THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS ISSUE #81
SPECIAL SECTION
Oncology ALSO IN THIS ISSUE THE COMPLEXITY OF
RADIATION ONCOLOGY
TRENDING TOWARDS STEREOTACTIC RADIATION A BOOST FOR LUNG CANCER CT SCREENING BREAST CANCER PREVENTION
VOLUME 4, NUMBER 6
OPTIONS BEYOND MASTECTOMY
Commitment Insurance
MARK EVERS, MD, LEADS UK MARKEY CANCER CENTER TO NCI DESIGNATION
We’re improving access to quality health care because you live and work here.
ky one
Better care is here. And here to stay. At KentuckyOne Health, we’re continuing to improve access to high quality health care. We believe that every Kentuckian from the hills of eastern Kentucky to the city of Louisville should receive the same level of care. As we welcome the University of Louisville Hospital and the James Graham Brown Cancer Center into our system, our more than 200 health care locations from hospitals to home health agencies are more committed than ever to creating healthier communities across Kentucky. Continuing Care Hospital Flaget Memorial Hospital Frazier Rehab Institute James Graham Brown Cancer Center
Jewish Hospital Jewish Hospital Medical Centers: East, South, Southwest, Northeast Jewish Hospital Shelbyville Jewish Physician Group
Our Lady of Peace Saint Joseph Berea Saint Joseph East Saint Joseph Hospital Saint Joseph Jessamine
KentuckyOneHealth.org
Saint Joseph London Saint Joseph Martin Saint Joseph Mount Sterling Saint Joseph Physicians Sts. Mary & Elizabeth Hospital
University of Louisville Hospital VNA Nazareth Home Care The Women’s Hospital at Saint Joseph East
FROM THE PUBLISHER’S DESK
REMEMBERING RICK
Volume 4, Number 6 ISSUE #81
PHOTO COURTESY SAINT JOSEPH HOSPITAL FOUNDATION
I met Rick Corman, aka, RJ Corman, president of RJ Corman Railroad Company on a snowy February morning in 2009 at the Saint Joseph Jessamine RJ Corman Ambulatory Care Center. We were there doing a story on the new medical facility, which was built with Corman’s financial support. I found Rick Corman to be patient and un-assuming yet passionate in his remarks on the need for a high quality medical facility in his hometown of Jessamine County. “We need it,” said Corman. “There are 26 stoplights between here and the nearest hospital and we’ve watched those ambulances drive past our business many times.” In April 2013, Corman bestowed another generous gift to the Saint Joseph Hospital Foundation to bring digital mammography services to Saint Joseph Jessamine. The gift, made in honor of Corman’s sister, created the Sandra J. Adams Digital Mammography Suite at the facility and marked the first time mammography services had been available at the center. Published reports say that RJ Corman and the RJ Corman Railroad Group is the Sandy Adams with Rick Corman largest philanthropic supporter in Saint Joseph at ribbon-cutting of Sandra J. Hospital history. Adams Digital Mammography Corman died on August 23, 2013 after Suite Saint Joseph -Jessamine a six year fight with multiple myeloma. When I heard the news of his passing, I remembered our interview in 2009 and the note he sent to me the next day. I kept the note, in his signature red ink, because I knew Rick Corman was a special and unique individual who cared about the health and welfare of Kentuckians, and he did something about it, just like the many physicians and healthcare providers that you read about in every issue of M.D. Update. I invite you to read the stories of some of the doctors, researchers and healthcare professionals who continue the fight against cancer and others health problems in Kentucky. Contact me if you have a story to tell. All the Best, Gil Dunn Publisher, M.D. Update 17
19
SUBMIT YOUR LETTER TO THE EDITOR TO JENNIFER S. NEWTON AT JNEWTON@MD-UPDATE.COM 2 M.D. UPDATE
PUBLISHERS
Gil Dunn PRINT gdunn@md-update.com Megan Campbell Smith DIGITAL mcsmith@md-update.com EDITOR IN CHIEF
Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGNER
James Shambhu art@md-update.com
CONTRIBUTORS: Scott Neal Stephanie Wurdock
CONTACT US:
ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:
Gil Dunn gdunn@md-update.com
Mentelle Media, LLC
38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502 M.D. Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials. Copyright 2013 Mentelle Media, LLC. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher. Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. Thank you. Individual copies of M.D. Update are available for $9.95.
CONTENTS
ISSUE #81
COVER STORY 4 HEADLINES 6 FINANCIAL 7 LEGAL 9 COVER STORY 14 SPECIAL SECTION
ONCOLOGY
24 NEWS 31 EVENTS
Commitment Insurance
UK Markey Cancer Center’s NCI designation and its “halo effect” will help further empower the region’s physicians and citizens to reduce cancer rates PAGE 9
SPECIAL SECTION ONCOLOGY 14 POWER, PRECISION, AND PATIENCE: A RADIATION ONCOLOGIST’S TOOLS 
14
16
18
20
16 TRENDING NOW: STEREOTACTIC RADIATION THERAPY  18 A BREATH OF FRESH AIR: CT SCREENING FOR LUNG CANCER  20 IN THE PURSUIT OF PREVENTION: BREAST CANCER OPTIONS 
ISSUE#81 3
HEADLINES
Collaborating to Cope with Change
New KMA President focuses on team-based care, navigating healthcare reform, and positioning the KMA for the future BY JENNIFER S. NEWTON LOUISVILLE The Kentucky Medical Association’s (KMA) new President Fred A. Williams Jr., MD, endocrinologist with Endocrine and Diabetes Associates PSC in Louisville, has clear goals for his 2014 term – addressing scope of practice for physician extenders and helping physicians navigate the deluge of healthcare reform changes coming next year. Throw in a strategic plan to position the KMA for greater relevance and success in the coming decade, and his plate looks pretty full.
A Collaborative Embrace
“Team-based care” is the rallying cry for the KMA, which is working closely with groups such as the Kentucky Academy of Physician Assistants (KAPA) and the Kentucky Coalition of Nurse Practitioners and Nurse
The Kentucky Medical Association’s new President Fred A. Williams Jr., MD
Midwives (KCNPNM) to tackle scope of practice issues and the need for addressing access to care in the state. The physician shortage in some areas of Kentucky,
particularly in non-urban settings, is no secret. Neither is the number of uninsured and underinsured patients in our state. Impending healthcare reform also makes for shaky ground going forward, as no one knows exactly what to expect. In October, the health benefit exchange, part of the Affordable Care Act, will begin, and in January 2014, Medicaid expansion takes effect, making approximately 308,000 more people eligible for Medicaid in Kentucky. “In an attempt to get our arms around the access problem, we recognize physicians by themselves are not going to be the sole
cutline
Sturgill Turner’s health care legal team is committed to providing comprehensive legal services to health care professionals, institutions and managed care organizations.
Serving health care providers with integrity. LEXINGTON ◆ STURGILLTURNER.COM 4 M.D. UPDATE
THIS IS AN ADVERTISEMENT
answer. We’ve got to embrace other providers,” says Williams, which is where physician assistants and nurse practitioners come in. “Our concept of the way this will work is healthcare teams, and these teams will be physician-led. Every member of a team will have a role that will be best defined by how well they’re educated and trained,” he says. “For safety purposes, for outcomes purposes, a physician-led team care model is what we all should be looking towards.” Scope of practice is a legislative issue and one that the KMA looks forward to addressing with the legislature during the coming legislative session. Williams is optimistic about the outcome of that work.
Chasing Butterflies in a Hurricane
The health benefit exchange and Medicaid expansion are only a couple of examples of the number of changes physicians are facing in 2014. KMA is tasked with helping physicians identify and adapt to these changes. “It’s kind of like trying to hug a shadow or chase butterflies in a hurricane. You are
trying to deal with something you can’t get your hands on,” says Williams. To aid in these endeavors, the KMA has done a number of regional symposiums over the past year. They have also started the KMA Community Connector Leadership Program. The goal is to get physicians more active at a local and community level, says Williams. The KMA is looking for physicians, who are leaders in medicine and in their communities, to work alongside business, government, and civic organizations to educate them about the importance of quality healthcare in Kentucky and promote KMA policies.
The Winds of Change
On the winds of change, another action item for the KMA and Williams this year is strategic planning. The healthcare system is changing, but so are the doctors practicing medicine. “The idea of organized medicine overall is very important because it creates a forum and a structure to help doctors do things they can’t do by themselves, like influencing legislation, educating patients and the public, being able as an organiza-
tion to impact a community’s health and a state’s health,” says Williams. The problem is the structure of the organization may not be ideal for newer generations of physicians and the issues they will be facing 10 or 20 years down the road. The group tasked with developing the strategic plan consists of 15 to 16 physicians, who are not board members and represent different geographic areas, ages, and specialties. KMA is also planning a survey of its members. In terms of public education, the KMA is trying a new tack this year, focusing its resources on one main issue rather than spreading resources over many areas. In 2014, Williams believes a major focus should be on the issue of providing a smoke-free environment in public areas around Kentucky, mirroring action taken in Lexington and Louisville. Bans on smoking in public areas have been a significant public health accomplishment for Kentucky, Williams believes, and should be extended statewide without impacting local bans that have already been implemented. ◆
ISSUE#81 5
FINANCE
A Financial Planning Update Just as one’s physical health changes over time, so does financial well-being. Thus, readers have asked how often a well-written financial plan should be updated. Many financial advisors will say that you should have a yearly update to your plan. My response is that updating the plan depends less on the mere passage of time and more on these four factors: (i) your profile or what you might call a history and financial physical, (ii) your goals, (iii) the economic environment, or (iv) the assumptions used in your plan. Changes to any one of these factors may be sufficient to warrant an update of your plan. Let’s say that you had a financial plan written several years ago; the real question is whether it is still on track to fulfill your long range goals and objectives. A brief comparison of your current financial profile compared to where the plan said you would be could indicate the need for an update. For now, let’s review some of the key elements of a comprehensive plan and ask how these factors might have changed over the past few years. As we near the end of the year, our firm will produce a checklist of items to consider for your financial checkup. If you are not a client of the firm and would like to be added to that distribution list, email casey@dsneal.com, and she will insure that you are added to that list.
Assumptions
Because a financial plan involves a projection into the future, assumptions about how the future will play out are necessary. It is vitally important for you to know what assumptions were used to generate the plan and how close to reality those assumptions have turned out to be. Key assumptions are income, inflation, investment return, tax rates, and spending. Different planners use different assumptions for many of these factors. Some plans assume a rising standard of living while others assume a constant inflation-adjusted standard of living. It is important for you to know which was used and to gauge your performance accordingly.
