know that Joan exhibAward is presented its outstanding leaderannually by the KSHP ship qualities and is a role model in our President to a KSHP member who has been Dr. Joan Haltom was presented the KSHp organization, but it is instrumental in the president’s award by amey Hugg, past gratifying to see her success of the organiza- president of KSHp, on october 18 during a recognized by her protion and for exceptional surprise ceremony at ephraim McDowell fessional peers through professional service to regional Medical Center. this award,” says Vicki the President and to the A. Darnell, president & organization during their term. Dr. Haltom chief executive officer, Ephraim McDowell has served in the past as a KSHP Board Health. KSHP is an affiliate of the American Member, KSHP President, KSHP Foundation President, member of the Educational Society of Health System Pharmacists, Programming Committee and is currently the national professional association that completing service as an elected Kentucky represents pharmacists who practice in delegate for the ASHP House of Delegates. hospitals, health maintenance organizaDr. Haltom was appointed as a Fellow of tions, long-term care facilities, home care, KSHP in 2009. Most recently she has served and other components of health care

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systems. ASHP, which has a long history of medication-error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. Assisting pharmacists in fulfilling this mission is ASHP’s primary objective. Oct 16th- 22nd is National Health System Pharmacy week. Ephraim McDowell celebrates the vital role pharmacists and pharmacy technicians play in providing quality healthcare at Ephraim McDowell Regional Medical Center and Ephraim McDowell- Fort Logan hospitals.

vNa Nazareth Home Care recognized

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LouisViLLe VNA Nazareth Home Care announced that for the sixth consecutive year, it has been named one of the top 500 home health agencies in the country according to HomeCare Elite. HomeCare Elite, a division of National Research Corporation of Chicago, identifies the top 25 percent of home health agencies in the United States and further highlights the top 100 and top 500 agen-

cies overall. Winners are ranked by an analysis of performance measures in quality outcomes, quality improvement, and financial performance. “VNA Nazareth Home Care’s record of success begins and ends with its team members,” says VNA Nazareth Home Care president and CEO Gerrie Leppert. “We have a staff for whom high standards, compassion, and caring are a way of life. As a non-profit agency, our mission is rooted in people, not profits.” The 2011 HomeCare Elite is the only performance recognition of its kind in the home health industry. The 2011 HomeCare Elite is brought to the industry by OCS HomeCare, the leading provider of homecare information, and DecisionHealth, publisher of home care’s most respected independent newsletter Home Health Line. The data used for this analysis were compiled from publicly available information. The entire list of the 2011 HomeCare Elite agencies can be ordered by visiting the OCS HomeCare website at www.ocshomecare.com. ◆

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Doctor’s Ball Honors Leaders among Louisville’s Healthcare Community

The 16th Annual Doctors’ Ball honored Louisville’s outstanding medical community on Saturday, Oct. 29, 2011 at the Marriott Louisville Downtown. Sponsored by the Jewish Hospital & St. Mary’s Foundation, this year’s celebration was a spooktacular affair, embracing the Halloween theme with many guests arriving in costumes and masks. The charity event raises funds to benefit the Jewish Hospital & St. Mary’s Foundation, which focuses community-based healthcare initiatives such as the construction of new patient care facilities, the acquisition of new technologies, providing educational opportunities for nursing students, and discovering medical breakthroughs. This year’s event honored seven individuals for excellence in leadership, innovation and service: J. David Richardson, MD, the Ephraim McDowell Physician of the Year, Don & Libby Parkinson, Community Leaders of the Year, Howard F. Bracco, PhD, CBHE, Excellence in Mental Health Award, Sandra E. Brooks, MD, MBA, Excellence in Community Service Award, Mark Slaughter, MD, Excellence in Education Award, Kathy Bertolone, RN, MSN, CFNP, Excellence in Nursing and Excellence in International Humanitarian Service.

Mark S. Slaughter, excellence in education award Winner.

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Louis Waterman, president, Jewish Hospital & St. Mary’s HealthCare Board of Directors, Libby parkinson and Don parkinson, Community Leaders of the year, and Jerry temes, MD, president, Jewish Hospital Healthcare Services Board of Directors.

