MD-Update Issue #110

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #111 WWW.MD-UPDATE.COM

VOLUME 8 • #7 • December 2017

Changing the Paradigm on Pain Management As a progressive pain clinic, Commonwealth Pain & Spine is taking a multimodal, team-based approach and altering the public’s misconceptions regarding traditional pain medicine SPECIAL SECTION IT’S ALL IN YOUR HEAD ALSO IN THIS ISSUE COMPUTER-ENHANCED TREATMENT FOR DEPRESSION REFINED DEEP BRAIN STIMULATION TECHNOLOGY THE PSYCHOLOGICAL COMPONENT OF PAIN

#1

in Kentucky for Stroke Care

Saint Joseph Hospital is the ONLY hospital in Kentucky to be recognized by Healthgrades as one of America’s 100 Best Hospitals for Stroke Care in 2017. Saint Joseph Hospital has also been recognized

by Healthgrades for Neurosciences Excellence in 2017, ranking it among the top 10 percent of hospitals in the nation for neurosciences. Saint Joseph has been recognized for Stroke Care Excellence five years in a row (2013-2017), ranking it among the top 5 percent in the nation for treatment of stroke.

This outstanding recognition highlights Saint Joseph Hospital’s commitment to being the best for you and your family. Trust your family’s care to the best health care providers in Kentucky, and among the best in the nation. It could be one of the most important decisions you ever make.

Visit KentuckyOneHealth.org/Awards to learn more.

CONTENTS

ISSUE #111

ON THE COVER: Kyle Young, MD, and Jason Lewis, MD, founders of Commonwealth Pain & Spine, are fellowship trained and accredited in both anesthesiology and pain management.

COVER PHOTO BY ROB DENSMORE PHOTO

3 HEADLINES 6 ACCOUNTING 7 FINANCE 9 LEGAL

11 Changing the Paradigm of Pain Management As a progressive pain clinic, Commonwealth Pain & Spine is taking a multimodal, team-based approach and altering the public’s misconceptions regarding traditional pain medicine.

14 SPECIAL SECTION: IT’S ALL IN YOUR HEAD 21 MENTAL WELLNESS 23 COMPLEMENTARY CARE 25 NEWS 27 EVENTS

SPECIAL SECTION IT’S ALL IN YOUR HEAD

14 USING TECHNOLOGY TO ENHANCE THE THERAPY EXPERIENCE: U OF L DEPRESSION CENTER

16 OFFERING REFINED DEEP BRAIN STIMULATION TECHNOLOGY: U OF L JEWISH HOSPITAL

17 B RINGING BROAD NEUROSURGICAL SERVICES TO BOWLING GREEN: GRAVES GILBERT CLINIC

19 P ROVIDING INNOVATIONS IN EDUCATION: UNIVERSITY OF LOUISVILLE

21 P ROMOTING A NEW APPROACH TO PAIN MANAGEMENT: BAPTIST HEALTH MEDICAL GROUP PAIN MANAGEMENT ISSUE #111 1

LETTER FROM THE PUBLISHER MD-UPDATE MD-Update.com

A Letter from Your New Editor

Volume 8, Number 7

ISSUE #111 PUBLISHER

Gil Dunn

I am pleased to introduce myself as the new editor-in-chief of MD-Update magazine.

For the past year, I have not only been a contributing writer, but an avid reader of this publication. Consistently, I’ve found myself impressed and enlightened by the breakthroughs within the healthcare field, the cutting-edge technology available within our state, and the ongoing dedication and innovation by the doctors profiled. Previously, I served as the editor of skirt!

Lexington magazine and have written for a broad spectrum of publications and organizations nationwide. Now, I relish the opportunity to spotlight the medical community for MD-Update.

My initial association with the medical profession came about in an unlikely fashion. After graduating with a degree in communications and theatre, I found my first acting gig not on the stage, but at the University of Kentucky’s College of Medicine where I was hired as a standardized patient. As most of you know, standardized patients serve as a training tool for medical students and residents by realistically portraying the vast scope of individuals, issues, and illnesses that healthcare professionals will encounter. Later, I went on to serve as coordinator of standardized patients. In this position, I had the privilege of working alongside physicians and faculty from a wide range of specialties. Throughout this time, I developed a deep admiration for their capabilities, commitment, and compassion.

In assuming editorship, I am thrilled to continue the magazine’s mission of connecting physicians across the specialties. I am devoted to upholding the integrity of information, visual appeal of the pages, seamless context of the images and stories, and timely content. For the future, my goal is to broaden our contributors and reader base, expand our website presence, and deepen our existing relationships.

I am so grateful for the opportunity to serve this community and look forward to forging relationships with each of you.

Here’s to Moving Onward and Upward,

gdunn@md-update.com EDITOR IN CHIEF

Donna Ison donna@md-update.com GRAPHIC DESIGN

Laura Doolittle, Provations Group

CONTRIBUTORS:

Jan Anderson, PsyD, LPCC Lisa English Hinkle Lisa Meeker Scott Neal Matthew Smith, CPA, CFE

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Gil Dunn gdunn@md-update.com

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2 MD-UPDATE

Headlines

The Institute for Sustainable Health & Optimal Aging Q&A with Anna Faul, PhD

BY GIL DUNN

Kentucky design or engineering firms?

The U of L Institute for Sustainable Health & Optimal Aging was founded in 2014 by the executive vice president for health affairs to create a center on aging that could bring multiple professions together and thrust Louisville into the forefront as a city whose goal is to be “the optimal aging capital in the United States.”

Anna Faul, PhD, is the executive director and driving force. The Institute was profiled in MD-Update, issue #97, in January 2016. We’re checking in with Dr. Faul to get an update on her ambitious goal and accomplishments.

■■ MD-Update It’s been almost two years since we spoke. What’s been going on at the Institute for Sustainable Health & Optimal Aging?

FAUL: Over the past two years, we have expanded and matured our efforts to create a society where aging is viewed as an opportunity, not a disease. During this time, we have moved into the implementation and evaluation phases on many of our grants and studies and diversified our programmatic offerings to ensure relevancy and increasing reach. We have also cultivated many essential partnerships that align with our mission of creating collaborative community networks of research, education, innovation, and practice. We have also led and supported a variety of advocacy initiatives in the areas of optimal aging, Alzheimer’s disease awareness, age-friendly cities, and veteran-friendly services.

■■ The Institute has four pillars of focus: Research, Innovation, Education, and Best Practices. Before taking them one at a time, can you start by defining what optimal aging is?

At the Institute, we believe that optimal aging is the ability to flourish throughout one’s life. At a community level, optimal aging is having intergenerational, compassionate communities that have all the resources available for people to lead physically, socially, and emotion-

Anna Faul, PhD

ally healthy lives from birth to death. At the individual level, optimal aging means you are able to live each day to the fullest, despite any aging-related challenges you might face.

■■ What are the research areas that the Institute is exploring? Clinical trials? What are the opportunities for translational research?

We are a recipient two HRSA Geriatric Workforce Enhancement Programs, which we call our Flourish Network. With these grants, we study the effectiveness of our Flourish Model of Care – an innovative way of approaching the holistic health of a person, including physical, emotional, and environmental health. We are excited to expand this model to more practices and increase the behavioral health component of this model in the coming months. The educational component of the Flourish Network has particularly strong results in connecting isolated older adults with the resources they need to age optimally.

We have been working with several local product innovators and researchers to develop devices that promote health and independent living for older adults. We have also supported electrical engineering capstone projects through the Speed School of Engineering at U of L. For example, a smart toilet that can weigh frail older adults to track weight loss, as well as reminder devices for older adults with cognitive impairment to do basic tasks alone at home. More broadly, innovation infuses all that we do – from our new mentorship capacity to health professionals in remote areas through the ECHO program to our care coordination and practice transformation.

Integrated Geriatric and Behavioral Health Care for Primary Care Settings Primary Care Practice Transformation Geriatric Work Force Development Translational Research Opportunities Conferences & CME Opportunities

www.OptimalAgingInstitute.org (502) 852-5629

■■ Have you been able to develop any new products or services that can be taken to the marketplace and put into use? Are there any partnerships with PHOTO BY ROB DENSMORE

ISSUE #111 3 MDUPdate2017Mini3.indd 1

11/21/17 11:08 AM

Headlines

■■ September was officially Optimal Aging Month in Louisville. How did it go?

This year’s Optimal Aging Month, our third at the Institute, was an incredible month filled with awareness-generating activities and educational programs. This year, we challenged everyone to perform intergenerational acts of kindness and to share their stories with us. Our goal was to dismantle generational divides and stereotypes by spreading compassion between generations. It was great to witness older adults and children sharing and learning from each other. We even had two Honorary Optimal Aging Catalysts, Basketball Hall of Fame player Darrell “Dr. Dunkenstein” Griffith and Basketball Hall of Fame coach Denny Crum.

■■ Is the Institute still offering student internships in different disciplines?

Our commitment to a transdisciplinary approach is the guiding principle of our stu-

dent opportunities. In addition to the engineering students I mentioned, we have over 10 social work student placements with the Institute each year and 3-4 geriatric and palliative medicine fellows. We also have interns from pharmacy, nursing, business, and law.

We are excited to announce several new behavioral health internships with generous living stipends for psychiatric nurse practitioners (doctoral-level), counseling psychology (master-level), and social work (master-level).

high utilization patients while helping practices maximize the new care coordination Medicare billing codes. We are also working on partnering with University of Louisville Physicians on a new project to pilot test the practice transformation potential of the Flourish Model. Our goal is to have primary care practices provide quality geriatric care to older adults in the communities they live in, with mentorship support from geriatricians and other professional experts at the University of Louisville.

■■ Tell us about the Institute’s engagement with area physicians and how you work with primary care practices to make them more aware of geriatric care coordination.

■■ Closing thoughts?

We are deeply involved with primary care practices in both Louisville and the surrounding rural counties, to spread knowledge and skills about quality geriatric care. Through our Flourish Model, we have been able to help rural practices reduce unnecessary costs on

The past two years have been an incredible journey for the Institute. It is inspiring to see the passion and commitment of our team and our partners to improve the lives of older adults. We have the potential to transform the way we age in Kentucky and we are excited to be at the forefront of the movement. We look forward to continuing to work together with all our partners to make optimal aging a reality for all.

MEDICAL REVIEW PANELS

Do you know what to do if you receive a proposed complaint from the Cabinet for Health and Family Services?

Kentucky’s newly enacted Medical Review Panel Law is changing the medical malpractice defense landscape, and Sturgill Turner’s healthcare attorneys are here to guide you through this unfamiliar territory. Visit www.sturgillturner.com/MRP or scan the QR code for the latest updates on the Medical Review Panel Law and how it impacts healthcare providers.

WE’VE DONE THIS BEFORE♦ LEXINGTON ♦ STURGILLTURNER.LAW 4 MD-UPDATE

Accounting

Tax Planning Check-Up

BY MATTHEW SMITH, CPA, CFE

As a healthcare professional, you know that a routine annual visit with a doctor is an important part of maintaining a patient’s physical health. Similarly, scheduling an annual review of your tax planning strategies will help keep you in good financial health. With the end of 2017 approaching, here are a few tax planning ideas to consider for 2017 and 2018. Keep in mind that tax planning is very dependent on your specific situation, so we recommend that you consult with your tax advisor before implementing any tax saving ideas.

