M.D. Update Issue #88

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #88

SPECIAL SECTIONS ORTHOPEDICS AND PHYSICAL MEDICINE & REHAB

DRS. GREG AND LINDA GLEIS CARVE COMPLEMENTARY PATHS TO EVER-EVOLVING CAREERS IN ORTHOPEDICS AND PHYSICAL MEDICINE AND REHAB

The Dynamic Duo ALSO IN THIS ISSUE VOLUME 5, NUMBER 6

 SPINE CENTER IN DANVILLE  SHOULDER/ELBOW EXPERT JOINS LEXINGTON CLINIC  ANTERIOR APPROACH HIP REPLACEMENT IN LAGRANGE  PM&R GROWS AT UOFL  RHEUMATOLOGISTS INCREASE INDEPENDENCE  APEX PT EMBRACES NEW BUSINESS MODEL

life

With each new first, we give more people a second chance at

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See all of our firsts at KentuckyOneHealth.org/heart.

Saint Joseph Heart Institute and Jewish Heart Care are now known as KentuckyOne Health Heart and Vascular Care.

KentuckyOne Health. The one name in heart care.

LETTER FROM THE PUBLISHER

Know Your Local School Board Member and Use Your Gravitas “I’d like to see physical education classes, taught every day, brought back to all schools in Kentucky,” said Dr. Miren Asumendi of Louisville to a round of applause after she stepped up to the microphone and addressed Lt. Governor Jerry Abramson at the KMA Annual Meeting on September 16, 2014. “I can tell you from my practice that exercise benefits mental health as well as physical health.”

Exercise and physical therapy rehabilitation in conjunction with minimally invasive joint and spine surgery is a recurring theme running through this edition of MD-Update.

In alignment with that theme, Dr. David Bensema, KMA president, says that reducing obesity among Kentuckians is this year’s KMA primary focus.

Abramson emphatically stated in his speech that economic decision-makers are focusing on the health of the population, including “the BMI of our 9th graders” when determining to locate in Kentucky. That’s a report card we know that puts Kentucky near the bottom in many health categories.

The good news, according the Abramson, is that some progress is being made.

Having 527,000 Kentuckians now with health insurance through Kynect should improve access to preventative health care. Kyhealthnow, “the state’s aggressive and wideranging health initiative sets goals and strategies for the health outcomes of Kentucky citizens.” Medicaid now covers smoking cessation treatments.

Speaking of smoking cessation, Abramson noted how in the past 2014 session, the Democratic-controlled House of Representatives passed “Smoke Free Kentucky” legislation, but the Republican-controlled Senate did not. According to Abramson, there are 173 school districts in Kentucky but only about 34 are smoke and tobacco-use free.

What can you do if you believe in the health and economic benefits of a Smoke Free Kentucky? “Get to know your local school board member,” says Abramson, “as well as your local legislator. Hold them accountable. Doctors have Gravitas. They’ll listen to you.”

Do you know the name of your local state representatives or school board members?

I know their names, but they don’t know me. I think I’ll give them a call.

GIL DUNN PUBLISHER, MD-UPDATE

Send your letters to the editor to: jnewton@md-update.com, jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax 2 M.D. UPDATE

Volume 5, Number 6 ISSUE #88 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: Jan Anderson, PsyD, LPCC Deborah Ballard, MD Keith Bridges Shannon Helton Lisa English Hinkle Scott Neal Aaron Sciascia

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

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CONTENTS

ISSUE #88

COVER STORY 4 HEADLINES 5 FINANCIAL 6 LEGAL 8 ONLINE MARKETING 10 Q&A 11 COVER STORY

14 SPECIAL SECTION ORTHOPEDICS 20 SPECIAL SECTION PHYSICAL MEDICINE & REHAB

The Dynamic Duo

22 RHEUMATOLOGY 24 COMPLEMENTARY CARE

Lifetime Louisvillians Drs. Greg and Linda Gleis carve complementary paths to ever-evolving careers in orthopedics and physical medicine and rehab

28 PRACTICE MANAGEMENT

BY JENNIFER S. NEWTON • PHOTOGRAPHY BY BRIAN BOHANNON ON PAGE 11

31 EVENTS

SPECIAL SECTION  ORTHOPEDICS

14 CHECK YOUR SIX: SPINE CENTER OF CENTRAL KENTUCKY

16 THE RIGHT FIT: LEXINGTON CLINIC ORTHOPEDICS – SPORTS MEDICINE CENTER

29 NEWS

SPECIAL SECTION  PHYSICAL MEDICINE & REHAB

18 SMALL SETTING, BIG SERVICES: BAPTIST NORTHEAST ORTHOPEDICS

20 FUNCTIONAL SPECIALISTS: UOFL PHYSICAL MEDICINE & REHAB

21 EPHRAIM MCDOWELL PHYSICAL THERAPY

ISSUE#88 3

HEADLINES

Shoulder Center of Kentucky’s 17th Annual Shoulder Symposium

BY AARON SCIASCIA, MS, ATC, PES, THE SHOULDER CENTER OF KENTUCKY Overhead athletes such as baseball, softball, and tennis players are no strangers to injury. The methods clinicians employ to evaluate and treat injuries in these athletes vary, and in some cases, can be ineffective. The expert faculty at The Shoulder Center of Kentucky’s 17th Annual Shoulder Symposium attempted to address these issues and others.

The faculty, comprised of team physicians, physical therapists, athletic trainers, and researchers who work with professional baseball and tennis players, presented information that both supported and challenged traditional methods of injury evaluation and treatment in an attempt to assist “Of the $1 billion spent annually on sport the symposium participants injuries in Major League Baseball, the with understanding current highest amount is on shoulder injuries at practice trends and existing $250 million,” said Michael Ciccotti, MD. evidence.

The symposium highlighted a key concept in anatomical function known as “the kinetic chain.” The kinetic chain describes the development of energy in one part of the body, and the manner in which the energy is transferred to other parts of the body. Using the overhead throwing motion as an example, the larger muscles of the legs and trunk develop the energy needed to a throw a ball overhead, while the smaller muscles of the arm absorb the energy to help direct the ball towards its target. Evidence was presented showing better postinjury outcomes when all kinetic chain segments are addressed in both the evaluation and treatment of overhead injuries.

The symposium participants were encouraged to utilize the kinetic chain approach Presenters at the 2014 with their patients because it provides a Shoulder Symposium were comprehensive means of examination and Tim Uhl, PhD, ATC, PT, FNATA; can improve treatment results.

Ellen Shanley PhD, PT; Michael Ciccotti, MD; The differences between treating elite Jed Kuhn, MD; athletes and recreational athletes were disW. Ben Kibler,MD; and cussed by Michael Ciccotti, MD, direcAaron Sciascia, MS, ATC, PES. tor of the Sports Medicine Team at the Rothman Institute, head team physician for the Philadelphia Phillies, and past president of Major League Baseball Team Physicians. The elite professional athlete has repeated exposure to injury, but also enjoys consistent training and rehabilitation therapy for injury that the non-professional usually does not, said Ciccotti. When describing the challenge of returning injured athletes to the playing field, Ciccotti quoted Winston Churchill, saying, “Success is going from failure to failure without a loss of enthusiasm.” ◆ 4 M.D. UPDATE

2014 KMA Annual Meeting

The 2014 KMA Annual Meeting was September 15-17 at the Hyatt Regency Louisville.

FOCUS FORWARD, The Path to Quality Care, was the theme, with Dr. Fred Williams Jr, president, presiding with the installation of new officers, David Bensema, MD, as president 201415 and Thomas Bunnell, “Get engaged with your local legislators and MD, KMAA. school board members.

The Tuesday, Doctors have the gravitas September 16th, mornto affect change,” Jerry E. ing session included an Abramson, Lt. Governor. address to the membership by the Honorable Jerry E. Abramson, Lieutenant Governor, Commonwealth of Kentucky who described the achievements and challenges of the Kyhealthnow initiative and goals for 2019.

Abramson repeatedly pointed out the success of Kynect, the state’s health care insurance connection which he noted signed up over 527,000 individuals (L-R) KMA out-going for health care insurance. president Fred A. Kyhealthnow, (kyhealthWilliams, MD, and now) said Abramson is a current president David collection of strategies J. Bensema, MD, heard the Lt. Governor urge focused on improving the the KMA membership health and health care of all to join with the state Kentuckians. ◆ to raise the level of health in Kentucky.

(L-R) KMA Past-President Shawn C. Jones, MD, and Cory Meadow, KMA director of Advocacy and Legal Affairs, after Abramson’s speech.

(L-R) Linda Gleis, MD, KMA sec-treas., with John M. Johnstone, MD, chair KMA committee on Public Health and Janice Bunch, MD, Bowling Green, commented on public health initiatives outlined in Abramson’s speech.

FINANCIAL

New highs: What to do NOW! Some people look at the S&P 500 at 2,000 Greater Recession and the DOW at 17,000 and feel that they and the years that have missed the boat by not being more have followed, heavily invested in equities. They want to what can we say jump in now. Others believe that because about our curwe are at all-time highs in the stock market rent situation? that now is the time to sell. The kind of Quantitative easreturns experienced in 2013 were never ing by the Fed is supposed to happen, statistically speaking being curtailed.

— we of course, accept them more readily Europe is beginthan the recession-induced catastrophes, a ning its own verBY Scott Neal la 2008. But we know all too well that the sion as ours winds Perfect Storm did happen in 2008 and that down. Unemployment is down to 6.1 perthe Fed fueled the recovery with unprec- cent, and the economy, while turning in edented levels of quantitative easing! a couple of good quarters of growth, is It is easy to find varied and conflicting marked by a high level of volatility. The data opinions about what to do, and often the seem to support a rosy outlook, but the US opinions are changing weekly, if not daily. may well be only the best looking house in Many investors, as well as advisors, are a bad neighborhood. saying simply, “Stay the course with your The next step of the data gathering current investments, rebalance to a chosen process is to assess your own current situaasset allocation and tion and to prepare all will be well.” That a projection for 2015 YOU MUST FIRST is quickly followed and beyond. The ASK AND ANSWER: with the admoniprojection should be tion to “continue based on where you WHAT IS THE VISION FOR MY your contributions stand now and applyFAMILY AND HOW WILL MY to retirement plans ing some reasonable in the same way that FINANCIAL STRATEGIES, TACTICS, assumptions about you have been doing AND TOOLS SUPPORT THAT VISION? the new year and all along.” Others beyond. It is imporare saying, “Everything is overvalued. Sell tant to take note of your assets and liabilities, stocks!” That advice might prove to be accu- as well as cash flow, and to allow this data rate in due time, but you must ask whether to inform your short-term decision making. such advice is truly in your best interest or Turning to self exploration, the relsimply in the best interest of the advisor. evant questions regard risk tolerance and We believe that you must first ask and risk capacity. To the extent that you have answer an important question that is truly adequate liquidity, that you have little or unique for each person and family. The no debt, and that you are living within your question: What is the vision for my family means, you have considerable risk capacand how will my financial strategies, tactics, ity. The current state of the market might and tools support that vision? Your invest- be unduly raising your risk tolerance right ment strategy should become an integral now. It’s worth mentioning that much of part of the answer. investment theory has been built on the Developing an appropriate investment assumption that the market has no memory strategy for times like these demands a from one year to the next. Given that we certain amount of self-exploration, as well investors make up the market, that now as consideration of the data that reflects seems instinctively an invalid assumption. the current environment. It’s easier to deal Most of us still hold onto memories of 2008 with gathering knowledge, so I begin there. and/or 2013. Which one prevails in your Based on what we have learned from the mind is key.

Once these steps have been completed, you must formulate an appropriate investment strategy for moving forward. Note that no investment strategy is completely risk free. Tradeoffs typically have to be made between one type of risk and another.

Most investors are presently obsessed with only one: market risk. However, there emerges two strategies: 1) a wealth growth strategy and 2) a capital preservation strategy.

