THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS ISSUE #76
SPECIAL SECTION
ATRIAL FIBRILLATION
Emergency & Hospital Medicine
A Huge Problem and Incredibly Common Multiple Approaches from a Multi-Disciplinary Team
VOLUME 4, NUMBER 1
Robert Salley, MD, Executive Director of Cardiovascular Services for Saint Joseph Hospital
ALSO IN THIS ISSUE ERs Close to Home in Lexington Area New Technology Treats ER Scheduling Headache How an EM Doctor Learned to Deal with the Media Hospital Medicine Creates a Win-Win
ky one
Pub: MD Update
Client: Saint Joseph Hospital
???????? FROM THE PUBLISHER’S DESK
Volume 4, Number 1 February 2013
The Cardiology, Emergency & Hospital Medicine Issue
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
FEBRUARY 2013 I know I’m dating myself, but when I was growing up in Maryland, the words “heart attack” and “calling an ambulance to go to the emergency room” struck fear in the minds and hearts of families. Seeing an ambulance arrive at a neighbor’s house evoked the collective terror that a father, a husband or friend was probably dying of cardiac arrest. Gratefully, that is not entirely the case today, although heart disease is still the number one killer in Kentucky. We have life saving surgeries, devices, medicines and procedures of prevention that save lives in the cardiologist’s office, in the cath lab, the operating room, the ambulence and the emergency suite. This issue of M.D. Update examines the efforts and skills of a new generation of Kentucky cardiology specialists and surgeons along with a look at Emergency and Hospital Medicine doctors. In our Special Section on Emergency Medicine meet Barry Parsley, MD, and Steven Stack, MD, two of the ER doctors who serve at Saint Joseph Hospital, Saint Joseph East and Saint Joseph Jessamine, Central Kentucky’s highest volume emergency departments with newly renovated facilities to accommodate the increased patient flow. Ryan Stanton, MD, Medical Director of UK’s Good Samaritan Hospital’s ER has a special working relationship with the media and he’s willing to share some tips. Jamil Farooqui, MD, of the Lexington Clinic’s Hospital Medicine section gives his view of the relationship bond he feels with his hospital patients. The many roles of the medical chaplain are described by Reverend Don Chase, of the Lexington Veteran’ Medical Centers. Please take a few minutes to read how a skilled medical chaplain participates in the healing and grieving process. Also in this issue of M.D. Update, you’ll find expert commentary from our financial, accounting and technology columnists. Contact them for their hands-on problem solving. Look for your specialty in upcoming issues and contact us to participate. Until then, best regards, GIL DUNN PUBLISHER, M.D. UPDATE
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CONTRIBUTORS: Don Chase Barbara Mackovic Scott Neal Calvin Rasey Porter Roberts G.T. Smith Jodi Whitaker
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CONTENTS
ISSUE #76
COVER STORY
ATRIAL FIBRILLATION
A Huge Problem and Incredibly Common
2 FROM THE PUBLISHER’S DESK 4 FINANCIAL AFFAIRS 5 ACCOUNTING 6 IT 8 COORDINATION OF CARE 10 IT’S YOUR MONEY 12 COVER STORY 15 CARDIOLOGY SPECIAL SECTION 17 EMERGENCY MEDICINE 20 HOSPITAL MEDICINE
23 NEWS 32 ARTS BY BARBARA MACKOVIC PAGE 12
SPECIAL SECTION EMERGENCY AND HOSPITAL MEDICINE
17 EMERGENCY CARE CLOSE TO HOME   
19 ER SOFTWARE 
20 HOW TO DEAL WITH THE MEDIA 
21 HOSPITAL MEDICINE CREATES WIN-WIN 
ISSUE#76 3
FINANCIAL AFFAIRS
Financial Chaplaincy As many readers already know I completed an extended unit (one year) of Clinical Pastoral Education in 1994 at the University of Kentucky Medical Center, and for another eight years volunteered one night each month as the chaplain on-call, usually on busy Friday or Saturday nights. I am often asked how that training has informed my practice as a financial advisor, since I had been a practicing CPA and financial planner for 15 years before that experience. The common thread in these two seemingly diverse paths is that they both involve serving people. I learned very early in my career that I had a choice which few in the world of finance would confront: I could simply deal with the quantifiable data, crunch the numbers, and lay out the results; or I could dig a little deeper and help clients to develop their own future story. I chose the latter. Some advisors refer to it as the “soft” side of finance. In addressing my own needs to meet the challenge in front of me I reduced my options to sociology, psychology, or pastoral care. The skill set of pastoral care, along with my own interest in theology, and a strong sense of calling led me to choose PC. Over the past 27+ years I have been afforded the tremendous responsibility and privilege to explore with clients their use of money, to nurture hope, and sometimes to confront despair. The wounds that are sometimes manifested through bank accounts are certainly not wounds to the body, but are wounds nevertheless, in search of healing. In today’s complex, bewildering array of financial products, we often find our clients confused and in need of guidance, alienated and in need of reconciliation, or trapped and in need of liberation. These situations call for a competency that cannot come from an accounting education or practice. To be sure, such needs are not always present with every client. Some of our clients simply want to make the most of their money—to have it work harder for them. If you are one of those, I encourage you to begin to construct your future story with a strong sense of hope. We can all agree 4 M.D. UPDATE
that how a person thinks about and feels toward the future is crucial to his or her overall wellbeing. In fact, I would go so far as to say that the ability to anticipate the future is perhaps BY Scott Neal one of the most authentic and distinctive characteristics of humanity. We are already well into the New Year, but it is not too late to begin thinking about where you want to be this time next year and what you want out of the exchange that you will make in the coming months, trading your life energy for money. As you begin to construct your future story, I invite you to think for a moment on the past year and write down as many accomplishments as you can recall. Look back over your calendar or appointment book. How many patients did you help? Think of the vacations and where those took you and any new relationships that you formed or longer-lived ones that you strengthened. Did you pay off some debts? Did you hit any milestone in your career? Did you learn any new procedures? Did you do something for which you were particularly proud? Take a moment and write them down. If you are like most people you probably don’t want to think about disappointments of the past year, but they can be quite instructive. It will be easier to construct a positive and hopeful future story when we give proper credence to mistakes and disappointments, recognize our own humanity, and move ahead. Our most successful clients are those who have learned from past disappointments and used those to construct their future story. What didn’t quite turn out the way you wanted it to or envisioned it would? Did a partner or other professional thwart your best laid plans? Did the government and the ever increasing tax and healthcare regulations impact your practice? Did a family member disappoint
you? Write them down. Next, take a moment as you reflect on these two lists to write down what you have learned. These can be major or minor life lessons or simply concrete examples of new or improved skills. The disappointments hold keys to uncovering potential learning that might become a focus of your future story. Reflect on the questions, “How did I do that? What could I have done differently to have avoided that disappointment?” Your answers can become your instructions to yourself. Now, think for a moment on the many roles that you play in life and those with whom you engage in each role: Parent, spouse, child, physician, partner, employee, employer, manager, coach, neighbor, citizen, customer, client, executive. Review each role and rate yourself to determine where you would like to focus the next year. Finally, in the context of each role, answer this: What are the goals that would move you closer to where you want to go and who you want to be? Make them specific and measureable. Find a balance between those that are achievable and those that are exciting and challenging. Start each one with a verb. You now have several lists. Use them as the springboard to write your future story with as much detail as possible. Make it positive. Make it personal. Write it in present tense. Place a recurring appointment on your personal calendar to sit down with these lists and your story at least once each month in 2013. Review them and construct action steps designed to keep you on track. Some advisors denigrate the use of hope, saying that it is not a strategy for success. But noted social psychologists have identified hopefulness as a vital component of human action, leading to the achievement of one’s goals. Have a great year! Scott Neal, CPA, CFP is the President of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with points of service in Lexington and Louisville. Call him on 800-344-9098 or write to him at scott@ dsneal.com ◆
ACCOUNTING
5 Financial Mistakes to Avoid As 2013 begins, many of us have made resolutions to improve our lives. Being CPAs, we tend to reflect more on the financial issues. After years of observations, we have witnessed 5 common mistakes that, if avoided, help establish foundations for successful financial futures. Not developing a team of trusted advisors. Working with the following team of qualified professionals would be of great value to a physician: Attorney, Financial Advisor, Insurance Advisor, Private Banker, and Certified Public Accountant (“CPA”). Each team member should have a strong background and understanding of healthcare and be willing to work with each other towards a common goal - your financial success. Your medical expertise comes from dedicating many years to your career. Many professionals have likewise dedicated their careers to developing their own expertise. You shouldn’t try to be an expert in everything. Because of the constantly changing nature and technical aspects of these professions, it would be easy to make a costly error or overlook a great opportunity without expert advice and the latest knowledge in these areas. This does not mean that you should blindly leave each of these areas up to the professionals, as it is ultimately your career and your financial well-being. Your advisors should be able to explain things to you in terms you understand, so you can select the best option for your situation. Just like a basketball team has a starting five, you should have a starting five for your future success. MISTAKE #1
Not spending the time to understand the employment agreement (or other contracts). Regardless of where you wind up practicing, odds are you will have to sign an employment agreement. Become familiar with the contract so you know what to expect. These agreements are presented in the beginning when everyone is excited about the future. However, it will be pulled back out again when a dispute arises. MISTAKE #2
You need to know how situations will be handled based on the contract language. Ask questions about sections you do not understand. Your attorney should help you understand BY L Porter Roberts Jr most parts of the agreement. Your CPA will assist you in understanding the sections of the document that address compensation, incentives, buyin options, or other financial components. If something you believe is important is not specifically in the document, please be sure to have this matter addressed before signing the contract. Not developing a personal budget. Nobody plans to fail, but many people fail to plan. Without developing a personal budget and tracking your spending, you will have no idea where your money goes. There are two components to obtaining self-made wealth: earning the money and saving/ spending the money wisely. Many people ignore the second part. When developing a personal budget, you need to account for all expenses, including easily overlooked items such as car repairs, medical expenses, gifts or vacations. Lastly, it is critical that your budget address retirement, savings, taxes, insurances, and debt repayments. Your financial advisor, insurance advisor and CPA can all provide valuable insight on these items. MISTAKE #3
Incurring too much debt. The ability to borrow funds presents wonderful financial opportunities in the right situations, but also creates problems when used for the wrong reason. It is very easy to get caught up in a lifestyle that consumes most of your cash flow. If your cash flow is already committed, you maybe forced to incur debt for important purchases that could have been avoided. When shopping for major purchases like MISTAKE #4
your auto or home, consider the long term impact of the debt repayment and how it will impact the other commitments and choices you may have in the future. Just because your lender pre-qualifies you for a large loan based on your current income, it does not mean that you should always purchase a home or auto that is near the maximum that you can afford. Also, not all investments are wise just because a friend told you about it and assures you that it is a winner. Your financial advisor and private banker will be able to guide you in these matters. Not planning for the future. You should always consider the future impact of current choices when making financial decisions. Getting started in a retirement plan is a great way to start planning for your future. Many employersponsored plans include an employer match which is an additional benefit for you. Consider obtaining adequate life and longterm disability insurance as another crucial component of your overall financial plan. Planning for the costs of other major financial events such as weddings and your children’s education, should be part of your future plans. Lastly, all plans should include some amount of savings for emergencies and unexpected events. At a minimum, we recommend consulting with your insurance advisor and financial advisor on an annual basis. While you may think these ideas are common sense, you would be surprised at how often these mistakes are repeated. Our goal is that at some point you will be able to choose between having to work longer or working longer because you want to. We incorporate these ideas in our planning and recommend that you do the same. We wish you good luck and good planning in 2013. As Thomas Edison said, “Good fortune is what happens when opportunity meets with planning”. MISTAKE #5