Individual & Healthcare Because of the time value of money, generally, it is better to accelerate tax deductions and defer taxable income. With tax reform discussions currently in progress, this is even more important. The current proposed reform includes tax rate decreases coupled with the removal of certain tax deductions.

Both items would amplify the importance of pushing income down the road and pulling deductions into the current period.

One of the primary ways to defer taxable income is to participate in some type of employer sponsored retirement plan or contribute to an IRA. In general, these plans enable you to take current year income and treat it as non-taxable for the current year while setting it aside for retirement. The growth of the funds is also tax-deferred. These amounts then become taxable when funds are withdrawn from the accounts. The 2017 maximum amount of your wages that can be set aside for 401(k) plans is $24,000 for those age 50 and older and $18,000 per year for others. The 2018 amounts are $24,500 and $18,500, respectively.

Healthcare is another area where you can save on taxes. Taking advantage of pre-tax health insurance options from an employer allows you to avoid taxation on the portion of your paycheck that goes towards health

insurance premiums. Also, the portion of your premium paid by your employer is tax-free to you. While it is true that medical expenses may be a tax deduction, the vast majority of taxpayers cannot use this tax benefit each year due to the rules and limitations regarding the deduction. One alternative is to utilize a Health Savings Account (HSA) to pay for medical expenses. An HSA must be paired with a high-deductible health plan that meets certain criteria. For 2017, you may fund $3,400 into the account for single coverage or $6,750 for family coverage. These amounts are deducted from your taxable income. If you only use the funds to pay for qualified medical expenses, the distributions are tax-free. For a taxpayer in the 35% federal and 6% KY income tax brackets, converting $5,000 of medical expenses from being paid with posttax dollars to pre-tax dollars is worth $2,050.

Business Business owners have additional tax saving opportunities related to their business activities. There are a wide variety of options when it comes to retirement plans. Depending on the structure and financial activity of the business and the type of retirement plan, up to $54,000 (and $60,000 for those 50 and older) could be contributed (and deducted from taxable income) for the 2017 plan year for the business owner.

The IRS has continued to allow the Section 179 deduction and 50% bonus depreciation as a tax benefit related to certain acquisitions of depreciable property for eligible businesses. Historically, when a business acquires a fixed asset, such as a Magnetic Resonance Imaging (MRI) magnet, that cost is deducted over the life of the asset, such as 5 years. In general, for 2017 the Section 179 deduction allows for the immediate expensing of up to $510,000 of these equipment purchases in the year the items are placed in service. The

50% bonus depreciation deduction allows for the immediate expensing of 50% of any new equipment purchases. The bonus depreciation percentage is scheduled to drop to 40% for the 2018 tax year.

Investments If you have taxable investments, there are numerous considerations. Holding securities for over a year allows the gains to be taxed at long-term capital gains rates, which are significantly less than ordinary income tax rates. If you have short-term capital gains, which will be taxed at ordinary tax rates, consider selling securities that have a loss since even long-term capital losses will offset the short-term gain amounts. Lastly, if you are charitably inclined, consider gifting long-term appreciated stock.

Your charitable contribution deduction will be the market value of the securities, and you will not have to pay any capital gains tax on the appreciation.

Matthew Smith is a CPA, CFE, and the Associate Director of Tax Services with Dean Dorton. He can be reached at msmith@deandorton.com.

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CONTACT gdunn@md-update.com 859.309.0720 ISSUE #111 5

Finance

How to Resolve 2017 and Move On

BY SCOTT NEAL

What’s the first thing that pops into your mind as you look back on 2017? Was it a good year? A bad year? A so-so year? At this writing, the S&P 500 total return is up 17.6% year-todate, the NASDAQ has grown by 26.2%, and NYSE Bitcoin Index is up a whopping 684%.

According to The Economist magazine, U.S. GDP is up 2.2% and some slight inflation is beginning to show up, now at 2.0% for the year. What’s not to like? We hear that managing a healthcare practice finds its way onto the “what not to like” list by many practicing physicians.

The administrative burdens placed on you have become enormous. So much so, that many of you would really like to give up on

the practice of medicine. To that, I have one question. Why did you get into the field in the first place? And then, what stands in your way of achieving that dream today? So, let’s take an honest look at where we are right now and set our sights on making 2018 a really terrific year.

First, the look back. Rather than comparing your portfolio’s performance to Bitcoin and filling your life with “shoulda, woulda, coulda,” wouldn’t it be better to concentrate on what went well? Dan Sullivan of Strategic Coach talks about The Gain and The Gap. While assessing interim progress on our predetermined goals, it is our human tendency to focus our first, and often only, attention

on the space between where we are today and where we had projected ourselves to be, what he calls The Gap. Sullivan cautions against this and instructs that we might be better off to first focus our main attention on the gains that we have made. I know that it is simply a shift in mindset and doesn’t change a thing about where we currently stand, but the mindset change can make a huge difference in how we approach The Gap. Now, I’m not a big fan of New Year’s resolutions. Frankly, most of the time, they don’t work. You know how it goes, you go to your gym in January and can’t even find a parking spot. But, then come February, it’s a different story altogether—the parking lot is

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Finance

half empty. We can find multiple definitions of “resolution.” The usual “act of resolving or determining an action” puts the focus on the future. But, maybe we need to first shine a light on an alternate definition: “The act or process of separating something into constituent parts.” To begin the process of assessment, we must first get resolution on the past, lest we carry it with us into the new year. So, let’s figure out how we do that.

Years ago, the army taught me the benefit of an After-Action Report and how to construct one. 1) State what we wanted to happen. (Your goals were written down, weren’t they?) 2) Acknowledge what did happen.

(Now is not the time for making excuses;

nobody is going to shoot you.) 3) Learn from the experience. (Focus on both what went well and what didn’t.) 4) Adjust behavior based on the learning.

Over the last year, I visited a few times with New York Times best-selling author, Michael Hyatt. In our first meeting, back in January, he outlined eight questions for processing the past year: 1) How did you see your year going? (What were your hopes, dreams, and aspirations for this year?) 2) If this last year were a movie of your life, what would be the genre? (Drama? Tragedy? Romance? Comedy?

Adventure?) 3) What were the two or three specific themes that kept recurring? 4) What did you accomplish this past year that you

THE PAIN TREATMENT CENTER OF THE BLUEGRASS ABOLISHING THE TYRANNY OF PAIN Ballard Wright, MD, PSC MAIN OFFICE:

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PHYSICAL MEDICINE AND REHABILITATION Katherine Ballard, M.D. Lauren Larson, M.D. Steven Ganzel, D.O. Rick A. Pellant, D.O. Zhangliang (John) Ma, M.D. INTERNAL MEDICINE Anand Modadugu, M.D.

FAMILY PRACTICE Laura Hummel, M.D. INDEPENDENT MEDICAL EVALUATIONS Ballard D. Wright, M.D. BEHAVIORAL MEDICINE Narda Shipp, APRN Kellie Dryden, LCSW Marie Simpson, LCSW

PALLIATIVE CARE Christopher Lyon, M.D.

AMBULATORY SURGERY CENTER

PHYSICIAN ASSISTANTS Lois Wright, MBA, PA-C Celeste Christensen, PA-C Shari Pierce, PA-C Jing Ye, PA-C NURSE PRACTITIONERS Becky Moore, APRN Teri Partin, APRN Lynne Shockey, APRN Jeff Eversole, APRN Alanna Smith, APRN Dijana Duval, APRN

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Feelings of dissatisfaction and disappointment are strongest where the chances of corrective action are clearest. are most proud of? 5) What did you feel that you should have been acknowledged for, but weren’t? 6) What disappointments or regrets did you experience this past year? 7) What was missing from this last year as you look back?

8) What were the major life lessons that you learned this past year?

He went on to quote The Opportunity Principle, “Feelings of dissatisfaction and disappointment are strongest where the chances of corrective action are clearest. What if disappointment was just a road sign pointing to an opportunity for personal transformation?”

Having seen a preview, I can recommend Michael’s new book, Your Best Year Ever: A 5 Step Plan for Achieving Your Most Important Goals, which will be out in January, just in time to head off the temptation to simply recite New Year’s resolutions that will soon be forgotten. For years I have said if we simply string together a series of best years yet, we will end up with a well-lived life. The time to get on with moving forward is NOW! I would love to know what goals you have for the coming year. One of mine is to help you achieve them through this column. I am honored to have had many of you tell me you look for my article each month. Happy Holidays!

Scott Neal is the President of D. Scott Neal, Inc., a feeonly financial planning and investment advisory firm with offices in Lexington and Louisville. Find his blog at www. dscottneal.com or write to him at scott@dsneal.com ISSUE #111 7

Legal

2017 Legislation Muddies the Water for Kentucky Physicians and Providers

BY LISA ENGLISH HINKLE

Majority Floor Leader Damon Thayer described Kentucky’s 2017 legislative session as the most productive regular session in modern history. Over a hundred bills addressed healthcare-related issues reflecting the priorities of Republican leadership and its initiative to repeal the Affordable Care Act (Obamacare). While many bills failed to gain traction, several were enacted that require Kentucky physicians and providers to change their practices, but also offer possible protection from lawsuits. The following is a review of some of the most important new legislation resulting from the 2017 session.

Senate Bill 4 – Medical Review Panels This new law creates a mandated buffer between providers and malpractice suits. The intent is for proposed medical malpractice suits to undergo a form of peer review before reaching court. Pretrial medical review panels make qualitative and quantitative assessments about liability and causation, thereby acting as a screen to separate valid claims from frivolous claims.

Kentucky’s legislation and implementing regulation require a pretrial review by a medical review panel, which consists of an attorney, as chairperson, and three healthcare providers. Before a suit for medical malpractice may commence, a medical review panel must convene, take evidence from all named parties, and produce a report to be submitted to the court if the malpractice suit is ultimately filed. Each party chooses a healthcare provider panelist, and then those two panelists select the third. Healthcare providers can only be excused from service on the panel for “good cause,” similar to the cause that must be shown for one to be excused from jury duty. Within nine months, the panel must submit a written opinion addressing whether 8 MD-UPDATE

the healthcare provider acted in a manner consistent with the appropriate standard of care. The medical review panel’s opinion may be used as an expert opinion in litigation, if the plaintiff decides to file suit, and the panel members may be called to testify as witnesses.

It is unclear how this system will affect providers in the long run. Unlike similar programs in other states, Kentucky’s system requires more participation from the healthcare community. At the time of this writing, a legal challenge to the medical review panel statute and regulation is pending before the Franklin Circuit Court in the case of Claycomb v. Cabinet for Health and Family Services. The plaintiffs allege that the new law discriminates against certain classes of litigants and claims by creating an unconstitutional barrier to access to the courts. The case has been submitted to Honorable Phillip Shepherd, but regardless of his decision, the outcome will likely be appealed.

surgery or trauma, or pain associated with a cancer diagnosis, hospice, or other end-of-life treatment. Medical necessity for the medication must comply with the Kentucky Board of Medical Licensure’s standards for prescribing controlled substances and House Bill 1.

