M.D. Update Issue #75

ThE buSinESS magazinE of KEnTuCKy PhySiCianS

and hEalTh CarE adminiSTraTorS

Issue spotlIght:

Plastic Surgery

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE Pain ADMINISTRATORS Medicine Special SectioN

December 2012

The Gilded Era of

Aesthetic Medicine

FeAtured physICIAns:

John belanger boyd buser bill Webb dennis Williams anthony yonts michael J. zackek

th so many unqualified hands reaching in the pot, the hottest tion in aesthetic medicine is whose hands are on the patient?

Addressing the Rural Physician Shortage

Planning for Market Leadership

A Tradition of Leadership, Innovation, and Research

How dermatology associates of Kentucky became one of the largest freestanding practices in the uS.

The Pain Treatment Center of the Bluegrass is dedicated to pioneering and providing multi-modality treatments for acute and chronic pain.

pikeville College school of osteopathic Medicine expands in order to meet growing need for primary care physicians in rural Kentucky and Appalachia.

Speci

Derm and

Also INsIde

and Southeastern Kentucky Edition

Central and Southeastern Kentucky Edition

JULY 2010

AuguSt 2010

The Business Magazine of KenTucKy Physicians and healThcare adMinisTraTors September 2011

NESS magaziNE of KENTUCKY PhYSiCiaNS

aNd hEaLTh CarE admiNiSTraTorS

thE buSiNESS mAgAziNE of KENtuCKy PhySiCiANS



Volume 3, Number 6

Saint Joseph Mobile Health Service Kentucky Blood Center

alSo iNSide

Practical Insights into Hospital Medicine and Pathology  Physician Q&A with Dr. Jim Roach on Complementary and Alternative Medicine  Coordination of Care: Nutrition 

Volume 3, Number 3

New contributors in IQ: Marketing, Estate Planning

a

Rural Family Physician John Belanger

VolumE 2, numbEr 1

More perspectives on the aesthetic medicine and cosmetic and plastic surgery from Dermatologists, Hand Surgeons, and an Oculofacial Plastic Surgeon

Dr. David Dunn addresses UofL’s readiness to take on 

All Women OB/GYN maintains ind

Special Section 

Dr. Joseph Fowler takes an inquisitive approach to sk

Brain Health

The Business Magazine of KenTucKy Physicians and healThcare adMinis

ANd hEAlth CArE AdmiNiStrAtorS

Special SectioN

 

New role of Pediatric medicine

ClubMD plants the seeds of reform with their patient-centered strategy

Economics pagE 4 asthma’s Match pagE 12 Central Kentucky Research powerhouse pagE 16

Sleep Me

now fully inTegraTed, The union of coMMonwealTh urology and lexingTon clinic deMonsTraTes ThaT qualiTy care and Physician auTonoMy coincide in The realiTy of Medical PracTice Mergers.

A

The

Pediatric & Adolescent Associates helps children (and their parents) achieve healthy, happy childhoods

SS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

NoVember/december 2011

october 2012

Kentucky Edition

Volume 2, Number 7

Merger Delivers MoRE

Volume 2, Number 8

todd Coté Philip deSimone horace hambrick david hoddy mahesh Kudrimoti Kristy menke Jennifer oliver mark Plunkett marcus randall Jennifer riebel Sibu Saha Jalil Shojaei-moghaddam Ann Quackenbush

VolumE 1, NumbEr 8

wakenin

after 15 yearS aS a rouge Specialty, Sleep mediciNe c

Featured Physicians: brian badger

Featured Physicians

Kim Clawson Jim Crase John d’orazio michael Karpf Nick Kouns Jun Liu Jay Perman Jim roach Thoman von Unrug William o. Witt

Specia

Urology

alSo iNSide  Transplant

Reinventing Primary Care

au

The Physicians’ ce sleeP diso graves-gilBer in Bowlin

a

Q&A with D Local Insight into Practi

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINIS

March 2011

J

Issue spotlIght:

Pain Medicine

ThE BusinEss MagazinE of KEnTucKy Physicians

and hEalTh carE adMinisTraTors

ars e y g n i t ThE CaRE a r Comprehensive ConTinUEs Celeb Pain Medicine t h g i s n i l a c i of Med Special SectioN

Oncology

the Stat of caNece r

INterVeNtIoNal paIN specIalIsts INspIre a New era of medIcINe

 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

New Collaborations between Primary Care and Pain Specialists Senate Bill 110 Lowers Eye Surgery Standards UK Pediatric Oncology Benefits from Student Fundraiser Colon Cancer Prevention Project

Volume 2, Number 3

alSo iNSide

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

luis Vascello,Md rick lingreen, Md, Jay grider, do/Phd

alSo iN thiS iSSue

Volume 3, Number 8

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



THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

February 2012

may 2012

JuNe 2012

Volume 3, Number 9

SS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

Special Se

Psychia

alSo iN

Former Medicare pro advises prov on new payment m

Coordination of Neuropsychologist is your ally in diag

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINIS

Sep

Also in this issue

Special SectioN

Women’s Health

 Musculoskeletal Radiologists Join Lexington Diagnostic Center  TAVR Now Available at Central Baptist Hospital  The Value of Hospice Care Caring for

diatric rdiologist esn’t Miss eat

Special SectioN

ocate for reducing Kentuckians risk for cardiac disease and improving to life-saving care, Dr. Juan Villafañe essing the unique cardiac needs of n and adults in Kentucky.

Orthopedics and Sports Medicne

Tabula Rasa

a blaNk Slate proVideS the caNVaS for premier GyNecoloGy aNd obStetricS to reiNVeNt womeN’S care

Special SectioN

Cardiology

Louisville Cardiologists Bring TAVR to KY

Physician Viewpoints on

Pediatric Subspecialists at the State’s University Hospitals Provide Leadership, Insight, and a Medical Home for Complicated Pediatric Cases

Baptist Health launches Sports Medicine program in Louisville with a team of fellowship-trained physicians and a new functional rehab facility

alSo iNSide

alSo iNSide 

Kentucky’s Children

ASSEMbLINg AN ALL-STAR LINEuP 

Pain Management for Sports Injury Rehabilitation

r7



(l-r)

s to ealth Seekies in yOne HIn equalit Kentuckim ce of El inateduce the Inciden Re d Access an Kentucky Cancer in

Special SectioN

PsyChiatry aNd the New sCieNCe oF the MiNd

Volume 3, Number 1

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

Neuroscience

Providers at Louisville-based integrative Psychiatry reflect on the desire among doctors and patients to get something more than just prescriptions out of mental health care.

Speci

M

December 2012 1

From the publisher’s Desk

Five Years Young

The photograph below was taken October 27, 2012 at a “Western Wear” party given by Dr. George Privett to introduce his two new radiologists, Jason Harris, MD and Robert Pope, DO. With me is M.D. Update co-publisher Megan Campbell Smith and Dr. Privett who grew up in Texas and came to Lexington in 1968 for his internship and residency at University of Kentucky Hospital.

The gathering included other physicians like Dr. Bruce Broudy, of the Lexington Clinic and current president of the Lexington Medical Society. Dr. Broudy and I talked about the challenges of maintaining a private medical practice, getting new members to participate in local medical societies and the sorry state of UK football.

For me, that evening epitomizes the great joy that comes from publishing M.D. Update magazine. For five years, we have met, interviewed and photographed thousands of Kentucky physicians and healthcare professionals. Our goal has always been simply to give Kentucky physicians and healthcare providers the opportunity to speak to one another through the pages of Dr. George privett, robert pope, DO, Gil Dunn, megan campbell Smith, M.D. Update about their work Jason Harris, mD get together to show and sometimes their personal story. To connect, their Western style. to renew, to get an update.

I frequently hear the comments, “I like your magazine. It gives me the chance to catch up on my friends, people I’ve worked with or went to med school with.” And, “I have so much to read for my practice, but I really like looking at the pictures of the other doctors.”

There is a very long list of doctors that I have come to know and admire.

Doctors who gave their time to participate in our project. Among them are Cameron Schaeffer, John Borders, Marty Luftman, George Privett, Mark Slaughter, Rebecca Terry, Ann Grider, Lori Warren, Pat Murphy, Bill Witt, Mike Zachek, Ron Shashy, Amberly Windisch, Ken Weaver, Ted Wright, Dermott Halpin, Ira Mersack, Robert Bratton, Steve Strup, David Bensema, Ardis Hoven, Ben Kibler, Richard Lingreen, Anir Dhir, Hamid MohammadZadeh, Randy Rowland, John Belanger, John Kitchens, Sylvia Cerel-Suhl and many, many others.

There have also been many allied professionals who contributed their knowledge and expertise to our pages. And of course, we thank the advertisers who believe in and support M.D. Update.

Thank you for giving your time and your interest for the past five years.

Happy Holidays.

All the Best gil Dunn December 2012

submit Your letter to the eDitor to JenniFer s. newton at Jnewton@mD-upDate.com 2 m.D. UpDate

Volume 3, Number 9 December 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 graPhiC Designer

James Shambhu art@md-update.com

Contributors: Courtney Bisig Jamie Wilhite Dittert Mo Imam Charles Metzker Scott Neal Ann Rhoten Kathryn Sandusky Turner West Stephanie M. Wurdock

ContaCt us:

aDvertising anD integrateD PhysiCian Marketing:

Gil Dunn gdunn@md-update.com

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However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials. copyright 2011 mentelle media, LLc. all rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher. please contact mentelle media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. thank you.

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contents Central and Southeastern Kentucky Edition

The Business Magazine of KenTucKy Physicians and healThcare adMinisTraTors

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

January 2011

JuNe 2011

Issue spotlIght:

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

Rural Medicine

ThE buSin buSinESS magazinEE of KEnTuCK KEnTuCKy CKy PhySiCianS

DeCeMber 2012 voluMe 3, nuMber 9

auguSt 2012

march 2012

2 froM the Publisher’s Desk

and hEalTh hEalT al h CarE adminiSTraT alT adminiSTraTorS ra orS raT

Issue spotlIght:

Plastic Surgery

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE Pain ADMINISTRATORS Medicine Special SectioN

December 2012

The Gilded Era of Aesthe Medicine Aesthetic

FeAtured FeA Fe Atured phys A pphysICIAns: hysICIA ICIAns: ns:

John belanger elanger boyd buser bill Webb dennis Williams anthony yonts y michael J. zackek

With so many unqualified hands reaching in the pot, the hottest question in aesthetic medicine is whose hands are on the patient?

Addressing the Rural Physician Shortage

Planning for Market Leadership

A Tradition of Leadership, Innovation, and Research

How d dermatology ermatology aassociates ssociates of Kentucky became one of the largest freestanding practices in the uS. uS.

The Pain Treatment Center of the Bluegrass is dedicated to pioneering and providing multi-modality treatments for acute and chronic pain.

pikeville ikeville College school chool of osteopathic steopathic Medicine expands in order to meet growing need for primary care physicians in rural Kentucky and Appalachia.

Special Sectio SectioN

Dermatology and Allergy

Also INsIde

Central and Southeastern Kentucky Edition

alSo iNSide al

Saint Joseph Mobile Health Service

Central and Southeastern Kentucky Edition

JULY 2010

AuguSt 2010

alSo iNSide  Practical Insights into Hospital Medicine and Pathology  Physician Q&A with Dr. Jim Roach on Complementary and Alternative Medicine  Coordination of Care: Nutrition

The Business Magazine of KenTucKy Physicians and healThcare healT eal hcare adMinisTraT ealT adMinisTraTors ra ors raT September 2011

ThE bUSiNESS NESS magaziNE of KENTUCKY NTUCKY PhYSiCiaNS

aNd hEaLT a hEaLTh L h CarE admiNiSTraTorS LT admiNiSTraT a orS aT

thE buSiNESS mAgAziNE of KENtuC KENtuCKy CKy PhySiCiANS



Volume 3, Number 6

Rural Family Physician John Belanger

Kentucky Blood Center

Volume 3, Number 3

New contributors in IQ: Marketing, Estate Planning

VolumE 2, numbEr r1

Volume 2, Number 6

More perspectives on the aesthetic medicine and cosmetic and plastic surgery from Dermatologists, Hand Surgeons, and an Oculofacial Plastic Surgeon

Dr. David Dunn addresses UofL’s readiness to take on the PPACA. 

All Women OB/GYN maintains independence.