Goals
The financial planning process begins with a statement of goals. Having written and updated financial plans for the past 30+ years, I have watched with more than a 6 M.D. UPDATE
passing interest as client goals have matured and changed over time. The most joyful time for client and planner is when a goal is accomplished and marked off the list. Occasionally BY Scott Neal however, goals become outdated. As you review your financial plan, it is important to note which of your goals it was trying to address at the time it was written and how those goals might have changed since then. If the goals are no longer valid, it is time to update the plan.
Net Worth
Most financial plans contain a presentation of your current financial net worth on the date of the plan as well as an annual projection of net worth into the future. Recall that net worth is simply assets minus liabilities as of a given date. A review of your current net worth compared to what the plan projected your net worth would be at the end of 2013 should be considered in your present review. The longer the planning horizon, the more significant any present deviation becomes. Prior to retirement, net worth should be growing as you age; therefore, a shortfall between actual and planned net worth is more indicative of the need for a plan update.
Cash Flow
If you know me, you have probably heard me say that there are five things, and only five things, that you can do with each dollar that comes into your life each year. That dollar can be used to (i) pay taxes, (ii) make payments on debts, (iii) be saved, (iv) be given away, or (v) be spent to support living standard. In other words, all dollars of income have to go someplace each and every year. Part of our job as financial planners is to help our clients make an informed decision about the distribution of annual gross income. Since every person has the most control over discretionary cash flow, i.e. what is left over after payment of taxes and debts, focus should be given to how these were projected and how they have actually
played out. As you might imagine, consumptive spending can sometimes get away from the best of us as the needs and wants of our families change or as our income grows and contracts. Changes in tax law occur nearly every year and for most readers, tax rates have gone up this year as the result of the fiscal cliff legislation at the beginning of this year.
Investment Returns and Inflation
A key element of most financial plans is the interplay between investment returns and inflation, called the real rate of return. If your plan was based on a long run average return of the stock market (approximately 10 percent) and inflation (three percent), it is possible that your real rate of return was projected to be seven percent per year for the entire planning horizon. If your actual return has been significantly different than the projection, particularly if it has been less, an update is in order. However, I should point out that most planners are fairly conservative when projecting returns so it should not be surprising to find a real rate of return over inflation of four-to-five percent in your financial plan. In deciding whether a plan should be updated, focus should be given to the long run (more than five years) average of your real returns rather than year-by-year assessments. Note however that returns are usually less impactful than spending decisions.
Environment
Needless to say, the past five years have brought on significant changes to our economy. For a long range plan, the key question is whether these changes have been normal, stationary changes or structural, and therefore more impactful in ways that are different than past cycles. We believe that the Great Recession of 2008-09 and the recovery since then has been anything but normal and that structural changes to the economy are playing out right before our eyes. Moreover, this is all happening on the eve of one of the greatest demographic shifts our economy has ever known—the retirement of baby boomers. Being attentive to these changes is key to understanding how existing plans ought to be updated and new plans developed. Scott Neal is president of D. Scott Neal, Inc. with offices in Lexington and Louisville, Kentucky. Comments and questions are welcome. To learn more, visit www.dsneal.com ◆
LEGAL
Responding to a KBML Grievance Between 75 and 99 percent of physicians will face at least one malpractice claim by the time they reach the age of retirement.1 This statistic encompasses lawsuits filed with the courts as well as medical board of licensure grievances. In Kentucky, the Kentucky Board of Medical Licensure is tasked with investigating grievances against its licensees.2 This article briefly discusses the Kentucky Board of Medical Licensure (KBML) grievance process and what to do in the event a licensure grievance is filed against you. The Grievance. The KBML is authorized to investigate alleged violations of the Kentucky Medical Practice Act. Violations of the Act include impairment of ability to practice due to drug or alcohol abuse, failing to meet minimal standards of care, prescribing drugs in an inappropriate manner, inappropriate sexual conduct in the course of practice, falsifying information, and performing duties beyond the scope of a license. The KBML does not regulate fee disputes, help patients sue physicians, or resolve questions of disability or insurance. Grievances must be submitted in writing by any individual, organization, or entity;3 grievances need not be filed by an attorney. The Initial Review. Once a grievance is filed with the KBML, it is initially reviewed by the KBML executive director to ensure that the KBML has jurisdiction. If the KBML has jurisdiction, the grievance is then referred to a medical investigator. The investigator contacts the physician, or “licensee,” and the grievant to discuss the allegations. The licensee is then given the opportunity to respond to the allegations in writing. The investigator may gather evidence from the licensee’s co-workers, the grievant’s medical records, and other sources such as pharmacies where the grievant has prescriptions filled. Medical experts may also be hired to assist in the investigation. The written results of the investigation are presented to an “inquiry panel,” which determines whether sufficient evidence exists to proceed with formal dis-
BY
Stephanie Wurdock
ciplinary action. If there is insufficient evidence, the grievance will be permanently closed. If there is sufficient evidence to proceed, the inquiry panel votes to issue either a formal complaint or a
“show cause order.” Responding to a KBML Complaint. When the inquiry panel decides that a grievance is substantiated, it issues a complaint against the licensee. This document is a formal pleading that closely resembles a complaint filed in a lawsuit. It sets forth charges against the licensee and commences a formal disciplinary proceeding. The licensee has 30 days from the date of notification that a complaint has been issued to submit a written response to the allegations. Failure to respond may be taken as an automatic admission of the charges. The licensee may request an administrative hearing once the licensee is on notice of the complaint. These hearings, which are similar to a civil trial, are held before a hearing officer or hearing panel and are open to the public. The KBML’s general counsel acts as the prosecuting attorney and the licensee may represent himself, or may choose to retain counsel. Evidence and witnesses are presented by both sides. After the hearing, the hearing officer/panel provides the inquiry panel with “Findings of Fact,” “Conclusions of Law,” and “Recommendation” for disposition of the case. A copy of those documents is sent to the licensee, who then has 10 days to file any written objections. The inquiry panel reviews the hearing officer’s filings and the licensee’s objections and decides whether to take disciplinary action. If the inquiry panel determines that there is no merit to the grievance, it will dismiss the case. If it determines that there is merit, it can reprimand the
licensee, suspend the license, put the licensee on probation, permanently revoke the license, limit the license, or fine the licensee (up to $5,000 per violation). The licensee may appeal the disciplinary action to the Jefferson County Circuit Court and move for a motion to “stay”—temporarily pause—the disciplinary action while the appeal is pending. Responding to a Show Cause Order. Alternatively, a show cause order may be issued directing the licensee to dispute why the KBML should not take a specified action. This document sets forth the basis for the KBML’s finding that grounds exist for disciplinary action. In addition, if the inquiry panel finds sufficient reasonable cause exists to believe that the continued unaffected practice of medicine by the licensee would constitute a danger to the health, welfare, and safety of the licensee’s patients or the general public, an order of temporary restriction may be issued under which the licensee’s license may be temporarily suspended, limited, or restricted until formal proceedings are concluded. Waiver of Formal Proceedings. At any time after issuance of a KBML complaint, show cause order, or emergency order, the licensee may seek informal disposition of the matter by signing a waiver. In doing so, the licensee agrees to abide by the KMBL’s ruling and cannot appeal or object to the ruling. Retaining Counsel. A licensee may represent himself in all stages of the KMBL grievance process. However, as discussed above, the KBML’s final decision may have significant ramifications for the licensee including permanent revocation of the licensee’s licensee to practice medicine. Therefore, any licensee against whom a grievance is filed should immediately inform his or her risk manager and/or malpractice insurer and obtain legal counsel. Stephanie M. Wurdock is an attorney at Sturgill, Turner, Barker & Moloney, PLLC, where she defends medical providers against claims of medical negligence. She can be reached at (859) 255-8581 and swurdock@sturgillturner.com. ◆ ISSUE#81 7
8 M.D. UPDATE
COVER STORY
Commitment Insurance
UK Markey Cancer Center’s NCI designation and its “halo effect” will help further empower the region’s physicians and citizens to reduce cancer rates
Dr. Mark Evers, director of UK Markey Cancer Center, hopes the center will have a hand in changing the culture of Kentucky.
BY TIM CORKRAN
PHOTOGRAPHY BY LIZ HAEBERLIN Some day in the future, when University of Kentucky Markey Cancer Center (Markey) Director Mark Evers, MD, reflects on his time leading the UK institution, he expects to see that “Markey had a hand in changing the culture of Kentucky,” in relation to cancer treatment and cancer-promoting behaviors. Recently, that vision became much more likely. Markey’s long-standing commitment to regional health – through cancer treatment and prevention – has been substantially bolstered by its July designation as a ISSUE#81 9
COVER STORY
WE KNOW THAT THE BEST WAY TO ERASE THE HUGE CANCER BURDEN IN OUR STATE IS THROUGH RESEARCH AND ADVOCACY, AND THE NCI DESIGNATION BRINGS BOTH TO OUR PEOPLE. – DR. SUSANNE ARNOLD National Cancer Institute (NCI) center. With the NCI designation comes increased funding for research and clinical trials and a mandate to address the regional phenomena contributing to high incidences of certain cancers. The people of the Commonwealth, long among the nation’s most cancer-prone, will find increased resources right at home to help them fight their cancers and change the behaviors that lead to them. Evers says, “Folks don’t have to cross the border to get top-notch cancer care. They won’t have to go to Vanderbilt or Ohio State.” And the physicians of the Commonwealth will find they have a “destination center of excellence, a nationally recognized cancer center nearby, so they need not send their patients elsewhere,” says Evers. The boon for research will empower Kentucky physicians with increased access to newly developed and very large clinical trials Dr. Susanne Arnold, associate director for Clinic Translations, believes research is critical to making progress on disease treatment.
10 M.D. UPDATE
reserved for NCI designated facilities and subsequent new standards of care.
Markey’s Commitment and Journey
For Evers, “A cancer center needs to stay true to its catchment population. We have a mandate to understand and take care of our population.” Markey is a textbook example of this. Founded in 1983 with money bestowed by Lucille Markey, matron of Lexington’s Calumet Farm family, its charge was to focus on the most common cancers of the region: lung, colorectal, gastrointestinal, and head and neck. Outreach to the cancer prone populations of Appalachia was always a focus, with hallmarks such as the community-focused “Faith Moves Mountains” program, in which local churches help with pre-cancer screenings and the establishment in 1990 of the Kentucky Cancer Registry (KCR). In 2005, UK’s NCI-funded five-state Appalachia Community Cancer Network (ACCN) was awarded. The 2009 arrival of Evers, a surgical oncologist and nationally recognized physician-scientist who had served as director of the University of Texas Medical Branch (UTMB) Cancer Center in Galveston, was the result of an exhaustive search and the beginning of a new era at Markey: the push to build a cancer center worthy of National Cancer Institute designation. Several key components of the effort had long been in place. Tom Tucker, PhD, associate director for Cancer Prevention and Control, had been with Markey from the start, and his work in cancer prevention and control in central Appalachia had been going on for several decades. Data from the KCR, which he helped develop, was used to focus resources on colorectal cancer screening. Using this data to guide the implementation of interventions, a statewide initiative was conducted resulting in a 22 percent decrease in both the incidence and mortality of colorectal cancer in Kentucky. Susanne Arnold, MD, associate director for Clinic Translations, an eighthgeneration Kentuckian, arrived at Markey in 1998 and has overseen hundreds of participants in clinical trials. Her work is
Tom Tucker, PhD, associate director for Cancer Prevention and Control, helped develop the Kentucky Cancer Registry.
infused with her Kentucky and medical lineage. “I learned a very valuable lesson from my father, who was also a physician and a Kentuckian — that we can’t make progress in the treatment of diseases without being invested in the research that we do,” says Arnold. Daret St. Clair, PhD, associate director for Basic Research, has been receiving NCI research funding since she began at UK in 1991; she went full-time at Markey in 2009. Her team’s efforts toward reducing the side effects of chemotherapy-induced normal tissue injury, including cognitive impairment (aka “chemo-brain”), has been groundbreaking. She now spends much of her time coordinating Markey research projects and mentoring their scientists.