Louis Waterman, president, Jewish Hospital & St. Mary’s HealthCare Board of Directors, tom partridge, president & Ceo, fifth third Bank Kentucky, J. David richardson, ephraim McDowell physician of the year, Jerry temes, MD, president, Jewish Hospital Healthcare Services Board of Directors, and tom Hirsch, president Jewish Hospital & St. Mary’s foundation Board president.

Howard f. Bracco, ph.D, CBHe, excellence in Mental Health award.

Mark S. Slaughter, excellence in education award Winner, and J. David richardson, ephraim McDowell physician of the year.

Louis Waterman, president, Jewish Hospital & St. Mary’s HealthCare Board of Directors, Sandra e. Brooks, MD, MBa, excellence in Community Service award Winner, and Jerry temes, MD, president, Jewish Hospital Healthcare Services Board of Directors.

Louis Waterman, president, Jewish Hospital & St. Mary’s HealthCare Board of Directors, and Kathy Bertolone, rN, MSN, excellence in Nursing award Winner and International Humanitarian Service award Winner.

Dr. Shawn Glisson, owsley Brown frazier Cancer Center program Director, and Mrs. vicki yates Brown, Healthcare attorney with frost Brown todd.

Mrs. adele Murphy, GLMS alliance presidentelect, Dr. James patrick Murphy, GLMS Secretary, and Megan Campbell Smith, M.D. UpDate editor-in-Chief. NoveMBer 2011 29

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Louisville Doctors promote Clean air

13th annual KSS Sleep Medicine Conference

The Kentucky Sleep Society (KSS)held its 13th Annual Sleep Medicine Conference in Louisville, KY on October 14-16. “We celebrate our vendors, exhibitors, and attendees for making this conference possible and a big success,” said Kathryn Hansen, KSS executive director. “Recognition goes to our great faculty,” said Hansen, “for the innovative education they provided 200 practicing professionals traveling from six states, to learn from national, regional, and local experts in sleep medicine, who had the opportunity to earn up to 24.5 continuing education credits during the conference.” Dr. Benisse Lester, chief medical officer from the Federal Motor Carriers Safety Association presented critical information which illustrated the physicians role in identifying and treating sleepiness among our CDL licensees. Jayme Matchinski, JD with Hinshaw & Culbertson, LLC identified regulatory statutes which govern our bottom line, and provided a snapshot of the need for compliance with federal standards. Hypersomnia and narcolepsy were contrasted by Dr. Barbara Phillips from UK, who is internationally recognized for her expertise. The role of the behavioral evaluation in hypersomnia presented by Dr. Ryan Wetzler in Louisville provided clinical indicators to carefully consider when assessing and treating sleepiness. Dr. James Pagel from Colorado demonstrated the importance of including the Primary Care providers as active partners with the Sleep Center to obtain positive outcomes with treatment protocols. As our industry moves toward 30 M.D. UpDate

Members of Kentucky Sleep Society Board (l-r) at the october 14 conference were Kathy ohlmann, rN,MSN,CoHNS; robert pope, MD; Donna arand, phD; Michael Zachek, MD; Sarah Honaker, phD; ryan Wetzler, psy D, CBSM; ruth thompson, MS, rrt, rpSGt and Kathryn Hansen, BS, CpC, executive Director Kentucky Sleep Society.

home diagnosis of obstructive sleep apnea, Dr. Charles Atwood presented on integration of out-of-center testing into practice. In an effort to expand our services, Dr. Donna Arand from BRPT challenged our traditional thinking with ideas to grow the business and increase services. The Technical Courses hosted education on specialized topics such as PAP Naps, cardiovascular changes monitored during a sleep, discussion of challenging case studies, advanced treatment options for breathing disorders, and an interactive review of the 2007 AASM Scoring Guidelines. Advanced practitioners had the opportunity to engage an upbeat motivational seminar and learn about how cloud computing may be implemented to streamline the sleep center. We were fortunate to hear from Sherry Johnston, winner of NBC’s The Biggest Loser, where she competed on Season 9 Biggest Loser Couples with her daughter Ashley. Sherry was thin until the age of 30; however, she was “skinny fat” and was not eating healthy or exercising. She let it spiral out of control after the death of her husband, but she reports that The Biggest Loser gave her the opportunity to “change and regain” her life. “The Kentucky Sleep Society remains committed to providing excellence in education and encourages colleagues to follow their educational updates on Facebook, Linked In, and at www.kyss.org,” said Hansen.