L. Porter Roberts, Jr., CPA, Medical Services Group of Barr, Anderson & Roberts, PSC in Lexington , KY. To contact him, via email lporterts@barcpa.com or (859) 268-1040. ◆ ISSUE#76 5
INFORMATION TECHNOLOGY
It’s Always Virus Season in IT Viruses - You do everything you can to prevent yourself from getting one. Are you doing the same for your computer? As an IT consultant, I spend my day moving from computer to computer. Touching the keyboards and mice connected to each of these units leaves me and the user exposed to whatever virus I’ve come into contact with at my last stop. Because of this I’ve made it a practice to use the hand sanitizers liberally and often. Of course, all of this is so I don’t get a virus or pass on a virus. Last week I arrived early at one doctor’s office and entered the practice as one of the nurses arrived. She had a very thick hacking cough, and it just so happened that it was her desktop computer I was there to work on. So after she moved the mouse and proceeded to type in her password, I reluctantly moved in to do what I needed to do. As soon as I was done I used the hand sanitizer that was on her desk and then went straight to the restroom and washed my hands in very hot soapy water. I was doing everything I could to keep from getting a virus. Since computers get viruses, we obviously need to take precautions to keep them healthy. Like humans, if we do things on the front end to avoid contact with the virus we’re much better off. Like the hand sanitizer, installing good antivirus software is necessary because it’s safe to assume you will be exposed. These two levels of defense, avoidance and precautionary measures, keep most work computers healthy. The next level of defense is not so simple:
the human element. Whether curiosity or gullibility, clicking on that one link or opening that one email is sometimes all it takes. One of the oldest ploys has recently BY G.T. Smith been making its rounds on the internet. You receive an email from UPS or FedEx advising you that your shipment has been delayed. Since it’s very common for us to order items that are shipped to us via these carriers, especially during the holidays, we click on the link to track our package, and that’s all it takes… we’re infected. But wait. Why didn’t the second level (antivirus software) take care of this threat? The reason is because you told the computer to do something, and it has no way of knowing that command was any different than you telling it to install a legitimate application. Healing this computer requires the final level of defense. I guess, to be accurate, it’s not so much a defense but a response. The virus I’m referring to (the UPS virus) installs a severe “rootkit” infection. It infects the files needed for the computer to boot, and as you try to use the system it infects more and more files. One of the ways we fix this type of infection is to remove the drive and run it through different tests using several different items in
our “tool box”. Typically after a deep cleaning, the drive can be put back in production. We have had past occasions where the virus or malware has infected the system so badly that it could not be healed. All the tools in our tool chest could not clean all the elements of the virus off of the system. Our only option then was to format the drive and reinstall the operating system and all of the applications. So to sum things up, to keep your system healthy it’s important be vigilant when opening or clicking on any external link to your network. Pay close attention to where that seemingly helpful link will send you. (You can hover your mouse pointer over the link, and its destination will be displayed.) If the email is from UPS, and the link goes to something other than UPS.com, it may be best to forgo clicking that link. If you feel the need to check on the package, open the confirmation email you received when you ordered the item, and then follow the tracking links that were provided. G.T. Smith is President of GAAN Technologies Inc. GAAN Technologies has been serving the Lexington area for the past 14 years as an IT consulting company. Prior to starting GAAN Technologies he worked as an IT project manager, a Systems Analyst for the University of KY Hospital, and traveled the United States installing computerized emergency notification systems for some of our nation’s largest companies and organizations.) ◆
2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com
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ISSUE#76 7
COORDINATION OF CARE
Chaplaincy in the Modern Healthcare System How Ministers of the Spirit Provide Care, Comfort and Healing BY REVEREND DON CHASE Current research, published by experts such as Dr. Harold Koenig, Duke University’s School of Medicine and Dr. George Fitchett, chaplain and CPE Supervisor at Rush University Hospital in Chicago, continues to highlight the vital and life-giving connections between spirituality and patients’ health outcomes. In turn, more and more hospitals appear receptive to the critical role that chaplains play as part of the healthcare team. A survey in the Wall Street Journal, “Bigger Roles for Chaplains on Patient Medical Teams,” (December 6, 2011) suggests that as many as two-thirds of US hospitals include professional chaplains as a part of their services to patients. At Hospice of the Bluegrass (HOB) in Lexington, the connection between spirituality and health is a serious issue. Reverend Bonnie Meyer, Director of Spiritual Care and Bereavement Services, said that HOB currently has 30 professional chaplains on staff who are assigned to various teams throughout the state, routinely working with patients and members of the clinical team. “The spiritual concerns of patients are instrumental in the overall health of a patient,” says Todd R. Cote, MD, chief medical officer of HOB. “It’s essential for physicians to identify these concerns as they often can contribute to suffering and to healing. A chaplain, working with a physician, can be an essential healthcare provider and team member to help our patients.” Psychiatrist Courtney Markham-Abedi, MD, of the Lexington VA Medical Center, shares similar sentiments. “Chaplains help us understand the patients more fully by attending to their spiritual needs. Having a chaplain at the bedside, especially during end-of-life situations, is very helpful for both the family and staff,” she asserts. Markham-Abedi has chaired the professional advisory group for the Clinical Pastoral Education (CPE) at the Lexington VA Medical Center for the past two years. Explaining the work of the professional chaplain, however, is a bit more nebulous. As chaplain and pastoral educator Reverend Dr. Martha Jacobs writes in the Hastings Center 8 M.D. UPDATE
Report [Nov-Dec 2008], “It can be really hard – or really easy – to explain what I do for a living. Chaplains share academic training with clergy, but we complete clinical residencies and work in health care organizations. Our affinities are with the patient and families, but we may also chair the ethics committee or serve on the institutional review board, and we spend a lot of time with staff. We must demonstrate a relationship with an established religious tradition, but we serve patients of all faiths, and of no faith, and seek to protect patients against proselytizing. We provide something that may be called ‘pastoral’ care, ‘spiritual’ care, or just
embracing their mission and contribute to a doctor’s desire to provide holistic and patient-centered treatment? While certainly not an exhaustive job description, I suggest four basic ways the chaplain contributes on healthcare teams. These four include the chaplain as clinician, educator, advocate, and pastor. The roles are certainly not distinct of one another with considerable overlapping between the four. As a clinician, the professional chaplain is trained to integrate one’s theology with the behavioral sciences. The chaplain is trained in such diverse areas as grief and grief theory, healthcare ethics, family systems, personality theory, life cycle concerns, multiculturalism, diversity, boundaries, conducting spiritual interviews and assessments, and conflict management among others. At the Lexington VA Medical Center chaplains routinely complete spiritual assessments on patients in the hospice and palliative medicine wards as well as mental health units. This meets The Joint Commission requirements and is used for the ongoing delivery of spiritual care during the patient’s hospitalization. As members of the interdisciplinary and discharge planning teams, the chaplain contributes pertinent information with the healthcare Reverend Donald Chase, teams for the benefit of the patient. M.Div., M.A., is a clinical chaplain and coordinator Confidential information that does for the Clinical Pastoral not have a direct impact on the Education (CPE) program ‘chaplaincy’ – but even patients’ health outcome, such as at the Lexington VA among ourselves, we do confession of a personal indiscreMedical Center. not always agree about tion, remains confidential and has no what that thing is.” place in the patient’s medical record. Chaplains have long been a source of comA clinically-trained chaplain practices fort to patients but recently the Association of from their spiritual and theological heritage. Professional Chaplains (APC) upped the ante In recognizing professional boundaries (we in 2009 with the release of its standards for are not the doctor, nurse, psychologist, social professional practice. The APC, the profes- worker, etc.) the chaplain’s heritage will sional organization for board certification, often guide his or her spiritual intervention. mandated that chaplains document their “We recently had a very challenging work in patient records, stay apprised of cur- patient,” recalls Reverend Dr. James Rayburn, rent research in the field, and concern them- Chief of Chaplain Services at the Lexington selves with evidence-based outcomes of treat- VA Medical Center. “He was an AIDS patient. ment modalities and spiritual interventions. All of his potential care-givers were out-ofstate. Earlier in his life he had been a seminary Roles of the Chaplain in student. The medical staff was frustrated and Hospital Care finding it very difficult to communicate with How can chaplains assist hospitals in him. So I asked our priest to visit him and
attempt to ‘draw him out.’ Not only was the priest able to draw him out, but the next day he celebrated communion with the patient. This communion service also involved confession. Our staff reported a change in the patient’s more open communication and participation in his treatment plan. This is an important role a chaplain is trained to do – to draw out the deepest, darkest hurts and heartaches of the human soul and then to explore the meaning of these with the patient.” Advocacy is an important chaplain function because chaplains are advocates for the patient first and secondarily for the patient’s family. A colleague shared the story of a latestage cancer patient who was frustrating the interdisciplinary team because she refused to leave her home and enter a hospice care facility. The team described the patient as being in denial and non-compliant. At the next visit, the chaplain learned that the patient was more than ready to go, but had promised her deceased husband years ago that she would take care of a family matter before her death. After discussing this with the chaplain, arrangements were made to fulfill her promise, and she peacefully made the transition to the care facility. The role of the advocate can be difficult. Sometimes it means promoting spiritual practices and resources for faith groups of the nondominant culture, navigating an oppressive or exploitive environment, and making sure that the patient and/or family voice is heard within a system with inherent power differentials. As a former parish pastor, I intentionally use the word “pastor” to describe a very important function of the chaplain. The image that many have of a pastor is one concerned with building and maintaining relationships, stewards of the institution’s best interests, and the one trusted with our emotions, hurts and joys, as well as disappointments and failures. The pastor is the one that hears our confessions, stories and jokes. While I like the word pastor to describe this chaplain function, I am aware that it emanates from my tradition as a Christian minister. Perhaps other concepts – facilitator, organizer, or coordinator -- might more aptly describe this role of the chaplain. Whatever one decides to call this function, it plays an important role in the life of the hospital. “Chaplains are trained in ethics, systems, and relationships. We’re able to bring clarification and new lenses to the table in order to help the healthcare team
do the right things for the benefit of our patients,” says Chaplain Rayburn. Chaplains have an ethical responsibility to care for doctors who want to practice the very best medicine, Rayburn says. “We have a unique role to be a ‘pastor’ to the caregivers who have moments of heartache when they are expected to make life-giving decisions and then live with them. But where do caregivers find their support, someone to come alongside of them? Chaplains can be a listening ear, support them, debrief with them. I remember one young doctor who had lost a child and then six months later had to run the code on a child and then here comes the grief returning from the loss of his own child. The chaplain was able to sit down, hold, and support the doctor. This allowed some powerful healing to happen.” As educators, chaplains are involved in facilitating support and spirituality groups, participating in psycho-educational programs, responsible for educating the hospital staff as to the role and scope of chaplaincy, and interfacing and teaching community
