M.D. Update Issue #74

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS October 2012

Special Section

Oncology

The Stat e of Cance r

Volume 3, Number 8

eks to e S h t l a e yOne HInequalities in e of Kentuckim c El inaeteduce the Inciden R Access aenrdin Kentucky Canc Also in this issue  Nurse navigators role in breast cancer care delivery  Musculoskeletal oncologist is UK’s NCI hopeful  Linear accelerator with SBRT / IGRT now available at Floyd Memorial  Lexington Clinic Cancer Centers Gain Accreditation  3D Mammography is Turning Heads

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OctOber 2012 1

from the editor’s desK

Kentucky is up to the challenge Unfortunately, you will read multiple times in this issue how Kentucky ranks poorly in incidence and mortality rates of cancer. The good news is so many of you, whether oncologists or just providers that interact with cancer patients in some way, are shining the spotlight on our weaknesses and trying to effect change. Percentages just don’t tell the whole story – what is happening in the clinic or the lab or the hospital every day is making a difference in the lives of patients.

In this issue, you will read about the changes

BY Jennifer S. Newton taking place at KentuckyOne Health, our cover story, as two systems merge together to integrate, and ultimately, expand oncology services throughout the state. Their mission of reducing inequalities in access to care and their vision of reducing the incidence of cancer are goals that physicians from all over the state are rallying behind.

With a similar mindset of bringing state-of-the-art technology to the population, Dr. Neal Dunlap is helping the Floyd Memorial Cancer Center of Indiana launch a new linear accelerator with SBRT, a more efficient, more effective way of delivering radiation therapy for inoperable lung cancer, and other malignancies.

In Louisville, Dr. Art McLaughlin and the Women’s Diagnostic Center have made a big investment in breast cancer detection as the first private center with 3-D mammography, which is shown to reduce recall rates and detect breast cancers earlier.

In Corbin and Richmond, radiation oncologists Dr. Joseph Wang and Dr. Jeniffer Huhn are ensuring the quality of Lexington Clinic’s cancer centers, which were accredited by the American College of Radiology in September.

It is our job at M.D. Update to communicate not just “the news,” but any story that connects you with other physicians doing similar things throughout the state and with providers whose services complement your own. We had a physician tell us recently that she likes reading our magazine because, among other things, it keeps her apprised of what the competition is up to, and that’s our job too.

Whatever it is you like about us or you would like to see us do in the future, we would love to hear from you. As always, we welcome letters to the editor, story pitches, and just good old general feedback.

All the best,

submit your Letter to the editor to Jennifer s. newton at Jnewton@md-update.com 2 M.D. UpDate

Volume 3, Number 8 October 2012 Publishers

Gil Dunn Print gdunn@md-update.com Megan Campbell Smith Digital mcsmith@md-update.com eDitor in Chief

Jennifer S. Newton jnewton@md-update.com sales Manager

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contents

oCtober 2012 voluMe 3, nuMber 8

cover story

2 froM the eDitor’s Desk 5 letter to the eDitor yes, MaMM in Martin!

6 heaDlines kentuCky CanCer founDation 8 one on one With norton’s Dr. ken Wilson 10 finanCial affairs by sCott neal

the state of cancer

11 insuranCe by seth saloMon 12 CoorDination of Care nurse navigators

KentuckyOne Health Seeks to Eliminate Inequalities in Access and Reduce the Incidence of Cancer in Kentucky

13 PraCtiCe ManageMent

by PatriCia CorDy henriCksen

ON tHe cOVer:

16 Cover story

Jacqueline Mater, MD, with Saint Jospeh cancer center; (seated); Dan Varga, MD, chief clinical officer for KentuckyOne (standing); and Shubhash Sheth, MD, with cancer and blood Specialists.

22 sPeCial seCtion onCology 29 neWs 32 events

speciaL section  oncoLogy 22 He’s Our Guy

23 High Output, Short amount of time

25 accredited cancer Services Go Farther

27 ahead of the curve OctOber 2012 3

Š 2012 Baptist Healthcare System, Inc. / Member, Baptist Healthcare System

????????

NO ONE

BEATS CANCER ALONE. LET A NURSE NAVIGATOR GUIDE YOU THROUGH BREAST CANCER TO RECOVERY. A Baptist East nurse navigator can assist you with every aspect of your fight against breast cancer, by helping you ask the right questions and understand the answers when it comes to your diagnosis and your treatment options. She can also help coordinate appointments, so you can focus on your recovery. For more information, call the Baptist East Cancer Resource Center at (502) 896-3009.

4 M.D. UpDate

baptisteast.com/breastcancer

Letter to the editor

yes, MaMM in Martin!

Dear Editor: As the President and CEO of the Saint Joseph Hospital Foundation (part of KentuckyOne Health) once in awhile a donor story becomes etched in your heart and memory and validates the fundraising work we do to support our KentuckyOne Health patients and families.

While healthcare news and issues remain in the news on a daily basis, this story begins at our critical-access hospital Saint Joseph Martin in Floyd County, Kentucky and probably didn’t make major headlines.

Simply put, I can assure you that the culture of philanthropy is alive and well in the beautiful mountains of eastern Kentucky and sometimes physicians do extraordinary things far beyond the reach of the stethoscope. As a seasoned fundraising professional this physician giving story makes you believe in the true spirit of generosity and goodness.

Last month I traveled to Martin, Kentucky as the town and the hospital turned pink to celebrate the arrival of digital mammography with a ribbon-cutting of the Drs. Chandra & Mehendra Varia Digital Mammography Suite.

The beautiful new digital mammography

The Varias, already known for their generosity, arrived in the United States in 1975 from India and have made their home in Martin, Kentucky since July 1979.

Dr. Mahendra has his own veterinary small animal clinic and Dr. Chandra Varia specializes in obstetrics and gynecology and has been practicing medicine for 42 years.

When the Varias first came to Kentucky, no one believed they would stay but they love the mountains and the people and they believe in giving back to their community.

Dr. Chandra and Dr. Mehendra Varia, we thank you for your generosity and for reinforcing the ‘why’ healthcare philanthropy Obstetrician Dr. chandra Varia and barry Stumbo, is paramount to our mission to president of the Saint Joseph Hospital Foundation, create healthier communities for celebrate the opening of Drs. chandra & Mehendra Varia our patients and families.

Digital Mammography Suite at Saint Joseph Martin in When I see the pink ribbons Floyd county, Kentucky. in and around the hospital, I know that over 400 women in Floyd suite was opened because long-time physiCounty have already been in for their mamcian Dr. Chandra Varia and her husband, Mehendra Varia, DVM, made the lead gift mogram on the new equipment.

Yes, Mamm! This project will save lives of $125,000 for the “Yes, Mamm in Martin!” campaign. Dr. Varia, who has delivered and as a physician, Dr. Varia not only pracover 3,500 babies, was passionate that Saint tices medicine, she practices philanthropy.

Joseph Martin needed digital mammography services. The community and over 50 other Sincerely, donors and physicians followed their example Barry A. Stumbo raising over $225,000 including a grant from President & CEO, the Susan G. Komen Lexington Affiliate.

Saint Joseph Hospital Foundation

Dr. Greg Davis on Medicine Wednesdays at 8:45 AM & 5:45 PM

Dr. Greg Davis is a forensic pathologist with UK HealthCare. Every week, Davis speaks with local health providers, professionals, and researchers.

OctOber 2012 5

headLines

funding milestone for Kentucky colon cancer screening program State allocates $1 million in matching grants over next two years; Foundation to raise private funds for collaborative programs that alleviate cancer burden. to fund colon cancer screenings, where early detection can eradicate the disease, cases affecting the uninsured create a heavy burden for communities as patients join the Medicaid rolls for a last chance at treatment. Past advocacy efforts by the CCPP led to the establishment of the Kentucky Colon Cancer Screening Program (KCCSP), a state-run agency designed to provide screenings at public health departments across the state, but

after four years the program remained completely unfunded.

leXington Thanks to a little political muscle and a lot of good evidence, champions for changing tactics: the political approach colon cancer screening and prevention can now point to Kentucky as an emerging February 28, 2012 was a momentous day leader for public-private collaboration in for colon cancer advocates. That was the day the reduction of the disease’s burden on that Governor Steve Beshear, himself a cancer employers, taxpayers and health systems. survivor, announced that his 2013-14 budget For eight years, Louisville gastroenterwould allocate $1 million in the biennium to ologist Dr. Whitney Jones has attacked the KCCSP. The non-profit Kentucky Cancer colon cancer incidence in Foundation (KCF), Beshear Kentucky through the educaannounced, would be responsible tion and advocacy non-profit for raising an additional $1 milhe founded, the Colon Cancer lion in private funds.

Prevention Project (CCPP).

During a press conference Providing education to patients in Frankfort, Beshear explained and health systems while advothat “despite Kentucky’s current cating for effective public policy, budget constraints, my adminisCCPP action brought a dramattration is recommending several ic improvement in the number critical investments designed to of cancer screenings performed tackle generational problems in Kentucky and improved its that plague our state. One of national ranking on this measure these investments is to provide from 45th to 32nd. Notably, colon cancer screenings for our this accomplishment came uninsured Kentuckians.” about without a public investLeading the charge for the ment in colon cancer screening.

Kentucky Cancer Foundation, Still, Kentucky continues and undoubtedly responsible for In March 2012, Dr. Whitney Jones joined Governor beshear and members of the Kentucky cancer Foundation to address health to have the highest annual the administrative turn-around, is advocates and cancer survivors during a colon cancer awareness rally the formidable political influence of incidence rate for colorectal at the state capitol. former State Auditor Crit Luallen. cancer. Without a program

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

6 M.D. UpDate

IMaGe cOUrteSY OF tHe cOLON caNcer preVeNtION prOJect.

by megan c. smith

By securing Beshear’s support, Luallen has empowered private donors, for the first time, to take the leap of faith that their investment in cancer prevention will have a profound impact on Kentuckians. I had a chance to ask Luallen how the funding was at last secured, and in an email she replied how it was under less than ideal circumstances that she and the KCF approached Beshear with the request for state funding.

She wrote, “The state had been forced to make a number of across-the-board cuts as a result of the recession and resulting declines in state revenues. But the argument for this funding is a fairly simple and compelling one. We cannot accept the fact that we have the highest cancer mortality rate in the nation. We must begin to invest more in prevention. By investing in screening and early detection we are not only saving lives, we are saving money. Governor Beshear immediately understood and agreed and gave us his full support. He was also influenced by our commitment to raise funds to match the state’s appropriation.”

Luallen recalled that many legislators came forward to champion the allocation because they were, like she, personally touched by cancer. In April 2012, the funding program was approved with strong bipartisan support.

