MD-UPDATE Issue # 97

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #97

SPECIAL SECTIONS PRIMARY CARE & SENIOR HEALTH BARIATRIC SURGERY

THE OPTIMAL AGING CAPITAL OF THE U.S.

VOLUME 7•#1•JANUARY 2016

The U of L Institute for Sustainable Health & Optimal Aging is leading the charge for innovation and transdisciplinary care of older adults

ALSO IN THIS ISSUE  PRACTICING DIRECT PRIMARY CARE  SPECIALIZING IN LAPBAND® AND

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Weight loss surgery can lower your cholesterol and your blood pressure, reduce joint pain, help control blood sugar, and give you a chance to live the life you’ve always wanted. You owe it to yourself to learn about the health benefits of weight loss surgery.

Visit KentuckyOneHealth.org/WeightLoss to learn more and register for a free seminar.

Flaget Memorial (Bardstown) · Jewish Hospital Shelbyville · Saint Joseph East (Lexington) · Sts. Mary and Elizabeth Hospital (Louisville)

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collaborative community networks of research, practice, innovation, and education.

The Institute for Sustainable Health & Optimal Aging empowers older adults to flourish by building collaborative community networks of research, practice, innovation, and education.

Physician-Specific Resources: Physician-Specific Resources: Participant Registry

Physician-Specific Resources: Participant Registry

health Access to age-related Physician-Specific Resources: Participant Registry health Access to age-related innovations

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Rural community models of care

Access to age-related health innovations

Rural community models Faculty Scholar Program

of care

innovations

Rural community models of care

Faculty Scholar Program 300 E. Market Street, Suite 200 Louisville, KY 40202

Rural community models Faculty Scholar Program

of care 300 E. Market Street, Suite 200 Louisville, KY 40202

Phone: (502) 852 - 5629 Email: OptimalAging@Louisville.edu

“Innovative coordinated care models have emerged ascoordinated promising solutions to thehave “Innovative care models population health crisis.

Join us in emerged as promising solutions tothis the “Innovative coordinated models person-centered approach tous improve the population health crisis. care Join in thishave emerged as promising solutions health of our aging population.”

to the the person-centered approach to improve “Innovative coordinated care models have population health Join us in this health of our agingcrisis. population.” emerged as promising solutions to the person-centered approach to improve the Anna Faul, Ph.D.

population health crisis. Join us in this health of our aging population.”

Executive Director Anna Faul, Ph.D.

person-centered approach to improve the Institute for Director Sustainable Health & Optimal Aging Executive health of our aging population.”

Anna Ph.D. Health & Optimal Aging InstituteFaul, for Sustainable Facebook/OptimalAgingInstitute Executive Director Anna Faul, Ph.D. Institute for Sustainable Health & Optimal Aging Facebook/OptimalAgingInstitute Executive Director

@ULOptimalAging

Connect with the Institute • •• • •• •• • • Faculty Scholar Program

• www.OptimalAgingInstitute.org Phone: (502) 852 - 5629 OptimalAging@Louisville.edu 300 E. Market Street, SuiteEmail: 200 Louisville, KY 40202

Phone: (502) 852 - 5629 OptimalAging@Louisville.edu 300 E. Market Street, SuiteEmail: 200 Louisville, KY 40202

www.OptimalAgingInstitute.org Phone: (502) 852 - 5629 Email: OptimalAging@Louisville.edu www.OptimalAgingInstitute.org www.OptimalAgingInstitute.org

Institute for Sustainable Health & Optimal Aging

Facebook/OptimalAgingInstitute @ULOptimalAging Facebook/OptimalAgingInstitute @ULOptimalAging @ULOptimalAging

ISSUE#97 | 1

CONTENTS

ISSUE #97

COVER STORY True to its transdisciplinary approach, the Institute has 13 social work students doing internships and is working with geriatric medicine fellows and medical students from U of L, as well as physical therapy and pharmacy students from other local universities.

3 PUBLISHER’S LETTER 4 HEADLINES 6 FINANCE 7 LEGAL 9 INVESTMENT 12 COVER STORY 16 SPECIAL SECTION: PRIMARY CARE & SENIOR HEALTH 20 SPECIAL SECTION:

THE OPTIMAL AGING CAPITAL OF THE U.S.

BARIATRIC SURGERY

The University of Louisville Institute for Sustainable Health & Optimal Aging is leading the charge for innovation and transdisciplinary care of older adults

26 COMPLEMENTARY CARE 29 NEWS

BY JENNIFER S. NEWTON, PHOTOS BY ROBERT DENSMORE PAGE 12

31 EVENTS

SPECIAL SECTIONS PRIMARY CARE & SENIOR HEALTH

16 HEALTHY BEGINNINGS: LEXINGTON CLINIC

2 MD-UPDATE

18 SUBSCRIBE TO BETTER PRIMARY CARE: BLUEGRASS FAMILY WELLNESS & ONEFAMILYMD

BARIATRIC SURGERY

20 A GUTSY DECISION: STS. MARY & ELIZABETH HOSPITAL

22 THE BARIATRIC TOOLBOX: BAPTIST HEALTH LOUISVILLE

24 THE STRUGGLE IS REAL: SAINT JOSEPH EAST

LETTER FROM THE PUBLISHER

MD-UPDATE MD-Update.com Volume 7, Number 1 ISSUE #97 PUBLISHER

Gil Dunn gdunn@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, MPH Scott Neal Calvin Rasey

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

Mentelle Media, LLC

38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502 M.D. Update is peer reviewed for accuracy.

However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.

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Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter.

Thank you.

Individual copies of M.D. Update are available for $9.95.

Why We Do What We Do In each issue of MD-UPDATE, we look for stories about Kentucky doctors and providers who are making a difference in the healthcare communities of the Commonwealth by implementing new technologies, innovative therapies, and research. The flip side is also true when we find doctors who have perfected their craft through the spectacularly ordinary practice of everyday medicine, treating their patients with finely tuned surgical, diagnostic, and listening skills.

We recognize that it is our profound privilege to hear firsthand from our Kentucky doctors how individually, and as a group, they advance the practice of medicine for the common good.

It is a great pleasure to present issue #97 of MD-UPDATE to you because it embodies all the elements we strive for in each issue. Our cover story on the UofL Institute for Sustainable Health & Optimal Aging sets forth their bold vision to basically make Louisville the healthiest and best place for adults to live and age in the U.S. How can you top that?

Led by a team comprised of a physician, social worker, nurse, jurist, and therapist, the Institute’s “trans-disciplinary care model” has the potential to effect lifealtering changes that will ripple across Kentucky for generations.

Our three stories on bariatric surgery and weight loss programs illustrate examples of innovation, team work, and the challenge of improving the health of Kentuckians. Each bariatric surgeon states unequivocally that surgery is simply one part of the solution. Patients are stakeholders in their health and quality of life.

Other examples of innovation are Drs. Rutherford and Ragland, who are rejuvenating the primary care physician model, and Dr. Deborah Ballard, who promotes wellness in body, mind, and spirit at any age through diet and gentle exercise and movement.

We do what we do because of what you do. Contact me if you have a story to share.

As Ever, All the Best,

Gil Dunn Publisher, MD-UPDATE PUBLISHER’S NOTE: Dr. Darryl L. Dochterman, 75, passed away on Dec 20, 2015. During the Vietnam War, he served as a captain in the Air Force and became a flight surgeon. After duty, Dochterman and family moved to Lexington, Ky., where he enrolled in the residency program in Radiology at the University of Kentucky. Dochterman spent the next 30 years practicing at Saint Joseph Hospital in Lexington and was instrumental in bringing the first MRI machine to Kentucky.

Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax ISSUE#97 | 3

HEADLINES

Baptist Health Welcomes Infectious Diseases Group

On Tuesday, December 8, Baptist Health Medical Group held an open house to welcome Anna Hart, MD, Nathan Bullington, MD, and Benjamin Klausing, MD, to Baptist Health Medical Group Infectious Diseases.

While inpatient consults in infectious disease were previously available at Baptist Health Louisville, the new group marks the opening of an outpatient clinic dedicated to the specialty. The office is located at Baptist Health Louisville, 3950 Kresge Way, Suite 405.

Hart, Bullington, and Klausing provide comprehensive consultations in infectious diseases and have a special interest in the treatment of HIV and Hepatitis C. Hart, who had been seeing inpatients at Baptist Health Louisville, is board-certified in internal medicine and infectious diseases.

She attended medical school at the Weill LOUISVILLE

Baptist Health Medical Group Infectious Diseases opened its new office located at Baptist Health Louisville in early December 2015. The practice includes (L-R): Nathan Bullington, MD, Anna Hart, MD, and Benjamin Klausing, MD.

Medical College of Cornell University, N.Y., and completed her residency in internal medicine and fellowship in infectious diseases at Vanderbilt University Medical Center, serving a year as chief fellow.

Bullington is board-certified in internal

She’s one reason Passport is the top-ranked Medicaid MCO in Kentucky.

medicine and attended medical school at the University of Alabama School of Medicine. He also completed his residency in internal medicine and fellowship in infectious diseases at Vanderbilt University Medical Center.

Klausing, who is board-certified in internal medicine, attended medical school at the University of Louisville. He completed an internship and residency in internal medicine at the University of Alabama at Birmingham. He then completed his fellowship in infectious diseases at Vanderbilt University, serving as chief fellow.

Hart, Bullington, and Klausing are now accepting new consults. ◆

We can give you 23,483* more.

Passport Health Plan is the only providersponsored, community-based Medicaid plan operating within the commonwealth. So, it’s no coincidence that Passport has the highest NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.

Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers.

Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information submitted by the health plans.

MARK-51677 | APP_11/16/2015

pass5339-3v1_ASK Provider Ad_7.375x4.8125.indd 1 4 MD-UPDATE PHOTOS PROVIDED BY BAPTIST HEALTH.

12/9/15 9:40 AM

HEADLINES

Shriners and Patients Celebrate Topping Out of New Medical Center at UK

Shriners Hospitals for Children and UK Healthcare celebrated an important milestone in the construction of the $47 million Shriners Hospitals for Children Medical Center on December 1—the “topping out” of the new building.

Construction began on the fivestory medical center, located on the UK HealthCare Campus, on March 9, 2015.

“Topping out” is the construction term used to indicate that the final steel beam is being placed on the building.

“It’s exciting to see the new building coming together,” said Jessica McPeters of Sevierville, Tenn. “Shriners Hospital has always provided amazing care for my daughter, Emma. I’m excited about the state-of-the-art equipment that will be available and how that will improve the level of care even more. The high level of technology and close proximity to other pediatric specialists at UK Children’s Hospital will provide so many new opportunities, not only for treatment but also to reach even more kids who need help.”

The facility, owned and operated by Shriners Hospitals for Children, will be a state-of-the-art ambulatory care center.

Shriners will occupy the bottom three floors for pediatric orthopedic care. UK HealthCare will lease the top two floors for ophthalmology services.

“This facility, designed to meet UK Ophthalmology’s growing clinical needs, will provide 50,000 square feet on two dedicated floors, where our outstanding team will provide comprehensive vision care ranging from general eye exams to the latest and most advanced sub-specialty treatment all in one location,” said Dr. Andrew Pearson, chair of the UK Department of Ophthalmology. “It will enable us to deliver the best, most innovative approaches in a personalized setting in this region and allow us to further accelerate our commitment to exceptional patient care, education, and clinical research.”

The new medical center will include a motion analysis laboratory, an EOS Imaging Center (the first in Kentucky), 20 patient LEXINGTON

Construction began on the five-story medical center, located on the UK HealthCare Campus, on March 9, 2015. “Topping out” is the construction term used to indicate that the final steel beam is being placed on top of the building.

Henry J. Iwinski, Jr., MD, pediatric orthopaedic surgeon and chief of staff with Ryan D. Muchow, MD, pediatric orthopedic surgeon, at the “topping out” ceremony for the new Shriners Hospitals for Children Medical Center.

(L-R)

exam rooms, two surgical suites, a rehabilitation gymnasium and therapy rooms, and interactive artwork. Energy efficiency was a priority in the design stage. The building will have geothermal heating and cooling, LED lighting and occupancy sensors, and automated equipment and controls.

