St Louis Medical News September 2015

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PHYSICIAN SPOTLIGHT PAGE 2

Mohamed Zayed, MD, PhD ON ROUNDS

Saint Louis University Hospital Makes Recovery Easier with Catheter-Less Prostatectomy Sameer Siddiqui, MD, Brings Procedure to St. Louis

By LyNNE JETER

Fifth Third Bank is Launching Third SU2C Campaign More Than $4.2 Million Has Been Raised Nationwide Several years ago when Dawn Van Houten’s mother was diagnosed with breast cancer, the family rallied to investigate treatment options. After more than a year of doctor visits, chemotherapy and radiation, they were ecstatic when she was reported cancer-free ... 3

No Relief for Allergy Sufferers Nasty Allergy Season ‘Getting Worse’ Everywhere Some might see some encouraging news in finding out that St. Louis has dropped from No. 20 in last year’s ranking of Spring Allergy Capitals to No. 25 in the recently released 2015 ranking of cities considered as the most challenging places to live for people with allergies ... 5

Sameer Siddiqui

(CONTINUED ON PAGE 4)

WHO’S TENDING OUR DOCTORS?

The AMA Steps Up with STEPS Forward Ambitious New Initiative Offers Physicians Strategies to Revitalize Medical Practices and Improve Patient Care

By LyNNE JETER

Editor’s Note: This article is part of a Medical News exclusive series, “Who’s Tending Our Doctors?” to focus on ways the industry can help alleviate physician stress and allow physicians to return to the joy of practicing medicine.

Several years ago, Christine A. Sinsky, MD, FACP, made two significant timesaving changes to her practice life that allowed her to leave work sooner and have more time for family and personal interests.

The first: taking a streamlined approach to prescription management.

Second: taking proactive planned care measures with patients via previsit (CONTINUED ON PAGE 4)

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Visit after follow-up visit, urologist Sameer Siddiqui, MD, listened empathetically as prostate cancer patients voiced the most difficult aspect of recovery from a radical prostatectomy. Eating, drinking and walking didn’t present significant post-operative problems. Instead, the greatest stressor involved another obstacle.

“The number one complaint from prostate cancer patients is having to deal with a penile catheter for up to two weeks after surgery,” said Siddiqui, SLUCare urology chief at Saint Louis University (SLU) Hospital. “Wives coming in with their husbands say they’re miserable, and very excited about getting that catheter out.”

To make radical prostatectomies more comfortable post-operatively for prostate cancer patients, Siddiqui began performing a new surgical option – a catheter-less

From industry conferences and continuing educational units to fun ways to support the area’s many non profits ... check the online calendar for healthcare happenings. www.StLouisMedicalNews.com

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SEPTEMBER 2015

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PhysicianSpotlight

Vascular Surgeon Works to Both Provide State-of-the-Art Care and Define It Clinical and Laboratory Efforts Complement Each Other

By LUCY SCHULTZE

How can you decrease the chance a diabetic patient will need a limb amputated?

What’s the best way to break up a dangerous blood clot in a patient who can’t tolerate invasive surgery? Which new device will best remedy a complex aortic aneurysm?

It’s questions like these that fuel the motivation of Mohamed Zayed, MD, PhD, as he dedicates his efforts in both the operating room and the science laboratory. His goal is not just to provide state-of-the-art care, but also to help define it.

“I feel very fortunate to be able to provide novel therapies to patients who would otherwise have limited options,” said Zayed, a vascular surgeon at Barnes-Jewish Hospital and assistant professor at Washington University School of Medicine.

Since joining Barnes-Jewish Hospital in 2014, Zayed has developed a diverse clinical practice that ranges from treating young patients with straightforward issues to older ones with severe life-threatening co-morbidities.

“My practice allows me to treat patients with a variety of vascular disorders,” he said. “I enjoy being able to operate across the full spectrum of the venous and arterial systems, and to be able to help patients from

all walks of life.”

At the same time, Zayed’s clinical investigatory appointment at Wash U allows him to devote considerable time to research.

His basic science laboratory is based in the Division of Endocrinology, Metabolism and Lipid Research, and he has received support from the Society of Vascular Surgery Foundation and the Vascular Cures Foundation.

His award from the latter, the Wylie Scholar Award, is granted to only one vascular surgeon in North America each year.

“The focus of my laboratory is to look at mechanisms that make diabetic patients more prone to peripheral arterial disease,” Zayed said. “Unfortunately, in that subset of patients, the peripheral arterial disease is much more prevalent than the general population and leads to significant life-altering complications.”

Working as a physician scientist at a leading institution is the realization of a long-held ambition for Zayed.

Born in Egypt, he and his family moved to England and ultimately to the United States, as his father completed a PhD at the University of London followed by a postdoctoral fellowship at the University of California, Berkeley. His father, Adel, has since led a research career in plant physiology and biochemistry.

“I used to visit my father’s laboratory as a child,” Zayed said. “I ultimately decided I wanted to be a scientist just like my father.”

That focus was refined during Zayed’s freshman year at the University of North Carolina at Chapel Hill when his father suffered a heart attack. Zayed became interested in medicine, and particularly in vascular biology. He was accepted into a medical scientist training program (MD/ PhD) at UNC, sponsored by the National Institutes of Health (NIH). During his PhD

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research in pharmacology, he studied the molecular processes that help blood-vessels development. Meanwhile, he connected with several vascular surgeon mentors at UNC, sealing the choice for his clinical focus.

“I also wanted to be like my mentors,” he said. “They were caring clinicians, but they were also thoughtful scientists. They were interested not only in treating the disease process, but also further understanding it in a way that can promote health in a larger set of patients.”

Zayed opted to do a full five-year residency in vascular surgery, selecting Stanford University for its program’s particular blend of medicine, science, and engineering.

“My training not only involved learning how to take care of patients and perform complex operations, but was also molded with opportunities for research and collaboration,” he said. “While I was in Palo Alto I also had the chance to serve as chief medical officer in a medical-technology company, which was truly a unique time of growth and development for me.”

Since arriving in St. Louis, Zayed has gotten his lab rolling with the mentorship of Dr. Clay Semenkovich, Washington University School of Medicine Chief of Endocrinology, and with recent grant funding.

This has helped create the Translational Cardiovascular Biobank & Repository program between Wash U and Barnes-Jewish Hospital.

“With support from the Department of Surgery, we have been able to restructure a protocol to allow patients coming for a vascular operation, to donate their plaque so that we can molecularly and biochemically study it in the laboratory,” he said.

“This provides a huge opportunity for us as surgeons to be able to study the underlying processes that lead to these diseases in the first place.”

In one current study, Zayed’s lab is identifying the molecular and biochemical causes of severe vascular disease in the lower extremities of diabetics.

“In my practice, unfortunately, I do at least one amputation a week,” he said.

“This is a disheartening process, as the limb has not been able to be saved. Obviously, we would like to preserve the limbs and make sure our patients maintain their functional capabilities.”