clergy – when used as PRN chaplains – spiritual care skills and methods. Does chaplain presence enhance the medical treatment offered by physicians? “Yes, obviously,” asserts Cecil “Pep” Peppiatt, MD, hospice and palliative medicine doctor at the Veterans Affairs hospital in Lexington. “In my field, especially with end-of-life practice, there are many issues that come up that are not exclusively of a physical nature. Our veterans have spiritual concerns and issues that need to be address before death. The chaplain is there to address them.” “It gives me personal support knowing that the chaplain is working with me and a greater sense of confidence to address spiritual areas with patients and their families,” says Pepiatt. Reverend Donald Chase, M.Div., M.A., is a clinical chaplain and coordinator for the Clinical Pastoral Education (CPE) program at the Lexington VA Medical Center. He is an Associate Supervisor with the Association for Clinical Pastoral Education. Previous to chaplaincy and involvement in clinical work, Chase served as a parish pastor for 22 years. He has also been a chaplain at the University of Kentucky hospital and Methodist Hospital in Ft. Worth, TX. ◆
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IT’S YOUR MONEY
The Effect of the American Taxpayer Relief Act on Estate Planning After much debate, the American Taxpayer Relief Act, “ATRA” was signed into law by President Obama on January 2, 2013. New and more favorable estate tax, gift tax and generation skipping transfer tax exemptions along with lower payable tax rates have gone into effect. The estate tax exemption was scheduled to drop January 1, 2013 from $5.12 million per individual to an insignificant $1 million per individual. This drop would have exposed the middle class to the estate tax. Also, tax rates for estate amounts over the exemption would have increased to 55% or even 60% in some cases. Fortunately, ATRA does not change the estate tax exemption, which will remain $5.12 million for individual or $10.24 million for married couples. Anything above exemption amount will be subject to the agreed 40% tax rate. The portability of the federal estate tax exemption has become permanent. This allows the surviving spouse to use the decedent spouse’s unused federal estate tax exemption without relying so heavily on other legal documents such as by-pass trusts. Although there are still many reasons to use and establish by-pass trust such as asset protection, remarriage of surviving spouse and to avoid the possibility of expensive probate administrative costs, not to mention time. The ATRA also provided that the unified estate and gift tax exemptions will remain unified. This allows the entire estate
tax exemption to be used during your lifetime or to heirs on death. For example, if you exceed the annual gift tax exclusion amount in any year, you can either pay the tax on the excess BY Calvin R. Rasey or take advantage of the unified credit to avoid paying the tax. By using the credit during your life, you will reduce the amount available to offset the estate tax upon death, but by not having the monies accumulating inside your estate this could out-weigh any disadvantages. The Generation Skipping Transfer Exemption (GST) has also been extended, because of ATRA. This allows those wanting to shift property by gift or at death to a person who is two or more generations below that of the person granting the gift. However, the GST is not portable and for this to be used properly, a taxpayer will need to utilize the proper legal documents. Under this approach, two trusts can be created; one holding property to which the GST exemption was originally allocated and the other holding property not originally allocated to any GST exemptions. Through this approach, the new GST exemption trust can minimize current distributions to older generations and maxi-
mize distributions to younger generations such as grandchildren. An approach such as this could offer significant tax benefit to taxpayers, while still allowing them to meet their overall family financial needs. If history is a good indicator, then what tax relief the government gives they can also take away. The United States first enacted the estate tax in 1797 and have been repealing, enacting and changing it almost every decade since. As a physician, in 2013, IS HAVING AN ESTATE PLAN IMPORTANT? Do you own your own business, then YES. Do you have significant assets in a 401(k) or IRA’s, then YES. Do you own a significant amount of life insurance, then YES. Do you want or intend to pass wealth to future generations, then YES. Do you worry about asset protection, then YES. Do you worry about protecting assets for and from your children, then YES. Estate planning is more than the impact of the tax laws briefly discussed in this article, it is about providing the protection and peace of mind that is important to you and your family. Securities Offered Through Securities America, INC.*Member FINRA/SIPC • Calvin R. Rasey • Registered Representative. Advisory Services offered through Securities America Advisors, INC.• A registered Investment Advisor Calvin R. Rasey • Investment Advisor Representative Securities America & its representatives do not provide tax or legal advice-Tax-law is subject to frequent changes; therefore it is important to coordinate with your tax advisor for the latest IRS rulings and specific tax advice, prior to undertaking and investment plan. Physicians Financial Services II, LLC and Securities America Companies are NOT UNDER Common Ownership ◆
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ISSUE#76 11
COVER STORY
ATRIAL FIBRILLATION
A Huge Problem and Incredibly Common
Multiple Approaches from a Multi-Disciplinary Team BY BARBARA MACKOVIC
Atrial fibrillation is the most common cardiac arrhythmia. Common symptoms include palpitations, fainting, chest pain or congestive heart failure. One of the most common indicators of atrial fibrillation is fatigue, which is not necessarily easy to diagnose. However, in some people atrial fibrillation may not cause any symptoms. Atrial fibrillation is more common in older adults, but can affect both men and women at all ages. It is estimated that 11 percent of Americans over the age of 80 have atrial fibrillation. Approximately five percent of Americans above age 70 have atrial fibrillation. Atrial fibrillation has been seen in patients as young as 20 and sporadically in 30, 40, 50 year olds. “It’s a huge problem and it’s incredibly common,” said Robert Salley, MD, executive director of Cardiovascular Services for Saint Joseph Hospital, part of KentuckyOne Health. “Approximately five million American are affected by atrial fibrillation today, and 12 M.D. UPDATE
an estimated 15 million will be impacted by the year 2050 due to our aging population,” said Ted Wright, MD, a cardiothoracic surgeon with Saint Joseph Cardiothoracic Surgical Associates. Atrial fibrillation is particularly dangerous because it increases the risk of stroke. By some reports, the degree of stroke risk can be up to seven times that of the average population, depending on additional risk factors. “Atrial fibrillation overall is still challenging to treat, but we have multiple methods available,” said Sameh Lamiy, MD, an electrophysiologist with Saint Joseph Cardiology Associates.
Treatment Options
There are two categories of treatment for atrial fibrillation: rate control and rhythm control. Sometimes physicians are too quick to treat symptoms, but Lamiy proposes a different set of guidelines for determining which category of treatment to pursue. “If the patient does not have symptoms or doesn’t feel the atrial fibrillation, I suggest using a rate control strategy,” said Lamiy. “Rhythm control is usually best applied for patients who experience symptoms from atrial fibrillation.” While rate control treatments work to lower the heart rate and maintain it within a normal range, rhythm control treatments seek to convert the heart rhythm from atrial
Robert Salley, MD, executive director of Cardiovascular Services for Saint Joseph Hospital
once did. The atrial fibrillation can escape being detected because they just stop doing physical activity.” Schoen says it is important for physicians to explore symptoms further. “The longer the patient is in atrial fibrillation, the less chance we have to get that rhythm straightened out,” Schoen said. Sameh Lamiy, MD, electrophysiologist with Saint Joseph Cardiology Associates
fibrillation to a normal rhythm. “If a patient has no symptoms, we will not be aggressive in treatment other than rate control and anticoagulation standard treatment, if indicated,” said Jeffrey Schoen, MD, director of Electrophysiology at Saint Joseph Hospital. “If a patient has significant symptoms and is unresponsive to medical treatment, then we will pursue the goal of achieving and maintaining sinus rhythm.” Sometimes atrial fibrillation can lead to slow alternating with fast rhythm, called brady/tachy syndrome. Often medications and a pacemaker will effectively treat this problem. If rate control is unresponsive to medications, then AV node ablation can be effective for rate control. “As doctors, we seek to treat atrial fibrillation patients with symptoms,” Schoen, added. “Atrial fibrillation can present different ways and can fool doctors. Especially when treating older people. They often slow down, and stop doing as much as they
New Techniques Lessen Risk, Increase Success
Therapies for treating atrial fibrillation range from medication to electrophysiology or ablation, and minimally invasive surgery to open-heart surgery. “We have many tools, including antiarrythmic medications, electrical cardioversion, catheter and surgical ablation,” said Schoen. “For patients with short-standing atrial fibrillation, they are typically best treated using medication,” said Wright. If medication is ineffective or it is determined the patient needs a higher level of therapy, often the next step is ablation, which involves a catheter inserted into a specific area of the heart. A cardiac electrophysiologist works to disconnect the source of the abnormal rhythm from the rest of the heart. Atrial fibrillation ablation by cardiac electrophysiologists via catheter ablation techniques have improved significantly within the last five years, improving outcomes and reducing complications. In patients with paroxysmal atrial fibrillation (episodes lasting less than seven days) ablation by the Saint Joseph EP team shows very promising results over the last two years, with a complete success rate of 90 percent. Patients with persistent atrial fibrillation (greater than seven days and less than one year duration) are more challenging
Jeffrey Schoen, MD, director of Electrophysiology at Saint Joseph Hospital
catheter ablation cases. Data from the Saint Joseph EP team showed complete success was achieved in 76 percent of cases and additional partial success in 20 percent of cases. These patients were satisfied with their clinical outcomes not necessitating additional procedures. Overall, catheter ablation at Saint Joseph Hospital over the last two years has yielded an 80 percent complete success rate. Catheter ablation complication rates at Saint Joseph have been low, around two percent. The surgical team at Saint Joseph Hospital recently started a minimally invasive surgical approach for atrial fibrillation ablation. Recent developments have lead to ablaISSUE#76 13
COVER STORY
tion procedures being performed using cameras and radiofrequency energy sources that are very safe while remaining effective. This technique uses small incisions on both sides of the chest. “We now have minimally invasive approaches so the amount of surgery a patient is exposed to is dramatically less, includes very little risk and high success rates,” said Salley. “This approach has been a nice addition to our program for catheter ablation failure and some of the more longstanding cases of persistent atrial fibrillation as first treatment,” said Schoen. “Our goal is to provide clinical benefit to our atrial fibrillation patients by the optimal treatment available at Saint Joseph Hospital.” For patients with persistent atrial fibrillation or persistent, longstanding atrial fibrillation, surgical ablation is more likely to be part of the treatment plan. Therapies such as the mini maze procedure may be used. The mini maze procedure uses radiofrequency ablation techniques with small incisions, and is most often used in patients with atrial fibrillation that do not have additional heart problem, such as valve issues or coronary artery disease. In recent years, advancements in technology have led to less invasive mini maze procedures being performed on patients with lone or sole atrial fibrillation. The maze procedure is more invasive and performed with a sternotomy. “Approximately 75 percent of patients who undergo the classic maze procedure via sternotomy are free from arrhythmia and medical therapy,” said Wright. “We hope to improve upon this using a hybrid approach.” Another newer development is hybrid ablation, which continues to be studied for treatment of persistent and longstanding, persistent atrial fibrillation. Hybrid ablation uses a dual approach. An electrophysiology cardiologist ablates from inside the heart and a cardiothoracic surgeon ablates on the outside of the heart. This combined approach provides these patients with a minimally invasive treatment option. 14 M.D. UPDATE
HYBRID ABLATION USES A DUAL APPROACH. AN ELECTROPHYSIOLOGY CARDIOLOGIST ABLATES FROM INSIDE THE HEART AND A CARDIOTHORACIC SURGEON ABLATES ON THE OUTSIDE OF THE HEART.
Ted Wright, MD, cardiothoracic surgeon with Saint Joseph Cardiothoracic Surgical Associates
Clinic Provides One-Stop for Diagnosis and Treatment
Saint Joseph Hospital is currently working to establish an atrial fibrillation clinic model where patients have access to multiple doctors using a multidisciplinary approach. Cardiologists and surgeons work to evaluate patients and identify the best treatment option for each individual. “The best way to treat atrial fibrillation patients over the long term is with a multidisciplinary approach that includes general cardiologists, electrophysiology cardiologists and cardiothoracic surgeon,” said Wright.