The law also clarifies definitions and requirements for the prescription of controlled substances; defines prescribing authority within long-term care facilities; and allows the Cabinet for Health and Family Services Office of Inspector General to investigate patterns of prescribing and report irregularities to appropriate authorities including licensure boards HB 333 took effect on June 29th, the Kentucky Board of Medical Licensure issued a proposed amendment, and public comment on the proposed amendment ended on August 31st, so final regulations should be published soon.

House Bill 333 – The Opioid Bill

Senate Bill 79 – Direct Primary Care (DPC)

To curb the growing epidemic of opioid abuse, the Kentucky Legislature took aim at fentanyl, a powerful synthetic opioid often mixed with heroin, that is experiencing a resurgence of use in the state. The new law creates harsh penalties for trafficking and importation, but it also creates new restrictions for healthcare providers.

Under the new provisions, healthcare practitioners may only prescribe three days of a Schedule II drug to treat pain for an acute medical condition. These drugs include oxycodone, hydrocodone, and, of course, fentanyl, carfentanyl, and fentanyl derivatives.

Exceptions include when the practitioner documents more than a three-day supply is medically necessary; when drugs will be dispensed in-house; or if the medication is prescribed for chronic pain, pain following major

Senate Bill 79 allows patients and physicians to enter into a direct primary care membership agreement to receive and pay for services without forfeiting insurance or Medicaid coverage. The direct primary care model is controversial, and Kentucky’s statute does little except create more ambiguities and murky waters for physicians who offer these services while participating in Medicaid, Medicare and insurance programs. This statute raises many questions as there are significant penalties for physicians who accept cash payments from Medicaid or Medicare patients for covered services. Likewise, most insurance contracts with providers prohibit physicians from billing patients for services that are covered by the insurance contract. As more physicians explore concierge medicine, which has numerous regulatory issues, the

Legal

direct primary care contract may provide a viable option for physicians who opt out of programs. Because Medicaid’s existing regulations effectively prohibit these agreements with Medicaid patients, Medicaid regulations are currently in direct conflict with the new law, so it will likely face legal scrutiny.

Concierge physician services can be a viable way to enhance physician payment and provide prompt access, but many concierge arrangements directly conflict with Medicaid and Medicare statutes and regulations. Senate Bill 79 attempts to address the issues, but it is not a comprehensive fix by any means.

House Bill 314 – KASPER Reporting Changes HB 314 changes KASPER requirements for toxicology reports, requiring hospitals report all positive toxicology screens performed by the hospital’s emergency department. Healthcare practitioners and pharmacists may also now review KASPER data on the birth mothers of infants being treated for neonatal abstinence syndrome or possessing symptoms of neonatal drug exposure. The new law also defines “fair market value” for Medicaid applications as the value set by an appraiser or property valuation administrator or as the price brought at auction.

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Conclusion It’s too early to gauge the impact of these new laws, as several directly conflict with existing statutes, regulations, and federal law, creating ambiguities and complexities for physicians and other healthcare providers. Medical review panels, in particular, are designed to stymie malpractice suits, and may prove effective in weeding out frivolous claims; However, the Plaintiff Bar is already concerned enough about the constitutionality of the statute that most plaintiff attorneys are filing lawsuits in addition to requesting medical panel review to prevent any statute of limitations problems that may arise if the statute is declared unconstitutional. This statute may ultimately provide some protection for physicians, but we won’t know until the courts rule upon the constitutionality issues.

Due to the legislative changes, prescribing medication has definitely become more complicated. HB 333 adds even more new restrictions to already tightly-controlled prescribing practices for Kentucky physicians, nurse practitioners, and physician assistants. Changes in classification by schedule of medication complicate Kentucky providers’ prescribing practices and require strict attention to avoid classification as a pain treatment center. With all the new legislative and regulatory changes, physicians and all providers must carefully review their prescribing practices to assure compliance with new state laws.

Thinking clearly. Caring deeply.

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

F E E - O N LY F I N A N C I A L P L A N N I N G L E X I N G T O N | L O U I S V I L L E | C I N C I N N AT I

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

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ISSUE #111 9

Cover Story

Changing the Paradigm on Pain Management

As a progressive pain clinic, Commonwealth Pain & Spine is taking a multimodal, team-based approach and altering the public’s misconceptions regarding traditional pain medicine

BY DONNA ISON LOUISVILLE In recent days, everyone seems

to have developed a strong response to the words “pain management.” The topic is being discussed on the nightly news, in congress, at the dinner table, and throughout the medical community. Misconceptions abound. But, with its unique approach, Commonwealth Pain & Spine (CP&S) is serving as an example of what a successful pain management clinic can accomplish and leading efforts to improve the lives of the patients they serve.

Founded in 2013 by Kyle Young, MD, and Jason Lewis, MD, CP&S has already assembled an impressive roster of nine “best-in-class” physicians located throughout Kentucky and Indiana. The founding partners represent a new breed of young physician entering the field of medicine. After graduating with a BS in microbiology from the University of Georgia, Young obtained his MD from the Medical College of Georgia and completed a residency in anesthesiology and fellowship in pain management at the University of Louisville (U of L). Lewis earned his Doctor of Medicine, completed a general surgery internship, anesthesia residency, and pain medicine fellowship at U of L, as well as a sports medicine fellowship at the University of Vermont.

In describing CP&S, Lewis says, “We are a comprehensive pain management clinic. We 10 MD-UPDATE

don’t just write prescriptions. We don’t just give injections. We do everything, and it is specifically tailored to each patient and their history and problem.”

James Jackson, MD, a partner with CP&S elaborates, “We provide a comprehensive pain clinic that focuses on patient-centered therapies. A lot of times patients go to pain clinics and they’re treated poorly, either because they require narcotic pain medication, or they’re labeled before they come in the door. That is what sets us apart from everybody. Every patient is treated as if they’re a human being.”

Jackson shares a common background with Lewis, Young, and others on the staff. He earned his medical degree, completed his residency and fellowship training, and served as an assistant professor in the Department of Anesthesiology at U of L. Nicolaus Winters, MD, who is also a partner in the practice, goes on to add, “We don’t form generalized plans that fit every patient.

We try to come up with a plan that’s individual.” Winters received his medical degree and completed his residency in anesthesiology at U of L as well, and went on to a pain management fellowship at the University of Alabama-Birmingham. He primarily practices in Evansville, Indiana and Owensboro, Kentucky.

Each of these four like-minded physicians had similar reasons for being drawn to the field of anesthesiology, primarily because it is

procedure-oriented and requires strong core medical competencies. Like the four mentioned here, all of Commonwealth’s physicians are fellowship trained and accredited in both anesthesiology and pain management. Many hold both Kentucky and Indiana licenses, including those featured in this article.

Their respective reasons for entering pain management all converge with one common goal—improving the lives of individuals by reducing their pain. Jackson states, “I’m going to make this very simple. Taking away pain.

Because sometimes these people are at their

In 2013, Kyle Young, MD, and Jason Lewis, MD, founded Commonwealth Pain & Spine, which takes a progressive, multimodal approach to pain management.

last resort. They’ve had surgery and they’ve had this and that therapy and nothing is working. So, to be able to make a difference when there is almost no hope is probably the most rewarding thing that I do.”

Offering Alternatives to Narcotics As a comprehensive pain management clinic, CP&S deals with a broad spectrum of chronic pain conditions encompassing everything from arthritis to complex regional pain syndrome (CRPS), but 90% of people

they manage come in with a chief complaint of head, neck, or back pain. “Chronic pain management in the United States is primarily low back pain and neck pain,” states Young.

In order to meet the diverse needs of their patient population, CP&S offers a wide range of treatments, including several traditional pain therapies such as occipital and intercostal nerve blocks and epidural steroid injections, to more cutting edge and complex options like Botox for chronic migraine relief, lumbar discography, and vertebroplasty. One of the newest offerings is regenerative medicine, PHOTO BY ROB DENSMORE

which Young describes as “taking a patient’s own stem cells through a bone marrow biopsy or harvest and injecting them into degenerating structures, usually joints, but also discs in their spine.“ In 2017, Lewis and Young started the region’s first institute committed to the advancement of regenerative therapies, PRIMed, headquartered in Louisville. Clinical trials for alpha-2-macroglobulin (A2M) injections, amniotic fluid injections and stem cell therapy have been producing exceptional results and are exciting new options for pain sufferers.

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“In the past, physicians were known for ramping up opioids and throwing narcotics at the pain instead of taking a comprehensive approach. We’re comprehensive, so we do everything from medication management to implantable devices.” — Nicolaus Winters, MD One of the most promising treatments they offer is neuromodulation. “Neuromodulation is the generic term for stimulating strategic targets in the nervous system to control or change the way a patient feels pain,” Young explains. There are two primary applications of neuromodulation, both of which deliver electrical currents to interrupt pain signals. They include spinal cord stimulation and deep root ganglion stimulation (DRGS), which have the unique capability of focusing in on more specific parts of the body.

DRGS is proving especially effective in treating CRPS, which is one of the most challenging presentations encountered in pain management. According to the Mayo Clinic’s website, complex regional pain syndrome is an uncommon form of chronic pain that typically develops after an injury, surgery, stroke, or heart attack and causes pain that is far out of proportion to the severity of the initial injury.

On the use of neuromodulation in addressing CRPS, Winters states, “It’s one of the few things that is revolutionary in pain management. This is one of those types of procedures that can give somebody significant quality of life improvement, besides just giving them good pain relief.” He has also found it to be highly effective in treating diabetic neuropathy.

The physicians at CP&S are well aware of the misconceptions around and stigmas attached to pain medicine. When prescribing opioids, the entire healthcare system has had to reassess the need and reformulate their approach. “Fifteen years ago, the thought was that opioids are safe. That opioids are effective, and can continually be increased with no consequences. That recently has been shown to not be the correct thought. But no research was done until the last ten years,” Winters says.

Winters goes on to state, “In the past, physicians were known for ramping up opioids and 12 MD-UPDATE

throwing narcotics at the pain instead of taking a comprehensive approach. We’re comprehensive, so we do everything from traditional medication management to implantable devices. But, I think we’ve always been ahead of the trend with opioid management and doing it responsibly. A lot of practitioners are still prescribing high dose opioids and that has shown to be very bad and very high risk for patients.”

Jackson elaborates, “From the general public’s perspective, you mention pain management and the first thing they think of is a pill mill with a pill-pushing physician, and that is the biggest misconception.”

Luckily, recent investigation and legislation has led to positive change. “Legitimate physicians who have done the training and done the fellowships and taken the tests … at the end of the day, they are the ones left standing and doing the right thing for the community,” says Lewis. “In the grand scheme of things, we are conservative about what we do. We are comprehensive and multimodal. We use other options than just writing prescriptions.”

As a partner with CP&S who holds medical licenses in both Kentucky and Indiana, Nicolaus Winters, MD, practice includes both Evansville, Indiana and Owensboro, Kentucky.