Zayed’s lab has generated preliminary findings that show differences between the lipid structure of plaques in diabetics versus non-diabetics. The lab is currently studying enzymatic pathways that regulate these lipids, to learn how they can be targeted therapeutically.

In his clinical practice, Zayed has been involved in implementing Angiovac™ as a new minimally invasive treatment option (CONTINUED ON PAGE 3)

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Fifth Third Bank is Launching Third SU2C Campaign More Than $4.2 Million Has Been Raised Nationwide

By LYNNE JETER

Several years ago when Dawn Van Houten’s mother was diagnosed with breast cancer, the family rallied to investigate treatment options. After more than a year of doctor visits, chemotherapy and radiation, they were ecstatic when she was reported cancer-free.

“Cancer has affected all of us,” said Van Houten, vice president of marketing and public relations director for Fifth Third Bank in St. Louis. “And even when we want to think it’s over, we’re never sure Dawn and Maxine Van Houten it won’t come back. Fortunately, novative cancer research, enabling scienresearch is underway to make sure cancer tific collaboration to quickly connect new won’t return.” therapies to cancer patients.

Fifth Third Bank has taken a strong A $142 billion bank headquartered in corporate social responsibility stand against Cincinnati, Ohio, Fifth Third Bank (NAScancer, launching its third campaign DAQ: FITB) has raised more than $4.2 to raise money for Stand Up to Cancer million for SU2C. The latest campaign (SU2C), a charitable program of the nonlaunched July 27 and runs through Oct. 17. profit Entertainment Industry Foundation When customers open a new Essential tasked with raising money to accelerate in-

Taken for Granted

By LARRY HENRY, Market Publisher, St. Louis Medical News

Everybody does it. We are all guilty…. even those of us who are involved in St. Louis healthcare. We take St. Louis healthcare capabilities for granted. I am certainly guilty, but thank goodness St. Louis healthcare was at the top of its game recently when I needed it the most.

We expect health providers in St. Louis to be ready and capable when we have a bump or bruise, or when we have a catastrophic illness. The good news is we live in one of the great medical centers in the world. St. Louis attracts many visitors to our city each year seeking world-class healthcare, and St. Louis delivers. But the patients who have the most benefit from our incredible healthcare institutions and healthcare professionals are the people who live in the Gateway City and the St. Louis region.

The approximately three million individuals who live in the St. Louis defined market area enjoy many benefits provided by a truly great city….the St. Louis Cardinals baseball team, great food, Forest Park, the St. Louis Zoo, and so much more. St. Louis healthcare should be right up there at the top of any list of benefits from living in our great city. I will personally never take the medical community we have in St. Louis for granted again. I’m just happy it exists for all of us.

While I was in a St. Louis hospital bed recently, my journalistic training suggested there might be a story that needed to be told about why St. Louisans are so blessed by our city’s healthcare capabilities. We have more than 50 hospitals in the area, so we are never far from care. There are hundreds of specialty clinics and more are popping up in our neighborhoods on a regular basis. We have two phenomenal medical teaching institutions…Washington University and St. Louis University. Both institutions are creating breakthrough advances in medical research and graduating remarkable providers for our healthcare institutions as well as other facilities throughout the country.

We will begin publishing a four-part series of articles in our October issue that will detail the depth and capability of St. Louis medical care. The articles will appear in the print edition, the digital edition and on the new website of St. Louis Medical News. Readers can access our new website at www. saintlouismedicalnews.com. We hope you have a greater appreciation of how blessed we all are to live in one of the great medical centers in the world after reading this group of articles.

I know that my family will never take St. Louis healthcare capabilities for granted again.

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Checking Account with $150, with direct deposit and three online bill payments made, Fifth Third Bank will donate $150 to SU2C. The bank will also donate $1 to SU2C when people share eligible posts using the #howifight hashtag on Facebook, Instagram, Twitter and Vine, up to $100,000 during the campaign.

The promotion, at 53.com/ howifight, follows the national trend of companies giving customers a variety of ways to give back to the community as they shop or conduct business.

“With cancer impacting so many, we asked ourselves, ‘Could a bank help in the fight against this disease?’” noted Maria Veltre, senior vice president and chief marketing officer for Fifth Third Bank. “That was more than two years ago, and we’ve proven since that we can make a difference with the help of our customers, employees and members of our communities, and we’re now leveraging the power of celebrity with (actor and cancer advocate) Maria Veltre Patrick Dempsey. With this campaign, we want to highlight all the ways that we help fight (cancer) every day.”

A $50 minimum deposit is required to open all accounts and obtain the $150 bonus. All requirements must be met and qualifying activity must be initiated and post to the account within 90 days of account opening. The bonus will be deposited into the new account Patrick within six weeks of comDempsey pleting requirements, and may be taxable as interest income and reported on IRS Form 1099-INT. The offer is limited to one bonus per account per household.

Fifth Third began working with SU2C in 2013 when the bank rolled out exclusive SU2C credit and debit cards, which generate donations to SU2C for every qualifying purchase made using those cards. Fifth Third Bank is the only card issuer to offer the SU2C payment cards.

“Through this campaign, Fifth Third has made an everyday necessity a more meaningful experience for their customer by supporting Stand Up To Cancer’s innovative cancer research,” said Rusty Robertson, co-founder of the organization, pointing out the dismal national statistics: one in two men and one in three women will be directly affected by cancer in their lifetime, according to statistics collected by the Surveillance Epidemiology and End

Results program at the National Cancer Institute. “We’re humbled by the incredible engagement this campaign has received from Fifth Third customers, and honored to continue this collaboration.”

SU2C was founded in 2008 on the belief that everyone can make a difference in the fight against cancer, Robertson pointed out.

“We’re profoundly grateful to each and every donor, of any level,” said Robertson.

Celebrity Patrick Dempsey will lend his image to Fifth Third’s new SU2C Campaign this year. He will be featured in a Fifth Third Bank and SU2C spot highlighting ways people can fight cancer.

As SU2C’s scientific partner, the American Association for Cancer Research (AACR) and a Scientific Advisory Committee led by Nobel Laureate Phillip A. Sharp, PhD, conduct rigorous, competitive review processes to identify the best research proposals to recommend for funding, oversee grants administration, and provide expert review of research progress.

Vascular Surgeon, continued from page 2 for removing large-volume blood clots in the chest, abdomen, and lower extremities.

Entering the body through small punctures or incision at the base of the neck or at the groin, the system works by suctioning the blood clots under x-ray supervision.

“I had used similar devices during my training,” Zayed said. “Through a joint collaboration between Barnes-Jewish Hospital interventional radiology and vascular surgery, we have been able to combine our expertise to introduce this unique option for patients who come to the Heart and Vascular Center for treatment.

“The key thing is providing patients with multiple options, both surgically and medically — especially those with unique comorbidities who cannot otherwise tolerate traditional treatment modalities.

“We encourage physicians in the broader community to feel free to consult with us if they have patients that are not candidates for conventional treatment options. Our clinical practice at Washington University and Barnes-Jewish Hospital has access to a unique array of novel treatments, as well as clinical and investigational trials that can benefit patients with a wide complexity of vascular disease.”