Dr. Joseph Fowler takes an inquisitive approach to skin allergies.

speciAl section 

Brain Health

The Business Magazine of KenT KenTucKy Ken Tuc ucK Ky y Physicians and healThcare heal heal ealTh hcare adMinis adMinisTraTors

Special SectioN

 Transplant  

New role le of Pediatric medicine m dicine

ClubMD plants the seeds of reform with their patient-centered strategy

Economics pagE 4 asthma’s Match pagE 12 Central Kentucky Research powerhouse pagE 16

now ow fully in inTegraT inTegraTed, egra ed, The egraT union of coMMonwealTh coMMonwealT onweal h onwealT urology rology and lexingTon clinic deMons onsTraT ra es ThaT raT ha qualiTy haT deMonsTraTes care and Physician auTonoMy coincide in The realiTy of Medical edical PracTice Mergers.

A

The

Pediatric & Adolescent Associates helps children (and their parents) achieve healthy, happy childhoods

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

NoVember/december ecember 2011

october 2012

wakening

Kentucky Edition

Volume 2, Number 7

Volume 2, Number 8

Merger Delivers MoRE Mo RE

The Physicians’ cenTer ce for sleeP disorders a aT graves-gilBerT clinic graves-gilBer in Bowling green.

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

March 2011

JaNuary 2012 Ja

Issue spotlIght:

ThE BusinEss MagazinE of KEnTucKy y Physicians

and hEalT hEalTh alTh carE adMinisTraT alT adMinisTraTors ra ors raT

yeArs g n i t ThE ThE CaRE Ca Comprehensive ConTinUEs Con celebrA Pain Medicine nsight i l A c i D e of m Oncology

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

New Collaborations between Primary Care and Pain Specialists Senate Bill 110 Lowers Eye Surgery Standards UK Pediatric Oncology Benefits from Student Fundraiser Colon Cancer Prevention Project

Volume 3, Number 1

INterVeNtIoNal paIN specIalIsts INspIre a New era of medIcINee

Volume 2, Number 3

alSo iNSide

Volume 3, Number 8

Volume 2, Number 10

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

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

luis Vascello,Md Vascello,M rick lingreen, Md, Jay grider, do/Phd

Seeks to ne Health alities in of KentuckyO Inequ Eliminate ce the Incidence Redu Access and Kentucky Cancer in

Special SectioN

 brain health

PsyChiatry PsyChiatry aNd d the New sCieNCe oF the MiNd

(l-r)

20 allieD health alSo iNSide i

Former Medicare pro advises providers on new payment models Coordination of Care: Neuropsychologist is your ally in diagnosis

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

may ay 2012

JuNee 2012

September 2012

Volume 3, number 9

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

February 2012

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Special SectioN

Orthopedics and Sports Medicne

a blaNk blaNk Slate proVideS the caNVaS for ppremier remier Gy NecoloGy aNd obStetricS GyNecoloGy to rei reiNVeNt NVeNt womeN’S care

Pediatric Subspecialists at the State’s University Hospitals Provide Leadership, Insight, and a Medical Home for Complicated Pediatric Cases

Baptist Health launches Sports Medicine program in Louisville with a team of fellowship-trained physicians and a new functional rehab facility

alSo iNSide

alSo iNSide

Physician Viewpoints on Pelvic Organ Prolapse and Cosmetic Surgery  Practical Insights into Vascular Care  Coordination of Care: Psychosocial Therapy  Audiology Treatments

Kentucky’s Children

ASSEM ASSEMbLINg SSEMbLINg g AN ALL-STAR LINEuP



Volume 3, Number 5



Pain Management for Sports Injury Rehabilitation  Organ Transplantation Researcher Establishes High Level of Chimerism  Notable Plastic Surgery Practices with Multispecialty Expertise

Special Sectio SectioN

Sleep Medicine

22 allieD health  ChiroPraCtiC & aCuPunCture

24 neWs 29 events 32 arts

Volume 3, Number 7

Tabula Rasa

Special SectioN

Cardiology

Louisville Cardiologists Bring TAVR to KY Effects of Cleveland Clinic Affiliation Radial Cath Gaining in Popularity Hypothermia in ER Improves Chances of Survival

Volume 3, Number 4

An advocate for reducing Kentuckians risk factors for cardiac disease and improving access to life-saving care, Dr. Juan Villafañe is addressing the unique cardiac needs of children and adults in Kentucky.

Volume 3, Number 2

Also in this issue

Special SectioN

Women’s Health

 auDiology

Special Sectio SectioN

Psychiatry

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS

after five years, thousands of interviews and photo shoots, Pediatric Kentucky physicians Cardiologist Doesn’t Miss a Beat “Like” m.D. Update, and we thank you for that!

 iMage-guiDeD Pain injeCtions

13 CoorDination of Care 14 sPeCial seCtion

Providers at Louisville-based ntegrative Psychiatry reflect integrative on the desire among doctors and patients to get something more than just prescriptions out of mental health care.

th hee State of caNcer

 by Central baPtist’s Dr. Mo iMaM

12 PraCtiCal insight

aalSo iNSide

Special SectioN

Neuroscience

 Palliative MeDiCine

Q&A with David Laird Local Insight into Practice Merger

Pain Medicine

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

8 PraCtiCe insight 10 PhysiCian vieWPoint

after ter 15 yearS aS a rouge Specialty, pecialty, ecialty, Sleep mediciNe ccomeS to.

t todd Coté Philip deSimone horace hambrick david hoddy mahesh Kudrimoti Kristy menke Jennifer oliver mark Plunkett marcus randall Jennifer riebel Sibu Saha Jalil Shojaei-moghaddam Ann Quackenbush

VolumE 1, NumbEr 8

VoLUmE 1, NUmbEr 7

Kim Clawson Jim Crase John d’orazio michael Karpf Nick Kouns Jun Liu Jay Perman Jim roach Thoman von Unrug William o. Witt

8 finanCial affairs

Sleep Medicine

Featured Physicians: brian badger

Featured Physicians

 With norton’s Dr. ken Wilson

Special Sectio SectioN

Urology

Part 2

6 legal

ANd hEAlth llth CArE C ArE AdmiNiStrAt AdmiNiStrAtorS A orS At

alSo iNSide

Reinventing Primary Care

auguSt 2011 augu

4 one on one

special section  brain health

18 toxin reaps results

14 Sports concussion center Hits close to Home

16 UK’s Newest National ranking December 2012 3

one on one

planning for the Future

part two

Norton Healthcare’s Kenneth C. Wilson, MD, on ACOs, the new Women’s and Children’s Hospital, and Systems of Care Design louisville This is Part Two of a two-part series on the overlapping trends of healthcare reform and the expansion of hospital-based services into suburban populations. On September 13, 2012, 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.

Megan C. smith: a lot of people hear about the increased hiring of specialists by hospitals and they think, “that’s got to cost a lot of money.” how do you respond to the distrust or doubt that they may have about one’s ability to get better efficiency and decreased costs when employing more specialists? and then, who exactly is bearing the initial cost to provide better care to the population?

Dr. Kenneth C. Wilson: There certainly is evidence that the more specialists you have, in general, the higher the cost. It is important for us as a healthcare system to be aware of that.

My response is that if we place the patient at the core, start with the patient’s best interest and work outward from there, then we are going to get it right most of the time. Oftentimes, when an individual needs care that is best delivered by a specialist, then that becomes the most effective care not only in terms of clinical quality and safety, but also in terms of cost.

Specialists working with primary care doctors in an integrated system can work to establish protocols and guidelines for the care for some of the more common things that people present with. As we do that more effectively and in an integrated way, I think there is nothing but increase of quality, increase of safety, and lowering the cost. A big piece of achieving that is the incentive.

4 m.D. UpDate

Since we are operating in a part of the country that is still the fee-for-service system, the answer to who pays for the cost is that we, the ones who employ specialists, pay the cost of that. But we believe two things. One is that we are providing a resource to the community and to our region, due to the size and the health of our system, when we are able to attract a critical mass of specialists to the area. And that becomes a community resource. We believe, and certainly it is our goal, that this would attract business to our healthcare system which would help to offset the cost of that care.

Ultimately, we as providers have to figure out ways to pay for what we do on the basis of population-based payments.

Will it ever go completely to population-based payments? Who knows?

I think maybe the next five or 10 years we will be experimenting with combinations of fee-for-service and population-based payments to see which make the most sense and work best. How do we get there? Through population-based payment systems that align incentives among all of the different stakeholders in the system.

That is key. how do you decide which specialists are needed, and how do you communicate with your practitioners to compel them or inspire them to achieve the vision of the aco?

There are plenty of organizations who do analysis to determine how many specialists, say, cardiologists, are needed to meet the needs of the population. That’s a place to start.

But as we try to create programs like the new Women’s and Children’s Hospital, determining the population need and how many physicians to hire is a dynamic assessment that depends on, among other factors, what your competitors are doing, and how your community is changing in terms of demographics.

Also, when we think about how women make up a larger percentage of the physician population, a trend that began back when I was in medical school in the late 70s and early 80s, now lots of women physicians want to raise families and choose during that period of their lives to work only part time. We then have to design job sharing opportunities, which then impact the number of specialists we believe we might need. As administrators, we have to make an educated guess and adjust as we go.

Dr. Ken Wilson We have comoversees clinical municated with effectiveness and physicians in town quality on Norton hall meetings where Healthcare’s accountable care we discuss the ACO leadership team. and what the big picture is. As we look at the specific structure of the ACO at Norton Healthcare, we started off on a very small footprint mainly because when the Bookings and Dartmouth people first approached us nobody really knew what an ACO was.

I remember the first conversations when we tried to understand this thing called an ACO. The academics had thought this thing through, but it was an academic idea that didn’t have a lot of specific structures envisioned all the way through. When we decided

to become part of the pilot, we were getting into something that we didn’t understand.

We didn’t want to get into something that would jeopardize the organization’s viability.

We wanted to make sure that it was something we could actually execute, and since we didn’t know what it looked like, we wanted to do it on a small scale.

Our ACO currently comprises employees of both Norton Healthcare and Humana, both organizations that are self-insured.

Norton employees who get health plan benefits and their dependents, as well as Humana employees in the Louisville market, are the eligible population to be in the ACO. An important element of the ACO is provider choice. This is unlike HMOs and capitated care of the 90s where the healthcare product was set up with a closed network of providers. Then, if a doctor was in the network, no problem. But if not, then you had to get another doctor. This was a strong dissatisfier to the public and doctors alike.

In an ACO, attribution is based on historical caregiving patterns. In other words, I have to have already seen a physician who is part of an ACO to be myself a patient of the ACO. Attribution, then, cuts the number down to about 7500 for our combined ACO population. We started off on a small scale.

There has been a lot about this in the press, so our communication with physicians has been around town halls and things like that. We are just about to embark on the first cohort of Norton Physician Leadership Academy. The Academy is going to take a group of 30+ Norton-employed physicians from all different specialties through a yearlong program of non-clinical education on topics that are important for physician lead-

Sports Concussion Center

ers in the organization to understand, such as healthcare finance, negotiation, leading teams and managing physicians. We see that as a key piece of educating our specialists and bringing them along. Certainly, all along they have been involved in their areas of specialty and clinical interest in the performance improvement and quality and safety work that we’ve historically done as an organization. Our history of quality and process improvement really goes back to the early 1980s at our organization. We have been at the work of quality improvement and process improvement for a long time, so physicians have certainly been a part of that all the time. one of the comments i hear in the gallery is that norton docs only refer to norton docs, followed by a skeptical, “how does that improve quality care?” what is your response to those concerns?

Well, certainly we would like that to happen. While that makes sense from a business perspective, we want our doctors to do what’s in the patient’s best interest.

Employing physicians certainly does something toward aligning them, but we want them to decide in the patient’s best interest regardless of whatever is out there.

Now we employ 600+ physicians, and that’s really occurred over the last five years, with the speed really picking up over the last two or three years. A large number of the narrow specialty physicians have been brought in from outside of the area. Some of the more core specialties and primary care were already practicing in this market, so they had established referrals or relationships with individuals. I think physicians,

for the most part, send their patients to people they trust, and that continues today.

I think that over time, as we develop more tight integration between our physicians on the primary care level and specialty and back, then I think that we all have ways of transforming the care within our system that will induce our physicians to send patients within Norton Healthcare because that’s the best place for them to send their patient.

There’s one more thing to mention in terms of investments. Norton had earmarked the money and made the decision around our electronic health record Epic, which we are in the midst of implementation as we speak, prior to the decision to participate in the ACO pilot. Still, the electronic health record is essential to accountable care. It’s no question.

You talked about the relationship between specialists and primary care, and improvements in the care of patients.

