core ink fall 2012 by LOCALiQ

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Fall 2012

A P U

C A T I O N O F T H E C O R E I N S T I T U T E

Quality benchmarking helps set standard for care

The Future of Healthcare The CORE Institute has played a major role in changing healthcare in the Valley

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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

from the Chairman

VOLUME 3, ISSUE 4 Fall 2012

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1.866.974.2673 CENTRAL PHOENIX

1820 W. Maryland Ave., Ste. 2 Phoenix, AZ 85015

GILBERT

3420 S. Mercy Rd., Ste. 200 Gilbert, AZ 85297

Mesa

1450 S. Dobson Rd., Ste. B-122 Mesa, AZ 85202

NORTH PHOENIX

2730 W. Agua Fria Freeway, Ste. 100 Phoenix, AZ 85027

PEORIA

10494 W. Thunderbird Blvd., Ste. 102 Sun City, AZ 85351

SPINE CENTER

10494 W. Thunderbird Blvd., Ste. 108 Sun City, AZ 85351

SUN CITY WEST

14520 W. Granite Valley Dr., Ste. 200 Sun City West, AZ 85375 THE CORE INSTITUTE Director, Marketing & Community Relations The CORE Institute® Allison M. Vasconcellos CLINICAL FACULTY Joshua Abrams, DO Damon Adamany, MD Robert C. Addicott, PT, MS, CSCS Sarim Ahmed, MD Krystle Alexander, PT, DPT, ATC Ali Araghi, DO Arash Araghi, DO Clifford Baker, MD Melissa Barrett, PA-C Robert D. Beckenbaugh, MD Harvinder Bedi, MD Nicholas P. Bellinaso, PT, DPT David Ben-Aviv, MD Scott Bleazey, DPM Kyle Brooks, PA-C John A. Brown, MD Mark D. Campbell, MD Eric N. Carter, PTA Robert Cercek, MD Aaron Clare, PA-C Lise Cote, ARNP-BC Amalia M. De Comas, MD Summer Dehnert, PA-C Hilary Delis, PA-C Eric Feldman, MD Benjamin Geer, MD Matthew L. Hansen, MD Lawrence Huff, Jr, MD David J. Jacofsky, MD Marc Jacofsky, PhD Sheila Janisch, FNP-BC Nathan Jeppesen, DPM John A. Kearney, Jr., MD Sarah Kocisky, PA-C Rene A. Lucas, MD Christina McKay, PT, DPT, CSCS Michael Manning, DO David Martineau, MD

Haley Meyer, PTA Mona Mhatre, MD Leonor Moncloa, PT, MPT, COMT Andrew Morchower, MD Olivia E. Morris, DO Steven L. Myerthall, MD Danial A. Neal, PT, MSPT Tony Nguyen, MD Janet Orozco, PA-C Frank Raia, MD Vimala Ramachandran, MD Guy Reyes, Jr., MD Nathan Richardson, MD Eric Robinson, MD Jason Scalise, MD Jennifer Schaeffer, RN, FNP-BC Lavon Schaffner, PTA, ATC/L Ryan Scott, DPM Scott Siverhus, MD Sylvia Spillett, PTA Matthew Stonestreet, MD Peter Strang, PA-C Geoffrey Streeter, PA-C Nicole Stoker, PA-C Mark Suchsland, PTA Travis Swift, PA-C Bradford Tenney, PA-C John Thompson, DO David Tom, MD Bryan Wall, MD Jennifer Watry, PA-C Matthew Weichbrodt, DO S. Douglas Werner, DO Stephanie Williams, PT, MSPT Christina Willman, PA-C Christina Wooldridge, PA-C Nicolas Zastrow, PA-C Michael Zwanziger, PT, DPT, CSCS

CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING FOR THE CORE INSTITUTE 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 Associate Art Director: Theresa Johnson Contributors: Emily Piraino, Alison Stanton, Jodi Tenenbaum