Construction is expected to be complete in the spring of 2017. ◆

“Shriners Hospital has always provided amazing care for my daughter, Emma. I’m excited about the state-of-the-art equipment that will be available and how that will improve the level of care even more.” Jessica McPeters of Sevierville, Tenn.

PHOTOS BY GIL DUNN

ISSUE#97 | 5

FINANCE

A Different Kind of Plan According to a recent poll, 41 percent of baby boomers who have a living parent are providing some sort of personal care, financial assistance, or both for their parents. Of those who are not currently providing care, 37 percent expect to someday.

The wild card in any financial plan is the risk associated with a potential longterm care need. This is exacerbated by the uncertainty of the length and severity of the need, if it occurs at all. Longevity plus incapacity can wipe out a family’s resources pretty quickly. For years, we have discouraged counting on an inheritance from an aging parent as part of one’s own financial plan. These days, to be prudent, we also encourage some clients to strongly consider that they may need to contribute to the support of parents.

Of course, when we raise that question, most people automatically assume that we are talking solely about finances.

In reality, a parent’s long-term care need can require physical and emotional support from adult children that money simply cannot buy. The financial need is often mitigated by long-term care insurance; however, before the benefit can be paid, policies usually require that the insured be unable to perform at least two activities of daily living: bathing, dressing, eating, transferring from bed to chair, toileting, and continence. Cognitive impairment that affects the person’s health and safety will also usually qualify. As we age we often simply need help with getting to and from a doctor’s appointment, keeping medicine dosages straight, shopping, preparing meals, opening jars. These are not activities that trigger long-term care benefits, but the need remains.

In his book, How to Say it to Seniors, David Solie presents five predictable dilemmas of aging: Where will I live?

How can I manage my health? How will I cope all by myself? What should I do about money? What is the right way for me to say good-bye? Each of these can be a source of difficulty for the person going through it and often presents itself as 6 MD-UPDATE

inter-generational conflict.

A more holistic approach to financial planning becomes essential when an aging parent becomes dependent upon their adult children.

BY Scott Neal Considering the combined resources of the aging parents and all their children, with their own diverse needs, takes the planning process into a totally new realm. The goal for many can be simply stated: meet the needs of mom and/or dad without endangering the children’s, or even grandchildren’s, financial well-being. The first step, if everyone is on board, is to view the family as a system. Defining the boundaries of the system can often be difficult and laden with emotion.

Most adult children of aging parents are still in the prime of their own careers, and while many are willing and able to contribute financially, they totally discount the time and energy required for proper caregiving. In a few cases, caregiving begins suddenly when mom or dad has a heart attack or takes a fall that results in a broken bone. More likely, the need develops more slowly. The adult child is called on first for something very simple, but then has to slowly take on added responsibilities as the need progresses. The price of added care is often paid in the caregiver’s loss of income, advancement, as well as significant expense paid out-of-pocket.

At some point in our lives, nearly all of us will face a developmental task marked by the conflict of attempting to hold onto as much control as possible, while at the same time letting go of our legacy. Facilitating the resolution to that conflict is no easy task and is usually best done in the presence of an objective third party. It is important to recognize that our aging parents may be struggling with this as they age. Regarding

seniors as persons who still have dreams and goals as well as fears and apprehensions is a big step toward jump-starting the resolution.

We encourage clients to begin these conversations while everyone in the family system is still reasonably healthy and thinking clearly. One book we typically recommend is The Other Talk: A Boomer’s Guide to Talking with Your Family About the Rest of Your Life, by Tim Prosch.

Another great resource is The National Alliance for Caregiving www.caregiving. org. We have found that the best place to start the conversation is usually around living arrangements. When asked, nearly everyone wants to remain in their own home and age-in-place. However, when the inability to perform even one of the activities of daily living gets introduced, many will see that aging-in-place alone simply will not be possible. Other options are living with children or moving to an assisted living or personal care facility.

Every family’s situation is different and each must decide which option is best based on the quality of life for all and the cost of each alternative.

As stated above, the time for planning is before care is actually needed. Emergent reactions to a need for care rarely produce optimal results when it comes to aging; but when the call comes, such reactions are unavoidable. It may help everyone involved to see that the earliest and slightest need for care is truly an opportunity to come together as a family unit and to integrate financial and life plans for the benefit of all. Such planning usually requires a team approach of legal, financial, insurance, and tax professionals. The strategic plan that gets developed from such a place will likely be far superior to the one that addresses each separately. If you have questions about this, please let us know.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and investment firm. Contact him at scott@dsneal.com or by calling 1.800.344.9098. ◆

LEGAL

Fair Market Value in Physician Compensation Arrangements under the Stark Law Models for physician compensation arrangements continue to change as health systems move toward physician alignment and clinical integration. Determining fair market value is critical for any physician compensation arrangement to satisfy the federal Stark and anti-kickback laws. These laws prohibit the payment or receipt of remuneration based on the volume or value of referrals of services paid for by a federal healthcare program. This article discusses the challenging task of determining fair market value under the Stark Law exception for physician employment arrangements.

The Stark Law prohibits a physician from referring Medicare beneficiaries to an entity (clinic, hospital, physician practice) for designated health services (DHS)1 when the physician (or his/her immediate family member) has a financial relationship with

the entity. Stark further prohibits the entity from presenting claims to Medicare for the prohibited referrals of DHS. A physician has a financial relationship with an

BY Sarah Charles Wright entity if he or she has an ownership or investment interest in the entity, or a direct compensation arrangement with the entity, e.g., as an employee or independent contractor. The physician and entity are held strictly liable under Stark if a prohibited referral for DHS is made and a claim is presented to Medicare, regardless of intent, and could be ordered to pay monetary pen-

alties and treble damages.

In short, if you have a compensation arrangement with a hospital or clinic that furnishes designated health services to Medicare beneficiaries and bills Medicare for those services, you are prohibited from referring Medicare patients to the entity for DHS, and the entity is prohibited from filing a claim with Medicare for the DHS unless a Stark exception applies. Every Stark exception to compensation arrangements, including the exceptions for “bona fide employment” and “personal services” arrangements, has three requirements: (i) compensation must be consistent with Fair Market Value (FMV) for the services performed; (ii) the volume or value of referrals generated or that could be generated by the parties cannot be taken into account; and (iii) the compensation must be commer-

ISSUE#97 | 7

LEGAL

cially reasonable. For example, if the entity is paying you for a medical directorship and also for chairing a medical staff committee, your compensation should be FMV for each service you provide, as well as FMV in the aggregate. This “stacking” of physician services can sometimes result in total compensation falling outside the range of FMV. The regulations do not define commercial reasonableness, and their definition of FMV is less than helpful. FMV is the value in arm’s-length transactions, consistent with the general market value. General market value means that the compensation (i) is the result of bona fide bargaining between well-informed parties who are not otherwise in a position to generate business for each other, (ii) has been included in other contemporaneous bona fide service agreements with comparable terms; and (iii) is not determined in any manner that takes into account the volume or value of anticipated or actual referrals.

Employed physicians can be paid in a manner that directly correlates to their own personal labor, including labor in the provision of DHS, but they cannot be paid for generating referrals of DHS performed by others. This means that physicians need to ensure that the services they provide in consideration for compensation are welldocumented. If the entity’s records do not sufficiently show that the services were performed by the physician, the agreed compensation could be viewed as payment for referrals.

To determine FMV, an entity will typically obtain an independent professional opinion from a specifically qualified and experienced appraiser to protect the compensation arrangement from future legal scrutiny. The request for a FMV opinion should be made by the entity’s legal counsel to ensure that it is performed using an accepted methodology, includes comparable and appropriate benchmark data, and does

not take into account the volume or value of referrals of DHS or other business that could be generated by the parties. When comparable data is unavailable, as is often the case for rural or health professional shortage areas, the appraiser may need to exercise professional judgment in adjusting the compensation range.

Once a FMV range of compensation is determined, it may be used to establish a base salary and/or an hourly or per work RVU rate of pay. Unit-based compensation is “deemed” by the Stark regulations to not take into account the volume or value of referrals or other business generated between the parties as long as the hourly rate or dollars per unit (i) is FMV for the services performed, and (ii) does not vary during the course of the arrangement in any manner that takes into account the volume or value of referrals or other business generated between the parties (including private pay healthcare business).

The Stark Law exceptions are complex and determinations of fair market value are inherently subjective and subject to scrutiny. More than one exception may apply to a physician compensation arrangement, and arrangements that seem fair and reasonable to the parties may still not be viewed as fair market value arrangements.

If you are contemplating a compensation arrangement with an entity that you believe is subject to the Stark Law, make sure you consult with an experienced attorney if you have any compliance concerns.

Sarah Charles Wright is a member of Sturgill, Turner, Barker & Moloney PLLC and concentrates her practice in managed care law and healthcare compliance. She can be reached at 859.255.8581 or swright@ sturgillturner.com.

(ENDNOTES)

1 Designated Health Services include: clinical laboratory, physical therapy, occupational therapy, outpatient speech-language pathology, radiology/imaging services, radiation therapy, home health, outpatient prescription drugs, inpatient and outpatient services, durable medical equipment, parenteral and enteral nutrients/equipment/ supplies, prosthetics, orthotics and prosthetic devices/ supplies. Id. ◆

8 MD-UPDATE

INVESTMENT

Tax the Seed or Tax the Harvest‌ Physicians are under attack! The everchanging healthcare system and monumental number of tax law changes not only have an impact today, but will have a looming effect at retirement. Justified or not, these concerns need to be addressed as there are solutions to reduce these financial burdens.

As Congress pushed through the American Tax Reconciliation Act in 2012, most physicians did not realize how deeply this would impact them. The potential loss of income may in turn result in lower retirement investing. For those physicians earning above $400,000 ($450,000 jointly), federal taxes increased 4.6 percent. Along with that increase, for those same highincome earners, taxes on long-term capital gains and qualified dividends jumped five percent from 15 to 20 percent. Personal exemptions have also been reduced by two percent for each $2,500 dollars of income

above $250,000 ($300,000 for joint filers.) If you think that hurts, for those whose income exceeds $372,501 ($422,501 for joint filers), personal exemptions are fully phased

BY Calvin Rasey out. This is on the heels of 80 percent of itemized deductions also being phased out.

Another fact to consider is a new surtax on unearned income for Medicare contributions. Most taxpayers don’t realize a new tax of 3.8 percent was assessed on the less of net investment income or modified adjusted gross income (MAGI) above $200,000 ($250,000 for joint filers.) Many physicians

are feeling the sting of the possible 13.49 percent tax increase along with the phaseouts of itemized and personal deductions.

The government hasn’t given anything; we still have government restrictions on tax-deferred qualified plans. After-tax dollars invested in stocks, bonds, and mutual funds are subject to higher tax brackets than in years past. This means that the tax-advantaged category/bucket loses some of its appeal because of the new federal tax. This not only takes a toll on your net income today, but also your income at retirement. At retirement your tax-deferred dollars become taxable; taxable investments are subject to higher capital gains; taxadvantaged investments could trigger up to an 85 percent tax on social security benefits; tax-advantaged investments could trigger an increase in Medicare Part B cost from $105 to $336 per month; and there is tax

ISSUE#97 | 9

INVESTMENT

exposure at age 70 ½ on required minimum distribution from tax deferred accounts.

Unless you have a magic wand to wave with the words, “Presto! Make my taxes disappear!” a financial planning solution is needed. Many physicians have found that adding an additional investment tool to their portfolio is not only useful today, but more so tomorrow. By utilizing the benefits of a well-structured life insurance plan to your portfolio you can protect your savings and gain these advantages: • Tax deferred growth opportunities • Tax advantaged source of retirement income • Tax-free benefit for your beneficiaries • No retirement contribution limits • No penalties for cash value taken before the age of 59 ½ • No required minimum distributions

• No impact on Social Security benefits • No effect on Medicare Part B • No effect on itemized or personal deductions Many in the medical community are finding themselves spending longer hours seeing patients, doing procedures, charting, and accessing clinical information. With the ever-changing world of medicine and the tsunami of tax law changes, supplementing one’s current retirement plan with an IRS-approved structured life insurance plan could play a significant role at retirement.

Think of your retirement plan as a farm.

