CORE Ink - Spring 2013

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SPRING 2013

A P U b l i C A T I O N O F T H E C O R E I N S T I T U T E

Powerful Partnership The CORE Institute and Porretta Center for Orthopaedic Surgery Combine Forces Performing ‘Miracles’ Back to Living a Full Life

A Tale of a Tail: Meet Mr. Stubbs

Accredited Professional Helping Patients to Recover

®

welcome

INK

A P U b l i C A T I O N O F T H E C O R E I N S T I T U T E

VOLUME 4, ISSUE 2 SPRING 2013

®

from the Chairman Keeping Life in Motion…

Arizona Business Magazine during their Healthcare

One State at a Time.

Leadership Awards receiving the “Special Merit

In the last edition of

Award,” and was named the #1 orthopedic group

CORE Ink, we told

in Arizona by Ranking Arizona: The Best of Arizona

you to expect news

Business. The rankings, published annually by

of growth into Detroit,

Arizona Business Magazine, are based on the

Michigan, and we are

largest opinion poll in Arizona and include more

excited to announce this

than 200 business and leisure categories. For the

expansion has come to

first time, Ranking Arizona included the category

fruition. In this issue,

of Orthopedic Practices, and The CORE Institute is

you will find our cover story detailing the expansion and what you can expect from The CORE Institute

honored to be chosen as #1.

The decision to expand outside of Arizona

in the near future. In addition, we bring you

marks a major milestone for our eight-year-old

education about physician assistants and their role

company. Since The CORE Institute’s inception

at The CORE Institute, an introduction to our new

in 2005, we have expanded from four providers to

physicians, photos of our doctors and staff keeping

approximately 100, over 400 employees and 16

life in motion, and lastly how and why we made a

locations. Our growth has been built on a platform

prosthetic tail for an alligator.

of evidence-based medicine and meticulous

Thus far in 2013, we announced our first out-of-

outcomes tracking managed by a proprietary

state expansion. We are excited to have partnered

Information Technology platform. We have had

with the world-class team of orthopedic surgeons

the privilege to care for hundreds of thousands of

and specialists at Porretta Center for Orthopaedic

patients, from all 50 states and eight countries.

Surgery based in the greater Detroit, Michigan

On behalf of all of our physicians, providers,

area with facilities in Novi and Southfield. The

and staff, The CORE Institute appreciates your

practice will be renamed The CORE Institute at

continued support.

Porretta. This partnership marks the first of many opportunities for The CORE Institute to expand

Keep Life in Motion!®

and implement our Excellence through Evidence® platform across the nation. We believe that Porretta Center for Orthopaedic Surgery and its talented team of physicians are the perfect partners as The CORE Institute continues to grow.

The CORE Institute received accolades from

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE

David J. Jacofsky, MD Chairman & CEO

General Manager: Cami Kaiser/cami.kaiser@pni.com Mgr. Creative Development: Isaac Moya/ imoya@republicmedia.com Editor: Jim Williams/JLWilliams@republicmedia.com

Managing Art Director: Tracey Phalen/ tphalen@republicmedia.com Design: Rachel Tullio Photography: Jeff Noble, Sheila Springsteen

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Contents Cover Story

Powerful Partnership

14

A strong new alliance has been formed between The CORE Institute and the Porretta Center for Orthopaedic Surgery, bringing together a team of world-class orthopedic services in two states to provide best-in-class patient care.

Read more on page 14.

Feat u r e

A Tale of a Tail

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The CORE Institute is sharing the national spotlight with an unlikely star: An 11-year-old alligator name Mr. Stubbs. See page 18.

D epartme n ts What’s New?

Ask the Expert

8 The CORE Institute is pleased to announce the addition of two new physicians to the team.

12 N ew techniques for knee replacement.

Patient Care

connect with us

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10 Thanks to The CORE Institute, a married father of four is back to doing the things he loves: flying, biking and enjoying his family.

CORE Candid 20 W hat does ‘Keeping Life in Motion” mean to you?

Community Relations 22 The CORE Institute on 3TV’s Your Life A to Z.

Specialty Spotlight 11 Meet Summer Dehnert, one of our Physician Assistants.

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what’s new New Providers The CORE Institute is pleased to announce the addition of two new physicians to our provider team as well as our expansion into the Michigan market with the partnership of Porretta Center for Orthopedic Surgery, now called The CORE Institute at Porretta. See page 14 to learn more about this expansion!