For both clinical and laboratory-based projects, Zayed and his teams aim to publish their findings in peer-reviewed journals in the coming year.

Outside of work, Zayed plays golf and tennis and spends time with his family. He and his wife, Nuha, have a son, Yusuf, and daughter, Nour.

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Saint Louis University Hospital Makes Recovery Easier, continued from page 1 prostatectomy – at SLU Hospital earlier this year.

“It’s a step in the right direction,” said Siddiqui. “To my knowledge, no one else in St. Louis is offering this particular option. The procedure has been published; it’s not on the cusp. It’s not experimental.

We’re certainly hopeful that other institutions will see the benefit in adopting it as well.”

Clinically, several studies – including those published by the American Urological Association and the Journal of the British Association of Urological Surgeons – have shown a catheter-less prostatectomy offers advantages such as low complication rates, decreased pain and an earlier return of continence.

“This is a big change in treatment for patients that’s starting to become more common at academic centers throughout the country,” said Siddiqui.

In the procedure, Siddiqui uses the da Vinci® Surgical System to remove the cancerous prostate gland in a minimally invasive fashion. Rather than open surgery, three tiny holes are used to insert the robot’s instruments into the body. The catheter – which previously was inserted into the penis’ urethra – is instead inserted

in the lower abdomen and connected to the urinary bladder. The approach routes urine directly from the bladder as the patient heals.

“In patients we’ve treated at SLU Hospital, they’ve seen a quick return to regular activity,” said Siddiqui.

Patient response was the major driver of introducing the new procedure to St. Louis, said Siddiqui.

“Patients who came to me after the procedure told me emphatically about their discomfort from the catheter,” he said. “Could we come up with some modification for patients to avoid the urethral catheter, and make the whole recover process easier and less painful?”

When mulling ways to make the procedure easier for prostate cancer patients, a study published in European Urology in August 2009, “Impact of Percutaneous Suprapubic Tube Draining on Patient Discomfort after Radical Prostatectomy,”

by Louis S. Krane, MD, Mani Menon, MD, and others at the Henry Ford Health Systems’ Vattikuti Urology Institute in Detroit, Mich., caught Siddiqui’s eye.

The study followed 202 patients who underwent a radical prostatectomy. Instead of requiring a urethral catheter for

adequate bladder drainage in the postoperative period, the authors used a technique of percutaneous suprapubic tube (PST) bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) to evaluate patient discomfort, complications, continence, and stricture rate after this procedure.

The primary end point was catheterassociated discomfort as measured with the Faces Pain Score-Revised (FPS-R).

Secondary end points included use of anticholinergics, complications related to the PST, urinary continence, and urethral stricture.

When compared with urethral catheter patients, PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6. Anticholinergic medication was required by one PST and four urethral catheter patients.

Ten patients required urethral catheterization for PST dislodgement or urinary retention. No patient had developed a urethral stricture at a mean follow-up of seven months, leading the authors to conclude that PST provides adequate urinary drainage following RALP with less patient discomfort and no increased risk of urethral stricture.

The procedure is fairly straightforward, and fairly easy to teach other surgeons with an interest in it, noted Siddiqui.

“There are concerns about a possible increased risk of urethral strictures forming without a catheter, but there’s been no demonstration of that,” said Siddiqui. “It’s easy for patients to understand and use, with a low risk of having a catheter placed subsequently when the tube is removed.”

Obesity is the primary complication to performing the procedural option because the suprapubic tube may be difficult to place, noted Siddiqui.

Because approximately 75 percent of patients are drawn from a 150-mile radius to SLU Hospital, many prostate cancer patients living in rural areas are making the trek to St. Louis to pursue the catheterless option, with some patients returning to St. Louis two weeks post-op to have the tube removed, and again at six weeks post-op for a follow-up visit.

“Some patients had been reluctant to have surgery because of the penile catheter,” said Siddiqui. “This process encourages them to focus on getting rid of the cancer with a procedure that will mitigate the discomfort.”

The AMA Steps Up with STEPS Forward, continued from page 1 laboratory tests.

“Just making a single change – prescription management – decreased phone calls to the practice by 50 percent. It saved 30 minutes of doctor time and 60 minutes of nursing time per doctor per day,” said Sinsky, an internist and partner in Medical Associates Clinic, a multispecialty group practice with sites in Iowa, Wisconsin and Dr. Christine Sinsky Illinois.

Sinsky is also the point person at the American Medical Association (AMA) for

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an ambitious new initiative offering physicians strategies to revitalize their medical practices and improve patient care. The practice changes she references are found in the initial 16 modules available online – free for AMA and non-AMA members – via www.STEPSforward.org.

“If you can follow one or two recommendations and go home earlier by reengineering the way you do your work, that’s a win-win all around,” said Sinsky.

The AMA took action to improve the lives of practicing physicians after a recent RAND survey showed the satisfaction physicians derive from their work is quickly eroding as time continues to be taken away from direct patient care because of grueling, bureaucratic obstacles.

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent,” said AMA CEO James L. Madara, MD. “That’s why the AMA is taking a hands-on approach to meeting their day-to-day concerns through the new online series, AMA Steps Forward.”

Broadly, the 16 modules address four key areas: practice efficiency and patient care, patient health, physician health, Dr. James L. Madara and technology and innovation.

Specifically, the modules cover these topics: • Conducting effective team meetings • Creating strong team culture • Electronic health record (EHR) implementation • EHR software selection and purchase

• Expanding rooming and discharge protocols • Improving blood pressure control • Improving physician resiliency • Medication adherence • Panel management • Preventing physician burnout • Preventing type 2 diabetes in at-risk patients • Pre-visit laboratory testing • Pre-visit planning • Starting lean healthcare • Synchronized prescription renewal • Team documentation Each module requires only snippets of time to study either online or printed in PDF format for a more traditional approach to learning. Live events provide yet another learning option. To earn AMA PRA Category 1 Credit™, participants must view the module content in its entirety, successfully complete the quiz answering four of five questions correctly, and complete the evaluation.

Modules include steps for implementation, case studies and downloadable videos, tools and resources.

“Within 30 minutes, physicians will know how to take the next step in their practices to work smarter, not harder,” said Sinsky.

For example, the module on effective team meetings begins with a 10-step process: • Identify the team.

• Meet routinely and “on the clock.”

• Agree on ground rules.

• Set a consistent meeting agenda.

• Rotate meeting roles.

• Solve problems as a group.

• Record action steps, owners and due dates.

• Practice good meeting skills.

• Have fun!

• Celebrate success.

Under ground rules, helpful hints include starting and ending each meeting on time, being fully present in the moment, staying on topic, focusing on the issue and not the individual, stepping up or back as needed, and giving thanks to the staff for their time. To stay on topic and maintain efficiency during the dedicated meeting time, it’s suggested that: “if the discussion wanders, the chair or other member can say, ‘Let’s take that offline,’ or ‘that sounds like an issue to put in the “parking lot” to talk about at another meeting.’ If the discussion strays, there may not be time at the end of the meeting for all the items on the agenda.”