Would you rather pay tax on the seed or the harvest? Each individual has a specific retirement need, and all retirement plans should be carefully tailored by an experienced team of financial advisors. Remember the words of Winston Churchill, “He who fails to plan is planning to fail.”

Saint Joseph London Foundation Presents

Calvin R. Rasey is president of Physicians Financial Services II, LLC and can be reached at 502.893.7001 and calvin.rasey@ securitiesamerica.com.

SOURCES: Internal Revenue Procedures 201152; American Taxpayer Relief Act; Economic Growth and Tax Relief Reconciliation Act of 2001; IRC Sections 1,86,1411,3101; Medicare. gov, Part B Premiums Securities Offered Through Securities America, INC.*Member FINRA/SIPC· Calvin R. Rasey· Registered Representative Advisory Services offered through Securities America Advisors, INC.·A registered Investment Advisor· Calvin R. Rasey· Investment Advisor Representative Physicians Financial Services II, LLC and Securities America Company are NOT UNDER Common Ownership. Securities America and its representatives do not provide legal or tax advice. Please consult with appropriate professionals regarding your specific situation. ◆

Gala

OLD HOLLYWOOD Featuring Entertainment by Kudmani Band, Sponsored by Legacy Nissan Silent Auction After Dinner Coffee Bar

Information or RSVP Please contact April Nease P: 859.313.2014 F: 859.313.2016 E: amnease@sjhlex.org Online: KentuckyOneHealth.org/ london-foundation

10 MD-UPDATE

Take a trip back to Hollywood’s unforgettable golden age at the event, inspired by the oh-so-glamorous leading ladies and men of yesteryear.

FEBRUARY 13, 2016 Cocktails 6 p.m. | Dinner 7 p.m.

The London Community Center

2016 Editorial THE BUSINE

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THE BUSINESS

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The Road Less Travel ed Cassis Der matolog to growing y & Aesthetics Cen a successful ter forges its own independen t practice path

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ALSO IN THIS

VOLUME 6•#5

DENT NEW KMA PRESI  Q&A WITH RADIATION THERAPY IN ERSHIP OF KENTUCKY PHYSICIA  ADVANCES RCH PARTN GING NS AND ER RESEA HEALTHC DAMA  A CANC TIVE, LESS ARE PROFESS IONALS BIOZORB™ MORE EFFEC THERAPIES BREAST SURGERY AND TION  TARGETED IC NCES DETEC  ONCOPLAST ISSUE #93 OGRAPHY ENHA MAMM 3D 

VOLUME 6•#6•

NOVEMBER 2015

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SPECIAL SECTIONS

COVERING ALL THE BASES

ALSO IN THIS ISSUE

 ONE STOP SHOP FOR SPORTS MEDICINE IN NEW ALBANY  PROBLEM SOLVING FOR MOTIVATED, HEALTHY PATIENTS  FIXING ORTHOPEDIC PROBLEMS IN OWENSBORO  THE PROS OF PROSTATE SCREENING  SEX, POWER, & BOUNDARIES FOR MEN

AND HEAL

ISSUE #92

CARE PROFESSION

ISSUE #91

 PEDIATRIC

INE OF KENTUCKY

PHYSICIANS AND

HEALTHCARE PROFE

SSIONALS iSSue #90

LAND OF OPPORTUNITY

Special SectioN

PAIN MEDICINE AND NEUROLOGY

MHA Kendra J. Grubb, MD, on, cardiovascular surge a joins U of L to build

PATIENT-RESPONS IVENESS, INNOVATION, AND COLLABORATION

William O. Witt, MD, uses three pillar s to enhance the patien t experience at Cardinal Hill Pain Institute

ALSO IN THIS ISSUE

RO’S  REBUILDING OWENSBO PROGRAM CARDIAC SURGERY  NEW EP SERVICES IN IN NEW ALBANY, SION  MANAGING HYPERTEN EVOLVES  A HEART TEAM GY  PREVENTIVE CARDIOLO G FOR  CT SCREENIN

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transcatheter and minimally invasive m heart surgery progra at Jewish Hospital.

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 FAMILY APPROAC H TO PAIN MANAGEM ENT  INJECTIONS FOR  ENDOSCOPIC MIGRAINES ENDONASAL SURGERY FOR SKULL-BASE TUMORS  BUILDING AN INTERVENTIONAL NEUROLOGY PROGRAM  NEUROLOGIST FILLS SERVICES GAP IN GEORGETO WN

Issue #98, February HEART & LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine, Smoking Cessation Issue #99, March/April INTERNAL SYSTEMS Transplant, Allergy & Immunology, ENT, Rheumatology, Gastroenterology, Endocrinology Issue #100, May GENDER-SPECIFIC MEDICINE OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #101, June/July MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine Issue #102, August/September SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine Issue #103, October CANCER CARE Oncology, Hematology, Radiology Issue #104, November IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Pain Medicine, Mental Health Issue #105 – Dec/Jan 2016 PRIMARY CARE AND PEDIATRICS Primary Care, Internal Medicine, Family Medicine, Pediatrics *Editorial topics are subject to change.

TO PARTICIPATE CONTACT: Gil Dunn, Publisher • gdunn@md-update.com • (859) 309-0720 Jennifer S. Newton, Editor-in-Chief • jnewton@md-update.com • (502) 541-2666 SEND PRESS RELEASES TO news@md-update.com

ISSUE#97 | 11

COVER STORY

THE OPTIMAL AGING CAPITAL OF THE U.S.

The University of Louisville Institute for Sustainable Health & Optimal Aging is leading the charge for innovation and transdisciplinary care of older adults BY JENNIFER S. NEWTON PHOTOGRAPHY BY ROBERT DENSMORE LOUISVILLE When was the last time you saw a Kentucky city at the top of a list of positive health care trends?

If the University of Louisville (U of L) Institute for Sustainable Health & Optimal Aging gets its way, Louisville will soon be the optimal aging capital of the United States.

With seven long-term care companies headquartered in the city, Louisville has become a geographic hub for the aging industry. Government, education, clinical, and community resources are starting to follow suit, and now the Institute for Sustainable Health & Optimal Aging is leading the charge to make Louisville a national leader in research, education, evidence-based practice models, and transdisciplinary innovation for older adults. “Aging starts at birth,” 12 MD-UPDATE

says Anna Faul, PhD, executive director of the Institute. “It’s not only about providing care to older adults. It’s about adapting a holistic view of caring for older adults.”

In 2013, 44.7 million Americans were age 65 or older, and that population is expected to increase by 21.7 percent by 2040, according to the Administration on Aging. It’s no secret that healthcare usage and costs increase as people age.

But Institute Medical Director Christian Furman, MD, MSPH, AGSF, says the implications are larger than just caring for an aging population. “If we can figure out the best care model for the older person, it’s the best model to optimally age for everybody,” she says.

An Institute is Born

A decade ago, U of L Geriatrics set out to raise the profile of the specialty of geriatrics.

Through a strategic planning process and the creation of an advisory board, a vision emerged for a center on aging that would bring all disciplines together to improve care. Mary Romelfanger, RN, MSN, CS, LNHA, associate director of the Institute, was a member of that advisory board.

She and then Department Chair James O’Brien, MD, were tasked with launching the idea of the Institute in March 2013. In the fall of 2014 their proposal was approved, and the Institute for Sustainable Health & Optimal Aging was born.

When O’Brien retired, the Institute tapped Faul to broaden their approach.

Born in South Africa and a clinical social worker by training, Faul came to the U.S. in 2000 and is currently the associate dean for the Kent School of Social Work at U of L. Her research in gerontology led to her being appointed a Hartford Geriatric Scholar,

which afforded her an opportunity to hone her aging focused research skills. She has been awarded 16 awards for excellence in teaching, mentorship, and research, has published 65 peer-reviewed articles and book chapters, and has presented over 145 peer-reviewed national presentations. She is also a fellow of the Society for Social Work and Research, is a member of the governor’s Council on Alzheimer’s Disease and other Dementing Disorders, and recently has been appointed a board member of the Health Enterprise Network. She is currently leading a transdisciplinary team of doctors, nurses, social workers, lawyers, and community service providers in promoting a coordinated care model for older adults under a

Mary Romelfanger, RN, MSN, CS, LNHA, associate director of the Institute for Sustainable Health & Optimal Aging, was a member of the Geriatric Medicine Advisory Board that helped launch the Institute and says that transitions in care is one of the biggest challenges in the care of older adults.

U.S. Department of Health Resources and Services Administration (HRSA) $2.5 million dollar grant.

Faul took over in February 2015 and brought a social work colleague of hers, Joseph D’Ambrosio, PhD, JD, LMFT, with her as director of Health Innovation and Sustainability. D’Ambrosio spent 25 years as a lawyer before deciding to pursue a career as a social worker and clinical marriage and family therapist. Together Faul and D����������������������������������� ’���������������������������������� Ambrosio have an energy and enthusiasm that drive the vision of the Institute.

Says D’Ambrosio, “The conversation Joseph D’Ambrosio, about medical care needs to change PhD, JD, LMFT, director a little bit. It����������������������� ’���������������������� s not just about mediof health innovation and cal treatment. It’s about addressing the sustainability for the social determinants of health, and it’s Institute for Sustainable about prevention.”

Health & Optimal Aging, In medicine, care models are often says, “The models we’re referred to as multidisciplinary or interpromoting here at the Institute are coordinated disciplinary, but Faul champions the care models where the term transdisciplinary for the Institute’s medical team becomes model. “Transdisciplinary is where we a part of a bigger team really start to blend, where I as a social that reduces the burden worker can see something wrong with a to physicians.” person’s medications and can alert the pharmacist or the doctor, and the doctor can alert me to say my patient doesn’t have a way to get the right food, or my patient is depressed and needs counseling,” says Faul.

ISSUE#97 | 13

COVER STORY

Why Geriatrics is Different

Furman, who is a geriatrician and palliative medicine physician as well as a professor and vice chair for Geriatric Medicine at U of L, contends that while all physicians have their patients’ best interests in mind, not all physicians are trained in what is best for older adults. “Just because you take care of older people doesn’t mean you treat them the way a geriatrician would,” she says.

One example she cites is the Foley catheter. “Everybody thinks the Foley catheter is great, but really you’re causing infection, you’re causing delirium, you’re making it worse. Until you know that, you think you’re helping patients,” says Furman.

Ultimately, Furman contends that putting systems in place to help older adults succeed in the healthcare setting, such as preventing falls, preventing infections, addressing polypharmacy, and focusing on advanced care planning, are beneficial to all patients.

Romelfanger, who has a master of science in gerontological nursing and experience as a case manager for the aging population, says one of the challenges for older adults is transitions in care. “The person who is transitioning from pre-hospital to hospital to post-hospital care moves through all of those different systems, but the individual provider housed in each of those systems doesn’t have to move. So it’s very difficult to get the whole picture of what the person has experienced and understands,” Romelfanger says.

Hospitals and hospitalists have improved efforts to prevent readmissions, particularly now that they are penalized for them, but Romelfanger says the primary care piece is still missing.

“CMS (the Centers for Medicare and Medicaid Services) and DHHS (the U.S. Department of Health & Human Services) have announced a series of awards for improving transitions of care through the primary care system. We just submitted one of those grants with key providers in state,” says Romelfanger.

14 MD-UPDATE

Christian Furman, MD, medical director of the Institute for Sustainable Health & Optimal Aging, believes it is important to train all providers in the care of older adults. “Just because you take care of older people doesn’t mean you do it the way a geriatrician would do it,” she says.

The Four Pillars of the Institute

In its effort to develop a coordinated, transdisciplinary model of care for older adults, the Institute focuses on four main pillars: 1.

Research, 2. Innovation, 3. Education, and 4. Evidence-based practice.

Research

The Institute builds on the university’s priority of translational research, promoting research from bench to bedside to community. While we all know what we should be doing to be healthy, the Institute addresses the question of how to make that happen, especially in areas of the state where resources are lacking or difficult to access, and from various disciplines.

Examples of current research projects at the Institute include:

A Geriatric Workforce Enhancement Program funded by HRSA to develop a model of care that connects primary care teams and community teams with a community health navigator in the middle to create comprehensive care plans and connect primary care physicians to community resources. The community teams could include community health workers and peer mentors trained by the Institute to provide health coaching, pastors, businesses, social workers, nutritionists, and social service agencies such as the local Area Agencies on Aging.