Education and Communication are Key When it comes to altering these attitudes, all agree education and communication are key. Young acknowledges, “It’s a little ironic, but physicians don’t always communicate well with other physicians. So, we go out of our way to forge relationships with the primary care physicians and surgeons in the community.” Each member of the practice stresses the importance of establishing and maintaining relationships with other providers, so they keep the lines of communication open by having face to face meetings and exchanging cell phone numbers.

Ultimately, it is about the patient. “It’s good for everybody involved, especially the PHOTOS PROVIDED BY COMMONWEALTH PAIN & SPINE

Partner James Jackson, MD, describes CP&S as “a comprehensive pain clinic that focuses on patient-centered therapies.”

patients. The patients love it when you can say, ‘Hold on just a second. Let me call your surgeon and ask him a question.’ I think it makes them feel reassured that the ball is not being dropped and that all of their physicians are on the same page when it comes to their treatment,” Young says.

Winters states, “What makes our clinic different is that the people we hire, from the front desk to the doctors, have a compassionate attitude and want to see the patients do

Cover Story

The staff at CP&S is dedicated to patient respect, collaboration, and accessibility. (l-r) Rita Tonini, MSN, FNP-BC, CGRN, April Nodine, PA.C, Johnna Shown, APRN, Barbara Lemmons, APRN.

well.” The entire staff at CP&S is dedicated to making every aspect of the patient’s experience positive, from their initial phone call to their first encounter with a CP&S physician.

Earlier this year, CP&S began posting a guarantee in their waiting rooms for patients to see. They call this “Our Pledge to the Patients

We Serve” and it includes a vow to respect each patient’s personal struggle with chronic pain, a promise to collaborate with the patient to help them get the best outcomes, and guaranteed accessibility.

These efforts are paying off. According to Young, “We are helping to change the paraPHOTO BY ROB DENSMORE

digm of chronic pain management. We’re starting to change attitudes within the communities where we practice.” Lewis concludes with, “Respect, trust, and communication are our core values. If you stick close to those things, genuinely try to help people, and do the right thing, everything else will fall into place.”

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The University of Louisville Depression Center Does It the Wright Way

Jesse Wright, MD, PhD, founding director of the UofL Depression Center

BY GIL DUNN LOUISVILLE For over 25 years, Jesse Wright,

MD, PhD, has committed the main body of his work and research to treating and researching depression. Always on the forefront, he is now using computer-supported technology creating a multi-media psychotherapy approach to help doctors treat depression.

Ten years ago, Wright was the founding director of The University of Louisville (U of L) Depression Center. The mission of the Center is to serve as the major regional resource for the treatment of depression and bipolar disorder research and education. He was an early adopter in a nationwide movement. There are now 26 depression centers throughout the United States, “All in university settings such as Stanford, Hopkins, Iowa, 14 MD-UPDATE

Michigan and Cincinnati,” says Wright.

Wright received his undergraduate degree from Juniata College in Huntingdon, Pa. and obtained his medical degree at Jefferson Medical College, Philadelphia. He completed his psychiatry residency training at the University of Michigan where he was chief resident and received his board certification in psychiatry in 1975. Dr. Wright earned his PhD from the U of L in 1986. Wright was the founding president of the Academy of Cognitive Therapy and the president of the Kentucky Psychiatric Association.

Wright has authored eight books on the subject of mental health and depression. The most recent is Learning Cognitive Behavioral Therapy; Breaking Free from Depression, 2nd edition. Wright says his current work is “in primary care, creating a system for delivering PHOTO BY GIL DUNN

cognitive behavior therapy (CBT) for primary care physicians to use throughout the state of Kentucky.”

Wright’s NIH Supported Research with Online Therapy Patients, who are referred to Wright’s research program by their primary care physician for depression, are able to work on their own, using a CBT online worksite which is enhanced by a weekly 20 to 30 minute computer-supported consultation with a trained therapist or “coach.” The patient accesses the CBT program by their laptop, tablet, or any computer, but not their cell phone.

Wright explains, “I was concerned that someone might be in the middle of their CBT session on their phone and get a little ‘ping’ that told them they had a message. It takes a

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concentrated effort for CBT to be effective.”

Some mobile phone apps for relaxation can assist in the success of CBT, but Wright emphasizes that uninterrupted sessions may be needed for effectiveness.

Success has been measured by NIHsupported studies including two randomized controlled trials in which the computer-supported groups did just as well as standard in-person therapy. The great advantages, says

Wright, are that “The computer-supported CBT can improve access to effective treatment, provide interactive learning experiences not found in standard treatment, and save a great deal of time and money.”

The goal of computer-supported care, says Wright, is “not to replace therapists but to help clinicians treat more people with available time, while enhancing the therapy experience.”

It's All In Your Head

Evidence Based Treatment that Works According to Wright, over the years there has been much research on both psychotherapy and pharmacotherapy to treat depression and anxiety. Some of them work better than others, but “CBT is the most heavily researched and has been proven to work through over 400 randomized clinical trials.”

Women are more likely to exhibit depression than men, says Wright. “Initially this was thought to be a recording bias, but the data shows it is based on actual findings of fact, about 2/3 to 1/3, women to men. Depression can be seen across the life-span, in its earliest stages in pre-teens, all the way through the adult and senior population. One out of 5 people have symptoms of depression. But only 50% seek treatment, and a minority have access to CBT.” Suicide rates among the senior population are on the rise, and there’s “even a bump in the suicide rate among the middle age population,” says Wright. “We’re not yet sure why that is happening. One of the special features of CBT is that it has been shown to dramatically reduce suicide attempts.” Thus, Wright tries to employ CBT with all of his patients with suicidal thoughts.

Comprehensive Treatment Treatment options for depression have advanced dramatically in recent years, says Wright, pointing to the use of computers to bring specialized care to a wider portion of the patient population, availability of newer more tolerable medications, development of evidence-based psychotherapies, and transcranial magnetic stimulation (a series of magnet induced stimuli of brain areas involved in depression). His message to primary care doctors is that a combined approach of medication or other biological treatments plus effective psychotherapy offers the best hope for severe depression. His book for the general public, Breaking Free from Depression: Pathways to Wellness details elements of a comprehensive approach to depression. “There are so many more things we can do now than we could before” says Wright.

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Improved Technology Means Improved Quality of Life for Parkinson’s Patients Refined Deep Brain Stimulation technology is now being offered at U of L Jewish Hospital

BY: DONNA ISON LOUISVILLE When tremors progress to a certain degree, they can severely reduce the quality of life of the individuals who suffer from them, making everyday activities like dining out, writing a thank you note, getting dressed, or even playing a game of cards nearly impossible.

“It was affecting me in eating, in writing, and in speech. The medicine was not allowing me to control the symptoms anymore,” explained Kathleen Prezocki. “Trying to put a necklace on and trying to get that hook in there – my goodness that was frustrating!”

But now, thanks to the St. Jude Medical Infinity™ Deep Brain Stimulation (DBS) system, there is an effective alternative solution. DBS, which delivers electrical impulses to the brain, similarly to a pacemaker delivering impulses to the heart, has been used to control tremors for 20 years. But, the St. Jude system, which was recently approved by the US Food and Drug Administration (FDA) for patients with Parkinson’s disease and essential tremor, features a directional lead which customizes the therapy for each patient. This precise customization reduces side effects while maximizing outcomes for patients. In addition, the precise control of the direction of the electrical stimulation reduced strain on the battery, resulting in longer battery life. It also employs a user-friendly iPod Touch controller, which is familiar for patients.

Of the device, neurosurgeon Joseph Neimat, MD, says, “This therapy can make a dramatic difference in a patient’s quality of life, particularly if they like to write, to play piano, to eat soup. And even though it is brain surgery, it’s a relatively low-risk surgery.” Neimat, who has implanted several hundred DBS devices, is the chair of the U of L Department of Neurological Surgery Prior to coming to U of L, Neimat served 16 MD-UPDATE

Neurosurgeon Joseph Neimat, MD consults with Kathleen Prezocki, the first patient in the region to receive the St. Jude Medical Infinity™ Deep Brain Stimulation system.

as medical director of inpatient neurosurgery and neurosurgery operating rooms at Vanderbilt University in Nashville, Tenn.

He also was chief of neurosurgery for Tennessee Valley Health Care of the Veterans Administration and held joint appointments with Vanderbilt’s Center for Integrative & Cognitive Neuroscience, Psychiatric Neuroimaging Program, and Department of Psychology.

Neimat earned his BA at Dartmouth, double majoring in music and biochemistry, then went on to earn a master’s in neurobiology and a medical degree from Duke University. He then completed his residency PHOTO PROVIDED BY U OF L

at Massachusetts General Hospital in Boston and a fellowship in functional neurosurgery at the University of Toronto. He is board certified in neurological surgery.

Upon learning about the new and improved DBS device, Prezocki opted to become the first patient in the region to receive the St. Jude device to control tremor in her right hand.

Neimat provided the implant for Prezocki at Jewish Hospital, part of KentuckyOne Health. Prezocki has seen major improvements since activating the device. “I can write again!” she stated. She has also been able to stop taking tremor medications and play bridge without a card-holder.

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Small Town Services Get Big City Upgrade Todd Shanks, MD, brings top-notch, multidisciplinary neurosurgical services to the fast-growing population of Bowling Green graphics, and Bowling Green is the fastest growing city in the state BOWLING GREEN Access. Access. of Kentucky over the past seven Access. It’s been the rallying cry years. In the past four years, it for years in healthcare reform. In demonstrated a 25 percent growth, Kentucky, and nationally, public and it’s projected to grow 25 to health officials and primary care 30 percent over next four to five physicians, as well as some speyears,” he says. cialists, have worked to bridge the Shanks received his medical access gap for more rural popdegree from the University of ulations. But what about highly Louisville (U of L). He performed specialized services? Traditionally, his residency at Louisiana State cutting-edge technology, groundUniversity in New Orleans and breaking research, or simply completed his training at U of L life-saving treatments for less comafter Hurricane Katrina. Shanks mon conditions have only been is fellowship trained in funcavailable at academic medical centional stereotactic neurosurgery, ters in the largest cities. At most, which he completed at Vanderbilt specialists would spend one day a University. He is still currentmonth at satellite clinics in rural ly actively engaged in collaboraareas of the state. tive research projects with both It is rare that a multi-fellowship Dr. Todd Shanks is a fellowship trained neurosurgeons with Western Kentucky the University of Louisville and trained physician would actually Orthopaedic and Neurosurgical Associates, part of the Graves Gilbert Clinic in Vanderbilt University. relocate to a smaller city to start a Bowling Green, Ky. Functional neurosurgery deals program in something as specialwith the treatment of movement ized as neurosurgery. But, that is just what in 1937 and serving a 10-county area. Today disorders, including deep brain stimulation, Todd Shanks, MD, has done. After nearly a the group comprises 170 physicians and over as well as epilepsy, cancer pain, and cradecade of practicing in Louisville, Shanks left 30 specialties. niofacial pain syndromes. However, outside metropolitan life to join Western Kentucky For Shanks, WKONA and its affiliation of academic medical centers, the volume Orthopaedic & Neurosurgical Associates with Graves Gilbert not only offered the for functional neurosurgery is typically not (WKONA), a part of the Graves Gilbert autonomy of a progressive model but was a enough to sustain a practice, so the majorClinic in Bowling Green. chance to build a top-notch program impact- ity of Shanks’ practice is made up of brain While Shanks enjoyed his work in Louisville, ing a large percentage of the population and spine tumors, as well as degenerative he says, “My personal vision is that I like a little in Western Kentucky. “I was recruited to spine diseases. While at Norton Hospital, he more autonomy in the world I’m in, and the Bowling Green with the plan to develop a helped develop the multidisciplinary moveability to control my direction. What was hap- neurosurgical service line which offered more ment disorder team as well as collaborative pening in Bowling Green, Kentucky, is what I than what had been traditionally present here. efforts in epilepsy and brain and spine tumor. saw the future becoming, which is large multi- It was the feeling of WKONA and Graves He was also the director of the surgical movedisciplinary physician groups developing.”