In October, 10 modules will be added to the website. By the end of 2016, the AMA plans to have up to 50 modules available online.

Concurrently with the rollout, the AMA and the Medical Group Management Association (MGMA) issued a practice innovation challenge, seeking more high-value, easy-to-adopt, and transformative medical practice solutions. Proposals were submitted through Sept. 1; the best solutions were eligible for one of several $10,000 prizes, in addition to having the ideas developed into future STEPS Forward modules. Winners will be announced at MGMA’s annual conference Oct. 11-14 in Nashville, Tenn.

“We issued the innovation challenge to tap into the creative energy that we know is present among physicians,” said Sinsky. “The goal is to help physicians take better care of themselves and their practices so they can, in turn, take better care of their patients.”

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No Relief for Allergy Sufferers Nasty Allergy Season ‘Getting Worse’ Everywhere

By JONATHAN SCOTT

Some might see some encouraging news in finding out that St. Louis has dropped from No. 20 in last year’s ranking of Spring Allergy Capitals to No. 25 in the recently released 2015 ranking of cities considered as the most challenging places to live for people with allergies.

Yet others, such as H. James Wedner, MD, the Dr. Phillip and Arleen Korenblat Professor and chief of the Division of Allergy and Clinical Immunology at the Washington University School of Medicine in St. Louis, view St. Louis’ dip in the rankings as not necessar- Dr. H. James ily being good news for Wedner the city as it is bad news for other cities rising in the rankings.

“It’s more that these other cities are getting worse - not that we’re getting better,” Wedner said.

Based on the medical reports he’s read and the rising number of allergy cases he’s treated, Wedner predicts this unpleasant trend to continue.

The 2015 Spring Allergy Capitals list is published annually by the Asthma and Allergy Foundation of America (AAFA).

The rankings are based on a variety of factors, such as average pollen levels and allergy medication use.

The allergy capitals earning a spot in the top 10 list are: No. 1, Jackson, Miss.; No. 2, Louisville, Ky.; No. 3, Oklahoma City, Okla.; No. 4, Memphis, Tenn.; No. 5, Knoxville, Tenn.; No. 6, McAllen, Texas; No. 7, Wichita, Kan.; No. 8, Dayton, Ohio; No. 9, Providence, R.I.; and No. 10, Richmond, Va. St. Louis earned a ranking in the top 25 because it shares many of the same characteristics as most of the other cities considered as being among the worst places for allergy sufferers. For instance, the allergy season in St. Louis lasts nearly all year long due to the large number of allergens drifting in the air of those who live in the city.

“We have large amounts of pollen in the early spring that comes from the trees, and then that’s followed by huge amounts of grass pollen,” Wedner said. “In fall, ragweed is the No. 1 allergy.”

The situation is made even worse because St. Louis is located in a river valley, and consequently, it is home to a lot of mold spores.

“So all of these factors conspire to make the community not a happy one for your allergy sufferer,” he noted. “If the winter gets very, very cold, then normally stlouismedicalnews

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we’ll see the number of allergy cases go down somewhat in January or February, but they never go down to zero. A number of years ago we monitored the mold spores in the air in St. Louis, and there were mold spores in the air 365 days that year. So it’s a challenge for the allergy sufferer here, and that’s just what you have to accept.”

Even though those with allergies face a nearly constant barrage of pollen throughout the year, Wedner said allergy sufferers can take steps to lessen the unpleasant impact of these tiny, unwanted guests.

He recommends that allergy sufferers stay indoors during the peak weeks of allergy season, and that they make sure their air conditioner has filters that will filter out most of the pollen and mold spores that might get in a home.

He also suggested that those who enjoy exercising outside, should do so in the evening because pollen counts tend to be highest in the morning and decrease as the day goes on.

Perhaps most importantly, Wedner said allergy sufferers should never use a humidifier indoors.

“We as allergists are violently opposed to humidifiers because all they do is grow mold,” he explained.

The most effective step an allergy sufferer can take is to pay a visit to an allergist.

“The thing that is most important for allergy sufferers is to know what they’re allergic to,” he said. “That will help everyone with allergies because once a doctor knows what the patient is allergic to, the doctor can give that patient some advice and prescribe some medicine, so that’s very important.”

Unfortunately, the future for allergy sufferers does not appear to be a pleasant one, and allergists around the world should expect to see a steady rise in the number of patients they’ll be treating.

Wedner noted that the large amount of data pertaining to the allergens and allergy cases across the globe show that the already bad situation is getting even worse.

“In the United States, we’re seeing an increase in the incidents of allergy of 6 to 7 percent per year, and much of the rest of the world is much worse than we are because the rates are going up even higher.

The places in the world where there were no allergies at one time are now seeing allergies,” he said. “So we’ll see more cases of allergies before we see them level off. I seriously doubt it will get better – at least not in my lifetime.”

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SEPTEMBER 2015

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At the Intersection of Education and Healthcare

By CINDY SANDERS

According to statistics from the Centers for Disease Control and Prevention, one in 68 children falls somewhere on the autism spectrum.

The fastest-growing developmental disorder in the United States, autism spectrum disorder (ASD) is almost five times more common in boys (1 in 42) than girls (1 in 189). Additionally, the CDC estimates it costs at least $17,000 more per year to care for a child with autism, including extra expenditures for healthcare, education and ASD-related therapy.

While there is still no cure for ASD, research has shown early intervention can have a Mark significant impact on a Claypool child’s development and ability to more fully interact with peers at school. It’s at this intersection of education and healthcare where Educational Services of America (ESA) offers resources to help these children thrive.

Headquartered in Nashville, Tenn., the company currently provides services in 27 states. “We serve about 17,000 kids a day, and they have a very wide variety of disabilities,” explained ESA President and CEO Mark Claypool, who founded the company in 1999. “We work primarily with public school systems,” he said,

noting the company partners with about 250 different systems. He added ESA also works directly with some state governments and insurance carriers.

“Providing quality services to children and young adults who need them is more important to us than who pays the bill,” Claypool stated.

While ESA, which has about 3,000 employees nationwide, has been in business for more than 15 years, Claypool said many of the programs being used have been around much longer with measurable results. The company has grown significantly through acquisitions and mergers, including the purchase three years ago of South Carolina-based Early Autism Project, Inc. (EAP).

“We had been working with older kids through school systems for a long time, but we wanted to identify a strong provider in the early intervention space,” Claypool explained. “Autism is a very dynamic disability, and the sooner you can intervene, the greater the impact on the child’s life.”

With EAP, he noted, “We acquired this really strong regional brand and put tremendous resources behind them.”

Today, EAP reaches four times the number of children and continues to expand with additional clinics coming online at a rapid pace. Currently, there are clinics and/or in-home services being provided in 11 states including Arkansas, Florida, Georgia, Kentucky, South Carolina and

For More Info & Referrals For more information on autism and other programming by Educational Services of America, go online to esa-education.com. For more information or to refer a child with autism to EAP, go to earlyautismproject.com.