“That is how we can best identify the appropriate therapy at the appropriate time.” The clinic approach provides patients with options very quickly, without various doctors’ visits, and gives them a complete therapeutic plan. This allows patients to select the therapy that they feel is best for them. The clinic is modeled after centers across the country that have been very effective in both raising awareness in their communities and given patients the tools they need to get effective treatment. The clinic at Saint Joseph hopes to provide patients with a single phone number and educational materials to access the multidisciplinary approach. A nurse coordinator will work one-on-one with patients and lead them through the care process. “Over the long term, the best way to serve this population of patients is through directed care by a center of excellence using a multidisciplinary approach,” said Wright. Patients will be able to call directly for an appointment, or be referred by their cardiologist or primary care physician. The keys are to identify the problem and begin therapy as soon as possible. “I have treated patients who have had atrial fibrillation for years but were not diagnosed,” said Lamiy. “Many patients are able to do things they could not once their atrial fibrillation is treated.” ◆
CARDIOLOGY
Digoxin Increases Risk in Patients with Atrial Fibrilation UK Healthcare Research Team Voices Concern about Heart Drug BY JODI WHITAKER
Digoxin, a drug widely used to treat heart disease, increases the possibility of death when used by patients with a common heart rhythm problem − atrial fibrillation (AF), according to a study by UK HealthCare researchers. The results were just published in the prestigious European Heart Journal, and they raise serious concerns about the expansive use of this long-standing heart medication in patients with AF. A group of University of Kentucky researchers − led by Dr. Samy Claude Elayi, associate professor of medicine at UK HealthCare's Gill Heart Institute − analysed data from 4,060 AF patients enrolled in the landmark Atrial Fibrillation Followup Investigation of Rhythm Management (AFFIRM) trial. This analysis was intended to determine the relationship between digoxin and deaths in this group of patients with atrial fibrillation, and whether digoxin was directly responsible for some deaths. “These findings raise important concerns about the safety of digoxin, one of the oldest and most controversial heart drugs,” said Steven E. Nissen, MD, Chairman of Cardiovascular Medicine at the Cleveland Clinic. "Although considered obsolete by some authorities, digoxin is still widely used. A thorough review by the FDA is warranted to determine whether regulatory action is needed, including stronger warnings about the use of digoxin in patients with atrial fibrillation. “ Digoxin is extracted from the foxglove plant and it helps the heart beat more
and beyond which it can be dangerous. Though digoxin has been used by physicians treating AF for decades, until now, there has been limited evidence demonstrating the effect of digoxin in patients with this
− compared to those not on digoxin in the AFFIRM trial− will die from any cause," Elayi said. "One additional patient out of eight will die from cardiovascular causes, and one additional patient out of 16 will die from arrhythmias. “This study calls into question the widespread use of digoxin in patients with AF, particularly when used for controlling AF rate in a similar way as in the AFFIRM trial," Elayi said. “These findings suggest that physicians should try to control a patient’s heart rate by using alternatives such as beta-blockers or calcium blockers ,as a first line treatment ," Elayi said of the study's results. "If digoxin is used, prescribers should use a low dose with careful clinical follow up, evaluate potential drug interactions when starting new medications, and monitor digoxin levels. "Patients should also be Samy Claude Elayi, MD, aware of potential toxicity and associate professor of medicine at UK HealthCare’s see their physicians immediately condition. “Digoxin in AF Gill Heart Institute in specific clinical situations. patients has hardly been For instance, if they experience studied,” said Elayi. “The main prospective increasing nausea, vomiting, palpitations or randomised controlled trials available with syncope, as those may precede arrhythmic digoxin were performed in patients with death," Elayi added. heart failure and sinus rhythm, and rouThe researchers say that the mechanism tinely excluded AF patients.” by which digoxin increases deaths among The results of the analysis found that patients is unclear. Deaths from classic digoxin was associated with a 41-per- cardiovascular causes - whether or not they cent increase in deaths from are due to arrhythmia - can partly but not any cause after controlling for entirely explain it. This suggests there must OUR STUDY UNDERSCORES THE other medications and risk be some additional mechanism that remains IMPORTANCE OF REASSESSING factors. An increase in deaths to be identified,” said Elayi. occurred regardless of gender or As a result of these findings, the THE ROLE OF DIGOXIN IN THE the presence or absence of under- authors conclude in their paper: “Our CONTEMPORARY MANAGEMENT OF AF lying heart failure. Digoxin was study underscores the importance of reasIN PATIENTS WITH OR WITHOUT HF. also associated with a 35-percent sessing the role of digoxin in the contemincrease in deaths from cardio- porary management of AF in patients with vascular causes, and a 61-per- or without HF.” strongly, and at a slower heart rate. It is cent increase in deaths from arrhythmias He concluded: “There is a need for commonly used in AF patients and in (problems with the rate or rhythm of the further studies of the drug’s use, particularly patients with heart failure. However, it can heartbeat). in systolic heart failure patients and AF – be problematic to use successfully as there is "Within five years of use, one addi- patients that would, in theory, benefit the a narrow dose range at which it is effective, tional AF patient out of six taking digoxin most from digoxin.” ◆ ISSUE#76 15
CARDIOLOGY
Cardio-surgical Team at UK HealthCare’s Gill Heart Institute Embraces TAVR BY JODI WHITAKER
Interventional cardiologists at UK HealthCare’s Gill Heart Institute are now performing multiple successful Transcatheter Aortic Valve Replacement procedures. The procedure, also known as TAVR, is used for patients with severe, symptomatic aortic stenosis who are not candidates for traditional Susan Smyth, MD, open-heart surgery. chief and medical The transcatheter director of the UK value team is led by HealthCare Gill Heart Dr. John Gurley and Institute. coordinated by Vicki Turner. The multidisciplinary team includes surgeons Dr. Chand Ramaiah and Dr. Hassan Reda; interventional cardiologists Dr. Khaled Ziada, Dr. Joseph Foley and Dr. Matthew Wiisanen; cardiac imaging specialists Dr. Steve Leung and Dr. Vince Sorrell; and anesthesiologist Dr. Johannes Steyn. "We are excited to offer this option to patients with aortic valve disease," says UOFL FIRESIDE CHATS PROMOTE BENCH TO BEDSIDE PARTNERSHIP CARDIOTHORACIC SURGEONS, ENGINEERS AND SCHOOL OF MEDICINE JOIN FOR IMPROVED CARDIAC CARE AND ECONOMIC GROWTH
A $5 million grant program, the Wallace H. Coulter Translational Partnership Award, which was awarded to University of Louisville, provides funding for an innovative partnership between UofL’s School of Engineering and the School of Medicine. Leaders of the programs are taking their message throughout the Commonwealth to meet with alumni and potential medical school students who are interested in engineering as well LEXINGTON
16 M.D. UPDATE
Gurley. "TAVR is the latest addition to UK’s comprehensive catheter-based structural heart program, which began offering balloon valvuloplasty in 1985." In a healthy heart, the aortic valve is able to open wide, allowing the heart to pump oxygenated blood to the body. In an aortic stenosis, the valve is unable to open adequately, resulting in an obstruction of blood flow from the heart chamber into the aorta. When the blood flow is obstructed, less oxygen is able to flow through, and patients can suffer from shortness of breath, chest pains or fainting episodes. During the miniJohn Gurley, MD, mally invasive TAVR led the transcatheter procedure, a prosthetvalve team ic valve is implanted within the diseased aortic valve using a catheter inserted through the groin area. Once in
as careers in medicine. “We want our alumni to know that we have not changed our core message,” said Toni Ganzel, MD, MBA, interim dean of the UofL School of Medicine. “We are committed to Uof L being a metropolitan research facility that improves the health of our statewide population through education, research, clinical care and community engagement.” Expected outcomes from the Uof L Schools of Engineering and Medicine partnership include inventions, patents, improved diagnoses and treatment of disease, consumer products, licenses and start-up companies. “It is important that we serve our community and actively partner with them to combat the profound health disparities that
place, a balloon is inflated to open the valve. Almost immediately, the new valve starts working in place of the diseased valve, resulting in improved blood flow. "Our valve team is the most experienced in the region," says Dr. Susan Smyth, chief and medical director of the Gill Heart Institute. "Dr. Gurley is a national leader in catheter-based approaches to structural heart disease, with 25 years of experience and important pioneering work. Our surgeons have some of the lowest hospital mortality in the country and our valve coordinator has 20 years of experience managing patients before and after heart surgery." "The valve program typifies UK’s state-ofthe art approach to cardiovascular care, combining new hybrid operating facilities, a major cardiovascular imaging center, and a multidisciplinary staff," Smyth adds. "The goal is to provide the most appropriate care possible - tailored to our individual patients but based on the latest evidence and technology." The new valve, developed by Edwards Lifesciences, is known as the Edwards SAPIEN valve. ◆
exist in our state,” said Ganzel. Mark Slaughter, MD, professor and chief, Division of Thoracic and Cardiovascular Surgery, Artificial Organs and Circulatory Devices, Cardiovascular Innovation Institute and surgeon, University of Louisville Physicians demonstrated some of the advancements in the miniaturization of MCS devices to promote myocardial recovery. Also presenting were Robert Kenton, PhD, chair, Department of Bioengineering and Steven Koenig, PhD, professor and investigator. Both Kenton and Koenig are with the J.B. Speed School of Engineering, Artificial Organs and Circulatory Assist Devices, Cardiovascular Innovation Institute. Mickey Ising, a second year
medical student in the Uof L School of Medicine, who holds a MS in bioengineering spoke of his interest in pursuing a medical degree to complement his interest in engineering and design. The partnership of UofL School of Medicine with Kentucky One Health facilitates these new initiatives said Ganzel. “It allows us to have a strong partner and immediate access to a statewide health care system and gives Kentucky One access and alignment with Uof L physicians at an academic flagship. As we expand our clinical trials and sites throughout the state for our physicians and medical students, we can increase the pipeline of healthcare professionals for decades to come,” said Ganzel. ◆
SPECIAL SECTION EMERGENCY MEDICINE
Close To Home
Lexington-area KentuckyOne facilities provide efficient, effective emergency room departments BY BARBARA MACKOVIC When a patient is stricken with a sudden work flow, allowing physicians and nurses health issue, recommending a visit to the to manage care in the most efficient ways emergency department is often the quick- possible. est way to ensure a patient receives effec“Before the renovation, we had one tive treatment as soon as possible. And for central nursing station in the emergency Americans, emergency department visits department. Now, we have two stations, tally up to more than 136 million annually. allowing nurses to be closer to patients, For residents of Lexington and surrounding areas, KentuckyOne Dan Andrews, MBA, RN, CEN, Health facilities provide numer- manager of Emergency Department and Operations at ous emergency department Saint Joseph Jessamine. "We’re options to meet any urgent averaging well below t"he healthcare need a patient may benchmark of door to provider face. times of 30 minutes or less." Saint Joseph Hospital was the first hospital in the Lexington area when it opened in 1877. The facility has continued to treat a high volume of patients in the area since its move to the current location on Harrodsburg Road in 1957. With the addition of Saint Joseph East to the system in 1998 and the construction of Saint Joseph Jessamine in 2009, the system has become the most robust in the area. Last year, the facilities’ emergency departments treated nearly 109,000 patients, more than any other hospital system in the Lexington area. With Kentucky’s statistically unhealthy population, these while monitoring them remotely through facilities are expecting to treat even more updated equipment,” said Steven Stack, patients in 2013. M.D., former emergency department chair, Saint Joseph East. “The new layout Expanding and Remodeling to ensures that we’re able to treat patients Meet Increased Demand quickly and effectively.” To meet growing demand, the emerThe renovation also allowed for new, gency departments at both Saint Joseph state-of-the-art equipment like the most Hospital and Saint Joseph East have been recent Phillips GE Central monitoring sysrenovated within the last two years. Most tem, a track based space efficient supply features of the renovations were aimed at storage system and pneumatic tubes to accommodating an increased number of send laboratory specimens. The renovation patients, as well as creating a more modern also lead to the creation of six oversized rooms, which allow for procedural care. LAST YEAR, SAINT JOSEPH’S EMERGENCY “The improved layout has allowed us to DEPARTMENTS TREATED NEARLY 109,000 treat our patients in a PATIENTS, MORE THAN ANY OTHER more timely manner, in HOSPITAL SYSTEM IN THE LEXINGTON AREA. turn, reducing our aver-
age length of stay to well below the national average, which falls around 2.5 hours,” Stack added. Saint Joseph Hospital also saw increased efficiency after a renovation that took the facility from a 20-bed to a 35-bed facility, in order to meet a growing need for emergency department services. Saint Joseph Hospital continues to see the highest volume of patients within the system. “Physicians recommend us to patients often because they know we work to find answers quickly,” said Barry Parsley, M.D., who is board certified in emergency medicine and serves as Medical Director for Saint Joseph Hospital and Saint Joseph JessamineEmergency Department. “For anything that could be remotely serious, we are often able to extensively evaluate a patient quickly, including performing needed lab work and diagnostic imaging.” “We’re dedicated to providing prompt, efficient care that’s respectful of patients’ time, all while providing the highest quality of care. We consistently rank above the 90th percentile in patient satisfaction, and we believe that is a result of the compassionate care we provide,” said Stack. Not only can patients anticipate quick, effective care, they’ve come to expect quality, too. The entire staff of physicians at Saint Joseph East and Saint Joseph Hospital is board certified in emergency medicine. The nursing staff includes certified emergency nurses. In addition, the entire nursing staff holds certification in Advanced Cardiac Life Support (ACLS), as well as trauma nursing and emergency pediatric nursing. ISSUE#76 17
SPECIAL SECTION EMERGENCY MEDICINE
Saint Joseph Jessamine RJ Corman Ambulatory Care Center Provides Top-Notch Care Closer to Home
Saint Joseph Jessamine opened in 2009 as Jessamine County’s first and only fullservice, 24/7 emergency department. The facility provides emergency care, diagnostic imaging, lab services, rehab services and several physician practices. With 29 stoplights separating Saint Joseph Jessamine and the nearest Lexington hospital, this facility means that residents are able to get highquality, emergent care close to home. “Currently, we are able to treat and release 95-96 percent of patients we receive at Saint Joseph Jessamine,” said Dan Andrews, MBA, RN, CEN, manager of Emergency Department and Operations at Saint Joseph Jessamine. “We’re averaging well below the benchmark of door to provider times of 30 minutes or less, meaning that we are fully equipped to see and treat the majority of our patients quickly.” Not only are these patients being seen quickly, Saint Joseph Jessamine regularly achieves patient satisfaction scores above the 90th percentile. Dr. Parsley was among the team responsible for developing Saint Joseph Jessamine. He has been with the Saint Joseph organization for more than 35 years and
Barry Parsley, M.D., is board certified in emergency medicine and serves as Regional Medical Director for Saint Joseph Hospital and Saint Joseph Jessamine-Emergency Department.