Having an integrated electronic health record across our entire organization will be a huge piece of promoting that. I guess you could do that at a small scale, but in most marketplaces I don’t see how you can do accountable care without a strong electronic health record and overcoming the challenges getting there.

Another key piece of accountable care will be the My Chart component, the patient health record which patients can manage and that physicians have access to as well. We as providers can only do so much, and we as individuals must become increasingly responsible to help with that as the ones receiving care. I think that brings it all together. ◆

841 Corporate Drive STE 310, Lexington KY 40503 Phone: (859) 475-4566 | Fax: (859) 296-1633 www.sportsconcussioncenterky.com

December 2012 5

legal

how to handle a subpoena Duces tecum Medical practitioners across pist notes, communications between your Kentucky are all too familiar with the folpractice and any attorney representing lowing scenario: an official-looking docuthat practice, evaluations prepared at the ment comes into the office, someone signs request of an attorney that would not for it, and inside you find a paper with have been prepared in the ordinary course strange words: “Subpoena Duces Tecum.” of business, and (for skilled nursing facilCongratulations, you have been subpoeities) material generated by the qualnaed! So what does that mean? A “subpoeity assurance committee. If a subpoena na” is a paper that commands a person to requests any of these documents, please appear before a court. A “subpoena duces consult the appropriate personnel. If nectecum” compels an individual to appear and essary, ask your attorney how to respond.

BY Jamie Wilhite Dittert bring with him certain records. This article How may a records custodian respond is intended to provide an overview of what ten policies regarding to a subpoena? If she chooses to produce

BY Stephanie m. Wurdock to do when you receive a subpoena duces the use and disclosure the records, she can ask for the reasonable tecum. (This article only addresses subpoe- of patient records to expenses of producing the records from nas issued in lawsuits in which you or your determine if the subpoena needs to be the requesting party. Once that payment is practice is not a party. If you or your office directed to a Health Insurance Portability received, the custodian may certify the accuis involved in a lawsuit and receive a sub- and Accountability Act (HIPAA) compli- racy of the records and then deliver them to poena in connection with that suit, please ance officer. Finally, the subpoena should the requesting attorney. If the records cuscontact your attorney immediately.) be forwarded to your office’s records cus- todian opts to produce the records before What information is contained in a todian. the deposition date, the requesting attorney subpoena duces tecum (hereinafter “subUnder HIPAA, any subpoena duces may cancel that appearance. poena”)? The subpoena should describe tecum that is not accompanied by a court Alternatively, the custodian may decide the records sought, order must contain that the records should not be produced which may be as broad a written statement and send the requesting attorney a written when You receive a as “a complete, certiand accompanying objection within ten days after the service fied copy of any and all documentation dem- of the subpoena, or on or before the schedsubpoena, ForwarD the onstrating that the uled deposition, whichever comes first. A medical/billing records pertaining to Jane requesting party made written objection requires the requesting Details to Your risk “reasonable efforts” to party to obtain a court order to get the Doe.” A subpoena must management personnel (1) notify the patient records. If the practice does not produce also identify the lawsuit whose records are being the records but fails to send a written objecto which it relates and First, as a subpoena For the contact informarequested, or (2) secure tion, the custodian may need to appear at tion for the attorney meDical recorDs maY a “qualified protective the deposition. Additionally, the practice order.”

“Reasonable may be subject to contempt of court and or party who issued the 1 inDicate that a lawsuit efforts” means that a other penalties. subpoena. Finally, the notice of the subpoena subpoena will direct a It is important to issue a prompt and is about to be FileD. was sent to the patient proper response to any subpoena and, thererecords custodian to or his attorney, the fore, it is paramount that you, your records appear for a deposition patient had enough time to object, and no custodian, and your office staff be familiar and to produce the requested records. It may also state that the records custodian objection was made or all objections were with the pertinent policies and procedures can produce the records before the specified resolved. A “qualified protective order” for handling subpoenas. time in lieu of attending the deposition. A limits the use of the records and directs that subpoena can be served by certified mail or all of records be returned at the conclusion this article is intended as a summary of how by personal delivery. of litigation. If the subpoena does not meet to respond to a subpoena duces tecum, and When you receive a subpoena, forward these requirements, the records should not does not constitute legal advice.

Jamie Wilhite Dittert and Stephanie m. the details to your risk management person- be produced until appropriate documentaWurdock are associates with Sturgill, turner, nel first, as a subpoena for medical records tion is provided. barker & moloney, pLLc, working in healthcare may indicate that a lawsuit is about to Certain records receive special proteclaw and medical malpractice defense. they be filed. Then, refer to your office’s writ- tion under state and federal law: HIV can be reached at (859) 255-8581. ◆ records, mental health records, psychothera-

leXington

1 Kentucky rule of civil procedure 45.01.

6 m.D. UpDate

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December 2012 7

Financial aFFairs

2012 wrap up In this space last month, we discussed the fiscal cliff. We won’t waste any more ink on that here, at least not for now. This month we focus on how you can take care of yourself and your family no matter which way things go in Washington.

There are really two strategic viewpoints to consider: technical and behavioral. Let’s deal first with the behavioral since that is more likely to be the core constraint toward a desired outcome. It’s also that which we can all do something about.

We all like to believe that we are immune from our own behavioral biases. I submit that these are likely to be so ingrained in the subconscious that unless we intentionally get them out and roll them around, we are prone to succumbing to them. When the news surrounding us is as negative and confusing as it is today, the temptation is to seek cover, or worse yet, to find confirmation of our worst nightmares. Today, I see confirmation bias cropping up regularly among investors. The message that bombards us these days is that we now face the end of the economic world as we know it.

That a tax increase will destroy us or that a reduction will save us. If you go looking for confirmation of either point of view, I can guarantee that you will find it. Our economy and the financial markets are certainly challenging and may likely get more so, but they are nowhere near total collapse.

If you believe that your financial world is falling in around you, you will likely take actions that are not in your best interest. So what are some things that you can do right now to prevent that from happening? First and foremost: get a firm grip on where you stand, today and take a look into 2013.

That doesn’t mean that you need to watch your investment accounts as they gyrate up and down from day-to-day or hour-to-hour.

What it does mean is that you will take a hard and realistic look at your balance sheet as of a given day. The balance sheet reflects the value of your assets and the current payoff of your debts. Repeat after me, “These are my current resources and my current debts. They are what they are.” You will undoubtedly know people who have more, as well as those who 8 m.D. UpDate

have less. That realization is sometimes a moment of pain leading to yet another behavioral issue: avoidance.

You can do the data gathering of your asset and liabilities the hard way by collecting

BY Scott Neal all the yearend statements and entering the data into a spreadsheet or money management program. But is that really the best use of your time? Ask your accountant or financial advisor if they have a way to capture these data electronically and present it to you in a useful format. Our firm uses a program that scrapes the data right from a client’s financial custodians into their balance sheet and updates it every night. We don’t need, nor do we want, passwords to all your accounts. The system is non-transactional so transactions cannot be effected from it, yet over time it creates a nice history of net worth and presents it graphically. Pay attention to what is relevant to your wellbeing.

Next, we suggest that you prepare a flexible projection of your cash flow for 2013.

By flexible we mean that you should address a best case, worst case, and most likely case for gross income. We have sorted through what we believe will be the near term effects of the healthcare reform act, but it is likely to be specific to you and your practice.

Thus, the makeup of your revenue stream is good information for you and your planner to know. For those with heavy Medicare / Medicaid practices, your outlook is likely to be substantially different from those of you who have a lot of private pay or patients with high quality insurance.

My point is that all good planning begins with a hard look at income and allocating all that income into the following: 1) taxes, 2) debt payments, 3) savings, 4) giving, and 5) consumptive spending. By the way, it is consumptive spending that determines your family’s living standard and a family’s maximum sustainable living standard under competing

scenarios can actually be determined using today’s dynamic programming tools, yielding more rational decision making.

It should not come as a shock to anyone that the politicos are primarily dealing with the fiscal cliff by tinkering with the current tax code rather than considering much needed overall tax reform. We will deal with it. In all their discussions they talk about top tax rates (the marginal rate) being increased from 35% to 39.6%. Our temptation then is to add in state, local and FICA taxes and we quickly get to 50% or more. But when most people think about their taxes they think in terms of total taxes divided by total income (the effective rate).

If you have read this column for very long, you know that I advocate using marginal rates for decision-making. That is still valid; however, when the tax code is in as much flux as it is today, our planning focus should be on the effective rate and how the extension of tax cuts or the imposition of new taxes will affect it. Modeling alternative scenarios under rapidly changing circumstances then becomes much easier.

Incidentally, we generally see total effective taxes of most physicians around 30%34% of total gross income. Don’t get me wrong; I want to work for each client to get the amount of taxes paid and therefore the effective rate as low as legally possible.

But let’s face it; much of what we hear in the news is not reality, it is pandering to our fears. The real question is how will an increase of 4-5% in marginal rate affect one’s effective rate, and how will that change affect a family’s living standard?

It goes without saying that we live in a world of ever-increasing complexity.

Fortunately, for us planners, technology has evolved to enable us to deal with it.

Sometimes, good planning begins with getting our own biases out of they way.

Scott Neal is president of D. Scott Neal, Inc. a feeonly financial planning and investment advisory firm with offices in Lexington and Louisville. He welcomes questions and comments from readers and can be reached via email at scott@dsneal. com or by calling 1-800-344-9098. ◆

practical insight  palliative meDicine

the value of hospice care leXington As someone who spends a significant amount of time discussing end-of-life care in professional and community settings I am familiar with the more pervasive misconceptions about hospice care and the discomfort that comes with discussing advance care planning, serious illness, the dying process, and death. Because of this, it is important to provide clarity on the programs and services offered by hospice providers, the value of hospice care for patients and families, and the importance of advance care planning.

Hospice services are available to individuals with serious illness, typically in the last six months of life, who have elected treatments aimed at palliating the symptoms of their disease irrespective of age or diagnosis. These services include an interdisciplinary team of highly trained professionals who work with a patient and

symptoms causing distress or discomfort; nurses who make home visits to ensure the patient is comfortable and to teach both the patient and caregiver about the disease progresBY turner West sion to increase caregiver confidence; certified nursing assistants who assist with bathing, dressing, and other activities of daily living; social workers who provide counseling services to the patient and family and connect them to available resources in their area; chaplains who respond to the spiritual needs of the patient and caregiver; and volunteers who offer practical support to the patient and family such as transportation, companionship, and respite care for the caregiver. Hospice care also includes individual and group counseling services available to the family after a patient dies. In addition to the interdisciplinary team, hospice services also include providing all the medications, medical supplies, and equipment related to the terminal diagnosis. there is an abunDance oF eviDence Succinctly, hospice providers are experts at providing qualthat Demonstrates that qualitY oF ity physical, psychosocial, and spiritual care to individuals in liFe increases For the patient anD the late stage of serious illness FamilY anD patient preFerences For while also supporting their families.

There is an abundance of treatment are FolloweD more oFten evidence that demonstrates that when hospice becomes involveD. quality of life increases for the patient and family and patient family to identify their goals of care and preferences for treatment are followed more then design treatments, therapies, and often when hospice becomes involved. interventions to maximize the patient’s Patients are able to spend their final months quality of life. This team includes hospice surrounded by loved ones with their sympphysicians specially trained in manag- toms managed effectively and improved ing sources of intractable pain and other quality of life rather than spending that

time in emergency departments, hospitals, and intensive care units. It is for these reasons that a recurring comment from patients and families is, “I wish I had known about hospice care sooner.”

Despite the overwhelming evidence on the value of hospice and that hospice is a benefit for individuals in the last six months of life, nationally the average length of stay from admission to death is 67 days, and the median length of stay is 17 days. More troubling is that, one-third of patients admitted to a hospice program die within a week of admission. These short lengths of stay are problematic for myriad reasons but primarily because the patient and family are not able to take full advantage of the scope of hospice services.

Hospice of the Bluegrass is committed to ensuring that all individuals know about the availability and value of hospice services.

For healthcare providers, we offer education on having difficult conversations with patients facing serious illness and on how hospice and palliative care can help your patients. For individuals in our community, we offer training on a wide range of topics related to end-of-life care including but not limited to advance care planning, understanding hospice and palliative services, and grief and loss.

With an aging population the need for advance care planning and the broader utilization of hospice and palliative care is essential. Hospice of the Bluegrass is here to meet the needs of the seriously ill and their families in our communities. turner West, mpH, mtS is director of education and community programs at Hospice of the bluegrass. ◆

Hospice of the bluegrass serves 32 counties in northern, central, and southeastern kentucky.