Mark Dekutoski, MD is internationally recognized as a pioneer, educator and leader in orthopedic spine surgery. He is a board certified and fellowship-trained academic orthopedic spine surgeon.

He specializes in minimally invasive spine deformityscoliosis, kyphosis, spine tumors, spondylolisthesis and disc degeneration.

Ejovi Ughwanogho, MD is a fellowship-trained orthopedic spine surgeon specializing in adult and pediatric deformity—scoliosis, kyphosis, spine trauma as well as cervical, thoracic and lumbar degenerative conditions including use of cervical/lumbar disc replacement and minimally invasive techniques.

patient care

Performing ‘Miracles’ Patient Back to Living a Full Life Thanks to The CORE Institute

By Gremlyn Bradley-Waddell

Years of suffering Schwartz suffered with shoulder pain for decades, the result of a fall he took while skiing in the 1980s. He didn’t see a doctor at the time but learned later he’d injured the labrum, the ring of cartilage attached to the shoulder socket, or glenoid. By 1995, the pain and difficulty of doing things he loved led him to undergo surgery to repair the labrum.

“It had become difficult to fly,” recalls Schwartz, who’s had his private pilot’s license for 37 years, “because you’re reaching up to the instrument panel, sometimes hundreds of times per

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JEFF NOBLE

Less than two years ago, Chris Schwartz was experiencing aching pain in his right shoulder, unable to even place his arm across his chest or sleep comfortably on his right side.

Thanks to a device called the DePuy Global Steptech APG (Anchor Peg Glenoid) and a successful shoulder replacement surgery performed by Jason Scalise, M.D., of The CORE Institute, the married father of four is now doing the things he enjoys — with ease.

“It has been nothing short of miraculous,” says Schwartz, 59, who owns an electronics firm in Orange County, Calif., and enjoys piloting his twin turboprop and cycling. “I’m able to fly, pain-free, I’m back on the bike, and I’m now able to throw a baseball or football.”

Institute at the Ohio clinic, he says. Prof.

Iannotti had not RTZ CHWA HRIS S C F O only worked ESY COURT PHOTO with Dr. Scalise to develop the software that converts CT scans into 3D digital images, therefore flight, to adjust radios, throttles aiding doctors in determining the best and controls.” course of treatment, but he also helped Unfortunately, the pain returned by to design the Global Steptech APG in 2003, and a second surgery revealed conjunction with DePuy, Schwartz says. his shoulder’s condition had significantly degraded. The operation eased Finding CORE the pain awhile, but he was in his docDr. Iannotti and Schwartz’s physician tor’s office again by 2011. Knowing determined a standard prosthesis the severity of the damage and the would be inadequate for Schwartz’s Cleveland Clinic’s renowned reputation joint and felt the Steptech was the for orthopedics, his physician sent CT superior option. Schwartz took the scans of Schwartz’s shoulder joint to advice but didn’t want to fly to Ohio Joseph Iannotti, M.D., Ph.D., chairman for surgery, so he did some research of the Orthopaedic and Rheumatologic Chris Schwartz has many hobbies, and most involve being active with his family.

He’s thankful to The CORE Institute for getting him healthy again.

www.thecoreinstitute.com

specialty spotlight

One of The CORE Institute’s Physician Assistants, Summer Dehnert Accredited Professional Helping Patients to Recover

By Gremlyn Bradley-Waddell

PHOTO COURTESY OF CHRIS SCHWARTZ

and found Dr. Scalise, one of only a handful of surgeons in the nation with experience implanting the device and right next door in Arizona. After several detailed phone conversations with Dr. Scalise, he was confident he had found the right surgeon. He said the surgeon, who received the Cleveland Clinic Innovator Award for his work on the software, was “unrushed, thoughtful and respectful.”

Dr. Scalise, who concurred with the other doctors about using the Steptech, notes only about 20-25 percent of patients will require a device like that.

“The Steptech is not desired for those with ‘routine’ arthritis of the shoulder, that is, arthritis without excessive glenoid erosions,” he says. “But when those erosions are present, this device is demonstrating itself to be extremely useful compared to other techniques.”