was among the first to staff emergency departments with primarily board certified physicians. “Because we were able to build this facility from the ground up, we were able to put incredible focus on making it the most efficient facility possible. With lab, x-ray and other diagnostic services readily available, this facility can provide nearly the same complete level of care as a full hospital facility,” said Parsley. While Saint Joseph Jessamine primarily services Jessamine County, patients also come from Garrard County, southern Fayette County and nearby Woodford County. “We like to say that we’re able to provide big city healthcare in the small town,” said Andrews. Saint Joseph Jessamine works closely with Jessamine County EMS to identify patients that are best served by the facility and which more Steven Stack, M.D., former emergency department chair, Saint Joseph East. "We consistently rank above the 90th percentile in patient satisfaction."
18 M.D. UPDATE
acute cases should be passed along to one of the more robust facilities in nearby Lexington. Saint Joseph Jessamine will occasionally take in patients presenting with severe symptoms to be stabilized before transport to a larger facility. For most cases, however, Saint Joseph Jessamine and its staff of board certified emergency physicians, physician assistants, nurse practitioners and RNs are able to fully treat patients on site, providing the same level of quality care as a full hospital. “We pride ourselves on providing topnotch care that’s close to patients homes,” added Andrews. Of the facilities, Saint Joseph Hospital and Saint Joseph East are both Accredited Chest Pain Centers from the Society of Chest Pain Centers. Saint Joseph Jessamine will seek accreditation this year, expected to be among the first standalone emergency facilities to receive such accreditation. “People generally assume that they will receive quality care when visiting an emergency department. What sets the Saint Joseph System apart is our compassion, our interest in patient well being, and our consistently demonstrated genuine concern—these things have been key to our success and growth as an organization,” said Stack. ◆
HEALTHCARE INNOVATION
Healthcare Innovation
New Technology Treats Scheduling Headache BY MEGAN C. SMITH There’s an adage about innovation – that the best technologies eliminate the need for humans to perform the most baneful of tasks. In this vein, among the most compelling stories I encountered in the past year’s search for innovative healthcare startups is how Intrigma, a new scheduling technology for the healthcare scheduling, revolutionized staffing in the toughest of all practices - the emergency department. The emergency department, of course, is the safety net for healthcare. It’s the one place guaranteeing treatment for all, and this situation often leads to overcrowding and safety issues that make the ED a site for high employee turnover and burnout. Scheduling ED physicians and staff, it follows, is a dynamic, highly variable, and complex process aimed at filling shifts, increasing staff satisfaction, and reducing the risk of burnout. A scheduler needing to fill the shifts of physicians who take time off for family activities or religious observances must consider the replacement physician’s needs, how many night shifts in a row did he fill, are his circadian rhythms being respected, and how slow or fast he is compared to the expected volume of the vacant shift. It is also time consuming and expensive, a task not easily delegated since it takes a physician leader with clout to smooth over the rough edges caused by calling in staff to fill in for someone who has requested time off. In the typical ED, on the typical day, there are over a billion possible scheduling combinations. To assess each for its suitability to that day is, for a human, a computationally impossible task. With a bit of irony mixed in as schedulers themselves burnout from this task, it’s no wonder that ED scheduling is often outsources to practice management firms. I first met Intrigma CEO Tal Eidelberg and heard his compelling backstory - in the summer of 2012 at a NYC MedTech forum. His story goes that he was nineteen, serving a compulsory term in the Israeli Army, when he designed his first scheduling software. It filled a guard post that had been plagued by hookie-playing and injury claims that landed scofflaws on much cushier patrols. Filling this guard post was the bane of the base, and
Intrigma CEO Tal Eidelberg was nineteen, serving a compulsory term in the Israeli Army, when he designed his first scheduling software. Today, he leads the development of advanced healthcare scheduling solutions for the most prestigious hospitals and private practices in the US.
designing a scheduling program to keep it filled, fairly, earned Eidelberg a great deal of latitude from a grateful commanding officer. A few years later, in graduate school at Stony Brook on Long Island, Eidelberg presented the software in class and a colleague turned to him saying how his wife, a physician at the nearby Stony Brook University emergency department, could really use a solution like his. Introductions were made, Intrigma was formed, and Eidelberg was mentored through the Long Island High Technology Incubator at Stony Brook, where high profile EDs like Montefiore Medical Center and the Ochsner Health System signed on to pilot the technology to the marketplace. “The best thing that good schedule can do is make sure that the physicians are well rested and give them the lifestyle that they want,” said Eidelberg, adding quickly that Intrigma’s software does this in an environment where physicians view some software products as “death by a thousand clicks.” A few months ago, I got the chance to sit down with the Intrigma teameduring the American College of Emergency Physicians convention in Denver, where it was apparent that Intrigma had become the stars of their field. Dan Ports, VP of technology, recalled
how the team’s agility in responding to customer requests, coupled with the goal of usability, allowed Intrigma to consistently bring more quality features to its users. “We have a feature that allows physicians to sign up for their own shifts,” he said, “and in the first version of this, it took about five clicks to sign up for a single assignment. If you’re just doing one shift, this is no big deal. But our client wanted to do a month’s worth of assignments at once, which meant 100 clicks. So we went back to the whit board and reengineered the process down to one click per assignment, which made our client very happy.” Ports’ job is to make sure that that details are not lost, that physicians can request their time off and then buy their plane tickets to Florida with confidence. He makes sure users benefit from the oversight built into cloud-based computing. Since Intrigma tracks every click, they know where the areas of difficulty are and can reach out to users offering help. Ports even recalls calling one user, after a dozen or so failed login attempts, to ask if they’d like to change their password. They said it was like they could read minds. Shortages are an interesting dilemma where Intrigma’s software makes the impossible possible. Eidelberg told me a story about a rural hospital, in a resort setting, that had a seasonal influx of patients simultaneous with a few regrettable staffing complications. First, one physician had serious illness in the family and couldn’t work at all that summer. Then, another physician got in a car wreck, and everyone had to put in two or three extra shifts per week. Finally, a third physician got burned out and quit. “In that situation, the medical director was in a very tight spot,” said Eidelberg. “Not only was he working seven days a week, he also had to call for favors every single day. With the shortage, he took what he could get.” Without the software to automate the schedule, and automate it right, this shortage would be impossible to manage. ◆ ISSUE#76 19
SPECIAL SECTION EMERGENCY MEDICINE
“Doctor, Someone from 60 Minutes Is On the Phone and Wants to Talk With You” How an ER Doctor Has Learned to Deal with the Media BY GIL DUNN
What’s the first thought that comes to your mind when you hear that a member of the media is trying to reach you? Is it a Good Feeling? Doubt? Anxiety? Annoyance? Ryan Stanton, MD, is Medical Director of UK’s Good Samaritan Hospital’s ER and current president of the Kentucky chapter of the American College of Emergency Physicians (KACEP/ACEP). He averages 1-2 media encounters per week in his role as a media spokesperson for ACEP, but Stanton has given as many as 15 media interviews in one week during certain elevated periods of activity that are not at all related to high profile crime, celebrity sightings or major trauma or accidents. More often, says Stanton, the media calls during flu season or severe hot or cold weather periods. Not exactly what TV or realty shows would have you believe, but much closer to the truth, according to Stanton. Stanton, a graduate of East Tennessee State University (ETSU) College of Medicine, spent a year in surgery before he completed a residency in Emergency Medicine at the University of Kentucky (UK) where is board certified and has a faculty appointment to teach Emergency Medicine. He joined MESA Medical Group full time in 2008, where a number of doctors have served in KACEP including Chris Pund, MD, as a past president and current board members Jeremy Stitch, MD and Doug Smith, MD. A Background in Media Helps
Ryan Stanton, MD, is Medical Director of UK’s Good Samaritan Hospital’s ER and current president of the Kentucky chapter of the American College of Emergency Physicians
and medical student, he worked at the public radio station at ETSU. During intervals in his residency at UK, Stanton worked for Clear Channel Radio as a board operator for UK football and basketball games. After Stanton completed his residency at UK, he went to Boston where he worked with Dr. Tim Johnson and the ABC News Medical Unit gaining valuable first-hand experience in a major media market. That translated into a working relationship in Lexington at the ABC affiliate MOST PHYSICIANS, HE SAYS, ACTIVELY AVOID THE WTVQ when MEDIA, BUT THE ABILITY TO COMMUNICATE WITH Stanton began THE PUBLIC CAN BE LEARNED THROUGH IN PERSON his medical career full time OR ONLINE TRAINING. at UK’s ER. Dealing with the media comes easy “I definitely don’t do it for the money,” to Stanton because he has experience on explains Stanton when asked about his the other side of the microphone. He first motivation. “I’ve always felt by definition encountered media at age 14 through a pro- that a physician is a teacher. Nature will gram at his church. While an undergraduate cure many of the injuries and illnesses we 20 M.D. UPDATE
see in the ER, the viruses, the cuts, the bruises. In the ER setting, I can teach the residents and some of the patients, give them the answers and explanations as to what’s going on, what’s going to happen. So on a grander scale through the media, I can teach people how to avoid getting sick and what to do when they become ill.” Addressing the vast mis-understanding in the US population of the difference between health and medicine also contributes to Stanton’s mission. “The US healthcare system is reactionary, not preventative,” he says. “Nobody sees that more clearly than an ER doctor.”