Louisville physicians gathered to discuss the deleterious effects of air pollution during Sacred Air: Breath of Life at the 16th annual Festival of Faiths, Nov. 4 at the Henry Clay Building in downtown Louisville. This symposium of diverse faith traditions convenes annually to explore common interests affecting the community and promote options for common action and interfaith understanding. A panel discussion was moderated by plastic surgeon and KMA past president Dr. Gordon Tobin and included local doctors Dr. Robert Powell, pulmonologist and chair of the Louisville Air Pollution Control Board; Dr. Jesse Roman, pulmonologist and chair of the UofL Department of Medicine; Dr. Mathew Zahn, pediatric infectious disease expert and medical director of Metro Louisville Public Health and Wellness Department; and

Louisville physicians Dr. Michael Bousamra, Dr. Gordon tobin, Dr. Jesse roman discussed air pollution during Sacred air: Breath of Life at the festival of faiths.

Dr. Michael Bousamra, thoracic surgeon with University Cardiothoracic Surgical Associates. Regarding the state of air pollution in West Louisville and Rubbertown, Tobin said, “Louisville, we have a problem... and there is no better medicine than a healthy, inspired citizenship.” “Lung disease is a global problem, an epidemic,” stated Roman, who addressed air pollution and uncontrolled lung tissue remodeling and inflammation which can occur as the result of breathing toxins in air contaminated by energy production from combustible bio-mass. While more prevalent in lesser developed nations, Roman

eventS said there are still areas of Kentucky where bio-mass, such as wood and coal, is a primary fuel source for cooking and heating. Studies show that women are exposed more to bio-mass fuel than men because they spend more time cooking and inside the home. In a pilot program, simply installing exhaust vent pipes to the stoves, dramatically improved lung function among the studied population. Since most smokers start the habit as young people, Dr. Bousamra seeks to influence Louisville’s teenage population to “think smoking is un-cool.” Five years ago, Bousamra founded “Drive Cancer Out”, an anti smoking initiative designed to stop the smoking habit before it begins. Today he partners with local entertainer Andre Green, whose campaign “Help Clear the Air” (www.helpcleartheair.com) features Croaky Man, a cartoon character who tells teens, “You smoke, you croak.”

King’s Daughters Medical Center’s thoroughbred award recipients (l-r) Beth Caruthers, Kellie DeLaney, and Keri Mulligan Stewart.

Commonwealth Health Corporation in Total Campaign for “Have a Sunny Kind of Day”, Owensboro Medical Health System in Total Campaign for “Minimally Invasive”, Frankfort Regional Medical Center in Total Campaign for “Name Badge Branding Campaign”, St. Claire Regional Medical Center in Total Campaign for “Foot Health and

excellence in Healthcare Marketing

On October 13, the Kentucky Society for Healthcare Public Relations & Marketing (KSHPRM) recognized excellence in healthcare marketing across multiple categories such as 4-color advertising, newsletters, and annual reports. Top honors go to the following Thoroughbred Awards recipients. Our Lady of Bellefonte Hospital in Overall Internal PR for “ConnectCare, Our Journey to EMR”, King’s Daughters Medical Center in 4-Color Print Advertising for “Primary Care Campaign”, Ephraim McDowell Health in 4-Color Print Advertising for “Real Men Wear Pink”,

Comfort”, Norton Healthcare in External Newsletters for “Stepping Up: Helping Kids Stay Fit and Healthy”, Kentucky Hospital Association in Annual Report for “KY Hospitals: The Fabric of our Communities”, Norton Healthcare in Annual Report for “KY Regional Poison Control Center”, Frankfort Regional Medical Center in Direct Mail for “Mild Campaign”, Our Lady of Bellefonte Hospital in General Brochures for “OLBH General Brochure”, Commonwealth Health Corporation in General Brochures for “Cardiac Cath Lab”, UK Healthcare in Special Purpose Publication for “Z-fold map”, Owensboro Medical Health System in Fundraising Campaign for “The New OMHS Hospital”, Commonwealth Health Corporation in Fundraising Campaign for “Charity Ball 2010”, Appalachian Regional Healthcare in Cooperative Partnership for “School Fitness Fairs”.

are your ears ringing? there is Hope! ashley Sides Johnson, thoroughbred awards chair and manager of marketing and public relations with Methodist Hospital in Henderson; pam Mullaney, KSHprM- Kentucky Hospital association (KHa) liaison and thoroughbred award recipient on behalf of the KHa; and Barbara taylor, KSHprM president and director of marketing and public relations with owensboro Medical Health System.