Veggie RX, a project where physicians prescribe a share of fresh fruits and vegetables

as an alternative or an adjunct to medications. The project is funded by the Humana Foundation, and the fruits and vegetables are provided through Fresh Stops, a local community-run program through New Roots, a non-profit organization, where people buy shares of fresh fruits and vegetables provided by the local farmers. This initiative will soon be expanded to an ExerciseRx program with a similar goal of supporting older adults’ efforts to live healthy lives.

The Age and Disability Friendly City Initiative, in conjunction with the City of Louisville, is an effort to create a supportive living environment for older adults by encouraging active aging through the optimization of opportunities for health, civic participation, and security.

The Institute is also a resource for academics or businesses wanting to do research who may need older adult participants. A participant registry at the Institute allows older adults to become participants in research projects and have a voice in any new initiatives involving their health and well-being.

Innovation

With the concentration of age-related industries, the Institute is looking to partner with local businesses to develop products that help people age optimally in their own homes.

One such project is a collaboration with U of L’s J.B. Speed School of Engineering to develop a toilet that can track weight, do a urinalysis and send data to healthcare professionals to help monitor markers of health in older adults from their homes.

“One of the main goals at the Institute is innovation and sustainability. How do we begin to look at providing medical

care in a different way that can be innovative and sustainable and not drain us of all our resources?” says D’Ambrosio.

Education

True to its promise to bring all disciplines to the table, the Institute has 13 social work students doing internships and is working

with geriatric medicine fellows, medical students and nursing students from U of L, physical therapy and exercise physiology students from Bellarmine University, and pharmacy and physician assistant students from Sullivan University.

For physicians and healthcare providers, the Institute acts as a continuing education resource. One program that began as a grant from the Reynolds Foundation that the Institute is now housing is the Chief Resident Immersion Training (CRIT) in the Care of Older Adults. “What they figured out nationally is that if you train the chief, they train the medical students and the residents and they train the faculty, so the dissemination goes both ways,” says Furman.

The two-day program teaches leadership skills as well as care for older adults. In June 2016 the Institute plans to include the

CRIT program as a pre-conference session to their national conference on Optimal Aging & Sustainable Health.

As part of the Geriatric Workforce Enhancement Program, the Institute teaches geriatrics to the healthcare workforce in rural areas of the state. “CMS is starting to figure out there will never be enough geri-

Anna Faul, PhD, took over as executive director of the Institute for Sustainable Health & Optimal Aging in February 2015 and is infusing the Institute with her energy and vision of a transdisciplinary care model for older adults.

atricians,” says Furman. “Instead of training geriatricians, let’s train everybody to know how to take care of older people.���������� ” The �������� program provides patient-centered education modules on subjects such as dementia, end of life care, polypharmacy, and how to work with a transdisciplinary team.

There are myriad options for physicians to take advantage of the Institute��������� ’�������� s educational opportunities, such as online modules, teleconferencing, visiting professorships, fellowships, and practice transformation assistance to facilitate care coordination.

The Institute is also positioning itself as the go-to resource to connect physicians with geriatric specialists and resources in

their own area. A statewide health coalition, with nine counties participating so far, is already underway, with the goal of providing comprehensive information about all geriatric resources in each county.

Evidence-Based Practice

Every project that’s done at the Institute by staff and students is done after review by the university’s Institutional Review Board (IRB) as a research study, so the evidence is in place to support the practice models they are promoting.

“We are trying to infuse the geriatric practice here at U of L to become more of a care coordination practice,” says Faul.

Another of the grants that they are applying for would be used to transform 15 primary care practices, from U of L Physicians and KentuckyOne Health, into care coordination practices. These practices would be given a practice transformation coach and become part of a large community support system to help patients be healthy and improve outcomes. The hope is that the work done with grants like this one provides the evidence to start changing the mindset of all healthcare providers.

The Institute is off to a blazing start, but there are still many aspects that will take time to develop. “It’s like a gear turning very slowly. The way we offer medical care to the public has to change. It costs too much; it’s not efficient. The models we’re promoting here at the Institute are coordinated care models where the medical team becomes a part of a bigger team that reduces the burden to physicians,” says D’Ambrosio.

Physicians know that prevention and wellness efforts are integral to improving the health of patients, and it seems the Institute’s message to physicians is simple – you don’t have to do it alone. “Our job at the Institute is to help physicians throughout the state with the education and resources to be able to care for older adults. It’s really exciting that we are leading the discussion on a national stage and that the Institute together with their partners are already successfully implementing a new model of care for older adults,” concludes Furman. ◆ ISSUE#97 | 15

SPECIAL SECTION  PRIMARY CARE & SENIOR HEALTH

Healthy Beginnings

Primary care relationships benefit the patient as well as the healthcare team BY SARAH WILDER A primary care physician is not just for sick visits. Primary care providers are an integral partner in the patient’s healthcare team – whether for an annual well-patient physical or treatment for an unexpected illness. Establishing care with a primary care provider is extremely important not just for patients, but for their specialty care providers as well.

Creating a primary care relationship is not only important for the patient’s health, but it also improves the ability of a specialist or other members of the healthcare team to respond to a patient’s needs and unique issues. “Regular checkups with an established primary care provider allow patients to form a relationship with a physician who can identify potential lifestyle changes for their health. Through annual exams and preventive screenings and tests, the primary care provider can identify risk factors and potential health problems early, and chronic diseases such as heart disease, cancer, and diabetes are much more treatable when caught early,” says Eiyad Alchureiqi, MD, Lexington Clinic primary care physician at Lexington Clinic Beaumont.

Lexington Clinic primary care providers work with their staff and referring specialists to keep the lines of communication open.

Sometimes it is a challenge for patients to consider a visit to the doctor outside of when they are ill. However, encouragement from specialists to establish a primary care relationship will improve the patient’s care, and it is essential for patients to understand how this LEXINGTON

Eiyad Alchureiqi, MD, Lexington Clinic Beaumont Primary Care Physician BELOW Andrew H. Henderson, MD, Lexington Clinic Chief Executive Officer LEFT

can help the patient when an unexpected health issue occurs. It is a common misconception of patients seeking treatment for a sudden illness or injury that the emergency room is the only place for treatment. While they will find treatment in the emergency room, there are other options for faster and more personalized treatment if the issue is not serious. Upon further assessment of a patient’s condition, they may be referred to an appropriate specialist.

Lexington Clinic has more than 50

MANY PATIENTS ESTABLISH A LIFELONG RELATIONSHIP FOR THEMSELVES, AND OFTEN FOR SEVERAL GENERATIONS OF THEIR FAMILY, WITH THEIR PRIMARY CARE PROVIDER. benefits their health now and in the future.

Patients are sometimes uncertain of when they should visit their primary care physician, when urgent care is needed, and when a visit to the emergency room is in order. Helping patients understand the difference between these types of care 16 MD-UPDATE

PHOTOS PROVIDED BY LEXINGTON CLINIC

primary care providers, at 10 different locations, throughout Lexington, Versailles, Nicholasville, and Richmond. These include providers in family medicine, internal medicine, internal medicine/pediatrics, and pediatrics and also include Walk-In/ Urgent Care. With this wide array of prima-

ry care providers, Lexington Clinic makes it easy for referring physicians and patients to select a primary care provider that best fits the patient’s individual needs in a convenient location. Through Lexington Clinic’s Referral Nurse program, a specially-trained referral nurse is available to assist referring physicians find a provider that is best suited to a patient’s needs. The Referral Nurse will connect referring physicians with the provider’s office to schedule the patient’s appointment. “With our connected electronic health record system, patients can

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ISSUE  HAND SURGERY IN THE DIGITAL  THE IMPACT AGE OF PLASTIC  MODERN SURGERY DAY GASTROE NTEROLO  ENDOSCO GY PIC GI TECHNIQ  THE CHALLEN UES IONALS GES OF APLASTIC ARE PROFESS  THE HEALTHC ANEMIA AND DRAW OF VASCULA R SURGERY ISSUE #92

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Sports Medicine/ Orthopedics

Men’s HealthBUSINESS MAGAZINE THE

The collaboration of specialties at KentuckyOne Health/UofL provides comprehensive care Sports Medicine to athletes of all ages

OF KENTUCKY PHYSICIANS

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SURGERY IN THE DIGITAL AGE  THE IMPACT OF PLASTIC SURGERY  MODERN DAY GASTROE NTEROLO GY  ENDOSCO PIC GI TECHNIQ  THE CHALLEN UES GES OF APLASTIC ANEMIA  THE DRAW OF VASCULA R SURGERY

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PAIN MEDICINE AND NEUROLOGY

transcatheter and minimally invasive heart surgery program

PATIENT-RESPONSIVEN ESS, INNOVATION, AND COLLAB

ALSO IN THIS ISSUE

ORATION William O. Witt, MD, uses three pillars to enhance the patient experience at Cardinal Hill Pain Institute

1

 REBUILDING OWENSBORO’S PROGRAM CARDIAC SURGERY  NEW EP SERVICES IN IN NEW ALBANY,  MANAGING HYPERTENSION EVOLVES  A HEART TEAM  PREVENTIVE CARDIOLOGY FOR  CT SCREENING LUNG CANCER

Volume 6, Number

2015 VOLUME 6•#2•MARCH

Issue #98, February  HEART & LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine, Smoking Cessation Issue #99, March/April  INTERNAL SYSTEMS Transplant, Allergy & Immunology, ENT, Rheumatology, Gastroenterology, Endocrinology Issue #100, May  GENDER-SPECIFIC MEDICINE OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #101, June/July  MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine

Special SectioN

MHA Kendra J. Grubb, MD, cardiovascular surgeon, a joins U of L to build

at Jewish Hospital.

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THE BUSINESS MAGAZINE

transition easily between physicians within the Lexington Clinic network when necessary,” says Andrew H. Henderson, MD, Lexington Clinic chief executive officer and a primary care physician with Internal Medicine at Lexington Clinic.

“Many patients establish a lifelong relationship for themselves, and often for several generations of their family, with their primary care provider. There is a sacred trust in these relationships, resulting in patients feeling free to present their fears, hopes, and dreams about life and death,” says Henderson. “We value these relationships and recognize this as an essential component in providing our patients the best possible care.” ◆

Y PHYSICIANS

OF KENTUCK

VOLUME 6•#4•JUNE/JULY

Chest pain Possible stroke symptoms: facial droop, debilitating headache, numbness or weakness in leg or arm Head injury with loss of consciousness Bleeding during pregnancy Fracture through the skin Severe abdominal pain Any injury that seems life or limbthreatening

 FAMILY APPROACH

alSo iN thiS iSSue

TO PAIN MANAGEMENT  INJECTIONS FOR  ENDOSCOPIC MIGRAINES ENDONASAL SURGERY FOR SKULL-BASE TUMORS  BUILDING AN INTERVENTIONAL NEUROLOGY PROGRAM  NEUROLOGIST FILLS SERVICES GAP IN GEORGETOWN

Issue #102, August/September  SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine Issue #103, October  CANCER CARE Oncology, Hematology, Radiology Issue #104, November  IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Pain Medicine, Mental Health Issue #105 – Dec/Jan 2016  PRIMARY CARE AND PEDIATRICS Primary Care, Internal Medicine, Family Medicine, Pediatrics *Editorial topics are subject to change.

TO PARTICIPATE CONTACT: Gil Dunn, Publisher • gdunn@md-update.com • (859) 309-0720 Jennifer S. Newton, Editor-in-Chief • jnewton@md-update.com • (502) 541-2666 SEND PRESS RELEASES TO news@md-update.com

ISSUE#97 | 17

SPECIAL SECTION  PRIMARY CARE & SENIOR HEALTH

Subscribe to Better Primary Care

Tracy Ragland, MD, and Molly Rutherford, MD, leave traditional primary care practices in favor of the direct primary care model to better meet patients’ needs, as well as their own BY JENNIFER S. NEWTON What if you could toss out the red tape, mindless clicking in the EMR, piles of paperwork associated with insurance coding and billing, and other administrative requirements associated with medical practice – and simply see patients at your own pace? What if you had more time for communication, education, research, and your personal life? Would you be a happier person and thereby a better doctor?