Gilbert Clinic that this was one of the areas ment disorder program and co-director of the Graves Gilbert Clinic is a multispecialty of medicine which needed further develop- craniofacial headache program with Brian physician group in Bowling Green, founded ment in this region. I looked at the demo- Plato, MD.

BY JENNIFER S. NEWTON

PHOTO BY ANDREW STURGILL

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I came down here to start this in Bowling Green because it was [WKONA’s] feeling that the caliber of neurosurgery had not been where it should be for a city of this magnitude. I looked at the demographics, and Bowling Green is the fastest growing city in the state of Kentucky over the past seven years. — Dr. Todd Shanks Collaboration is Key Within WKONA, Shanks is creating multidisciplinary service lines to meet the varying needs of patients. “We’re developing a brain and spine institute. What we have in spine is a compilation of physicians who do spine, who work together. When we have complex patients, we review and we conference them.

We discuss current trends and what the latest data supports to do. We follow our outcomes,” he says.

The multidisciplinary team includes a

full-service pain management division through Interventional Pain Specialists (IPS) and comprehensive physical therapy services through ProRehab, both offered on-site. WKONA is also recruiting physical medicine and rehab physicians to the team.

In the field of movement disorders, Shanks has been instrumental in developing a movement disorder team with the recruitment of Amelia Mooney, PhD, a clinical neuropsychologist, from the University of Kentucky and Emme Igbokwe, MD. The team includes a physical therapy service line for different movement disorder pathologies.

In collaboration with Vanderbilt University, Shanks is exploring areas where the two programs intersect and can conference movement disorder patients and share in the same data pool. Through that partnership, he has three or four movement disorder patients scheduled for DBS for the first time ever in Bowling Green.

Future plans are in the works for a craniofacial headache center, which is in the planning stages in cooperation with pain specialists and neurologists. Shanks is one of just a few neurosurgeons in the state fellowship trained to treat craniofacial pain.

The Team Drives the Tools Shanks emphasizes that the multidisciplinary team shapes the way advances in technology are being utilized to identify the most appropriate treatment for patients, whether that is surgery or not. Brain tumors located next to critical structures pose complex

• Practice Management and Advisory Services

• Accounting and Financial Outsourcing

• Medical Billing and Credentialing

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• Human Resources

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• Technology

859.255.2341 deandortonhealthcaresolutions.com 18 MD-UPDATE

challenges. He uses Brainlab navigation for real-time imaging and improved accuracy.

“We use a compilation of techniques, including advanced intraoperative navigation and brain mapping to safely remove lesions. This is critical when lesions are close to eloquent structures and fiber tracts which can lead to unwanted deficits, if injured.”

Coming is the Medtronic Visualase® system, which Shanks describes as a “tissue laser ablation system for deep seeded intracranial lesion.” While radiofrequency ablation is not new, previous iterations lacked the ability to identify the size of the lesion or how different tissues respond to heat fields. With Visualase, surgeons use intraoperative CT to place a lead in the brain in the operating room. “Then we take the patient to the MRI scanner and do thermal ablation under MR imaging so we can actually destroy the lesion in real time, knowing how much we are doing.”

For spinal surgery, the O-arm™ Intraoperative Imaging System uses CT imaging with navigation in real time to see where screws are placed, thereby decreasing surgical time, increasing accuracy, and causing much less disruption to the spine’s supporting tissues.

All of the technology and the team approach have one thing in common – “to cut down the inadvertent loops people go around to get appropriate therapy,” says Shanks.

“The biggest thing is not understanding what you can do, but understanding what you can do appropriately and with high quality,” he concludes.

Empowering physicians to focus solely on the demands of their clinical practice

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Enhanced Competence Leads to Enhanced Care Through the National Curriculum Initiative in Developmental Medicine, Priya Chandan, MD, MPH, is providing medical students much-needed education about and exposure to people with intellectual/developmental disabilities.

BY TANZI MERRITT LOUISVILLE Growing up, Priya Chandan, MD,

MPH, watched her older brother, who has Down syndrome, navigate the world and witnessed the challenges he faced. This experience set her on a path to a career in developmental medicine. Chandan is committed to improving healthcare for individuals with intellectual and developmental disabilities (IDD) by addressing one of the root problems: discomfort in the medical community that stems directly from a lack of clinical provider training. Chandan received a grant from the American Academy of Developmental Medicine and Dentistry and Special Olympics International as part of the National Curriculum Initiative in Developmental Medicine (NCIDM), whose mission is to bring IDD-focused curricula to medical schools.

Chandan, a physician-scientist, is an assistant professor at the University of Louisville.

There she holds a joint appointment in the Department of Health Management & Systems Sciences in the School of Public Health and Information Sciences and in the Division of Physical Medicine & Rehabilitation in the Department of Neurological Surgery.

Throughout her career, Chandan had noticed how, due to medical advances, the lifespans of those with IDD had greatly increased, but knowledge among clinicians about how to interact with adults with IDD had not kept pace. “Intellectual and developmental disabilities were once considered pediatric conditions, so most providers did not get any training in this area, and we have a growing adult population that providers aren’t comfortable with,” says Chandan. “Research has shown that a lack

Priya Chandan, MD, of the University of Louisville, is expanding medical education through the National Curriculum Initiative in Developmental Medicine.

“The goal is to provide training in the field of developmental medicine, which includes the care of individuals with IDD across their lifespan. Training all providers is important because these patients will be patients in every area of the healthcare system.”

— Priya Chandan MD, MPH of competence makes providers hesitant to provide care for these individuals.”

Chandan envisioned a simple fix—better training. Better training for medical students and clinicians would lead to better care for adults with IDD, and the natural place PHOTO PROVIDED BY U OF L

for her to start was with Special Olympics International.

“Because of personal experience with my brother, I’ve always been interested in developmental medicine, but my first experience working in this field was during an internship with Special Olympics International (SOI),” says Chandan. During this internship, she had the opportunity to work alongside SOI Healthy Athletes staff, who direct programs that offer free health services and health information to Special Olympics athletes.

Early on, SOI saw the value in expanded training for clinicians, and a partnership was established with the American Academy of Developmental Medicine and Dentistry (AADMD), and the National Curriculum Initiative in Developmental Medicine (NCIDM). Funding was secured to establish the first cohort of Medical School Partners, which includes the University of Louisville, Baylor University, and the University of Colorado. The program plans to expand to four cohorts and 12 medical schools.

The premise of NCIDM is simple. Chandan explains, “The goal is to provide training in the field of developmental medicine, which includes the care of individuals with IDD across their lifespans. Training all providers is important because these patients will be patients in every area of the healthcare system.”

Inclusive health encompasses policies, services, and all aspects of medical practice.

One aspect of the program is an ambulatory elective for fourth year medical students, offering a new rotation experience at Lee Specialty Clinic. “The students who have participated are planning to go into a variety of medical fields, but they all understand the growing need for familiarity with this population,” she ISSUE #111 19

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says. The elective has been successful and has introduced an ever-increasing number of medical students to the care of adults with IDD. A second aspect of the program is an innovative approach for interdisciplinary clinical conference sessions with second year medical students. Medical school faculty had first envisioned adults with IDD speaking directly to students, but realized that for many with IDD, the idea of speaking in front of a group was intimidating. Chandan and her collaborators were aware of the value of this information to the students, but were cognizant of barriers the format presented, so they developed a Photovoice program to bridge the gap.

In the Photovoice program, athlete-leaders who are participants in Special Olympics Kentucky were asked some key questions, such as what advice they have for medical students.

The answers to these questions were illustrated with related photographs. The final product is a package of information with pictures, quota-

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“Even though you may need the caregiver at times, it’s crucial to talk directly to the patient. They may need some support from a caregiver, but you need to address the patient first.”

— Priya Chandan, MD, MPH tions, and scenarios that can be used as an aid in conversations between adults with IDD and medical students, arming the athlete-leaders with a guide that empowers them to lead conversations with students on their own.

Chandan’s work also led her to the role of clinical director of MedFest, an event created

by Special Olympics of Kentucky in 2005.

During MedFest, both residents and practicing clinicians are recruited to provide free sports screening physicals to Special Olympics athletes. At MedFest, residents have a unique opportunity to “...gain experience working with these individuals in a non-acute setting.

They are getting to know them as people and learning communication strategies to use when working with them in clinical settings.”

Though Chandan’s career has revolved around inclusive health, she realizes very few providers have had any training or the opportunity to gain skills in this area. For all clinicians, her advice is to listen to the patient with IDD, talk to them as an adult, include them in their treatment plan, and give them the same respect you would any other patient.

Says Chandan, “Even though you may need the caregiver at times, it’s crucial to talk directly to the patient. The patient may need some support from a caregiver, but you need to address the patient first.”

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No Pain? Big Gain!

Kristal Wilson, MD, and the staff at Baptist Health Medical Group Pain Management are Hitting Pain Where It Hurts

BY JIM KELSEY LOUISVILLE “Where does it hurt?” That’s the

common question asked of someone in pain.

Medical professionals naturally follow up with “Why does it hurt?” and “Is there a way to fix the problem?” But what about when the problem can’t be fixed? What about chronic pain that the patient must live with?

In the past, the specific questions about where and why it hurts have been treated with generalized pain medication. But opioids are quickly giving way to pain management that is as targeted and specific as the location of the pain itself.

That, says Kristal Wilson, MD, is the primary message she wants to share with the rest of the medical community.

“Pain medicine, in general, has a very bad misperception,” Wilson says. “When someone thinks about pain management, they think of a pain clinic that just passes out opioid medication. Government restrictions over the last five years have cut back on pill mills, but the misconception that all we do is opioid therapy remains.”

Wilson, who practices at Baptist Health Medical Group (BHMG) Pain Management in Louisville, graduated from the University of Louisville School of Medicine. She became interested in pain management during the anesthesia portion of her residency.

“There was a lot of need in the community that I saw,” Wilson says. “Cancer pain, chronic pain, people needing help. That really drove me toward trying to help with pain management.

Wilson describes the scope of the BHMG Pain Management practice as “anything from head pain to toe pain.” They treat both acute and chronic pain with the average age of the patients presenting being 70 years old. Large joint pain and migraines are also common presentations among patients both young and old.

Dr. Kristal Wilson is employing new pain management treatments at BHMG Pain Management in Louisville.