For more information call 800-876-6005, email: education@hospicebg.org, or visit www.hospicebg.org.

December 2012 9

phYsician viewpoint  carDiologY

tavr offers life-saving option for aortic stenosis

bY Dr. mo imam leXington Coronary artery disease (CAD) took center stage in the 1980s to early 2000s, but with aggressive medical management and raising awareness in the popula-

risk of surgery), the patient has not received a definitive diagnosis, or the family and patient have declined the procedure due to frailty or advanced age.

Surgical AVR is gold standard for AS and should be performed promptly once symptoms occur due to the high risk of sudden death. Some patients may be too high risk or inoperable, and these are exactly the cardiothoracic surgeon Dr. mo Imam and interventionalcardiologist Dr. patients who are best paula Hollingsworth are part of the suited for transcatheter taVr team at central baptist Hospital. aortic valve replacement Other vital members of the team (not (TAVR). pictured) are anesthesiologists Dr. Results of TAVR were thomas Young and Dr. alan carter, evaluated by the pivotal radiologist Dr. Katherine Jenkins, PARTNER trial, which and valve coordinator and ct nurse compared TAVR to other navigator Liza crall. modalities of treatment, i.e. medical management and surgery in high-risk patients. TAVR was shown to lower mortality by almost 50 percent compared to medical management. In the other cohort, TAVR was shown to be non-inferior to surgical AVR in high-risk patients, but incidence of stroke and vascular injury was greater with TAVR. Current trials are underway comparing TAVR to AVR in low-risk patients.

At Central Baptist Hospital, these procedures are done in the hybrid operating studies have shown that up to 60 percent room, which is a cross between a surgical of patients with severe AS are untreated. suite and a cardiac cath lab. Currently, only Reasons for this profound under-treatment the Edwards Sapien valve has been approved are primarily because the patient has either by the Food & Drug Administration and been deemed inoperable (“misunderstood” can be placed either transfemorally or, in

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pHOtO cOUrteSY OF ceNtraL baptISt HOSpItaL.

tion, the incidence of CAD has been dramatically reduced. Instead, CAD has been upstaged by valvular heart disease, primarily aortic stenosis (AS). Within the next decade or two AS will represent a medical tsunami

on the cardiology horizon because of an aging population.

There are approximately 1.5 million cases of AS in the United States at this time. Survival after the onset of symptoms is about 50 percent at two years. Various

patients who do not have good vascular access, through the apex of the left ventricle (transapical-TA). TA is done through a mini-thoracotomy without stopping the heart or using the heart-lung machine.

Complications of TAVR include stroke (5.5 percent) caused primarily by thromboembolism during catheter manipulation in the aortic arch or from the calcified native aortic valve. Other major complications included vascular injury (15 percent), severe paravalvular leak (10 percent), coronary artery obstruction (0.5 percent), and pacemakers (5 percent).

Benefits of TAVR include reduced pain, reduced hospital stay, earlier return to regular activities and a very low blood transfusion rate.

TAVR is approved by the FDA only for inoperable patients or very high-risk patients. When patients with severe AS

within the next DecaDe or two aortic stenosis will represent a meDical tsunami on the carDiologY horizon because oF an aging population. are referred to the Heart & Valve Center at Central Baptist, they are evaluated by a valve nurse navigator and undergo an echocardiogram and a CT angiogram to evaluate the vascular access. They are then evaluated by a heart team consisting of two cardiac surgeons and two interventional cardiologists. If the patient is deemed inoperable or

high risk, he/she will undergo TAVR. It is important that patients should not have any significant co-morbidities that would preclude the expected benefits from the correction of the AS. The patient should be “dying of ” rather than “dying with” AS. The best outcomes in medicine are achieved when the correct procedure is applied to the correct patient. When done appropriately, TAVR adds “years to life” and “life to years” in this group of patients with an otherwise very dismal prognosis. ◆

For patient referral contact central baptist Hospital at 859-260-5500 or at www.centralbap.com

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practical insight  image-guiDeD pain inJections

one Fortunate coincidence

New hires lead to brand new service line for Lexington Diagnostic Center & OpeN MRI bY megan c. smith leXington The great thing about coincidence, since we never see it coming, is how fortunate we feel when that chance happening brings with it a golden opportunity we never even knew we wanted.

That’s what happened to George Privett, MD, medical director of Lexington Diagnostic Center & OPEN MRI, when he was looking to expand his radiology staff. Surprisingly, the two best candidates were both musculoskeletal radiologists, and both were fellows at Virginia Commonwealth University/ Medical College of Virginia, albeit just one year apart.

Prior to their eventual employment with Lexington Diagnostic, the two radiologists Jason Harris, MD, and Robert Pope, DO, had never met. But they spoke enthusiastically to Privett about their fellowship experiences which included extensive training in image guided injections and procedures, the safety and efficacy of the C-Arm fluoroscopy, and the rewarding smiles of patients who benefited from the image-guided pain injections.

Duly impressed, Privett suddenly found himself contemplating the launch of his center’s first medical service line since the imaging and diagnostic center opened 24 years ago.

“I’m very excited to be getting involved in interventional pain management,” says Privett. “For a long time, we have had a close relationship with the field, and as providers move away from narcotics, image-guided pain injections offer us a great opportunity to continue to serve our patient community through a time of change.”

epidural and Facet Joint Injections

Both lumbar epidural steroid injections and facet joint injections involve the doctors placing anti-inflammatory corticosteroids under the guidance of C-Arm fluoroscopy. Steroid injections decrease the inflammation of the nerve root so as to reduce pain in the back or 12 m.D. UpDate

Drs. robert pope (above) and Jason Harris (left) each completed a musculoskeletal fellowship at Virginia commonwealth University/medical college of Virginia. their expertise in musculoskeletal mrI and joint and epidural steroid injections (pictured above, as administered by Dr. pope) led to the founding of a brand new service line at Lexington Diagnostic center & OpeN mrI. medical director George privett, mD, is excited about the opportunity to provide safe and effective image guided pain injections to his patients.

legs, hopefully for several months while the injury or cause of pain is healing.

With facet joint injections, the steroid is mixed with the anesthetic lidocaine. “When we are in the right spot,” says Pope, “the patient frequently gets immediate relief.

Sometimes, people require multiple injections to calm down the inflammation, and I enjoy seeing patients who maybe were apprehensive the first time come back with a big smile because the injections are very effective in helping to manage their pain.

With the introduction of this service, it is important to note that Lexington Diagnostic is not becoming a pain management facility but, according to Pope, “offering image-guided pain injections to our patients and providers in much the same way they can order an arthrogram or MRI.” To assure patient safety and comfort, there are important factors that referring physicians should consider, notes Harris. Patients must have had an MRI within a year and have stopped any anticoagulants. Also, regarding the recent and tragic meningitis outbreak, Harris affirms that they get all of their products direct from a major pharmaceutical com-

pany, not a compounding pharmacy.

“Joint and spine injections are very safe procedures,” he says. “We use a very small needle to inject a local anesthetic, and then we use a fine, 22-gauge needle for the epidural or joint injection. In this procedure, common complications arise from not injecting into the right space, so we use contrast and watch under the fluoroscope to make sure we are avoiding important structures, like veins, for both the local anesthetic and the joint or epidural injection.

“Of course, any time you puncture the skin, you have a risk of infection, and that is one thing we work very hard to minimize.”

Most patients tolerate the small amount of pain associated with the procedure “very well,” says Harris, but he also recognizes that patients with very inflamed nerve roots tend to feel a pressure sensation, which he compensates for by injecting very slowly.

As radiologists, Harris and Pope have extensive experience with the fluoroscopy and interpretation of the MRI, and, Pope observes, “Our fellowship training in the administration of these injections helped us gain greater confidence handling the needle.” ◆

coorDination oF care

always upbeat

A former patient recalls how Cardinal Hill Stroke OT provided unique and supportive therapy. bY gil Dunn leXington I want to introduce you to a man who, since 2006, has had a knee replacement, an aortic valve replacement, two strokes, and now works three part time jobs - and he’s 74 years old.

Pete de Castro of Georgetown attributes this renewed enthusiasm and engagement in life to his unique occupational therapy experiences, once in 2006 following knee replacement surgery and again in 2009 following stroke, at Cardinal Hill Rehabilitation Hospital.

De Castro returned to Cardinal Hill after suffering first one mild and one more severe stroke during his recovery from aortic valve replacement. He was partially paralyzed on his left side and experiencing balance impairment. Occupational therapist Katya Winchell, MS, a certified brain injury specialist, recalls that de Castro presented with decreased balance in standing, decreased endurance for participating in desired tasks, and decreased gross and fine motor coordination in his left upper extremity.

Working with Cardinal Hill physicians, Winchell developed de Castro’s OT regimen to focus first on regaining independence and completing desired occupations and tasks, such as dressing and completing household chores. During OT, de Castro would participate in a leisure task while standing to address his balance, endurance, strength and memory for path finding. Other times, he worked

on gross and fine motor coordination of his able to shake his PSD because of the constant upper extremities. support from Cardinal Hill staff and his family.

One of de Castro’s favorite rehab When he first arrived for stroke therapy, de Castro was told to expect two weeks of programs was Pet Therapy Day in the inpatient rehab, but he promised his doctor Conservatory. Small animals, dogs, cats, and he would be out in one. Driven, he added even goats were brought in for the patients to play with. “It was independent sessions a petting zoo for in the evenings to grown-ups, and it the three daily seswas fun,” he says. sions he worked with The positive Winchell. “Pete had atmosphere helped de a wonderful attiCastro regain mobilitude toward regainty and independence. ing his strength,” “I realized that I had says Winchell. “It to get myself going was because of his to get back into life,” motivation and positive attitude that Pete he says. “No one at was able to meet his Cardinal Hill ever said ‘No you can’t discharge goal of Occupational therapist Katya Winchell and do that.’ They were Saturday, only six days cardinal Hill rehabilitation Hospital success always encouraging after being admitted story pete de castro reminisce in the rehab gym. me and were a treto Cardinal Hill.” mendous source of hope.”

“I wanted to prove the doctor wrong,” Today, de Castro works 3-5 days a says de Castro, “and I wanted to get week as a tour guide at the Toyota Motor home.”

Manufacturing plant in Georgetown. He is a greeter at Keeneland Race Track every post Stroke Depression Post stroke depression (PSD) is a com- April and October, and he has his own flag mon condition after stroke. Major depression business in which he displays flags at comoccurs in nearly 33% of stroke patients; minor munity events. Next April, you’ll find de depression hits nearly 30% of stroke survivors. Castro front and center when the Cardinal Many male stroke patients report depression Hill Rehabilitation Hospital van pulls into as a result of having physical disabilities and Keeneland, treating patients to a day at the limitations post stroke. De Castro says he was track. Pete will be there to greet them. ◆

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December 2012 13

SpeCial SeCtion  Brain HealtH

Sports Concussion Center Hits Close to Home Lexington psychiatrist helps workers and athletes recover from concussion. By Gil Dunn

LEXINGTON What would you do if a family member developed a medical condition that was outside your expertise but not so far that you couldn’t help?

When Lexington, Kentucky, psychiatrist, Steven W. Croley, MD, learned that his son had experienced a concussion while playing youth soccer, Croley himself was propelled into the diagnosis, treatment, and rehabilitation of concussion symptoms.

Though not a neurologist, Croley soon learned that the treatment protocol of concussion and head injuries was lacking vital objective evaluation tools, one of which is objective balance testing. Croley says that standard evaluation relies heavily on a subjective clinical observation ,such as the Romberg test for balance.

Such testing, says Croley, is too subjective and interpretive by the clinician administering the test. ”We can’t see the damage done to the neurological circuitry through imaging. And previously all we have is the physical manifestations of the symptoms of brain damage due to injury such as loss of consciousness, headaches, blurred vision, and sleep disorders. Along with neurocognitive testing, now we have technology that enables us to objectively evaluate and track the patient’s balance ability. It’s is a critical step forward,” he states.

The technology Croley employs as the medical director of his Sports Concussion Center is a software program called Equilibrate by Balance Engineering, which

Steven W. Croley, MD, is medical director of the Sports Concussion Center

measures the stability of the patient’s upper and lower body functions. Croley had experience in evaluating his patient’s executive function in his psychiatric practice. Many mood and mental health disorders show a pattern similar to, or caused by head injuries. Difficulties with judgment, time management, insight, attention to detail,

and impulse control were behaviors that Croley’s psychiatric patients have in common with head injuries.