It sounds almost too good to be true. But two primary care physicians in Crestwood have left their traditional practices to help pioneer a new model – direct primary care – that is promising just that.

The physicians, Molly Rutherford, MD, owner of Bluegrass Family Wellness, and Tracy Ragland, MD, owner of OneFamilyMD, are quick to note that direct primary care (DPC) is different from concierge medicine, in which practices can carry very expensive annual fees and may still bill insurance. While each DPC business is unique, Rutherford and Ragland share a business model as well as office space. For an affordable monthly fee, $50 for adults age 26-45 for example, patients get unlimited access to their physician, routine office-based tests and procedures, and wholesale-priced medications and labs, without the hassle of billing insurance.

Says Rutherford, “If you can afford a smartphone, you can afford this.”

“It’s all about the patient-physician relationship,” says Ragland. “It’s better primary care for the masses.”

CRESTWOOD

The Breaking Point

Rutherford, who is from Virginia and did her training there, was looking for a place to practice that would satisfy her desire to practice rural medicine and her husband’s desire to be a city police officer. She landed in Carrolton, Ky., for five years before joining Paige Primary Care Center in LaGrange, 18 MD-UPDATE

PHOTO BY ROBERT DENSMORE

Molly Rutherford, MD, board-certified in family medicine and addiction medicine, is the owner of the direct primary care practice Bluegrass Family Wellness in Crestwood.

LEFT

Tracy Ragland, MD, board-certified in internal medicine and pediatrics, is the owner of OneFamilyMD, a direct primary care practice in Crestwood.

RIGHT

a patient-centered medical home, to be closer to her family. However, she found the pressures of patient volumes and coding, the focus on data, and the subsequent transition to electronic medical records (EMR) to be “toxic” and disruptive to patient care. “I was questioning whether I made the right decision to go into medicine,” she says.

Then Rutherford read about Josh

Umbehr, MD, owner of Atlas MD in Wichita, Ks., who was modeling a DPC approach. She consulted Umbehr and decided to make the transition. “If you don’t have financial security, it’s hard to make the jump,” she concedes, but Rutherford had the advantage of being dually boardcertified in family practice and addiction medicine and knew her addiction practice

would help balance the financial risk.

Although Ragland was happy with her group practice and partnership, she was becoming increasingly dissatisfied with the traditional healthcare “system.” An internal medicine and pediatric physician with Internal Medicine and Pediatric Associates in Crestwood, she had become increasingly involved in physician advocacy, looking for ways to improve her caregiving experience, but she found, “Every solution seemed to create more problems.”

Rutherford and Ragland have known each other for a long time, and in fact, Ragland is Rutherford’s physician. When Ragland learned of the DPC model and also consulted with Umbehr, she thought, “I’m either going to do this, or I’m not going to do medicine anymore.”

Rutherford leased their current space in

• An in-office pharmacy that provides medications at wholesale prices Kentucky is one of 44 states that allows physicians to dispense medications. Ragland estimates they carry 85 to 90 percent of the medications their patients need, mostly generics and no controlled substances, and save their patients a significant amount of money, sometimes enough to cover the cost of their monthly subscription.

The patient volume for both physicians has changed drastically, dropping from 2,000 patients to closer to 300 each.

Ragland says she does not plan to have many more than 400. Both physicians employ just one assistant each. No other office staff is necessary since they are not filing insurance, and they have the time to make patient calls themselves. When someone is out sick or on vacation, they cover for

WHAT IS THE BEST WAY TO GET DOCTORS INTERESTED IN PRIMARY CARE? WE CAN BE A REAL PART OF THE SOLUTION. May 2015, and Ragland began practicing there in July 2015.

The Direct Primary Care Model

In Bluegrass Family Wellness and OneFamilyMD’s model, patients buy a monthly subscription, which ranges from $10 for children to $100 for adults age 65+.

That subscription includes: • An annual wellness exam • Unlimited office visits (an average of 30 minutes long but up to an hour or more for complex issues) • Unlimited technology visits and 24/7 access to the doctor via phone, email, text, and Skype • Same-day appointments • Before and after-hours visits • Work site visits and house calls if necessary • Minor in-office procedures • Routine lab work (Additional labs provided at wholesale prices.)

each other and share assistants.

When asked how the 24/7 access affects their work-life balance, Rutherford says, “I prefer it,” explaining she was always doing notes and thinking about work after hours anyway, and now she spends less time in the office. “We’re doing what we’re trained to do, not coding,” she says.

Ragland, who gets one to two after-hours calls per week, concurs. “It doesn’t feel like work. I would much rather meet someone in the office at 8 p.m. to listen to a wheezing child after a pleasant day,” she says. And, she points out that when she was on-call in her group practice, she was responsible for over 6,000 patients, not just her 2,000.

While the direct-care approach works in a primary care setting, it might not work in a practice where services are more expensive and specialized. That is what insurance should be for, says Rutherford, to cover non-routine care, expensive procedures, and hospitalizations. Both practices

work with insurance specialists who can help patients find lower cost, high-deductible plans coupled with Health Savings Accounts that complement their DPC subscriptions.

The next step for the two entrepreneurs is reaching out to small businesses that are self-insured, a demographic that established DPC practices throughout the United States are helping save 20 to 30 percent or more on healthcare spending. In addition, unions and state Medicaid programs are trying DPC and seeing substantial benefits.

“Spending a little more on primary care saves drastically on avoidable emergency room visits, advanced imaging, hospitalizations, and more, no matter who is paying the bill,” says Ragland.

In response to critics who say DPC physicians are selfishly making the primary care shortage worse, Ragland responds, “What is the best way to get more doctors interested in primary care? Show them they can do what they went to school for, take great care of patients, and find a work-life balance on their own terms. We can be a real part of the solution – more primary care doctors, better patient and employee satisfaction, and much less spending by individuals, businesses, and governments on healthcare.” ◆

6225 W Hwy 146, Suite 1 Crestwood, KY 40014 502.565.6429 unbridledMD@icloud.com www.bluegrassfamilywellness.com

6225 W Hwy 146, Suite B Crestwood, KY 40014 502.558.6202 Dr.Tracy@OneFamilyMD.com www.onefamilymd.com

ISSUE#97 | 19

SPECIAL SECTION  BARIATRIC SURGERY

A Gutsy Decision

Extensive aftercare program and committed patients enhance success of bariatric procedures at Sts. Mary and Elizabeth Hospital, part of KentuckyOne Health BY JIM KELSEY The mindset of a surgeon is that surgery is going to fix the problem. So, it goes against the grain when a general surgeon says, “The surgery itself does very little.”

But those are the words John Olsofka, MD, general surgeon, Louisville Surgical Associates, affiliated with KentuckyOne Health, used when describing bariatric surgery. Not that he’s opposed to bariatric surgery. He and his partner, Vincent C. Lusco III, MD, also a general surgeon, perform nearly 300 such procedures annually. But he’s the first to admit that their role as surgeons is only one part of the patient’s journey toward better health.

“There’s a perception that you’re taking the easy way out by having surgery versus getting to the gym and eating less,” Olsofka says. “The reality is it’s not the easy way out.

It’s taking responsibility for your health and your long-term success.”

That responsibility carries on past the surgery, which Olsofka describes as giving the patient the tool they need to be successful.

From there, the patient must work with the physician, dietitian, exercise physiotherapist, and their support group to make the “tool” work long-term.

Louisville Surgical Associates launched a bariatric program at Sts. Mary and Elizabeth Hospital, part of KentuckyOne Health, in 2003 and has developed an extensive aftercare program to help patients make the longterm lifestyle changes necessary to succeed.

Olsofka admits that it’s not often that general surgeons are involved in counseling, therapy, and education to this degree, but says bariatric surgery isn’t a typical surgical fix.

“We treat this like a food addiction, LOUISVILLE

20 MD-UPDATE

PHOTO PROVIDED BY DR. JOHN OLSOFKA

Dr. John Olsofka is board certified in general surgery and has been with Louisville Surgical Associates for over 14 years. He helped launch the LAP-BAND bariatric surgery program at Sts. Mary and Elizabeth Hospital, which has performed over 4,000 procedures to date.

and all addictions are treated with support, accountability, and motivation,” he says, noting that bariatric procedures make up about 30 percent of the practice. “The band or balloon or bypass is the support

tool. Friends, family, and physicians are the support group.

The accountability is they have to keep their appointments and follow some simple rules. Then you have motivation. The patient has to want to. It can’t be forced on them.”

Neither can the type of bariatric surgery a patient chooses. With bypasses, sleeves, bands, and balloons all available, patients have many options from which to choose. Until recently, Olsofka and his group have exclusively offered LAP-BAND® surgery, but they were selected as one of the first programs in the country to be trained in the gastric balloon and now offer the ORBERA™ gastric balloon.

The balloon, he says, opens bariatric surgery to a whole new patient population with BMIs that are in the 30 to 40 range. “The balloon fills that gap for the person who is not responding well to pharmacological or exercise programs but doesn’t want to go into the surgical realm,” Olsofka says. “The typical patient that would present with the balloon has the narrow BMI, has generally been healthy in their life but is really busy at work, has gotten behind the eight ball, and has put on 30 or 40 pounds.”

The balloon offers a way to get back on track utilizing a temporary tool with a good safety profile. It is placed endoscopically with minimal sedation, and the patient is able to get back to work very quickly.

Instances of ruptures or leaks are rare, and, if they do occur, the balloon can either be removed or will pass on its own. The

The reason we brought the ORBERA gastric balloon into our practice is because there is a gap between the medical treatment of weight loss and surgical treatment.

– Dr. John Olsofka primary difficulties occur during the first couple of weeks with patients presenting feelings of nausea or being uncomfortably full. Those states of discomfort typically dissipate after a couple of weeks, and the patient is able to adjust for the remainder of the six months the balloon is in place.

But, much like the aftercare program Louisville Surgical Associates employs for their LAP-BAND patients, the care doesn’t end when the balloon is removed. “Even though the balloon is only in for six months, we’re going to follow the patients for an entire year and continue to assist them with nutrition and exercise and sup-

port so they can have the best result and maintain it,” Olsofka says.

Olsofka says that patients who engage in the program can expect to lose three-anda-half times more weight than they would with a regimented weight loss and exercise program. With the help of the aftercare program, the hope is that the patient will adopt some behavior modifications allowing them to maintain their weight loss long term.

Replacing the balloon if they fail to do so is not approved currently, so the next option would be a surgical procedure.

“People are interested in the balloon, but then they recognize that the LAPBAND is a permanent solution that is covered by insurance [the balloon is not],” Olsofka says. “That’s what makes our program a little different than the sleeve and bypass programs, because that’s a pretty big jump to have a surgery to remove part of the stomach or bypass when you’re just in that 30-40 BMI range.”

The LAP-BAND procedure also is done on an outpatient basis and takes about 30 minutes to perform. The downtime from work is usually about two-to-three days. Olsofka says that patients with the LAP-BAND can expect to lose one-to-two pounds per week consistently. While that’s a slower process than the balloon, the longterm success can have a significant effect on the patient’s overall health. These patients often present with disorders such as diabetes, hypertension, or sleep apnea, the impact of which can be reduced or eliminated through weight loss.

Stronger together.

Frequently it is those types of disorders that lead patients to seek out a solution.

About 95 percent of Louisville Surgical Associates’ patients find what they are looking for on their websites: lapbandoflouisville.com and gastricballoonky.com.

Taking the first step on their own makes the patient’s prospects for success that much more promising.

“You have to have a motivated patient regardless of what you do,” Olsofka says.

“The patient has to decide, ‘I’m sick and tired of this and I need to do something different.’ People who do not do well are kind of forced into it by a family member or a doctor. But those who are compliant with the program, I can look in the eye and say, ‘If you do your job and I do my job, it works.’” ◆

John Olsofka, MD Ss. Mary & Elizabeth Hospital Louisville Surgical Associates 4402 Churchman Avenue, Suite 202 Louisville, KY 40215 502.361.6059 www.kentuckyonehealth.org/ weightloss

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ISSUE#97 | 21

SPECIAL SECTION  BARIATRIC SURGERY

The Bariatric Toolbox

John Oldham, MD, brings a singular focus and a variety of tools to Baptist Health Louisville’s Weight Loss Surgery Program BY MELISSA ZOELLER John Oldham, Jr., MD, FACS, FASMBS, has seen the field of bariatrics have its fair share of controversy over the years, but it’s the innovation and growth that got him passionate about making bariatrics his life’s work.