Wilson works closely with the primary care physicians, as well as relevant specialists, to help identify the source of the pain and plan any available solutions, such as surgery. The most common surgical referrals are to neurosurgeons for back and neck pain or orthopedists for large joint pain, such as shoulders, knees and hips.

But the specialist Wilson most often refers her patients to has nothing to do with surgery or a physical solution.

The Psychological Component of Pain “The number one referral overall is to psychology,” she says. “Almost every patient with chronic pain has some type of psychological component. We refer almost every patient who comes through with chronic pain to a pain psychologist.”

Pain psychology helps patients stay away from unhelpful thoughts about their pain or develop techniques to distract themselves from their pain. Relaxation techniques, building coping skills, and addressing anxiety or depression are all part of a pain psychologist’s approach.

PHOTO PROVIDED BY BAPTIST HEALTH LOUISVILLE

Wilson’s approach depends on the source and location of the pain, but increasingly she turns to solutions other than opioids.

“The misconception that we’re all about medication is false,” she says. “We take a multimodal approach and treat the patient, not just the patient’s complaint. We do interventional treatment to target the pain generators and more precisely deliver the therapies.

Whether it be a steroid injection into the epidural space or joint, or a Botox injection for migraines, we’re actually treating the source of the pain rather than leaning on medication.”

Wilson points to Botox as prime example of a better solution than opioids for patients suffering from migraines.

“It’s not that Botox is brand new, but it’s becoming more acceptable and gaining in popularity as a treatment for migraines,” Wilson says, noting that opioids have proven ineffective for migraines. Botox has a strong track record of success and comes with few, if any, side effects.

However, opioids remain a big part of Wilson’s daily practice. One, because they are still useful in some situations. Secondly, because many of her patients have been relying on them for decades. Patients who have been on opioid therapy for years develop a high tolerance and are on very high doses, leading to the side effects of misuse and abuse.

Convincing these individuals that there are better options is often met with resistance. “Trying to show the patient that opioid therapy is not the best for them after they have been on it for 20 years is very challenging,” Wilson says.

Better Options than Opioids Among the treatments that are often better solutions than opioids are spinal cord stimulation, nerve blocks, and injections. Spinal cord stimulation involves the placement of stimulating leads into the epidural space. New technology has enabled physicians not only to be more ISSUE #111 21

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“Almost every patient with chronic pain has some type of psychological component. We refer almost every patient who comes through with chronic pain to a pain psychologist.”

— Kristal Wilson, MD precise in the placement of the leads, but also to adjust the wave lengths and frequency.

Precision is also the driving force behind a new type of knee injection that Wilson says is a vast improvement over the more commonly administered steroid.

“In many cases, intra-articular joint steroid injections aren’t effective,” she says. “We offer a genicular nerve block. The genicular nerve is one of the main nerves that supplies the knee.

22 MD-UPDATE

We go in and block the nerve and see if the patient receives any pain relief. If they do, it is diagnostically positive that the source of their pain is coming from that nerve.”

Once the nerve is confirmed as the source of the pain, Wilson can perform a radiofrequency ablation, which involves applying thermal heat to the nerve. That heat causes the nerve to scar over and results in pain relief of six months to a year. “You can actually do that procedure on many nerves throughout the body, with arthritic back pain being the most common indication,” Wilson says.

Wilson notes that the impact of these procedures can be life-changing. For instance, some patients who need knee replacements can’t get them because they are overweight.

Their knee pain prevents them from exercising. The genicular nerve block can treat the pain, allow them to exercise and lose weight, and subsequently get the knee replacement.

“I really like my job when somebody gets

improvement in their quality of life,” Wilson says. “I have patients tell me that I gave them their life back. That’s why you become a doctor.”

BAPTIST HEALTH CENTER FOR PAIN CONTROL 2400 Eastpoint Parkway Suite 410 Louisville, KY 40223 For appointments or referrals, call

502.253.6625

Mental Wellness

Journaling Away the Holiday Blues

BY JAN ANDERSON, PSYD, LPPC

It may sound strange, but the best part of showing up for the Eleventh Annual University of Louisville (U of L) Depression Center Conference wasn’t the continuing education credits. I was invigorated and inspired by the day-long program focused on the treatment of depression and other mood disorders, including approaches to help families deal with a suicide attempt.

Still, as I found myself confessing to Jesse Wright, MD, PhD, director of the U of L Depression Center, I felt like I was going to the dark side. I admitted, “In a few weeks, those of in us in the helping professions will gear up for what I’ve come to think of as ‘selective negative focus’ on the holiday season. How long have we been focusing on ‘surviving the holidays’?

Twenty, thirty years? I wonder if it’s actually helping. Could we possibly be making it worse by priming ourselves to expect ‘It’s going to be really bad,’ like a self-fulfilling prophecy?”

Fortunately, what I feared didn’t happen.

Jesse, the author of Getting Your Life Back: The Complete Guide to Recovery from Depression, which was chosen by Self Magazine as one of the eight best self-help books, didn’t judge me as dismissive or insensitive to those whose depression is exacerbated during the holidays.

I realize that the “ain’t it awful” mentality is just a natural reaction to the other extreme of “perfection focus” — the notion that an acceptable holiday can’t be “perfectly okay” unless it’s truly perfect.

So, if both of these extreme mindsets are inaccurate, unrealistic, and a setup for a letdown, what’s the solution?

Integrating opposites creates balance and harmony, but it’s trickier. It’s inherently more complicated, more interesting, more fun (paradoxically), and not as hard as you might think.

So, let’s get started. Here are two opposite approaches to emotional regulation. They work best when you give yourself permission to freely draw on either or both.

see what you just wrote, not even you.

• Do not reread these pages or allow anyone else to read them.

• Destroy them immediately after writing them.

Let It All Hang Out Sometimes, you must clear out the negative, so the positive can get in.

A simple, discreet way to discharge negative emotions, so you don’t have to haul them around all day or inflict them on others, is a writing exercise. This one, I adapted from Charles Pennebaker’s research on journaling as therapy in conjunction with a writing technique by author Julia Cameron, which she calls Morning Pages: • Write three pages of longhand, stream-of-consciousness writing • Write whatever comes to mind, right off the top of your head, without any concern for grammar, reader interest, or good writing skills — because no one will

The complete privacy of your writing will help release your inhibitions, so you can process without judgment whatever thoughts or feelings come up. Don’t edit anything out no matter how silly, shameful, or insecure.

I think of this as a practical, applied form of meditation—a mindful writing meditation, if you will. But that term sounds too nice and therefore inhibiting, so I prefer to call it the Morning Core Dump.

The Morning Core Dump corrects the misperception many people have that meditation means “think only positive thoughts.”

The point of mindfulness isn’t an obsessive avoidance of negative emotions or an obsessive pursuit of happiness, it’s about emotional balance and equanimity. Loosely translated, that means “comfort and joy.”

This paradox is highlighted in a recent study by Amanda Shallcross at the University of Denver. She and her colleagues found that an acceptance, “allowingness,” and curiosity toward negative thoughts and feelings may help people reduce their feelings of depression or stress.

One of the things I like most about Morning Core Dump is that it creates a “container” to process your thoughts and feelings in private.

It can also help you emotionally regulate and prepare yourself for interactions with others.

For guidance on how to handle an anticipated conversation, see my article Learning from our Worst Conversations in issues #109 and #110 of MD-Update and at my website blog at www.DrJanAnderson.com.

What’s the Big Deal About Gratitude?

Psychologist Martin Seligman, whose research is among the most-cited in the world, ISSUE #111 23

Mental Wellness

is an international expert on learned helplessness, depression, and well-being.

He observes, “Human beings have evolved to spend much more time thinking about negative experiences than positive ones. We spend a lot of time thinking about what has gone wrong and how to fix it, or how to do it differently next time. In the past there may have been an evolutionary advantage to this way of thinking, since it seems to be innate.

However, for modern humans this negative bias is the source of a lot of anxiety, depression, and general lack of wellbeing.”

So, how can we regulate our emotions and keep ourselves in better balance? One of the evidence-based interventions, developed by Seligman, is a deceptively simple exercise called Three Good Things.

What happens after a week? Seligman says, “Most people like it so well, they just keep doing it.”

• For a week, before you go to sleep, write down three things that went well today.

Corporate Government Affairs Healthcare Regulation Real Estate Litigation Estate Planning Medical Malpractice

• Then reflect on why they went well.

Seligman and his colleagues at the University of Pennsylvania determined in a series of well-designed research studies that this tool works because gratitude gives you a break from focusing on what goes wrong in life and keeps you from taking for granted the good things.

This results in a chance to regroup mentally and recharge emotionally with a fresh perspective and more resilience.

Who would have thought something so simple would become an evidence-based intervention for anxiety and depression? Of course, there’s an app for it called Three Good Things.

Another helpful app is the Five Minute Journal by Intelligent Change, which offers options for a morning and/or evening entry. I prefer the Five Minute Journal app, rather than the paper journal, for two reasons: It’s free and I can add a passcode for privacy.

If you’re susceptible to negative thinking when you first wake up, I recommend you do

the gratitude entry in the Five Minute Journal first thing in the morning. That way you can get a jump on things and set the tone for the day, before the negative news cycle infiltrates your psyche.

Keep experimenting until you hit on the variations or combinations of journaling that work best for you and can easily be incorporated into your lifestyle. As life goes on and things change, periodically review and adjust your approach to help yourself from keep from getting stuck or giving up entirely.

Emotional regulation, especially the processing of negative emotions, can be tricky. If you’re not getting good results from either of these journaling techniques, there’s a possibility that you may be more than mildly depressed or anxious. If you or others around you are concerned, do yourself, and thçem, a favor—consult a professional. You won’t be alone. So many Americans are affected, at some point in their lives, by depression that it’s now considered the “common cold” of behavior health issues.

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24 MD-UPDATE

Complementary Care

How Hearing Loss Can Impact One’s Mental Health Lucinda Batta, AuD, of Bluegrass Hearing stresses the link between good hearing and good overall health.

BY LISA MEEKER

Experience What Sets Bluegrass Hearing Clinic Apart from the Rest

LEXINGTON Everyone knows that hearing aids

and assistive listening devices help and reduce the strain of trying to understand all the mumbling that is going on around you.

While the ability to hear your loved one or enjoy your favorite TV show is the short-term goal, it turns out there is more at stake than just your hearing health. Research shows that untreated hearing loss has a profound effect on one’s mental state, affecting everything from temperament, to perceived life satisfaction, to cognition.

The increasing population of those with hearing loss is becoming a significant issue.

Some experience mental and emotional issues such as anger, depression, anxiety, loneliness, frustration, and decreased cognitive functioning. These issues are common among those with untreated hearing loss, and because most people wait an average of 7-10 years to seek treatment, you have millions of people with an unnecessarily poor quality of life.

People with hearing loss usually find communication difficult, and this can lead to stress, fatigue, and social isolation. In turn, social isolation leads to depression, especially in older adults. Research today shows the link between hearing loss and depression is more of a problem than previously thought.