The wealth growth strategy would be more appropriate for those investors who have a longer time horizon and relatively high risk capacity and tolerance. A capital preservation strategy would be appropriate for those with lower risk capacity or tolerance and certainly for those with a shorter time horizon. Some blending of the two may be in order for the average investor.

Most investors today want two things: protection of the wealth that they have accumulated, while getting market-like returns as the market goes up. One of the ways to get there is to invest in a diversified asset allocation, yet with risk controls that have the potential of protecting the capital from suffering serious drawdown as the market retreats from each new all-time high.

In essence, it is a strategy of “cutting losses while they are small, and letting winners run.” That means it is critical to know why you are buying or holding a particular asset, and to have a good reason for the timing and price of its purchase, as well as its sale.

We realize that answers to all financial questions are currently evolving at a rapid rate. Now, perhaps more than any other time in recent history, as advisors we have found the need to be more flexible in our thinking. Our advice is that you do the same. One of our goals is to enable each of our clients to think more clearly in a world that is full of noise. Call or email us if we can help.

Scott Neal, a CPA and CFP, is president of D. Scott Neal, Inc. a FEE-ONLY financial planning and investment advisory firm with offices in Lexington and Louisville. He can be reached at scott@dsneal.com or toll free at 1-800-344-9098. ◆ ISSUE#88 5

LEGAL

New Opportunities, New Responsibilities Who are your Business Associates?

Even though health care providers and physicians have been required to have Business Associate Agreements (“BAAs”) since the enactment of the HIPAA, the Department of Health and Human Services (“HHS”) Final Rule, which implements the HITECH Act, changes the business associate (“BA”) relationship. New requirements for these agreements have been issued, which means that all existing BA agreements must be reviewed for compliance. The Final Rule has created not just new responsibilities, but also new liabilities for BAs that provide services to covered health care entities. Importantly, this new liability for BAs means that physicians and covered entities have opportunities to shift the risks of breach to the BA in these agreements or at a minimum to seek indemnification for the costs of mitigating a breach, caused by a BA. In June, the HHS Office of Civil Rights (“OCR”) released its Annual Report to Congress on Breaches of Unsecured Protected Information (“Breach Report”). The Breach Report shows that although business associates were the culpable party for 118 out of the 458 breaches (or 26 percent) covered during the Breach Report’s 2011-2012 reporting period, the individuals affected by the business associates’ acts numbered over 8.7 million individuals or 59.3 percent of the total number of individuals affected by breaches reported in 2011 and 2012. Prior to the Final Rule, the health care provider, rather than the business associate, was the party that was fined and carried the expense of mitigation. While physicians and covered entities still carry the burden of notification, business associates may also be investigated and penalized for breaches. Based on statistics like these, it is more important than ever that physicians know who their business associates are, have the appropriate agreements in place, and know how those businesses will address breaches when they occur.

Expanded Definition of Business Associates

In 2009, as part of HITECH, Congress defined a BA as “persons or entities that provide a service for or on behalf of a covered 6 M.D. UPDATE

entity other than the provision of healthcare.” The Final Rule, however, revises the definition so that a BA is now a person or entity that creates, receives, maintains, or transmits

BY Lisa English Hinkle PHI in fulfilling certain functions or activities for a covered entity. The Final Rule specifically includes health information organizations, e-prescribing gateways, data transmission providers as well as those that have “routine access” to PHI as BAs. In addition, a new category of BAs was added to the definition that specifically identifies lawyers, accountants, and consultants, among others.

The Final Rule also provides that a BA’s subcontractors that create, receive, maintain, or transmit PHI on behalf of a BA qualify as a BA themselves. In other words, these downstream contactors must comply with the same applicable HIPAA provisions as BAs and provide assurance that they, too, will protect PHI by executing a BAA with their BAs. Data transmission providers, collection services, experts, consultants, auditors, accountants, lawyers, and even data storage or document shredding companies are now considered BAs if they use or have access to PHI. The Final Rule clarifies that a person or entity becomes a BA by definition, not by the presence of a contract.

Business Associates’ Increased Liability

Along with extending the definition of a BA, the Final Rule makes parts of the HIPAA Security Rule and Privacy Rule apply directly to BAs. Previously, BAs were only contractually liable for breaches involving violations of their BA agreements with the covered entity; now, the BA is potentially liable for civil and criminal penalties for any non-compliance with HIPAA regulations. Under the Final Rule, BAs are directly liable for: • Implementing the administrative, technical, and physical safeguards required

by the HIPAA Security Rule and maintaining all required documentation; • Complying with the BA agreement and disclosing PHI only as permitted; • Making reasonable efforts to limit disclosure of PHI to the minimum necessary standard; • Maintaining an accounting of all disclosures; • Executing a BA agreement with any subcontractor that creates, receives, maintains, or transmits PHI on the BA’s behalf; • Disclosing PHI to the covered entity, individual, or individual’s designee as necessary to satisfy a covered entity’s obligations to respond to an individual’s request PHI; • Notifying the Covered Entity of any unauthorized disclosure of PHI or breach; • Taking reasonable steps to cure any breach including a breach of a subcontractor; and • Providing PHI to HHS to demonstrate compliance during investigations.

Reviewing and Revising Agreements

It is becoming increasingly evident that businesses outside the health care industry remain largely uninformed about new HIPAA-related responsibilities and have not undertaken efforts to comply. Some companies not only lack the knowledge about these obligations, but also the operational capabilities and financial resources to implement compliant policies and procedures.

This means that having thorough business associate agreements is even more important so that a BA’s duties to have effective HIPAA and HITECH procedures in place and to maintain physical security of protected health information are fully set forth. A thorough business associate agreement is a contract and carries the potential for seeking damages for a breach caused by a business associate.

The Final Rule expands the responsibilities of business associates, but also increases the need for strong business associate agreements that clarify those requirements setting forth the expectations of the covered entity.

The Final Rule does recognize that BAs vary greatly in size and resources and creates

the ability to tailor compliance. As a result, complying with HIPAA may vary from one BA to another; there is not a one-size-fits-all plan for BAs to implement under the Security Rule. Safeguards, policies, and procedures can be tailored to address the size, complexity, and capabilities of business associates. Even so, the risks must be identified and addressed in a reasonable manner so that alternative solutions may be implemented. Despite its flexibility, certain aspects of the Final Rule are mandatory. For example, companies must be capable of tracking and accounting for PHI disclosures. Business associates must also be able to interpret the “minimum necessary” standard for every disclosure. Such ambiguous (and highly-technical) terms may be especially difficult to understand for businesses with limited understanding of HIPAA, making it even more important for physicians to take the time to ensure that a BA’s duties and responsibilities are comprehensively set forth in the contract. While the general compliance deadline with the Final Rule was September 23, 2013, covered entities, BAs, and subcontractors can continue to operate under existing BA contracts until September 23,

2014 when current BAAs must be amended for compliance.

Physicians should keep in mind that boilerplate BAAs are rarely, if ever, sufficient.

Although standard BAAs may offer a useful starting point for defining the covered entity/ BA relationship (or the business associate/ subcontractor relationship, if the agreement is used for this purpose), they generally lack the detail and specificity that most parties find necessary to protect their rights. There are many terms that can be drafted into a BAA to specify parties’ rights and responsibilities beyond what is required by the Final Rule.

For example, many covered entities prefer to include notification procedures in the event a breach is discovered. The HITECH Act requires business associates to notify covered entities of a breach of personal health information within 60 days of discovery. However, covered entities may want a much shorter notification period, such as 14 days, to protect relationships with patients and to allow for quicker remedial action. And, importantly, business associate agreements can also provide for the business associate’s indemnification of the health care provider for things like the cost

of notification and penalties.

Conclusion

Being able to identify who are business associates under the expanded definitions is extremely important as not having an agreement is a violation of HIPAA and can subject a provider to fines. Physicians and all health care providers should review their vendor and service provider lists to identify all business associates and execute compliant agreements that not only cover required terms, but that also include terms that will protect them if a breach occurs and fines or penalties are assessed as a result of a BA’s actions/ inactions. Given the high costs of mitigating the impact of breaches and increasingly high fines, strong agreements are important.

Lisa English Hinkle is a member of McBrayer, McGinnis, Leslie & Kirkland, PLLC. Ms. Hinkle concentrates her practice area in health care law and is located in the firm’s Lexington office. She can be reached at lhinkle@mmlk. com or at (859) 231-8780.

This article is intended as a summary of federal and state law and does not constitute legal advice. ◆

ISSUE#88 7

ONLINE MARKETING

When Advertising is Not a Game In my prior career, I was an architect, and in my training were lectures on professional practice. One of those was on the topic of why professionals don’t advertise. Sounds familiar?

It’s a matter of economics, I was told, and a matter of professionalism. I was told that professionals advertising would cause a snowball effect. Once begun, it would start a rivalry where ultimately all advertisers would lose. “The Nash equilibrium!” I’m pretty sure someone chanted. “We are all professionals here,” the common reasoning goes, “so we agree it is in our mutual interest to reject the game and act in fairness. We will not advertise, and to protect our word is our reputation.” Thus, we concluded that advertising is an unseemly act among professionals.

But, of course, professionals do advertise (and if you are a fan of the collusion/ game theory argument, I expect to

count you among them!). What we were taught in college is wrong.

Professionals advertising is not about winning games or profits.

It’s about conveying value from

BY Megan Campbell Smith the firm to the customer. Sure advertising can raise profits, but advertising is about beneficence.

Let’s consider an example:

When I studied at CUNY in 2012, I did some research into how patients use media to help them solve their urgent medical concerns. I talked to people who had a

strong need to find a doctor – a third or fourth opinion, a dreadful diagnosis – and inquired how they found that provider.

One of my study subjects was a mother of a young woman with a difficult vision impairment who, despite having an accurate diagnosis, wasn’t finding satisfaction in the course of treatment for her daughter. They had exhausted the referrals in her known network. The condition was deteriorating, and the family felt afraid and ignored. The mother said she searched the internet for two or three weeks trying to find someone who could help, and finally she discovered the ophthalmologist to treat her daughter.

“How did you know he would help?”

I asked. “Well, he had published an article online about how he treated my daughter’s condition. I could just tell he was the right one,” she answered.

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Did you catch that? In product development we call that “secret sauce.” What this mother revealed is that the way for doctors to get discovered by patients is to write and publish articles about conditions you treat.

I heard this same secret sauce revealed in 75 percent of my cases. They said that your persona – who you are, what you look like, how you speak – will signal in an instant whether you are the right provider because, ceteris paribus, patients can’t tell one ophthalmologists’ skills from another.

Maybe you’re thinking, “That’s great, but what does it have to do with advertising?” My point is this is advertising.

Advertising means to issue an alert, give notice, inform. Advertising occurs when you intentionally signal to customers that your firm can meet their needs. In contemporary media, the fastest growing advertising seg-

PROFESSIONALS ADVERTISING IS NOT ABOUT WINNING GAMES OR PROFITS. IT’S ABOUT CONVEYING VALUE FROM THE FIRM TO THE CUSTOMER.

ment is native advertising, or essays like this mother found, because they are a win-win for everyone involved. Customers need your services and learn you are out there. You gain validated customers who, after first impressions, still want to work with you.

Professionals advertise because they have a mission to improve society through their training and skills, and if professionals want to fulfill that mission, then they must somehow communicate to society what they can do for them. Through this telling, advertising conveys value (information) from the one who created it to the one who benefits from it. Thus, advertising is mutually beneficial.

Megan Campbell Smith is the digital publisher of MD-UPDATE. Contact her at mcsmith@ md-update.com ◆

ISSUE#88 9

Q&A

A Conversation with Incoming KMA President Dr. David J. Bensema MD-UPDATE EDITOR-IN-CHIEF JENNIFER NEWTON SAT DOWN WITH INCOMING KMA PRESIDENT DAVID J. BENSEMA, MD, MBA, FACP, THE MORNING THE KMA ANNUAL MEETING BEGAN.

have a resolution to elevate obesity to our primary focus.