On March 1, 2012, Dr. Scalise performed Schwartz’s shoulder replacement surgery and after a brief stay in the hospital, the California man was back home. Physical therapy went well, as did post-op visits with his local physician.

“Kudos to Jason Scalise,” says a very pleased Schwartz, who was impressed by his stay in the Valley.

“It seems pretty apparent that, in Phoenix, The CORE Institute doctors are the standouts.”

If they’re recovering from a hip or knee replacement, patients at The CORE Institute’s office in Phoenix get to know Summer Dehnert pretty quickly.

She evaluates and treats orthopedic patients and writes their prescriptions, so it might be surprising to learn she’s not a doctor. Rather, she’s a physician assistant, or PA, a growing profession within the medical field. PAs graduate from an accredited educational program, the curriculum of which is based on medical school, and are nationally certified and state-licensed to work under a physician’s supervision.

“Physician assistants are considered mid-level providers, similar to a nurse practitioner, and have a master’s degree, whereas medical doctors earn doctorates,” says Dehnert, who has practiced medicine at The CORE Institute for more than six years and has treated thousands of patients. As one of the PAs, her primary focus has been shoulder and elbow reconstruction but, in the last year, she also has transitioned to helping patients manage hip and knee arthritis.

According to the American Academy of Physician Assistants (AAPA), because PAs are trained and educated similarly to physicians, the two share similar diagnostic and therapeutic reasoning. In fact, the Physician-PA practice may best be described as delegated autonomy, the organization says. Physicians delegate duties to PAs, and within those range of duties, PAs autonomously make decisions regarding patient care. This team model is an efficient way to provide high-quality medical care, the AAPA says, as PAs alleviate some routine work for physicians and help them maximize office hours and treat more patients. Another upside of the profession is that the preventive care PAs provided helps cut down on overall

Summer Dehnert healthcare spending by warding off diseases that strain the economy and work production.

During their training, PAs complete more than 2,000 hours of clinical rotations, practicing PAs also participate in lifelong learning and, in order to maintain national certification, they must complete 100 hours of continuing medical education every two years.

The PA profession was created in the late 1960s as a response to a shortage of physicians, and the AAPA says that the shortage continues today, making PAs more valuable than ever. In fact, the organization reports that the Bureau of Labor Statistics “predicts that PAs will be the second-fastest-growing profession in the next decade, increasing from 74,800 in 2008 to 103,900 in 2018.”

Dehnert loves her career, which allows her to care for patients and “work with some of the best doctors in the country.”

She says that even as a kid, whenever a friend had a problem or a scraped knee, she was the person who wanted to help fix things. So being a PA suits her perfectly.

“I was always the one who wanted to be a caregiver,” she says, “and orthopedics is one of the few fields in medicine where we really fix people.”

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ask the expert

Getting Pain Relief

New Techniques for Knee Replacement

By William Higginbotham III, MD

Q : I am a 64-year-old former collegiate football player, and have been concerned for a number of years by right knee pain. Ten years ago, I had arthroscopic surgery on my knee and was told that in the future I may require a knee replacement. Are there any new techniques available for knee replacement surgery?

A :The American Academy of Orthopedic Surgeons reports that one in seven Americans will experience an orthopedic impairment with pain inflicting bones, joints, tendons, and muscles. Total knee replacement provides pain relief to individuals with knee pain related to any form of arthri-

tis, most often osteoarthritis, injury or a prior history of surgery. Total knee replacement surgery is considered to be one of the most important medical advancements of the 20th century. In the past, physicians considered individuals between the ages of 60 and 75 to be the ideal candidates for this procedure. However, in recent years, improvements in materials and technology have allowed people of virtually all ages to have successful knee replacement surgery if needed.

At the beginning of the past decade, the development of computer-assisted

In recent years, improvements in materials and technology have allowed people of virtually all ages to have successful knee replacement surgery if needed.

William Higginbotham III, MD

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William Higginbotham, III is a board certified orthopedic surgeon with over 20 years of clinical experience specializing in total knee and hip replacements. He currently serves as the Chief Medical Officer for The CORE Institute at Porretta

orthopedic surgery allowed surgeons to improve the accuracy in which implants were positioned at the time of surgery.

This technique utilizes intra-operative measurement to “map” a patient’s boney anatomy and to “navigate” the position of bone cuts.