Healthcare is changing. Period. Even for those trying to fight it…it will change. In this edition of CORE Ink, we have focused on change. Seven years ago, founding physicians, Dr. John A. Brown, Dr. Mark D. Campbell and I brought our expertise to provide Valley residents best-in-class orthopedic care. Since then, The CORE Institute has delivered orthopedic care to hundreds of thousands of patients in Arizona and around the world. We are home to the most sophisticated motion analysis gait laboratory and a state-of-the-art biomechanics facility. Our documented, superior patient outcomes are ensured by a unique and dedicated Quality Department, which sets the benchmark in orthopedic care through evidence-based medicine and standardized protocols. In this issue, Eric Tomlon, our Chief Operating Officer, addresses five key areas of the future of The CORE Institute and healthcare: Co-Management, Medicare Savings and Healthcare Reform, Electronic Medical Records, Accountable Care Organizations, and Health Information Privacy. In addition, our Executive Vice President of Quality and Clinical Care, Sarah Kocisky, PA-C, discusses quality benchmarking and what that means for you, your family and your community. As you may know, in 2011 we brought you news of a joint venture between The CORE Institute and Banner Health. We are pleased to announce that the Banner CORE Center for Orthopedics is not only at Banner Del E. Webb Medical Center, but has now expanded its services to additional locations at Banner Thunderbird Medical Center and Banner Desert Medical Center. This partnership between Banner Health and The CORE Institute is dedicated to delivering innovative, revolutionary orthopedic care to patients from around the world. By partnering with hospitals, The CORE Institute is able to expand the services we offer to patients and enhance the patient experience by focusing on the entire continuum of care, from their first visit with the physician through their return to keeping life in motion. The future of healthcare will require such partnerships. We have cared for patients from all 50 states and many countries. We pride ourselves on superior outcomes and great care…every patient, every time. On behalf of all of our physicians, providers and staff, The CORE Institute appreciates your continued support. Keep Life in Motion!®

avid Jacofsky, M.D. D Chairman and CEO

Cover Story

The Future of Healthcare The CORE Institute spotlights hot topics that are changing the face of the healthcare industry in 2012. PICTURED LEFT TO RIGHT: Dr. Mark Campbell, Dr. David J. Jacofsky, Dr. John Brown and COO, Eric Tomlon.

Ta b l e of Contents Departments What’s New?

8: What’s new at The CORE Institute? How about 24/7 scheduling!

Specialty Spotlight

Patient Care

9: Helping get an athlete back on the field.

Specialty Spotlight

10: Meet Dr. Bryan Wall, Shoulder Surgeon and The CORE Institute Arizona Market President.

Ask The Expert Research

11: Concerned about having a knee replacement? Dr. Steven L. Myerthall helps expain how it works.

Research

20: The MORE Foundation brings advances in orthopedic care through innovation and technology.

Community Relations

In the Community

10} Cubital Syndrome

21: The CORE Institute provides on-site medical care for more than 6,000 volleyball players.

CORE Candid

22: The CORE Institute is “Best Places to Work.”

18} Secure Tracks

19} High Standards

Innovative New Rehabilitation

Quality Benchmarking

Features The “Other” Tunnel Syndrome

What’s new at THE CORE Institute

Introducing 24/7 Appointment Scheduling! Making a doctor’s appointment can become stressful and often times difficult due to the restricted business hours of the eight to five. Look no further, The CORE Institute is making it easier for you to schedule an appointment, 24 hours a day seven days a week, simply by calling 866.974.2673. Based upon feedback from our patients, we have recently expanded our appointment service allowing you to schedule your

appointment at your convenience, anytime, anywhere. Adopting technology and improving efficiency of our services is always top of mind. Thank you for your feedback! We look forward to continuing to serve you, your family and our community.

“Schedule appointments 24/7! Yes, 24/7 every day of the year!”

DEPT HEDDER PATIENT CARE HERE

Patient Gets ‘Super’ Care Christine O’Hayre is back playing soccer thanks to The CORE Institute.

on an overturned rug during a middle of the night visit to the bathroom. After hurrying in to assist his wife, Phillip Payne noticed right away that Edith’s right shoulder did not look right. He rushed her to the emergency room, where a physician took x-rays that showed a bad break that would probably require surgery to repair. During an appointment with her own physician the following day, Edith was referred to Dr. Arash Araghi at The CORE Institute. After reviewing the x-rays, Dr. Araghi confirmed that Edith would need surgery, which he scheduled at Banner Del E. Webb Medical Center in Sun City West. “He had to put in a steel plate and some screws into my shoulder after a second procedure to relieve some swelling and some fluid buildup. I seemed to be on the mend,” Edith said. “I’m healing pretty well and have a good range of motion.” Both Edith and Phillip were impressed with the kindness and knowledge that Dr. Araghi showed during the entire process. “He was very nice and he answered all of my questions” Edith said, adding that she was pleased that The CORE Institute assisted in scheduling her physical therapy sessions. As far as Phillip is concerned, the only thing that Dr. Araghi lacks is a new uniform that he can wear while treating his patients. “All he needs is a red cape and a white spandex suit with a ‘superhero’ icon across his chest,” Phillip said. The CORE Institute really does Keep Life in Motion!