Media Relations: A Balancing Act
Stanton is currently featured in two onair programs for WTVQ: “Doc on Call”, a question and answer segment which airs once a week during the noon newscast and “What’s Going Around,” a regular feature program designed for public education of current health topics and trends. Additionally, Stanton produces two pod-
IS CALLING!
Guidelines for ACEP Spokespersons
GENERAL TIPS • Don’t get blindsided. Negotiate ground rules in advance. Set a time limit. Ask about the angle of the story, the deadline and who else is being interviewed. • Set the agenda. Try to identify the reporter’s angle, stay on message. Be prepared to drive home a few main points, supported by one or two strong statistics and a personal story. Use ACEP’s talking points as a resource. • Relax, be personable but not too casual. Build a relationship, but remember everything is on the record, unless you both agree it is not. • Use plain English. Avoid medical jargon. • Put a human face on the issues. Tell a story. Talk about the issue’s affect on your patients. • Always respond in a positive way. Don’t repeat negative words. Defensive: “Our emergency department does NOT provide poor service.” Stronger: “Our emergency staff are dedicated to providing the best care for our patients.” • Use effective body language. Don’t distract people from your words by folding your arms, rocking, or placing hands in pockets. Avoid sympathetic nodding. • Make comments worthy of sound bites. For TV or radio news stories, you might have 7 to 10 seconds at most to make your point. • If you are being interviewed on the telephone, stand up rather than stay seated. It will energize you and your voice.
For media assistance, contact ACEP’s Public Relations Department at
800-320-0610, ext. 3008
GUIDELINES FOR ACEP SPOKESPERSONS
• Respond quickly. Most reporters are on deadline. You must be reliable and accessible to conduct media relations. Consider e-mailing local reporters about your availability as a resource — contact pr@acep.org if you need e-mail addresses. • Identify yourself as an ACEP spokesperson. If ACEP coordinates the interview, identify yourself as a spokesperson for ACEP or your Chapter. If your hospital coordinates the interview, try to mention ACEP during the interview. • Keep your messages consistent with ACEP’s messages. This is especially important on policy issues. Before the interview, visit the spokespersons’ page at www.acep.org/spokesperson. It increases the specialty’s effectiveness in advocacy when emergency physicians repeat key messages at national, state and local levels. • Participate in training. ACEP offers media training and presentation training at Scientific Assembly and the Leadership & Advocacy Conference. ACEP spokespersons are required to take at least one media training class.
© American College of Emergency Physicians. Reprinted with Permission
THE PRESS
• Call ACEP’s PR Department for help at 800-320-0610, ext 3008. PR staff are available to help you with talking points, as well as to provide advice on crisis communications. If you are contacted by a national reporter, be aware that ACEP’s President may want to handle the call or may have designated a specific ACEP member to handle the topic. • Coordinate with your hospital. Learn your hospital’s rules for conducting media relations. Develop relationships with the PR staff and coordinate with them. Make them aware that you are media trained, are serving as an ACEP spokesperson and are interested in doing interviews.
Visit the spokespersons’ page on ACEP’s Web site at
www.acep.org/spokesperson
casts. One is for consumer healthcare education and airs on Tennessee public radio station WETS-FM, 89.5 and iTunes. Stanton’s other weekly podcast is for EM News, a magazine designed for ER physicians. It is a summary of the most current ER research and best practices. “It’s difficult for ER doctors in rural settings to stay up to date on ER trends,” says Stanton. Both MESA Medical Group and UK are supportive of Stanton’s media involvement, he says. “The iPhone has revolutionized everything for my podcasts. I can get broad-
cast quality during downtimes and night shifts at the hospital. I can do the two minute consumer podcast in about 15 minutes. The physician podcast takes longer. I usually do that in my basement while relaxing after a shift. MESA doesn’t schedule me during the television show and UK PR is very helpful taping the “What’s Going Around” program. We all want to get our message out to the community,” says Stanton. Preparation & Training Are the Key Stanton encourages all physicians to take advantage of the media relations train-
ing from ACEP that are applicable to all doctors, because one day the media may call you. Most physicians, he says, actively avoid the media, but the ability to communicate with the public can be learned through in person or online training. “Getting comfortable with the media is important because media outlets turn to physicians as experts. The ER is the hub of dayto-day healthcare and ER doctors have the best view of the over –picture,” says Stanton. The moral of the story: Be Prepared and Be READY. ◆ ISSUE#76 21
SPECIAL SECTION HOSPITAL MEDICINE
Lexington Clinic Hospital Medicine
Hospital Medicine Creates a Win-Win Continuum of Care BY GIL DUNN Hospital medicine physicians are a key ingredient for a positive hospital experience. Whether your patient requires minor ER care or admission to the hospital for several days, a hospitalist will be the physician to care for them. Hospital medicine physicians specialize in, and oversee all aspects of your patient’s care within the hospital setting. The use of hospital medicine physicians translates into benefits for both patients and physicians. Patients can feel comfortable knowing that they are receiving roundthe-clock, high quality care from physicians who are intimately familiar with the hospital setting. Primary care physicians no longer have to fit hospital rounds into an already hectic schedule and are able to maintain higher office efficiency, while being confident in the knowledge that their patient is receiving top-notch care. LEXINGTON, KY
Hospitalist Section at Lexington Clinic
The Hospital Medicine section was established by Robert Cooper, MD and Mitchael Estridge, MD. The current section is made up of seven board-certified physicians, Jamil A. Farooqui, MD; Mitchael G. Estridge, MD, PhD; Timothy D. Brammel, MD; Dan E. Calleja, MD; Yuchen Ma, MD; Gerry A. Bernardo, MD; and Imran Hassan, MD. Lexington Clinic hospitalists work at Saint Joseph Hospital in Lexington and have courtesy privileges at Saint Joseph East, where Lexington Clinic has adjacent medical offices. As the hospital face of Lexington Clinic, the Hospital medicine section cares for Lexington Clinic in-patients who are admitted by Lexington Clinic Family Practice or Internal Medicine physicians, as well as patients with com-
plex medical issues who were admitted by Lexington Clinic specialists. “I often sense a feeling of relief among patients and their families when they learn I am with Lexington Clinic. You must remember, that in the hospital setting, patients are often at their lowest point and something familiar is very comforting,” says Jamil A. Farooqui, MD, Lexington Clinic hospital medicine head of section. While a large percentage of the patients they see are Lexington Clinic patients, Farooqui is quick to point out that all seven physicians in the hospital medicine section take service calls at Saint Joseph ER for all patients. Taking ownership of patient care in the hospital and gaining patients’ trust is the challenge and the reward for Farooqui. Hospital medicine TAKING OWNERSHIP OF PATIENT CARE IN THE allows me to “work out of the box,” he says. HOSPITAL AND GAINING PATIENTS’ TRUST In a complex in-patient medical situation he IS THE CHALLENGE AND THE REWARD OF must consult quickly HOSPITAL MEDICINE. and in real time with
22 M.D. UPDATE
Jamil A. Farooqui, MD. "I often sense a feeling of relief from patients when they learn I am with Lexington Clinic, patients are often at their lowest point and something familiar is very comforting."
his specialist colleagues, not waiting for a time consuming out-patient consult. “We put the patient at the center of the care by having multiple doctors, cardiologist, pulmonary, nephrologists and others all consult at the same time,” Farooqui says.
Recruitment Opportunity & Challenge
Every Hospital Medicine leader acknowledges the challenge of recruiting physicians to their practice. Farooqui is upbeat when discussing the issue because he feels Lexington Clinic’s location in Central Kentucky gives him a real advantage. “When recruiting physicians you have to be attractive with the city, the lifestyle and the coverage within the hospital. Lexington Clinic’s location and organization allow us to offer all of those elements. We also govern our own schedules which allow us to determine when and where we work. That self-governance is very attractive to me and to my colleagues,” he says. ◆
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NEWS EVENTS ARTS
Hamad and Shams join Baptist Medical Associates Prospect
Mitra Shams, MD, and Reem Hamad, MD, have joined Baptist Medical Associates Prospect. Shams is a 1994 graduate of the University of Vienna Medical School in Vienna, Austria. She completed her family medicine residency at Southern Illinois University School of Medicine in Springfield in 1999 and her internal medicine residency at St. John’s Mercy Medical Center in St. Louis in 2002. Shams is board certified in internal medicine. Hamad is a 1987 graduate of the Damascus University Faculty of Medicine. She completed her internal medicine residency at University of Louisville Hospital in 1995. Hamad is board certified in internal medicine. PROSPECT
Byrum, Hoffman, and Mandzy join Baptist Medical Associates
Henry Byrum, MD, Russell Hoffman, MD, and Lana Mandzy, MD, internal medicine, have joined Baptist Medical Associates. Their practice is located at 4003 Kresge Way, Ste. 400. Byrum is a 1974 graduate of the University of Vermont College of Medicine in Burlington. He completed his internship and residency at the University of Kentucky in 1977. He is board certified in internal medicine. Mandzy is a 1986 graduate of the Kyiv Medical LOUISVILLE
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Institute in Ukraine. She received a PhD from the Scientific Research Institute of Occupational Health and Work-Related Diseases in Kyiv in 1992. She completed her internal medicine internship and residency at University of Louisville Hospital in 1999 and 2001, respectively. Mandzy is board certified in general surgery. She is fluent in English, Ukranian, and Russian and knows some Polish and Slovak. Hoffman is a 1976 graduate of the University of Louisville School of Medicine. He completed his internal medicine internship and residency at Indiana University in 1979. He completed a fellowship in endocrinology and diabetes at Indiana University in 1980. He is board certified in internal medicine.
Shee, Sutkamp, Swift, and Kim join Baptist Medical Associates
Jun Oh Kim, MD, George Shee, MD, Michael Sutkamp, MD, and James Swift, MD, FACP, internal medicine, have joined Baptist Medical Associates. Their practice is located at 4002 Kresge Way, Ste. 124. Kim is a 1998 graduate of the University of Louisville School of Medicine. He completed his internal medicine internship and residency at Good Samaritan Regional Medical Center and Carl T. Hayden VA Medical Center in Phoenix, Arizona, in 2001. He is board certified in internal medicine and is fluent in conversational Korean. Shee is a 1973 graduate of the University of Louisville School of Medicine. He completed his internal mediLOUISVILLE
cine internship and residency at St. Joseph Infirmary in Louisville in 1976. Sutkamp is a 1990 graduate of the University of Louisville School of Medicine. He completed his internal medicine internship and residency at Christ Hospital in Cincinnati, Ohio, in 1993. Sutkamp is board certified in internal medicine. Swift is a 1980 graduate of the State University of New York College of Medicine in Syracuse. He completed his internal medicine internship and residency at Letterman Army Medical Center in San Francisco, California, in 1983. Swift is board certified in internal medicine.