Within the past few years, the introduction of shape-matching technology has taken the technique of knee replacement surgery to the next level. Prior to surgery, patients are required to undergo an MRI scan of their knee, as well as a routine X-ray examination. Then, using sophisticated 3-D software, the information obtained from the MRI scan is utilized in the manufacturing of custom cutting guides. Because these guides or blocks are built based on the anatomy of each patient individually, they allow for more accurate bone cuts during surgery, thereby optimizing the size and placement of the prosthesis.

If conservative treatment–such as physical therapy, medication or other treatments–has been ineffective, knee replacement might be your best option at controlling your pain. Please consult a CORE specialist if you are experiencing knee pain to discuss treatment options available for you.

www.thecoreinstitute.com

Immobilized

by Arthritic Ankles?

LEARN MORE

inbone.com Talk to your surgeon to see if ankle replacement is right for you.

007542A 08-Apr-2013

Powerful

Partnership

The CORE Institute and Porretta Center for Orthopaedic Surgery Combine Forces 14

www.thecoreinstitute.com

cover story A powerful new partnership is bringing together a team of world-class orthopedic services in two states to provide best-in-class patient care.

The CORE Institute in Phoenix has joined forces with the Porretta Center for Orthopaedic Surgery in Michigan strengthening two highly reputable medical practices with expanded resources, expertise and knowledge. The Porretta Center for Orthopaedic Surgery will now be named The CORE Institute at Porretta®. The partnership was announced in March of this year.

“The CORE Institute was attracted to the Porretta Center for Orthopaedic Surgery because of its excellent leadership and talented employees,” said Dr. David Jacofsky, MD and Chairman and CEO of The CORE Institute. “Porretta was attracted to The CORE Institute because of its worldclass reputation and its program of evidence-based medicine and meticulous outcomes tracking managed by a proprietary Information Technology platform.

Together our future and expected growth is bright.”

The expansion is one of many planned for the country over the next couple of years and may be one of the only of its kind in the nation.

“This partnership marks the first of many opportunities for The CORE Institute to expand and implement our Excellence through Evidence® platform across the nation,” added Jacofsky. “We believe the Porretta Center for Orthopaedic Surgery and

Did You Know? >T he Porretta Center for Orthopaedic Surgery was started by Dr. Charles Porretta in 1959. >F or two years running, The CORE Institute in Phoenix has been selected a Best Place to Work. >T he CORE Institute’s state-of-the-art, minimally invasive, computer navigated surgical equipment is some of the most technologically advanced in the world, allowing for more surgical precision, faster recovery time, and smaller scars.

its team of talented physicians are the perfect partners as The CORE Institute continues to grow.” The CORE Institute’s Excellence through Evidence® platform is an alignment among hospital administrators, hospital staff, physicians and patients to improve outcomes through a proven team approach.

At the CORE of the Partnership Over the past eight years, The CORE Institute has positioned itself as orthopedic leaders in Arizona.

Their board certified and fellowship-trained physicians are recognized for providing a wide range of specialized care in the areas of surgical, non-surgical and reha-

>T he CORE Institute at Porretta’s Orthopedic Surgeon Todd J. Frush, MD is the associate team orthopedic surgeon for the NBA’s Detroit Pistons. He also provides orthopedic team coverage for Madonna University and Hartland High School. > I n 2012, The CORE Institute clinics in Phoenix saw more than 36,000 new patients. > The CORE Institute was awarded the 2013 #1 Orthopedic Practice in Arizona by Ranking Arizona

bilitative hip, knee, shoulder, elbow and ankle procedures, joint replacement sports medicine, arthroscopy and more. They work with fracture management, foot and ankle reconstruction, physical medicine and rehabilitation, comprehensive spine care and orthopedic traumatology, complex articular cartilage restoration,

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cover story musculoskeletal oncology and pain management.

The CORE Institute has also been a pioneer in research with multiple labs including a biomechanical lab and a motion analysis lab that have advanced the knowledge of orthopedic surgery.

Porretta Center Stands Out The Porretta Center for Orthopaedic Surgery is known for offering excellence in caring for a number of orthopedic problems using advanced subspecialty training and surgical expertise.

Many of their physicians are noted faculty members of the Orthopaedic Surgery Residency Program at the Detroit Medical Center and Providence Health Systems.