EMILY PIRAINO

In early July, Edith Payne tripped

The CORE Institute Gets Athletes Back On The Field By Alison Stanton

On July 15, 2011, Christine O’Hayre broke her ankle while playing in a competitive co-ed indoor soccer game. After falling to the ground in tremendous pain, O’Hayre was taken to the emergency room, where she was told she would need surgery to fix the break. O’Hayre’s boyfriend, who was familiar with The CORE Institute, suggested that she go there for help. O’Hayre, a Glendale resident, arrived at The CORE Institute feeling nervous, in pain, and hoping that she could avoid surgery. She met with Dr. Tony Nguyen, whose helpful and kind personality immediately helped set her mind at ease.

“Dr. Nguyen ordered various films to be taken of my ankle. He made his assessment, and advised me that I really needed surgery,” O’Hayre said. “He was very patient in answering all of my questions. I admired the fact that he’s an athlete himself, and he truly understood the agony of having an injury. Dr. Nguyen’s goal for me was to play soccer again without any restrictions.” Seven months after undergoing surgery, O’Hayre returned to the soccer field. She is thankful that her ankle is fully healed, and extremely grateful for Dr. Nguyen’s dedication and loyalty in helping patients who have suffered an injury—especially athletes. “Thank you, Dr. Nguyen,” O’Hayre said. “I’ll never forget you!”

specialty spotlight

Meet Dr. Bryan Wall The CORE Institute Vice Chairman and Arizona Market President

By Alison Stanton

The CORE Institute is pleased to announce Dr. Bryan Wall now serves as Vice Chairman and Arizona Market President. Wall is a boardcertified and fellowship-trained specialist in arthroscopic and reconstructive surgery of the shoulder, including reverse shoulder arthroplasty. His dedicated skill set and outstanding academic record have made him one of the leading shoulder specialists in the nation and was named the 2007 recipient of the prestigious “Mel Post Award for Excellence in Clinical Research” by the American Shoulder and Elbow Surgeons (ASES). Wall noted that The CORE Institute is currently focused on working closely with hospitals to deliver new systems that will help them collaborate with each other and increase patient satisfaction. “In addition, we are continuing to expand our presence in the Phoenix market,” Wall said. “We have a high quality, unique orthopedic healthcare delivery system in this area and we want to reach as many patients as possible.” In order provide the entire state of Arizona and beyond access to the best possible physicians and care, Wall said. The CORE Institute is actively working on recruiting even more highly trained specialists to its facilities. As for the future of healthcare, Wall said he believes it will definitely be

“

Our goal is improved patient satisfaction and exceptional care… every patient, every time.”

different, regardless of what happens in Washington, D.C. “In 12 to 18 months, if the current healthcare reform goes on as planned, or even if something else ends up taking its place, there will be a significant difference,” he said. “We believe that we have a healthcare system that is not necessarily sustainable at the national level in its current form. The future will be about quality benchmarking and proving superior outcomes. We believe this positions The CORE Institute perfectly going forward, as we have had a progressive quality program here since inception.” Whatever eventually takes place with healthcare, Wall said quality outcomes will become more important than ever. “For example, both private insurers and the government do not necessarily want to pay for care that is overly costly due to high rates of complications, or care that is not comprehensive and integrated,” he said. “They will be looking more for quality of care and providers that are confident enough in their outcomes to take financial risk for things like poor results and re-operations. The CORE Institute has been forging a path for this type of reimbursement with both Medicare and some private payers for quite some time, and as such, will help lead these changes. Our goal is improved patient satisfaction and exceptional care…every patient, every time.”

www.thecoreinstitute.com

ASK THE EXPERT

Knee Replacement New Techniques Available For Knee Replacement Surgery By Steven L. Myerthall, M.D., Orthopedic Surgeon at The CORE Institute

QUESTION: I am a 64-year-old male former collegiate football player, male and have been concerned for a number of years about 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?

ANSWER:

ORTHO FACT:

Currently, there are greater than 350,000 knee replacements performed annually in the United States, with that number expected to increase as the population ages and demands a more active lifestyle.

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, when used at the time of surgery, they allow for more accurate bone cuts, thereby optimizing the size and placement of the prosthesis. If conservative treatment, such as physical therapy, medication or other treatments have 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.