While at UTMB-Galveston for 20 years, five as Cancer Center director, Evers nurtured a committed group of cancer professionals, including administrators, post-docs, graduate students, and research staff, 34 of whom sought to come to Markey with him. Evers notes that, “It is not typical to bring so many people with you, but a major institutional commitment by Dr. Michael Karpf, (UK’s executive vice president for Health Affairs) and former UK President Lee Todd was really what it took to make it happen. This has allowed us to jump-start many of the programs key to earning the NCI designation.” Arriving with Evers was Heidi Weiss, PhD, biostatistician and associate director of Shared Resources and a veteran of 20 years in the field, many at other NCI designated cancer centers. Under her direction, Markey’s six shared resource facilities are coordinated to maximize the value of the research conducted, from laboratory to clinical trials. Simplified, her job is two-fold: “To ensure that Markey’s shared facilities – which are funded by the NCI – deliver high quality, state-of-the art, and cost-effective services that will enhance the entire spectrum of cancer research; and as a biostatistician, to help Markey’s researchers design clinical trials and find the story in the data produced from those trials,” says Weiss. Dave Gosky, MBA, associate director for Administration, was another eager transplant. He has an MA in Classics from the University of Pennsylvania to go with his MBA, and he and Evers led the program together in Galveston. An impression left on him by a mentor committed to cancer patient care directed his career as a young man, and he has stayed in oncology because “I feel that, as an administrator, my job is to ensure that all of the cancer physicians and researchers have the tools, equipment, and staffing they need to do their job successfully and serve more patients thoroughly.”
Fertile Ground for NCI Designation
The team that Karpf assembled at Markey in 2009 immediately began working towards the NCI designation. All NIH funded NCIdesignated cancer centers are institutions dedicated to research in the development of more effective approaches to prevention, diagnosis, ISSUE#81 11
COVER STORY
and treatment of cancer – and committed to reach out to underserved populations. Markey had all of these attributes, but it took Evers’ leadership – and $119 million dollars from multiple sources including UK HealthCare, the Commonwealth, and generous philanthropic and community support – to coordinate the effort and presentation that would earn the designation. NCI-designated cancer centers experience a typical suite of benefits. Access to funding increases, high profile researchers are drawn in, and broader scientific collaborations and information sharing with other NCI centers are enabled. Ultimately, research-giving data and clinical trials abound, and a better use of statistics supplies valuable information. The resulting new standards of care are what doctors in the region benefit from most. Cancer patients find access to multidisciplinary, state-of-the-art treatment; expertise in rare cancers; and outreach, education, and cancer control programs. The coattail effect extends to the local communities as medical professionals relocate, drug companies arrive, and high tech jobs increase.
Value Added at Markey
Dave Gosky, MBA, associate director for Administration, followed Evers to UK.
research to our clinical trials.” With NCI’s mandate to focus on Markey’s catchment population, she plans “even more focus on developing new treatments that are effective in these Appalachian populations.” Specifically, they are developing more effective treatments to reduce incident rates of multi-factor lung and GI cancers in these populations. “The NCI designation will really boost our ability to do this,” she says. Weiss’ focus on “developing better clinical trials around the novel therapies that will serve our catchment populations” will be bolstered in several ways. Designation will help her increase the multidisciplinary nature of Markey studies to maximize what can be learned from the clinical trials. Multidisciplinary grants that can come with the NCI designation, some of which are $8 to $10 million grants to be used over five years, are anticipated. She also will have access to open clinical trials that involve other NCI-designated cancer centers. “This collaboration will enrich the quality of our trials,” she says. Together, these
This pattern is already manifesting itself at Markey. Evers notes that, “Our number of physician referrals has already increased, and several hospitals who were watching us in the NCI process are now wanting to talk to us about affiliations.” The face of the research is being affected also. “We have already taken advantage of grant supplements of $100,000 and $125,000, which are only available to NCI designated cancer centers,” he continues. “And we just announced a group of fully-funded metabolic investigators who have chosen to relocate with us.” The evolution in standards of care that the average Kentucky physician will experience is gradual, but it is underway. St. Clair began mobilizing for the future of research at Markey two years before the designation was awarded. Now that it is in place, she has increased funding for multiple projects already underway and received abundant input about her proHeidi Weiss, PhD, gram’s strengths and weaknesses. She biostatistician and says her teams are primed to “put the associate director of Shared basic research and the clinicians togeth- Resources, is a veteran of er and increase the rate of applying the 20 years in the field of cancer research.
12 M.D. UPDATE
will produce more compelling and convincing “stories” from the data that will in turn bring better treatments to the cancer patients of the Commonwealth. She sees a “comprehensive attack on the whole continuum of cancer in Kentucky.” Arnold concurs: “We know that the best way to erase the huge cancer burden in our state is through research and advocacy, and the NCI designation brings both to our people.” Tucker, the sage of the center and its man in the field, says “The last phase of translational research is broad-based implementation. This is where the products of the clinical trials are disseminated to the medical practitioners of the region.” He is energized by the work of Evers’ committed team, noting that in the last four years, “This cancer center came together the way a true cancer center should.” Gosky’s job, while larger, will only be made easier by the NCI designation because, “It allows us to do more of what we have been committed to all along: recruiting grant-funded faculty, getting more science into the outreach of the cancer prevention and control program, increasing the number of patients in clinical trials, and replacing seasoned faculty.” For him, the “halo effect” of the NCI designation is simple: “When you are successful, people want to be part of that success.” For his part, Evers will continue to work his 80-hour weeks. He has been blessed with great philanthropic support, especially from Markey Cancer Foundation Chair Sally Humphrey, her board, and the equine community of the region who continue to support Evers and the Markey Cancer Center. But he will use the NCI designation to fuel his push to increase annual grant funding from $30 to $50 million, grow his patient referral base, and establish Markey as the cancer treatment provider for all of central Appalachia.
Value Added for Physicians and their Patients
Physicians of the region should be aware that this designation establishes Markey as their resource for all things cancer. Evers wants them to know that, “For the complicated cases, for the tertiary cases, for the interesting clinical trials, folks don’t have to leave our borders. We are in the same league as MD Anderson and The Cleveland Clinic; that’s the kind of rigorous review we have had to go through to get this designation.”
WE ARE IN THE SAME LEAGUE AS MD ANDERSON AND THE CLEVELAND CLINIC; THAT’S THE KIND OF RIGOROUS REVIEW WE HAVE HAD TO GO THROUGH TO GET THIS DESIGNATION. – DR. MARK EVERS The population of the region can in turn expect to become healthier. “A cancer center’s mission should be on the people that it serves,” says Evers. “We’ve got to really focus
Daret St. Clair, PhD, associate director for Basic Research, has focused on on our patient population and reducing chemotherapycancers that are prevalent there, induced side effects to and the NCI designation provides normal tissues.
the mandate for doing this into the future.” The collaborative team of highly competent and congenial individuals who have coalesced under his energetic and insightful leadership is poised to deliver on this. Tucker concludes with his patent optimism: “If we continue to push collectively like this, as a community, as a state, we will be able to reduce the cancer burden and move ourselves out of that awful position of highest cancer mortality rate in the country.” ◆
ISSUE#81 13
SPECIAL SECTION ONCOLOGY
Power, Precision, and Patience The Radiation Oncologist’s Three Tools BY TIM CORKRAN
must then employ clinical judgment to choose which option is most appropriate and beneficial. “It takes a significant amount of time to contour your target volume,” Amin-Zimmerman says. Prows adds that to get the most actionable information out of the imaging equipment, “You really need to know your anatomy.” Reading the imagery carefully and inferring beyond its limitations before contouring your target and planning therapy is the fundamental task. “Your plan is only going to be as good as your accuracy of telling the computer, ‘This is what I want to treat and these are the structures I want to avoid,’” says Prows. This necessary deliberation runs counter to most people’s perception of radiation therapy as a quick blast that “zaps” a tumor.
Pinpoint Precision
Since the 1990s, radiation therapy has been honing its precision; the accelerators that produce the beams are becoming more sophisticated all the time. Adjusting beam number, trajectory, and intensity, in light of tumor size and location data collected through CT and MRI scans, is the primary tactic of the radiation oncologist. The basic tool of 3-dimensional conformal radiation therapy (3DCRT) has been advanced to IMRT, which allows for better treatment of concave tumors often found wrapped 14 M.D. UPDATE
Honing In Dr. Janalyn Prows has a special interest in head and neck cancers, where concerns of toxicity and complications are great.
around organs. Now IGRT can allow better targeting of tumors, because it accounts for internal organ motion. Processing this data to produce an optimal course of treatment is a measured and artful act. The computer planning can give the physician options. The physician Dr. Falguni AminZimmerman has an interest in prostate cancer because of the multiple treatment modalities available.