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Tennessee in the Southeast.

“We’re growing very rapidly,” Claypool said. “In fact, we’re in the process of opening 15 new autism clinics in the next year.”

Applied Behavior At the heart of the program is the use of Applied Behavioral Analysis (ABA).

“We know the evidence supports ABA as the most effective treatment, by far,” said Claypool. “It enhances positive behaviors and diminishes negative behaviors.”

According to the Center for Autism and Related Disorders, the effectiveness of this evidence-based therapy has been well documented over the past 40 years. ABA utilizes the principles of learning theory to craft interventions designed to measurably improve ‘socially significant behaviors,’ which include reading, academics, social skills, communication, and adaptive living skills including self-care, toileting, understanding time and money, and honing work skills.

“The same model of behavioral therapy is applied to all of our children across the board but will vary in its intensity,” Claypool explained of addressing individual needs depending on where a child falls on the spectrum.

Finding a way to help these children is critical considering the number of children diagnosed with ASD. “If we don’t do this, the cost will be staggering. These young people will not be able to transition to adulthood and lead normal adult lives,” Claypool pointed out.

With ABA therapy, however, he said the team has seen some remarkable outcomes. “There is no one type of child with autism. There are IQs all over the board, but many do have high IQs and need to have their potential unlocked,” he continued.

That was certainly true for one South Carolina mom. Told it would be best to find her son a residential program because he would never function on his own, she took matters into her own hands and became the co-founder of the Early Autism Project. Today, that son is working on his master’s degree at the University of South Carolina and speaks eight languages.

While certainly not every child with autism will perform at that level, Claypool said all children deserve the chance to reach their own potential.

The Intersection of Healthcare & Education

Realizing that ability, however, can be more difficult in some states than in others.

Claypool explained Part C of the Individuals with Disabilities Education Act requires public school systems to identify preschool children with special needs.

However, he added, “It’s very, very loose how to do that. Frankly, it’s not followed through on very often. That issue really drove parents who had children with autism to find another way to have their children identified, diagnosed and treated.”

Of importance, he continued, is the understanding that special education, as it is constructed, is built on civil rights law.

“That’s important because it was built on a minimum set of services defined as ‘free and appropriate.’

“But that’s not enough for parents,” Claypool said. “They want progress, and they want to know their child is going to get the very best treatments.” Therefore, he continued, “More and more, they are looking to healthcare rather than education systems to bridge the gap.”

According to the Autism Health Insurance Project, 39 states plus the District of Columbia have now enacted autism insurance mandates, meaning all fully funded, state-regulated insurance plans must provide the benefits specified by law.

While the specifics vary from state-tostate, each of the mandates requires insurers to provide ABA to young children with autism. Self-funded (employer-sponsored) plans, however, are not legally required to offer autism benefits even in states that have mandates.

As of May 2015, Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming had no autism insurance mandate. Ohio, Hawaii, Mississippi and North Carolina were in process of enacting a mandate, and Utah had passed legislation, but it won’t go into effect until 2016. Additionally, the federal government has recently told all states their Medicaid programs must offer ABA therapy for children under 21, but only a handful of states have put this directive into action at this point.

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MGMA Releases Latest Provider Compensation Data

By CINDy SANDERS

In late July, the Medical Group Management Association (MGMA) released findings from the 2015 Provider Compensation Survey Report, an annual analysis of compensation and productivity data illustrating market characteristics across specialties and organizational settings.

“MGMA has been collecting data on medical group management since 1926,” noted Todd B. Evenson, chief operating officer of the national organization for healthcare administration and medical practice management. “For the last 25 years, we’ve also been specializing in the space of physician compensation and non-physician compensation.”

Based on 2014 data, this year’s survey found physicians reported salary increases over the past year with primary care physician increases Todd Evenson outpacing those of specialists (3.56 percent increase vs. 2.39 percent, respectively). Specialists, however, still report a higher median compensation at $411,852 compared to a median compensation of $241,273 for primary care physicians.

The 2015 benchmarking report included information on nearly 70,000 providers across the United States. In addition to geographic diversity, Evenson said the data was representative of both large and small practices, various ownership structures including hospital-based providers, and more than 170 specialties.

Evenson said the collected data is important for a number of reasons, not the least of which is that physicians are being recruited on a national level. To remain competitive, he noted, it’s important to look at the compensation methodologies being used by colleagues in various parts of the country.

While primary care physicians enjoyed a 3.5 percent increase in median compensation between 2013 and 2014, the figures are even more interesting when taking a slightly longer view. Evenson noted physicians in this space have seen a 9.2 percent increase in compensation since 2012.

“Will primary care physicians be compensated at the same levels as specialists? Not likely,” Evenson said. However, he continued, “They will continue to play an integral role as care models evolve. Primary care physicians are truly the lynchpin of the new practice model as we move from fee-for-service to fee-for-value.”

Evenson added, “There’s a particular demand for primary care physicians … both because they are the backbone of the referral system and key to a value-based system.”

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showed a continuing shift towards newer models of care. “Historically, it was normal to see 100 percent of compensation plans be productivity based,” explained Evenson. “In 2012, 50 percent of respondents said they were on a 100 percent productivity based compensation plan. In 2013, it was 39 percent; and actually this year, it was 25 percent of respondents.”

As he noted, that’s a 25 percent decline in that metric over the past three years.

Evenson said the current data highlights the gradual shift toward rewarding practitioners for improved operational efficiencies, enhanced quality and access to care. While the direct link to quality is still relatively small, it is growing. Just a few years ago, only 3.4 percent of physician compensation was tied to quality metrics. “Now we’re seeing as high as 10 or 11 percent,” he said. “That value over volume concept that physicians seem to be embracing is really beginning to pay off for them.”

He added, “The behaviors they are trying to promote are tied to that triple aim (of healthcare) … reducing the per capita cost of healthcare, improving the health of populations, and improving the patient experience of care.”

Evenson said those in the behavioral health sector are also seeing improved

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compensation as their work complements that of primary care providers in managing a population’s health.

The industry is really recognizing a need to look to behavioral health services to better deliver quality care. The likelihood that someone dealing with a chronic health condition is also dealing with a behavioral health issue is high,” Evenson pointed out.

Recognition of that link has been evident in the MGMA compensation survey over the last few years. “Since 2009, there has been a 21.9 percent increase in compensation for psychiatrists. Now, their median compensation is $244,796,” Evenson said, noting that now puts psychiatrists roughly equivalent to their primary care counterparts.

Economic forces of supply and demand are another issue factoring into physician compensation. A predicted shortage of physician providers in both primary and specialty care could fuel higher compensation rates down the road. Referencing a March 2015 report from the Association of American Medical Colleges (AAMC), Evenson noted the analysis projected a shortfall of between

46,000 and 90,000 physicians by 2025.

In addition to compensation figures, Evenson said MGMA’s annual report also collects information regarding total charges, collections, encounters, RVUs (relative value unit), productivity, benefits, demographics, organizational types, and regional differences all the way down to a state level.