Originally from Owensboro, Ky., Oldham attended the University of Louisville Medical School and then completed his residency in Dayton, Ohio. He practiced general surgery for two years before he was approached with a unique opportunity to start a minimally invasive bariatric program at Georgetown Community Hospital in Georgetown, Ky. “During my residency, everything in bariatrics was done invasively, nothing minimally invasive,” states Oldham. “I saw many patients lose weight but also many complications because of open incisions.

When I started seeing the change to laparoscopic and the benefits outweighing the risks, I knew I wanted to get involved.”

With the assistance of his then-partner, Derek Weiss, MD, the program was a success and led the way to the creation of Bluegrass Bariatric Associates, which opened several practices across the state.

After practicing at Baptist Health Louisville for five years, in 2013 Oldham signed on as the medical director of the Weight Loss and Bariatric Surgery Program.

Early this year, he also took on the role of director of bariatric surgery at Floyd Memorial Hospital & Health Services in New Albany, Ind. LOUISVILLE

A Singular Focus

While most bariatric surgeons also perform general surgery, Oldham’s sole focus is bariatrics. His practice offers a full range of bariatric procedures, as well as a medical weight loss program that provides access to dieticians, medications, psychologists, exercise trainers, and much more.

“A lot of people think of the old days when they think of bariatric surgery, but 22 MD-UPDATE

PHOTO PROVIDED BY BAPTIST HEALTH

it’s not that way anymore,” adds Oldham.

“It can be done very safely with very few complications. The patient has to understand that this is just a tool to help with weight loss, not some magic fix. That’s why they go through a long process of education to understand how all these tools work.

Our goal is to educate our patient to help them decide what tool is right for them.”

Dr. John Oldham performs over 350 bariatric cases annually and is currently the only bariatric surgeon at Baptist Health Louisville.

The Toolbox

And his tools are abundant. From gastric bypass, including revisional surgeries, LGCP (laparoscopic greater curvature plication), and the gastric sleeve to the LAPBAND® and the newest ORBERA™ gastric balloon, which was just FDA approved in the fall of 2015, Oldham makes it his mission to help his patients find the right method to keep the weight off permanently.

“If the patient is a diabetic, then we may lean them toward a more metabolic or

physiologic procedure like a gastric bypass or a sleeve gastrectomy,” states Oldham. “If a patient has a high BMI, they would also be directed toward these procedures. We want the patient to be comfortable with the procedure and decide which tool works best and fits them.”

While performed laparoscopically, the sleeve gastrectomy and gastric bypass are surgical procedures that involve removing a portion of the stomach (sleeve) or rerouting of the intestines (gastric bypass). The LAPBAND is a minimally invasive laparoscopic option that is adjustable and leaves the stomach intact. The new ORBERA gastric balloon is the least invasive approach yet.

Performed endoscopically, the ORBERA balloon stays in the stomach for six months, to help promote a feeling of satiety and reduce appetite, and is then removed.

“A patient’s weight is definitely a factor when it comes choosing the right procedure,” states Oldham. “Patients with a lower BMI of 30 or those not ready for surgery are ideal candidates for the balloon, while individuals with a BMI of 35 and greater are usually better candidates for the surgical procedures.”

All patients are advised to see their primary care physician first to get them in the right frame of mind for surgery. Most insurance companies require a three-month or six-month diet before the procedure, but dieting can only go so far for some.

Oldham explains that each individual has a genetically determined set weight point, which is the main reason for a high dieting failure rate. After surgery, a new weight point is set. Some bodies will lose 50 to 60 percent of the excess weight, and some will lose 100 percent of the excess weight.

The average range is 60 to 80 percent excess weight loss, with long-term sitting at 50 to 60 percent.

“Our bariatric surgical options help patients fight against heredity and lose as much excess weight as possible, but

Our bariatric surgical options help patients fight against heredity and lose as much excess weight as possible, but it all depends on the work put in. it all depends on the work put in,” says Oldham. “If a patient is on the lower end of weight loss, they can use our tools, along with a healthy lifestyle, to get to where they want to be.”

And if a patient is not seeing results,

revisional surgeries are available to remove the old method and put a tool in place that will ensure positive outcomes.

“Obesity is a disease in which there is a treatment. It is not a willpower issue; all bodies are genetically predetermined,” states Oldham. “Everyone can diet and exercise, but keeping it off is the hard part.”

He adds, “Instead of having patients struggle and struggle, we have now have a very safe, effective solution. A solution that allows people to once again play with their kids, grandkids, get off lifelong blood pressure and diabetic medications, and do things they couldn’t do before. I love getting the chance to change lives that way. It’s awesome.” ◆

John S. Oldham, Jr., MD, FACS, FASMBS 3900 Kresge Way Suite 42 Louisville, KY 40207 Phone:502.894.9499 www.baptisthealthweightloss.com

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THIS IS AN ADVERTISEMENT ISSUE#97 | 23

SPECIAL SECTION  BARIATRIC SURGERY

The Struggle Is Real

KentuckyOne Health Weight Loss Surgery at Saint Joseph East takes a comprehensive approach to long-term weight loss BY JIM KELSEY Genetics and lifestyle contribute to gradual weight gain leading to obesity, with the one commonality that it doesn’t happen overnight. But with weight loss surgery, an individual obtains the power to control their weight again.

“The biggest thing we teach our patients is that weight loss surgery does not eliminate the struggle with weight, but it does give an individual tremendous help with their battle,” says Amanda Nighbert, RD, LD, bariatric dietitian at the KentuckyOne Health Weight Loss Surgery at Saint Joseph East.

Two full-time bariatric surgeons at the Center perform gastric bypass and gastric sleeve procedures, and they are cautiously evaluating whether to add gastric balloon to their scope of surgical services, waiting for more outcome data of its long-term success.

“It is imperative to determine not only if a patient is a good candidate medically and psychologically for surgery but also to determine which procedure best meets and addresses the patient’s medical and behavioral needs. Patients should not choose a procedure based on anything other than their own medical and surgical history and their eating habits,” states Program Director Karen Hillenmeyer, BS, PA-C. Medical Director Joshua P. Steiner, MD, FACS, received his surgical training at the University of Kentucky (UK) and completed his laparoscopic fellowship at Cedars Sinai Medical Center in Los Angeles.

Steiner joined the Center for Weight Loss Surgery at Saint Joseph East in July of 2002.

His partner, Thomas H. Greenlee, MD, FACS, also a UK trained surgeon began his general surgery career in 1984 and bariatric surgery in 2003. Both surgeons, Steiner and Greenlee, also perform a variety of advanced laparoscopic surgery, including anti-reflux procedures, gallbladder surgery, hernia surgery, and colon surgery.

Over 5,000 laparoscopic bariatric procedures have been completed at the KentuckyOne Health Center for Weight Loss Surgery since Hillenmeyer developed the program over 14 years ago.

LEXINGTON

24 MD-UPDATE

PHOTOS BY GIL DUNN

(L-R) KentuckyOne

Health Weight Loss Surgery is led by Program Director Karen Hillenmeyer, BS, PA-C, with Exercise Physiologist Billi Benson, BA, Med, and Amanda Nighbert, RD, LD, bariatric dietitian.

Medical Director Steiner states that the operation is just one piece in the success of the weight loss program. “The initial evaluation and education, follow-up, and the Center’s team are more important than the operation itself,” he says. “Without the support staff – the exercise physiologist, the dietitian, the counseling – you will not have long-term successful patients.”

“These patients work very hard,” he continues. “We work for about an hour during the surgical procedure, and the patient works for a lifetime to achieve goals and maintain their weight loss” Greenlee adds, “The longevity of our program is a testament to the success of our patients. We have people who have lost extreme amounts of weight and eliminated diabetes, sleep apnea, and hypertension, among other medical conditions, and kept that weight off for over 10 years. Not many programs can say that.”

A Comprehensive Team Effort

A patient’s weight loss work is done with considerable help from the team at the Center, led by Hillenmeyer. It actually

starts prior to surgery, when Hillenmeyer, Nighbert and Exercise Physiologist Billi Benson, BA, Med, meet with the patient during the initial visit. A patient’s current diet and activity level, as well as medical, surgical, and physical issues or limitations are presented, and what type of support system the patient has.

“I believe that the dietary and exercise intervention and education are as important as the operation itself,” Nighbert says. “Without the education on how to use the tool, the tool doesn’t work. It is imperative to have a comprehensive multidisciplinary team such as ours to support the patient. ” Nighbert, who has been with the Center since its formation, has been instrumental in contributing to the success of many patients. One of the more unique aspects of the program is the presence of a full-time exercise physiologist.

“People in the medical field are impressed that the hospital has hired an exercise physiologist to work with our patients,” says Benson, who joined the practice in 2003 with the purpose of educating and encouraging patients. “After surgery, we develop an exercise routine that can be done at home or at a local gym that works all of the major muscles. This promotes more fat loss and builds more muscle.”

Currently about 60 percent of the patients are women, says Benson, but the number of male patients has increased in the past few years. Candidates for bariatric surgery must have a minimum of 35 BMI with at least one significant co-morbidity such as diabetes, high blood pressure, or sleep apnea or a BMI of 40, perhaps without one of these life threatening comorbidities.

Hillenmeyer says that “proven success requires the patient staying informed, connected, and motivated. Our program does this by being readily available to

RIGHT: “Primary

care doctors are referring more patients to us for bariatric surgery because the results have been so positive, and there are minimal complications from the surgery,” says Dr. Thomas Greenlee.

BELOW: “The follow-up and the Center are more important than the surgery itself,” says Dr. Joshua Steiner, director of Bariatric Surgery at Saint Joseph East.

our patients. Follow-up visits are coordinated with visits to the dietician or exercise physiologist. Both written and verbal instructions are given at each visit. Our patients always know what they should be doing from the time they walk through our door until they return at their next visit.”

“We also offer a Back on Track program for patients that are having difficulty with weight control in a group setting so patients see they are not alone,” Nighbert says.

“It’s fun to come back when you’re succeeding and we’re all celebrating, but often patients are hesitant to return when they’re struggling. That’s the most important time to come back because we understand and

“Old habits that don’t die will cause a patient to not lose as much or even put some weight back on,” Benson says. “But a successful patient who sticks to the program, everything changes. What they can physically do, how they plan meals, how they cook, how they move, as well as their mental state. It’s not uncommon to see a total transformation to a much healthier and happier patient.”

The struggle with weight is real and involves a team effort. ◆

want to help our patients be successful.

We understand that hectic schedules that limit exercise time and encourage fast food options are significant hurdles to sticking with a healthy lifestyle.”

Weight Loss Surgery At Saint Joseph East 160 N. Eagle Creek Drive Lexington, KY 40509 859.967.5520

ISSUE#97 | 25

COMPLEMENTARY CARE

Performing Under Pressure Do you believe that you perform better under pressure? Do you do your best creative thinking under a severe pressure deadline? Do you worry about a child or colleague that chokes under pressure?

I had just tuned in to a Wharton Business School interview of Dr. Hank Weisinger, a world-renowned psychologist and expert in the field of pressure management. The New York Times best-selling author was drawing on 10 years of research on 12,000 people — including elite athletes, corporate executives, and Navy SEALs — to describe how he handled one of his own pressure moments, a crucial boardroom presentation. Moments before entering the boardroom, Weisinger simply told his client, “I’ll do my best.”

The Myth Of Performing Under Pressure

I thought his response was rather… lame.

But I’m glad I kept listening, so I could discover I’d been buying into the myth of “clutch performance” — when a person magically rises to the occasion and performs better than ever before, simply because of the pressure he or she faces.

“You‘re not going to generate super human performance when you are under pressure. The best you can do is your best – you can‘t do magically better than you have before. And because of the ubiquitous negative effects of pressure, it is more realistic to think that the best you will be able to do under the circumstances is approximate your true capabilities,” contends Weisinger.

According to Dr. Saul Miller, a psychologist and performance specialist, “Some people don’t see pressure as an exclusively negative force. They say they enjoy pressure and think of it as a positive creative force.”

I immediately thought of my husband, who describes his 10-year career flying Air Force 2 as “outrageous.”