Bensema, who resides in Lexington, is an internal medicine specialist by training and is currently the chief medical information officer and chief information officer for Baptist Health System.

I’m probably the first KMA president in a long time to come in without my own agenda, and the major reason for that is that Dr. Williams and the team with the strategic focus group have done so much work and have provided us with such a significant change that if it’s passed by the house of delegates, my focus is going to be on supporting that transition and the implementation of the changes sought by the strategic focus group.

What is the main focus of this year’s annual meeting?

Do you have any personal priorities beyond the obesity focus?

“Focus Forward” is the title of the meeting, and its purpose is to share the strategic initiative focus that has been developed over the last year under the direction of Dr. Fred Williams, our current president. It also will allow the membership to review those changes and hopefully accept a resolution that will alter the structure of our meetings and move us to a more relevant, streamlined function, one that’s more responsive to physicians’ needs. There has been a lot of work to reduce the number of standing committees and move towards commissions that will have a set focus, limited timeframe, and go away when their task is completed, so that what we do is continually relevant and evolving instead of the same process over and over again.

get more physicians involved in leadership and provide them with an opportunity to make an impact.

The other piece is that we will hear from Dr. Steve Stack, who is a Lexington emergency room physician but more notably is the president-elect of the American Medical Association (AMA). Kentucky is in a very unique role in that we have the immediate past-president of the AMA in Dr. Ardis Hoven and Stack the presidentelect. Within two years we’ll have had two Kentuckians as president of the AMA, and that’s essentially unheard of.

What are some of the other highlights of the strategic initiative that will be discussed with the membership?

He’s talking about the Governor’s health initiative, which is a chance for the state to focus on some of the health issues we face uniquely in Kentucky. We have a constellation of things – obesity, tobacco-use, preventable cancers, preventable coronary artery disease – that leave us 49th in the country when you look at the Gallup polls on self-rated health status. Our Community Connector program is a great connection with that initiative.

A year ago we passed a resolution that each year we would choose a health focus for the KMA. Last year was the non-smoking ordinance statewide, which unfortunately has not yet passed. We will continue to have that as a focus, but this year we

In terms of Focus Forward, the major area is going to be the Community Connector Program. It is an opportunity for physicians to go through some formalized and in-person leadership training to develop and participate in a public health initiative in their community working with other non-profit organizations, charitable groups, and having a chance to develop more diverse teams. It requires leadership within the KMA as well as in the community. We think that’s going to be a very viable way to 10 M.D. UPDATE

Lieutenant Governor Jerry Abramson is presenting at the meeting. What will he discuss?

What will physicians be facing this year in terms of national health care reform?

Most notably the continuation of meaningful use is an absolute strain on our physicians. There is a resolution related to the ability to exchange health information electronically and have documentation of that.

Does the KMA have any new initiatives concerning physician extenders?

We’re going to advocate for the number of physician assistants (PAs) that can be supervised at any given time to increase from two to four. That’s in cooperation with Kentucky Association of Physician Assistants.

We hope that allows physician led teams to provide greater access for the patients.

Is there anything else you’d like physicians to know?

With the KMA, we are engaging physicians in more meaningful ways in their communities. So KMA recognizes health care is local, and the Community Connector program is a way to reignite that local emphasis.

The last thing from my standpoint, I used to close my Lexington Medical Society letters with this in 2001, and I still believe in it more than ever – Physician-led. Now and always. ◆

COVER STORY

PHOTOGRAPHY BY BRIAN BOHANNON

The Dynamic Duo Lifetime Louisvillians Drs. Greg and Linda Gleis carve complementary paths to ever-evolving careers in orthopedics and physical medicine and rehab

BY JENNIFER S. NEWTON Louisville may be Kentucky’s largest city, but with a web of hometown connections, it is a place where the six degrees of separation rule rarely needs more than two degrees to ring true. When you ask a native Louisvillian, “Where did you go to school?” the question more often refers to high school than college.

Imagine then, the serendipity of two lifetime Louisvillians who have benefitted from all the hometown metropolis has to offer. Their story sounds like a romantic comedy. They met on a blind date in high school – he was at St. Xavier and she at Assumption. They married before their senior year in college – he at the University of Louisville (UofL) and she at Bellarmine University – and attended medical school together at UofL. Both went on to have success-

LOUISVILLE

ful medical careers in complementary specialties – his in orthopedics and hers in physical medicine and rehabilitation – in addition to raising four children together.

This is the story of Drs. Gregory and Linda Gleis. Imagine how many connections they have made and how many lives they have touched along the way …

Med School Companions

Greg’s career path was set from a young age. “I knew I wanted to do orthopedics,” he says. “I played

Drs. Greg and Linda Gleis are two outstanding individual physicians who together form an incredible team for their own family, for service to the medical profession, and their community. Linda was the GLMS president in 1991-92. She brought a new external focus, urging physicians to network with non-medical groups and organizations. She also was the society’s first female president.

Greg also has been active in the GLMS and has been a delegate to the KMA for many years. He also handled many family obligations to allow Linda to attend to her association duties.

—LELAN WOODMANSEE, CAE, executive director of the Greater Louisville Medical Society

football through the Catholic system in grade school and high school and ISSUE#88 11

COVER STORY

knew that’s what I wanted to do.”

Linda’s path was not as decidedly direct.

Initially she studied medical technology at Bellarmine, but the courses were the same as pre-med. During the rotations, she was encouraged to think about becoming a physician, and eventually she thought, why not become a doctor?

The summer before their junior year of med school, they both got internships at Frazier Rehab Institute under Dr. Thomas Kelly. “That’s when I fell in love with rehab because it incorporates orthopedics, neurology, psychology, and internal medicine,” says Linda. “It was just so dynamic and holistic from my perspective.”

Continued Career Convergence

Following his residency, Greg became an attending at University Hospital, which had opened its doors in May 1983. There he saw a large volume of trauma cases, but realized his main interest was the spine. Dr. David Seligson, then chief of Orthopedics at UofL, arranged for Greg to go to New Orleans and

What Greg brought to the practice were things we hadn’t done before … He was really highly regarded by insurance companies and workers’ compensation and still is.

- TOM STELTENKAMP, ATC, Administrator for Ellis & Badenhausen Orthopaedics

12 M.D. UPDATE

complete a spine fellowship at St. Charles Hospital with Dr. Henry LaRocca, editor of the medical journal Spine.

Around the same time, Linda began practicing at Frazier upon completion of her residency. Three years later, in 1985, her career began to take giant leaps. She and her partners Dr. David Watkins and Dr. John Shaw started a private practice group called Rehabilitation Associates. Additionally, she became director of the Physical Medicine and Rehabilitation residency training program for Frazier, which she would run for 10 years, and became the chief of Physical Medicine and Rehabilitation at the Louisville VA Medical Center.

In 1986, Linda and Greg’s career paths converged at the VA when Greg left the trauma service at University to become chief of Orthopedics at the VA, while still maintaining his private practice.

Tapping the Spine

When Greg was training in New Orleans, he developed an interest in chronic spine problems. “That’s what interested me – the people who don’t get well,” he says. In the late 80s, he visited a spine rehab clinic in Texas developed by Dr. Tom Mayer because he was drawn to the concept of “optimizing the abilities people had.”

In 1990, Greg split off from Orthopedic Associates with Dr. John Johnson and Dr. Dick Holt to open his own spine rehab clinic. “They were doing lots of spine surgery, and I was interested in the non-operative spine parts; so I felt that would be a good patient flow,” Greg says.

He remained chief of Orthopedics at the VA until 1995, when he “decided to quit trying to do both things and concentrate in private practice.”

In 1998, Greg closed the underperforming spine rehab clinic and joined Ellis & Badenhausen Orthopaedics. “Since I was

the only person in the group interested in seeing people with back pain, the other orthopedic surgeons were glad to divert that population towards me, and I was happy to see them,” he says.

Evolution of a Second Act

Linda advises that flexibility is one of the keys to longevity in a medical career. For Greg, this has proved to be true, as his interest in chronic cases would hold the key to the second act of his career.

“Going back to 1988 was the first time I saw somebody in a different perspective,” says Greg. It was one workers’ compensation case that soon led to more. “Pretty soon, half of my daytime work [at Ellis & Badenhausen] was seeing workers’ compensation difficult cases, the cases that had not succeeded with normal treatment,” he says.

Greg became an advocate for workers’ comp as well, authoring an article for the Journal of the KMA on cost analysis and getting involved with the Department of Workers Claims.

Greg also became a high school team doctor for several schools, such as Manual High School and Trinity. A graduate of St. X, his allegiance was always torn, but he focused on taking care of the kids.

In 2004, Greg retired from Ellis & Badenhausen to concentrate solely on independent medical exams (IMEs). Today he does four examinations a week, but he’s still working 50-60 hours, says Linda, when all the paperwork is factored in.

“I don’t need to read autobiographies,” says Greg with a smile. “I read people’s medical stories for work.”

Greg is also active on the board of directors of Kids’ Chance, an organization that raises scholarship money for high school students going on to college or vocational school.

Leading the Way in Organized Medicine and Education

One of Linda’s legacies at Frazier was initiating specialized service line programs that are now the institute’s hallmark. “At Frazier, initially everything was general rehab. Early on we assisted in making a focus for traumatic brain injury and spinal cord, and then stroke,” says Linda.

COVER STORY

I was a medical student at UofL when Linda was residency program director around 1990. She was a big influence on me going into the field of physical medicine and rehabilitation … A lot of residents who are now in practice can look back on their training and see Linda Gleis as one of their primary mentors during their residency training and look at her as a model physician in our field.

—DARRYL L. KAELIN, MD, medical director of Frazier Rehab Institute and chief of the division of Physical Medicine & Rehab for UofL

As if being in private practice, a director of a residency program, and service line chief at the VA, not to mention a mother of three small children at the time, were not enough, “When I was early running the residency program, I got involved with organized medicine, with the Greater Louisville (then Jefferson County) Medical Society (GLMS),” says Linda. Dr. Ken Peters recruited her to run for SecretaryTreasurer in an effort to get more women on the board. She agreed in order to further an agenda of accessibility for people with physical limitations, shortly before the Americans with Disabilities Act passed.

Two years later, Peters encouraged Linda to run for GLMS president. She agreed and won the election and subsequently became the first woman president of the GLMS in 1991. During that time she also had her fourth child and remembers bringing the baby to board meetings before she was old enough to go to daycare, saying, “Hey, it was the 90s.”

Linda utilized her platform as president to raise awareness of a topic that was still relatively hush-hush back then – domestic violence. “That year my whole focus was on domestic violence and the physician’s role and how you can help protect the patient,”

she says.

When Linda finished her presidential term with the GLMS, Peters once again encouraged her to run – this time for Secretary-Treasurer of the Kentucky Medical Association (KMA), a position she has held since 1999.

Linda is also involved with the GLMS Foundation. As PM&R residency director for a decade, Linda has certainly influenced the career path of many physicians, and her educational legacy continues in her work to further the Foundation’s scholarship initiative. “I’ve always had a focus on the power of education to change people’s lives,” she says. Linda currently chairs the scholarship committee for the GLMS Foundation, which awards $20,000 each year for tuition assistance for four to five U of L medical students.

In 2005, she phased out her private practice, and in November 2012 she retired as service chief of the VA. However, she continues to cover clinics at the VA as a feebased physician.

Juggling Act

The 1980s and early 1990s were a particularly hectic time for the couple, who somehow balanced demanding careers and raising a young family. Cheerios, fast food, laughter, and faith seem to be part of their The legacy of Dr. Linda Gleis at the UofL School of Medicine is a long one, from earning her degree and completing her residency, to serving on faculty and gratis faculty for more than 30 years.

She established a solid foundation for our Physical Medicine and Rehabilitation residency program, both by expanding the program, as well as solidifying our relationship with what is now Frazier Rehab Institute. Her hands-on work, as well as all those who have come after her, have helped countless people in Louisville and beyond.