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NoveMBer/DeCeMBer 2011 31

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heaLing gardenS Landscapes and First Impressions

Better patient outcomes give hospitals a competitive edge as well as a healthier bottom line. Documented research supports all of the positive effects of gardens and landscape to healing and restoration. This can be a powerful moment when you make that important first impression. To make a really good impression, it is important to build a strong entry and arrival experience. It starts with the first visual. Next is the path that connects your patient with the front door. It should be smooth, safe and provide the most welcoming of transitions. This experience includes an entry garden – one that is totally sensed and touched - not just seen. This will provide some pause, interest, excitement, and a clear impression of who you are and what is inside. This experience should be, at the least, exciting. It might also provide some relief and a pause for a moment of healing. Bill Henkel is owner and partner of Henkel Denmark of Lexington. He can be reached at (859) 455-9577 or bill@henkeldenmark.com. ◆

Bill Henkel is Kentucky’s only landscape architect certified in Design, Build and Management of Healing and Health Care Gardens

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32 M.D. UpDate

patients, families, staff, doctors and administrators. Healing gardens have value to healthcare facilitation in many ways. Patients heal faster and with BY Bill Henkel less pain, medication, and expense. Families feel better about the medical processes and have a place to restore hope and spirit. Staff members experience stress relief from time spent in gardens, which reduces costly staff turnover. Doctors and administrators also find stress relief in natural settings. Hospitals benefit with more satisfied patients, speedier healing and turn-around.

(C)iStoCKpHoto/BaSIeB

Gardens for healing have been in use for hundreds of years. Long before technology came to the forefront of medical treatment, gardens were incorporated into most environments where healing therapy was practiced. With modern innovation in medical practices, green spaces have been replaced by medical equipment and gardens became an afterthought of the healing process. Many medical facilities viewed the landscape as the caboose of the project, the least important and at the tail end of the budget – ultimately to disappear. Since the goal of any healing space is to help people feel better, less stressed, safe, comfortable, and more energized, consider making your landscape garden the first thing patients and visitors see when coming to your healthcare facility. I have been immersed in nature all of my life. I have been a registered landscape architect for 33 years, which means that as owner and partner in my firm I have designed, built, and managed beautiful gardens in the Bluegrass for homes, offices, hospitals and horse farms. I acknowledge and respect the healing effects of time spent in natural surroundings. Earlier this year I trained and was certified in the design and building of healing gardens at the Regenstein School of the Chicago Botanic Garden, which made me Kentucky’s only registered Landscape Architect with a Healing Garden certification. The value of healing gardens to hospital and other medical facilities has been researched for years and is now well documented. That documentation supports the positive effects of healing garden for

Each year, hundreds of patients walk out on us.

Clinicians and researchers: working side by side, and working miracles. As the lead center of the Christopher and Dana Reeve Neurorecovery Network, we work side by side with University of Louisville researchers to bring innovative new therapies straight to the patient. Where other centers focus on compensation, our focus on recovery makes all the difference. Learn more at 866-540-7719 or frazierrehab.org.

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Spinal Cord injury

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Brain injury

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Who undeRstands the financial needs of a Medical pRactice MoRe than a doctoR?

Dr. Gregory Kasten, Founder/CEO Unified Trust

In the early 1980â&#x20AC;&#x2122;s Dr. Gregory Kasten was a successful, practicing anesthesiologist. He began exploring ways to achieve successful financial outcomes for both himself and his fellow physicians and his innovative ideas lead to the creation of Unfied Trust. Today, Unified Trust is a national trust company. Weâ&#x20AC;&#x2122;re located in Lexington, Kentucky and are one of a handful of companies in the country that offer true fiduciary responsibility. We also have more experience and expertise in dealing with the unique issues facing physicians, medical practices and groups than anyone in the area. To learn more about our innovative and systematic approach to helping doctors and medical practices reach their financial goals, call Gregory Kasten at 859-296-4407 x 202 or visit unifiedtrust.com.

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