The surgeons at the Porretta Center for Orthopaedic Surgery has delivered orthopedic care to tens of thousands of patients around the world since opening their doors in 1959. They are academically active and committed to supporting schol-

arly activity and orthopedic research and were one of the first orthopedic practices at the Providence Hospital.

Impact of Partnership The partnership raises the bar of excellence in patient care and standards for both orga-

nizations. The CORE Institute at Porretta now has access to corporate resources including human resources, marketing, Information Technology, research, billing, accounts payable and more.

The strength of the union is evident, in part, in the

numbers. The CORE Institute opened in 2005 with just one location and four physicians and will now have nearly 100 providers, over 400 employees and 12 locations in Arizona and four in Michigan, located in Novi and Southfield.

The CORE Institute has cared for hundreds of thousands of patients from all 50 states as well as eight countries and the partnership should greatly expand their reach. The decision to expand outside of Arizona marks a major milestone for The CORE Institute. As the organization continues to expand in Michigan and into additional markets, their headquarters will remain in Arizona and will grow to continue to support the national infrastructure that is in place.

Patients Benefit All of this adds up for patients who will now have access to a national network.

“Partnering with The CORE Institute will directly benefit our patients and help Porretta grow,” said Dr. David Markel, Michigan Market President of The CORE Institute at Porretta.

“The CORE Institute has achieved their mission of bringing a new standard of excellence to surgical care in Arizona. We are excited to expand the same in Michigan.

That means, higher patient satisfaction, greater standardization using evidence-based best practices, better clinical quality and more efficient performance.”

feature Story

tale a

of a

The CORE Institute in National Spotlight for Creating Custom Prosthetic for Gator

Dr. Marc Jacofsky, with his famous patient, Mr. Stubbs, and staffers at Phoenix Herpetological Society. Jacofsky made national headlines by creating the first-ever prosthetic alligator tail.

By Dolores Tropiano Mr. Stubbs has a tale about his tail that is securing him star status both locally and internationally. And The CORE Institute is sharing the spotlight.

Stubbs started out in life as an average alligator until an older cage-mate snapped up his tail. Later, the gator got his new name and his alligator adventure began.

The 11-year-old alligator came to the Phoenix Herpetological Society eight years ago and recently caught the attention of The CORE Institute. Until then, The CORE Institute, which specializes in comprehensive orthopedic care, had not necessarily built its reputation

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on reptile research. But they found a way to make the project a fit with their philosophy.

“Our motto is to keep life in motion,” said Dr. Marc Jacofsky, Executive Vice President of Research and Development for The CORE Institute in Phoenix.

“And that does not exclude animals.”

Talented Team Takes on Tail A collaborative team including Jacofsky, Justin Georgi, an Assistant Professor in the Anatomy Department at Midwestern University, Russ Johnson, President of the Phoenix Herpetological Society and his knowledgeable staff, and Sarah Jarvis,

www.thecoreinstitute.com

took a mold of Mr. Stubbs’ stump and merged the cadaver tail mold with his stump mold.

“Figuring out the strapping system was one of the most challenging aspects of the project,” said Jarvis.

After several iterations, the artificial alligator tail was complete with scales that coordinate with Stubbs’ skin. The tail is held on to Stubbs’ stub with nylon straps and strategically placed holes in the bottom allow for bathroom breaks and water drainage.

“The new tail immediately improved Stubbs’ mobility and ability to walk straight,” Johnson said.

was in the middle of a mob of media on March 11, 2013 as he sported his new tail at the Phoenix Herpetological Society in North Scottsdale.

“People used to make fun of him.

They would point and laugh. But not anymore,” joked Johnson. “Now he is signing autographs.”

Stubbs sported sunglasses (and a securely shut mouth) as camera’s clicked away. His story unfolded.

Research Associate with The CORE Institute, quickly went to work to produce a 3-foot-long prosthetic tail, which is believed to be the first ever created for an alligator.

After three months and an estimated $6,000 in man hours and materials donated by The CORE Institute, Mr. Stubbs

A Tail for the Gator Georgi helped put the project in motion by studying the gator’s gait using a computer and camera system and the anatomy of a cadaver alligator tail. With the research he gathered and Jacofsky’s vision, the specifics for a tail that would allow it to be flexible enough to move and propel Stubbs forward, yet maintain proper balance on land and in water, took shape.