Total knee replacement provides pain relief to individuals with knee pain related to any form of arthritis, 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 orthopedic surgery allowed surgeons to improve the accuracy in which implants were positioned at the time of surgery. This technique utilizes intraoperative measurement to “map” the patient’s bony anatomy and to “navigate” the position of the bone cuts. Within the past few years, the introduction of ShapeMatching 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 routine X-ray examination. Then, using sophisticated 3-D software, Medical Illustration © 2012 Nucleus Medical Media, Inc., www.nucleusinc.com

COVER

The CORE Institute and the Future of Healthcare The CORE Institute spotlights hot topics that are changing the face of the healthcare industry in 2012 By Eric Tomlon |

The CORE Institute Chief Operating Officer

Is there another topic among Americans as polarizing as our health, and its future? As our nation undertakes an evaluation and potential overhaul of healthcare legislation, The CORE Institute will remain progressive and forthright in its approach to delivering the best in clinical medicine, research, education, payment reform strategies and health system integration. Hereâ&#x20AC;&#x2122;s a look at five major factors that will affect the public in the coming months, and the role The CORE Institute will play in changing the landscape of healthcare.

www.thecoreinstitute.com

The CORE Institute and the Futur e of Healthcar e

Co-management

The CORE Institute is aware of the political complexity of healthcare, and it’s the company’s intention to lead the way in payer-reform strategies for its patients. One of those avenues is co-management. As you may have heard, The CORE Institute will embark on a new journey in service line development. We are excited to announce that the Banner CORE Center for Orthopedics is expanding to Banner Thunderbird Medical Center in Glendale and Banner Desert Medical Center in Mesa. The Banner CORE Center for Orthopedics, which originated at Banner Del E. Webb Medical Center, offers a hospitalphysician alignment strategy through co-management of the musculoskeletal service line. In 2011, The CORE Institute and Banner Health joined together to form a partnership offering a unique delivery system of innovative, revolutionary orthopedic care with a focus on the early deployment of new research tools, innovative technologies, evidenced-based care and standardized protocols. Patients who seek orthopedic surgery, experience an integrated continuum of care from preadmission, through the surgical environment, acute-care stay, and inpatient rehab and outpatient therapy. Care coordination, clinical metrics and standardized protocols will be uniform for patients in the program. Its mission: “The Banner CORE Center for Orthopedics is a world-class partnership providing transformational patient care through evidenced-based outcomes, innovation and collaboration.”

Key focus on orthopedics Many service lines will be critical to patient care in the hospital setting, including cardiology and oncology. Orthopedics is particularly important for many reasons, some of which include: • Joint replacement demand is expected to continue to grow at a rapid rate for the next 20 years. • According to a study published in the March 2010 edition of The Journal of Bone & Joint Surgery, the demand for orthopedic services will, in the near future, reach epidemic proportions. Consider the following statistics:  Number of hospital admissions for hip fractures is 350,000 annually; this number is expected to double by 2050.  Number of femoral neck fractures annually is 250,000; this number is expected to reach 500,000 by 2040.  By 2030, the number of people over age 45 will increase by 37 percent.  The number of people 65 or older increased 74 percent between 1998 and 2005, and is expected to increase 104 percent from 2000 to 2030.  Right now, Baby Boomers comprise 26 percent of the U.S. population (78 million). By 2030, 60 percent will have more than one chronic condition; 50 percent (26 million) will have arthritis; and more than 33 percent will be obese (a major risk factor for osteoarthritis).  Between now and 2020 the demand for orthopedic services in the US will increase by 23 percent, far faster than the number of newly trained surgeons. Source: “Knee Replacement in the United States: Preparing for an Epidemic,” Iorio, R. et al. J Bone Joint Surg Am. 2008; 90:1598-1605

• Orthopedic procedures are expected to see a tremendous growth between 2010 and 2030 — knee replacements by more than 600 percent; hip replacement by more than 200 percent. Other orthopedic services — spine, back, sports medicine and diagnostic — are also expected to see significant growth. Source: Future of Orthopedics: Strategic Forecast and Investment Blueprint, 2008 The Advisory Board

• Banner Health agrees with

experts that an alignment through co-management models will help physicians and hospitals improve outcomes, reduce cost and improve efficiency in order to prepare for bundled payment programs as they roll out next year. Because of the changing face of healthcare, the Banner CORE Center for Orthopedics has chosen to work within a platform that will accommodate new payer strategies, including bundled payments, Accountable Care Organization structures and pay-forperformance models. Our physicians, therapists, nurses, industry partners, payers and health-system administration will be focused on this effort with the patient and family at the center. Through co-management, orthopedic surgeons participating in the program will benefit from increased collaboration and participation in the design, management and monitoring of hospital services as well as coordinated achievement of quality performance metrics based on the performance of the entire department. This is a great opportunity for physicians and the hospital to work together, toward quality improvement, and to share in the rewards of improved efficiency. We are excited about this new venture and we invite you to learn more about our Banner CORE Center team at bannercorecenter.com