—TONI GANZEL, MD, dean of the UofL School of Medicine

success formula.

Linda often worked late and had to round at two hospitals, which meant leaving the house by 6 a.m. Left with evening bedtime rituals and daycare drop-off before 7 am, “Greg would have our three sons sleep in whatever there were wearing the next day, and they’d get up, grab their bags of cheerios and milk, and drive to daycare,” she says. “Our kids joked, ‘We had cheerios for breakfast and supper. The only different meal we had was at daycare.’” Greg adds, “There was a lot of fast food.”

Greg recalls the days before cell phones when his wife would work late on a project.

“When Linda starts working, she’s in the zone. She doesn’t think about calling and saying I’m going to be late. So I just went to bed, hoping she’d come home,” says Greg. On one occasion, after pulling an allnighter to prepare for a residency accreditation review, Linda finally returned home in the morning, but just to change clothes and return to work for a breakfast meeting.

Greg and Linda agree that the students coming out of medical school today have a different mindset. “From the very beginning they want to make sure they have balance in their lives. Whereas in our generation, those first years, it was very time consuming,” says Linda. With over half of today’s physicians being employed by health systems, there is a dramatic difference from the days when physicians spent their first two years working to become a partner in a practice.

When asked about today’s health care challenges, Linda says, “For our age group, we’re seeing more people retire early because there is so much uncertainty and you get frustrated because you feel like patient care is being compromised sometimes … I think our students coming out now will be a little better prepared for that aspect because they’re training during that time.”

Health care is changing in Louisville, in Kentucky, and across the nation, but some things remain the same. The Gleis’ are a testament that the values of dedication, cooperation, teamwork, and humor will always be part of a successful career formula and that adaptability and service to the community can hold the key to extending your career. ◆

ISSUE#88 13

SPECIAL SECTION  ORTHOPEDICS

Check Your Six

Former army surgeon Dr. Robert Knetsche has your back BY JIM KELSEY In military jargon, “watch my six” means “watch my back.” Certainly it’s a term that Robert Knetsche, MD, an orthopedic and spine surgeon, is familiar with after 22 years in the U.S. Army. But for him it has a double-meaning, given his current position as the medical director of the Spine Center of Central Kentucky in Danville.

The practice, which opened in August of 2008, offers complete spine care and pain management. Knetsche averages 300 surgeries per year and approximately 800 patients are seen at the Spine Center each month.

“This is really a mom and pop spine surgery center because my wife is the practice manager, and she manages it with the help of our great staff,” Knetsche says.

“Our practice is a multi-specialty practice for spine care. I perform spine surgery and do my own injections and other minimally invasive procedures before surgery. We have pain management as well as electro-diagnostics to determine neurologic problems.

We do our own bracing; we have procedure suites; and we do our own urinalysis for drugs and other diagnostics.”

It’s a comprehensive array of patient care and services that enables the Spine Center of Central Kentucky to treat a wide patient population with expertise and the most upto-date procedures. Primarily, Knetsche’s typical patients are adults from 25 to 95 suffering from degenerative conditions.

Knetsche received his medical degree from the Medical University of South Carolina, Charleston in 1994 after he had served four years as a tank commander in the U.S. Army. He then embarked on an 18-year residency, specialty, fellowship, and military service journey. He interned in general surgery at the Dwight D. Eisenhower Army Medical Center; took residency in orthopedic surgery at William Beaumont Army Medical Center in El Paso, Texas, and completed a fellowship in spine surgery at University of Colorado Health Sciences Center in Denver.

In 2003 Knetsche took the position

DANVILLE

14 M.D. UPDATE

PHOTOGRAPHY BY GIL DUNN

Knetsche has witnessed first-hand the evolution of spine surgery in the last 20 years to a point where “endoscopic and minimally invasive surgeries will be the future standard of care.”

of chief of Spine and Neurologic Surgery Service at Landstuhl Regional Medical Center, Landstuhl, Germany, which was responsible for spine surgical care for all combat theatre casualties from Iraq and Afghanistan, a catchment area of 400,000 people, including all military and government personnel stationed in Europe.

He was deployed into combat as chief of Orthopaedic Surgery with the 14th Combat Support Hospital, in Bagram, Afghanistan performing over 400 orthopedic and spine surgeries on soldiers and civilians.

Knetsche’s Army experience prepared him well for treating a wide range of patients and conditions. “We would have 60 people who were blown up show up at our door, every single day,” Knetsche says.

“It was a very grueling experience. As you can imagine in Afghanistan, you’re going to see a lot of people with gunshot wounds or

dismembered or who are injured from some kind of crazy bomb mechanisms.

“The Army was a lot of work and a lot of brutality, but it was one of the most wonderful training grounds for a surgeon because I got to do things that very few people have done and that hopefully we won’t have to do again. I feel like the Army was a wonderful time. It let me serve my country. I loved doing that.”

Knetsche now specializes in complex spine surgery, such as scoliosis surgeries that can take 10 to 12 hours, and in minimally invasive spine surgeries involving several very small incisions that reduce the levels of blood loss and pain while doing the same work of a traditional open surgery.

Surgery is the last resort for Knetsche, as he reports that only seven percent of the Spine Center patients undergo surgery and has witnessed positive outcomes with nonsurgical procedures, including injections, pain management, and physical therapy.

Roughly half of the Spine Center’s patients report lumbar back pain with radiation down the leg, indicative of a disc hernia-

tion or spinal stenosis. Back pain from facet joint arthritis and neck pain with radiation down the arms are other common patient complaints.

lators are getting smaller. I envision one day they’ll be the size of a postage stamp.”

Motion preserving technology: “Artificial disc technology in the lower back and the neck solves the problem of nerve damage and nerve compression. With this technology, we can leave about 70 percent of the normal motion of the involved spinal segment. I think it’s going to revolutionize spine surgery.”

Minimally Invasive Laminectomy: “The minimally invasive or endoscopic laminectomy will be the standard in the future for lumbar spinal ABOVE Robert P. Knetsche, stenosis. As the population ages, MD, LTC, orthopedic spine spinal stenosis is becoming more surgeon and medical and more prevalent.

Not All Cases Are Routine

“Occasionally we see spinal tumors,” Knetsche says. “We see multiple myeloma, a cancer syndrome that is fairly unusual but occurs when plasma cells mutate and develop into plasmacytoma. Another presentation we see fairly uncommonly is cervical spondylotic myelopathy, degeneration of the cervical spine to the extent that the spinal cord is being damaged.”

Rare or common, a universal component of each of these back and neurological problems is pain. To ensure that patients at the Spine Center of Central Kentucky are treated as effectively for their pain as for their actual conditions, Knetsche recently welcomed Ellen Flinchum, MD, to the team.

“We wanted to have a specialist in medical management of pain as well as a physiatrist who could help with the physical therapy part,” Knetsche said. “Dr. Flinchum brings both things to us.”

“I tell my patients there are three parts to you getting better,” says Knetsche. “One third is me picking the right surgery for you and doing the right surgery, and it turning out well. One third is your attitude and your compliance with the program… and the final piece is physical therapy. If you don’t have the proper physical therapy, you’ve only done two-thirds of the equation, and in most places 67 percent is a failing grade.”

Flinchum echoes Knetsche’s opinion on a patient’s mind-set and therapy. “A big challenge is getting my patients to buy into the idea that exercise really works,” says Flinchum, whose treatment plans typically include physical exam and psychological evaluation, physical therapy, home exercise programs, injections, braces, and medicine.

director of the Spine Center of Central Kentucky.

LEFT Ellen Flinchum, MD, physiatrist, pain medicine specialist, joined the Central Kentucky Spine Center in August 2013 to bring pain management expertise to the practice.

“It’s not just injections and medicine,” she states.

A Path for Success

The Spine Center of Central Kentucky recently received a Gold Seal awarded from the Joint Commission for all Spine Surgery including Cervical Surgery, Lumbar Fusion and Laminectomy. “Getting these awards means that we have good outcomes, we have very low complication rates, and that our patients are happy,” says Knetsche. ◆

No Looking Back

As in any medical field, advanced technology, detailed research, and new ideas are bringing about significant change. Knetsche gives his viewpoint on four of the most prominent in spine surgery: Endoscopic Spine surgery: “One of the advances I’m most excited about is endoscopic spine surgery, where we make incisions of two or three millimeters and use scopes. I do some endoscopic surgeries, and I really see spine surgery moving there in the next 10 to 20 years.

Pain management using spinal cord stimulators: “We put devices on the spinal cord that block pain and let the patients control their pain with a remote control that can turn it up or down. And the stimu-

For patient referrals Robert P. Knetsche, MD 236 West Main Street Suite 200-203 Danville, KY 40422 Phone 859-238-7746 Fax 859-236-0261 SpineCenterofCentralKentucky.com ISSUE#88 15

SPECIAL SECTION  ORTHOPEDICS

The Right Fit

Lexington Clinic Orthopedics – Sports Medicine Center adds Brent Morris exactly where he should be BY TIM CORKRAN LEXINGTON Brent Morris, MD, has landed his dream job. To join the Lexington Clinic Orthopedics – Sports Medicine Center means three things to him: For one, this Powell County native and UK medical school graduate is coming home; secondly, he gets to practice in close proximity to renowned shoulder specialist W. Ben Kibler, MD; and finally, Morris’ abundant energy for moving his field forward collaboratively will find fertile ground in the proactive professional culture of Lexington Clinic. “I fell in love with the people and the culture they have created here at Lexington Clinic,” he proclaims.

Such enthusiasm parallels his sentiments about his field, particularly his work on shoulder replacement and revisions. Morris was drawn to the work because “It’s a very complex and rapidly evolving aspect of orthopedics with lots of research opportunities.” After residency at Vanderbilt, he landed a prestigious fellowship in shoulder and elbow surgery at Texas Orthopedic Hospital in Houston.

He calls this “a unique opportunity to work at one of the top orthopedic-only hospitals in the country.”

Value Added at Lexington Clinic

Besides his youthful enthusiasm, Morris brings considerable strengths to the Lexington Clinic Orthopedics – Sports Medicine Center. He is already well-versed in the complexity of upper body joint repair; the mentorship and training he received in Houston was first rate. He was the sole shoulder and elbow fellow working under a staff that includes three senior shoulder specialists and two senior elbow specialists.

He notes that Texas Orthopedic was “a great environment for learning about particularly complex orthopedic cases, as so many are referred there from all over the country.”

His work on awareness of opioid 16 M.D. UPDATE

PHOTO PROVIDED BY LEXINGTON CLINIC

that greater use of objective data correlating patient profiles with abuse tendencies and diligent use of the electronic registries kept in many states will help orthopedists reduce opioid abuse.

Morris already has ample experience with anatomic and reverse total shoulder replacements, and many other arthroscopic and open procedures, so he anticipates being an integral member of the shoulder and elbow staff at Lexington Clinic. He knows he will have to be patient, starting with broad-based duties and a diverse patient population. In his words, these will span “from the young throwing athlete to the elderly patient with a fracture or shoulder arthritis.”

Eventually, he expects “to build toward a practice consisting primarily of comDr. Brent Morris feels privileged plex arthroscopic and open to be fellowship-trained in elbow shoulder surgeries.” and shoulder surgery at Texas That eventuality will be Orthopedic Hospital in Houston and greatly enhanced by his proxmentored by renowned orthopedic imity to Dr. Kibler. Morris surgeon Dr. W. Ben Kibler. abuse among orthosays, “It’s an honor to learn pedic patients will also be of value, as from one of the greatest thinkers in orthopemany Kentucky communities continue to dics. The way Dr. Kibler approaches specific struggle with this issue. As lead author of orthopedic problems is affecting how orthopethe paper, Narcotic Use and Postoperative dists across the world think about them.” Dr. Doctor Shopping in the Orthopaedic Trauma Kibler is a Vanderbilt alumnus, and Morris Population, Morris presented data show- first met him during Morris’ residency there. ing that one-in-five of such patients were Morris says, “The mentorship and teaching abusing the system in search of additional that Dr. Kibler offered was extremely valuopioids after surgery. Morris notes, “Pain able.” Their mutual interest in shoulder work management is a large and important aspect has left a deep impression on Morris: “It’s rare of the work of the orthopedist. We feel that in life to find someone who shares such a pasthe orthopedic trauma population is partic- sion for a specific thing. He will certainly be a ularly vulnerable.” The study also concludes great influence on me as I start practice.”