He said drilling down in the data allows those in healthcare to dissect the information in myriad ways, and added it’s critical to learn from one another to adopt best practices that address the triple aim.

“You can take these benchmarks and truly understand what opportunities you have for efficiencies and for providing better care by understanding your colleagues’ activities in the industry,” Evenson concluded.

For more information on the 2015 Provider Compensation Survey Report, go online to mgma.com. Detailed data is available for purchase in two formats – electronically through MGMA DataDive™ or by ordering printed reports.

Compensation and the many other market forces impacting healthcare management will be explored in depth at MGMA’s annual conference scheduled for Oct. 11-14 in Nashville, Tenn.

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Telemedicine: A Virtual Compliance Jigsaw Puzzle A Closer Look at the New Wave in Healthcare Delivery

By LYNNE JETER

Telemedicine has quickly become the hottest topic in healthcare delivery, as the industry strives to adapt to its murky waters of compliance. New services, such as Zwivel, a cosmetic surgery consultation service, are coming online with unprecedented frequency, piquing the interest of physicians and administrators about the unknown possibilities of telemedicine.

“Perhaps we shouldn’t be surprised by this trend,” said Michael Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services, a 4,000-member group with physicians in all 50 states. “High speed inMichael ternet connections are Sacopulos now the norm. Services like Facetime and Skype are more popular than ever. Under continued pressure to cut costs and cope with declining reimbursements, administrators believe telemedicine offers a tool for increasing efficiency. Patients also like the convenience and increased options that flow from telemedicine. So what’s not to like? Shouldn’t we embrace the ‘new normal’ and sign on to a great, brave new world? Maybe, first let’s proceed with caution.”

Among the state and federal compliance requirements when taking a practice online are licensure, professional liability considerations, standard of care, patient privacy, informed consent, and referrals for emergency surgery.

Licensure

Medical providers “must be licensed by, or under the jurisdiction of, the Medical Board of the State where the patient is located,” according to the Federation of State Medical Boards’ Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.

“Unfortunately,” noted Sacopulos, “this requirement imposes traditional state boundaries on the cyber world. Efforts need to be made to identify the residences of prospective telemedicine patients so the medical provider does not accidentally practice in a state without a license.”

Professional Liability

Most professional liability insurance policies provide state-specific coverage, meaning that if a provider accidentally practices telemedicine on an out-of-state patient, there may be no coverage, said Sacopulos.

“Providers wanting to expand into the area of telemedicine should check with their insurance carrier,” he suggested.

“Another consideration relates to cyber issues. Traditional medical malpractice 8

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policies provide little to no coverage for electronic breaches. The nature of a telemedicine generates exposures to a variety of cyber risks. Any practice moving forward with offering telemedicine should have a comprehensive cyber insurance policy.”

Standard of Care

It’s imperative to note that telemedicine is the practice of medicine, and not “medicine lite,” Sacopulos pointed out.

“All the duties and obligations that come with in person consultations are owed to the remote telemedicine patient,” he explained.

The American Medical Association (AMA) recently stated there’s a general consensus among AMA members that care provided via telemedicine needs to meet the same standard as care provided in person.”

Also, the Federation of State Medical Boards made clear the position by stating: “In fact, these guidelines support a consistent standard of care and scope of practice notwithstanding the delivery tool or business method in enabling physicianto-patient communications.”

“Before starting to use telemedicine as a tool to consult with remote patients, a practice should plan how it will meet the standard of care it provides for its in-office patients,” said Sacopulos. “For example, how will it document a dermatological condition? If the condition is normally

photographed when a patient is in the office, then the practice should be ready to capture the same quality of image via telemedicine. Each step of the consultation should be planned in advance to ensure it is equal in quality to an in-office evaluation.”

Patient Privacy

Sacopulos said it’s also important to note that any form of electronic communication with a patient should immediately bring to mind HIPAA and HITECH Act obligations.

“Whether the electronic connection with the patient is via email, text messaging, or video conference, the platform should be secure,” he said. “Private and confidential patient information is being transmitted and the patient has a legal right to protect the information in transit.”

The Federation of State and Board Telemedicine (FSMB) Guidelines specifically state: “Physicians should meet or exceed applicable federal and state requirements of medical/health information privacy, including compliance with HIPAA and state privacy, confidentiality, security, and medical retention rules,” said Sacopulos, adding that FSMB Guidelines suggest maintaining written policies to address: • Privacy; • Healthcare personnel who will be processing messages and patient communications;

Physicians’ Telemedicine Checklist Physicians interested in electronically interacting with their patients should first work their way through this checklist: • Examine the electronic communication between the practice and its patients. From patients portals to staff testing, a complete picture is needed of the practice’s electronic communications before engaging in telemedicine; • Make sure forms of electronic patient communications are HIPAAcompliant and secure; • The internet may know no bounds, but a medical license does. Be careful not to provide medical services to individuals who live in states in which there’s no license; • Check with the State Board of Medicine to determine state-specific telemedicine limitations; • Develop a specific informed consent document that complies with state requirements and also the Federation of State Medical Board’s suggestions; • Develop a list of disclosures to provide to prospective patients before engaging in telemedicine services; and • ºMake sure there’s adequate insurance coverage. Check with a professional liability carrier and secure a cyber-insurance policy.

“With advanced planning and a little effort, you’ll be able to weave your way through the compliance requirements to practice telemedicine, leaving you and your patients to enjoy the benefits of a telemedicine practice,” said Michael J. Sacopulos, JD, CEO of Medical Risk Institute and general counsel for Medical Justice Services.

SOURCE: Michael J. Sacopulos, JD.

• Hours of operations; • Types of transactions that will be permitted electronically; • Required patient information to be included in the communication, such as patient’s name, identification number and type of transaction; • Archival and retrieval; and • Quality oversight mechanisms.

“Finally, telemedicine practitioners are cautioned to periodically evaluate their policies and procedures to insure they remain current and readily accessible,” he said. “FSMB informs us that electronic communications received from patients must be maintained within secured technology password-protected encrypted electronic prescriptions, or other reliable authentication and techniques.”

Sacopulos said it’s reasonable to assume that additional patient privacy requirements will be coming in the near future.

“This well may be in reaction to large scale breaches, such as Anthem Insurance experienced earlier this year,” he said.

“Studies show that medical identity theft grew at an alarming rate in 2014. Government officials, including the FBI and California Attorney General, have specifically cautioned medical providers that their patients’ electronic data is at risk for hacking and theft. All of this should serve as a warning to telemedicine providers to comply with existing state and federal regulations. Telemedicine providers should also anticipate increasing privacy standards.”