2 3

The CORE Institute and the Futur e of Healthcar e

Medicare savings, healthcare reform

According to the Centers for Medicare and Medicaid Services actuary report in April, Medicare will save $200 billion through 2016 — largely attributed to healthcare reform. Medicare beneficiaries also will save $208 billion through 2020, USA Today reported. Earlier in the year, the Supreme Court heard arguments on the Constitutionality of new Patient Affordable Care Act. Both sides argued the issues that’s at the very heart of healthcare reform debate: Can the government force Americans to buy health insurance? It will remain to be seen how our society will wrestle with the fundamental question – is healthcare a right, or a privilege? State governments are designing new delivery systems utilizing ACOs, medical homes and other mechanisms offered by CMS. Clearly the election in 2012, and the policy determination after the fact will answer some, but not all questions. The CORE Institute believes true savings come from a focus on clinical quality, patient safety and evidence-based medicine – reducing errors and waste in the healthcare system. Regardless of what happens in Washington, The CORE Institute’s focus will always be the best in clinical care — and our organization will work with local and national legislatures to make sure that our patients have access to the best in sub-specialty orthopedics. We will endeavor to work with our government and managed care partners on payment reform strategies until we have exhausted all of our efforts.

Electronic Medical Records

Recently, The CORE Institute has been under construction. We implemented GE Centricity as our Electronic Medical Record in 2011 and begin submitting for Meaningful Use attestation according to federal benefit requirements. This was a huge undertaking for our organization by completely changing the way we document all our patient encounters. If during your recent visit we have appeared to be focused, and in some cases delayed, we are very sorry. However, we are convinced the outcomes for better patient management and accuracy will be worth the implementation efforts. As you may or may not know, healthcare providers will be required to have an electronic medical record. The CORE Institute is ahead of the curve. The U.S. government has set an aggressive goal for the healthcare industry, ensuring every American has an electronic healthcare record by 2014. As healthcare reform takes shape over the next several years, hospitals and healthcare providers will need to embrace the concept of transitioning from paper charts to electronic data bases that house clinical and demographic information, thereby replacing the old paper chart. An EHR system allows for quick and easy access to patient records and a rapid transfer of information from physician to physician, pharmacies and other departments within an organization. In lifethreatening situations, electronic information is easier to process and deliver. Electronic data can eliminate potential errors in handwriting and multiple transcriptions. Moreover, by avoiding multiple

entries, hospitals and physician groups can increase efficiencies and streamline operations, allowing the focus to shift from heavy clerical tasks to more mission-critical tasks. Most importantly, electronic databases allow us to more easily record and monitor clinical data. At The CORE Institute, we take great pride in benchmarking our performance, both internally and externally. By utilizing data warehousing and easily reporting clinical metrics, our physicians can better monitor performance and reduce variation by utilizing realtime information, and accurate clinical data derived from electronic data input — versus waiting for manual tabulation. This will be a tremendous help to our continual quality improvement efforts. Thank you for your patience while we implement this important improvement opportunity.

Accountable Care Organizations

For those of us who recall the “managed care” of the 1980s and HMO’s entrance into the healthcare industry, ACOs or accountable care organizations, may look familiar. At a high level, these entities are designed to align physicians and hospitals in groups that pool their resources with the goal of trimming spending while boosting the quality of care. ACOs are new in their currently defined legal form; however, there are few in existence already on the East Coast. In Arizona, you may have heard that Banner Health Network, Dignity Health Network and John C. Lincoln Health Network will all embark on ACO strategies. The CORE Institute will participate in an ACO arrangement with the Banner Health Network, Arizona Integrated Physicians through its

www.thecoreinstitute.com

The CORE Institute and the Futur e of Healthcar e MediSun partnership, and Banner Physician Hospital Organization. The plan is designed to provide a quality network of participating providers with highly coordinated care for Medicare and commercial insurance beneficiaries. As reported on Banner Health Network’s website, “(BHN) is comprised of Banner Health-affiliated physicians, 13 acute-care Banner hospitals (12 in the Phoenix metro area), and other Banner services in Arizona. Nonprofit Banner Health is Arizona’s largest healthcare provider. The network will ensure convenient access to Medicare beneficiaries and others with more than 2,600 Banner-affiliated physicians located throughout Maricopa County and into Pinal County.” This ACO, like other accountable care organizations, accepts patient care and financial accountability for those served by the network. It is one of a few networks in Arizona serving patients in a population healthmanagement model. This model offers a highly coordinated patient experience through a primary care setting that seeks to improve patient outcomes, provide more effective management of chronic care and emphasize wellness. A key result of this patient-centered model will be higher efficiency that will result in reducing costs.