“As someone who has worked for six Governors before running myself for public office, I have seen Kentucky too often spend more and more on the problem at the expense of solutions,” Luallen concluded.

“It is the goal of the new [Kentucky] Cancer Foundation to begin to put more sources into prevention and detection to change the course we are on in Cancer.”

In addition to Jones and Luallen, the founding trustees and board members of the foundation are Dr. David Stevens of Lexington, Lyle Hanna of Lexington; and Jack Hillard of Lexington.

public-private collaboration to relieve the Disease burden

This initial funding, totaling $2 million, will help public health departments across the state provide 4000 colon cancer screenings for uninsured Kentuckians.

When I caught up with Jones in late September, he was about to release RFPs for the pilot sites and was very optimistic about where the program is headed. “This is a pro-

active approach to reduce cancer incidence by removing polyps or finding those cancers earlier,” he said, “rather than waiting a year or two until the patient doesn’t have insurance and comes in with advanced cancer.

We’re hoping we can prevent it completely

“the argument for this funding is a fairLy simpLe and compeLLing one. we cannot accept the fact that we have the highest cancer mortaLity rate in the nation. we must begin to invest more in prevention. by investing in screening and earLy detection we are not onLy saving Lives, we are saving money.”

- crit LuaLLen

by removing large polyps or, at minimum, identify them at a stage that is curable surgically without the need for chemo and radiation.”

The program is designed, like the breast and cervical programs, to recruit patients <250% poverty level who are eligible and appropriate for screening based on risk assessment. The screenings will take place at 5-10 pilot sites around the state in urban and rural settings.

As a novel program, Jones said it is imperative to “evaluate our successes and challenges.” Since health departments will administer they tests - and health departments don’t perform colonoscopies - the program will use fecal immunochemical test (FIT tests) and refer colonoscopies based on symptoms, family history, or positive FIT tests to community partners.

“One of the innovative issues is that we are not building any bricks and mortars here,” said Jones. “We are using existing channels and community linkages through the health departments and their community partners to provide this screening.”

Dr. Stephanie Mayfield, Commissioner of the state Department for Public Health, has brought resources in health information technology and data management to the

project. Her expertise, including seven years as the director of the state’s public health laboratory, “has set us up for success,” said Jones, “so we will be able to evaluate what we are doing and be able to rapidly expand this service once we’ve completed the initial two years.”

With the goal of expanding beyond the pilot program to all health departments, Jones will be looking for data that builds the economic argument of potential savings to state Medicaid and Disability programs.

After the initial project, the KCF will raise private funds to pay for future prevention and early detection services for the uninsured including mammograms, pap smears, and smoking cessation programs.

These funding programs support the state’s comprehensive strategies to reduce the incidence of cancer, collectively the Cancer Action Plan (CAP), that has been administered by the Kentucky Cancer Consortium (KCC) since 1999. Dr. Daniel Kenady, chair of the consortium, remarked that “cancer is too big and complex a problem for any one group to address efficiently.

Comprehensive cancer control offers the power of collaboration as a key approach to reducing cancer.”

Once health departments are selected as pilot sites, Jones notes that they will “certainly be reaching out to local physicians, both primary care physicians and specialty physicians who perform endoscopy. There is no funding for treatment, unfortunately, in this $2 million, so we will be relying on community partners to provide treatment.”

“It is not optimal,” he said, “but breast and cervical [cancer programs] had no treatment dollars for years before it was enacted on a national level. It’s just the struggles we’re going to have to go through.”

The KCF aims to meet these challenges by recruiting strong board and medical advisory group members and, said Luallen, “by partnering with health care providers and others who are passionate about turning the numbers around.” ◆ For information about the

kentucky Cancer foundation contact Jack Hillard (859) 489-9135 or jackehillard@yahoo.com. pO box 21741, Lexington, KY 40522

OctOber 2012 7

one on one

planning for the future

Norton Healthcare’s Kenneth C. Wilson, MD, on ACOs, the new Women’s and Children’s Hospital, and Systems of Care Design louisville On September 13, Norton Healthcare broke ground on a new 100,000 sf tower to convert the old Suburban Hospital into a comprehensive women’s and children’s services center for the St. Matthews area. MD UPDATE digital publisher Megan C. Smith sat down with Norton’s Kenneth C. Wilson, MD, system vice president of clinical effectiveness and quality, to discuss how the new hospital fits into the organization’s accountable care model. This is Part One of a two-part series on the overlapping trends of healthcare reform and the expansion of hospital-based services into suburban populations.

Megan c. Smith: i wanted to start by asking you about your job title - a real sign of the times. what does “clinical effectiveness and quality” leadership mean to norton healthcare physicians and administration?

Dr. Kenneth c. Wilson: You will see the term “clinical effectiveness” around with a number of healthcare organizations. The concept is that as we move from our current reality into a more value-based future, providers will have to be accountable not only for the quality and safety of care, as they always have been, but also accountable for the economic side of healthcare.

The broader value equation will be increasingly important, so the purpose of clinical effectiveness is to assess whether we are providing good outcomes in the context of reasonable, sustainable cost. how does your prior experience in clinical practice influence your work as a physician leader today?

My training and 20 years’ experience as a primary care physician inform the work that I do every day. When I made the transition to this kind of work about 15 years ago, it occurred to me that as a practicing physician there is no question whether you impact the lives of your patients. But, you do that one patient at a time such that at the end of the day, or the end of the week, 8 M.D. UpDate

tive on what we’re trying to accomplish. how is your work tied into the development of norton’s new aco model of care?

Broadly, my role with the ACO is to work with Dr. Steven T. Hester, our chief medical officer, around the BrookingsDartmouth Accountable Care Pilot Sites program, in which we are partnering with Humana. We were in the original group of three, expanded over the first year into five organizations, partnering with the BrookingsDartmouth folks to study strategies in the development of commercial ACOs. Now certainly Kenneth c. Wilson, MD there are lots of healthcare organizations that the month, or the year, you have touched are working in the ACO space, if you will, a finite number of individuals in terms of through the Pioneer ACO in the Center their healthcare and their quality of life. for Medicare and Medicaid Innovation, to In the role as a physician executive, a the Medicare Shared Savings Program at physician manager, a physician leader, we the Innovation Center as well. Premier has are working to develop processes and sys- a large collaborative. That the Accountable tems of care for entire populations. While Care Act actually contains the language I’m not the one on the sharp end of care, “accountable care organization” probably the work that I and my colleagues in has a fair amount to do with that. leadership do impacts many more people, There is a saying out there that if you’ve multiply your impact through the work. seen one ACO then you’ve seen one ACO. I feel strongly, as do the other leaders and As I talk to folks around the country, I disour organization, that physicians are crucial cover there are lots of different ways people in moving all healthcare organizations to a are designing their accountable care organiplace that will allow us to be more effective zations with varying parts, principals, and in the future. partners. We at Norton Healthcare come Physicians spend at least the early parts to see that accountable care is less about of their lives training and learning to do organizational design - though there are their craft, and they invest lots of time and components of organizational design that energy. What I did as a physician gives me really promote and help provide accountperspective on what we do as provider orga- able care – and more about accountable care nizations and helps to inform my perspec- being more of an idea or a concept that you

bring to the provision of healthcare.

Let’s discuss norton’s new women’s and children’s hospital, not in a brick-and-mortar sense, but rather on the topic of specialized or comprehensive service lines and their role in the aco. what does it mean to norton to have this new women’s and children’s hospital going forward into accountable care?

What our organization is creating is not only the bricks and mortar, but the infrastructure, the “systems of care” of the organization. At the core of our Women’s and Children’s Hospital program are two concepts: a system of care approach and a team-based approach, which are very sympathetic with accountable care models.

A lot of the conversation in the healthcare reform world is around how we are organized. There have been hospitals and physicians who until the last five years or so were for the most part independent business people. Entrepreneurs who worked in a feefor-service system.

Norton Neuroscience Institute. We’ve been able to create a real critical mass of neuroscience specialists: a neurologist, neurosurgeons, and other specialists. We’ve been able to create a Headache and Migraine Program whereas this level of expertise in our area was previously unavailable - the closest place for people who struggled with chronic headaches with Chicago, to the Diamond Headache Clinic.

Another example is eating disorders.

While eating disorders do affect men, it is predominantly a female issue. So, again, folks who needed really intensive support and care had to travel outside the area. If I’m looking at it, if I’m running an ACO and I have to be accountable for the total cost of care for the population, having to send people out to Philadelphia for eating disorders or Chicago for migraines would increase the cost for that population.

Because of the creation of the Women’s Program, we have been able to bring and strong services to women.

“if i’m looking at it, if i’m running an aco and i have to be accountable for the total cost of care for the population, having to send people out to philadelphia for eating disorders or chicago for migraines would increase the cost for that population. because of the creation of the women’s program, we have been able to bring and strong services to women.”

One of the problem areas is how the interests of physicians and interests of hospitals are not always closely aligned. In our market, a preferred and predominant mode of physician alignment is employment, so the Women’s and Children’s Hospital is employing specialty physicians central to the care of women and children in our area.

A couple of early examples are from our

The other big thing about this program is early intervention. If you look at any population of people, a relatively small percentage of that population, say 5%, are responsible for an inordinate amount of the cost of healthcare. These are people typically with multiple, chronic medical problems that are fairly well along the path of disease progression. One of the things about

American healthcare is that we haven’t generally placed a lot of emphasis on wellness and prevention in the fee-for-service system.

One of the key strategies of the Women’s and Children’s Hospital’s programs is care centered around early intervention.

Specifically, early diagnosis and intervention to bone health issues such as osteoporosis, osteopenia, things like that, so as to prevent more costly and more quality of life impacting problems like pathologic fractures, orthopedic issues, and so on.

Another example is a strong urogynecology program. Childbearing puts a lot of women in a situation where they develop bladder problems, so an ability to diagnose bladder problems early provides an opportunity for intervention that is less invasive, improves quality of life, and greatly impacts the total cost of care for the population.

So, clearly, I think that the women’s care agenda through these types of examples is very compatible with the big picture of accountable care.

One the pediatric side, Norton has had Kentucky’s only freestanding pediatric hospital, Kosiar Children’s Hospital, for a long time. Our pediatric physician alignment is with the Department of Pediatrics at the University of Louisville, although with a few exceptions they are not employed. Still, the pediatric story is much the same.