Prows has a special interest in treating head and neck cancers. Successfully completing a course of treatment for these tumors is challenging because of the high dose needed for cure and the potential for significant toxicity that can be debilitating. Early detection may preclude the very toxic combination of radiation therapy and chemotherapy. “If you can get by with radiation alone, you have smaller volumes treated with less acute toxicity and less long-term complications,” she explains. IMRT is very useful as
PHOTO COURTESY OF LEXINGTON CLINIC
The power of the atom is expensive to harness and difficult to understand, but in the right hands, it can be very efficacious. Janalyn Prows, MS, MD, and Falguni Amin-Zimmerman, MD, radiation oncologists at Lexington Clinic’s John D. Cronin Cancer Center, are those right hands. They utilize that power on a daily basis, as they utilize Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy (IGRT), and Brachytherapy, combined with their clinical judgment and deliberate planning, to make an immediate impact on the lives of cancer sufferers. Harnessing the potential – of the atom and these technologies – and integrating it with their own medical judgment allows them to treat tumors precisely, but a course of radiation treatment is more involved than many doctors and patients assume. “It’s a time-consuming process of determining a course of treatment that will maximize focus on cancer and minimize damage to surrounding tissues,” says Prows. Both Prows and Amin-Zimmerman are board certified in Radiation Oncology and find their field very rewarding and engaging. Prows, who joined Lexington Clinic in 2004, notes, “It is very rewarding to see a patient that you treated years before doing well and cancer-free.” For AminZimmerman, who came to Lexington Clinic in 2007, “Being part of a team of physicians – surgeon, medical oncologist, and primary doctor – who work together towards the goal of getting a patient through treatment and recovery is very appealing to me.” LEXINGTON
it allows for better sparing of surrounding normal tissues. One of Amin-Zimmerman’s areas of interest is in treating prostate cancer. Brachytherapy, implanting radioactive iodine seeds, is a valuable tool here, though not every man is a candidate for it. IGRT is also very useful when delivering high doses of external beam therapy, as the prostate tends to move as the bladder and rectum volumes change. Amin-Zimmerman finds that, “The beauty of prostate cancer treatment is that, in early cases, you may have multiple ways to treat it: brachytherapy, surgery, and external radiation can all be options.”
new ways of delivering radiation are being explored. Cost, and how it will affect their ability to treat patients, is a concern for Amin-Zimmerman and Prows. “You have so much cost incurred by having the equipment required to do what we do,” says Amin-Zimmerman. Both doctors believe that insurance companies also need education so they do not deny coverage. Prows has noticed that sometimes the people
Kentucky’s only NCI-designated cancer center
Spreading the Word
Both agree that patients and referring physicians could benefit from increased information regarding radiation therapy treatment. Educating patients about radiation therapy side effects is important. Many patients erroneously assume any malady that occurs during their course of radiation therapy, or thereafter, is due to radiation toxicity. “If I am radiating someone’s lung that would not have caused the rash on their leg. We hear such complaints more often than you would think,” says Prows. Amin-Zimmerman and Prows find that some referring physicians are complicit in this thinking. “We are trying to educate other physicians and the public that radiation is a targeted treatment with local side effects,” says Prows. Another misconception radiation oncologists face is that people think radiation therapy is more expedient than it is. “Most patients are very anxious to get their treatment started,” Prows states. “But planning a course of therapy is often a time-consuming process that requires a team effort to ensure patient safety.” Many doctors also have a simplified view of what has to happen before a course of radiation is administered. “Some referring doctors don’t realize how much work is involved up front before a patient can start on a very precise, high dose course of radiation,” she adds.
who are making the decisions regarding payment “can’t understand why you need to do something in a more complex and expensive way. Radiation therapy, and the radiation oncologist’s expert use of it, is a powerful tool in the fight against a deadly disease. If properly understood by patients and their physicians, this can lead to more beneficial outcomes. ◆
At UK Markey Cancer Center, we’re winning in the fight against cancer. Markey is the only National Cancer Institute (NCI-designated) facility in Kentucky. Earning that distinction signifies national excellence in clinical care and cancer research. Our patients benefit from: • New drugs and treatment options only offered at NCI centers • Access to trials only available at NCI centers • A team of expert physicians, scientists and staff offering compassionate care If you or someone you know is diagnosed with cancer, we’re ready to fight with you. For an appointment, call 800-333-8874 or visit markey.uky.edu
An NCI-Designated Cancer Center
B. Mark Evers, MD Director, Markey Cancer Center
Patience and Perseverance
Advances in the field of radiation therapy have slowed to some degree in recent years. Work is being done on how to best combine radiation and chemotherapy, and
4-4898
ISSUE#81 15
SPECIAL SECTION ONCOLOGY
Trending Now
Stereotactic techniques reduce treatment time and improve toxicity in radiation therapy BY JENNIFER S. NEWTON LOUISVILLE Don Stacy, MD, radiation oncologist with Radiotherapy Centers of Kentuckiana and resident expert on stereotactic radiosurgery and radiotherapy, has seen an evolution in radiation therapy over the past five to 10 years. “The general trends in radiation reflected in our practice are the movement from tiny doses of radiation five times a week for several weeks to large doses of radiation in a few treatments over a week or so,” says Stacy. Commonly referred to as stereotactic treatment, which was once just used on the brain, it now has implications for almost every treatment site. While it’s always been known that larger doses are more effective in destroying cancers, the toxic effects used to outweigh the benefits. Advanced technology now makes
therapy than standard treatments because of the ability to “super-focus” radiation. Stereotactic treatments fall into one of two categories: stereotactic radiosurgery, which is a single high dose of radiation, and stereotactic radiotherapy, which is given in two to five treatments. Radiotherapy Centers of Kentuckiana is a private radiation therapy practice affiliated with Vantage Oncology, a national oncology group that provides management and standardized care across multiple centers throughout the country. The practice is home to Stacy and his two partners, Frederick H. Albrink, MD, and David P. Musich, MD. They have two office locations, one in Louisville and one in Jeffersonville, Indiana.
Complex Process = SuperFocused Results
Dr. Don Stacy specializes in stereotactic radiosurgery and radiotherapy.
stereotactic techniques possible. With the advent of CT scans, robotics, and computer programming, radiation oncologists are able to give large doses of treatment safely. “In 10 to 20 years, probably nearly all radiation treatments will be given in that format,” predicts Stacy. In addition to reduced treatment times, the toxicity is much less with stereotactic 16 M.D. UPDATE
With so much technology, radiation therapy requires a complex, multistep planning process. The first step is to get a CT scan of the patient in the position they will receive the radiation in to help calculate doses. Additional studies, such as MRIs or PET scans, are then completed based on the site of the tumor. Special software fuses all the scans in the computer system so the radiation oncologist can see all the images at once. The next step is a contouring process where physicians and staff map out the target area and the normal structures to avoid. The computer system then calculates the radiation doses and suggests the most effective and safest ways to administer the
radiation. Finally, “Before a patient receives treatment, because it’s so complicated now, there’s a quality assurance process where our physics staff treats a “phantom” patient with the exact same tumor to verify what the computer is saying is possible is actually possible on the radiation machines,” says Stacy. Once a course of radiation is administered, the radiation oncologist continues following the patient. Dr. Stacy emphasizes that, “There are certain areas where it is very important for radiation oncologist to be involved on long-term basis, specifically head and neck cancers because it is such a toxic treatment with long term effects.”
An Array of Options
Three-dimensional radiation therapy, utilizing CT scans for planning, used to be the most common type of external radiation. However, Stacy says most of the Radiotherapy Center’s patients now receive a more advanced type of radiation called Intensity Modulated Radiation Therapy (IMRT). It uses a process called inverse planning, where, instead of the physician directing the computer, the computer does the calculations and plots the best options. “The computer guides you because it is able to see a million ways to do it. It gives the radiation ways the human mind really would not have thought of or doesn’t have time to think about,” says Stacy. As opposed to 3-D radiation therapy, where physicians treat a region with large margins in order to blanket the tumor, IMRT focuses on much smaller areas, limiting toxicity. The problem is that tumors in some parts of the body move, such as in the prostate and the lungs. “If you’re going to do focused, small margins around the tumor, you have to verify that you’re radiating the right spot,” says Stacy. Image Guided Radiation Therapy (IGRT) was developed to address this issue. Stacy uses IGRT in conjunction with IMRT in almost every patient. Commonly used for skin cancers, elec-
tron beam therapy treats cancers on the surface to avoid radiation penetrating too deeply. “There are some internal forms of radiation too, but it’s fallen out of favor because there tend to be more side effects for patients and it’s harder to calculate radiation doses,” offers Stacy. This includes prostate cancer, for which Stacy prefers external radiation, although he acknowledges there are a few sites where brachytherapy is still the primary option, like in the case of cervical cancer. Another form of radiation is radionuclide therapy. These treatments, including a product called Samarium, have been used in bone metastasis in prostate and breast cancers to relieve pain and improve quality of life. Recently the FDA approved a new product called Xofigo® for use in prostate cancer bone metastasis patients. A Radium product, Xofigo actually provides an “overall survival advantage and has significant activity in reducing bone pain,” says Stacy. Treatments like Xofigo are available early to Radiotherapy Center patients because they participate in clinical trials with large pharmaceutical. Stacy says studies now focus on refining radiation therapy rather than proving its value, with a large focus on stereotactic techniques because they are so much more effective in preliminary studies. One of the challenges for radiation therapy practitioners is the continuous cost of keeping up with technology. “In this particular specialty, there’s a huge capital outlay. All these machines cost millions of dollars,” says Stacy. He predicts the longterm trend will be physicians forming multispecialty oncology groups to remain viable and contain costs. ◆
FOR PATIENT REFERRALS:
EE FR ncer ast Ca ent
Bre ssessm A Risk creening S 93
948-
43
Breast cancer isn’t convenient. Advanced care is. Nobody wants to get breast cancer. But if you do, it’s good to know that advanced care is nearby. Our multidisciplinary team collaborates to develop personalized treatment plans to meet every woman’s needs. Our breast cancer nurse navigator will guide you through the process, and our rehab and survivorship programs will help you return to the life you enjoy as quickly as possible. With the most cutting edge radiation technology in Southern Indiana and access to the latest clinical trials, we will show you that advanced breast cancer care is not only convenient, it’s personal.
1322 Spring Street Jeffersonville, IN 47130 812.285.6000 3920 Dupont Square Louisville, KY 40207 502.409.9701
floydmemorial.com/cancer Convenient locations in New Albany, Jeffersonville, Scottsburg, Salem and Corydon
MD Update Mamo2 4.85x10.indd 1
8/20/13 12:10 PM ISSUE#81 17
SPECIAL SECTION ONCOLOGY
A Breath of Fresh Air
Dr. Jonathan Kraut hopes new recommendations and increased access to annual CT screenings will significantly reduce lung cancer deaths in Kentucky BY JENNIFER S. NEWTON LOUISVILLE Thoracic surgeon Jonathan Kraut, MD, with Thoracic Surgical Specialists in Louisville, part of Baptist Medical Associates, says he chose thoracic surgery over general surgery and other specialties because of the impact he could make. “You can really affect a lot of change doing thoracic oncology,” he says. And change is upon us. In 2011, the National Lung Screening Trial (NLST), sponsored by the National Cancer Institute (NCI), published its findings, which cited a 20 percent reduction in lung cancer deaths for people who received low-dose helical CT scans compared to standard chest X-rays. While physicians such as Kraut began using CT scans as a screening tool based on those
cer. Because the Centers for Medicare & Medicaid Services (CMS) usually follow the guidelines of the USPSTF, this means that CT screening for high risk individuals should soon be covered by Medicare and Medicaid, with the hope that private insurers will follow.