Jacofsky and Jarvis first created a mold from a cadaver tail of a similarsized gator. They filled the mold with a silicone material that matched the density and weight distribution of the real cadaver tail. They took the time to match that alligator’s natural colors by tinting the silicone material with some artistic interpretation. They next

Trying Time with Tail Swimming with the new tail was a little slow. Until then, Stubbs had learned to swim with his front feet and now needs to relearn what he had done prior to his accident – to move in part by the propulsion of his tail. A floaty is helping with the process of keeping the 35-pound animal above water as he continues his therapy.

The rehabilitation process may take months, as Stubbs learns to swim with his artificial tail which will mostly likely increase his life. Gators are known to live as long as humans logging some eighty-five years. Tail-less could have caused all kinds of trouble such as repetitive stress on the other joints or even drowning.

“It was putting persistent pressure on his vertebrae and could have contributed to osteoarthritis, spinal cord damage and more,” said Georgi.

The 7-foot-long Stubbs will probably require a new tail every 24 months as he grows.

Alligator Adventure to Continue?

Meanwhile Jacofsky is back to his usual working routine at The CORE Institute but as requests come in for ailing alligators across the country, he jokes that the experience may have opened up new opportunities.

“I think I may have to reinvent myself as an animal prosthetist.”

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core candid

The CORE Institute Keeping Life in Motion!

What Does ‘Keeping Life in Motion’ Mean to You Davina Mistretta, New Business Development Associate Keeping my body in motion, helps me keep my mind at rest.

Staying in motion is about health-both physical and mental.

I’ve found that when I’m not exercising, my other goals suffer as well. I’m not sure where in the process the magic is, but there is absolutely some relationship between productivity and physically staying in motion. Climbing up the mountain or just taking a walk around the building can change my perspective and get me motivated to go again. Truly, the key to my personal happiness is staying physically in motion….keeping life in motion.

core candid Erna Brigham, Hospital Coder Keeping Life in Motion is a way of life. For me, it’s staying active and healthy by exercising my mind and body. To start my day, I make sure my children are ready for school and have everything they need to start their day off right.

After, the focus turns back to me. Whether it’s a morning workout or a good song on the radio on the drive to work, I try to start off the day stress free. While at work, I focus on my job role and sharing a laugh and a smile with my co-workers. After a good dinner I exercise regularly by playing volleyball 2 – 3 times per week and I instill a workout routine that I follow when I am not playing volleyball. I keep all aspects of my life in motion which makes for a happier, healthier Haley Meyer, Physical Therapist Assistant I keep life in motion by setting challenging, but attainable, goals and working hard and pushing my body to the limit.

I train for triathlons, marathons, and duathlons throughout the year and love how much dedication it takes and how much you get to learn your physical and mental limits. One of my favorite quotes: “Life is like riding a bicycle. To keep your balance, you must keep moving,” Albert Einstein.

Rene Lucas, MD, Interventional Spine and Pain Management Physician Nothing compares to the simple pleasure of a bike ride. — John F. Kennedy

core candid

community

The CORE Institute on 3TV’s Your Life A to Z The CORE Institute takes great pride in their communities and had the wonderful opportunity to partner with 3TV’s Your Life A to Z to showcase the latest advancements in orthopedic care. This segment of Your Life A to Z featured Dr. Mehmet Oz of The Dr. Oz Show.

As Chairman and CEO of The CORE Institute, and one of the top knee surgeons in the country, Dr. David J. Jacofsky reviewed the typical signs For more information or if you have an event you would like us to participate in, please contact us at communityrelations@ thecoreinstitute.com

and symptoms that would require a hip or knee replacement and common treatments. Dr. Jacofsky also showcased the latest technology in postoperative care with the Secure Tracks® system. Secure Tracks is a ceiling mounted support system to expedite patient recovery after surgery, helping patients to walk farther and faster without the fear of falling. Look for this special segment airing until June on Arizona’s 3TV. In addition, we were honored to support the Sun Health Foundation for their donor receptions and community lecture series. In February, we provided medical coverage for the first annual Festival Fiesta Classic volleyball tour-

Dr. Mehmet Oz of The Dr. Oz Show

nament hosted at University of Phoenix Stadium. The Festival Fiesta Classic hosted over 500 local athletes and we look forward to providing medical coverage this summer to the Volleyball Festival for the fifth consecutive year.