We know that, for example, if you look at imaging for children, there is evidence in the literature that suggests that nonpediatric systems of care would probably create more frequent issues with radiation exposure for kids. Our associated physicians create diagnostic imaging protocols for children that go a long way to reducing the radiation exposure and the risk of cancer due to pediatric imaging. Branching out from our downtown location at the Kosair Children’s Hospital to the Women’s and Children’s Hospital in suburban Louisville provides us an opportunity to expand specialty pediatric services for folks who may not have had access to that level of comprehensive specialty care previously. ◆ OctOber 2012 9

financiaL affairs

running over the edge As most of you are probably aware, our not been addressed country is facing a “fiscal cliff ” at the end of by either candidate the year. But what exactly does that mean? in the first two of The “fiscal cliff ” refers to the combinathe Presidential tion of the expiration of the Bush Tax cuts debates and is not that were enacted in 2001 and 2003 and likely to be menrenewed until December 31; the expiration tioned in the third. of the 2% payroll tax cut; the expiration of They surely know the AMT patch that keeps it from hitting so what we face, but many of the middle class; the reduction of are trying very the exemption of estate taxes from $5 milhard to avoid even

BY Scott Neal lion to $1 million; plus the across-the-board talking about it. spending cuts that were enacted as a result We could suppose that some in Washington of the failure of the super-committee to see it as the opportunity to do nothing furarrive at a satisfactory solution to our deficit ther; thereby raising tax receipts while cutting and debt problem. spending all while blaming the outcome on According to Simpson-Bowles the other party. Some could even see it as a of the National Commission on Fiscal viable solution to the debt and deficit. While Responsibility and Reform, it means that it could be a start, it is far from an optimal there are $7.7 trillion of economic events deficit reduction solution. headed our way very shortly. This is truly From a personal perspective, the cliff a moment in time of historical importance. will result in a tax increase for everybody on It spite of the widespread use of the the tax rolls. The nonpartisan Tax Policy word trillion, it’s still really hard for most Center issued a report in October revealing of us to think about the magnitude of a that it expects the expiring tax provisions to trillion dollars, much increase the amount less 7.7 of them. of taxes paid in 2013 our firm’s economist, dr.

Think for a moment by $536 billion. That woody brock, has called for about spending $1 a is an average increase redefining the deficit. he second for every secof about $3,500 per claims that one cannot talk ond of every day. It household. Since our about deficit without first would take more than readers are likely to 32,000 years to reach be in the upper tax labeling it either “good” or a trillion. If you had brackets, the increase “bad.” a good deficit would spent a $1 million a is likely to be signifibe produced by spending day for the past 2,000 cantly greater than the on investments that would years, you would still average. Furthermore, reasonably be expected to only be about three many states, including produce a positive rate of fourths of the way Kentucky, generally there. And we are adopt federal tax rules. return for many years to talking about 7.7 The cliff therefore is come. the bad deficit would be times that amount to likely to increase the covered by tax receipts and, hit all at once! It’s average of each taxpaythereby, eliminated entirely. decision time. er’s state income taxes However, it as well. appears that nobody in Washington is doing Sequestration of the budget will result in anything about it. In fact, we heard from cuts to non-exempt government programs a person who regularly roams the halls of from 7.6% to 9.6%. Medicare is limited to a Congress that there are more than a few mem- 2% reduction. Social security and Medicaid bers of that body who will be happy to let it are not affected. The cuts, while scheduled to happen. Moreover, as of this writing, it has take affect over a nine year period are expected 10 M.D. UpDate

to be $109 billion in 2013. Bottom line is that most physicians will see a decrease in income and an increase in taxes.

Many have rightfully wondered what effect this will have on the economy as a whole. We believe that it should be labeled as “austerity” in much the same way that Europe has dealt with its varied crises. Some would conclude that we need that, others argue that it has thrown Europe into recession and because of our size will cause worldwide recession or, in some cases, depression. Christine Lagarde, head of the IMF, has recently warned against too much austerity. Deflation becomes a much greater threat than inflation.

It’s time for bold ideas for permanent reform. Our firm’s economist, Dr. Woody Brock, has called for redefining the deficit.

He claims that one cannot talk about deficit without first labeling it either “good” or “bad.”

A good deficit would be produced by spending on investments that would reasonably be expected to produce a positive rate of return for many years to come. Interestingly, the math for this was worked out by two noted economists in 1970. When you consider this kind of spending, think about the interstate highway system that dramatically increased productivity or the space program that produced incredible technology. Brock’s plan calls for a Domestic Marshall Plan that would rebuild our nation’s crumbling infrastructure, and would put thousands of people to work, just as our economy needs the stimulus. The bad deficit would be covered by tax receipts and, thereby, eliminated entirely. Such a plan would be respected by the bond market and credit rating agencies alike.

Now is the time for us to call upon our elected representatives to work toward true consensus of a grander plan than either party has put forth to date. So much is at stake and it is not very likely to come about as long as gridlock remains the order of the day in Washington.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and investment advisory firm. Questions and comments are welcome via email at scott@dsneal.com or by calling 1-800-344-9098. ◆

insurance

finding success in 2013 Is your business on-track to achieve the goals you had in mind when the year began?

While these last months can be busy for business owners trying to finish the year strong, it is also important to dedicate time to outlining a plan that will provide for a successful 2013.

With this in mind, I would suggest the following…

closing Out 2012

Take stock on ways in which expectations were exceeded as well as any shortcomings.

How can these findings be used to better plan for 2013?

Perhaps success in one area should warrant a slight change in overall positioning or strategy. Or maybe with a little more attention, the component of your business that is not currently meeting expectations can be brought in-line over the year’s final months.

Also, begin considering what the big “takeaways” are from the year and how those can map into your overall goals and strategies for 2013.

2013 Goals

What does your ideal 2013 look like? The trick is to set goals that strike a balance between being aggressive and realistic. Map the various metrics you are striving for (i.e. revenue, net income, etc.) across each month. Do you expect them to be the same in each period or do they scale-up throughout the year?

Are you currently aligned in the most beneficial manner for addressing your ideal model? Every

component of your business – sales, marketing, operational structure, etc. – should be organized in a way that best helps to meet your monthly targets.

execution

Once you have synthesized your monthly goals into a yearlong model, you now have the roadmap to drive your business throughout 2013. Of course it will only get you to your destination if you track against it regularly. Determine how to stay on-top of your progress throughout the year and who will own this reporting.

Find a time for a weekly meeting with key executives and make sure that this becomes an institutionalized practice. Not only will it keep everything on-track, it will also highlight individual deliverables – providing the all-important accountability that will be needed to meet your goals.

BY

Seth Salomon

Loose-ends

Did you find time in 2012 to address the long-term protection of your business?

Succession planning, partnership agreements, key-executive insurance, and other valuable tools can be vital to the longevity of your organization. Identify potential areas of exposure and begin implementing solutions before the end of the year.

Also, now is a good time to review your benefit programs and make sure they are appropriately providing for you and your employees. Whether a company-sponsored retirement plan, group insurance, profitsharing plan, or perhaps a pool of earned equity, you want to make sure that you are appropriately incentivizing your staff and doing so in a way that makes sense for your business in the year to come.

personal planning

Are you properly allocating and managing assets outside of your business? Whether planning for retirement, children/grandchildren’s education, or perhaps a key personal expense that is on the horizon, diversifying your portfolio beyond your business is of the utmost importance and not something you want to go another 12 months without addressing.

Perhaps this is one of the last years your income will allow you to take advantage of a ROTH IRA contribution or maybe you are above 50 and are able to make a catch-up contribution to your IRA.

In closing

Whether it is on your own, or with a trusted advisor, find time to plan accordingly and then stay on-top of your goals throughout the coming year. If you can do those two things, 2013 could most certainly be the year you have been waiting for.

Seth Salomon (seth@salomonco.com) specializes in strategic financial planning for business owners, individuals, and families. Seth returned to Lexington, KY after 14 years in atlanta and New York city to join his father at Salomon & co., a comprehensive wealth management group serving small businesses and families for over 38 years (securities and financial planning offered through LpL Financial, a registered investment advisor, member FINra/SIpc). Seth holds a ba in International economics from emory University and an Mba in Finance from NYU’s Stern School of business. the opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual. to determine which investments or products may be appropriate for you, consult your financial advisor prior to investing.

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coordination of care

patients face many choices

Nurse navigators help guide breast cancer patients through a maze of options. by tina tooLe-harper

12 M.D. UpDate

The primary role of the nurse navigator is to be a patient advocate. As an advocate, the navigator guides the patient past barriers to prompt diagnosis and treatment.

The concept of patient navigation was founded and pioneered in 1990 through the groundbreaking work of Dr. Harold Freeman of New York. Freeman studied low-income breast cancer patients in Harlem, discovering that women who received guidance had better results. Today, it is quickly becoming standard practice in hospitals across the nation.

Putting out this helping hand to breast cancer patients has quickly become the most enjoyable part of my job. It is a pleasure to

be a connection point for these patients, to calm their fears, dispel myths, impart strength, and show them that we care.

With a nurse navigator showing the way, the journey through cancer is paved with hope. tina toole-Harper, rN, cbcN, is a nurse navigator and cancer resource nurse specialist with baptist Hospital east. ◆

For the newly diagnosed, this range of choices can be overwhelming at a time when they are under a great deal of stress.

Ideally, the nurse navigator sits in with the patient and physician as treatment is discussed. this way the navigator can hear what’s said, and help the patient understand what to expect from the upcoming treatment.

IMaGe cOUrteSY OF baptISt HOSpItaL eaSt

louisville To be understood and to understand – that’s a basic need for breast cancer patients. They want to understand their choices – and select the options which are best for them – and to have someone understand their fear and emotional pain.

At Baptist Hospital East – and other hospitals across the nation – nurse navigators serve as the bridge between the physician and the patient. Many times patients do not want to “bother” their doctor with their questions or concerns, but they feel free to talk to a nurse.

And there’s a lot to talk about. Medical advances have resulted in a variety of treatment choices for breast cancer patients in terms of surgery, chemotherapy, radiation, and hormone therapy. Not to mention breast reconstruction and help after treatment – from support groups to exercise rehabilitation.

For the newly diagnosed, this range of choices can be overwhelming at a time when they are under a great deal of stress.

Ideally, the nurse navigator sits in with the patient and physician as treatment is discussed. This way the navigator can hear what’s said, and help the patient understand what to expect from the upcoming treatment.

At Baptist Hospital East, a nurse navigator is available for every patient who has a diagnosis of breast cancer. Patients may be referred from their physician, or the patient may call the navigator themselves to get connected to this free service.

Providing patients with accurate and understandable information is a key element. Patients are offered a one-on-one educational visit with the nurse navigator prior to surgery so that they may have a better understanding of what to expect in the postoperative period.

All along the way, the navigator plants seeds about what’s coming next, or resources that may be valuable, such as support groups.

Patients may not be ready for this step yet, but can start processing the thought of sharing their cancer journey with others.

Additional referrals may be needed –

to help with financial or transportation concerns, dietary issues, or other matters.