Shelbyville practice becomes Baptist OB/GYN Associates
Arlene Kraut, MD, has joined Baptist OB/ GYN Associates, part of Baptist Medical Associates. Kraut is a 1996 graduate of the Mount Sinai School of Medicine in New York, New York. She completed her obstetrics and gynecology residency at Maimonides Medical Center in Brooklyn, New York. Kraut is board certified in obstetrics and gynecology. SHELBYVILLE
CBH Hosts Open House at New Beaumont Facility
LEXINGTON Central Baptist Hospital is hosting
an open house at its new Beaumont facility at 3084 Lakecrest Circle on February 5. Visitors can tour the facility as well as enjoy light refreshments during the open house event from 4-7 p.m. The new facility is home to Baptist Internal Medicine & Endocrinology at
NEWS
Beaumont, where female internal medicine physicians Christine Ko, MD; Vinette Little, MD; Carol Mitchell, MD; Chitra Raghavan, MD, and Shannon Roberts, DO, provide a full spectrum of adult primary care to both men and women. Providers Sarah Grimm, PA-C, and Angela Lanter, APRN, can accommodate same-day visits for patient convenience. Also in the practice are endocrinologists Kristina Humphries, MD, and Anna Marino, MD., who each have specific interests in care for diabetes and thyroid disorders. Central Baptist Hospital Breast Imaging Services is also in the new facility, providing state-of-the-art digital screening mammography and bone densitometry. It is one of six CBH Breast Imaging Services locations serving the region under the guidance of breast radiologists Sandra Bates, MD; Molly Hester, MD; Francie Masters, MD; Angela Moore, MD, and Medical Director Tamara Patsey, MD.
this represents a return to Kentucky for him and his family.
years of experience in nursing administration as well as Davenport named COO/ a clinical foundaCNO for Ephraim McDowell tion in oncology Health nursing and hospiDANVILLE Sally Davenport, RN, MS, NEAtal staff developBC, has been named Ephraim McDowell ment. Davenport Health’s Chief Operating Officer/Chief received her bacNursing Officer with responsibility for calaureate degree nursing and clinical operations for Ephraim from the University McDowell Regional Medical Center, of Nebraska at Ephraim McDowell Fort Logan Hospital, Kearney, Nebraska, and her master’s Ephraim McDowell Clinics, A Children’s degree from Creighton University in Place, and McDowell Place of Danville. Omaha, Nebraska, and completed the Davenport joined Ephraim McDowell Johnson and Johnson Wharton School of Regional Medical Center in 2007 and Business Executive Nurse Fellowship. She most recently served as vice president of also earned Nursing Executive, Advanced patient care services/chief nursing officer. (NEA-BC) certification from the She is a seasoned nurse executive with 25 American Nurses Credentialing Center.
Baptist Health Names Hanson as President & CEO
Baptist Health (formerly Baptist Healthcare System) has named Stephen C. Hanson president and chief executive officer, effective March 8. Hanson succeeds President and Chief Executive Officer Tommy J. Smith, who announced his retirement last year. Hanson, 61, has served in various senior leadership positions for Texas Health Resources since 2005, most recently as executive vice president and operations leader for the region covering Dallas-Fort Worth. Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States and includes 25 affiliated acute care and short-stay hospitals. Hanson also served as president and CEO of Kentucky-based Appalachian Regional Healthcare from 1999 to 2005, so LOUISVILLE
ISSUE#76 25
NEWS
Norton Cancer Institute Qualified by NCCN ARP
The National Comprehensive Cancer Network® (NCCN®) Affiliate Research Project (ARP), developed by the NCCN Oncology Research Project (ORP), has qualified Norton Cancer Institute, a community-based affiliate of Moffitt Cancer Center—one of the 21 NCCN Member Institutions. Located in Louisville, Kentucky, Norton Cancer Institute is operating as an ARP site under the leadership of John Hamm, MD, Medical Director, Norton Cancer Institute Research Program. Norton Cancer Institute is the eighth community-based NCCN Member Institution affiliate to qualify for the NCCN ARP, increasing the scope of potential patients for the more than 60 actively LOUISVILLE
accruing ORP trials. Norton Cancer Institute will have access to new and innovative cancer drugs for patients in collaboration with NCCN Member Institutions; Principal Investigators of NCCN-funded studies will have access to Norton Cancer Institute as an NCCNqualified community site.
Norton Neuroscience Institute first in Louisville to offer new treatment for recurrent glioblastoma brain tumors
Norton Neuroscience Institute is the only clinical provider in Louisville to offer a new treatment for recurrent glioblastoma brain tumors using the NovoTTF100A system. This noninvasive device produces alternating electrical fields that LOUISVILLE
target tumor sites and disrupt the rapid cell division exhibited by cancer cells. As glioblastomas remain the most common and destructive primary brain tumors, the innovative NovoTTF-100A technology at Norton Neuroscience Institute will provide patients in Kentucky and Indiana with an alternative therapy after surgical and radiation options have been exhausted. Glioblastomas are tumors that arise from astrocytes, the cells that make up the supportive tissue of the brain. These tumors are highly malignant because the cells reproduce quickly and are supported by a large network of blood vessels. Glioblastomas represent 17 percent of all primary brain tumors, according to the American Brain Tumor Association. Although they are the most common type of primary brain tumors, treatment remains difficult because
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the tumors contain varying types of cells. The NovoTTF-100A technology offers new hope for patients with recurrent glioblastomas. The NovoTTF-100A system was approved by the U.S. Food and Drug Administration in April 2011 and Norton Healthcare acquired the device in August 2012. Certified physicians such as Renato V. LaRocca, MD, cancer medicine specialist and neuro oncologist with the Brain Tumor Center, a collaboration of Norton Neuroscience Institute and Norton Cancer Institute and David A. Sun, MD, PhD, neurosurgeon with Norton Neuroscience Institute, are currently using this technology on brain tumor patients in Louisville and hope to extend treatment to glioblastoma patients throughout the region.
Baptist Medical Associates receives recognition for diabetes care
Nineteen Baptist Medical Associates physicians, physician assistants, and nurse practitioners have received recognition from the Diabetes Recognition Program of the National Committee for Quality Assurance (NCQA) and the American Diabetes Association (ADA) for providing quality care to their patients with diabetes. The physicians, physician assistants, and nurse practitioners, located in Louisville and La Grange, recognized are: Michael Davis, MD; Charles Gaba, MD; Albert Hoskins, MD; Keith Krawiec, MD; Douglas Marquess, MD; Sarah Merrick, MD; Tami Secor, MD; Brenda Townes, MD; Stacey Waring, MD; and Jill Watson, MD; all interLOUISVILLEÂ ANDÂ LAGRANGE
nal medicine; Tonya Perkins, MD, internal medicine and pediatrics; Donna Gatewood, MD; Ray Johnson, MD; Gerlinda Lowrey, MD; and Jeffrey Reynolds, MD; all family medicine; Physician Assistant Amy Davis, PA-C; and Nurse Practitioners Terri Clifford, APRN; Abby Hefner, APRN; and Cheryl Thurman.
Jewish Hospital Implants Temporary Neurostimulator
The first temporary endoscopic neurostimulator implantation in the region was performed recently at Jewish Hospital, part of KentuckyOne Health. For patients with severe gastroparesis, a disorder that slows or stops the movement of food from the stomach to the small intestine, this procedure can determine if a permanent implant will restore their ability to digest. LOUISVILLE
To learn more about working with MESA, contact us today.
1-877-601-6372 | MESAMedicalGroup.com
ISSUE#76 27
NEWS The temporary implant was followed by placement of a permanent device, which stimulates the nerves and muscles in the stomach to aid digestion in a manner similar to how a pacemaker is used to control heart rhythm. The temporary endoscopic procedure was performed by Thomas Abell, MD, director of the Jewish Hospital GI Motility Clinic and the Arthur M. Schoen, MD, chair in Gastroenterology at the University of Louisville, who specializes in gastric motility, the movements of the stomach that aid in digestion by moving food into the small intestine. The permanent device was placed by Robert Cacchione, MD, associate professor of Surgery at UofL. Cacchione has extensive experience with gastric stimulation devices. Abell pioneered the development of the implantable neurostimulator with medical device manufacturer Medtronic while at the University of Tennessee. His research includes conducting National Institutes of Health-sponsored clinical trials to standardize the treatment protocols for gastroparesis
while at the University of Mississippi. One such trial is now under way at the University of Louisville.
“Our research has led us to introduce this treatment protocol to other orthopeadic surgeons in our healthcare system,” said Arthur Malkani, M.D., orthopaedic Jewish Orthopaedic Care surgeon, Shea Orthopaedic Group, Jewish Develops New Protocol Physician Group. “In addition to the overLOUISVILLE Orthopaedic surgeons and anesall health benefits to our patient, this protothesiologists with Jewish Orthopaedic col benefits our entire system. By reducing Care, a part of KentuckyOne Health, have the number of transfusions needed, we can researched and implemented a new protocol preserve blood supply and save valuable that has drastically reduced the number of health care resources for other patients.” patients who require a blood transfusion “The mortality rate is higher for following total joint replacement surgery. patients who require a blood transfusion The program has significant benefits to and those patients don’t do as well,” said patients. Jiapeng Huang M.D., Medical Director Jewish Orthopaedic Care teams are of Anesthesia, Jewish Hospital Medical using transexamic acid, a medication that Campus. “Eliminating the need for a works to reduce blood loss, for patients blood transfusion is safer for the patient and undergoing total knee and hip replacement reduces overall medical costs affiliated with surgeries. Their research showed the use the procedure.” of the medication protocol reduced the number of patients who required a blood Central Baptist Hospital’s transfusion dropped from 14 percent to 2 Orthopedic Program Earns percent in total knee replacement surgeries. Certification from The Joint The study will be submitted for consider- Commission ation to The Journal of Arthroplasty. LEXINGTON Central Baptist Hospital has
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NEWS earned The Joint Commission’s Gold Seal of Approval® for its Orthopedic Program, specifically Hip and Knee, by demonstrating compliance with national standards for health care quality and safety in diseasespecific care. As of November 15, 2012, Central Baptist was the only hospital in Lexington and one of only four programs in Kentucky to hold this certification.
location is also a large benefit to patients and employees. All patient exam rooms have been equipped with the Epic electronic medical records system to ensure the most effective and efficient care possible as well as allow patients to access their own medical records. The new facility will also have updated furnishings, additional parking, more spacious rooms and be handicap accessible.
CBH First in Kentucky to Receive SCPC A-Fib Certification
Ambati Receives International Ophthalmology Award 
Central Baptist Hospital has received full Atrial Fibrillation Certification status from the Society of Cardiovascular Patient Care (SCPC). CBH is the first healthcare facility in Kentucky to receive this certification and is one of only 12 programs in the country to earn the honor. Central Baptist Hospital has demonstrated its expertise and commitment to quality patient care by meeting or exceeding a wide set of stringent criteria and undergoing a comprehensive review by an accreditation review specialist from the SCPC. Central Baptist’s protocol-driven and systematic approach to patient evaluation and management allows physicians to reduce time to treatment and to help patients to decrease their length of stay in the emergency department and the hospital. LEXINGTON
Norton moves practices from Dorsey Plaza to Middletown
On January 11, 2013, Norton Immediate Care Center – Dorsey Plaza and Norton Community Medical Associates – Dorsey moved to a new, state-of-theart facility and were renamed Norton Immediate Care Center – Middletown and Norton Community Medical Associates – Middletown. The new space, located at 12903 Shelbyville Road, will provide a patient-focused environment for area families and bring the newest in health care technology to the Middletown area. The previous site for the immediate care center and physician practice was at 10284 Shelbyville Road in Dorsey Plaza. With much of the area’s patient population moving toward Middletown, that location was no longer the most convenient. While convenience is a key factor for the move, the growth potential for the new LOUISVILLE
Dr. Jayakrishna Ambati, professor and vice chair in the Department of Ophthalmology and Visual Sciences and professor of Physiology at the University of Kentucky College of Medicine, was awarded the 2013 Prix Soubrane de la Recherche en Ophtalmologie for his contributions to research in age-related macular degeneration (AMD). The award was presented on Jan. 11 at the 7th Annual Macula of Paris Congress in Paris, France, by Dr. Gisèle Soubrane, proLEXINGTON
fessor of ophthalmology and chair emeritus at the University of Paris East-Creteil, for whom the award is named. This annual conference brings the most highly regarded clinicians and researchers from around the world together to discuss treatments of the future for macular diseases. Ambati is the first physician to receive this award since it was instituted in 2011 to recognize and distinguish a physician/ scientist for his or her work in basic and clinical research. The Ambati team at UK has made pioneering contributions in AMD and ocular angiogenesis and elucidated the mechanisms of inflammation, innate immunity, and RNA biology in the pathogenesis of AMD. His laboratory reported numerous seminal advances in journals such as Nature, Cell,
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ISSUE#76 29
NEWS
Nature Medicine, New England Journal of Medicine, PNAS and JCI. Ambati, the Dr. E. Vernon & Eloise C. Smith Endowed Chair in Macular Degeneration at UK, accepted his award on behalf of his research group.