Under a Dark Cloud
Kentucky has one of the highest per capita rates for tobacco use and lung cancer. “We find the vast majority of lung cancers we see are already progressed to the point where surgery is no longer a curable option,” says Kraut, estimating that group makes up twothirds of his patient population. According to the CDC National Program of Cancer Registries, lung cancer deaths in Kentucky were nearly 3,300 in 2009, and Kentucky ranked highest in the US in lung cancer incidence. Kraut attributes the prevalence in part to patient behavior but also to an inadequacy in getting patients the right care. “That’s our biggest problem, patients not having access to low-dose CT scans,” says Kraut. Kentucky’s barriers to access are trifold: geographical, Dr. Jonathan Kraut started the Multidisciplinary financial, and educaLung Care Clinic at Baptist Health in 2009. tional. The majority of rural patients findings, lung cancer screening just got a Kraut sees already have advanced lung boost in July 2013 when the US Preventive cancer. Currently patients have to pay out Services Task Force (USPSTF) issued guide- of pocket for lung CT screening, although lines recommending annual CT screening Baptist Health has negotiated the rate down for individuals at high risk for lung can- to $184. While primary care physicians are 18 M.D. UPDATE
certainly knowledgeable about medicine, they may not know who qualifies for screening or where to send those patients. “As a network, as a member of the medical community, we need to do a better job of educating primary care physicians,” says Kraut. He also notes that referrals often come from the front desk, so office staff needs to be educated as well.
Guiding Light
The USPSTF guidelines recommend annual CT screening for high-risk individuals who fit the following criteria: Current or former smokers ages 55-79 with a 30-pack year history of smoking. Pack years are defined by the number of cigarette packs smoked per day times the number of years smoked. Former smokers must have quit within the last 15 years. The American Cancer Society, The American College of Chest Physicians (ACCP)/American Society of Clinical Oncology/American Thoracic Society, The American Lung Association, and The National Comprehensive Cancer Network (NCCN) also recommend CT screening for similar populations. The NCCN recommendations, based on the NLST, differ in that they cover ages 55-74, and they also recommend screening for those ages 50 and up with at least a 20-pack year history and one additional risk factor.
Size Matters
The overall reduction in lung cancer deaths in the NLST study is a result of the numerous advantages of CT screening. Historically, chest X-rays were not used as a screening tool but a diagnostic one and often detected lung nodules incidentally. The downside to X-rays is their minimum threshold for detection, which is one to two centimeters in size. “CT scans are so accurate now they can pick up nodules that
are two millimeters in size,” says Kraut. By detecting nodules earlier, potential cancers are easier to surgically resect and require fewer additional treatments, such as chemotherapy and radiation. Smaller size nodules also make minimally invasive surgery an option. As opposed to traditional thoracotomies, minimally invasive techniques allow surgeons to resect lobes through several one-inch incisions using a camera. The benefits are less pain, less recovery time, and shorter hospitalization for the patient. One of the concerns with CT screening is the exposure to radiation. Kraut says the data is still evolving, so the true risk is not yet known. However, the National Lung Cancer Partnership estimates the amount of radiation exposure in the lung screening CT is equivalent to that of a mammogram. Once a CT detects a suspicious nodule, Thoracic Surgical Specialists use a solitary nodule calculator to get an estimate of the chance that nodule is cancerous. The surgeons then refer to ACCP guidelines
and Fleischner Society Recommendations for the follow-up and management of lung nodules. The NCCN is also a reference point.
Putting the Pieces Together
Kraut is part of the Multidisciplinary Lung Care Clinic at Baptist Health Louisville, which he and partner Robert W. Linker, III, MD, started in 2009 when they joined Baptist Medical Associate, part of the Baptist Health system. The physician group meets weekly to engage in prospective case review, resulting in coordinated and comprehensive decision-making and planning for each patient. “Basically the patient has several consults at one time, so they don’t have to go to several different offices and don’t have to wait weeks or months to get care,” says Kraut. The clinic includes specialists from medical oncology, radiation oncology, pulmonary medicine, thoracic surgery, radiology, pathology, and a nurse navigator. Kraut is working through the lung care clinic to educate primary care physicians
on early detection and the resources available. In addition to seminars and CMEs, last year he created a biennial oncology symposium for primary care physicians, focusing on lung, breast, colon, and prostate cancers. “If I had it my way, it would be a knee-jerk reflex. If you saw somebody with a nodule, you would just call our lung care clinic and get them set up for an appointment. Unfortunately, one of the downsides of more rural medicine is that they don’t always have all those resources available to them and they don’t always know who to call,” says Kraut. Beyond establishing and communicating an easy system for referring patients to the lung cancer screening program, Kraut believes a “bricks and mortar” cancer center is critical to improving access. To that end, Baptist Health will soon unveil the Charles and Mimi Osborn Cancer Center on campus to centralize cancer services. “It has to be something that’s tangible that people can identify as a destination for cancer care and where they can get all their treatment in one location,” says Kraut. ◆
Would you rather be here? Or HEAR?
Engineered for performance. ISSUE#81 19
SPECIAL SECTION ONCOLOGY
In the Pursuit of Prevention
Patients at high risk for breast cancer now have options beyond prophylactic surgery BY JENNIFER S. NEWTON Mention the word “mammogram,” and some women might cringe at the discomfort the test can cause. But like it or not, the majority of adult women are familiar with mammograms and their importance. Modern mammography has existed since 1969 and has long been an avenue of early detection for breast cancer. While still a screening staple, medicine has made giant strides beyond mammography in the pursuit of prevention. “Multiple trials have been published with outcomes indicating that we can prevent breast cancer in women considered to be at high risk,” says Ifeoma Roseline Okeke, MD, board-certified medical oncologist and hematologist with Floyd Memorial’s Cancer Center of Indiana. NEW ALBANY, IN
More than Mastectomy
In terms of prevention, Okeke educates patients on three options. First, she addresses lifestyle factors. “The behavioral modifications shown consistently in multiple trials to reduce risk of breast cancer are reduction in amount of alcohol consumption, exercise, and weight control,” says Okeke. She advises patients to limit alcohol intake and get regular exercise to maintain a healthy body weight. Then Okeke turns to medicine. The National Cancer Institute’s (NCI) Breast Cancer Prevention Trial (BCPT), published in 1998, and the Study of Tamoxifen and Raloxifene (STAR), published in 2006, demonstrated the effectiveness of these drugs in preventing estrogen receptor positive breast cancer. Tamoxifen and raloxifene (Evista®) are selective estrogen receptor modulators (SERMs). “They block effects of endogenous estrogen on normal breast tissue and breast cancer,” says Okeke. Tamoxifen has been available for decades and is FDA-approved for pre- and postmenopausal women. The STAR trial found tamoxifen, when taken daily for five years, prevented breast cancer by as much as 50 percent. STAR researchers demonstrated an equivalent success rate with raloxifene; 20 M.D. UPDATE
Dr. Ifeoma Roseline Okeke is a boardcertified medical oncologist and hematologist with Floyd Memorial’s Cancer Center of Indiana, who has a particular interest in the prevention and treatment of breast cancer.
however it is only approved for use in postmenopausal women. According to Okeke, early studies of a chemoprevention drug called exemestane are boasting successful effective rates upwards of 65 percent over a three-year period, but it is not yet FDA-approved for chemoprevention. Currently exemestane is used to treat post-menopausal women with breast cancer in the adjuvant and metastatic setting. Okeke cautions that physicians do need to familiarize themselves with the side effects of chemoprevention medications, however it is important to weigh the risks and benefits prior to prescribing these. Tamoxifen can cause blood clots and increases risk of endometrial cancer. Raloxifene can increase risk of thromboembolic events, though less often than tamoxifen. The catch is chemoprevention drugs only reduce the risk of developing estrogen receptor positive breast cancers. These
medications do not prevent hormone receptor negative breast cancers. “Women with BRCA1 mutation tend to have triple negative breast cancer and in the P1 prevention studies, tamoxifen was not effective in preventing breast cancer in these patients. Women with BRCA2 mutation had risk reduction of up to 62 percent with tamoxifen,” says Okeke. Prophylactic bilateral mastectomy is the most effective modality in preventing breast cancer, with success rates of over 90 percent. Okeke explains, “It is impossible to remove all breast tissue during prophylactic mastectomies, and mutated microscopic cells left behind can undergo malignant change. Risk reduction mastectomy should generally be considered in women with BRCA1/2 mutation, other strongly predisposing gene mutations, compelling family history, or women with Lobular Carcinoma.”
It’s in the Genes
Genetic testing is another avenue that is changing the way physicians and patients view prevention. Genetic mutations of BRCA1 or BRCA2 are responsible for five to 10 percent of all breast cancers linked to mutations. A woman who tests positive for a BRCA mutation has a lifetime risk of developing breast cancer of 50 to 85 percent. “Most women with these mutations, if they live long enough, will develop breast cancer,” says Okeke. The lifetime risk for ovarian cancer is 15 to 40 percent. Okeke says these women are also offered prophylactic oophorectomies (surgical removal of the ovaries). BRCA testing is indicated in patients with a significant family history of early onset breast cancer or ovarian cancer,
patients that develop breast cancer at a Brown Cancer Center in Louisville, cancer either due to family history, prior young age, patients diagnosed with two Okeke’s interest in breast cancer began biopsy reports, or just wants more inforprimary breast cancers or breast and ovar- while practicing in Akron, Ohio, before mation, we want to create a center that ian cancer (including fallopian tube and coming to Floyd Memorial. “There are so she can turn to close to home, to properitoneal cancer), and male breast cancer. many aspects to breast cancer care, and it vide her with resources to address these concerns,” she says. Okeke also Although the cost of genetic hopes to reach women through testing can be prohibitive, most RESEARCH HAS SHOWN YOU CAN ACTUALLY their primary care physicians insurance companies will cover the and in the community through cost if the clinical criteria are met. DO SOMETHING TO PREVENT BREAST self-referrals. Women found to Okeke says the genetic lab they utiCANCER IN WOMEN CONSIDERED HIGH RISK. be high risk would be admitted lize has programs to assist the unininto the program, educated about sured and underinsured patients. their prevention options, and referred to For women with germline mutation keeps evolving with regards to genetics, the appropriate provider. who choose not to undergo prophylac- prevention, clinical research and molecular Her prevention efforts extend beyond tic mastectomies, Okeke advises aggressive targeted therapies. It is very dynamic and the walls of the Cancer Center through screening beginning at age 25. This includes interesting,” she says. clinical breast exams by a physician two-toOkeke’s goal is to develop a breast educational seminars and CMEs to discuss four times a year, monthly breast self-exams cancer prevention clinic at the Cancer risk assessment and prevention. Women are living longer with breast starting at age 18, annual breast MRI/ Center of Indiana. While no specific mammogram, and consideration of chemo- plan is in place yet, Okeke envisions a cancer than they did 20 years ago, and prevention. MRI has been found to have multidisciplinary approach, involving a regular screening is key to early detection. greater sensitivity in disease detection than medical oncologist, plastic surgeon, breast But for Okeke, “Prevention is the one mammogram in these patients. surgeon, psychologist, genetics special- aspect of breast cancer care that has been ist, clinical research personnel, and nurse lagging behind nationwide.” It is her hope navigator. “When a woman has concerns that education and increased awareness can Waving the Red Flag Fellowship-trained at the James Graham regarding her risk of developing breast change that. ◆
ISSUE#81 21
SPECIAL SECTION ONCOLOGY
Saint Joseph Ambulatory Imaging Services Sees Opportunity in a Niche Market Outpatient imaging centers in the suburbs to be user-friendly and convenient BY GIL DUNN
LEXINGTON According to a published report in Radiology Business Journal (August 2013), from 2003 to 2011, “the outpatient imaging center market exhibited consistent year-over-year increases in the number of centers” operating, likely due to the rapid expansion of imaging utilization. Seeing an opportunity for patient growth in a niche market, KentuckyOne Health, which operates Saint Joseph facilities across Central Kentucky and has opened the first and “the only hospital-owned Independent Diagnostic Testing Facilities in the state,” according to Director, Adam Gossom, RT (R), (ARRT). These Saint Joseph Outpatient Care Centers are located in Richmond, KY and off Tates Creek Rd
in south Lexington. As Director of Ambulatory Imaging Operations for Central and Eastern Kentucky, Gossom believes that patient comfort, convenience, and an overall exceptional patient experience will be the key factors in his centers’ success. The challenge, says Gossom is assuring both patients and referring physicians that imaging in a retail environment is comparable to the hospital based results, without the difficulties inherent in a visit to a hospital, 22 M.D. UPDATE
THE CHALLENGE IS ASSURING BOTH PATIENTS AND REFERRING PHYSICIANS THAT IMAGING IN A RETAIL ENVIRONMENT IS COMPARABLE TO THE HOSPITAL BASED RESULTS.