Bluegrass Hearing Clinic Audiologist, Lucinda Batta, AuD, states, “Current research has shown the significant link between untreated hearing loss and major depressive disorder. Thankfully, the research doesn’t end

(800) 470-4757

Doctor of Audiology, Lucinda Batta, has been serving the community as a member of Bluegrass Hearing Clinic since 2016.

there. Studies have further shown decreased odds of depressive disorder when the hearing loss is treated. Good hearing health is linked to good overall health.”

Hearing loss is the third most occurring condition in older adults. Presbycusis, the most common form of hearing loss, is associated with aging and occurs gradually. It is characterized by loss of the highest frequency consonant sounds and trouble understanding speech in the presence of background noise. Between 25-40% of those over the age of 50 have hearing loss, and many have never had a baseline comprehensive hearing test by an audiologist to determine what they can and cannot hear.

It is important that physicians look for symptoms of depression and screen patients accordingly, especially if hearing loss is suspected. A simple comprehensive hearing test PHOTO BY TIM WEBB

•Doctors of Audiology •Locally Owned And Operated for Over 20 YEARS! 11 Convenient Locations Bardstown Cynthiana Danville Elizabethtown

Frankfort Lexington Manchester

www.BluegrassHearing.com

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could change the course dramatically. Referring patients with hearing loss and depression for treatment, may help patients regain an emotional wellbeing and become socially engaged once again, therefore experiencing an improvement in their quality of life.

Lisa Meeker is Marketing Director for Bluegrass Hearing.

ISSUE #111 25

Complementary Care

Fighting Opioid Overdose in Kentucky, One Spray at a Time

Daniel Wermeling, PharmD, counteracts opioid overdoses by getting Noloxone in the hands of the Kentuckians who are most at risk

BY CHUCK CLENNEY LEXINGTON The opioid epidemic in the United

States has recently been declared a public health emergency. Drug overdose is now the leading cause of death among Americans under 50. University of Kentucky (UK) College of Pharmacy professor, Daniel Wermeling, PharmD, has spent the last 40 years working with academic and community partners to battle this crisis by improving the distribution of Naloxone, a spray form of an anti-opioid drug, to those who are most at risk.

Wermeling entered UK in 1977, joined the faculty in 1990, and has since focused his research on the design, formulation, manufacturing and clinical testing of drug application methods. “A lot of my research, in the early days, was on pain management. We were involved in studying some of the new opioid-related compounds and drug delivery systems that are now approved. We have been working with the Health Department and other organizations in our communities, and even in the counties surrounding Lexington, with education, offerings, and to provide Naloxone to individuals and families who are at high risk of overdose,” says Wermeling.

In 2009, Wermeling began developing new intranasal methods to administer Naloxone through 24 prototypes that were tested at UK. It was then fast-tracked by the FDA, and distribution began. Wermeling explains, “I would contact some of the organizations that I knew had individuals in residence who were recovering. Then, I learned more about locations in Fayette County where individuals who were at high risk, who weren’t in treatment, were located. When I had learned that Fayette County had approved needle exchange for the Health Department, it was clear that that was the highest risk population in the county.”

26 MD-UPDATE

Dr. Daniel Wermeling’s research is instrumental in the design, formulation, manufacturing, and clinical testing of drugs and delivery systems designed for intranasal administration.

When an opioid overdose occurs in the body, the drug interacts with neuroreceptors in the brain to provide pain-relief, but when it’s too much, an area of the brain that tells our bodies to breathe automatically is affected and rate of breath gradually diminishes. When Naloxone is sprayed, it blocks the neurological effects of the opioid on the brain’s receptors to a point where people wake up and start breathing. Wermeling’s intranasal spray has allowed police, ambulance services, and paramedics to now administer Naloxone directly into an overdosing patient’s nose without the hazardous use of needles.

Wermeling is now working with Lexington’s anonymous needle exchange program to distribute Naloxone. “At the clinic, there are all walks of life. From people that were homeless to those who look like they have middle-income lives. You have all kinds of PHOTO PROVIDED BY UNIVERSITY OF KENTUCKY

things that can happen, but mostly, people are orderly and grateful for the needle exchange and for the counseling, and to get access to Naloxone,” says Wermeling. In their first year, they saw about 50 patients a week and distributed about 3,200 Naloxone kits.

These kits, with a market cost of $100 each, are provided for free in conjunction with training on overdose recognition and Naloxone administration. Wermeling adds, “Because of the stigma associated with the whole circumstance, people are either shunned in society or they feel shunned, and so when they have somebody who is actually paying attention to them and their healthcare needs, they are extremely appreciative of us taking the time to provide the services and product to them.

This was a volunteer thing, and it’s kind of why you get into healthcare.”

News

Gerard Colman Takes Baptist Health’s Top Post LOUISVILLE Following

a nationwide search, Gerard “Ger” Colman, who served as the chief operating officer of the Aurora Health Care System in Milwaukee, Wis., will step up as Gerard “Ger” Colman CEO of Baptist Health.

For 25 years, Colman has been involved in healthcare, with experience in ranging from operations, finance, information technology, and physician engagement.

Allen Rudd, Baptist Health Board of Directors chairman states, “We are fortunate to have found someone with his breadth and depth of experience with not-for-profit and faith-based organizations.”

Colman, who holds a doctorate in healthcare management from the University of Texas School of Public Health, states, “I look forward to working with our Baptist Health presidents, their respective boards, employees and physicians.”

KentuckyOne Health Announces Bruce Tassin as CEO LEXINGTON It

has been announced that Bruce Tassin, president of Saint Joseph Hospital, will also serve as chief executive officer for KentuckyOne Health and lead Kentucky-based operaBruce Tassin tions of the recently expanded Southeast Operating Division for Catholic Health Initiatives (CHI).

“KentuckyOne Health is committed to compassionate and innovative care for the patients we serve. Bruce’s proven track record at Saint Joseph Hospital and his connection to this community demonstrates that we have a leader who will deliver on these promises,” says Jane Chiles, chair of the KentuckyOne Health Board of Directors.

Tassin has spent much of his 27 year career as a hospital and health system administra27 MD-UPDATE

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

tor in faith-based health systems, developing and implementing successful strategic plans, achieving improved quality measures, and guiding increased financial growth.

“I am honored and humbled to take on this expanded role within KentuckyOne Health to lead a long-term strategy of excellence in health care,” says Tassin. “There is a proud legacy across the organization, along with a passion at all levels to improve care in the community.”

National Cancer Institute Recognizes Jessica Croley, MD LEXINGTON The National

Cancer Institute (NCI) Community Oncology Research Program (NCORP) has recognized Jessica Croley, MD. Croley, who is with KentuckyOne Health Gerald “Ger” Colman Hematology and Oncology Associates, was recognized for her successful level of participation and the number of patients she has enrolled to the NCI clinical trials over the past three grant years. Croley, who was presented the Appreciation Award, was part of only 10 percent of all NCORP rostered physicians who qualified for an award.

“When it comes to treating cancer, having access to clinical trials gives my patients more options,” says Croley. “With the option of clinical trials, I can better customize treatment plans for each individual to give them a better chance for many more quality years.”

University of Louisville receives $6.7 million grant to become Superfund Research Center LOUISVILLE After a 20-year effort by the

University of Louisville (U of L) to secure Superfund money, it has received a $6.7 million grant from the National Institutes of Health, becoming one of fewer than two dozen Superfund Research Centers across the United States. The funding will be used to establish a new, multidisciplinary center at U of L that will support the federal Superfund Hazardous Substance Research and Training Program,

where researchers will study how exposure to pollutants contributes to cardiometabolic disease.

Sanjay Srivastava, PhD, a professor and researcher in cardiovascular medicine at the U of L School of Medicine, will lead the project.

Srivastava says, “This is a very prestigious grant for the university and will help raise the awareness of environmental issues as they relate to health, and train the next generation of environmental scientists.”

Created in 1980, The Superfund program is part of a federal government effort to clean up land identified by the United States Environmental Protection Agency as a potential risk to human health or the environment due to contamination by hazardous waste.

Baptist Health and Hardin Memorial Health Sign Letter of Intent ELIZABETHTOWN Following a two-year long pro-

cess of exploring potential affiliations, Hardin Memorial Hospital (HMH) has signed a letter of intent with Baptist Health, which authorizes both parties to move forward with necessary steps to pursue a proposed acquisition.

Currently, both entities are involved in the due diligence and negotiation process, with 18 due diligence teams covering operational, legal, and financial areas. This process is projected to take several months.

As an integrated system of providers and facilities, HMH serves approximately 400,000 residents in 10 Central Kentucky counties, and is the third largest employer in Hardin County.

“The challenge for independent, county-owned hospitals like HMH, faced with a demanding and uncertain environment of increased costs and declining reimbursements, is to continue to ensure that clinical expertise and capital investment keeps pace with citizen demands for the highest level of local healthcare,” says Hardin County Judge/Executive Harry Berry, who also serves as chairman of the HMH Board of Trustees. “This transaction will assure that HMH will emerge stronger operationally and financially as a regional healthcare leader.”

Events

With less than 3 minutes to go, racers are ready and the lead cyclist is poised to start the 5th annual Yes Mamm 5K! PHOTOS BY GIL DUNN

Eric Gilliam, president Saint Joseph East, John Stewart, MD, medical director of the Stewart Home and School in Frankfort, and Richard Budde, MD were all smiles after the race.

Chad Harston, MD, of the Lexington Clinic and son, Spenser Harston, a 7th grader at The Lexington School, finished together at 29:29-:30 for 1st place in Spenser’s age group.

Saint Joseph Hospital Cuts the Ribbon on New Cardio Thoracic Vascular Unit LEXINGTON The

Saint Joseph Hospital Foundation, part of KentuckyOne Health, had a ribbon cutting on October 17, 2017 to celebrate a major renovation to the Wilma Thornton Cardio Thoracic Vascular Unit (CTVU) at Saint Joseph Hospital, in honor of Mrs. Thornton, a former patient who passed away in 2011 at age 86.

Mrs. Thornton credited Saint Joseph Hospital with allowing her to enjoy “bonus FREEIMGES.COM/JASON MORRISON

28 MD-UPDATE

The Boarman family came out to support the Saint Joseph Hospital Foundation. Pictured are (l-) Dana Boarman, Meredith Boarman, Saint Joseph Hospital Foundation and Dr. Christopher Boarman (ret).

years” by providing outstanding care. Following one surgery, her son wrote a personal note to the hospital president expressing the family was “forever in debt and grateful.”

Two months before Mrs. Thornton passed away, her son Michael Thornton and his wife, Amy, pledged $1.5 million to the Saint Joseph Hospital Foundation, the second largest donation in foundation history. The gift created the Wilma E. Thornton CTVU Suite at Saint Joseph Hospital. Improvements to the CTVU Suite include major facelifts for 22 patient rooms to provide a more peaceful environment, and upgrades throughout the nurses’ work stations and common areas. The CTVU Suite is designed to help patients with heart, lung, and vascular illnesses.

Events

Yes, Mamm! Has Record Crowd and Beautiful Weather NICHOLASVILLE The 3rd annual Yes, MAMM!