Informed Consent

Before practicing telemedicine, a medical provider should obtain appropriate patient informed consent. The informed consent document should: Clearly state the patient’s identity; Clearly state the physician’s identity and qualifications; Specify the scope of activities the practice will be using telemedicine technologies to fulfill, such as patient education, prescription refills, and scheduling appointments; The patient must acknowledge that it is within the medical provider’s sole discretion to determine if the available telemedicine technologies are adequate to diagnose and/or treat the patient; The patient should acknowledge the possibility of, and hold harmless the medical provider for, any technology failures and/or interruptions; The practice should, as part of the informed consent process, provide information on the telemedicine technologies privacy and security standards, such as the inscription of data and firewalls; and The informed consent document (CONTINUED ON PAGE 9)

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Rejected or Denied?

By SHELLY BANGERT

Basketball coach John Wooden said, “If you don’t have time to do it right, when will you have time to do it over?” He may have been making a point about sports, but the principle is also true for revenue cycle management.

Medical claims should be submitted right the first time – with correct coding and correct patient demographic information. Properly submitted claims reduce the number of rejections and denials, which in turn shortens your payment cycle and generates cash more quickly.

Some people use the terms rejection and denial interchangeably, but they are not the same. Additionally, the follow up steps for handling rejections and denials represent two different workflows, so it is helpful to define the terms as a first step toward improving results.

Rejected claims do not meet basic data requirements. Rejected claims are

Telemedicine, continued from page 8

should specify express patient consent to forward patient information to a third party if necessary.

Referrals for Emergency Service

“The FSMB suggests that telemedicine practitioners have a written protocol in the event that a remote patient needs emergency services,” said Sacopulos.

“This emergency protocol should cover possible scenarios when patients require acute care. How and where referrals are to be made should be covered in this protocol.”

State-Specific Requirements

The scope of permissible telemedicine varies significantly by state. Some states specifically require a physician/patient relationship to be established first in person with an exam and diagnosis and treatment plan, including prescriptions. Only then may telemedicine be conducted.

“Telemedicine is receiving much attention at the moment,” said Sacopulos.

“The American Medical Association is in the process of adopting a Code of Ethics for physicians who provide clinical services through telemedicine. Texas has recently issued new telemedicine guidelines to its practitioners. All of this should serve as a warning to those interested in telemedicine to consult with their State Board of Medicine before engaging in telemedicine activities.” stlouismedicalnews

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returned unprocessed. They do not make it into the payer’s system to be assessed and adjudicated. Rejected claims must be resubmitted with corrected information.

Denied claims have been received and processed by the payer’s adjudication system.

Denied claims can be appealed based on the payer’s requests for modifications or additional documentation. Denied claims do not need to be resubmitted. In fact, they cannot be resubmitted. Instead, they must be appealed, because the payer has already made an initial determination about payment.

Physicians and practice managers are sometimes confused about these terms.

They may spend time trying to improve their results without understanding the differences between rejected and denied claims.

Improving results with rejected and denied claims should focus on work processes that address the core issues. High rates of rejected claims, for example, must be addressed by scrubbing claims in advance, before they are submitted to payers. Denied claims, on the other hand, must be addressed by pursuing the appeals processes that are specified by each payer.

Shelly Bangert is director of revenue cycle management at Hawthorn Physician Services Corp. in St. Louis. Shelly can be reached at sbangert@hawthorngrp.com.

GrandRounds Federal $2.5 Million Grant to SLU Aims to Transform Geriatric Care Funded by a three-year, $2.5 million grant from the U.S. Department of Health and Human Services, Saint Louis University will lead an initiative to improve the health of older Missourians by training primary care health providers in geriatrics.

SLU will receive $843,000 the first year.

SLU has recruited two other universities, a rural hospital, a hospital system, two federally-qualified community health centers, a senior center and a health nonprofit to join in an ambitious plan that addresses the significant shortage in underserved urban and rural areas of health care professionals who know how to care for older adults. The project will involve professionals and students in geriatric medicine, geriatric psychiatry, nursing, social work, physical therapy, occupational therapy and interprofessional education.

Providing the care our older adults deserve is a huge challenge that requires the commitment of many different professionals from many institutions according to John Morley, M.D., who also is director of geriatric medicine at Saint Louis University and the project’s director.

Collaborative partners include A. T. Still University Osteopathic Medical School/ Missouri Area Health Education Center in Kirksville and Perry County Memorial Hospital. University and community partners are Washington University in St. Louis, SSM Health, Myrtle Hilliard Davis and John C. Murphy Health Centers, Northside Youth and Senior Service Center and the St. Louis Alzheimer’s Association.

Crime-Scene Compound May Be Newest Tool in Fight Against Malaria The compound that detectives spray at crime scenes to find trace amounts of blood may be used one day to kill the malaria parasite.

Luminol glows blue when it encounters the hemoglobin in red blood cells.

And now, researchers at Washington University School of Medicine in St. Louis have shown that they can trick malariainfected red blood cells into building up a volatile chemical stockpile that can be set off by luminol’s glow. To achieve this, the scientists gave infected red blood cells an unusual amino acid and used luminol’s glow to trigger the chemical, killing the parasite.

The light that luminol emits is enhanced by the antimalarial drug artemisinin, said senior author Daniel Goldberg, MD, PhD, professor of medicine and molecular microbiology. These agents could be combined to form an innovative treatment for malaria.

The World Health Organization (WHO) estimated that in 2013, malaria infected 198 million people and killed 584,000, the majority of whom were African children.

The new therapy would have an advantage over current malaria treatments, which have become less effective as the parasite mutates. WHO recommends that artemisinin — the most commonly used antimalarial drug — only be used in combination with other treatments because the parasite is becoming resistant to it.

The new approach targets proteins made by human red blood cells, which the parasite can’t mutate.

In the study, researchers led by first author Paul Sigala, PhD, a scientist in Goldberg’s laboratory, worked with human red blood cells infected with the malaria parasite. They wanted to better understand how the parasite gets hold of heme, the deep red, nonprotein part of hemoglobin that carries oxygen. Heme is essential to the parasite’s survival.

The malaria parasite opens an unnatural channel on the surface of red blood (continued on page 10)

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MGMA of Greater St. Louis Join us at an upcoming meeting!

• September 9: Lunch Meeting on Self Pay Collections & Cash Control • October 21: PAC Conference • October 24: MGMA of Greater St. Louis Charity Event • November 11: Lunch Meeting - Time for Your Annual Practice Check-Up SEPTEMBER 2015

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GrandRounds cells. When scientists put an ingredient of heme — an amino acid — into the solution containing the cells, the amino acid entered the cells through the channel and started the heme-making process.

The process led to a buildup of a molecule called protoporphyrin IX. When exposed to light, this molecule emits dangerous, chemically reactive compounds known as free radicals, killing the parasites.

The research team plans to test the approach in animal studies.

All of the agents — the amino acid, the luminol and artemisinin — have been cleared for use in humans individually, so they are optimistic that they won’t present any safety problems together, said Goldberg, who is co-director of the Division of Infectious Diseases.

Mercy Clinic Welcomes New Physicians Mercy Clinic, the multi-specialty physician group affiliated with Mercy Hospital and Mercy Children’s Hospital, recently added new doctors and new satellite offices.