He sometimes sees the same pattern with elderly patients, car accident victims, and war veterans who are misdiagnosed with post-traumatic stress disorder, when it is really head injury driven (mTBI).

Balance testing is an important diagnostic tool even though the circuitry involved such as eyesight, inner ear, and cerebellum function, which controls proprioception, cannot be imaged. How to measure a patient’s balancing functions has been a quest that Croley pursued.

The Equilibrate system works by having the patient stand on a measuring platform wearing a vest with reflective plates. Cameras record and sensors in the platform measure the patient’s movements while he performs certain tasks such as standing on one foot, leaning, shifting weight from one foot to another, and standing with eyes closed. The data on the patient’s movements is received by the cameras and are transferred to a computer with software that will analyze and compare the patient’s movements with either his personal history or national standards for healthy patients of similar height, weight, and age.

“Ideally, if we had a baseline test, preinjury, we could systematically and objec-

Broadening Our Scope of Orthopaedic Care

George P. Boucher, MD

1780 Nicholasville Road, Suite 501 | Lexington | (859) 278-3481 | www.kybones.com 14 M.D. UpDate

equilibrate software measures the stability of upper and lower body while the patient stands on the platform wearing a vest with reflective plates.

part of the process and a service offered by the Sport Concussion Center. Scott Cook, PT, with Performance Physical Therapy in Nicholasville, Kentucky, works with many of Croley’s patient athletes to develop core muscle strength and joint positioning sense.

“After a head injury, core strength is needed to compensate for any malfunctioning of the athlete’s internal balance control system,” says Cook. The Equilibrate balance testing system gives Cook valuable information to assess the progress of physical therapy and the athlete’s rehabilitation. tively chart the patient’s recovery by monitoring his balance ability and track how far we have to rehabilitate the athlete before he or she can return to play, “ says Croley.

returning to play

The new national consciousness of the effects of head injury to athletes is the new normal, says Nita Smith, marketing and education director for the Sports Concussion Center. Her focus is to reach

ConCussion LegisLation in March 2012, the Kentucky legislature passed HB 281, sponsored by representative Joni l. Jenkins (D -Jefferson) and co-sponsored by 34 fellow representatives of both parties. passage in both House and Senate was unanimous. the new legislation added language to previous legislation that directed the Kentucky Board of education to require that interscholastic coaches complete an approved training course on common sports injuries such as heat and cold illnesses, emergency recognition, and head, neck, and facial injuries.

Kentucky athletic directors, trainers, and coaches and make them aware of new technologies available for the evaluation of concussions. Kentucky now has legislation that requires a medical examination and doctor’s permission before a student athlete with a head injury can return to play. “Our role is to provide a tool for medical professionals to monitor and watch athletes recover from head injuries,” says Smith.

Rehabilitation by physical therapy is

in the new legislation, the “not return to play” provision was added as well as a requirement that interscholastic coaches “seek proper medical treatment for a person suspected of having a concussion” (KrS 160.445, 2a). the March 2012 legislation further stated that “a student athlete suspected by an interscholastic coach, school athletic personnel, or contest official of sustaining a concussion during an athletic practice or competition shall be removed from play at that time and shall not return to play prior to the ending of the practice or competition until the athlete is evaluated

to determine if a concussion has occurred. the evaluation shall be completed by a physician or a licensed healthcare provider whose scope of practice and training includes the evaluation and management of concussions and other brain injuries. a student athlete shall not return to play on the date of a suspected concussion absent the required evaluation (KrS 160.445, 3a). legislators additionally stipulated that the concussed student athlete is not permitted to return to practice or play until a “written clearance from a physician is provided” (KrS 160.445 3c). u

the Long View on Head Injury to Young athletes

Second Impact Syndrome (SIS) and Chronic Traumatic Encephalopathy (CTE) are serious medical conditions that can result from repeated brain injuries from contact sports. Balance testing is now employed by the NFL, the NHL, college programs, and the Department of Defense for concussion evaluation.

New understanding of the brain damage caused by concussions and new technology have moved the conversation from the sidelines and training rooms to front page headlines and to the local level of youth sport leagues. “The new technology provides us with objective data to determine when an athlete should or should not return to the playing field,” says Croley. “From subjective evaluation to objective data, it is still a clinical judgment decision, but new balance testing technology allows us to make that decision with more information, more data, and more certainty.” u

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SpOrTS CONCuSSION CENTEr

(859) 475-4566 841 Corporate Drive, Suite 310 Lexington KY 40503 www.sportsconcussioncenterky.com Facebook at Sports Concussion Center DeCeMber 2012 15

SpeCial SeCtion  Brain HealtH

uK’s newest national ranking

Comprehensive Stroke Center is a National Leader in Volume and Complexity of Care

By Jennifer S. newton

LEXINGTON “Although we are the very best in college basketball in Kentucky, we are not the very best in controlling risk factors for stroke and other vascular disease,” says neurologist Michael Dobbs, MD, director of the UK Comprehensive Stroke Program.

“As a matter of fact we’re among the very worst in the country. We’re ranked in bottom five for the most serious risk factors for stroke, including poorly controlled blood pressure, diabetes, and high cholesterol, not to mention smoking.”

Stroke Center, a volume which has tripled since Dobbs trained at UK in the late 1990s. The center treated more than 1500 stroke patients last year, making it not only the largest stroke center by volume in Kentucky, but placing it among the top centers in the nation. Its population includes about 30% hemorrhagic stroke, double the national average.

Beyond the overall health of Kentucky’s population, Dobbs attributes UK’s volume to the exclusivity of its services. As a comprehen-

the two most important trends in neurology today are quality and safety. “I think it’s best for us to lead those and shape those here at UK, so that we can better know how to serve our unique population,” he says. UK’s leadership is evidenced by their mortality index, which tends to be lower than most academic centers nationally. As opposed to mortality rate, mortality index takes into consideration the severity and complexity of patients and measures whether mortality incidence is lower than expected.

“it is our responsibility at uK HealthCare as a flagship university medical center for the state to lead the improvement of stroke care throughout the state.”

- Dr. Michael Dobbs

Neurologist Dr. Michael Dobbs is the director of UK’s Comprehensive Stroke program.

While this year’s preseason college basketball rankings are undoubtedly more familiar to Kentuckians than the state’s stroke statistics, for Kentucky physicians this is no revelation. However, what is notable is the connection between Kentucky’s high incidence of disease and the high volume of stroke patients at the UK Comprehensive 16 M.D. UpDate

sive stroke center, they offer any eventuality of stroke care, from medical management and risk factor control to the most complicated surgical care. “We are really only place in Kentucky that offers the degree of complexity of stroke care that we do,” says Dobbs.

UK does not take its position at the top of the pack lightly. According to Dobbs,

An illustration of UK’s commitment to stroke care is their new advanced care stroke unit at UK Chandler Hospital. Opened in May 2011, the unit features 20 stroke beds staffed by neurology trained nurses and physicians and 24 ICU beds dedicated for stroke and neurologic patients. Dobbs believes this level of skill and expertise is the key to quality and safety. “That’s really what makes the difference in preventing complications from stroke,” he says.

As director of the Stroke Center since 2010, Dobbs leads a team of professionals he says starts at the top, with Executive Vice President of Health Affairs Dr. Michael Karpf. Neurosurgery is led by Dr. Justin Fraser, and interventional neuroradiology is led by Dr. Abdulnasser Alhajeri. The physicians are backed by a team of specially

trained nurses, including a neurology nursing director, stroke unit nursing director, and stroke program coordinators.

Stroke Care Network

In 2008, Dobbs developed a Stroke Care Network to partner with community hospitals to improve quality and outcomes for stroke patients. The program, which began with Georgetown Community Hospital, now encompasses 21 hospitals in the state and sees about 5,000 patients annually.

“What we strive to do is have a strong base in education for physicians, nurses, and emergency medical personnel, but also for public at large,” says Dobbs, who estimates the program has screened 10,000 people over the last several years.

Going forward, electronic health records (EHR) will be influential in stroke care.

“We are in the process of building a stroke registry within our network to better track quality and outcomes,” he says.

Another initiative of the network is educating school children on how to recognize stroke symptoms and prevent risk factors for stroke. Dobbs likens this to teaching foreign languages to kids at a very young age, when they best learn them. “If we’re successful, we should have healthier Kentuckians for the next generation, and the extra effects will be that we will not only have fewer strokes but fewer heart attacks and less costs in healthcare” he says.

Stroke research

UK’s distinctiveness continues in the research realm, as they are one of only a few major hubs in the country for a clinical trial called NETT (Neurologic Emergency

Treatment Trial). Through the efforts of Comprehensive Stroke Center founder Dr. L. Creed Pettigrew and Emergency Chief Dr. Roger Humphries, MD, the center received an NIH grant for emergency neurologic care, a vehicle for multiple clinical trials. Currently the center has two stroke trials underway in the NETT program.

“Additionally, we are among the early stroke programs to treatment patients with stem cells for ischemic stroke,” says Dobbs. u

Michael Dobbs, MD, is director of uK HealthCare’s stroke program, recognized as the leading center in Kentucky for the management of stroke. to learn more visit ukhealthcare.uky.edu/stroke.

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SpeCial SeCtion  Brain HealtH

toxin reaps results

Dr. David Salvatore uses Botox to combat the effects of stroke and other neurologic disorders. By JENNIfEr S. NEwTON

LOuISVILLE Poison, paralysis, and facial rejuvenation. It sounds more like an episode of General Hospital than the historical description of an FDA-approved medical treatment. Yet, physicians are using botulinum toxin in a growing number of ways in to block nerve signals to muscles and reduce spasms that cause often painful conditions that interfere with quality of life.

First studied in the 1950s, botulinum

use in upper limb spasticity and for chronic migraine. However, Baptist Neuroscience Associates neurologist David Salvatore, DO, says botulinum toxin has been used for off-label uses for 20+ years and is already the standard of care for some conditions.

For upper limb spasticity, “It’s a first line treatment,” says Salvatore. “It’s not an issue for us to get insurance to approve it at that point because oral medications, like muscle

Dr. David Salvatore, with baptist Neuroscience associates, says that unlike cosmetic applications of botox, medical uses require more extensive training and better knowledge of anatomy.

toxin was originally a treatment for strabismus or crossed eyes. Botox®, the most commonly recognized brand of botulinum toxin, was the first to be FDA approved for strabismus and blepharospasm (eyelid spasms) in 1989. It reached popular fame in 2002 when Botox Cosmetic was FDA approved for use in frown lines.

In 2010, the FDA approved Botox for 18 M.D. UpDate

relaxers, don’t go directly to muscle and have other side effects.” The same is true for lower limb spasticity, although it has not been FDA approved.

post-Stroke Care

Spasticity is the primary indication for Botox in stroke patients. It can also be used in stroke patients with sialorrhea, excessive

salivating, where a small amount of the toxin is injected into the parotid gland.

For Salvatore, who is also the medical director of Baptist Hospital East’s Stroke Program, Botox is just one of the treatment options in an area he says gets little attention – post-stroke care. After the acute care and in-hospital stabilization and assessment stage, rehab typically ensues, whether in an acute care, skilled nursing, or other setting. While Salvatore believes many PM&R physicians do a good job of taking over care here, he suggests neurology should continue to play a role to monitor and manage effects that occur weeks or even months after a stroke.

Two of the issues Salvatore emphasizes are post-stroke depression and spasticity.

Evaluating for depression while a patient is in the hospital is a difficult task because existing depression scales typically try to identify behavior that has been happening for a month or more, and oftentimes, a patient’s mood or behavior does not change until after they leave the hospital. “The reason that’s important is because there was a study done with Paxil that patients with signs of post-stroke depression were put on this medication and actually their motor outcomes were better and activities of daily living, quality of life, all improved,” he says.

Salvatore also cautions that depression medications do not work overnight. “If we can identify as early as possible and get them on the medication, we’re going to give them their best chance at optimal outcomes.”

In terms of spasticity, the symptoms can occur months post stroke, when weak muscles begin to tighten up. Botox can be very successful when this is caught in midstage before the muscles are completely contracted. When used in conjunction with physical and occupational therapy to loosen muscles and slow progression, Botox can greatly improve quality of life and can prevent pain and skin infections.