Jewish Hospital Launches "STEMI Network"
A new program at Jewish Hospital – called the STEMI Network – will reduce the time between heart attack and care. Patients presenting with symptoms of acute myocardial infarction will be handed off directly to a special team that will bypass the ER and take the patient straight to the cardiac catheterization lab. For patients with a heart attack or a complete blockage of the coronary artery, it will ensure the fastest access to life saving care in Louisville Metro. STEMI is an acronym meaning “ST segment elevation myocardial infarction,” which is a type of heart attack. This is determined by an electrocardiogram (EKG) test. A STEMI is a more severe type of heart attack. Through the STEMI Network, which launched December 1, the Emergency Department at Jewish Hospital receives EKG results transmitted wirelessly by Louisville Metro EMS (LMEMS) providers when they suspect that the patient is having a STEMI in the field. Once the emergency department receives the patient’s EKG, they will confirm whether the heart attack is one with elevated ST segments—a pattern on an EKG reading that indicates a total blockage. If a total blockage is suspected, the emergency physician will then activate the cath lab team. When LMEMS arrives at the hospital, hospital staff will transport the patient directly to the cath lab, allowing physicians to clear the blockage sooner. “For patients with a complete blockage, urgent treatment can decrease the extent of heart muscle damage and thereby improve mortality risk,” said Steven Raible, M.D. “Our goal is to limit the damage to the heart and improve outcomes by getting patients in the cath lab as quickly as possible.” While all heart attacks are serious, those considered a STEMI, which involves a total LOUISVILLE
30 M.D. UPDATE
artery blockage, are those requiring the quickest treatment. Because of the total blockage, STEMI heart attacks cause rapid loss of heart muscle that cannot be regenerated. In these situations, time saved is muscle saved.
Third hyperbaric chamber added at Baptist Hospital East
A third hyperbaric chamber has been added at Baptist Hospital East to help handle the increasing demand for treatment of slow-healing wounds. The new unit was delivered and installed on Friday, Dec. 7 in the Wound Care Center, located on the first floor of the Baptist East Medical Pavilion, 3900 Kresge Way, on the hospital’s campus. Patients with diabetic ulcers and other types of slow-healing wounds can benefit from hyperbaric oxygen therapy (HBOT) used to treat wounds that have shown no improvement in four weeks of conventional treatment. Pressure ulcers, traumatic wounds, problem surgical wounds and other types of complex softtissue injuries may also be treated at the center. ST MATTHEWS
Paily voted Best of Kentuckiana
Rejith Paily, MD, FACP, an Internal Medicine/Primary Care physician with Jewish Physician Group, a part of KentuckyOne Health was recently voted the #1 Family Physician as part of the “Best of Kentuckiana” by WHAS TV. Paily has been practicing in Louisville for more than 10 years.
Jewish Hospital & St. Mary’s Foundation Board to invest $18 million in Louisville facilities
The Jewish Hospital & St. Mary’s Foundation board of directors has approved the disbursement of more than $18 million from unrestricted funds for facility advancements, advanced clinical research and more. The grants being made by the Foundation represent the largest grants in its history and will enable KentuckyOne Health to better serve the healthcare needs of our community. LOUISVILLE
The funding disbursements range from a $500,000 investment in making the Kosair Charities Children’s Peace Center at Our Lady of Peace kid-friendly to a $1.5 million grant to continue the hand transplant program, a partnership of physicians and researchers at Jewish Hospital, Kleinert Kutz & Associates, Christine M. Kleinert Institute and the University of Louisville. The largest single project is a $5 million investment to create a hybrid operating room and Resuscitation Center at Jewish Hospital. The Resuscitation Center, the first in Kentucky, will allow for new, cutting-edge treatments such as the use of hypothermia therapy for some patients in cardiac arrest, a treatment endorsed but The American Heart Association. The hybrid operating room will create more space for innovative new procedures such as transcatheter aortic valve replacement (TAVR) for patients who are not candidates for open-heart surgery but need heart valve replacement. Other projects funded include: Purchase of a NOGA® XP Cardiac Navigation System to provide leading-edge evaluation, mapping, and navigation tools to support physicians performing cardiac procedures at Jewish Hospital Build out of existing space at Frazier Rehab Institute creating a shared space for established clinical research programs conducted in partnership with the University of Louisville to foster interdisciplinary translational research Two additional locomotor treadmills at Frazier Rehab Institute to expand the nationally recognized spinal cord injury research program with the University of Louisville Upgrades to existing technology and equipment in intensive care and critical care units at Sts. Mary & Elizabeth Hospital and Jewish Hospital Shelbyville Additional equipment in the Community Fitness & Wellness Center at Frazier Rehab Institute to serve the wellness needs of disabled individuals in the community
KentuckyOne Health Announces Headquarters Location in Louisville LOUISVILLE
After months of reviewing locations
NEWS
in Kentucky and southern Indiana, including Lexington and Louisville, KentuckyOne Health officials announced that Louisville has been selected as the headquarters location for KentuckyOne Health. The corporate offices will be located in downtown Louisville at 100 East Liberty Street in the Jewish Hospital Medical Plaza building. Jewish Hospital & St. Mary’s HealthCare in Louisville and Saint Joseph Health System in Lexington merged on January 1, 2012 to form KentuckyOne Health, and recently partnered with University of Louisville Hospital | James Graham Brown Cancer Center. KentuckyOne is the largest health system in Kentucky with more than 200 locations and more than 3,100 licensed beds across the Commonwealth. Ruth W. Brinkley, president and CEO of KentuckyOne, said, “Downtown Louisville is the right choice for our headquarters for a number of reasons, including the proximity to several of our Louisville facilities; easy access to other areas in the Commonwealth; convenient access to the Louisville International Airport and a location in the largest city in the Commonwealth. In addition, the Jewish Hospital Medical Plaza is already one of our owned assets, which made it a financially viable option.” “The alignment of our recently announced partnership with the University of Louisville Hospital | James Graham Brown Cancer Center is another reason why this is the right decision,” added Brinkley. Executives are currently located in the Jewish Hospital Rudd Heart & Lung Center on Abraham Flexner Way in Louisville. The new location is just two blocks away. Plans for the headquarters include two floors with several offices, cubicles, and a number of conference rooms. While the corporate headquarters will be in Louisville, KentuckyOne Health is a statewide organization. Additional corporate leadership and support offices will remain located throughout the Commonwealth, including Lexington. KentuckyOne Health’s leadership team will continue to travel across the Commonwealth to interact with all constituents. ◆
A great heart center for all of us. Heart disease is the number one cause of death in Indiana. That’s why we created a center to provide the most advanced care for all kinds of heart diseases. With national caliber experts and the latest technology, we can actually stop a heart attack and make traditional heart surgery less invasive. We’re proud of the recognition we’ve received. But we’re even more proud to be the choice of more people every year. Because having a great heart center isn’t just good for us, it’s good for everybody.
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1/17/13 3:46 PM ISSUE#76 31
ARTS
The Nude Explores the Human Body and Its Relationship to Time, Space, and Others BY MD UPDATE For 27 years, the Lexington Art League has presented The Nude, an exhibition exploring the figure in contemporary art. This year’s theme, Self & Others, specifically challenged artists to consider the nude and its influences on who we are and how we relate to others. That concentration on Self & Others, led Becky Alley, LAL’s exhibitions and programs director, to expand the visual art offerings associated with the annual Nude. “When we asked artists to consider Self & Others as a sub-theme to The Nude, we were referencing self-portraiture and figure study, but we were also asking them to think about the self stripped down to its barest bones, to consider conceptual undercurrents wrapped up in the figure,” Alley said. “Recent work by Gaela Erwin, an artist who has worked in selfportraiture for more than 20 years, seemed an interesting extension of that idea, so we added a second exhibition of her work. Erwin’s exhibition, My Mother, My Sister, Myself: Portraits by Gaela Erwin, represents a departure from self-portraiture. After receiving a grant from the Italian Cultural Institute of Louisville, Erwin traveled to Rome to spend several weeks studyLEXINGTON
MD Update publishers Gil Dunn and Megan Campbell Smith with Cameron Schaeffer, MD and his wife Dr. Jennifer Schaeffer 32 M.D. UPDATE
enjoyed being photographed, relaxed during the sessions. They made her feel useful to my work, which she valued, and it was her way of nurturing me.” Erwin’s portraits exploring the evolving relationships with her mother and her sister offer a deeply personal investigation of Self & Others that mirrors the contextual themes presented on a larger scale in The Nude. Featuring more Back to Back – My ing the intense realism of Caravaggio. Mother and My Sister than 50 works of art Inspired by his use of light, Erwin by Gaela Erwin culled together from began painting portraits of her mother, more than 600 submiswho is in declining health due to dementia. sions, The Nude, which is supported by “At one point in my mother’s illness I M.D. Update, features the work of artists had to make frequent trips to her North from four countries and 16 states, includCarolina home, and I always left feeling ing Kentucky. Juror Ebony Patterson, assisexhausted and grief-stricken,” said Erwin. tant professor of painting at University of “Worse still, I found myself resenting time Kentucky, noted that contemporary artists away from the studio even though I knew are using the human figure to delve into I was doing the right thing. I reframed my issues of sexuality, identity, gender polivisits as an extension of my studio practice tics, fertility, disability, beauty, love, and and began photographing my mother and vulnerability. turning the images into portraits. I came to “The figure, especially the nude figure, see visiting my mother in a new light – liter- is powerful on its own because it’s absoally – and the experience allowed my moth- lutely universal; we’re all humans and we all er and I to connect in a way that her illness have a nude state of being,” said Patterson. typically didn’t allow. Mom, who had always “Because it is such a raw subject, it can easily carry the burdens of this human experience. The Nude: Self & Others demonstrates the power of the figure to reveal social, political, and personal issues that are central to modern life.”
Brian Smith, MD, Jenna Daniels with Amy and Rick Lozano, MD, enjoyed The Nude Preview party at Lexington Art League.
Robert Bratton, MD, Medical Director Lexington Clinic, with wife Linda Bratton viewed the offerings at The Nude.
The Nude runs through March 3, 2013 at the Lexington Art League. Contact (859) 254-7024 or www. lexingtonartleague.org for more information. ◆
THE NUDE an exploration of the human vessel and its effect on individual identity and the social and sexual politics that affect us all
OPEN THRU
March 3, 2013 FOR MORE INFO ON EVENTS, LECTURES, & WORKSHOPS: 859.254.7024 www.lexingtonartleague.org
Image: from the series “I Am a Cutter” by William Pearce Cox
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