Moving His Practice and Lexington Clinic Forward

Morris is excited about the future of orthopedics at Lexington Clinic. Its promotion of sub-specialty care and the support for clinical research suit him well. He anticipates multiple opportunities to bring innovations to the practice, particularly in elbow arthroscopy and improved techniques for Tommy John surgery.

He also sees an activist role for himself. He anticipates helping colleagues take advantage of the lessons of his research on opioid abuse. Outreach to young athletes who might suffer the elbow injury repaired

by Tommy John surgery will be a part of his

practice. This will take the form of promoting reduced pitch counts among the youth baseball population. Morris says, “I think that part of our job is to educate parents, coaches, and players about preventing such injuries. Any young people we can keep healthy and out of our offices, is a success.”

Lexington Clinic, with its culture of professional growth, will be an easy place to do this. Morris values the “culture of improving patient care by looking at results and trying to be better with every patient encounter” that he has already observed there. He also values the system-wide EMR for its ability to produce prospective registries. These produce validated outcome measures, which physicians share with

patients to show how their department is doing. Morris sees a bright future at Lexington Clinic, concluding, “I believe Lexington Clinic will continue to lead the way in outcomes-based orthopedic care.”

Enthusiastic and energetic, Morris knows he has found the ideal repository for his talent and aspirations. The Lexington Clinic Orthopedics – Sports Medicine Department continues to grow and serve the community effectively, and bringing in physicians committed to innovation and collaboration like Morris is key to its success. Facilitating mentorship by Dr. W. Ben Kibler will ensure Lexington Clinic that Morris’ many attributes are maximally utilized. ◆

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THIS IS AN ADVERTISEMENT ISSUE#88 17

SPECIAL SECTION  ORTHOPEDICS

Small Setting, Big Services

Baptist Northeast Orthopedics provides leading-edge care in a small hospital atmosphere

BY JENNIFER S. NEWTON

LAGRANGE It is easy to assume that larger hospitals have a distinct advantage when it comes to acquiring new technology and procedures, but at Baptist Northeast Orthopedics, the small-town, community hospital atmosphere of the 120-bed Baptist Health LaGrange and a commitment to offer the most effective procedures for patients have only enhanced the practice’s ability to provide comprehensive orthopedic care.

Baptist Northeast Orthopedics, a part of Baptist Surgical Associates, is home to three surgeons – Eugene Jacob, MD, Nicholas Kenney, MD, and Jeremy Statton, MD – and draws patients from Jefferson, Oldham, Shelby, Henry, Trimble, and Carroll counties.

Jacob founded the practice in 1985 and was joined by Statton three years ago.

Statton, in particular, has made it a priority to train in the most up-to-date orthopedic techniques. He is the only surgeon at the hospital performing the anterior approach to total hip arthroplasty (THA), in addition to a broad range of other orthopedic procedures, including reverse total shoulder arthroplasty (RTSA).

A Kentucky native, Statton grew up in Owensboro and attended the University of Louisville for college, medical school, and residency. While completing a fellowship in sports medicine at the University of Cincinnati (UC), Statton had the opportunity to work with the Cincinnati Bengals and the UC Bearcats. He also completed a small trauma fellowship in Vienna, Austria.

His broad-based training and skill set also allow him to share his talents through mission work. Statton has been on three trips to Africa, including some time in Kenya. “I’m able to help doctors that are there full-time and interact with doctors in residency during their training there,” he says.

Despite Statton’s travels, the LaGrange community is a perfect fit for his commit18 M.D. UPDATE

PHOTO PROVIDED BY BAPTIST HEALTH

says. That includes rotator cuff and labral tears, shoulder arthroscopy, and reconstructive procedures, including RTSA. RTSA has been around for about a decade and Statton describes it as “a huge development in treatment options for shoulder problems in older folks.”

The differentiating factor for RTSA is that rather than just replacing the joint surface, as in most joint replacements, the procedure also addresses the function of chronically torn rotator cuff muscles, improving not only pain, but also function.

Shifting to the Hip

Dr. Jeremy Statton performs the anterior approach total hip arthroplasty and reverse total shoulder arthroplasty at Baptist Health LaGrange

ment to provide leading-edge care for his patients. “For me personally, I know everybody in the hospital, so when I take care of patients, all the nurses know who I am and they know what I want. They can call me anytime, even when I’m not on call, which I welcome, so we can provide excellent care,” says Statton. He says the same is true of his interactions and communication with consulting physicians.

Shoulder Strong

The shoulder is where Statton’s main area of interest lies. “I do absolutely every problem that can happen in a shoulder,” he

Statton’s interest in shoulder procedures translates to a caseload heavy with shoulder patients. However, that balance has slowly shifted over the last couple of years. “At one point I was probably doing two-thirds shoulder and one-third knees and some hips,” says Statton. That all began to change when Statton began performing the anterior approach for hip replacement two years ago. “Now that I’m doing anterior hip, it has probably changed so it’s 50 percent shoulder, 25-30 percent hips, and 20-25 percent other things,” he estimates.

A desire to provide a full complement of orthopedic services to patients at Baptist Health LaGrange was a driving factor for Statton in seeking out training in the anterior approach. “We want to provide everything we feel comfortable doing for our patients out here, so they don’t feel like they need to go somewhere else,” says Statton.

WE WANT TO PROVIDE EVERYTHING WE FEEL COMFORTABLE DOING FOR OUR PATIENTS OUT HERE, SO THEY DON’T FEEL LIKE THEY NEED TO GO SOMEWHERE ELSE. – Dr. Jeremy Statton “Because [the anterior approach] has been something that’s advantageous for patient recovery, I decided to learn it so we could also offer that at this hospital.”

The benefits of anterior THA are like those commonly recited for laparoscopic surgery – smaller incisions and quicker recovery. In this case, the anterior approach spares cutting the muscle, facilitating fewer restrictions on post-operative movement than with the posterior approach because of a greatly reduced risk of hip dislocation.

Statton says long-term outcomes for both procedures are probably the same at a year but significantly different in the short-term, which appeals to patients.

Another advantage of the anterior approach for the surgeon is better visualization with x-ray, “so you can more accurately assess the anatomy, looking at whether leg lengths are equal on each side, what we call the offsets,” says Statton.

Although there are some obvious benefits to anterior THA, posterior hip replacement is still the norm. “My guess is that still less than 20 percent of surgeons do the procedure with an anterior approach,” estimates Statton. A few reasons for the lack of proliferation of anterior THA may include conflicting reports on early complication rates, the learning curve for established physicians, the approach not being taught universally in residency, and the need for a special table that allows better access to the hip joint. Contraindications for anterior THA can include morbid obesity and previous posterior hip surgery.

Recovery and Beyond

Regardless of the type of orthopedic

surgery patients receive, Baptist Health LaGrange offers a number of services that help complete the continuum of care. For total joint replacement patients, the hospital offers a Total Joint Camp, a three-hour program that includes pre-admission testing, a tour of relevant hospital departments, and a presentation to help patients understand what will happen in surgery and what to expect during recovery. The hospital is also equipped to meet all a patient’s post-op rehab needs, including short-term inpatient rehab, home health services, and outpatient rehab.

Sports Medicine is another focus of the practice, and Statton puts his fellowship training to use as one of the team doctors for North Oldham High School.

Whether tending to injuries on the field, in the wild, or simply in the operating room, Statton and Baptist Northeast Orthopedics are taking the extra step to provide the latest treatments for patients in the small-town community of LaGrange. ◆

FOR PATIENT REFERRAL,

Jeremy Statton, MD, Orthopedic SurgeryBaptist Northeast Orthopedics, 1023 New Moody Lane, Suite 102, La Grange, KY 40031 502-222-0598 www.baptistmedicalassociates.com ISSUE#88 19

SPECIAL SECTION  PHYSICAL MEDICINE & REHAB

Functional Specialists

UofL’s PM&R Division grows to better train residents and restore function to patients

BY JENNIFER S. NEWTON

In its 41st year, the Physical Medicine & Rehabilitation Residency Training Program at the University of Louisville (UofL) was historically a private residency run by Frazier Rehab Institute, now a part of KentuckyOne Health. In

LOUISVILLE

Dr. Darryl L. Kaelin is the medical director of Frazier Rehab Institute and chief of the division of Physical Medicine & Rehabilitation for UofL.

2011, UofL decided to create the Division of Physical Medicine & Rehabilitation and bring faculty on. The first three faculty members were part of the old Rehabilitation Associates group that Dr. Linda Gleis (this month’s cover story) was once a part of.

In June 2011, Darryl L. Kaelin, MD, was recruited as the fourth faculty member and chief of that division.

Kaelin was a med student at UofL when Gleis was residency program director. He counts her as one of his mentors. In fact, Gleis gave Kaelin some advice. She said, “If you want to come back to Louisville to practice, you might want to train elsewhere.” That’s just what Kaelin did.

Leaps and Bounds

Kaelin returned to Louisville to not only take over a position that once belonged to his mentor but also to build a new legacy for the program. “We were fortunate enough to be able to negotiate a growth model with 20 M.D. UPDATE

the university and have been able to expand over a two-year period to 10 physicians,” says Kaelin. “Now we have specialists in just about every area of rehabilitation including brain injury, spinal cord injury, cancer rehab, sports medicine, pain management, and pediatric rehab.” He adds, “This not only allows us to take care of all the people who need our services in the Kentuckiana area but also allows us to better train the residents who are coming through the residency program.”

The program currently has six residents, two per year in post-graduate years two, three and four. “We are looking to expand because we feel there is a need for more training in the field and maybe going to as many as 12 residents in the future, but that requires funding in order for that to happen,” says Kaelin.

The symbiotic relationship between the university and Frazier is evident in the organizations’ shared missions of education, clinical care, and research. “Frazier Rehab acts as the hub of our training program as well as all of our clinical and research programs,” says Kaelin. Frazier provides convenient inpatient units and outpatient clinics for residents to treat patients. Residents also see patients at physician offices at Southern Indiana Rehab Hospital, Baptist Health Louisville, and UofL. Among the division’s rehab services, the spinal cord injury program may be the most well known. “We have what’s called a ‘Model System’ spinal cord program, which means that we’re recognized as among the top spinal cord programs in the country,” says Kaelin.

Two of the areas with the most growth right now are the brain injury program, which Kaelin leads, and pain management, led by Dr. Jonathan Pratt, a fellowshiptrained pain specialist experienced in interventional treatments and medication therapy.

Generating Awareness

Because physical medicine and rehabilitation (physiatry) is a relatively small specialty, physiatrists spend a considerable amount of time educating patients and physicians about their services. “We comprise about only 1.1 percent of all physicians. However, almost everyone that develops an illness or injury that results in a loss of function could benefit from treatments that a physiatrist can provide,” offers Kaelin.

Physiatrists often have to differentiate themselves from physical therapists, orthopedic surgeons, and even neurologists. Says Kaelin, “We think of exercise as medicine.

We are specialized in prescribing specific types of treatments, whether modalities like electrostimulation or ultrasound, or therapy prescriptions that work specifically for a person’s problem.” Kaelin calls physiatrists “functional specialists,” with expertise in non-surgical treatments and helping people regain function and independence.

Advancements in the field of PM&R include a growing area of technology and computerized equipment, such as electrostimulation, body vibration, and specialized treadmills that get patients better quicker.