Health Information Privacy

One of the hottest topics besides healthcare reform is patient privacy. As a society, we typically believe that our medical and other health information should remain private and protected and we would like to know who has access to this information. There are federal laws that protect this information. The Privacy Rule, a

federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information; whether in electronic, written or oral form. The Security Rule, a federal law that protects health information in electronic form, requires entities such as physician offices covered by Privacy Rule to ensure that electronic-protected health information is secure. Health plans, and most healthcare providers including hospitals, must all comply with these regulations. Information that is protected includes information your healthcare providers placed in your medical record, including conversations, treatment plans, x-rays, and demographics related to your personal information. Healthcare providers must put appropriate safeguards in place to protect your health information and reasonably limit uses and

disclosures — “minimum necessary” for healthcare operations purposes. If healthcare providers have arranged to share protected health information for the business of healthcare operations, its vendors must also comply with those same regulations. Healthcare providers must have solid policy and procedures and training programs on Privacy and Security to provide guidance and set standards for privacy protection and security. The CORE Institute takes your privacy very seriously. We are constantly monitoring our compliance and safeguards related to this endeavor. Although these laws are often changing and interpretation can be cumbersome, it is our intent to always meet this important obligation. For more information on our privacy standards, see our Notice of Privacy Practices online at thecoreinstitute.com.

DEPT HEDDER CUBITAL TUNNEL HERE SYNDROME

Cubital Tunnel: The “Other” Tunnel Syndrome Understanding the difference betwenn the two disorders and how they are treated By David Martineau, M.D., Hand & Upper Extremity Surgeon at The CORE Institute

Most people have heard about, or experienced, carpal tunnel syndrome

Treatment of cubital tunnel differs from carpal tunnel in their location, but the principles are similar.

(see CORE Ink Summer 2008). This condition is the result of pressure on the median nerve at the wrist, causing numbness and tingling into the thumb, index, long and half of the ring finger. It is often worse at night and with activities such as driving a car or talking on the phone. Many ask about the same symptoms involving the small finger and half of the ring finger — this may be cubital tunnel syndrome.

How to know Cubital and carpal tunnel syndromes are similar in many ways: They are the result of pressure on a nerve. Symptoms include temporary numbness and tingling, which can cause weakness in the hand and the symptoms are often worse at night. The differences,

however, are important to distinguish. As noted above, the location of the symptoms is critical. Numbness and tingling into the small finger and half of the ring finger is characteristic of compression on the ulnar nerve. In cubital tunnel syndrome, the ulnar nerve is being compressed as it courses along the inside of your elbow

Cubital Tunnel: The “Other” Tunnel Syndrome behind your “funny bone” (medial epicondyle). The diagnosis is based on the history of symptoms, along with a physical exam. Your doctor will check for carpal tunnel at the same time. Tapping over the various nerves may illicit tingling into their respective targets (positive Tinel’s sign). In cubital tunnel syndrome, tapping over the inside of the elbow will result in tingling into the small and ring fingers. Your doctor will often hold your elbows bent to try and illicit numbness and tingling in the small and ring fingers. If positive, the diagnosis of cubital tunnel syndrome is further considered. In severe cases, inspection of the hands will reveal wasting of the muscles and weakness in the fingers. With the aforementioned clinical history and physical exam, your doctor will recommend an EMG/Nerve Conduction Study. This helps to not only confirm the diagnosis, but also assesses its severity.

Treatments Although cubital tunnel differs from carpal tunnel in its location, the principles for treating both these conditions are similar. Efforts will be made to keep pressure off the nerve by keeping the elbow straight, especially at night, with some form of brace or elbow pad. Antiinflammatory medication may also help. These measures may be beneficial so long as the condition is not deemed severe with evidence of nerve damage including weakness, wasting and/or nerve study changes. If conservative measures fail and/or you have severe findings, surgery is an option, which can be performed on an outpatient basis. First, an incision is made along the inside of your elbow. Next, the nerve is identified, protected and the constricting structures are released from mid-arm down to the upper forearm. Occasionally the nerve may be “transposed” or moved in front of the medial epicondyle. This can be done routinely, or if unstable, after release. It can be moved under the skin

(subcutaneous), within the muscle, or under the muscle (sub muscular) in the forearm. The wound is closed with stitches that dissolve under the skin and a soft bandage or splint is applied. Most people notice immediate symptom relief, but full recovery often depends on the severity of symptoms prior to surgery. Please consult a CORE specialist if you are experiencing any of these symptoms.

SECURE TRACKS

“Secure Tracks allows patients to stand completely upright and walk with a natural gait without using a harness, gait belt, or walker.” — Les Dace, Chief Executive Officer, Secure Tracks.