Other neurologic conditions Salvatore knowledge of the anatomy. needle that allows the physician to hear that injects for include hemifacial spasms, cerviWhen it comes to the risk of complica- he/she is in the muscle and how active the cal dystonia, and chronic migraine. For all tions from Botox, it varies depending on muscle is. “For stroke patients, it’s really indications, in general, botulinum toxin the dose and condition being treated. “For identifying what muscles are optimal for their is injected every three months. It can be post-stroke patients, it’s extremely low risk,” spasticity and then knowing you are in the administered sooner in cases where the says Salvatore. “When injecting medica- muscle before you inject,” says Salvatore. body breaks it down quicker, howSalvatore has been with ever injecting too often carries the risk if you Can CatCH SpaStiCity in StroKe Baptist Neuroscience Associates, of developing antibodies against the which is employed by Baptist patientS in MiDStaGe, Botox iS a firSt Health and is the only neuroltoxin, making it less efficacious. ogy group practicing at Baptist While results are hard to measure line treatMent.

Hospital East in Louisville, for a in stroke patients, studies have shown year and a half but has been utibotulinum toxin reduces patients’ dislizing botulinum toxin for over ability scores. Outcomes are more five years through training in general neuquantifiable in chronic migraine, where two tions into peripheral muscles you have fewer rology and physiatry.

He is also a trainer multi-center preemptive studies have dem- problems with systemic side effects when onstrated a decrease in nine headache days utilizing a moderate dose of the medica- for Allergan, the maker of Botox, teaching from an average baseline of 20. tion.” On the other hand, injecting for cer- other providers how to inject for chronic vical dystonia in the neck requires expertise migraine and avoid side effects. The group recently hired Dr. Tracy Eicher, a neuroloexperience Minimizes risks in avoiding critical structures.

Unlike cosmetic applications of Botox In both instances, Salvatore uses a tech- gist with Botox experience to help Salvatore where injections are relatively simple, medi- nique called EMG guidance, which utilizes manage the high volume of Botox and cal uses require more extensive training and a microphone-like device on the end of the botulinum toxin patients he sees. u

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allieD HealtH  auDioloGy

Get in the loop Although hearing aid technology has significantly improved since digitalization in the 1990s, there continue to be situations that challenge and frustrate hearing-impaired listeners. Places of worship, airports, theaters, ticket booths and movie theaters tend to be extremely difficult listening environments, often creating such an unsatisfying experience that the hearingimpaired person avoids these situations entirely.

If hearing aids are so advanced, why do they continue to have problems with reproducing a clear sound in certain environments? The answer is in the microphone.

In large more reverberant rooms, the sound is degraded before it reaches the hearing aid LEXINGTON

microphone. The hearing aid can only reproduce the input provided. If the microphone detects a degraded signal, it will amplify a degraded signal sometimes making speech totally BY ann L. rhoten unintelligible.

With the passage of the Americans with Disability Act, many churches, theaters and other large venues have installed wireless transmitters that use infrared and FM technology to send the signal to the

real ear MeaSureMent A Must-Do Best Practice lexinGton technological advances have given us significant improvements in the overall sound quality of hearing aids. we are now able to provide the consumer with clear sound processing, better speech understanding, improved performance in noise, style, and comfort. after fitting a patient with hearing aids, practitioners are forever asking the patient, “How does that sound?” and, “Does that sound better now?” these questions, even if answered positively, are still very subjective. new technology allows us to make extremely accurate sound adjustments and customize and individualize each patient’s hearing aids to their hearing loss and to their personal sound preferences. Still, in asking these questions, we 20 M.D. UpDate

BY Kathryn

Sandusky

aren’t receiving a scientific view of how the aids are performing in their ears. every ear canal is a different shape and size, and acoustical changes occur specific to these criteria when patients are fitted with hearing aids. for practitioners, a “visual” representation of the performance of the hearing aids in the patient’s ears can be invaluable in correctly adjusting the instruments to each person.

real ear Measurement (reM) is an electroacoustical measurement of just this process. a tiny probe microphone is inserted into the ear canal along with the hearing aids and is able to show us on a computer screen the performance of the instruments compared with optimum performance guidelines. we then make necessary adjustments and retest using reM until the desired results are achieved. these measurements provide us with verification that the hearing aids are performing accurately, meeting a set of measurable specifications and expectations. reM is quick, painless, and a “must-do” part of proper protocol for successful hearing aid fittings.

Kathryn Sandusky, auD, Faaa is owner of Central Kentucky audiology in Lexington. reach her at (859) 277-5090. u

hearing-impaired patrons. These are effective means of transmitting speech clearly but require special headsets be checked out and worn, and experience has shown people are reluctant to use this technology. Not only is there a stigma and hassle attached to checking out the conspicuous headsets, but facility owners find they can’t be used with existing amplification systems and require a separate installation for each setting.

Fortunately there has been a resurgence of a seasoned but effective technology called hearing loops. Hearing loops are like Wi-Fi for your hearing aid. They turn the hearing instruments into wireless speakers for a PA system or television set. A hearing loop works by wirelessly transmitting the signal from a PA system or television, through a magnetic field, and to the small copper telecoil in the hearing aid. The telecoil picks up the signal from the magnetic field and converts it into an acoustic signal in the hearing aid. Because the signal is never airborne, it provides a clear, intelligible sound with no interference from background noise and no degradation of the signal.

Since approximately 60-70% of hearing aids come standard with a telecoil, the telecoil need only to be activated and programmed by an audiologist. Anytime the hearing aid user is in a facility which is looped, the telecoil can be accessed by pushing a button at the back of the hearing aid.

There are many advantages of a hearing loop over infrared and FM systems.

First, most hearing aids are equipped with a microphone plus telecoil setting enabling one to hear the people nearby while simultaneously receiving direct input from the PA system. With infrared and FM headsets, only the input from the PA system is received sometimes making it difficult to communicate with those around you.

Additional benefits of hearing loops include no extra equipment to be checked out, the telecoil can be utilized in any looped venue, it is simple to access, hygienic and provides clear, intelligible sound. In the event there is no telecoil in your hearing aid or one does not wear a hearing aid, just like FM and infrared, listening devices are still available

allieD HealtH  auDioloGy

in venues where the hearing loop is installed, audio signals are never airborne. they are transmitted wirelessly to a hearing aid telecoil, which creates a clear and intelligible sound. there is no background noise or degradation of the sound.

Look for this sign to for check out. identify hearing loop In 2010, the Hearing Loss enabled venues. For more Association of America and the information, visit www.

American Academy of Audiology loopamerica.com. announced a joint collaborative public education campaign “Get in the Hearing Loop.” The campaign aims to enlighten and excite hearing aids users, as well as audiologists and other professionals who dispense hearing aids regarding telecoils and hearing loops and their unique benefits. As a result of the campaign, Michigan, Wisconsin, New York, California and North Carolina have installed a significant number of loops. This list of places looped is long and varied but include small, portable loops in places such as drive-thru windows, check-out counters, taxis and tour buses. Large, permanent loops tend to be installed in theaters and churches, and my hope is for Kentucky to be the next state with a growing loop network. ann rhoten, auD, CCC/a, is the owner of Kentucky audiology and tinnitus Services and specializes in the treatment and management of tinnitus and sound tolerance issues. You may reach her by email at arhoten@kytinnitustreatment.com or by calling (859) 554-5384. u DeCeMber 2012 21

allieD HealtH  CHiropraCtiC & aCupunCture

neurological rehabilitation facilitated by acupuncture and Chiropractic Neurology provides an inclusive and descriptive base that encompasses several serious health problems faced by today’s patient. These domains include disorders of the spinal cord, the peripheral and autonomic nervous systems, the cerebellum, vestibular, and basal ganglia systems, muscular/ neuromuscular junction receptors, sensory and neuroendocrine systems, as well as neuroanatomy neurophysiology dilemmas.

Chiropractic and acupuncture protocols have worked synergistically to assist in the complementary care of the following neurological problems: foot drop, vertigo and balance problems, movement difficulties, LEXINGTON

visual disturbances and eye fatigue, memory and concentration challenges, dystonia, reflex sympathetic dystrophy, post stroke rehabilitation, ADHD and learning disorders, periphBY Charles Metzker eral nerve injuries, neuropathies, radiculopathies such as numbness and pain from traumatic injury.

Chiropractic therapy has become an

22 M.D. UpDate

pHotograpHY CoUrteSY oF JoSH SaxtoN

according to Dr. Metzker, acupuncture activates nerve receptors that block pain signals.

integral part in aiding neurological problems by applying principles found in Functional Restoration Rehabilitation (FRR). Chiropractic neurology recommends treatments known as afferent stimulation. This includes the use of elements in our physical environment that are non invasive and non surgical. Chiropractic adjustments, brain exercises, light, heat, water, sound, and electrical stimulation are some examples. Concepts started by FRR in the 1970s are commonly used in the modern chiropractic practice. Chiropractic methodology has assisted many patients to break out of the depression and disability of previous intractable pain. FRR concepts and principles are fully described and referenced by Robert Gatchel PhD in his MMPI Disability Profile in Spine Dec.1, 2006.

Two certifying chiropractic neurology boards fully describe complementary chiropractic involvement in the diagnosis and treatment of neurological problems. These are the American Chiropractic Neurology Board (ACNB) and the International Board of Chiropractic Neurology (IBCN). Both of the boards involve extensive post graduate education and examination beyond the regular chiropractic educational degree.

Acupuncture has provided well documented results in reducing neurological pain from several diagnosed illnesses.

Trauma, infection, nerve degeneration, exposure to toxic chemicals, shingles and diabetes are some of the many conditions producing neurological pain. Specific point stimulation by acupuncture needles release neurotransmitters and opioids to reduce painful, sensitive areas. Acupuncture activates nerve receptors that block pain signals.

Electrical stimulation of the needles alters the bodys electrical system and allows a transfer of material and electrical energy to restore biochemical and physiological balance to the damaged tissue. This is referred to as “the restoration of Qi.” An acupuncture treatment to specified points will restore the proper flow of the excessive

or deficient Qi. This reduces the amount of recovery time in many conditions. This information is studied and incorporated by all properly trained acupuncturists and described clearly in a recent article by Glenn Hensle L.Ac of Newport, California.

Extensive research in acupuncture’s effect on neurological dilemmas and diagnoses is found in Acupuncture Therapy for Neurological Diseases by Dr. Ying Xia of Yale University School of Medicine and Drs. Xiaodong Cao, Gencheng Wei, and Jieshi Cheng of the Shanghai Medical College of Fudan University. Val Hopwood and Clare Donnellan in their book Acupuncture and Neurological Conditions also provide a spectacular view into a similar evidenced

aCupunCture HaS proviDeD well DoCuMenteD reSultS in reDuCinG neuroloGiCal pain froM Several DiaGnoSeD illneSSeS. based approach to acupuncture’s positive effect. Both treatises provide clear clinical options from a Traditional Chinese Medicine (TCM) and Western medical perspective.

A most recent study published in the Journal of the American Society of Neurorehabilitation suggests that acupuncture provides “statistically significant benefits in physical functioning and recovery when used as an adjunct to conventional stroke rehabilitation measures.” This was a

study initiated by a grant to the Emperors College of Traditional Oriental Medicine five years ago. This was a study conducted at the Daniel Freemans Rehab Center of inpatient stroke rehabilitation in Los Angeles.

This study rests alongside an estimate by the American Heart Association that there are between 500,000 – 750,000 strokes in the U.S. each year resulting in 150,000 deaths.

Thus, a sincere effort to elucidate complementary therapies for neurological problems is a societal imperative.

Dr. Charles Metzker, DC, Cac is a licensed/ certified chiropractor and acupuncturist. He can be reached at his Lexington practice (859) 268-4111. u

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newS  eventS  artS

gastroenterology group Joins baptist Medical associates

LOuISVILLE Baptist Gastroenterology Associates has joined Baptist Medical Associates.

Members of the group are: Lauren C. Briley, MD, is a 2004 graduate of University of Louisville School of Medicine. Briley completed her internal medicine residency at University of Louisville Hospital in 2008, serving as chief resident her final year. She completed a gastroenterology/hepatology fellowship at University of Louisville Hospital in 2011.

Brian M. Dobozi, MD, is a 1999 graduate of Loyola University Stritch School of Medicine in Chicago.

Dobozi completed his internal medicine residency at Chandler Medical Center in Lexington in 2002. He completed a gastroenterology fellowship at Duke University Medical Center in Durham, N.C., in 2005.

Michael V. Greenwell, MD, is a 1985 graduate of the University of Louisville School of Medicine.

Greenwell completed his internal medicine residency at University of Louisville

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

Hospital in 1988. He completed a gastroenterology fellowship at University of Louisville Hospital in 1990.