At UofL, clinical trials further their mission to expand research and improve clinical care. Current areas being studied include: the effects of locomotor training and medications on spinal cord injuries, the effects of Nudexta on emotional dysregulation after brain injury and stroke, and the effects of botulinum toxin and intrathecal Baclofen on spasticity.

In addition to growth in specialized areas of clinical care, the PM&R program is also looking to expand its geographic reach into the state as part of UofL and the KentuckyOne network. One manifestation of that will be a telerehab program being developed over the next year to allow physicians to follow patients after a severe trauma or debilitating illness once they return home to more rural areas of the state. ◆

SPECIAL SECTION  PHYSICAL MEDICINE & REHAB

Ephraim McDowell Physical Therapy Alternative to surgery and vital part of post-surgical plan

BY KEITH BRIDGES, executive director Ephraim McDowell Health

As many as 80 percent of people will have some type of back or neck pain within their lifetime. Sometimes surgery is the only solution to the problem, followed by a regimen of physical therapy, but in many instances, physical therapy alone can return patients to a reduced or pain-free life. Ephraim McDowell Regional Medical Center’s Spine Physical Therapy team specializes in the care of patients with spine and neck pain.

Physical therapists work with patients to evaluate symptoms by taking a detailed history of pain and symptoms, assessing muscle strength, joint mobility, neurologic integrity, balance and coordination, flexibility, and specific movement patterns.

Then, these skilled therapists build individualized treatment plans for each patient, with one-on-one care. Aside from a variety of pain control techniques, patients focus their physical therapy on stretching and strengthening tasks, along with other therapeutic treatment, to help align the spine and pelvis, decrease muscle tension, and nerve compression. Although Ephraim McDowell Spine Physical Therapy specializes in spine rehabilitation, patients receive care for sacroiliac joint pain, rib articulations, hip pain, headaches, chronic pain, and orthopedic joint problems.

Ephraim McDowell’s post-surgical physical therapy is often key to helping patients reach their maximum level of functionality following spine or orthopedic surgery. Through consistent, professionally guided physical manipulation of muscles and bones, combined with state-of-the-art facilities providing aquatic therapy, patient recovery is enhanced, often shortened, and the quality of life improved.

The physical therapists at Ephraim McDowell Spine Physical Therapy have been recognized for their knowledge as presenters at professional conferences, university instructors, and sought out by sports teams and athletes seeking to improve core stability and treatment of joint injuries. ◆

DANVILLE

Shelley Bigelow, Ephraim McDowell Spine Physical Therapy patient and Erik Drake, DPT. The patient is coordinating a spinal stabilization activity with upper extremity movements.

PHOTO PROVIDED BY EPHRAIM MCDOWELL HEALTH

ISSUE#88 21

RHEUMATOLOGY

Decreasing Inflammation, Increasing Independence: Lexington Clinic Rheumatology serves geriatric population as well as others

BY TIM CORKRAN

LEXINGTON Modern rheumatology is a multifaceted field that can offer its patients dramatic relief from their inflammation-related suffering. Committed to addressing the causes of pain rather than its symptoms, Haider Abbas, MD, Lexington Clinic rheumatologist, relishes reducing autoimmunebased inflammation to preserve the independence of his patients, particularly the elderly. Success at this is both his focus and his reward. “Ours is a very exciting field. We see diseases that make active people miserable, and by treating those patients correctly, we can absolutely turn them around,” he says.

Rheumatology appealed to Abbas early in his internal medicine residency because of the complexity of the cases he encountered and the capacity of available treatments to do great good. This drew him to fellowships at Wake Forrest in Rheumatology and Geriatrics, and he is board-certified in both.

He came to Lexington Clinic in 2007 to revive a rheumatology program that had not existed for two years. In 2010, Sonia Nair, MD, joined the Lexington Clinic Rheumatology Department, and together they have a very busy clinical practice. They have seen growth in the field with a move towards standardization of care and the benefit of biologics, and are seeing their own practice benefit from the proactive professional culture at Lexington Clinic.

A Complex Specialty Compels Practical Physician Choices

Though popularly simplified as the study of sore joints, rheumatology is primarily concerned with autoimmune issues, many of which are systemic and manifested in soft tissues such as muscles and blood vessels. Non-mechanical inflammation is 22 M.D. UPDATE

PHOTOS PROVIDED BY LEXINGTON CLINIC

the common denominator in the work of rheumatologists, and its sources can be complex and elusive. As Abbas says, “Rheumatology goes beyond the surface, beyond the skin, bones, and muscles, to deep inside the body.”

Abbas cites Lupus as a typical rheu-

Dr. Haider Abbas, head of section of the Lexington Clinic Rheumatology Department, is board-certified in both Rheumatology and Geriatrics.

RIGHT Rheumatolgist Dr. Sonia Nair, boardcertified in Rheumatology and Internal Medicine, lives by the pledge – “I, as a rheumatologist, will do everything in my power to help patients maintain functionality in any afflicted joint.”

ABOVE

matologist’s concern: Its cause has a genetic component that is unspecified; its symptoms are vast, disparate, and inconsistent; and its potential to inflict suffering is great. Rheumatoid arthritis is another common condi-

tion, but Abbas notes that many of what he and Nair treat are so-called orphan diseases.

These tend to have a variety of symptoms, some systemic, some not. He finds the challenge of orphan diseases engaging, saying, “Such conditions require a very meticulous diagnostic approach and treatment plans based on each individual patient.”

As so many autoimmune issues arise in the elderly population, Abbas knew he could best serve his patient base with full training in geriatrics. “I felt that I had to do a fellowship in geriatrics to get the full benefit of my expertise,” he says, adding that he is “much more comfortable working with my patient population having done that fellowship.”

Loss of physical independence so preoccupies elderly arthritis sufferers and Abbas feels well equipped to alleviate that anxiety.

The patient population treated by the Lexington Clinic Rheumatology Department

is in fact 60 percent over the age 65, but Abbas and Nair see plenty of younger patients for non-mechanical joint pain. Orphan diseases that may baffle primary care physicians afflict many of these patients. Sixty percent of all their patients are female. “Auto immune diseases are more common in the female population,” he explains.

A Dynamic Clinic and an Evolving Field

Abbas was drawn to Lexington Clinic by “the excitement of reestablishing the Rheumatology Department,” and still finds it a fertile ground for his desire to build a patient-centered practice. With a systemwide EMR in place, he and his colleagues are sharing records and tests in a way that is cost-effective and expedient. Abbas also values Lexington Clinic’s commitment to improving quality of care through increased peer review and tracking of outcomes.

The innovative nature of the field of rheumatology excited Abbas from early on; many new interventions were coming out when he started. In the last 10 years, he notes, “Rheumatology has moved forward considerably in terms of therapeutic interventions and treatment tools.” More evidence-based standards of care have been established for the more common maladies, and “there is a spirit of innovation when it comes to the orphan diseases.” This is a necessity, as Abbas explains, “We are seeing more and more incidences of these in our elderly population.”

Abbas notes that the practice of geriatric rheumatology benefits greatly as the elderly population grows. There is abundant valuable clinical data on responses to treatments because of all the trials going on in that age group. This has a direct effect on his ability to treat his elderly patients. “Instead of just using the therapeutic offerings we tend to use on the general population, we are now able to focus our treatments on what the data shows is best for them,” he says.

Innovation in the field of biologics

has also had a great impact on rheumatol- and support available to Abbas and Nair, ogy. “Biologics have been the frontrun- but they will be best served by the physiners in the last 10 years for increasing our cians’ commitments. For Nair this takes the treatment options,” form of a pledge: ORPHAN DISEASES HAVE NO “I, as a rheumatoloAbbas says. Nair adds that many of gist, will do everySPECIFIC TREATMENT, SO the joints that were thing in my power RHEUMATOLOGISTS MUST previously allowed to help patients to simply degrade functionINNOVATE TREATMENT PLANS maintain until replacement ality in any afflicted FOR THEIR PATIENTS. are being preserved joint.” For his part, through biologics.

Abbas’ adheres to “The majority of our rheumatoid arthritis the field’s fundamental value, concluding, patients avoid surgery now because of the “Rheumatology leads directly to the quality advances in biologics,” she states. of life of the patients because of our ability Lexington Clinic’s rheumatology to maintain their physical independence – patients benefit from the array of methods especially our elderly patients.” ◆

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ISSUE#88 23

COMPLEMENTARY CARE

Consumer-Driven

Adaptability and customer service are the hallmarks of Apex Physical Therapy’s independent business model BY JENNIFER S. NEWTON

The pages of MD-UPDATE often relate the challenges physician practices face in the wake of the Affordable Care Act (ACA), but physician offices are not the only businesses affected by the law. Complementary services, such as physical therapy practices, have also seen significant consequences from the legislation.

According to Patrick Myers, PT, DPT, OCS, MS, COMT, founder and owner of Apex Physical Therapy, the biggest issues his practices face are akin to those physicians encounter – decreased reimbursement and increased paperwork. Indirectly, the increasing trend of hospital-employed physicians has created an additional challenge for independent physical therapy practices, who rely on physician referrals for part of their patient base. Apex has countered the trend by adjusting its strategy to focus more on consumer-driven marketing.

LOUISVILLE/LAGRANGE/HILLVIEW

10 Years and Growing

Myers opened Apex 10 years ago at its Middletown location to follow a desire to be an independent business practitioner. The practice specializes in outpatient orthopedic therapy for pediatric and adult patients.

“Most of the things we see are musculoskeletal. We do see some very modest neurological deficits,” says Myers. However, they are not afraid to refer out neurological issues that area outside of their wheelhouse.

Today, Apex is one of the largest independent physical therapy practices in the area, and each of their therapists holds a doctorate in physical therapy. “I do think more people are recognizing physical therapy not only as an adjunct source of their health care, but I think they’re making the choice the first time,” says Myers. “We’re at 10 years in practice, and we’re busier company-wide than we’ve been ever.”

In April 2011, MD-UPDATE featured Myers and his use of the Australian-based Maitland Concept for manipulative phys24 M.D. UPDATE

PHOTOGRAPH BY BRIAN BOHANNON

Patrick Myers, PT, DPT, OCS, MS, COMT, is the founder of Apex Physical Therapy and holds specialized training in Maitland Australian Physiotherapy, Mulligan Manual Therapy, and dry needling.

iotherapy. All of Apex’s therapists now use components of the Maitland or Mulligan concepts in their practice.

Brad Conder, PT, DPT, OCS, clinic director of Hillview and River Road, has used manual therapy techniques for eight of his 10 years of practice and is close to being Maitland certified. “As a company we try make sure all our therapists are trained in the best physical therapy training out there with the most evidence behind it,” says Conder.

One of the practice’s keys to success, according to Conder, is scheduling patients appropriately so there is enough time for a combination of manual therapy and exercise prescribed by therapist. “The combination of those two things usually yields the best outcomes backed up by evidence,” he says.

LaGrange

Co-owner and Clinic Director Nick

Austin, PT, DPT, OCS, CSCS, joined Apex in 2006 when he partnered with Myers to open the company’s LaGrange clinic.

The clinic doubled in size in its first few years and moved to a new building Apex designed. It houses both private and open treatment areas and is set up for TRX training, dry needling, and massage.

Dry needling is another technique almost all of Apex’s therapists are certified in. “Dry needling uses an acupuncture needle with a different approach. The approach of the needle is to stimulate a local twitch response in a trigger point,” says Austin. The twitch response resets the muscle and results in decreased pain and spasms. Typically one to three sessions are needed to see the expected effect, and the therapy can be used alone or in conjunction with other therapies.

Hillview

Conder joined Apex six years ago and has been the clinic director at the Hillview location for three years. “I was attracted to Apex’s small private model,” says Conder.

Nick Austin, PT, DPT, OCS, CSCS, is the owner and clinic director of Apex LaGrange and is a certified strength and conditioning specialist.

BELOW Brad Conder, PT, DPT, OCS, is the clinic director of Hillview and River Road and is spearheading the company’s new industrial medicine program.

one of the ways we meet the challenge of bigger and larger competitors in the community is to try to treat people as well as we can possible treat them.”

