Physician's Practice Nov. - Dec. 2012

St. Luke’s healthbeat for physicians

Physician Leadership Academy A

rea physicians and healthcare managers learn how to effectively manage the upcoming transformation in healthcare.

The new era of healthcare – in which payment is tied to better managing population health – will require physicians to exercise expertise in healthcare finance, care coordination, information technology and teamwork. Skills and information that get little attention in medical school.

St. Luke’s and the Iowa Health System (IHS) began partnering with the American College of Physician Executives (ACPE) in 2010 to give physicians a broader knowledge base and prepare them for leadership roles as healthcare delivery changes.

“In light of healthcare reform, coordination within and between management leaders and physician

leaders is only going to become more critical to ensure best outcomes for patients,” said Ted Townsend, St. Luke’s president and CEO. The Physician Leadership Academy provides intensive, graduate-level courses accredited by the ACPE. Topics cover leadership skills, the current healthcare environment and business skills. In addition to the year-long program of classes, physicians complete a final project.

The curriculum incorporates both distance education and on-site classes in Des Moines to meet the scheduling demands of working physicians throughout Iowa and Illinois. Skills taught include

In this issue A1

Leadership Academy Local physician leaders graduate A3

Advanced Medical Team Pilot program serves chronically ill A4

IPC welcomes new physicians An endocrinologist and pulmonologist A6

Pediatric surgery at St. Luke's Performed by Jeffrey Nielsen, MD.

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James Bell, MD St. Luke’s, Hospice and Palliative Care 2012 Physician Leadership Academy graduate

, P.O. Box 3026 Cedar Rapids, IA 52406-3026 319/369-7211 stlukesmedstaff.com

St. Luke’s Hospital – A1

“ Having physicians trained at Physician Leadership Academy is a significant step in ensuring that the patient remains at the center of the equation. It also depoliticizes what is unfortunately becoming an all too political issue.”

managing challenging healthcare initiatives and ways to significantly contribute to the strategic direction of IHS. James Bell, MD, St. Luke’s Hospice and Palliative Care, recently graduated from the Physician Leadership Academy. “More than ever, it is important for all providers of healthcare to cooperate and think globally about the best way to care for patients. This is critical in a rapidly evolving and incredibly complicated environment. Having physicians trained at Physician Leadership Academy is a significant step in ensuring that the patient remains at the center of the equation. It also de-politicizes what is unfortunately becoming an all too political issue,” Bell said.

Last year, a Management Leadership Academy was added for clinical and business leaders.

The graduate-level course of study is also accredited by the ACPE. Both Academies worked with national experts on topics such as patient care innovation, healthcare industry transition, regulatory impacts and leading change. Final projects ranged from leading the implementation of new population health strategies to business planning models across enterprises.

Participants from both programs engaged in the projects collaboratively.

Congratulations St. Luke’s 2012 Leadership Academy graduates

James Bell, MD St. Luke’s Hospice and Palliative Care

In 2012, more than 65 leaders from throughout the system graduated in a joint class of Physician and Management Leadership Academy participants on August 3, 2012.

Mohit Chawla MD Cardiologists, L.C.

IHS Leadership Academies benefit quality of patient care

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– St. Luke’s Hospital

A patient can have an excellent experience with his or her physician, but if the physician is not equipped to lead in administrative decisions or address financial concerns, the outcome for the patient may be less than ideal. St. Luke’s and IHS developed the Physician Leadership Academy in partnership with the American College of Physician Executives (ACPE) to ensure physicians are prepared and positioned to lead at all levels of healthcare delivery.

Likewise, hospital and clinic managers benefit from a broader perspective in order to better align initiatives that support improved patient care. The Management Leadership Academy, developed in partnership with the ACPE, is designed to help clinical and business leaders at IHS lead the System’s transition to a more physician-driven, patient-centered organization.

Clayton Schuett, MD St. Luke’s Physicians and Clinics Family Medicine

Both Leadership Academies allow participants to learn and network with peers across the System. The next session for both academies will start in early 2013.

If you’re interested in participating in the next Leadership Academy, contact John Sheehan, St. Luke’s executive vice president and COO, at 319/369-8099.

Tracy Reittinger, MD St. Luke’s Hospitalist

AMT

Advanced Medical Team I

owa Health System (IHS) pilots a program in Cedar Rapids to improve healthcare for complex, chronically ill patients.