PHOTOGRAPHY COURTESY SAINT JOSEPH
ABOVE: Siemens Fluoroscopy for upper and lower GI LEFT: Adam Gossom, RT (R), (ARRT), director of Ambulatory Imaging Operations, says his team focuses on patient comfort and care. BELOW: CT scans have dose reduction software for patient well being
such as distance from home, unfamiliar setting and difficult parking. One strong advantage is the Saint Joseph brand name in Central Kentucky. “Being connected to Saint Joseph and having the images read by the same board certified radiologists as in our hospitals, has helped,” says Gossom.
Direct Access: Plug Into D. Scott Neal’s Expertise With D. Scott Neal’s financial planning and guidance, you have direct access to the power of his knowledge and the energy of his wealth management philosophy. No middle man to take a cut, water down the plan, or slow the process.
Comfort, Perks, and State-of-the-Art Imaging
To enhance the patient experience Gossom says his team focuses on comfort and care while giving patients “the best radiology experience they’ve ever had. We offer our patients a relaxed, spa-like atmosphere with private dressing rooms, heated spa robes, spa music, dark chocolates, a calming décor, and easy, accessible parking in front of the facility.” Imaging services offered at the south Lexington location include digital screening mammography, ultrasound (general, OB, and vascular), bone density screening that accommodates up to a 450-lb weight limit (as opposed to a 300 lb limit), a Siemens Luminous Agile x-ray, plus fluoroscopy for lower and upper GI. This is the latest technology from Siemens, and unlike other tables, it accommodates over 600 lbs and is height adjustable. “This technology is fantastic and is completely digital,” says Gossom. CT scan is also available with dose reduction software. “People are becoming more and more aware of radiation doses, so I felt that this technology was important to offer our patients,” says Gossom.
Cost Saving for Patients
As the Affordable Care Act comes into play, January 2014 and an estimated 400K+ new patients are added to Medicaid in Kentucky, an influx of patient visits to all imaging centers is expected. Additionally, previously uninsured individuals will now participate in the Kentucky Insurance Exchange with a variety of deductibles. Being an Independent Diagnostic Testing Facility, we can provide more affordable care to our patients and their payers. We offer the same high quality services that you would receive in a hospital but we are able to charge less than hospital rates and be easily accessible and close to home for our patients, says Gossom. ◆
With D. Scott Neal, the connection is direct, the possibilities are electrifying. Call Scott. Plug in.
F E E - O N LY F I N A N C I A L P L A N N I N G
Lexington | Louisville | Cincinnati 800.344.9098 |
D S N E A L . C O M
MEDICAL CONSULTANT POSITIONS Social Security Administration Kentucky Disability Determination Services Qualified Candidates will:
Be a U.S. Citizen
Have a current license in your specialty
Review electronic and paper disability claims
Provide consultant services to Disability Adjudicators
Provide medical evaluations of disability claims
Social Security needs your help to meet the demands of today’s disability claims workload.
Contact: Todd Mobley 502-782-1538
ISSUE#81 23
SPECIAL SECTION ONCOLOGY
Cancer Patient Rehabili tation Gets the STAR Treatment ®
Saint Joseph Hospitals Embrace Nationally Recognized Cancer Survivorship Rehab Program By Gil Dunn Saint Joseph Breast cancer surgery Park Physical Therapy in the SJH Medical Hospital (SJH) Rehabilitation patients make up the Office Building; Saint Joseph East; Saint Manager Vickie Heierman, majority of SJH STAR® Joseph Jessamine and the Beaumont Center a 34 year veteran of Saint outpatient rehab clients, YMCA in Lexington. Joseph, wanted to expand but are not the totaland improve the rehabilitaity. Heierman lists patients Pre-Habilitation: tion services for cancer surviwith esophageal, brain, The Next Great Thing vors by having her clinicians rectal, stomach, ovarian Heierman is particularly enthused about the better trained and better cancer and all types of can- advent of a “pre-habilitation program for prepared. In October 2012, cer who can benefit from cancer patients” which she projects to begin under Heierman’s leadership, the STAR® and ASTYM® before the end of 2013. Pre-habilitation is SJH initiated the STAR® Vickie Heierman, PT, STAR® rehab protocols. ASTYM® the process on the continuum of care that Program and Certification Coordinator, Saint Joseph treatments range from 6 to occurs “anywhere from two to six weeks (Survivorship Training and Rehab Manager 12 sessions and patients are after diagnosis and before surgery or treatRehabilitation), an evidencetypically discharged with ment begins,” says Heierman. based, reimbursable training program from greatly improved functionality, decreased The benefits to pre-habilitation are mulOncology Rehab Partners (ORP). pain, and the skill and knowledge to manage tiple, including establishing a pre-treatment According to ORP’s website, STAR® was their physical stresses. baseline status of a patient’s mobility and developed by Julie Silver, MD, an assistant Twenty five SJH staff members con- function; identifying pre-treatment impairprofessor at Harvard Medical School, a sisting of PT’s, OT’s, Speech Therapists, ments; and improving the physical and cancer survivor and author of several books Nurse Navigators, social workers and even mental health of the patient prior to treaton cancer rehabilitation. Heierman says chaplains received certification after a 20 ment. These, in turn, can result in reduced that “rehabilitation and pre-habilitation for hour multi-discipline online course. STAR® morbidity or mortality from treatment and cancer patients are often overlooked and for cancer survivors is offered at four decreased hospital stay or readmissions. people think they have to live with the full central Kentucky locations: Saint Joseph To gauge the effectiveness of the STAR® side effects of chemotherapy program, SJH Rehab uses and surgery. But rehabilitation a “Distress Management” NCCN Guidelines™ Version 1.2011 Distress Management and pre-habilitation can really questionnaire for patient satisfaction and staff evaluimprove the quality and quanation. (See Chart) The tity of a patient’s life.” Distress Management quesScarring from mastectotionnaire from the National mies, for example, takes an Comprehensive Cancer enormous toll on breast can10 Extreme distress Network provides Heierman cer survivors, both physically 9 8 and her staff with “an objecand psychologically. Scar tis7 tive, evidence-based tracking sue can prevent simple tasks 6 of a patient’s progress towards such as brushing hair, dressing 5 4 recovery with functional outor doing simple daily tasks. 3 come measures,” she states. Heierman says that Saint 2 Heierman stresses that Joseph physical and occupa1 0 No distress doctors and patients need tional therapists employ the to know that pre-habiliASTYM® (advanced soft tissue tation and rehabilitation mobilization) treatment sysservices are beneficial and tem for rejuvenating damaged available to cancer patients soft tissue, using ergonomiThe Distress Management questionnaire provides objective who have just been told, cally designed tools designed evidence –based tracking of a patient’s progress towards recovery. “You have cancer.” ◆ to increase blood flow.
LEXINGTON
NCCN Guidelines Index Distress Management TOC Discussion
SCREENING TOOLS FOR MEASURING DISTRESS
Instructions: First please circle the number (0-10) that best describes how much distress you have been experiencing in the past week including today.
10 9
Second, please indicate if any of the following has been a problem for you in the past week including today. Be sure to check YES or NO for each. YES NO Practical Problems YES NO Physical Problems q q Child care
q q Appearance
q q Housing
q q Bathing/dressing
q q Insurance/financial
q q Breathing
q q Transportation
q q Changes in urination
q q Work/school
q q Constipation
q q Treatment decisions
q q Diarrhea q q Eating
Family Problems
q q Fatigue
8
q q Dealing with children
q q Feeling Swollen
q q Dealing with partner
q q Fevers
7
q q Ability to have children
q q Getting around
q q Family health issues
q q Indigestion
6
Emotional Problems
5
q q Depression
4
q q Fears
3
q q Sadness
2 1 0
q q Nervousness q q Worry
q q Loss of interest in usual activities
q q Memory/concentration q q Mouth sores q q Nausea
q q Nose dry/congested q q Pain q q Sexual
q q Skin dry/itchy q q Sleep
q q Tingling in hands/feet
q q Spiritual/religious concerns
Other Problems: _________________________________________ ________________________________________________________
Version 1.2011, 10/12/10 © National Comprehensive Cancer Network, Inc. 2010, All rights reserved. The NCCN Guidelines™ and this illustration may not be reproduced in any form without the express written permission of NCCN®.
Reproduced with permission from the NCCN 1.2011 Distress Management Guidelines. To view the most recent and complete Guidelines, go online to www.nccn.org.