Their culture of customer service extends to physicians as well. Apex’s staff believes in a team approach to care and a two-way street for referrals: physicians refer to them and they refer out when patients need another service. Apex strives to have great working relationships with physicians because they see themselves as an extension of the physician’s health care team.

“We’d like to be the place you would send your mom to,” concludes Austin. ◆

ABOVE

“Being a small private practice, we get to really control how we run our business.”

The Hillview clinic, is located in Bullitt County, and has a slightly different mix of patients than the other clinics, which includes a significant amount of work industry patients. They also see sports injuries, spine patients, and automotive patients. Open for four years, the Hillview clinic doubled its volume in its first year of business. Conder estimates 25 percent of Hillview’s patients in a month are return patients or family referrals because of the practice’s reputation and service.

River Road

Three months ago, Apex opened its newest location, a small satellite clinic located inside Heuser Health, a medically oriented fitness practice, on River Road. “We came across a great relationship with Dr. Louis Heuser at Heuser Health. Really the practices fit together perfectly like puzzle pieces,” says Myers.

The partnership has spawned a new business model for Apex that focuses on industrial medicine. “We are developing a new business model to where we can actually reach out to companies with more of a wellness and prevention model,” says Conder. The River Road Clinic gives Apex a presence on the north side of Louisville, as well as a base for expanding their industrial

medicine concept.

Apex has partnered with DSI Work Solutions, who offers work injury prevention and management programs and training, to promote the new model. “We don’t focus on injury; we focus on prevention,” says Conder. The program offers “frontend” services, such as prevention programs, work station evaluation, and post-offer job screenings within OSHA guidelines, in addition to back-end treatments once an injury has occurred.

Conder says so far the model has been successful and is one they are looking to grow. Apex is in the process of opening another clinic with Heuser in east Louisville.

Culture of Customer Service

While Apex still receives a good number of physician referrals, they are seeing an increase in direct access patients and wordof-mouth referrals. Both Myers and Austin believe their strong culture of customer service is an important factor driving these results. “We train for customer service at all levels with our staff,” says Austin. “That’s

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GET BACK TO

PHYSICAL THERAPY GET BACK TO LIFE. FASTER.

Give us a call today about the aches and pains that are slowing you down.

502.245.1136 www.apexptky.com Middletown • laGranGe Hillview • river road

TOP PHOTOGRAPH BY BRIAN BOHANNON, BELOW PROVIDED BY APEX

ISSUE#88 25

COMPLEMENTARY CARE

Three Mindfulness-Based Ways to Resilience I may be the only person I know who uses on a daily basis the information explored in his or her doctoral thesis — and enjoys sharing it with my clients. As a health professional, you may also be interested in the study of resilience — how the average person manages to cope effectively with daily stresses and successfully adapts to loss, adversity, and other conflicts and struggles of life.

The cultivation of mindfulness - the ability to focus in an open, relaxed way on present moment experience - is one of the most practical and powerful ways I know to develop resilience. Studies show that mindfulness is a powerful way to take a break from stressful thoughts and gain perspective before you react or respond. People who exhibit greater mindfulness tend to enjoy greater satisfaction and intimacy in relationships and deal with relationship stress more constructively.

Here are three ways that both you and your patients can quickly and easily translate the mind-body benefits of mindfulness into your everyday life and relationships.

Mindful Breathing

Don’t be fooled by the simplicity of mindful breathing — it is a very powerful stress reduction practice. Studies have found that mindful breathing has a profound effect on your physiology and can improve sleep and energy cycles, decrease anxiety, lower blood pressure, and even correct heart arrhythmias.

The Calming Breath is a very effective anti-anxiety technique and also helps my clients refresh and refocus, both mentally and physically. The first variation of the Calming Breath uses a 1:2 ratio, which means you’re inhaling for four counts and exhaling for eight counts. Much of the benefit of this breathing practice comes from keeping the exhalation twice as long as the inhalation.

I recently recorded a series of podcasts featuring a guided experience of the Calming Breath. Each podcast lasts two to three minutes and can be downloaded from my website for listening on a mobile device or computer. A number of my clients have used the Calming Breath to get through the anxiety of an MRI or uncomfortable dental procedures.

26 M.D. UPDATE

Mindfulness Meditation

Mindful breathing cultivates the ability to concentrate in a relaxed way and provides a gateway to the

BY Jan Anderson, PsyD, LPCC added benefits of a mindfulness meditation practice. Mindfulness helps my clients tolerate and explore subjective experiences that may be uncertain, unfamiliar, uncomfortable, and paradoxical.

It is not surprising that researchers have found that people who were more mindful throughout the day tended to also show enhanced self-awareness, were more able to regulate their behavior, and reported more positive emotional states. As therapist and author Stephen Cope puts it, meditation creates “a container to hold life in such a way that we are not shattered by it.”

For those who can spend 10 to 20 minutes in a comfortable seated or reclining position, I recorded a Mindfulness-Based Stress Reduction (MBSR) CD of four guided meditations that my clients use to help get to sleep, prepare mentally and emotionally for surgery, or help manage chronic pain.

Mindful Walking

You may recognize in yourself or your patients that the idea of sitting, uninterrupted and undisturbed, for 10 to 20 minutes is not the best place to start cultivating a mindfulness practice. Most of us have an “Inner Pusher” voice inside us that insists that we constantly be in a state of doing versus being. Besides, most of us are already plenty sedentary.

For some of my clients, a better place to start is with Mindful Walking. I modified this practice from the classical walking meditation (which involves walking extremely slowly and methodically) into a more practical experience that can be done almost anywhere.

Translation: No one will mistake you for a zombie — you’ll be able to do this in public.

Begin your walk with a sense of grate-

fulness for the opportunity to cultivate mindfulness. Let your intention be to focus visually enough to be aware of your surroundings, but not distracted by them.

As you walk along, let your attention rest on any or all of the following three awareness “anchors” that are connected to present moment experience: 1) sounds in your environment; 2) your breathing; and 3) sensations in your body. Whenever your attention wanders from one of these three awareness anchors, exchange “thinking” for “sensing” of sound, breath, and body and feel yourself returning to the here and now.

Dr. Jan Anderson is a Licensed Professional Clinical Counselor with a Doctorate in Clinical Psychology. Her private practice includes over 15 years of experience counseling individuals, couples, and families. ◆

COMPLEMENTARY CARE

Could Acupuncture Help You? Chronic pain, migraine headaches, obesity, anxiety, depression, and addictions are very difficult to treat. Currently offered drugs, surgeries, counseling, and physical therapies rarely provide a complete relief for these conditions. This has led many suffers and medical providers to explore other therapies. The use of acupuncture in the United States is expanding rapidly, especially in pain clinics and substance abuse and mental health treatment facilities.

Acupuncture encompasses a family of therapies involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Acupuncture has been around for thousands of years and is one of the key treatments used in traditional Chinese medicine.

We do not know exactly how acupuncture works. This is partially because acupuncture and other treatments outside of traditional Western medicine have not been studied in the same way as drugs and surgeries. Fortunately, there are a growing number of studies available now to guide patients and medical providers when considering acupuncture as an option. These studies offer some insight into the way acupuncture works. Multiple research studies have shown that acupuncture activates the body’s natural painkillers, producing an effect like narcotic pain medications. Acupuncture may

also stimulate nerves that override pain signals.

Regardless of how it works, studies of brain function and structure suggest that acupuncture has positive speBY Deborah Ann Ballard, MD, MPH cific, measurable effects on the brain’s response to pain.

A review of the scientific literature shows that acupuncture offers a good chance of helping people with some of the most common chronic medical problems. For example: Acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. Acupuncture for migraine headache is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects.

Acupuncture can also be a valuable nondrug treatment for patients with frequent episodic or chronic tension-type headaches.

Acupoint stimulation appears to be effective in treating fibromyalgia compared with medications. Acupuncture has been shown to offer good short-term relief for back pain.

Acupuncture is generally very safe. Skin infections can occur if the needles used are not sterile, so it is best to receive acupuncture from a certified acupuncturist and ask how the needles are sterilized. You can check with the Kentucky Board of Medical

Licensure to see if your acupuncturist is certified. Some, but certainly not all health insurance plans cover acupuncture therapy.

It is clear that a person’s perceptions, beliefs, and attitudes toward acupuncture greatly influence whether or not it will help.

It is also clear that attention to proper diet, physical activity, and lowering of stress help any medical therapy work better. While some people dismiss acupuncture as having a placebo effect, dedicated researchers are intensely trying to understand how medicine can leverage the marvelous ability of our minds to control pain, accelerate healing, and relieve suffering. After all, aren’t those the real goals in treating any form of illness?

In summary, acupuncture is a reasonable treatment option for many people suffering with common chronic health problems. It is much less expensive and risky than surgery and spinal injections, and has fewer side effects than addictive or sedating pain medications. Integrative medicine is a growing subspecialty that incorporates acupuncture and other therapies formally called “complementary” or “alternative” in a person’s overall treatment plan. You can find a board certified integrative medicine provider by searching the American Board of Integrative Holistic Medicine website.

Deborah Ann Ballard, MD, MPH, is an internal medicine specialist with KentuckyOne Health Primary Care/Healthy Lifestyle Centers and is certified by the American Board of Integrative Holistic Medicine. ◆

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

ISSUE#88 27

PRACTICE MANAGEMENT

Practice Management Group Learns Value of Patient Listening Skills

BY SHANNON HELTON, PRESIDENT BGMGMA The topic of Blue Grass Medical Group Management Association’s (BGMGMA) August meeting was “Hearing the Patient: Listening Skills and Empathy.” The speaker was Laura Cooley, PhD, who serves as director of Education for The American Academy on Communication in Healthcare (AACH). Cooley interactively discussed the art of communication and presented data to support the practice that empathy enhances efficiency and presented examples of how providers can respond to patients more empathically.

BGMGMA has two more meetings scheduled in 2014. The topic for the October 16th meeting is “Contract Negotiations” and attorney Pam Basconi of Lexington is the speaker. Specific questions from membership will be solicited prior to the meeting to ensure the information provided is relevant to the audience.

The November 13th meeting will include the annual Vendor Fair along with a Payer Panel. The panel will consist of representatives from multiple insurance carriers.

BGMGMA offers several different packages to vendors and applications for the Vendor Fair are available at BGMGMA website,

bgmgma@gmail.com.

BGMGMA was formed in Lexington, Kentucky, in 1989, to provide an educational and networking forum for practice managers. BGMGMA has over 150 members representing nearly 125 local physician offices in Central Kentucky.

The BGMGMA is affiliated with the Kentucky Medical Group Management

LEXINGTON ATTORNEY PAM BASCONI WILL PRESENT “CONTRACT NEGOTIATIONS” AT THE BGMGMA’S OCTOBER 16TH MEETING. Association (KMGMA) and the National Medical Group Management Association (MGMA), but operates as an independent entity with its own by-laws and elected leaders.

To achieve its mission, BGMGMA provides 10 educational lunch meetings yearly featuring speakers on current medical management practice issues.

The educational meetings are held in Lexington at various locations. The annual dues for Active and Associate Members are $50; student members $15; Business Partner $200. ◆

A Joint Commission accredited private surgery center where our physicians perform diagnostic and surgical procedures for the treatment of pain, to include:

PO Box 23110, Lexington, KY, 40523 bgmgma@gmail.com. www.bgmgma.com

28 M.D. UPDATE

NEWS ď ľ EVENTS ď ľ ARTS

Physicians join KentuckyOne Health Primary Care Associates

COME PLAY

SHELBYVILLE Leticia Allen, MD, has joined KentuckyOne Health Medical Group. She will practice at KentuckyOne Health Primary Care Associates, formerly Shelby Family Medicine.

The office is located at 60 Mack Walters Road in Shelbyville.