Kevin J. Heine, MD, is a 1985 graduate of the University of Louisville School of Medicine.

Heine completed his internal medicine residency at University of Louisville Hospital in 1989, serving as chief resident his final year. He completed a gastroenterology fellowship at the University of Virginia in Charlottesville in 1992.

Lori Weis, APRN, is a 2003 graduate of the Spalding University family nurse practitioner program. She holds a bachelor’s degree in nursing from Eastern Kentucky University.

punnett Joins baptist Medical associates Crestwood

Michael Punnett, MD, family medicine, has joined Baptist Medical Associates Crestwood.

He is a 2000 graduate of the University of Louisville School of Medicine. He completed his family medicine residency at Memorial

CrESTwOOD

Health University Medical Center in Savannah, Georgia, in 2003. He is accepting new patients.

reichert Joins baptist Medical associates eastpoint

LOuISVILLE Mary Lou Reichert, MD, family medicine, has joined Baptist Medical Associates’ location at Baptist Eastpoint, 2400 Eastpoint Parkway near Anchorage. Reichert is a 1980 graduate of the University of Louisville School of Medicine. She completed her family medicine residency at St. Elizabeth Medical Center in Dayton, Ohio, in 1983. Reichert is board certified in family medicine.

Flaget Memorial announces New Hodgenville practice

Flaget Memorial Hospital, a part of KentuckyOne Health, hosted an open house Friday, November 9, at 2 p.m. at the hospital’s new Hodgenville practice, Flaget Primary Care Associates, for primary care physician, Melanie Mooney, MD. Mooney is a Vermont native who has spent her last 20

BArDSTOwN

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

24 M.D. UpDate

newS

years in Kentucky. She got her undergraduate degree at Western Kentucky University, attended the University of Louisville School of Medicine, and then completed an internship and residency at the university’s Glasgow/Barren County Family Medicine practice. She has practiced primary care medicine since 2001. Before coming onboard with Flaget Hospital, the physician worked at Westlake Regional Hospital in Columbia.

The new Hodgenville practice is being housed in the former office of D.M. Shivakumar, MD, located at 908 South Lincoln Boulevard. Mooney will begin practicing at the renovated office at the beginning of December. In the meantime, physicians and nurse practitioners from Flaget will treat patients there.

When Shivakumar closed his office that left just two family medicine practices in LaRue County to cover a population of more than 14,000, according to Flaget President and CEO Sue Downs, MSN, CENP. “We are excited to be providing essential medical care to the citizens of LaRue County – and to those of southern Nelson County,” Downs said.

Norton Healthcare Welcomes Sheila Ward, aprN, Womenfocused psychiatric Nurse practitioner

A specialized service is now available at Norton Suburban Hospital, future LOuISVILLE

home of Norton Women’s Hospital and Kosair Children’s Hospital – St. Matthews.

Sheila Ward, APRN, has joined Norton Healthcare to provide much-needed women’s mental health services. Her services include psychiatric evaluation and treatment of women with depression or anxiety disorders and those who are experiencing hormonal challenges such as premenstrual syndrome, infertility, postpartum depression and menopause. Ward comes to Norton Healthcare with more than 31 years of experience as a nurse practitioner and 10 years’ experience in women’s mental health.

Her expertise in this area will further the mission of the hospital by providing women with a full range of health care support.

Ward will provide outpatient services for patients of all practices as well as inpatient consultations. The addition of this mental health program expands the comprehensive plan for the renovated hospital, expected to be completed in spring 2014.

The hospital will also include an inpatient eating disorders unit and support group, a migraine clinic, pelvic disorders center, a wide range of birthing options, additional pediatric services, and an expanded neonatal intensive care unit.

UofL announces partnership with Kentuckyone Health

LOuISVILLE The University Medical Center (UMC) and the University of Louisville (UofL) announced that they have entered a

partnership that brings together University Hospital and the James Graham Brown Cancer Center with KentuckyOne Health.

The agreements for the partnership have been signed by the partners along with Governor Steve Beshear. This new collaboration with KentuckyOne Health is essential for University Hospital | James Graham Brown Cancer Center to continue its core mission as an innovative academic medical center and a vital regional safety net hospital that provides the highest level of care to all patients. This partnership will maintain local control of the hospital. Additionally, it enables UofL to continue to recruit and retain the best faculty for its health schools, which are critical as the pipeline of future generations of doctors, nurses, dentists, and caregivers.

All current UMC policies for women’s health, end-of-life care and its pharmacy remain unchanged. UMC will continue to manage and operate University Hospital’s Center for Women and Infants (CWI).

All women’s health services will continue to take place at CWI, at the same location and provided by the same people as today.

This includes the full range of reproductive services.

Highlights of the partnership include $543.5 million of investment during the first five years, expanding to $1.394 billion over 20 years. Work on the partnership will begin immediately with an implementation on or before March 1, 2013.

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trover Health System becomes baptist Health Madisonville

LOuISVILLE Baptist Health (formerly Baptist Healthcare System) announced today that Trover Health System is joining Baptist as its eighth hospital in the state. Effective November 1, Trover Health System will become Baptist Health Madisonville.

Trover – located in Madisonville – began exclusive discussions with Baptist nearly a year ago after selecting Baptist from proposals submitted by several healthcare organizations. LifePoint Hospitals and Owensboro Medical Health System were also considered as finalists in the process. Each finalist was selected based on its ability to assist Trover with the design and implementation of new models of care and payment reform, access to capital, experience with recruit-

ing physicians and building solid physician relationships, and developing service line partnerships. After an extensive evaluation process, Baptist was chosen as the system of choice by the Trover Board of Directors.

Plans are already underway which demonstrate the benefits of the relationship. In response to the community’s growing need for primary care physicians, Baptist Health Madisonville is actively recruiting for internal medicine and family practice physicians. Renovations also are planned for the Mother/Baby Unit, Emergency Department and Same Day Surgery, in addition to updates to other areas of the hospital. There will be an emphasis on updating healthcare technology and facilities at the Madisonville campus, while Baptist Health also offers access to a statewide network of hospitals,

outpatient facilities, and physicians ready to respond to patients’ needs.

Johnson named 2013 SeC team physician of the Year

LEXINGTON The University of Kentucky’s chair of the Department of Orthopaedic Surgery and Sports Medicine Darren Johnson, MD, has been named the 2013 Southeastern Conference Team Physician of the Year. This award is chosen by the athletic training staffs at SEC member institutions and is given annually to recognize a team physician who has contributed greatly to both his or her school’s teams and to the SEC sports community. Voting criteria includes both reliability to the physician’s athletic department and noted involvement in the field of sports medicine. Johnson, who began at UK in 1993, currently serves as head orthopedic surgeon for UK Athletics.

Flaget Memorial to open Family Care practice in New Haven

BArDSTOwN Flaget Memorial Hospital, a part of KentuckyOne Health, will be opening a family care physician’s office in New Haven in the early part of 2013. The decision to open the practice was made after the hospital staff did a needs assessment, said Flaget Vice President of Ambulatory Services and Projects Rick Vancise, BSN, MBA/HCM. “Part of the mission of KentuckyOne Health is to bring access to health care close to home,” Vancise said. “It’s clear that New Haven is a medically-underserved area. Our intent is to do outreach to patients in this type of area.” The building that will house the new practice will be constructed on what is currently a vacant lot on Center Street across from the Joseph L. Greenwell Funeral Home.

A private developer will construct the building and provide parking spaces. The hospital will be leasing the building for its new practice, and will hire the physician and other staff members.

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Flaget Memorial receives Chest pain accreditation

BArDSTOwN Flaget Memorial Hospital, a part of KentuckyOne Health, has received Chest Pain Accreditation from the Society of Chest Pain Centers. flaget employees who helped to win the award are: (ltor) flaget Director of lab Services Mary ann Schentrup, Mt, aSCp, Director of pulmonary Services Heather Mattingly, rrt, Director of patient access Carol Cothern, CHaM, emergency Department interim Director Kelley Broyles, BSn, emergency Department Charge nurse Jill Clark, rn, and flaget Chief nursing officer/Chief operating officer norma Goss, MSn/eD. not present for the photo were flaget Chest pain Center Director Charles Sowder, MD, former flaget emergency Department Director laura larue, BSn, MBa, nelson County Dispatch Center Director Debbie Carter, and nelson County eMS Director of education eva prewitt.

Kosair Children’s Hospital Non-Invasive Cardiology receives National accreditation

LOuISVILLE Louisville-based Kosair Children’s Hospital Non-Invasive Cardiology has been granted a three-year term of accreditation in Echocardiography in the areas of Pediatric Transthoracic by the Intersocietal Accreditation Commission (IAC).

Accreditation by the IAC means that Kosair Children’s Hospital Non-Invasive Cardiology has undergone a thorough review of its operational and technical components by a panel of experts. The IAC grants accreditation only to those facilities that are found to be providing quality patient care, in compliance with national standards through a comprehensive application process including detailed case study review.

IAC accreditation is a “seal of approval” that patients can rely on as an indication that the facility has been carefully critiqued on all aspects of its operations considered relevant by medical experts in the field of Echocardiography.

ate facility as quickly as possible.

In March 2008, Kentucky lawmakers passed House Bill 371, which established the initial framework of a statewide trauma system and the formation of the Kentucky Trauma Advisory Committee. The law encouraged the establishment of trauma centers and the drafting of written transport protocols for EMS providers to better define

which patients require transfer to a trauma center. Additionally, the statewide trauma system provides better, standardized education for providers -- from first responders and EMT/paramedics, to nurses, physicians, and even hospital administrators.

Trauma centers recognized as part of the Kentucky Trauma Care System include: Level I trauma centers -- UK Chandler

First group of Hospitals Designated Members of Kentucky trauma Care System

Ten hospitals were recognized as part of the state’s first official statewide trauma system during the 2012 Statewide Trauma and Emergency Medicine Symposium in late October. The goal of the state trauma system is to get the ‘right patient to the right place at the right time’ by providing education for doctors, nurses, and paramedics to care for and assess severely injured patients, so that they are taken to the most appropriDeCeMber 2012 27

newS Hospital (Lexington), Kentucky Children’s Hospital (Lexington), Kosair Children’s Hospital (Louisville), and University of Louisville Hospital. Level III trauma centers -- Ephraim McDowell Regional Medical Center (Danville) and Taylor Regional Medical Center (Campbellsville). Level IV trauma centers -- Ephraim McDowell Fort Logan Hospital (Stanford), James B Haggin Memorial Hospital (Harrodsburg), Livingston Hospital (Salem), and Marcum & Wallace Hospital (Irvine).

bluegrass Care Clinic awarded Funding for HIV/aIDS Care, education

LEXINGTON The Bluegrass Care Clinic, part of the University of Kentucky Department of Infectious Disease, has recently received millions in funding to advance the care of individuals living with HIV/AIDS in Central and Eastern Kentucky.

The Bluegrass Care Clinic was one of 114 community-based organizations, university hospitals, and health departments nationwide to be awarded Ryan White Part D funds to enhance the medical care of women, infant, children, and adolescents living with HIV/ AIDS living within the clinic’s 63 county service area. Under the direction of Dr. Alice C. Thornton, the Bluegrass Care Clinic provides a wide range of services to HIV-infected patients, including: HIV specialty care, primary medical care, medication adherence counseling, medical case management, mental health services, and nutrition counseling. The total award for the Part D grant is $1.2 million over a period of three years (2012-2015).

The clinic was also recently awarded approximately $1.3 million in Ryan White Part B funds from the Kentucky Cabinet for Health and Family Services, Department for Public Health, to provide medical case management and supportive services to individuals living with HIV/AIDS. The BCC is one of six sites across the state of Kentucky funded to provide a wide range of community-based medical and non-medical support services, including physical and mental health care, nutrition, and transportation services. The Part B program serves approximately 850 uninsured and underinsured patients living in 63 Central and Eastern Kentucky counties.

The clinic also receives Ryan White Part C funds in the amount of $699.932 annually 28 M.D. UpDate

from 2010-2015, for a total of $3.4 million over five years. The BCC receives approximately $2.5 million annually in Ryan White funds, making possible a wide array of programming necessary to serve patients.

baptist east receives Consumer Choice award

LOuISVILLE Consumers in the Louisville market have voted Baptist Hospital East as the No. 1 healthcare facility in the Metro area for the seventh consecutive year. The poll was conducted by the National Research Corporation. Baptist East is a 10-time winner of the honor, and has been recognized more consecutive years than any other Kentucky hospital. Other winners in Kentucky were Central Baptist Hospital and the UK Medical Center in Lexington and The Medical Center in Bowling Green.