“Some pressure is not only enjoyable, it’s essential,” continues Miller. “In physiology and medicine, pressure is a necessary part of normal function. In the sexual response, the buildup and release of pressure is an integral 26 MD-UPDATE

part of the pleasure of orgasm.

In the circulatory system, it’s pressure that enables the blood to circulate through the arteries and veins. What is undesirable

BY Jan Anderson, PsyD, LPCC and dangerous is to have repeated and prolonged periods of excessive pressure.”

What is it about pressure that can sabotage our efforts when we need to do our best? In Performing Under Pressure: The Science of Doing Your Best When It Matters Most, Weisinger identifies three components that elicit our anxiety and can cause us to underperform in high-pressure situations: • The outcome is important to you • The outcome is uncertain • You feel you are responsible for, and are being judged on, the outcome

Pressure Traps

Not only is pressure part of the human condition — so it’s not going away — but Miller argues that people need a moderate degree of pressure to stay focused and

… would I be able to quickly understand what was (really) going on with a person I’d never before laid eyes on? Would I be able to quickly form a “therapeutic alliance?” A counselor typically gets just one shot to get that connection established. On top of that, I had decided — from the very start of my private practice — to not accept insurance, so my clients were paying out-of-pocket for my services.

I didn’t realize at the time that I was engaging in two cognitive distortions that Weisinger’s research identified as particularly harmful to our ability to perform under pressure: 1. Magnifying the singularity of the event: This is my one and only chance and I don’t want to blow it.

2. Magnifying the importance of the event: This is the most important event of my career.

The ability to understand and manage pressure is a key life skill. Thanks to the latest studies from neuroscience and frontline research by those like Weisinger, we now have a wealth of evidence-based solutions that help improve mental focus and emotional control, as well as calm the physical distress associated with pressure.

Pressure Solutions

I remember very clearly the day when I

THE ABILITY TO UNDERSTAND AND MANAGE PRESSURE IS A KEY LIFE SKILL. perform at their best. But what about some of my clients, I wondered, that consistently perform at a high level, but never escape their own private pressure trap? They’re always feeling the heat… even when the weather is cold.

We all have our personal brand of pressure. In the early days of my practice, I often felt, along with excitement and eagerness, a flush of anxiety before a new client arrived. My clinical supervisors had told me that my diagnostic skills were good, but

let myself relax a bit, really connect with the person in front of me, and … think.

Confirmation came in the form of a seismic shift in my effectiveness with clients.

Looking back, I realize I had stumbled upon one of Weisinger’s pressure solutions: Instead of seeing high-pressure situations as threatening, see them as a challenge or opportunity. I certainly didn’t thrive on pressure, but I did thrive on challenge — which, to me, translated as interesting, creative, and fun.

Know your Personal “Pressure Points” Some people freak out when they’re in the spotlight — job interviews, presentations, solo performances. Others are unnerved in interpersonal situations — difficult conversations, networking events, collaborative projects.

Once you gain insight into how pressure affects you and puts you at risk, you can focus on specific techniques and methods designed to reduce your anxiety, put yourself back in control, and restore your sense of confidence.

Balance Deep Pressure with Deep Relaxation When my golf instructor introduced competitive drills in our group clinics, I immediately sensed the tension. “You need to get used to performing under pressure during practice,” he explained. “It will prepare you

for the pressure of playing on the course.”

Next, counteract imposing pressure on yourself with learning to consciously relax yourself. Think of this as a way to inoculate yourself against pressure moments by decreasing daily anxiety and stress. The “structured relaxation” pre-race routine used by 14-time Olympic Gold Medalist Michael Phelps started when he was 12 years old, with his mother Debbie guiding him through a progressive relaxation every night before bed. Eventually he could do it by himself and ultimately could reach “a deep state of relaxation on the count of two” before a race.

Be a Control Freak — Meditate Once you can consciously relax yourself, you can begin to cultivate a form of relaxed mental control called “mindfulness” — your

ability to pay attention in a relaxed way — so you’re less distracted, better able to focus on what’s important, and respond in a nonreactive way.

A pressure moment can undermine our performance when we focus on factors we can’t control. The mental discipline of mindfulness helps you focus on what you can control — and not be distracted by what you can’t.

One of Weisinger’s pressure solutions is Be a Control Freak. “To execute this pressure solution effectively, you have to be able to know (a) what you can control, (b) what you can’t control, and (c) when your focus starts to shift to things you can’t control, so you can snap it back.”

You may want to try combining these pressure solutions. No pressure — just something to think about. ◆

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FamiLY PRaCTiCE Laura Hummel, M.D. BEHavioRaL mEDiCiNE Narda Shipp, ARNP Kellie Dryden, LCSW Marie Simpson, LCSW

NuRSE PRaCTiTioNERS Becky Moore, ARNP Teri Partin, ARNP Lynne Shockey, ARNP Jeff Eversole, ARNP

Joint Commission Accreditation, The Quality Distinction

A Joint Commission accredited private surgery center where our physicians perform diagnostic and surgical procedures for the treatment of pain, to include: Epidurals Intrathecal Pumps Spinal Cord Stimulation MILD Facet Blocks Vertebroplasty Neurolytic & Sympatholytic Denervation For further information on the region’s largest freestanding pain treatment facility, call: (859) 278-1316 ext 258 • Fax: (859) 276-3847 • www.pain-ptc.com ISSUE#97 | 27

COMPLEMENTARY CARE

Tai Chi and Qigong

Promoting wellness in body, mind, and spirit at any age Americans today live almost twice as long as our ancestors born prior to 1900. Unfortunately, many elders now spend the last 25-30 years of their lives burdened with chronic diseases such as diabetes, heart disease, arthritis, depression, neurological disorders, and osteoporosis.

For the healthy, however, the years beyond age 50 can be the most enjoyable time of their lives. After years spent gaining an education, working, and raising children, healthy elders can focus on hobbies, travel, learning, and spending time with loved ones. Studies of very healthy elderly people around the world show they share certain behaviors. They tend to eat a mostly Mediterranean type diet — mostly plantbased, whole foods with fish as the primary source of animal protein. They are not overweight or obese. They don’t consume tobacco or excessive amounts of alcohol.

They are physically active. Most importantly, they have low amounts of stress and high amounts of love and purpose. All these lifestyle traits together give the best chance of truly happy golden years.

Tai chi, an ancient martial art, is an excellent way to promote wellness in mind, body, and spirit at any age. Because it is a gentle form of exercise, tai chi is particularly suited for older people. Tai chi embodies the concept of yin and yang – balancing the polar opposite components of our nature to produce health, happiness, and harmony. Qigong exercises involve various movements and breathing techniques to improve the flow of “qi,” or life force, throughout the body. Tai chi and qigong are often practiced together.

Tai chi forms are a precise sequence of gentle flowing movements combined with controlled breathing. In order to appreciate the complexity and beauty of the forms, it is best to observe a skilled practitioner. Lloyd Kelly, a tai chi master who teaches classes for KentuckyOne Healthy Lifestyle Centers, can be seen performing in the following YouTube video: https://www.youtube.com/ watch?v=fffqSlcBQ3k.

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Practicing tai chi sharpens focus, clears the mind, improves balance and strength, and is simultaneously relaxing and energizing. There are numerous

BY Deborah Ann Ballard, MD, MPH studies demonstrating the heath benefits of tai chi for a long list of health problems, including Parkinson’s disease, heart failure, menopause symptoms, fibromyalgia, osteoarthritis, hypertension, chronic obstructive lung disease, stress, and anxiety.

Dr. Paul Lam, director of the Tai Chi for Health Institute, has developed specific tai chi programs for fall prevention, arthritis, diabetes, osteoarthritis, and back pain. The Arthritis Foundation certifies tai chi instructors through Dr. Lam’s training programs.

In addition, tai chi classes provide an opportunity for socialization and camaraderie. The tai chi greeting sets the tone for the classes: The open right hand is placed on the fisted left hand with the thumbs outside, in front of the heart. The open hand symbolizes friendship, the fist symbolizes strength, and the thumbs symbolize humility.

Primary care physicians, geriatricians, orthopedists, neurologists, and pain management specialists can recommend tai chi to their patients backed by a large body of scientific evidence. Regular practice of tai chi can decrease the need for pain medications, antihypertensive drugs, anxiolytics, and antidepressants, decrease the risk of falls, and improve mobility, cognition, and mood. Tai chi instructors certified by the Arthritis Foundation are trained to avoid the risk of injury and recognize when students exhibit problems indicating the need for medical evaluation.

“The Harvard Medical School Guide

to Tai Chi: 12 Weeks to a Healthy Body, Strong Heart, & Sharp Mind,” 2013 Harvard Health Publications, by Peter M. Wayne, PhD, is an excellent text for those wishing to explore in depth the scientific evidence regarding tai chi.

The following websites also provide nice overviews of the health benefits of tai chi: • The Arthritis Foundation: http://www.arthritis.org/living-witharthritis/exercise/workouts/otheractivities/tai-chi-arthritis.php • Tai Chi for Health Institute http://taichiforhealthinstitute.org • National Center for Complementary and Integrative Holistic Medicine https://nccih.nih.gov/health/taichi http://www.health.harvard.edu/stayinghealthy/the-health-benefits-of-tai-chi

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

Deborah Ballard, MD, MPH

KentuckyOne Healthy Lifestyle Centers Integrated Medicine 250 E. Liberty Street, Suite 102 Louisville, KY 40202 502.581.0110

NEWS  EVENTS  ARTS

Bix Named Honorary Lecturer at University of Glasgow LEXINGTON Dr. Gregory

Bix has been given honorary status in the College of Medical, Veterinary and Life Sciences at the University of Glasgow, Scotland. Bix will be an honorary clinical lecturer in the Institute of Neuroscience and Psychology. His appointment will expire in 2020.

Bix, an associate professor in the University of Kentucky’s Departments of Neurology, Anatomy and Neurobiology, and the Sanders-Brown Center on Aging, is also the director of the Center for Advanced Translational Stroke Science and the Paul G. Blazer, Jr. Endowed Professor of Stroke Research.

Dobbs Appointed Associate Editor for QMHC LEXINGTON DR. Michael

Dobbs, associate chief medical officer for UK HealthCare, has been named associate editor for the publication, Quality Management in Health Care (QMHC), published by Wolters-Kluwer Health.

QMHC is a peer-reviewed journal that provides a forum for readers to explore the theoretical, technical, and strategic elements of healthcare quality management.

The journal’s primary focus is on organizational structure and processes as they affect the quality of care and patient outcomes.

Ambati Elected to National Academy of Inventors

Dr. Jayakrishna Ambati, professor and vice chair in the Department of Ophthalmology and Visual Sciences, and professor of physiology at the University of Kentucky College of Medicine, has been LEXINGTON

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

elected Fellow of the National Academy of Inventors (NAI).

Election to NAI Fellow status is a high professional distinction accorded to academic inventors who have demonstrated a proficient spirit of innovation in creating or facilitating outstanding inventions that have made a tangible impact on quality of life, economic development, and the welfare of society.

Ambati is an internationally recognized authority who has pioneered innovative concepts in macular degeneration, a blinding disease that affects 150 million people worldwide. Findings from his lab have been published in the most prestigious scientific journals such as Nature, Science, Cell, Nature Medicine, The Journal of Clinical Investigation, and the Proceedings of the National Academy of Sciences.

He will be inducted during the NAI’s 5th Annual Conference April 14 - 15, 2016, in Washington D.C.

Speicher Joins Baptist Health as Cardiovascular Program Director

Baptist Health recently hired Michelle A. Speicher, MBS, BNS, RN, FACHE, NE-BC, as the new Cardiovascular Program director for the Kentuckiana region. In her new role, Speicher will be responsible for the overall administration and coordination of the cardiovascular program including planning, directing, monitoring, coordinating, and evaluating the success of the overall cardiovascular service line.

Prior to joining Baptist Health, Speicher served as the director of Clinical Care/ Cardiovascular Services and Float Pool at Baylor Regional Medical Center in Grapevine, Texas. Currently, she is completLOUISVILLE

ing her doctorate of business administration from Southern California University. She completed her bachelor of science in nursing and master of business administration in integrative management from Michigan State University.