Allen attended medical school at Ross University, and completed her residency at the Baton Rouge General Family Medical Program. She has received a number of awards, including Chief Resident, Gerringer Outstanding Resident Award, and Scholarly Activity Award. Allen is board-certified in family practice.

LOUISVILLE Iosbani Alberteris, MD, has joined the KentuckyOne Health Medical Group. He is practicing at KentuckyOne Health Primary Care Associates, formerly Sun Valley Family Care.

The office is located at 9616 Dixie Highway in Louisville.

Dr. Alberteris is a dedicated family doctor with more than 15 years of practice

SEND YOUR NEWS ITEMS TO M.D UPDATE > news@md-update.com

experience. He obtained his M.D. degree at the University of Havana in 1996; completed a family medicine residency at the University of Havana; and completed a family medicine residency at the University of Louisville. He is board-certified by the American Board of Family Medicine.

LOUISVILLE Joshua Bentley, MD, has joined the KentuckyOne Health Medical Group.

He will practice at KentuckyOne Health Primary Care Associates, formerly Highlands Internal Medicine. The office is located at 1250 Bardstown Road in Louisville.

Bentley completed his undergraduate degree at the University of Kentucky, graduating magna cum laude with biology honors. He attended medical school at the University of Louisville School of Medicine, and completed his residency in family medicine at the U of L Department of Family and Geriatric Medicine. Bentley is boardcertified in family medicine.

LOUISVILLE Amy Kim, MD, has joined KentuckyOne Health Medical Group. She will be practicing at KentuckyOne Health Primary Care Associates, located at 9520 Ormsby Station Road in

Louisville.

She graduated with a bachelor of science degree in biology from Butler University in Indianapolis, Indiana; attended medical school at the Wright State University Boonshoft School of Medicine in Dayton, Ohio; and completed a family medicine residency at the University of Louisville. Dr. Kim is board-certified in family medicine.

Lexington Clinic Announces Addition of New Physicians

LEXINGTON Lexington Clinic is pleased to announce the addition of three new physicians: Justin D. Johnson, MD, Scott A. Merkley, MD, Brent J. Morris, MD, Saranne Perman, MD, and Jeffrey L. Yates, MD, PhD. Dr. Justin D. Johnson will be joining Commonwealth Urology: Urologic Associates, A Part of Lexington Clinic. He received his medical degree from the University of Kentucky College of Medicine, completed an internship and residency in Surgery and an additional residency in Urology at the University of Nebraska Medical Center. Dr. Johnson is boardeligible in Urology and provides services in adult male and female urology, benign prostate disease, incontinence, male sexual

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ISSUE#88 29

NEWS dysfunction, pediatric urology, stone disease, urological cancers and vasectomy (noscalpel technique). His professional interests include all aspects of urology, including adult male, female and pediatric urology.

Dr. Scott A. Merkley is joining the Lexington Clinic Gastroenterology department at the Lexington Clinic Ambulatory Surgery Center. Merkley received his medical degree from the University of Louisville School of Medicine. He completed a residency in Internal Medicine and a fellowship in Gastroenterology and Hepatology at the University of Kentucky Chandler Medical Center.

Merkley is board-eligible in Gastroenterology and board-certified in Internal Medicine. He provides services in diagnostic and therapeutic endoscopy including colonoscopy with biopsy and polypectomy, flexible sigmoidoscopy with biopsy and polypectomy, upper endoscopy with biopsy, band ligation of varices, dilation of esophagus and pylorus, argon plasma coagulation/ablation of angiodysplasia, PEG placement/replacement and wireless small bowel capsule endoscopy.

Dr. Brent J. Morris will be joining the Lexington Clinic Orthopedics – Sports Medicine Center. He received his medical degree from the University of Kentucky College of Medicine, completed an internship in General Surgery and a residency in Orthopedic Surgery from Vanderbilt University and most recently completed a fellowship in Shoulder and Elbow Surgery from Texas Orthopedic Hospital, in affiliation with University of Texas Health Science Center at Houston.

Morris is board-eligible in Orthopedic Surgery, specializes in total shoulder replacement and reverse total shoulder replacement including primary, complex and revision shoulder replacements, and provides services in shoulder and elbow surgery, sports medicine, general orthopedics, traumatic injuries and workers’ compensation. His professional interests include all types of 30 M.D. UPDATE

shoulder surgery and pathology and general orthopedics.

Dr. Saranne Perman is joining the Lexington Clinic Family Medicine Department at Jessamine Medical and Diagnostics Center.

Perman received her medical degree from and completed a residency in Family and Community Medicine at the University of Kentucky College of Medicine. Perman is board-certified in Family Medicine. She provides services in general family medicine for adults and children, geriatric medicine, and preventative medicine. Her professional interests include general family medicine, women’s health and prevention.

Dr. Jeffrey L. Yates will be joining the Lexington Clinic Hospital Medicine Department.

He received his medical degree from the University of Kentucky College of Medicine and completed a residency in Internal Medicine and Pediatrics at Indiana University. Yates is board-eligible in Internal Medicine and Pediatrics and provides services in internal medicine and pediatrics

ENT Specialist joins Advanced ENT and Allergy

LOUISVILLE Advanced ENT and Allergy is pleased to announce the addition of Dr. Amy Ingram to its physician network.

A Kentucky native, Ingram received her Doctorate of Medicine with honors from the University of Louisville, and completed her Otolaryngology Head and Neck Surgery Residency at Southern Illinois University in Springfield, also with honors. She is a Magna Cum Laude graduate of Georgetown College in Georgetown, Ky., where she received her undergraduate degree in 2005.

With the addition of Ingram, the group of 14 physicians will be increasing their availability in providing full service ear, nose, throat, allergy, and audiology services to patients throughout Kentuckiana.

Louisville Cardiology Welcomes Adams and Semder

LOUISVILLE Jesse Adams, III, MD, and Christopher Semder, MD, have joined Louisville Cardiology Group, part of Baptist Medical Associates.

Adams is a 1987 graduate of the Bowman Gray School of Medicine at Wake Forest University. He completed his residency in Internal Medicine at Barnes Hospital, Washington University School of Medicine in St. Louis in 1990, where he also completed his fellowship in Cardiology in 1995. He is board certified by the National Board of Medical Examiners, the American Board of Internal Medicine, and the American Board of Internal Medicine Division of Cardiology.

He is a Fellow with the American College of Cardiology.

Christopher Semder, MD is board certified in Internal Medicine and Cardiovascular Medicine. He is a 2007 graduate of the Marshall School of Medicine in Huntington, West Virginia. He completed fellowships in Internal Medicine, Cardiovascular Medicine and Interventional Cardiology at Vanderbilt University Medical Center in Nashville, Tennessee. He is a Fellowin-training with the American College of Cardiology and is a member of the American Medical Association and the American College of Physicians.

Louisville Cardiology Group is located at 3900 Kresge Way, Suite 60, Louisville, KY 40207. They also have offices in La Grange at 1023 New Moody Lane, Suite 101. ◆

EVENTS

Lexington Medical Society Golf Outing Reaches 25th Year The 25th Annual BB&T/ Lexington Medical Society (LMS) Golf Outing was held on Wednesday August 27th at the University Club in Lexington. Eighty-eight golfers teed it up in a Shamble format on a hot, humid day that ended with a torrential thunderstorm.

Winning teams were: First place - Bill Cox; Dennis Pike, Billy Gatton Jones, Bill Shouse. Second place - David Smyth, Tony Scatena, David Solomon, Mike Adams. Third place - Porter Roberts, Anjum Bux, MD, Wendy Cropper, MD, Sam Cropper.

All proceeds of the event go to the Lexington Medical Society Foundation, which supports a variety of community causes and organizations such as Baby Health, Nathanial Mission, and Surgery on Sunday. John Collins, MD, Lexington Clinic, chair of the LMS Golf Committee commented on the continuing work of the LMS Foundation saying, “Doctors and nurses volunteer at these organizations to provide health care for people of Central Kentucky who continue to struggle with the health care system.” ◆

(L-R) John Webb, Tom Waid, MD, Lexington Medical Society president, Roberto Genaly, MD, and Robin Bradley paused for a moment between shots in the 25th Annual LMS Golf Outing.

(L-R) The team of Sam and Wendy Cropper, MD, Anjum Bux, MD, and Porter Roberts took 3rd place in the 25th Annual LMS Foundation Golf Outing.

Bruce Koffler, MD, shows his form in the BB&T Chipping contest.

(L-R) Paul Hasken, Jackie Omohundro, Susan Neil, MD, and Brian Hill enjoyed the sunshine and the golf.

(L-R) Arvinda

Padmanabhan, MD, George Page, MD, Randal Owen, MD, and John Voss, MD, supported the LMS Foundation with a game of golf.

(L-R) Hameed Koury, MD, Michael Kirk, MD, Tad Hughes, MD and Bert Laureano, MD, had a good time supporting the LMS Foundation and each other.

PHOTOGRAPHY BY GIL DUNN

ISSUE#88 31

EVENTS

Heat exhaustion and dehydration are the most common ailments seen during outdoor summer events, says Maya, as a KentuckyOne Health volunteer treats a young patient.

KentuckyOne Health Sponsors Medical Service at PGA Championship After a year of planning, KentuckyOne Health provided medical care for the 40,000-50,000 spectators daily at the 96th PGA Championship in Louisville, August 4-10, 2014. Mario Maya, MD, medical director for the event, estimated a potential 250,000 patients from the combined spectators, staff, and PGA professionals.

With that number, “statistically speaking, anything could happen. From stroke, cardiac arrest, and appendicitis to elbow or ankle fractures and sprains,” says Maya.

He says it was seven long days, a break from his normal practice, and the opportunity to help his community, while “riding around in a golf cart on a beautiful golf course.”

“We anticipate a number of different types of injuries, but the most common during events like these are heat exhaustion, headaches, lacerations, and allergies,” says Maya, board certified in emergency medicine. He practices occupational medicine with Occupational Physicians Services of Louisville. “Other injuries include sprains, strains, bruises, and fractures. Our purpose is to keep everyone safe and well so that they can enjoy this wonderful sporting event,” he says.

“The rains cut down on heat related illnesses this year,” Maya says. “Instead, we saw more sprains and strains from slip and falls due to wet ground conditions.”

KentuckyOne has provided medical

32 M.D. UPDATE

management for five of the six tournaments hosted at Valhalla including the 2000 PGA Championship, 2004 Senior PGA Championship, 2008 Ryder Cup, 2011 Senior PGA Championship, and 2014 PGA Championship.

KentuckyOne Health managed three medical trailers, each staffed with a physician, a registered nurse, and an administrative support person. These locations were staffed daily for the duration of the event from 6:30am until 8pm or whenever the day was complete. More than 150 volunteers worked for KentuckyOne during the week of the tournament to provide medical care, including on-call physicians in a variety of specialties, such as pediatricians for PGA pros traveling with children.

Each trailer was equipped with a variety of medical supplies from the simple to serious: stretchers, wheel chairs, oxygen, LIFEPAK defibrillators and monitors, injectables, cardiac and intubation equipment, splints, sutures, band-aids, tape, and analgesics. Additionally, roaming EMS crews from Louisville Metro EMS monitored the course. “It was a total team effort,” says Maya.

Athletes are not the only ones to sustain injuries at these events. Attendees are often the ones that need medical attention. “KentuckyOne Health is proud to be a partner and provide the care needed for volunteers and attendees,” said Denise Wooldridge, RN, BSN, director of KentuckyOne Health Sports Medicine.

What was the biggest challenge for Maya? “Getting to the site of a medical incident, through the crowds, without making a lot of noise. The PGA doesn’t like a lot of noise at their events,” says Maya. ◆

PHOTOGRAPHY PROVIDED BY KENTUCKYONE HEALTH

(L-R) Wooldridge, Maya, and Elaine May in one of the KentuckyOne Health First Aid trailers are prepared for “almost anything.”

An all-volunteer staff provides care for an estimated 250,000 possible patients during the seven day PGA Championship event.

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