24 M.D. UPDATE
DIS-A
NEWS EVENTS ARTS
KentuckyOne Names Alagia Chief Medical Officer
LOUISVILLE Damian “Pat” Alagia III, MD, joined KentuckyOne Health as chief physician executive and chief medical officer effective Sept. 16. Alagia is an experienced clinician, healthcare executive, and entrepreneur. Prior to coming to KentuckyOne Health, Alagia worked as an executive in two private equity-backed companies, first as the president of Safe Sedation, a provider of anesthesia services to ambulatory surgery centers and office-based practices, and later as the chief medical officer of Novasys Medical, the creator and developer of an office-based technology used to treat female incontinence. Alagia attended Georgetown University as an undergraduate and completed medical school and residency training at the same institution. Following his residency and while building the practice, he earned MSB and MBA degrees in finance from the John Hopkins University and served as the president of the Medical Society of the District of Columbia. Alagia is a board-certified OB/GYN who completed three years of general surgical training at the University of Louisville Hospital before finishing his obstetrics
SEND YOUR NEWS ITEMS TO M.D UPDATE > news@md-update.com
and gynecology training at Georgetown University Hospital. Alagia was founding partner of a group OB/GYN practice in McLean, Va., and later was founding director of the Minimally Invasive Gynecology Surgery program at George Washington University Hospital.
Physicians Join Lexington Clinic
LEXINGTON Lexington Clinic is pleased to announce the association of Chih C. Chang, MD, with the Lexington Clinic Endocrinology Department at Lexington Clinic South Broadway. Chang received his medical degree from the University of Louisville School of Medicine. He completed an internship and residency in Internal Medicine at the Dwight David Eisenhower Army Medical Center and a fellowship in Endocrinology at the University of Louisville School of Medicine. Chang is board-certified in Internal Medicine and Endocrinology. Lexington Clinic is pleased to announce the association of Gabriel H. Phillips, MD, with the Lexington Clinic Neurosurgery Department at Lexington Clinic at Saint Joseph Office Park. Phillips received his medical degree from the University of Tennessee Health Science Center College of Medicine. He completed a residency in Neurosurgery at the University of Tennessee - Memphis. Phillips is board eligible in Neurosurgery.
His professional interests include minimally invasive spinal procedures, spinal fusions, neurosurgical oncology, and stereotactic radiosurgery.
Physicians join Baptist Medical Associates
LOUISVILLE R. Ryan Johnson, MS, DO, family medicine, has joined Baptist Medical Associates located at 9070 Dixie Hwy., Suite 6. Johnson is a 2005 graduate of the Lake Erie College of Osteopathic Medicine in Erie, Penn. He completed his family medicine residency at the Fort Wayne Medical Education Program in Indiana in 2008. Johnson completed a hospitalist fellowship at the Fort Wayne Medical Education Program in 2009. He is board certified in family medicine.
Robert Cacchione, MD, general surgery, has joined Baptist Surgical Associates located at 4001 Kresge Way, Suite 210. Cacchione is a 1994 graduate of the University of Pittsburgh School of Medicine. He completed his general surgery internship and
ST.˛MATTHEWS
2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com
ISSUE#81 25
NEWS
Epidurals Facet Blocks
Intrathecal Pumps Vertebroplasty
Spinal Cord Stimulation Neurolytic & Sympatholytic Denervation
MAIN OFFICE: 2416 Regency Rd, Lexington KY 40503
26 M.D. UPDATE
SATELLITE OFFICES: 181 Roy Campbell Dr, Hazard 110 Hardin Ln STE 4, Somerset
residency at the University of Louisville in 1999. Cacchione completed a laparoscopic surgery fellowship at Staten Island University Hospital in Staten Island, N.Y. in 2000. He is board certified in general surgery. LOUISVILLE MedEast Physicians, along with its occupational medicine services, has joined Baptist Medical Associates. The practice is located at 4003 Kresge Way, Suite 410.  Melissa Barrett, MD, is a 1984 graduate of the Tulane University School of Medicine in New Orleans, La. She completed her internal medicine residency at Worcester Memorial Hospital in Worcester, Mass., in 1987. She is board certified in internal medicine and is a certified medical review officer and senior aviation medical examiner.  Charles Bowlds, MD, is a 1977 graduate of the University of Louisville School of Medicine. He completed his internal medicine residency at the University of Louisville in 1980. Bowlds is board certified in internal medicine and is a certified medical review officer and senior aviation medical examiner.  Joseph Cecil Jr., MD, is a 1972 graduate of the University of Louisville School of Medicine. He completed his internal medicine residency at the Medical College of Wisconsin in Milwaukee in 1975. He is board certified in internal medicine.
NEWS
 Arthur Hurst Jr., MD, is a 1970 graduate of the University of Louisville School of Medicine. He completed his internal medicine residency at Baptist Memorial Hospital in Memphis, Tenn., in 1976. He is board eligible in internal medicine and is a senior aviation medical examiner.  Mary Lewis, MD, is a 1984 graduate of the University of Louisville School of Medicine. She completed her internal medicine residency at the Hospital of St. Raphael, affiliated with Yale University, in New Haven, Conn., in 1987. She is board certified in internal medicine and is a certified medical review officer and senior aviation medical examiner.
Kenney joins Baptist Northeast Orthopedics
Nicholas Kenney, MD, orthopedic surgery, has joined Baptist Northeast Orthopedics, part of Baptist Surgical Associates. He will see patients at 1023 New Moody Lane, Suite 102, La Grange; and 2400 Eastpoint Pkwy., Suite 110, at Baptist Health Eastpoint near Anchorage. Kenney is a 2007 graduate of the University of Louisville School of Medicine. He completed his orthopedic surgery residency at the University of Florida in Gainesville in 2012. Kenney recently
LA˛GRANGE
completed an orthopedic surgery sports medicine fellowship at the University of Kentucky. He is board eligible in orthopedic surgery.
Swift joins Baptist Cardiac Surgery
LOUISVILLE Vicky Swift, APRN, has joined Baptist Cardiac Surgery, part of Baptist Surgical Associates. Swift is a 2011 graduate of the family nurse practitioner program at Indiana Wesleyan University in Marion, Ind. She also holds a bachelor’s degree in nursing from Indiana Wesleyan University and an associate degree in nursing from Jefferson Community and Technical College.
Head joins Thoracic Surgical Associates
LOUISVILLE Amy Head, APRN, has joined Thoracic Surgical Associates, part of Baptist Surgical Associates. Head is a 2012 graduate of the family nurse practitioner program at Indiana Wesleyan University in Louisville. She also holds a bachelor’s degree in nursing from Indiana Wesleyan University and an associate degree in nursing from Jefferson Community and Technical College.
Lockhart joins Baptist Bariatric Surgery
LOUISVILLE R. Jane Lockhart, APRN, has joined Baptist Bariatric Surgery,
part of Baptist Surgical Associates. Lockhart is a 2004 graduate of the family nurse practitioner program at Spalding University in Louisville. She also holds a bachelor’s degree in nursing from Bellarmine University.
Baptist Health Names Jahn Chief Clinical Officer
LOUISVILLE Timothy Jahn, MD, has been named Baptist Health chief clinical officer effective Nov. 4. Jahn currently serves as system chief medical officer for Abrazo Health, a six-hospital system in Phoenix, Ariz., owned and operated by Vanguard Health Systems (based in Nashville, Tenn.). In this newly expanded role, Jahn will oversee quality initiatives and clinical integration to ensure a collaborative approach that provides higher quality, better coordinated, and more efficient care for patients. In addition, Jahn will have responsibility for information technology, assuring that the information and clinical systems Baptist Health implements truly assist caregivers in providing top-level care. As an internal medicine specialist and emergency physician, Jahn’s 27-year career in healthcare includes hands-on experience as a practicing physician in a multispecialty practice, and a dozen years in the U.S. Navy, including service as a flight surgeon. In his administrative roles, he has led major quality and patient safety initiatives at for-profit and faith-based healthcare systems.
Baumgartner Named President of Baptist Health Madisonville
MADISONVILLE, KY. Michael A. Baumgartner has been named president of ISSUE#81 27
NEWS
18th Annual Doctors’ Ball Honors Physicians and Leaders
Baptist Health Madisonville, effective Sept. 23. Baumgartner currently serves as president of St. Francis Regional Medical Center in Shakopee, Minn. He succeeds Baptist Health Madisonville President E. Berton Whitaker, who announced his September 2013 retirement in April. Baumgartner, 57, brings more than 34 years’ experience as president of various hospitals from North Dakota to Missouri. In his current leadership role, Baumgartner has fostered the growth of St. Francis from a small community hospital to a comprehensive regional medical center, ranked in the top 10 percent nationwide for quality. Baumgartner’s healthcare career includes consistent highlights in improved financial strength, collaborations among physicians and hospital leadership, improved efficiencies through technology and IT advances, and a strong focus on giving back to the community. Current President Bert Whitaker announced his retirement in April, after serving Baptist Health Madisonville since June 2006. He led the transition from Trover Health System to Baptist Health, effective November 2012, and counts among his accomplishments the growth of the medical staff, completion of a $1.8 million physician office space and expanded services throughout the region, including two clinics in area Walmart stores to treat minor injuries and illnesses.
UK HealthCare, Appalachian Regional Healthcare, and Appalachian Heart Center Join Forces
LEXINGTON Appalachian Regional Healthcare (ARH), Appalachian Heart Center (AHC), and UK HealthCare’s Gill Heart Institute have announced they will join forces to deliver the highest quality and state-ofthe art cardiovascular care to residents of Eastern Kentucky. This collaboration will improve access to patient-centered care and create an extension of the Gill Heart Institute into the region. It also provides patients access to UK’s comprehensive cardiovascular exper28 M.D. UPDATE
LOUISVILLE For 18 years, the annual Doctors’ Ball, hosted by the Jewish Hospital & St. Mary’s Foundation, part of KentuckyOne Health, has honored the service of area physicians and community leaders. This year’s event is planned for October 19, 2013 at the Marriott Louisville Downtown at 280 West Jefferson Street in Louisville. The 2013 Doctors’ Ball will recognize some of the area’s most innovative and caring doctors and community leaders including: Frank B. Miller, MD Ephraim McDowell Physician of the Year Lindy & Bill Street Community Leaders of the Year Muhammad Babar, MD Excellence in Community Service Bryan Carter, MD Excellence in Mental Health Mary Fallat, MD Compassionate Physician Award Luis R. Scheker, MD, & Tsu-Min Tsai, MD Excellence in Education
The black-tie event will include cocktails and silent auction beginning at 6:30 p.m., then dinner and an awards ceremony at 8 p.m. Live entertainment will be provided by Groove Essential. Tickets are $250 each. To purchase tickets to the Doctors’ Ball, visit kentuckyonehealth.org/DoctorsBall or call 502.587.4596. tise and resources while maintaining the familiarity of community health care providers. Dr. Vidya Yalamanchi, Dr. Rao Podapati and Dr. Srini R. Appakondu from the Appalachian Heart Center, longstanding icons for cardiovascular care in the region, will team up with the Gill Heart Institute for advanced treatment options not readily available in the local area. The physicians will also become UK College of Medicine faculty members. The AHC cardiologists will join the Gill Heart Institute team providing services in Hazard including UK’s specialty cardiologists who are currently seeing patients in the area, as well as Dr. Edward Setser, UK cardiothoracic surgeon who began performing cardiothoracic procedures including coronary revascularization and heart valve replacements in Hazard in 2011. In addition, UK HealthCare and ARH have agreed to jointly administer and manage cardiovascular services at Hazard ARH and five other ARH hospital locations throughout Eastern Kentucky. The agreement includes the Hazard ARH Regional Medical Center, Harlan ARH Hospital, Whitesburg ARH Hospital, McDowell ARH Hospital, Mary Breckinridge ARH Hospital, and Williamson ARH Hospital. In addition, the Appalachian Heart Center has clinics in Hazard, Harlan, Hyden, and Cumberland.