Keeping Patients’ Recovery ‘On Track’ Les Dace, Chief Executive Officer, Secure Tracks

Patients recovering from hip or knee surgery can now rehabilitate faster and more safely by using an innovative new

Innovative new rehabilitation device speeds hip, knee surgery recovery

device recently made available to hospitals and rehabilitation centers all over the country. This new device, called Secure Tracks, consists of a ceiling-mounted monorail track, a patented trolley and a U-shaped patient support system. “Secure Tracks allows patients to stand completely upright and walk with a natural gait without using a harness, gait belt or walker,” says Les Dace, Chief Executive Officer at Secure Tracks. To see how the device would potentially aide in patient recovery, a six-month clinical study was conducted with Banner Del E. Webb Medical Center and Banner Sun Health Research Institute in collaboration with The CORE Institute. The first installation took place at Banner Del E. Webb Medical Center, where early on, the potential for patient safety and recovery was evident. During the study, hundreds of patients were monitored and investigated to determine the differences between patients using the Secure Tracks system versus the traditional walker. The study revealed that patients who used the Secure Tracks system instead of a conventional walker walked up to

152 percent farther, 45 percent faster, demonstrated a more normal gait, experienced less post-surgical pain and healed more quickly. For patients who undergo lower extremity surgery, these findings were truly groundbreaking. “The time to ‘up and go’ demonstrated by patients at their two-week follow-up visit was significantly reduced, and the pain was reduced because they got active sooner,” says Sarah Kocisky, PA-C, Executive Vice President of Quality and Clinical Care at The CORE Institute. “Our physicians are extremely happy with the outcomes.” When using a traditional gait belt and walker, many hospitals need the use of two physical therapists to walk only one patient, particularly when larger or higherrisk patients are involved. The Secure Tracks device actually takes the place of the second therapist, allowing the remaining therapist to monitor the patient’s gait, instead of focusing simply on holding the patient up. “Some hospitals have lifts that roll down the corridor and lift the patient out of a wheelchair, but those devices are solely used for lifting, not therapy,” Dace says. “Secure Tracks is the only rehabilitative device of its kind.” For more information or to see Secure Tracks in action, visit securetracks.com.

www.thecoreinstitute.com

QUALITY BENCH MARKING

Best-in-Class Quality benchmarking helps set standard for care By Sarah Kocisky, PA-C Executive Vice President, Quality & Clinical Care, The CORE Institute

The CORE Institute is committed to providing bestin-class orthopedic care. We set the standard in orthopedic care for patients by pioneering new research tools, innovative technologies, evidence-based care and standardized protocols. Our physicians are all held to a series of quality metrics. By using standardized protocols centered on evidencebased research, we ensure that our physicians are practicing world-class medicine and that the best outcomes for patients are achieved. “Through quality benchmarking and management, we provide patients the comfort of knowing that we have done our research to ensure we have limited complications that can occur during and after surgery.” — Sarah Kocisky, P.A.-C

Over the last six years, The CORE Institute has invested millions of dollars, and a great deal of time, tracking various quality benchmarks related to patient outcomes. Through quality benchmarking and management, we provide patients the comfort of knowing that we have done our research to ensure we have limited complications that can occur during and after surgery. Our Quality department monitors our practice’s risk for post-operative blood clots and continually evaluates patients risk of infection by ensuring a sterile environment. Our ongoing improvement efforts support an environment of patient satisfaction. All CORE physicians are ranked and graded against national averages and continue to practice evidence-based medicine. As healthcare changes and advances, our data collected will become instrumental as The Center for Medicare Services (CMS) begins to ramp up the quality reports about physicians and their outcomes. Over the next few years, CMS will require physicians to report their complications as well as patient satisfaction. As always, The CORE Institute remains at the forefront in orthopedics, providing best-in-class patient outcomes… every patient, every time.

RESEARCH

The MORE Foundation Brings Advances In Orthopedic Care Through Innovation and Technology Team includes world-class researchers, scientists and surgeons By Allison Vasconcellos, Director, Marketing and Community Relations, The CORE Institute

The MusculoskeletalOrthopedic Research and Education Foundation was founded in 2008 to support ongoing research, education and community outreach while aiding the prevention and treatment of disease in the field of orthopedics. Since 2008, the MORE Foundation has pioneered innovative orthopedic programs, developed new technologies and spearheaded breakthrough research to advance the understanding of orthopedic care. The MORE Foundation’s mission is to promote innovation in the field of orthopedics and encourage access to education for medical professionals and community members in Arizona and around the world. The support and resources provided by the MORE Foundation are invested in orthopedic research and outreach programs to benefit the community. Initiatives include pursuit of technological and scientific advancements, new medical technologies, capital projects and expansion of preventative care education.