The nurse navigator is a conduit to those resources, whether they are based at the hospital or in the community.

The nurse navigator stays in contact with the patient before, during, and after treatment. When the patient doesn’t know whom to call, the nurse navigator is a safe sounding board.

practice management

prepare now for your medical audit Audits by Federal and State governments of claims submitted by healthcare providers have increased significantly in recent years.

The number of entities with audit authority has also increased and, among many others, includes: Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), Comprehensive Error Rate Testing (CERT), Medicare Integrity Contractors (MIC), in addition to the initial auditing entity, the Office of Inspector General (OIG). The most active audit entities at present are RACs and MICs. Practices need to prepare now for these upcoming audits in order to minimize risk, ensure that entity audit findings are correct, and understand the appeals process if it becomes necessary to challenge the entity audit findings.

RACs were established under the Medicare Modernization Act of 2003 as a

pilot program to identify improper Medicare payments. By 2008 CMS reported that RAC had succeeded in collecting more than $1 billion in Medicare improper payments from BY patricia cordy Henricksen just six states. By 2006, the Tax Relief and Health Care Act made the RAC program permanent and mandated that CMS extend it to all 50 states, allowing private third-party auditors to work on a contingency basis under contract to CMS to conduct audits and keep a percentage of recouped payments which they identify as improper.

Improper claims are identified by either

automated or complex reviews. Automated reviews are conducted without review of the medical records supporting the claim.

Complex reviews identify claims where the RAC believes there are overpayments but require further review of medical records or other documentation. Significantly, RACs may not audit based on randomly selected providers or claims, but must use data analysis techniques to perform targeted reviews.

For complex reviews, the RAC may either appear unannounced on site to review the provider’s records or request that the provider mail or securely transmit the records. RACs must abide by Medicare policies, regulations, CMS manuals, National and Local Coverage Determinations, and may not apply their own coverage, coding or billing policies.

An appeal of a RAC determination follows the same protocol as any other

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practice management

Medicare appeal. One caveat is that providers must submit a rebuttal to the RAC within 15 days of an initial determination or demand. There are five levels of appeal: Redetermination (120 days after denial) Reconsideration (180 days after Redetermination decision) by the Qualified Independent Contractor (QIC) Administrative Law Judge (ALJ) Hearing (60 days after decision by QIC)

Medicare Appeals Council (MAC) Hearing (60 days after decision by ALJ) Federal District Court (60 days after MAC decision) A recent memorandum from CMS regarding appeals shows that providers were successful in overturning RAC determinations approximately 34% of the time.

Given the incentive for the RAC contractors to find errors, providers should pursue

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an appeal if they believe the RAC determination to be in error.

CMS has also begun to examine potential overpayment by state Medicaid programs. As part of this process, CMS has entered into contracts with Medicaid Integrity Contractors (MIC). There are three types of contractors for this program: 1. Review MICs which analyze claims data to identify payment vulnerabilities; 2. Audit MICs which conduct post-payment audits of documentation to identify overpayments; 3. Education MICs which educate providers as needed based on discovered issues.

Regardless of the type of audit or the reason for initiation, there is a great deal of commonality. All audit programs are out to recoup money and providers should take steps to prepare for an entity audit. Not every provider has the manpower or financial resources to audit every claim that may be reviewed by one of the programs, but there are several preparatory and proactive measures that providers can take to minimize risk and ensure that they are ready for necessary and immediate action when faced with an entity audit.

The first step is to appoint an audit coordinator who will be responsible for responding to medical record audit requests within the limited time-frame allowed by the auditing entity.

Conduct a risk assessment, beginning with an internal audit of the requested medical records in order to ensure proper coding and billing conventions were followed.

Conduction of regular internal audits even before entity audit notification is ever received will assure correct coding and billing conventions are being followed. Providers, managers, and coders should review the annual Work Plan of the Office of the Inspector General (oig.hhs.gov/reports-and-publications/workplan/index.asp), which provides information regarding issues that are under scrutiny.

Develop a work plan for response to audit notifications and documentation requests from an entity auditor. Issues to consider include: Who will gather and copy requested documents?

Who will be responsible for auditing the documents?

Will an internal audit be sufficient?

Should an outside auditor be engaged?

Who is responsible for tracking deadlines?

It is important to provide education to all impacted providers and staff, especially after identifying any potential risk areas.

Providers, as well as staff, should be appropriately trained in order to prevent future errors.

If errors are identified through selfauditing, disclose the errors in order to mitigate damages and to prevent a potential entity audit. If possible, pay the claim directly to the MAC or state program and establish a mechanism for correction and education of the specific issues. These areas should then be continually monitored and audited to ensure compliance. A formal Compliance Plan should be in place – and in force – within the practice, as it will demonstrate to entity auditors that compliance is an essential component of the practice.

The elimination of fraud, waste, and abuse in government-funded healthcare reimbursement programs is a top priority, and the government now has many weapons in its arsenal. The audit entities mentioned here are but a few that are in place. Providers need to be aware of how these programs work and be proactive in taking preventive measures in order to minimize risk and exposure.

Additional information is available from the Kentucky Medical Association at www.kma.org, as well as CGI, the RAC auditor for Kentucky, at http:// racb.cgi.com, and the Medicare carrier for Kentucky, Cigna Medicare, at www.cgsmedicare.com/kyb/index.html.

Additional helpful websites include: www. ama-assn.org and www.cms.gov.

Patients turn to social media for answers.

Patients turn to social media for answers.

Patients turn to social media for answers.

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I N S I D E H E A LT H

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I N S I D E H E A LT H

patricia cordy Henricksen, cHca, cpc-I, Kentucky’s first digital media project to connect patients and doctors in the advancement of heal cpc, ccp-p, pcS, acS-pM, is the executive Submit your profile at NEWMEDIA.MDVice president and Senior auditor of Soterion Medical Services www.soterionmedical. Kentucky’s first digital media project to connect patients and doctors in the advancement of health outcomes.

Submit your profile at NEWMEDIA.MD-UPDATE.COM com She is a Lead editor for medical coding text books published by elsevier, Inc., and is a certified Instructor for the professional Medical coding curriculum, the coding certification program of the american academy of professional coders. ◆ OctOber 2012 15

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Cover Story

equalities in In te a in m li E to s k Health See ence of Cancer in Kentucky KentuckyOneed e Incid Access and R uce th

By Jennifer S. newton Kevin Costner dramatizing Devil Anse Hatfield in a recent History Channel miniseries recalled what is perhaps Kentuckyâ&#x20AC;&#x2122;s most notorious feud â&#x20AC;&#x201C; the Hatfields vs. the McCoys. In healthcare, Kentucky ranks notoriously as well, and for all the wrong reasons.

Leading the nation in incidence and mortality rates for lung cancer, Kentucky

is down from the top spot in colon cancer, although it is still in the top three. With high rates of smoking and other detrimental lifestyle factors, the Commonwealth continues to do battle on many medical fronts.

A newly merged organization is hoping to tackle cancer in a more attentive and comprehensive manner statewide.

cancer and blood Specialists welcomes Khuda Khan MD, PhD (far left).

Also pictured: Michael carroll MD; I. Mohammad Khan MD; Vijay raghavan MD; Subhash Sheth MD. OctOber 2012 17

Cover Story

The recent merger of Saint Joseph Health System and Jewish Hospital & St. Mary’s HealthCare (JHSMH) into KentuckyOne Health™ has poised the organization to shrink the accessibility gap and integrate high quality services across the state.

The mission and vision of KentuckyOne is to be the premier, integrated, comprehensive health system in the Commonwealth providing high-quality care close to home — reducing the incidence of disease and eliminating inequities in access. The broad oncology program goals are simple, yet lofty: to detect cancers at an earlier stage and grow life expectancy.

The merger encompasses oncology services from the two legacy organizations in multiple locations in Louisville and Lexington and outlying areas, such as Shepherdsville, Shelbyville, Bardstown, Berea, London, and Mount Sterling.

High Quality, Low cost care

“In the world of accountable care modeling, the best way to control costs and the best way to assure the best clinical outcomes possible is to manage patients holistically,” says Mark Milburn, vice president of oncology services for KentuckyOne. In order to put this vision into practice, KentuckyOne is approaching their growth plan from a patient need standpoint, rather than a business expansion one. “We’re going to

Hematologists/oncologists and radiation oncologists at Saint Joseph cancer center (seated) Jacqueline Matar, MD, MbA; Jessica Moss, MD (standing) Scott t. Pierce, MD; Donald e. Goodin, MD; richard c. Matter, MD; Monty S. Metcalf, MD

make a very large investment in cancer,” says Dan Varga, MD, chief clinical officer for KentuckyOne. “We’re trying to really be thoughtful and deliberate about understanding what the Commonwealth needs, what the oncology care delivery model for next 20 years should look like, and make investments in programs and technology that will support that.”

Milburn advocates the pathway to high quality, patient-centered care is controlling costs through patient safety, adherence to national guidelines, and prevention of adverse or unintended healthcare access. “I really believe that as we move forward and begin to address the needs of populations like Kentucky, we’re going to have to find a way to provide high quality, low cost care, and to me the lowest cost care is the one where you treat the patient appropriately,” he says.

reducing Inequalities in Access

Mark Milburn, Vice President of Oncology Services, KentuckyOne Health 18 M.D. UPDAte

Identifying and serving populations with limited access is something Subhash Sheth, MD, medical director for Jewish Cancer Care, has experienced firsthand. Board certified in medical oncology and internal medicine, Sheth is part of Cancer and Blood Specialists, the only medical oncology group providing

cancer care in Louisville’s South End. Jewish Cancer Care has grown, encompassing sites in Louisville and surrounding counties. KentuckyOne provides the platform for Sheth to extend his vision of serving a population with poor access.

“We came to realize that there are multiple underserved areas across Kentucky. There are certain areas with the highest concentrations of things, like lung cancer, without much of any screening or treatment going on,” says Sheth.

With a large focus on lung cancer, the organization is already pursuing one of its top priorities: screening and prevention.

With breast and colon cancer screenings already in place, they have launched a lung cancer screening program in Jefferson County, which Sheth hopes to expand to other areas soon.

collaborating for consistent Quality

Just nine months old, one of the challenges KentuckyOne faces is how to integrate and link numerous providers from two different legacy programs across hundreds of miles.

With 20 years’ experience in the Lexington market at Saint Joseph Cancer Center, Jacqueline Matar, MD, a medical director of radiation oncology, embraces the opportunity to collaborate with oncologists across the state. “Since joining with KentuckyOne, I have now met and

begun collaborating with physicians in the Louisville market and the London market, so it is truly becoming a statewide approach,” she says.