U of L’s Trover Campus a National Model in Drawing Physicians to Rural Practice

Although many rural residents who previously were uninsured now have health insurance thanks to the Affordable Care Act, a shortage of physicians in many rural communities means it still can be difficult for rural residents to obtain healthcare.

The University of Louisville School of Medicine has been working to increase the number of physicians in rural communities by training doctors at Trover Campus at Baptist Health Madisonville for 17 years.

William J. Crump, MD, associate dean for the Trover Campus, and his colleagues at U of L have assembled data to demonstrate that their efforts are paying off. The physicians who spent the last two years of medical school at the rural location are much more likely to ultimately practice in a rural setting.

In a study published online in The Journal of Rural Health, Crump reveals that 45 percent of the physicians who completed medical school at the rural campus now practice in rural areas, compared with only seven percent of graduates who remained on the urban campus. The authors examined data for 1,120 physicians who graduated from the U of L School of Medicine between 2001 and 2008, including those who completed training at the traditional urban campus as well as Trover Campus.

They used statistical methods to control for the percentage of graduates who had rural upbringing and chose family medicine, factors that previously were shown to predisLOUISVILLE

ISSUE#97 | 29

NEWS

pose a physician to rural practice, and were able to demonstrate the rural campus itself added to the likelihood a physician would choose a rural practice.

Almost two-thirds of Kentucky’s counties are considered health professional shortage areas, meaning they have far too few primary care physicians. The University of Louisville focused on correcting this shortage by establishing the Trover Campus in Madisonville, Ky., a town of 20,000 that is 150 miles southwest of Louisville in the west Kentucky coal fields. It was believed that training students from small towns in a small town would more likely produce physicians for the small towns, and now this concept has been proven. Trover Campus was only the second in the United States to be placed in such a small town.

Agencies Align with VNA Health at Home

Seton Home Health and TriCounty Hospice have aligned their brands to KentuckyOne Health as VNA Health at Home. As part of the KentuckyOne Health family, this alignment will create a stronger, more unified structure as VNA Health at Home continues to care for patients and build healthier communities throughout London, Ky. and its surrounding communities.

Working directly with Saint Joseph London and other community health care providers, VNA Health at Home is a full service healthcare organization that believes the best place for someone to get better, and faster, is in their own home. VNA Health at Home provides quality, coordinated home care and hospice services through a team of skilled professionals, such as nurses, physical therapists, occupational therapists, social workers, speech therapists, home health aides, volunteers, and chaplains.

Providing quality care to the community for over 40 years, VNA Health at Home in London, Ky. serves Pulaski County, Laurel County, Clay County, Knox County, and Whitley County.

Local sister agencies, Hospice of Nelson LONDON

30 MD-UPDATE

County in Bardstown, Ky., St. Joseph Home Care in Lexington, Ky. and VNA Nazareth Home Care in Louisville, Bardstown, Campbellsville, Elizabethtown, Ky. and Clarksville, In. have also aligned their brands to KentuckyOne Health as VNA Health at Home as of December 1, 2015.

Hardin Memorial Health Joins UK Markey Cancer Center Research Network Physicians and other leaders from Hardin Memorial Health (HMH) and the UK Markey Cancer Center – Kentucky’s only National Cancer Institute (NCI)-designated center – celebrated the new partnership at the HMH Cancer Care Center in Elizabethtown. In recognition of this higher level of patient care, HMH cancer patients attended the event and hung holiday ornaments in awareness of some of the area’s most prevalent cancers.

As a member of the UK Markey Cancer Center Research Network, HMH will be able to conduct Markey-led and NCI-led clinical trials because of Markey’s position as an NCI-designated cancer center.

HMH now is one of four research sites of the Markey Cancer Center Research Network. The HMH cancer care team was invited to join the network based on previous performance in research, including a study to identify the best approaches to help cancer patients quit smoking, which will help improve their response to cancer treatments.

Inclusion in the research network is an extension of an existing partnership of HMH and the UK Markey Cancer Center.

In 2014, HMH joined the center’s affiliate network, which focuses on sharing new evidence-based findings and access to refer patients to clinical trials.

ELIZABETHTOWN

Ephraim McDowell Heart & Vascular Institute Moving to New Location

The Ephraim McDowell Heart & Vascular Institute will soon have a new location. Construction is currently underDANVILLE

way for a new Ephraim McDowell Heart & Vascular Institute that will be located on the corner of Walnut and Third Street in Danville. The practice is currently in two locations, one on Walnut Street and the other on Ben Ali Drive.

“The new Heart & Vascular Institute is a $1.25 million project that will improve the cardiology services that are offered to our patients,” says Sally Davenport, president and CEO, Ephraim McDowell Health.

“Consolidating the two offices will be more convenient for our patients to see excellent doctors in close proximity to Ephraim McDowell Regional Medical Center.”

The new facility will offer office appointments, cardiac testing, cardiac and pulmonary rehabilitation, and management of venous disease including varicose veins.

The anticipated date of opening for the new location is early May 2016.

Baptist Health Joins Guardian Research Network

The Guardian Research Network (GRN) is rapidly expanding with the addition of four partner healthcare systems including Baptist Health (Kentucky), encompassing 76 hospitals in nine states.

Guardian Research Network is a national consortium of healthcare organizations that uses a sophisticated, unparalleled data collection and warehousing system to gather information on hundreds of thousands of patients. This data is evaluated with the most advanced healthcare research and analytic methods that result in bringing cutting-edge therapies specifically targeted to each patient’s cancer. Patients whose hospitals are participating with GRN will now have access to leading cancer treatment therapies close to home.

“Baptist Health is excited about the opportunity to be a member of the Guardian Research Network. Participation in GRN offers Baptist cancer patients a personalized approach to the care and treatment of their disease in their own communities,” said Timothy Jahn, MD, chief clinical officer of Baptist Health. ◆ LOUISVILLE

EVENTS

Hope Scarves Donates $50,000 to James Graham Brown Cancer Center

Hope Scarves, which provides scarves and stories of hope to women facing cancer, donated $50,000 to the James Graham Brown Cancer Center in support of translational metastatic breast cancer research. The check was presented on Thursday, December 10, at the Kosair Charities Clinical & Translational Research Building, 505 S. Hancock St., and tours of the research lab were offered.

This marks Hope Scarves’ first major donation to translational metastatic breast cancer research. The donation is in support of research conducted by Dr. Yoannis Imbert-Fernandez at the James Graham Brown Cancer Center. The gift will directly support Imbert-Fernandez’ research to determine the effects of simultaneous suppression of estrogen signaling and a key metabolic enzyme known as PFKFB3 on sugar metabolism, growth, and survival of metastatic breast cancer. This research could lead to improved treatment options for people with metastatic breast cancer within the next year.

In September 2015, MD-UPDATE partnered with Hope Scarves as a sponsor of their signature event, Colors of Courage.

The event hosted 500 people and raised over $125,000, $15,000 of which was earmarked for metastatic breast cancer research.

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ABOUT HOPE SCARVES:

Louisvillian Lara MacGregor, founder of Hope Scarves, was 30 years old and seven months pregnant when she was diagnosed with breast cancer in 2007. She was diagnosed with Stage IV metastatic breast cancer in 2014. In 2007, a mutual friend mailed MacGregor a box of scarves with a note saying, “You can do this!”

It was a heartfelt gift that led to the creation of Hope Scarves, a Louisvillebased nonprofit serving women facing cancer. Hope Scarves captures the stories of courageous women who have faced cancer, along with the headscarves they wore during treatment. The scarves are then dry-cleaned through a partnership with

Attendees toured the research lab of Dr. Yoannis Imbert-Fernandez, whose research seeks to improve treatment options for metastatic breast cancer.

ABOVE LEFT: On December 10, Hope Scarves donated $50,000 to the James Graham Brown Cancer Center for metastatic breast cancer research.

ABOVE: Lara MacGregor, founder of Hope Scarves, was proud to make their first major donation to translational metastatic breast cancer research.

LEFT: James Graham Brown Cancer Center Deputy Director Jason A. Chesney, MD, PhD, addressed the crowd during the check presentation.

TOP:

Highland Cleaners. The scarves, survivor stories, and scarf tying instructions are then passed along to another woman facing cancer, spreading a message of hope.

To date, Hope Scarves has distributed more than 2,300 scarves and survivor stories to all 50 states, nine countries, and to women ranging in age from five to 93, battling many types of cancer. To learn more about Hope Scarves, visit www.hopescarves.org. ◆

PHOTOS PROVIDED BY HOPE SCARVES

ISSUE#97 | 31

ARTS

Artist: Body Coming to Lexington Art League

CURATOR JULIEN ROBSON AND LAL REINVIGORATE EXAMINATION OF THE FIGURE THROUGH THE LENS OF SELF PORTRAITURE IN CONTEMPORARY ART The Lexington Art League (LAL) launches 2016 with the exploration of a foundational and timeless subject — the figure — in the upcoming exhibition Artist: Body, presented by QX.net. For this exhibition, LAL hired guest curator Julien Robson, former curator of Contemporary Art at The Speed Museum in Louisville.

Robson, who hails from Vienna, London, and Louisville, has explored numerous private collections and galleries from London to Cincinnati to curate this exhibition, serving as a platform for Kentucky artists to be seen in an international framework.

Artist: Body takes the concept of a figure show and translates it through the lens of the self-portrait in contemporary art.

Robson states, “Throughout the ages, images of the human body have been used by artists, often to explore allegory, beauty and sexuality. Time has witnessed many shifts in the way the body is portrayed, and in recent decades, influenced by contemporary thinking and the availability of different visual technologies, artists have increasingly employed themselves as both the subject and object of their works.”

“The Lexington Art League understands the value that many have placed on our January exhibition dedicated to the study of the figure. It is important to note, however, that this first exhibition cycle of 2016 is not a return to The Nude. Artist: Body is an

Self Portrait Suspended IV, Sam Taylor-Wood, 2004 LEFT: Feet Frontal, John Coplans, 1986

LEXINGTON

ABOVE:

intense self-analysis. It is for both the local artist and local collector, but does not contain an abundance of work from either. This show is contemporary art as idea and not object. Artist: Body is pivotal as it elevates our discourse about the purpose contemporary art holds in our lives,” says Christine Huskisson, president of the LAL Board of Directors.

Much of the work in Artist: Body portrays the artists’ sense of ownership of her or his body and, most importantly, how it is represented. While the themes explored within the exhibition are vast and multilayered, one prominent connecting fiber is the vulnerability each artist shares as they expose viewers - and in many cases showcase – their most intimate selves in working with their own bodies. “In this context the image of the artists’ body is open and vulnerable, subject to self analysis and intimate dissection, while at the same time resisting a comprehensive interpretation,” Robson added.

“The examination of the figure has long been a foundational practice for LAL. Through an extraordinary collection of selfportraits that illustrate the daring practice of depicting one’s self through art, Robson has curated an intense and thoughtful exhi-

bition with the highest level of conceptual integrity,” said Stephanie Harris, executive director of LAL. Kicking off the exhibition cycle for Artist: Body, LAL will host a warm-up event entitled Fourth Friday: A Figure Study on January 22nd from 6-9pm and set to include live figure drawing in the spacious galleries of the Loudoun House. Artist: Body Opening Preview Party is February 19th from 6-10 pm at the Loudoun House.

For additional information, visit www.lexintonartleague.org. ◆

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FOR TICKETS:

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(859) 233-3535 OR

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Lexington

Art League

A Figure Study Fourth Friday Event January 22, 2016

Artist:Body

Presented by qx.net Opening Preview Party February 19, 2016

FOR EVENT & TICKET INFORMATION: 859.254.7024 www.lexingtonartleague.org

All Lexington Art League programs are made possible through the generous support of LexArts. LexArts allocation of $5 single donation to the operations of the Lexington Art League.The Kentucky Arts Council, a state arts agency, provides ope League with state tax dollars and federal funding from theallocation National Endowment the Arts. the Additional All Lexington Art League programs are made Art possible through the generous support of LexArts.

LexArts of $50,000forrepresents largest support provid Recreation. single donation to the operations of the Lexington Art League.The Kentucky Arts Council, a state arts agency, provides operating support to the Lexington

Art League with state tax dollars and federal funding from the National Endowment for the Arts. Additional support provided by Lexington Parks & Recreation.

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