Since 2008, the MORE Foundation has pioneered innovative orthopedic programs, developed new technologies and spearheaded breakthrough research to advance the understanding of orthopedic care.

share musculoskeletal clinical advancements and improvements to standard of care. The MORE Foundation supports a team of world-class researchers and scientists that collaborate with fellowshiptrained orthopedic surgeons and dedicated professional staff specializing in orthopedic hip, knee, shoulder, wrist, hand and elbow procedures, sports medicine, arthroscopy, fracture management, pain management, comprehensive spine care and joint replacement. In addition, the MORE Foundation is home to a sophisticated motion analysis gait laboratory and With assistance of donations, state-of-the-art biomechanics facility. It is staffed by the MORE Foundation is able to: bioengineers and scientists with specialties in an array Inform the public about disease prevention and treatment through community relations events, lectures of biomechanical areas including: musculoskeletal anatomy, gait and motion analysis, the mechanical and workshops, and collaborate with other reputable non-profit organizations to deliver important information testing of orthopedic devices and implants, and sports performance. The CORE Institute supports the MORE to community members. Offer orthopedic care for patients unable to afford it by Foundation and its physicians may participate in clinical studies using their expertise in orthopedics, including funding elective or uncovered services on a case-bysurgical procedures and device design. This provides case basis. a vibrant research community for clinical orthopedic Advance the prevention and treatment of orthopedic and musculoskeletal disease by aiding the underwriting studies and biomechanical research. Contributions are used to further orthopedic education, of cutting-edge research and studies to benefit patients research and patient care in Arizona and around the world. and their families. The orthopedic research labs are structured under a non Extend our knowledge to healthcare professionals profit, 501(c)(3) organization. As such, the MORE Foundation in Arizona and around the world to improve patient outcomes as well as sponsor multirelies on external funding for its orthopedic research studies. disciplinary educational events for physicians to For more information, visit more-foundation.org

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www.thecoreinstitute.com

IN THE COMMUNITY

The CORE Institute Provides On-site Medical Coverage For Athletes Phoenix is named home to the Volleyball Festival that took place at the Phoenix Convention Center this past summer. Club volleyball teams from around the world came to play, including Arizona hometown favorites as well as near and far reaching places like California, Illinois, Texas, New Mexico, Washington, Virginia, Idaho, American Samoa, Alaska, Puerto Rico, Canada and Brazil. Phoenix welcomed 540 teams, 6,000 athletes, 1,500 parents, 2,000 coaches, 110 officials, 60 sports medicine professionals and 60 administrative personnel. Continuing to serve the Valley and the Volleyball Festival, The CORE Institute, headquartered in Phoenix, donates their time to provide on-site medical coverage for athletes.

The Phoenix Convention Center transforms to create 107 courts for play and plenty of hospitality accommodations for youth athletes and parents. The Volleyball Festival enlisted the largest integrated orthopedic group in Phoenix, The CORE Institute to help make the Volleyball Festival a safe and successful event. Since the Volleyball Festival made Phoenix its home in 2009, The CORE Institute has contributed not only administrative time, but family practice and orthopedic physician coverage each day of the festival as well as all the medical supplies. The CORE Institute and the Volleyball

Festival have a great history together and look forward to many years to come, caring for these great athletes. For more information, please visit volleyball-festival.com.

CORE CANDID

The CORE Institute: A ‘Best Place to Work’ World-class organization, world-class employees make the difference By Alison Stanton

In 2011, The CORE Institute received an award naming it one of the Best Places to Work by the Phoenix Business Journal. Offering employees a supportive and positive work environment that values teamwork and communication and at the forefront of patient care. Three employees — Diane Harms, Tasha Greene and Mark Sayo — recently expressed what they like about working at the world-class facility. Harms has worked at The CORE Institute for almost seven years. Starting out as the facility’s first triage nurse, she moved into the role of Clinical Care Manager about five years ago. She spends her days overseeing the Triage Department’s staff of five employees.

“I thoroughly enjoy my position here at The CORE Institute as I have had the opportunity to grow with the company,” Harms says. “I work with loyal and caring physicians and co-workers who are like a family to me. We care about each other, we care about our patients and it has shown by the growth we have experienced.” Greene, who has worked for The CORE Institute for six years, said she thoroughly enjoys the teamwork and sense of camaraderie she shares with other employees. “There is a level of integrity, unity and accountability at our company,” she says. “We are all on one team with one common goal…to improve care for our patients, their families and our community.” Sayo is one of five triage nurses on a

team managed by Harms. He recently celebrated his one-year anniversary with The CORE Institute, and said he couldn’t be happier to work there. “The number one thing that comes to my mind when I think about my job is the people I work with, in both administration and the clinics,” he said. “Everyone performs their job based on The CORE Institute’s overall mission, defining the standard of patient care. I love working for a company that is continuously growing and is the leader in orthopedic patient care across the United States.” With best-in-class patient care at the center of all they do, The CORE Institute lives up to their reputation in the community, not only with their patients but with their employees as a best place to work in the Valley.

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