Those collaborations are building on pre-existent ones. Matar and Saint Joseph have collaborated closely with the Flaget Cancer Center in Bardstown, Kentucky, since its inception. “However, because of geography, Bardstown is actually more connected to Louisville physicians. Now that we are all working together, we’ve completed the loop,” says Matar.

Monte E. Martin, MD, double-boarded in medical oncology and hematology, says

helps him deliver a higher level of oncology services in a rural setting. “The merger with the hospital and working together helps us a lot with delivery of medications, being able to take better care of patients, and having a lot more access to other facilities,” says Niazi. “We have a very coordinated way of working with the hospital.”

Access to chemotherapy medications has been an issue for Niazi and other independent oncology practitioners because of cost and insurance issues. Being part of a larger, hospital-affiliated entity has changed that. Niazi is also trying to establish some dedicated cancer beds at Saint Joseph London, so they can provide in-patient chemotherapy.

Currently those patients must be transferred to tertiary care centers.

One way KentuckyOne seeks to demonstrate the quality of their oncology services is through accreditation. Jewish Cancer Care is fully accredited by the American College of Surgeons Commission on Cancer. KentuckyOne has submitted applications for Saint Joseph Hospital and is moving forward with a plan to seek accreditation for all locations.

even though we’ve been competitors in some instances, our goal is to retool the entire system to provide the best care for patients, and that is a goal everyone can get around. the Flaget Cancer Center is almost like an oncology boutique. “What’s different about our approach here is we have one nursing staff shared between radiation and medical oncology, so patients’ continuity of care is 100%,” says Martin. Shared staff and space translates into the ability to have multimodality conferences at any time on any patient. Having worked at UofL and within the JHSMH system, Martin believes his expertise plus the services available at Flaget provide the same quality of care a patient would receive in a larger city.

M. Azeem Niazi, MD, is board certified in internal medicine and medical oncology and has practiced hematology/oncology in London, Kentucky, for over 11 years at the Commonwealth Cancer Center. Niazi also believes the merger under KentuckyOne

One high impact example is the implementation of a systemwide electronic health record (EHR). KentuckyOne has the benefit of partaking in CHI’s national rollout of comprehensive inpatient and ambulatory EHR platforms. Both are in the early phases and are set to be complete in 2014.

“It is very nice to be part of nationwide implementation plan and the stability that comes along with that and then to have the support of a national oncology service line,” says Milburn.

An increased opportunity for research and clinical trials is another benefit of the merged organization. Martin looks forward to the advantage of unifying all providers and institutions with EHR and the pros-

Advantages of a Larger Organization

Through the merger, KentuckyOne has some big advantages, the most outstanding being the backing of a well-established, national healthcare system – Catholic Health Initiatives (CHI), which is part of Catholic Healthcare Oncology Network Monte e. Martin, MD, hematologist-oncologist with (CHON).

Flaget cancer center.

According to Varga, tapping into CHI’s national oncology consortium to identify best practices and borrow other pects that will afford. “What’s going to programs’ implementation strategies to effi- be interesting and a great opportunity by ciently translate those models for local use is having so many oncologists unified as a an operational boon. group throughout the state, we’ll be able to OctOber 2012 19

Cover Story

qualify for more clinical trials that are open to larger entities, such as universities and huge conglomerates,” says Martin.

Another partner in KentuckyOne’s quest for a statewide network is 21st Century Radiation Oncology, the largest provider of radiation oncology services in the US. Mark Jones, MD, medical director for Louisville Radiation Oncology Center affiliated with 21st Century, says the affiliation has allowed his center to be the first in the state to use new technologies such as stereotactic radiosurgery and gamma function. There are four facilities statewide either owned or operated by 21st Century Oncology, all with access to the latest clinical trials. “We have the most advanced physics support available including planning software, which is the lifeblood of what we do, as opposed to a more local or regional market that might not have the resources available to a larger network,” says Jones. “And while technology is important, the real strength of our treatment center is the personal and caring approach to cancer care demonstrated by an exceptional staff, many of whom have served the south Louisville area for over 10 years.”

cancer rehab StAr certified Saint Joseph outpatient rehabilitation recently earned Star Program® Certification from the Massachusetts-based oncology rehab Partners, leading experts in the field of survivorship care. Star Program Certification uniquely qualifies facilities to offer premium rehab services to cancer survivors who suffer from debilitating side effects, caused by treatments. Saint Joseph is the first certified Star

Program in Kentucky, now available at Saint Joseph hospital, Saint Joseph east, and Saint Joseph Jessamine. to receive its certification, Saint Joseph outpatient rehabilitation executed oncology rehab Partner’s conventional medicine and evidencebased standardized model of oncology rehabilitation service delivery, successfully implementing the program’s evaluation and treatment protocols and rehabilitation training. these services are covered by health insurance providers and will be offered to patients

Jones also believes 21st Century’s nationally recognized division integration with multidisciplinary practices will be beneficial models for KentuckyOne going forward. “There is just great synergy there I believe,” he says.

technology and Investment

One financial implication of the merger is a significant investment commitment, not just for cancer, but across all medical specialties. “We have the scope and scale for investment that we didn’t have as individual health systems before,” says Varga.

“Given that Kentucky leads the nation in terms of cancer deaths in certain sites and disease burden is incredibly high, we’ll obviously be spending a significant component of the $320 million, which was committed to KentuckyOne when we

the recent merger of Saint Joseph Health System and Jewish Hospital & St. Mary’s Healthcare (JHSMH) into KentuckyOne Health has poised the organization to shrink the accessibility gap and integrate high quality services across the state. (seated) Jacqueline Mater, MD, with Saint Jospeh cancer center; Shubhash Sheth, MD, with cancer and blood Specialists; and (standing) Dan Varga, MD, chief clinical officer for KentuckyOne.

20 M.D. UPDAte

by a knowledgeable and sensitive medical staff that is specially trained to work with survivors of all forms of cancer.

Specialty caregivers from a pool of disciplines – including physicians, physical and occupational therapists, speech pathologists, dieticians, mental health professionals, etc. – will work together with each patient on a personalized rehabilitation plan to increase strength and energy, alleviate pain, and improve daily function and quality of life. ◆

merged, in the cancer domain,” he says.

One of the tasks for KentuckyOne is expanding technology throughout the state, but also determining what is appropriate in each situation. “Our goal is to have navigation for the patients, so that each patient is guided throughout their treatment course in the most efficient manner,” says Matar. For instance, elements such as EHR, infusion technology, and basic surgery capability will be deployed broadly; however cuttingedge radiation therapy treatments such as Cyber-Knife or intra-operative radiation may not be warranted for every location.

Jones concurs, “While we don’t want to create a cookie-cutter model, we do want to establish a level of excellence that is uniform.”

In an effort to impose high-tech care in

we’re going to make a very large investment in cancer. we’re trying to really be thoughtful and deliberate about understanding what the Commonwealth needs, what the oncology care delivery model for next 20 years should look like and make investments in programs and technology that will support that.

–Dr. Dan varga

underserved populations, KentuckyOne is working with CHI’s research arm on a telemedicine program to try to affect change in hard to reach areas. “We’re working with leaders in ambulatory care and in women’s’ services, cardiovascular, and neurology to see how the use of telemedicine will allow us to reach out to areas in Kentucky where the presence of a physician is not a luxury for that community,” says Milburn. As it relates to cancer services, Varga says, “We will be using our telehealth clinics to facilitate the early diagnosis of cancer by making it easy for patients in small, remote communities to gain access to specialists' consultative services without leaving their communities. In addition, while they are in the course of their treatment plans, they can similarly be followed in their local communities by their treating specialist. This is all consistent with our philosophy to deliver exceptional care close to home." The telemedicine program is being piloted in Powell and Wolfe counties. ◆

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SPeCial SeCtion  onColoGy

he’s our Guy

Future NCI designation just might rest on UK musculoskeletal oncologist’s shoulders. By Megan C. SMith LeXingtOn So what if UK Markey Cancer Center’s multi-year quest for NCI Cancer Center designation hinges on his success?

Patrick O’Donnell, MD, PhD, the orthopaedic oncologist recruited to get a new but necessary program off the ground, says he feels no pressure.

O’Donnell, who was one of the last recruits to join UK just weeks before their 860-page application for NCI designation was complete, joined UK Healthcare in August 2012 to head up the Center for Musculoskeletal Oncology. Being one of the rarest of rare subspecialists, O’Donnell’s skills dovetail with UK’s strategic recruitment of those singular providers who can serve a statewide need. At the same time, Markey’s NCI path required the establishment of a new musculoskeletal oncology program, and O’Donnell got pegged as the pivotal recruit.

In the big picture, there are lots of O’Donnells out there; the realignment of healthcare delivery has primed the conditions that make their employment very favorable for both sides. Of UK’s multidisciplinary musculoskeletal oncology team, eight were recruited for the NCI-propelled launch.

“Musculoskeletal oncology is a team sport,” says O’Donnell. We got a chance to speak in late September - a few days after the NCI application was filed - in O’Donnell’s office at the Department of Orthopaedics and Sports Medicine at the Kentucky Clinic. “The orthopedic surgeon is only one piece of the puzzle. Pediatric oncologists, medical oncologists, musculoskeletal radiologists, and radiation oncologists – all of these people are part of our multidisciplinary team. I’m just the surgeon in a team that is 12 people strong.”

the rarest of rare Specialties

“In Kentucky, there are only two orthopaedic oncologists. We’re the rarest of rare of the rare specialties,” emphasizes O’Donnell.

22 M.D. UPDAte

MarKey’S nCi Path requireD the eStaBliShMent of a new MuSCuloSKeletal onColoGy ProGraM, anD o’Donnell Got PeGGeD aS the Pivotal reCruit.

While preparing to sign with UK, which involved about three years of talks with Markey’s Mark Evers and UK’s Michael Karpf, O’Donnell recalls how at times he vacillated between going to a program where he would be “the only guy” and going someplace where he could gain from a senior practitioner’s many years of expertise.

Taking the leap of faith to be that guy, he says, felt right.

“Orthopedic oncology is easy, it really is.

If you don’t get the tumor out, the patient is not going to live,” says O’Donnell.

“The hard part is the critical decisionmaking. especially when the decision to proceed involves major invasive treatment.”

It’s with the decision-making that O’Donnell says he really benefits from having Karpf and Evers behind him. O’Donnell points to the team mentality, how being part of an institution that aims for the best was the deciding factor for his decision to join UK. “I didn’t come to be on some JV team and struggle through all this stuff.

Dr. Patrick O’Donnell is an orthopedic cancer surgeon and heads up UK Markey cancer center’s Musculoskeletal Oncology center.

Having the institution’s support is mandatory, and it’s why I came.”