Winners of the 2012/2013 Consumer Choice Awards are determined by consumer perceptions of quality and image.

Consumers were asked about the overall quality of the hospital, the expertise of its physicians and nurses and the image and reputation of the facility. The award identifies hospitals which healthcare consumers have chosen as having the highest quality and image in over 300 markets throughout the US.

UK Chandler Hospital receives Consumer Choice award

The University of Kentucky Albert B. Chandler Hospital has been named a winner of the 2012-13 Consumer Choice Award in Modern Healthcare by the National Research Corporation. The award is given to hospitals that consumers believe provide the highest quality care and maintain the best image in over 300 markets throughout the United States.

Winners of the award are chosen based on surveys of over 250,000 households representing over 450,000 consumers in the contiguous 48 states and the District of Columbia. Of the households surveyed, 3,200 hospitals named by consumers are analyzed and ranked, with the winning facilities being ranked the highest.

The internet survey invitations began on September 1, 2011, and extended until the end of August 2012.

LEXINGTON

UK HealthCare, arH Working to tackle Heart, Health Issues in eastern Kentucky

UK HealthCare and Appalachian Regional Healthcare (ARH) are working to form collaborative agreements in which the two hospital systems would work with community physicians to strengthen cardiovascular care in southeastern Kentucky. “UK HealthCare and ARH are both committed to improving healthcare throughout Eastern Kentucky and we have a long track record of working together toward that goal,” said Dr. Michael Karpf, executive vice president for health affairs at the University of Kentucky. “Heart disease is a particularly pressing health challenge for Eastern Kentucky and the entire Commonwealth.

That’s why we are working together and with community physicians to establish collaborative agreements where we leverage the best of what two strong health organizations bring to the table in attacking this critical health issue.”

Specifically, UK HealthCare and ARH officials have signed a non-binding Letter of Intent that establishes the parameters for a management agreement that both parties hope to be worked out over the next -few months. The management agreement could include: The execution of a three-year clinical management agreement that can be extended

by UK HealthCare and ARH; planning and development for the cardiovascular program; re-engineering patient and work-flow processes to strengthen cardiovascular care; improving clinical protocols for treatment; community outreach to improve access to education regarding cardiovascular care; developing metrics aimed at assessing the work being done and progress in improving cardiovascular care and outcomes in southeastern Kentucky; and improve access to staff development and training. When executed, the management agreement would allow UK HealthCare and ARH to jointly administer and direct cardiology services at Hazard ARH Regional Medical Center as well as ARH’s other hospitals where heart services are provided, including Harlan, Whitesburg, McDowell, Mary Breckinridge, and South Williamson. u

HAZArD

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KMa alliance & gLMSa Visit McDowell House in Danville

DANVILLE On November 7, members and guests of the KMA Alliance and the Greater Louisville Medical Society Alliance toured the Ephraim McDowell House in Danville, KY where the first surgery in the state of Kentucky was performed on Christmas morning 1809

by Dr. Ephraim McDowell who removed an ovarian tumor. It was first thought that alliance members the patient, Mrs. Jane with the KMa and Todd Crawford, was gLMS are working to restore the expecting twins. But ephraim McDowell after examination House in Danville, McDowell assessed Ky. pictured (from that it was a tumor. the bottom left): The surgery to remove Diane parks, the 22.5 lb tumor anita garrison, was performed with- Joann Daus, out anesthetic or Nancy bunnel, Antisepsis, neither of Don Swikert, Kim Moser, which was known in ruth ryan, the medical profession Nancy Swikert, at that time. patty pelligrini,

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FIND OUT HOW. The Alliance member’s tour included a recap of the history of the house and McDowell’s famous surgery, followed by a tour of the upstairs bedroom where the surgery was performed, the apothecary which houses a large collection of late 18th and early 19th century apothecary ware and the garden. The afternoon ended with a tea in the formal dining room.

The Greater Louisville Medical Society Alliance has contributed to the restoration of the children’s room at the McDowell house and continues to support the preservation on a regular basis. A restoration of the slave quarters is now underway.

The McDowell house was purchased by the KMA in 1935. They deeded the house to the state of Kentucky, who had it restored by WPA.

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National expert’s Message to Kentucky Sleep Society: Sleep Disorders affect public Safety

Attendees of the Kentucky Sleep Society (KSS) heard from a national expert in transportation safety of the dangers resulting from fatigue at the annual Fall Meeting of the KSS. The keynote speaker of the conference, Member Mark R. Rosekind, LOuISVILLE

“Fatigue is a major factor in transportation safety,” Member Mark r. rosekind, phD, of the NtSb at KY Sleep Society annual meeting

PhD, National Transportation Safety Board presented the NTSB’s approach to sleep disorders and the public’s safety.

The mission of the NTSB, said Rosekind, is to determine the probable cause of major accidents on the nation’s highways, railroads, waterways and airways and to make recommendations so those accidents don’t happen again. The NTSB is an investigative and advocacy group and has no regulatory, enforcement or legislative authority.

Fatigue resulting from sleep disorders, sleep loss, and circadian rhythm disruptions have been identified as a probable cause in accidents in every mode of transportation and fatigue has been on the NTSB’s “Most Wanted” list of safety improvements since the list was first published in 1990. From its accident investigations, the NTSB has made over 200 safety recommendations related to fatigue.

Fatigue is defined by NTSB criteria that recreates, at a minimum, the previous 72 hours of an operator involved in a crash.

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The criteria include the quantity and quality of the operator’s sleep; when did the accident occur and what was the circadian rhythm or body clock of the operator; how many hours had the operator been awake prior to the crash; and has the operator been diagnosed with a sleep disorder.

According to Rosekind, people with sleep apnea have a 6x greater risk factor for having a car crash than people without the sleep disorder. Yet 80% of people with sleep apnea are undiagnosed. “Health care providers are the critical element in dealing with the public’s education of the risk factors from sleep disorders,” said Rosekind.

Education, diagnosis, treatment and compliance are the top four methods for dealing with the problem, he said.

Currently, there is little and inconsistent federal policy directly addressing sleep disorders, stated Rosekind, in spite of the fact that the NTSB has recommended the establishment of such programs for over a decade. In fact only in 2011 were new major rule changes made in “hours of service” for transportation workers.

Previous rules of “hours of service” had been in effect since the 1930’s.

Medical evidence states that a high body mass index of 30-35 is often an effective predictor of sleep apnea, said Rosekind, but not everyone with sleep apnea has a high BMI. Similarly, gathering reliable statistics from local law enforcement officials investigating crash site is challenging, said Rosekind. Local police are not medically trained to recognize sleep disorders and operator’s in a crash are often not able to remember exactly what happened before the crash.

The greatest misconception among the public, said Rosekind is how much they underestimate the prevalence of sleep disorders and how much risk they pose to the general public when undiagnosed and untreated. “In the transportation industry, people with sleep disorders are a risk threat to themselves and to everyone they come in contact with,” he said, “and education is a top priority for addressing the problem.”

go reD For Women: all about Survivors

LEXINGTON On Friday, November 16, more than 650 women attended the Central Kentucky Go Red For Women Luncheon to learn how to reduce their risk of cardiovascular disease – the number one killer of women. Highlights of the day included guest speaker, and “Survivor Nicaragua” contestant, Holly Hoffman and the Macy’s Survivor Fashion Show.

The event raised nearly $130,000 for the American Heart Association, which will be used for research and education efforts in Central and Eastern Kentucky.

robert Sallee, MD, executive administrator of Cardiovascular Service Line Saint Joseph Hospital, Saint Joseph east, and Julie e.

Coffey, FaCHe, director of the Saint Joseph Heart Institute. Dr. Sallee addressed the need for women to be proactive in their heart health at go red For Women Luncheon.

Making Impact Saint Joseph Foundation StarS gala

LEXINGTON Almost 300 supporters of the Saint Joseph Hospital Foundation (SJHF) enjoyed an evening of dining, dancing, silent auction and entertainment provided by Off The Clock at the 24th Annual Evening with the STARS (Saint Joseph Associates for Renowned Service) on Saturday, November 10, 2012 at the Marriott Griffin Gate.

The Saint Joseph Hospital Foundation

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StarS members teresa Wallen, chair, Saint Joseph Hospital Foundation board of Directors; Helen o. Hamilton; Katherine McCarty; Marilyn todd; Leslie Fannin, president, StarS; barry Stumbo, president and Ceo, Saint Joseph Hospital Foundation; ann-phillips Mayfield; Sheila Devine; Sally blake; Jane Warner; and alice Stewart-Kain.

along with the STARS Committee and John Smithhisler, KentuckyOne Health Lexington Market Leader and Saint Joseph Hospital President, were extremely proud to honor Nurses’ Choice Award Winners: Ketan Merchant, DO, Saint Joseph East; Mitchael Estridge MD, Saint Joseph Hospital and Robert Hewett, Outstanding Community Volunteer.

SJHF president and CEO Barry Stumbo recognized the significant impact the STARS program has had on the foundation, raising over $1 million to support the SJHF mission and outreach programs. “This is not about income, it’s about impact,” said Stumbo, “and the critical need to reinvest

in our equipment, our technology, and our people.” STARS fundraising program has supported the Patient Family Assistance Fund and contributed to the acquisition of new EKG, nursing simulators, and digital mammography.

STARS president, Leslie Fannin said,

“Each year, the committee strives to exceed the previous year’s goal and this year is no exception. Philanthropic partnerships with the community allow Saint Joseph to continue its ministry and mission began by the Sisters of Charity of Nazareth over 130 years ago. We work hard to ensure that Saint Joseph patients and families receive the highest quality of care possible for mind, body and soul.”

STARS has hosted this annual gala since 1989, raising almost $1 million in that time. SJHF is a part of KentuckyOne Health, and it invests in outstanding patient care facilities and services, the education of health caregivers, advanced clinical research and improved access to quality medical care. One of the Foundation’s primary goals is “to bridge the gap between medicine and compassion.” u

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StarS honorees for Nurses’ Choice award: (left) Ketan Merchant, Do, Saint Joseph east; and (right) Mitchael estridge MD, Saint Joseph Hospital. outstanding Community Volunteer: (center) robert Hewett, chairman of the Kentuckyone Health board of Directors.

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DeCeMber 2012 31

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nature, art, and Healing

By Courtney BiSiG LOuISVILLE Findings from several studies show that hospital gardens and photos of nature have medical benefits for patients. Donald Vish, a Louisville attorney with a passion for photography, has researched several such studies and has become fascinated by these findings. As Norton Suburban Hospital becomes Norton Women’s Hospital and Kosair Children’s Hospital – St. Matthews, Vish is sharing his talents by furnishing the facility with beautiful photographs acquired in 37 parks and neighborhoods in Louisville.

Uppsala University Hospital in Sweden conducted a study on 160 heart surgery patients in an intensive care unit. The patients were exposed to varied conditions, which included having a nature photograph on the wall, having abstract paintings or having blank walls. Surveys confirmed that patients exposed to scenes with trees, water, and green nature were more at ease and 32 M.D. UpDate

“Willow Lake” by Donald Vish (inset), is one of the photographs the Louisville attorney contributed to the future Norton Women’s Hospital and Kosair Children’s Hospital – St. Matthews.

needed less pain medicine than those who experienced the other conditions. Several studies have been done with similar results, proving that seeing scenes of nature produces powerful benefits for hospitalized patients.

Vish’s drive for helping others combined with his love of photography inspired him to work on the art for the new women’s and children’s facility. Using his keen eye for spectacular scenes in nature, Vish has traveled to 37 parks and neighborhoods in Louisville to capture local beauty for the facility’s future patients.

His photos will be infused onto mediums using a gas sublimation printing process and then placed in the hallways, nursing stations and patient rooms of the hospital.

Vish hopes to bring a sense of place to the hospital, helping patients feel at

home in an environment that can otherwise bring stress to a family. He does other philanthropic work outside of his law practice, including teaching photography classes to underprivileged youth and serving as the executive director and a board member of the J & L Foundation, a philanthropic organization focused on peace, racial harmony and child welfare.

Colleagues at his law firm, Middleton Reutlinger, were so impressed with his work that they converted the top floor of their practice building into an art gallery in January 2006.

Executives of Norton Women’s Hospital and Kosair Children’s Hospital – St. Matthews hope Vish’s work will inspire their patients just as it did his co-workers, allowing them to benefit from the power in the nature that surDonald Vish rounds us every day. u

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