Yuval Asner, MD, pediatric psychiatrist, joined Mercy Clinic Child and Adolescent Psychiatry. Dr. Asner earned his medical degree from Indiana University School of Medicine in Indianapolis, Indiana. He completed psychiatry along with child and adolescent psychiatry residencies at John Hopkins Hospital in Baltimore, Maryland.

Kaitlin Poeth Beckman, MD, infectious disease physician, joined Mercy Clinic Infectious Disease. Dr. Poeth earned her medical degree from SUNY Downstate Medical Center in Brooklyn, New York. She completed an internal medicine residency and infectious disease fellowship at Hofstra North ShortLong Island Jewish Medical Center in Manhasset, New York.

Jennifer M. Chung, MD, internist,

opened Mercy Clinic Internal Medicine. Dr. Chung earned her medical degree from University of Virginia School of Medicine in Charlottesville, Virginia, and completed an internal medicine residency at Duke University in Durham, North Carolina.

Elliott Farberman, MD and Lynn Nelms, MD, pediatricians, opened Mercy Clinic Pediatrics and also a practice at Mercy Clinic Pediatrics - O’Fallon with Heather Joyce, MD and Melissa Rickerson, MD. Jennifer M. Heeley, MD, pediatric geneticist, opened Mercy Kids Genetics.

Dr. Heeley earned her medical degree from Washington University School of Medicine and completed a pediatric residency and pediatric genetics fellowship at St. Louis Children’s Hospital.

Venkata Kenguva, MD, internist, joined Mercy Clinic Adult Hospitalists – St. Louis and will care for hospitalized patients at Mercy Hospital St. Louis. Dr. Kenguva earned his medical degree from Andhra Medical College in Andhra Pradesh, India, and completed an internal medicine residency at St. Luke’s Hospital in St. Louis, Missouri.

Ryan L. Kroeger, DO, internist, joined Mercy Clinic Adult Hospitalists – St. Louis and will care for hospitalized patients at Mercy Hospital St. Louis. Dr. Kroeger earned his medical degree from A.T. Still University – Kirksville College of Osteopathic Medicine in Kirksville, Missouri, and completed an internal medicine residency at Mercy Hospital St. Louis.

Daniel M. Maxfield, MD, general surgeon, joined Mercy Clinic Surgical Specialists. Dr. Maxfield earned his medical degree from University of Oklahoma in Oklahoma City, Oklahoma, and completed a general surgery residency at University of Missouri – Kansas City in Kansas City, Missouri.

John Moore, MD, anesthesiologist and pain management physician, opened Mercy Clinic Pain Management and will

be serving as director of Pain Management at Mercy Hospital St. Louis Robert H. Neumayr, MD, cardiologist, joined Mercy Clinic Heart and Vascular. He earned his medical degree from University of South Dakota School of Medicine in Vermillion, South Dakota, and completed an internal medicine residency at Mayo Clinic in Rochester, Minnesota. Dr. Neumayr also completed a cardiology fellowship at Saint Louis University in St. Louis, Missouri.

Aaron Pickrell, MD, to Mercy Clinic East Communities. Dr. Pickrell will join Mercy Clinic Adult Hospitalists – St. Louis Dr. Pickrell received his medical degree from St. George’s University School of Medicine in Grenada, West Indies. He completed an Internal Medicine Residency at Lincoln Medical and Mental Health Center in Bronx, New York.

Christie Pickrell, MD, emergency medicine physician, joined Mercy Clinic Emergency Department Physicians and cares for patients in the emergency department at Mercy Hospital St. Louis.

She earned her medical degree from St. George’s University School of Medicine in Grenada, West Indies, and completed an emergency medicine residency at Newark Beth Israel Medical Center in Newark, New Jersey.

Sreelatha Varma, MD, family medicine physician, joined Mercy Urgent Care Center. in Hazelwood. Dr. Varma earned her medical degree from Guntur Medical College in Guntur, India, and completed an internal medicine residency at Saint Louis University School of Medicine.

Mark W. Vogel, MD, cardiologist, joined Mercy Clinic Heart and Vascular.

Dr. Vogel earned his medical degree from Northwestern University in Chicago, Illinois. He completed an internal medicine residency at Mayo Clinic in Rochester, Minnesota, and also completed a cardiology fellowship at Barnes-Jewish Hospital in St. Louis, Missouri.

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GrandRounds First ‘Hybrid’ Procedure Performed at Christian Hospital The first cardiac hybrid procedure at Christian Hospital was performed in July in the new $5.5 million hybrid room, the only one of its kind in North County and among only 2 percent in hospitals nationwide. There will be a ribbon-cutting ceremony this month to officially recognize the opening of the hybrid room.

The hybrid room is equipped with advanced medical imaging technology and combines the procedures of a cardiac catheter lab, such as placement and correction of pacemakers, with the features and capabilities of a surgery room when more complex surgical treatment is required.

The hybrid room allows Christian Hospital to provide high-tech, cutting-edge procedures according to Nabil Munfakh, MD, medical director of cardiothoracic surgery at Christian Hospital.

The hybrid room was made possible through the fundraising efforts of the Christian Hospital Foundation through donations to the foundation from hospital employees, physicians, the Christian Hospital Auxiliary and the community.

Logan University Appoints New Dean of Students Logan University is pleased to announce that Shelley Sawalich, PhD, has accepted the position of Dean of Students, Office of Student Affairs. Dr. Sawalich holds a Doctorate in Philosophy in Higher Education from Saint Louis University, a Master Dr. Shelley of Science in College StuSawalich dent Affairs from Eastern Illinois University and a Bachelor of Arts in English from the University of Illinois,

Urbana-Champaign.

Previously, Dr. Sawalich was the Director of the Academic Resource Center at Webster University and the Director of Academic Support in the Student Success Center at Saint Louis University.

She has also served in similar roles at The University of Alabama and Eastern Illinois University.

Dr. Sawalich has a tremendous amount of experience providing management, vision and leadership for undergraduate and graduate programs that supports academic success, professional growth and development for students.

Over 500 Cyclists Participate in 2015 St. Luke’s Hospital Tour De Wellness

Pictured in the hybrid room last Thursday during the history-making procedure are, from left, cardiothoracic surgeon Stefano Schena, MD; certified surgical tech Melissa Desuza; cardiovascular tech Sloan Kessinger; and interventional cardiologist Deepak Koul, MD.

More than 500 cyclists of all levels participated in the 2015 St. Luke’s Hospital Tour de Wellness. The cycling event, produced in partnership with Chesterfield Parks, Recreation & Arts and Trailnet, offered three routes starting and ending at the Chesterfield Amphitheater. And after the ride, participants enjoyed a celebration with music, food and exhibit booths.

The goal of the St. Luke’s Hospital Tour de Wellness is to inspire good health in the community. The event raised $25,000 to help support St. Luke’s community outreach programs and screenings. Sponsors of the ride included the Bill Voss American Family Insurance Agency and The Staenberg Group.

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SEPTEMBER 2015

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Missouri Admitted Carrier of Medical Malpractice Insurance Re-insured by A+ Rated Lloyd’s of London

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