“These guys have protected my time,” he continues, “allowing me to focus on the Musculoskeletal Oncology Center. They also make sure we have the money that we need for our research and for our nurse practitioner, whose work is dedicated to musculoskeletal oncology services.”

And if he needs something more?

O’Donnell says, “I don’t have to suffer in silence. I just call the big boss, say ‘I don’t like this. This is not going well,’ and they solve the problem.

“All I want to do is take care of cancer patients. That’s why I went into medicine, and that’s what I’m good at. Having guys like Drs. Karpf and Evers in my corner their support of this program allows me to take good care of our patients.” ◆

SPeCial SeCtion  onColoGy

high output, Short amount of time

SBRT Will Reduce Costs and Improve Outcomes for Floyd Memorial Patients

By Jennifer S. newtOn

Mathematical statistics and measurements abound in the science of healthcare. So, when a technology comes along that measures precision in millimeters and improves methods close to 100%, clinicians take notice.

The new Varian Linear Accelerator with stereotactic body radiotherapy (SBRT) and image guided radiotherapy (IGRT) at the Floyd Memorial Cancer Center of Indiana is predicted to cut treatment times by up to 90% in eligible patients, a staggering statistic in the delivery of healthcare. The linear accelerator is currently being assembled at the center and is planned to be operational in mid- to late-October.

Neal Dunlap, MD, radiation oncologist with the Floyd Memorial Cancer Center of Indiana, has been using SBRT therapy at the James Graham Brown Cancer Center in Louisville for years and is optimistic about bringing cutting-edge treatment closer to home for Southern Indiana patients.

The benefits of SBRT are multi-fold, including drastically reduced treatment times, fewer side effects, and a potential cost savings to providers and patients. In essence, SBRT techniques “allow for higher doses of radiation to smaller volumes of tumor,” says Dunlap. In contrast to conventional radiation therapy, the Varian Linear Accelerator utilizes a form of IGRT called cone beam CT to accurately assess a patients’ position utilizing CT imaging before and during each treatment to pinpoint tumor areas with greater precision. In doing so, there is a greater ability to avoid normal structures, limiting side effects for patients and increasing tolerance for therapy.

“The other key feature is what is called a ‘high output’ to deliver a lot of radiation in a short amount of time,” says Dunlap. This allows for quicker treatment of patients and the potential for higher tumor kill capabilities by delivering radiation at a higher dose rate, although this is still being studied.

The main indication for SBRT is inoperable lung cancer. Therapy with a standard accelerator platform can take approximately

new aLBany, in

35-40 treatments. With SBRT, the same therapy can be accomplished in one to five treatments. SBRT can also be used for brain, liver, lung, pancreas, prostate, and spinal cord lesions.

An active lung cancer screening program has also become one of the tools Floyd Memorial is using to fight the disease.

Because Kentucky leads the nation in incidence and mortality rates of lung cancer, there is a state initiative, which Southern Indiana has embraced, to improve diagnosis and cause “stage migration” of the disease, thereby catching lung cancers earlier and improving outcomes.

reducing cancer costs

“One of the big pushes of CMS is improving efficiency and quality and decreasing costs of care,” says Dunlap. “By having more accurate treatments, we’re able to deliver more cost effective medicine.”

Consolidating radiation treatment courses will not only benefit patients in terms of

Dr. Neal Dunlap with the Floyd Memorial cancer center of Indiana specializes in high dose radiation through stereotactic body radiotherapy (Sbrt).

fewer side effects, less treatment time, and potentially better outcomes, but will be a source of cost savings for the system and the patient.

Head and Neck cancer

Much attention has been given to the HPV vaccine debate, with ethical and religious beliefs clashing with scientific data.

However, recent recommendations from the CDC, FDA, and American Academy of Pediatrics have advocated inoculating not only young women, but also boys and men between the ages of 11 and 26. One reason for this is a causal link between the HPV virus and rising cases of head and neck cancer.

Dunlap says 40% of head and neck cancers in the oropharynx are related to the HPV virus. “We’re routinely doing testing on these tumors to see if they contain that virus, and it’s important because patients with that viral component in their tumor OctOber 2012 23

SPeCial SeCtion  onColoGy do much better than the standard smoking- radiation Oncology team related head and neck cancer,” says Dunlap. Dunlap jokes that he is not allowed to touch While head and neck cancer is low on the radiation accelerator. The truth is only the incidence list of all cancers, Kentucky the radiation therapists are trained to operand Southern Indiana have higher rates ate the machine, which is why the treatment because of the prevalence of smoking in the team is essential. For radiation oncology that region. Fortunately, patients in Louisville and Southern the fielD of raDiation onColoGy iS Indiana have access to experts GoinG to exPerienCe a Shift towarDS like Dunlap, who was recruited reDuCinG raDiation tiMeS, reSultinG to the University of Louisville in leSS exPenDitureS Per Patient, More for head and neck and lung effiCient throuGhPut of PatientS, anD cancers and is part of a multileSS treatMent tiMe for PatientS. disciplinary team of oncology professionals.

Floyd Memorial contracts with Dunlap and his two radiation oncologist includes the oncologist, nurse, radiation theracolleagues to provide services at their compre- pist, physicist, and dosimetrist. hensive cancer center. These physicians also The Floyd Memorial Cancer Center of practice at the James Graham Brown Cancer Indiana has the advantage of an integrated Center in Louisville, which allows Southern PET/CT scanner. “We put [patients] in the Indiana patients access to experienced special- position we want to treat them in and get a ists but the convenience of treatment close to PET scan at the same time, which can be home at Floyd Memorial. “We’re really trying more accurate for delineation of tumor volto translate what we have in an academic set- umes and more accurate targeting,” advoting into the community,” says Dunlap. cates Dunlap. ◆

24 M.D. UPDAte

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accredited Cancer Services Go farther Lexington Clinic Cancer Centers in Corbin & Richmond Receive ACR Accreditation By giL Dunn

LeXingtOn Lexington Clinic’s Southeastern Kentucky Cancer Center (SKCC) in Corbin and Richmond Regional Oncology Center (RROC) in Richmond received accreditation from the American College of Radiology (ACR) in September. With this accreditation, all three Lexington Clinic cancer centers are fully accredited by the ACR. This accreditation, which makes SKCC and RROC the only ACR accredited facilities in their respective areas, represents the highest level of quality and patient safety. It is awarded only to facilities meeting specific Practice Guidelines and Technical Standards developed by ACR after a peer-review evaluation by board-certified radiation oncologists and medical physicists who are experts in the field.

Patient care and treatment, patient safety, personnel qualifications, adequacy of facility equipment, quality control pro- AbOVe: Dr. Joseph M. Wang, radiation oncologist cedures, and quality assurance programs at Southeastern Kentucky cancer center. are assessed.

Lexington Clinic took over operation rIGHt: Dr. Jeniffer L. Huhn, radiation oncologist richmond regional Oncology center. of the SKCC in 1996.The facility was relocated and new technology, such as a and community that Southeastern linear accelerator, was acquired. Lexington Kentucky Cancer Center is a leader in the Clinic built the RROC in 1997 as part of its processes, equipment, and physician and growth plan to bring quality cancer care to staff knowledge required to provide truly the less urban communities it serves. excellent cancer care and treatment,” says Having a physical presence in these Wang, who says he joined Lexington communities provides Lexington Clinic Clinic in October 2010 because of its physicians a unique insight into the needs of reputation as a leader in cancer care. their patients. The patients benefit because Adhering to the highest standards of they receive high quality services and care in care is part of his daily routine conducted a convenient and comfortable setting close in preparation for the accreditation proto home, says Angela Johnson, CPC, RN, cess, says Wang. For the ACR evaluation, Lexington Clinic director of Oncology and he submitted his charts for audit and was Neurosciences. interviewed by the ACR accreditation team.

The goal of the Lexington Clinic Wang completed his residency in radiaRadiation Oncology section is to provide tion oncology at the Universities of Iowa state-of-the-art radiation oncology services Hospitals and Clinics after his anatomic in a compassionate, patient-centered envi- pathology residency at Aultman Hospital ronment, says Joseph M. Wang, MD, a radi- at Northeastern University in Canton, ation oncologist at the SKCC. “The ACR Ohio. Wang received his medical degree accreditation demonstrates to our patients from the China Medical College, School of

Medicine, in Taichung, Taiwan.

Wang is energized by the technological advances in radiation oncology that continue to provide an array of available patient treatment options. Stereotactic body radiation therapy (SBRT) is an emerging form of image guidance based radiotherapy treatment that delivers a high dose of radiation to the target using either a single fraction or a small number of fractions with a high

degree of precision within the target areas of the body. “With favorable outcomes and low side effects, SBRT has attracted the attention of many physicians, and patients are becoming increasingly educated about SBRT as a treatment option,” says Wang.

Special linear accelerators have been designed to provide SBRT as well as some available device attachments for existing linears, such as stereotactic radiosurgery (SRS).

These new technologies will continue to evolve and expand, says Wang, who believes the radiation oncology industry is poised to continue with technological advances OctOber 2012 25

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due to “the dedicated professionals working diligently throughout the country to ensure patients have their cancer successfully treated,” he states.

richmond regional Oncology center

Jeniffer L. Huhn, DO, is the radiation oncologist at the RROC. Huhn joined Lexington Clinic in 2008 having completed her residency in general surgery and radiation oncology at the University of Kentucky Medical Center. Huhn is board certified in radiation oncology with a practice in CT Simulation, IGRT, IMRT, prostate implants, and three dimensional treatment planning.

For Huhn, the ACR accreditation affirms the quality of the personnel at the RROC, and the evaluation process “gives us

26 M.D. UPDAte

immense pride in knowing that we deliver safe and appropriate radiation therapy with state-of-the-art equipment.”

An example of state-of-the-art technology that interests Huhn is Mobile Device Management (MDM) software that enables the radiation oncologist to aim radiation treatment at the target tumors while limiting the dosage to the healthy, surrounding tissues and structures. “This amazing technology, along with refined imaging equipment, gives us confidence that we are treating the disease with accuracy and avoiding both the long- and short-term negative side effects of the treatment,” says Huhn.

radiation therapy: A Mainstay of cancer treatment

Wang estimates that nearly half of all cancer patients receive radiation therapy as part

of their initial treatment or for salvage or palliative treatment of their illness. Wang foresees a bright future for radiation oncology, as the role of radiation therapy in the management of common cancers, such as lung, breast, prostate, head and neck, and gastrointestinal tract cancers, continues to expand in the next decade as a result of a number of imaging, technological, and biological advances. This progress in different aspects of medicine has changed the way each patient’s healthcare is planned, prescribed, and delivered by radiation therapy or by other modalities, says Wang, such as highly targeted surgical approaches and molecular biologic and targeted therapies from medical oncology.