5K run/walk which benefits the Saint Joseph Hospital Foundation was Saturday October 14, 2017 at the picturesque RJ Corman Railroad

A partially obscured Kathy Budde, Marta Kenny, MD, and Richard Budde, MD, of Kentucky One Health Radiology enjoyed the beautiful autumn weather while running in the Yes Mamm 5k!

“Thanks to Mrs. Thornton’s surgeon at Saint Joseph Hospital and the wonderful care she received, she was able to spend an additional three years with her two sons and grandchildren, enjoying UK basketball games, trips to Keeneland and much more” said Leslie Buddeke Smart, president, Saint Joseph Hospital Foundation. “Mrs. Thornton was a vibrant woman who was forever grateful to the hospital. We too are grateful for Mrs. Thornton, and the legacy she leaves behind.”

Robert Salley, MD, executive director cardiovascular services at Saint Joseph Hospital, said the CTVU suite has the capacity to reduce hospital stays to 1-2 days after open heart surgery as patients come to the CVTU off ventilation, by-passing the recovery unit.

Miranda Mullins, a Lafayette high school graduate and future nurse, finished 2nd place women overall with a time of 19:41.

Group headquarters in Nicholasville, KY. Over 450 runners participated to raise money for the Saint Joseph Hospital Foundation (SJHF) which provides financial support to allow for mammography screenings for low-income and under-insured women in 15 counties throughout Central and southeastern Kentucky.

The SJHF, founded in 1989, raises funds to support the core values of the hospital. This year it is projected that 360+ mammograms will be funded for underinsured women.

Candace Alexander, PT, DPT, CLt and Kathy Forrest, PT, DPT with KentuckyOne Health Rehabilitation services were on hand to support the cause and provide runners with post-race physical therapy.

Leslie Buddeke Smart, CFRE, president Saint Joseph Hospital Foundation with Amy and Michael Thornton at the ribbon cutting for the new Wilma E. Thornton CVTU at Saint Joseph Hospital.

Ahmad Chaudhry, MD, cardiovascular surgeon and Robert Salley, MD, executive director cardiovascular services at Saint Joseph Hospital PHOTOS BY GIL DUNN

ISSUE #111 29

Events

Kay Redfield Jamison, PhD talks with Jan Anderson, PhD, MD-Update Mental Wellness columnist before Jamison’s presentation at the Muhammad Ali Center.

“I am shaken and stirred by the compassion of this community,” — Gordon Tobin, MD, Ephraim McDowell Physician of the Year.

Attending the annual event were Amanda Hettinger, MD, with Jesse Wright, MD, Joyce Spurgeon, MD, and David Casey, MD, chairman, Uof L Dept. of Psychiatry and Behavioral Sciences.

U of L Depression Center presents Professor who’s Grappled with Bipolar Disorder to Discuss Genius and Mania LOUISVILLE Kay Redfield Jamison, PhD, a

Johns Hopkins University psychiatry professor and New York Times bestselling author discussed the relationship between mental illness and creativity at the annual U of L Depression Center dinner on October 19, 2017 at the Muhammad Ali Center.

Jamison’s current book, Robert Lowell, Setting the River on Fire: A Study of Genius, Mania and Character, brings a fresh understanding to the work and life of Pulitzer Prizewinning poet Robert Lowell, whose intense, complex, and personal verse left a lasting mark on the English language and changed the public discourse about private matters.

Jamison brought her expertise in mood disorders to bear on Lowell’s story, illuminating the relationships among mania, depression, and creativity, as well as the details of Lowell’s treatment and how illness and treatment influenced the great work that he produced and often became its subject.

Jamison herself battled mental health issues as early as her teenage years. While pursuing her career in academic medicine, Jamison found herself succumbing to the same exhilarating highs and catastrophic depressions that afflicted many of her patients. Her disorder launched her into ruinous spending sprees, episodes of violence, and an attempted suicide.

30 MD-UPDATE

Louisville native Dawne Gee, WAVE 3 News was honored as Community Leader of the Year.

Randy Schrodt, MD, joined Jesse Wright, MD, and Chrissy Schrodt at the UofL Depression Center’s annual dinner.

Her memoir, An Unquiet Mind, rose to the best-selling list in 1995 and was cited for its candid examination of bipolar illness from the dual perspectives of the healer and the healed, revealing both the terror and allure that at times prompted her to resist taking medication.

When asked by MD-Update‘s Dr. Jan Anderson if she had any advice for people who were considering being more forthcoming about their mental health issues, Jamison said, “There will be consequences, both personally and professionally. So, have your ducks in a row.

Have your support system in place.”

During Jamison’s talk on the connection between creativity and mania, she said “Let’s not glamorize this. There are people on one end of the spectrum that do very, very well as far as creative success, but there are many more people on the other end of the spectrum that do very badly.”

PHOTOS BY GIL DUNN

Valerie Briones-Pryor, MD, honored with Compassionate Physician Award, currently serves as division Medical Director, Kentucky One Health Hospital Medicine Associates.

“You hug patients physically or emotionally,” — Gerald Temes, MD, KentuckyOne Health, Excellence in Leadership Award.

Events

Brian Ganzel, MD, Toni Ganzel, MD, dean of UofL School of Medicine, Leah Brown, Louis Waterman, Jason Chesney, MD and friend.

22nd Annual Doctors’ Ball Raises Nearly $100,000 for Jewish Hospital Trager Transplant Center Patient Assistance Fund LOUISVILLE The 22nd annual Doctors’ Ball was

Saturday, October 21, 2017 at the Marriott Louisville Downtown and hosted by the Jewish Hospital & St. Mary’s Foundation, part of KentuckyOne Health. The annual event helped raise nearly $100,000 to benefit the Jewish Hospital Trager Transplant Center patient assistance fund.

The Trager Transplant Center is nationally recognized for performing Kentucky’s first adult heart, pancreas, heart-lung, and liver transplants, as well as the first minimally inva-

Sarah Moyer, MD , receives Humana Physician Excellence in Community Health Award from Brian Loy, MD.

sive kidney donation in Kentucky. More than 5,000 organs have been transplanted at Jewish Hospital since 1964 including 500 hearts, 900 livers, and 3,000 kidneys.

The 2017 Doctors’ Ball recognized some of the area’s most innovative and caring doctors and community leaders including: Gordon Tobin, MD, – Ephraim McDowell Physician of the Year; Dawne Gee, WAVE 3 News – Community Leader of the Year; Valerie Briones-Pryor, MD, – Compassionate Physician Award; David Casey, MD, and Valerie Casey

Jiapeng Huang, MD, KentuckyOne Health, Jewish Hospital & St. Mary’s HealthCare President, pledged $10,000 on behalf of the medical staff.

Leslie Buddeke Smart, division VP for development for Jewish Hospital & St. Mary’s Foundation, spoke on the Foundation’s plans for the future.

David Casey, MD, Al Martin, MD, Mary Helen Davis, MD, and Valerie Casey.

Dr. and Mrs. Casey were honored for Excellence in Mental Health.

– Excellence in Mental Health; Dr. Norton Waterman – Excellence in International Humanitarian Service, awarded posthumously; Gerald Temes, MD – KentuckyOne Health Excellence in Leadership Award; and Sarah Moyer, MD – Humana Physician Excellence in Community Health Award.

The black-tie event included cocktails, a silent auction, dinner, and an awards ceremony. During cocktail hour and after the program concluded, guests enjoyed a Casino Royale experience.

Val Slayton, MD, and Melanie Knight.

Dr. Jan Anderson, MD-Update Mental Wellness columnist, and husband Bill Elder.

Gil Dunn, MD-Update, Julie McWhorter, MD, Col. Tim McWhorter and Scott Neal, MD-Update Financial columnist & Fee Only Financial Planning.

PHOTOS BY ROBERT BURGE

ISSUE #111 31

Events

Ahmad Chaudhry, MD, cardiovascular surgeon at KentuckyOne Health, Sepideh and Scott Neal, MD-Update Financial columnist, Dr. Jan Anderson, MD-Update Hamid Mohammadzadeh, MD, cardiothoracic surgeon with KentuckyOne Health.

Mental Wellness columnist and her husband Bill Elder.

Rob and Stephanie Sarrantonio, Director of Marketing KentuckyOne Health, Central and Eastern Kentucky.

Jane Chiles, chair of KentuckyOne Health Board of Directors with Gil Dunn, publisher, MD-Update.

Shawn Chapman and Jessica Moss, MD, KentuckyOne Health Oncology Associates.

Jan Anderson, PhD, talks with Dan Goulson, MD chief medical officer, KentuckyOne Health at STARS.

Joy and Tharun Karthikeyan, MD, Physician of the Year at Saint Joseph Hospital with Leslie Buddeke Smart, CFRE, president Saint Joseph Hospital Foundation.

Saint Joseph Hospital Foundation Brings Out the STARS LEXINGTON The 29th annual “Evening with the STARS,” Saint Joseph Associates

Robert Salley, MD, executive director cardiovascular services at Saint Joseph Hospital and wife Kristy Johnson, cardiology APRN. 32 MD-UPDATE

For Renowned Service, was a glittering event on Saturday, November 11, 2017 at the Lexington Convention Center.

Honored as the Saint Joseph Hospital Physician of the Year was Tharun Karthikeyan, MD, an orthopedic surgeon with Lexington Clinic and director of total joint replacement services at Saint Joseph Hospital. The late RJ Corman was honored as Community Volunteer of the Year and Paul McGroarty, MD, was honored posthumously as the Physician of the Year at Saint Joseph East.

PHOTOS BY PARHAM BAKER

2018 EDITORIAL CALENDAR & OPPORTUNITIES Issue #112 (January)

YOU’RE AS HEALTHY AS YOU FEEL & LOOK

Internal Medicine, Geriatrics, Integrative Medicine, Prevention, Wellness, Plastic & Aesthetic Surgery, Dermatology

Issue #113 (February)

To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM 859.309.0720

Donna Ison, Editor-In-Chief DONNA@MD-UPDATE.COM 678.446.9089 SEND PRESS RELEASES TO

NEWS@MD-UPDATE.COM

HEART & LUNG HEALTH

Cardiology, Cardiovascular, Cardiothoracic, Pulmonology, Sleep Medicine

Issue #114 (March/April)

LET’S TAKE A MOMENT TO DIGEST THIS

Gastroenterology, Radiology, Endocrinology, Bariatric Surgery, Nutrition & Wellness

Issue #115 (May/June)

WOMEN’S & CHILDREN’S HEALTH

OB/GYN, Women’s Heart Care, Urology, Pediatrics, Prevention and Wellness

Issue #116 (July/August)

MUSCULOSKELETAL HEALTH

Orthopedics, Sports Medicine, Physical Medicine, Rehab

Issue #117 (October)

CANCER CARE

Oncology, Hematology and Radiology

Issue #118 (November/December)

IT’S ALL IN YOUR HEAD

Neurology, Pain Medicine, Ophthalmology, ENT, Psychiatriy, Mental Health

Issue #119 (January 2019)

YOU’RE AS HEALTHY AS YOU FEEL & LOOK

Internal Medicine, Geriatrics, Integrative Medicine, Prevention, Wellness, Plastic & Aesthetic Surgery, Dermatology

*Editorial topics and dates are subject to change.