Flaget Memorial Hospital Opens New Primary Care Office
Flaget Memorial Hospital, part of KentuckyOne Health, has opened a new primary care facility in Willisburg – KentuckyOne Primary Care. Connie Pate, APRN, will provide care at the office, which will offer a variety of services including annual physical exams, well-woman exams, and preventative health consultations. Additionally, the clinic will treat acute illnesses and chronic conditions such as hypertension, asthma, and diabetes.
WILLISBURG
New Eastern State Hospital Opens
LEXINGTON Steve Beshear joined local leaders, state officials and representatives from University of Kentucky and UK HealthCare for a ribbon-cutting at the new Eastern State Hospital facility on September 4. The new hospital is located at UK’s Coldstream Research Campus in Lexington. The 239-bed, approximately 300,000-square-foot replacement facility will provide a modern setting for inpatient psychiatric treatment, along with specialized services for individuals with acquired brain injuries, and individuals with psychiatric disabilities requiring nursing facility level of care and forensic mental health services.
ISSUE#81 29
NEWS In addition to the inpatient hospital, the new Eastern State Hospital campus will include three 11,000-square-foot personal care homes, each with 16 beds, offering a less restrictive level of care that promotes patients’ return to a community setting. These personal care homes will provide residential psychiatric services and serve as a step down from the acute care setting. The $129 million facility replaces the 185-year-old Eastern State Hospital, the
second oldest psychiatric hospital in the country. It will be managed and operated by UK HealthCare, through an agreement with the Cabinet for Health and Family Services (CHFS). This new partnership will not only maintain and improve quality patient care, but also allows UK to leverage its considerable expertise in research and clinical therapies to modernize treatment options while training the next generation of behavioral health providers.
Baumann Recognized for Service to Kentucky’s Children
LEXINGTON Since his arrival at the University of Kentucky in 1972, Dr. Robert Baumann has been on a mission - a mission to reach as many Kentucky children as possible to provide neurological care they may not oth-
erwise receive. Last week, Baumann was recognized for his dedication to the health of children by being named the recipient of the Kentucky Chapter of the American Academy of Pediatrics’ Don Cantley Community Service Award. The UK HealthCare Child Neurology Satellite Clinics were established to help patients in outlying parts of the state get the follow-up care they need. These patients - all under the age of 21 - suffer from neurologic disease, the most common being epilepsy. Other patients may suffer from migraines, cerebral palsy, muscle disease, brain tumors or hydrocephalus. In addition to Manchester and Pikeville, clinics are now held in Ashland, Prestonsburg, Barbourville, Hazard, Morehead and Somerset. ◆
CORRECTION: The “Cassis Dermatology & Aesthetics Center” article in Issue #80 of M.D. Update incorrectly identified Erivedge (vismodegib) as FDA-approved for basal cell nevus syndrome. Erivedge is currently only FDA-approved for recurrent basal cell carcinoma and inoperable basal cell carcinoma. 30 M.D. UPDATE
EVENTS
GLMS Foundation Scholarship Golf Tournament 2013
LOUISVILLE The Greater Louisville Medical Society Foundation held its 3rd annual Scholarship Golf Tournament on Monday, September 23, 2013 under perfect weather conditions at the Hurstbourne Country Club. Sixteen teams of players, physicians and businesspeople participated in the shamble format. The Scholarship Golf Tournament raises scholarship funds for University of Louisville medical students. On Monday $20,000 in scholarship funds were announced and given to Heather J. Bellis-Jones, B. Ryan Nesemeier and Alex A. Thomas. Winners were selected based on outstanding academics and community service and each received a $5,000 check. Bryan A. Lamoreau received the Jewish Hospital & St. Mary’s Foundation Healthcare Horizons Award of $5,000. The tournament championship team, sponsored by Stock Yards Bank, was Bart Brown, Jonathan W. Pratt, MD, Rick Tobe and Michael D. Weaver, DO. The second place team, sponsored by Merrill Lynch was Pam Gregory, Tommy Gregory, Dawn Stambaugh and Ron Stambaugh. Third place went to the team co-sponsored by Clark Memorial Hospital and Republic Bank: Steve DeWeese, Bhupesh Pokhrel, MD, Camela A. Pokhrel, MD, and Joseph L. Thompson, MD. A special “Worst Putter Award” – sponsored by Mary G. Barry, MD, in memory of her father, journalist Mike Barry – was given to a well known hand surgeon from an internationally known plastic surgery and hand transplant group, who will remain anonymous in accordance with M.D Update’s policy of “do no harm” to physicians or their reputation. During the Scholarship Golf Tournament, players were treated to brunch, luncheon baskets and a cocktail reception. There was a live auction and a raffle to raise money for the scholarship fund. ◆
Winning team at the GLMS Foundation Scholarship Golf Tournament was (l-r) Bart Brown, Rick Tobe, Jonathan Pratt, MD, Michael Weaver, DO.
Bob Clarkson and Marty Walthers played a speed round for the Clarkson Insurance Agency team. Dr. Michael McCall’s drive was pinhigh but ten feet to the right on the Hole in One contest for a new car. (Left right) Michael McCall, MD, Nathan Polley, MD, Travis Schutt, John Yusk, MD. Tournament sponsor Stock Yards Bank had Bob Hecht, VP, Chris Ocschner, Kirk Owens, MD, & Josh Meijer, MD playing their best game.
Kleinert Kutz Hand Care Center fielded a team with Tsu-Min Tsai, MD, Bob Mackin, CEO, and was joined by Charles Bisig, MD and Tommy Thompson, MD of Thompson & Chou Center for PM&R.
Toni Ganzel, MD, dean of U of L School of Medicine relaxes with scholarship recipient B. Ryan Nesemeier and Linda Gleis, MD GLMS Foundation Scholarship Committee chair.
KMA Annual Meeting
David J. Bensema, MD, KMA Chair of the Board of Trustees & KMA President-elect with new KMA president, Fred A. Williams, MD
LOUISVILLE Drug addiction and prescribing controlled substances were the topics addressed by the keynote speakers at the KMA Annual Meeting, September 9-11, 2013. Dr. Ardis Hoven, president of the AMA addressed the House of Delegates. KMA delegates passed resolutions calling for continued effort on tort reform and supporting statewide legislation restricting smoking in public places, an initiative of the Committee on Health & Welfare of the Kentucky House of Representative, led by Susan Westrom, (D) 79th, Lexington. New KMA president, Fred A. Williams, MD and KMA Alliance president Mrs. Rhonda Rhodes were sworn in by Chair of the Board of Trustees David J. Bensema, who is KMA President-elect. ◆
ISSUE#81 31
EVENTS
Lexington Medical Society Golf Outing
The 24th annual Lexington Medical Society (LMS) Golf Tournament was played under blue skies and comfortable weather conditions on Wednesday August 28, 2013 at the University Club in Lexington with 100 golfers participating. The winning team in the 18 hole shamble format was Scott Carling, Pat Cashman, Jim Hixson and Jay Rutherford of the team sponsored by SIS. Second place went to the Professionals Insurance Agency team of Ben Asher, MD, John DeWeese, Jeff Heile and John Horn. Third place team was Chris Ball, Jason Harris, MD, Pat Harris and Steven Slater The LMS golf outing was started 24 years ago to bring physicians and community members together, said John Collins, MD, Lexington Clinic, chair of the LMS Golf Committee and tournament organizer. The first outing was about 40 participants. The proceeds from the tournament go to the Lexington Medical Society Foundation which takes request for needy organizations with connections to the medical field. The LMS Foundation was originally organized to start the local blood bank. Now organizations such as Baby Health, Nathanial Mission and more recently Surgery on Sunday are being supported. “These are outstanding examples of serving the medical needs of citizens who fall through the cracks in our health care system. Doctors and nurses volunteer at these organizations to provide care at no charge or minimal charge,” said Collins. ◆ LEXINGTON
Lexington Clinic team at the Lexngton Medical Society Golf Outing included (l-r) John Sartini, MD, Michael Cecil, MD, John Collins, MD, and John Douglas John Dineen, Lexington Clinic, keeps his head down for his approach shot while Bruce Broudy, MD, and his son Brian Dineen look on.
An experienced team of golfers from Professionals Insurance Agency finished in 2nd place at the LMS Golf Outing. All smiles are (l-r) Ben Asher, MD, John Horn, John DeWeese & Jess Heile.
M.D. Update took a day off to play golf with team members (l-r) Peyton Tierney with Mass Mutual, Joe Hill, MD, Plastic Surgeons of Lexington, Calvin Rasey of Physician Financial Services and Gil Dunn, publisher, M.D. Update.
Mike Marnhout, of Bluegrass Oxygen looks please with his shot and delivers a classic follow through.
James shambhu New Figurative work November 14-December 17 opeNiNg November 15 gallery Hop fashion + accessories + fine art 116 old lafayette avenue ring: 859-317-8793 W& F, 11:30-5:30 or by appointment @ anytime 32 M.D. UPDATE
Š 2013 Baptist Health
NO ONE
BEATS CANCER ALONE. LET A NURSE NAVIGATOR GUIDE YOU THROUGH BREAST CANCER TO RECOVERY. A Baptist Health nurse navigator can assist you with every aspect of your fight against breast cancer, by helping you ask the right questions and understand the answers when it comes to your diagnosis and your treatment options. She can also help coordinate appointments, so you can focus on your recovery. For more information, call the Baptist Health Cancer Resource Center at (502) 896-3009.
BaptistHealthLouisville.com/BreastCancer
W4 O N LL , 201
OMar. 31 R N E ct. 1– O
We’ve got great news for your uninsured patients.
Quality Health Coverage. For Every Kentuckian.
Now everyone can afford the healthcare coverage they need. You know that covered patients are healthier patients. And now, kynect, Kentucky’s Healthcare Connection, is making that a reality for everyone. From now on, no one has to choose between medical care and other necessities. Even better, kynect will make wellness and preventive care a priority. So you can deliver the highest quality of care and better outcomes for all of us. Help your patients take the first step and let them know how easy it is to enroll. kynect.ky.gov
1-855-4kynect