That progress is what Lexington Clinic radiation oncologists strive towards on a daily basis. ◆

SPeCial SeCtion  onColoGy

ahead of the Curve

Independent Diagnostic Center Is Kentucky’s First Private Adopter of 3D Mammography By MeGan C. SMith LOuiSViLLe We’re accustomed to the big medical centers doing it – being early adopters of new technologies and touting the patient benefits on billboards. But driving down highway 71 into downtown Louisville, a surprising message emerges: A local, private diagnostic center is offering the best possible breast imaging technology – 3D mammography.

OK – so it’s a bit more provocative than that with a woman holding a sign over her breasts that reads, “They look even better in 3D”. Jokes aside, the message that the independent Women’s Diagnostic Center of Louisville has invested in state-of-the-art 3D mammography makes one stop and take notice. The imaging technology combines digital breast tomosynthesis (DBT) with traditional 2D mammography, of which DBT was just approved by the FDA in February 2011 and had until just this autumn been available regionally only at the University of Kentucky Markey Cancer Center.

Provocation accepted, we set out to understand what compels a private, local provider to make a big investment like this.

According to Women’s Diagnostic Center’s CEO and medical director Arthur McLaughlin II, MD, it’s a simple matter of understanding customer need and delivering it.

a mainstay of the big centers, McLaughlin created a prototypical imaging and diagnostic center specializing in comprehensive mammography services long before the mainstream.

“Back in the 80s, asymptomatic screening mammography was proving to dramatically reduce breast cancer mortality, and was just taking off,” McLaughlin says, his Kentucky draw instilling a sense of familiarity and ease right from the start. “Louisville was ready for something like this, but hospitals at the time did not have the women’s centers like they do now.

“That’s why we created a women-only breast center where we could provide diagnostic mammograms, physical breast exam, and consultation, and do it privately, away from the hospital setting.”

We know today that women’s care preferences include consultation with the physician authority, participating in the review of the mammogram, and same day biopsy whenever possible, but

25 Years in the Driver’s Seat

When McLaughlin helped launch the Women’s Diagnostic Center in 1986, he was helping to pave the way for one of the stickiest trends in healthcare today – the woman-focused care center. Though now

An eye-catching billboard touts the Women’s Diagnostic center’s investment in 3D mammography to Louisvillearea travelers.

actually providing those services in the face of dwindling reimbursements reveals a real commitment to customer service.

In the case of Women’s Diagnostic Center, commitment to customer service is a launching pad for a modern healthcare value proposition.

technology’s role in Valuebased Medicine

Here’s the deal: The imaging quality of digital breast tomosynthesis combined with 2D screening mammography is so good that it can reduce the recall rates for screening mammography by 40 percent.

A study of 7,578 screening mammograms by Yale University School of Medicine, released May 2012, shows a recall rate of 6.6% for digital breast tomosynthesis combined with 2D screening mammography. Recall rates for 2D screening mammography alone came in at 11.1%.

What does 40% fewer worried women mean to an independent care provider like

Women’s Diagnostic Center? How about significantly better patient satisfaction, improved quality, and costefficient delivery (and receipt) of annual screening mammography.

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Dr. Art McLaughlin II is medical director and ceO of Women’s Diagnostic center of Louisville – the state’s only private provider of 3D mammography.

By avoiding unnecessary services, which might include ultrasound-guided biopsies, repeat imaging and the time spent viewing them, McLaughlin and his group deliver value-based medicine to a population that is eager to receive it.

“All high-risk women should be getting an annual mammogram, and all women from age 40, too,” McLaughlin reminds us. 3D mammography is not only more efficient in reducing recall rates, it improves

cancer detection.

Studies on the technology’s impact on cancer detection show varying improvements in specificity and sensitivity, but most authors find, as does McLaughlin, improved detection and improved confidence from the higher quality images.

When we spoke with McLaughlin in October, Women’s Diagnostic Center been using its three 3D mammography machines for just over a month and had already found a “a few cancers we would not have found otherwise.”

Because the technology combines traditional breast x-ray with 3D slices of the breast, McLaughlin can better differentiate between prominent breast tissue and early masses.

“This technology is appropriate for all women and for screening and diagnostic mammography, but it is most helpful in fatty breasts and dense fibrocystic breasts,” he says.

Digital breast tomosynthesis is not cov-

ered by insurance at this time, and patients who opt for the service pay an additional $50 fee. Utilization is around 30-40%, and McLaughlin reports that many women who opted out this year have taken home literature in consideration of next year’s screening.

“Financially, we think 3D mammography will decrease total costs of care – not only in the emotional costs in distress to patients who receive call backs, but also in the hard costs of those additional diagnostic work ups including more mammography and ultrasound.

Just a 30% decrease in false alarms offsets the additional fee,” he says, “and if we include the benefits of finding more cancers, then the savings can be huge.” ◆

women’s Diagnostic Center this region’s only Independent breast Imaging center of excellence offering comprehensive, state-ofthe-art breast care.

For additional information about 3D tomosynthesis, call (502) 893-1333 or visit WomensDiagnosticcenter.com.

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Pediatric cancer researcher recruited to Louisville

LOuiSViLLe Kenneth Lucas, MD, has joined University of Louisville Department of Pediatrics as division chief Kenneth Lucas, MD of Pediatric HematologyOncology and Stem Cell Transplantation, and Kosair Children’s Hospital as Chief, Pediatric Hematology/Oncology. Formerly a Pennsylvania State University researcher and pediatric cancer physician, Lucas brings with him the Phase 1 Trial of a vaccine to prevent recurrence of neuroblastoma and sarcoma, among the most common and deadly of all childhood cancers.

The trial, which began at Penn State a year and one-half ago, is generating referrals from around the world. With Lucas’s appointment, The Addison Jo Blair Cancer Center at Kosair Children’s Hospital will be the primary site for this trial. Thus far, he has recruited about half the patients allowed for this study.

Lucas replaces Salvatore Bertolone, M.D., who has been named University of Louisville Department of Pediatrics Chief Clinical Operations Officer. Bertolone will continue to see pediatric cancer patients in addition to overseeing the operations of the department’s 13 subspecialty practices.

Lucas began his career investigating ways to combat Epstein-Barr and Cytomegalovirus infections in bone marrow transplant patients. After his team found a way to use patients’ immune systems to fight these infections, they turned to cancer, using strategies they had learned about immunology in the immune-compromised zones of bone marrow transplant patients.

Lucas developed his research in stem cell transplantation and immunotherapy for cancer and post-transplant infections during

SenD your newS iteMS to M.D uPDate > news@md-update.com ????????

his fellowship at Memorial Sloan Kettering Cancer Center. He received his medical degree in 1989 at the State University of New York Upstate Medical Center in Syracuse and completed his pediatrics residency in 1992 at Children’s Hospital of Pittsburgh. Before joining the University of Louisville, he was the director of the Pediatric Stem Cell Transplant Program at Penn State Hershey Medical Center.

Woodford Family Physicians, PSc Joins Lexington clinic

Lexington Clinic, Central Kentucky’s oldest and largest multi-specialty medical group, announced today the association of Woodford Family Physicians, PSC, as part of a strategic alliance to further enhance healthcare service delivery to patients.

Woodford Family Physicians, PSC, is a physician group practice that has been providing high quality, personalized care for residents of Woodford County since 1994.

“We are very pleased to become an associate practice of Lexington Clinic,” said Robby K. Hutchinson, MD, Woodford Family Physicians, PSC. “By combining our efforts, we are better positioned to provide the best care for our patients,” said Steve T. Vogelsang, MD, Woodford Family Physicians, PSC. This association is expected to take effect on November 1, 2012, at which time Woodford Family Physicians, PSC physicians will become members of Lexington Clinic’s Associate Physician Network.

Lexington Clinic and Woodford Family Physicians, PSC are striving to ensure minimal patient impact during this transition.

LeXingtOn

Dr. Pell Wardrop recognized by American Academy of OtO-HNS

LeXingtOn Pell Wardrop, MD, of Lexington was awarded the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Honors Award and was recognized during the AAO-HNSF 2012 Annual Meeting & OTO EXPO at the Walter E. Washington Convention Center in Washington, DC, in September.

The AAO-HNS presents the Honors

Pell Wardrop, MD

Awards to medical professionals in recognition of extensive meritorious service through the presentation of instructional courses, scientific papers, and participation on any AAO-HNS/F committee or in an Academy leadership position.

Wardrop is currently the medical director of Saint Joseph Sleep Wellness Center, part of KentuckyOne Health, in Lexington.

KentuckyOne Health Appoints New Physician Leaders and Invests Additional $30 Million in Heart and Vascular Services

LOuiSViLLe KentuckyOne Health, a leader in cardiovascular care, announced that it will invest an additional $30 million in its KentuckyOne Heart and Vascular Institute over the next three years. KentuckyOne has already invested more than $100 million over the past 10 years bringing the total investment to more than $130 million during that time.

KentuckyOne Health treats more heart patients than any other health system in the state of Kentucky and has performed many firsts in heart care in Louisville, Lexington, the region, state and world. Plans for the additional $30 million include investments in outreach, collaboration, technologies, and programs.

“With KentuckyOne’s development of virtual/remote consultation clinics across the state of Kentucky, doctors can provide care to patients with heart disease closer to their homes,” said Mark Slaughter, M.D., newly appointed executive director of cardiovascular services for the KentuckyOne Health Louisville market and the director of the Division of Thoracic and Cardiovascular Surgery at the University of Louisville.

OctOber 2012 29

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“Investment in state-of-the-art technology upgrades of our cardiac catheterization and electrophysiology laboratories means patients across central and eastern Kentucky will have access to more of the newest technologies in the U.S.,” said Robert Salley, MD, new KentuckyOne Health executive director of Cardiovascular Services in the Lexington market. “We will see enhancements to our coronary care nursing units and expansion of our cardio diagnostics ambulatory platform.”

Physician alignment will also be a large part of the investment with an expansion of the heart and vascular physician network within a Clinically Integrated Network, partnerships and affiliations with healthcare continuum partners, along with an additional cash infusion in the ambulatory electronic health records.

UK researcher Among 14 in the U.S. to receive Prestigious NIH Award

LeXingtOn Brandon Fornwalt, MD, assistant professor of pediatrics, physiology and biomedical engineering in the Division of Pediatric Cardiology at the University of Kentucky, has been selected to receive the National Institutes of Health (NIH) Director’s Early Independence Award. The award provides funding for junior scientists who have demonstrated outstanding scientific creativity, intellectual maturity, and leadership skills with the opportunity to conduct independent biomedical or behavioral research by skipping the traditional postdoctoral training period.

Fornwalt was among 14 exceptional junior scientists who have completed doctoral degrees or clinical residencies in the past year and have been chosen to be supported by the NIH Common Fund and contributing NIH Institutes. NIH plans to commit approximately $25.9 million to support their research projects over a five-year period. Fornwalt will receive $1.96 million over five years to advance his research in exploring the role of dyssynchrony – a condition where the heart suffers from uncoordinated contraction – in pediatric heart disease with magnetic resonance imaging (MRI).

Originally from South Carolina, Fornwalt joined the faculty at UK in 30 M.D. UPDAte

2011 and directs the Cardiac Imaging Research Laboratory at Kentucky Children’s Hospital. He attended the University of South Carolina receiving undergraduate degrees in mathematics and marine science. He worked in a free medical clinic for a year before starting a combined MD/ PhD program at Emory University and the Georgia Institute of Technology in Atlanta.

After finishing his degrees in 2010, he completed an internship in pediatrics at Boston Children’s Hospital.

Louisville Market Leader, were included in the list of 120 women who demonstrate outstanding leadership within the hospital and ruth brinkley healthcare industry.

Honorees were selected based on a wide range of management and leadership skills, including oversight of hospital or health system operations, financial turnarounds and quality improveephraim McDowell and ment initiatives. central baptist Named top This is the Performers by the Joint seventh time that commission Becker’s Hospital DanViLLe, LeXingtOn Ephraim McDowell Review has honRegional Medical Center (EMRMC) in ored Brinkley as a Danville and Central Baptist Hospital leader in healthin Lexington were named as two of the care, the fourth nation’s Top Performers on Key Quality for Rutledge.

Measures by The Joint Commission, the Both leaders have leading accreditor of health care organiappeared multiple zations in America. The hospitals were Valinda rutledge times on lists of recognized for exemplary performance top “Women in using evidence-based clinical processes Hospital and Healthcare Leaders” and top that are shown to improve care for heart “Hospital and Health System Leaders.” attack, heart failure, pneumonia, and surgical care. central baptist receives Platinum EMRMC and Central Baptist were Performance Achievement Award among 620 hospitals in the U.S. earning the for Heart care distinction of Top Performer on Key Quality LeXingtOn Central Baptist Hospital is Measures for attaining and sustaining excel- one of only 164 hospitals nationwide to lence in measurable performance. The list receive the American College of Cardiology of Top Performers represents only 18 per- Foundation’s NCDR ACTION Registry– cent of more than 3,400 eligible accredited Get With The Guidelines Platinum hospitals nationwide. The ratings are based Performance Achievement Award for 2012. on an aggregation of accountability meaThe award recognizes Central Baptist’s sures reported to The Joint Commission commitment and success in implementing during the 2011 calendar year. a higher standard of care for heart attack patients, and signifies that the hospital has KentuckyOne executives reached an aggressive goal of treating these Named to becker’s Hospital patients to standard levels of care as outlined review’s “120 Women by the American College of Cardiology/ Hospital and Health System American Heart Association clinical guideLeaders to Know” lines and recommendations.

LOuiSViLLe Becker’s Hospital Review To receive this award, Central Baptist has named two female leaders from consistently followed the treatment KentuckyOne Health to its annual list, guidelines in the ACTION Registry– “120 Women Hospital and Health System GWTG Premier for eight consecutive Leaders to Know.” quarters and met a performance stanRuth Brinkley, CEO of KentuckyOne dard of 90% for specific performance Health, and Valinda Rutledge, CEO of measures. Implementation of the treatJewish Hospital and KentuckyOne Health ment guidelines is a critical step in sav-

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ing the lives and improving outcomes of heart attack patients.

procurement agency servicing 114 counties in Kentucky.

central baptist Awarded Medal of Honor for Organ Donation

Norton Neurological residency Program Accredited

LeXingtOn Central Baptist Hospital has been awarded the U.S. Department of Health and Human Services’ Bronze Medal of Honor for Organ Donation for achieving and sustaining national goals for donation, including a donation rate of 75 percent or more of eligible donors.

CBH was among four Kentucky hospitals and 404 hospitals nationwide recognized October 4 during the Seventh Annual National Learning Congress on Organ Donation and Transplantation in Grapevine, Texas. Awards were presented for work done during the time period of April 1, 2010 through March 31, 2012.

Central Baptist collaborates with Kentucky Organ Donor Affiliates (KODA), an independent, non-profit organ and tissue

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LOuiSViLLe The Neurological Physical Therapy Residency Program at Norton Healthcare in collaboration with Bellarmine University was accredited in September by the American Board of Physical Therapy Specialties, the governing body on certifications for the American Physical Therapy Association.

This residency program is the only one of its kind in Kentucky, and one of only 17 in the country. The program produces leaders with advanced neurologic rehabilitation training who will make a lasting contribution to their local and professional communities.

Residents in the program have the opportunity to treat patients with various neurologic diagnoses across acute

care, inpatient rehabilitation, and outpatient settings. Each resident spends time in specialty clinics and with therapists and physicians who are specialists in their field. Residents in the Neurological Physical Therapy Residency Program at Norton Healthcare also participate in clinical research and teaching responsibilities in Bellarmine University’s Doctor of Physical Therapy Program. In addition, they complete a case study and participate in coursework with a focus on advanced neurologic physical therapy evaluation and interventions.

Being accredited by the American Physical Therapy Association means that this program follows the rules and standards set forth by the professional association. This is important for physical therapy residents, because they will automatically qualify to take their specialty exam after completing the residency. Sitting for a specialty exam in physical therapy is not guaranteed to other students. ◆

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congressman ben chandler Visits Lexington Medical Society

LeXingtOn The October meeting of the Lexington Medical Society (LMS) on October 9, 2012 at The Red Mile Clubhouse honored LMS past-presidents from 1968 through 2011. Nineteen past presidents attended the annual event.

In near record time, under 30 seconds, the membership accepted the nominating committee’s report for the LMS officers for 2014. A vote that the featured speaker, Congressman Ben Chandler, D-6th District, US House of Representatives said should be imitated in Washington.

Chandler addressed the LMS membership and spoke of the difficulty of passing legislation in Congress when the extreme wings of each party attempt to dominate the process.

“Being a moderate, I get attacked by each side,” said Chandler who is running for reelection in November.

The Affordable Care Act is an example, said Chandler, of a bill that has elements that he both agreed with and disagreed with. Chandler stated that the PPACA needed modification, not repeal. ttob

Members of the Lexington Medical Society pause for a snapshot with rep. ben chandler and Mrs. Jennifer chandler, including Dr. David bensema, Dr. David cassidy and, Mrs. rowshan Karim and Dr. Farhad Karim

Kentucky Medical Association Annual Meeting

The Kentucky Medical Association (KMA) Annual Meeting was held September 10-12 in Louisville. KMA officers for 2012-13 are Linda Gleis, MD, secretary-treasurer; Fred A. Williams, MD, president-elect; Uday V. Dave, MD, president; William C. Harrison, MD, vice-president.

Honors for individual achievement awards were presented to William E. Doll, Jr, Outstanding Layperson Award; Baretta R. Casey, MD, MPH, Distinguished Service Award; Rice E. Leach, MD, Community Service Award; Randall G. Rowland, MD, PhD. LOuiSViLLe

 Steven Stack, MD, chairman of AMA board of trustees; and carolyn Kurtz, VP, Lexington Medical Society at the KMA Annual Meeting, September, 2012 in Louisville.

32 M.D. UPDAte

Doctors’ ball Honors Service of Area Physicians and community Leaders

LOuiSViLLe Over 650 physicians and healthcare community leaders attended the annual Doctor’s Ball on Saturday October 13 to honor Louisville physicians and to raise nearly $300,000 for Jewish Hospital & St. Mary’s Foundation.

hOnOreeS at the DOCtOr’S BaLL gathereD with heart patient B.J. finney (FAr rIGHt): (Ltor) robert D. Acland, MbbS, FrcS, excellence in education Donald Varga, MD, excellence in community Service Steven J. raible, MD, ephraim McDowell Physician of the Year Susan M. berberich, MD, compassionate Physician Henry V. Heuser, Jr., community Leader of the Year richard Neal Garrison, MD, excellence in research Ltor

John rhodes, MD; rhonda rhodes, president-elect KMAA; James Patrick Murphy, MD, president-elect of the GLMS; Adele Murphy, president of the GLMSA; Megan campbell Smith, publisher Mentelle Media.  the Varga family turned out to honor father Donald Varga, MD: Andrew Varga; Dan Varga, MD; Kimberly Alumbaugh, MD, VP, executive director of Women’s Services for Jewish Hospital & St. Mary’s Healthcare; Jennifer Newton, editor-in-chief with M.D. UPDAte; Michael Newton, republic bank.

Matt Williams, MD, University cardiothoracic Surgical Associates; Lauren Williams, co-chair of Doctor’s ball Planning committee; toni Ganzel, MD, interim Dean UofL School of Medicine; brian Ganzel, MD, University cardiothoracic Surgical Associates.

 M.D. UPDAte publisher Gil Dunn; Mary bousamra; and Michael bousamra, MD, University cardiothoracic Surgical Associates.

 Stites & Harbison, PLLc attended the Doctor’s ball to show support for the Jewish Hospital & St. Mary’s Foundation: Marjorie Farris, JD; Ozair Shariff, JD; and Jennifer Landrum elliott, JD, chair Health care Service Group.

Dr. Philip Bernard Chief, Heinrich A. Werner Division of Pediatric Critical Care at UK HealthCare

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your patients, too.

For a limited time, there is no charge for your hospital or practice to join KHIE. Visit www.khie.ky.gov or call 502-564-7992 to learn more.

EffEctivEly managing your rEvEnuE cyclE is thE kEy to opErating a hEalthy practicE. With Cash Flow Options from PNC and a dedicated Healthcare Business Banking team, we can help you take advantage of everyday untapped opportunities. Like helping ensure access to credit. So you can be prepared for cash shortfalls. Or accelerate receivables to effectively manage how you receive and direct incoming payments. For uncovering opportunities to help improve your revenue cycle and to learn more about PNC Advantage for Healthcare Professionals, visit pnc.com/cfo, stop by a branch or call 1-855-PNC-4HCP. SM

for the achiever in you

AccelerAte receivAbles improve pAyment prActices invest excess cAsh leverAge online technology ensure Access to credit

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All loans are subject to credit approval and may require automatic payment deduction from a PNC Bank Business Checking account. Origination and/or other fees may apply. PNC is a registered mark of The PNC Financial Services Group, Inc. (“PNC”). Cash Flow Options is a service mark of The PNC Financial Services Group, Inc. © 2012 The PNC Financial Services Group, Inc. All rights reserved. PNC Bank, National Association. member fDic