Five percent of the population – those with complex, chronic illnesses – have the highest hospital readmission rates and the longest hospital stays. To improve the health for this group and help them use services more appropriately, IHS and St. Luke’s is developing an early intervention program using an interdisciplinary team of health professionals called the Advanced Medical Team (AMT), which is made up of a physician, nurse, pharmacist, therapist, social worker and others who support primary care providers. Pilot programs are being tested in Cedar Rapids, Des Moines and Fort Dodge.

The initial target population for the AMT at St. Luke’s will be patients of Donald E. Paynter, MD, Internists, PC, and his staff. Patients will be identified by a trigger tool that indentifies individuals who are requiring frequent hospitalizations, Emergency Department visits and clinic visits. A nurse care

Team medicine This collaborative effort between various disciplines within the AMT provides more intense case review, which reveals the root cause for any continued failure and results in appropriate care planning and better use of healthcare resources.

The aim is for unstable chronically ill patients to be more satisfied with their clinic-based care and experience fewer avoidable hospitalizations with a decrease in the length of stay when they are hospitalized. In addition, clinic work flow should improve and use of community-based services, home health and palliative care/ hospice services should increase.

“The pilot project will help us learn how best to structure the program, replicate it and roll it out in other clinics. We want to make sure we get it right,” said Carmen Kinrade, director of nursing operations and nursing support for St. Luke’s. “It’s the right thing to do for patients as their care becomes more complex.”

IHS has provided a basic outline to support the AMT pilot programs, but the specifics are being determined by AMT design teams in each region.

Carmen Kinrade, director St. Luke's nursing operations and nursing support

The relationship with primary care providers will be maintained and enhanced as the care navigators follow patients across the continuum of care and keep physicians updated. When patients are admitted to the hospital, AMT care navigators will communicate with inpatient navigators, making sure all providers involved understand the changes in the patient.

Handoffs should improve.

“We’ll be able to help complex, chronically ill patients remain in the environment they prefer to live in for as long as possible,” Kinrade said. The process will help providers respect and honor patients’ wishes while improving their healthcare.

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Patient-centered care Physicians are a key component to determining which patients will be served by the AMT.

P.O. Box 3026 Cedar Rapids, IA 52406-3026 319/369-7211 stlukesmedstaff.com

St. Luke’s Hospital – A3

Donald E. Paynter, MD, IPC

navigator will serve as the liaison between the patient and primary care provider and will mobilize resources around the patient.

The care navigator will coach patients, coordinate their care and implement interdisciplinary care plans.

IPC welcomes two new specialists Education and training MD, Deccan College of Medical Sciences, India Intensive care and outpatient medical internships, Yashoda Hospital, Hyderabad, India Internal medicine internship, University of Arkansas for Medical Sciences, Little Rock, Arkansas Internal medicine residency, University of Arkansas for Medical Sciences, Little Rock, Arkansas Endocrinology fellowship, Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences and Central Arkansas Veterans Health Care System, Little Rock, Arkansas

Certifications Advanced Cardiovascular Life Support Certification Basic Life Support Education Commission for Foreign Medical Graduates American Board of Internal Medicine

Professional Memberships Andhra Pradesh Medical Council Indian Medical Association Educational Commission for Foreign Medical Graduates

Endocrinologist Prasuna Rao Madhavaram, MD The ability to prevent the progression of chronic disease inspires endocrinologist Prasuna Rao Madhavaram, MD, and drew her to a field she describes as extraordinary. Rao began practicing in the new endocrinology clinic at Internists, PC, on November 1.

“Endocrinology fascinates me because of the multiple complex effects that hormones exert in all aspects of our metabolism, development and growth. The role of an endocrinologist is a unique blend of both a healthcare provider and an educator. It is essential to educate patients regarding their disease process. It is possible to lead a productive and healthy life despite having diseases like diabetes, but not taking them seriously can be deadly,” Rao said.

In January 2013, Rao will open an obesity and weight management clinic and is forming a strong weight-loss support team to staff the full-fledged obesity center.

“Obesity is an epidemic affecting over half the U.S. adult population.

Obesity increases the likelihood of various health problems particularly heart disease, type 2 diabetes, obstructive sleep apnea and osteoarthritis,” Rao said.

She and her husband, Pavan Chepyala, a gastroenterologist who joined Gastroenterologists, PC, learned about Cedar Rapids from Rao’s sister, who moved to the city two years ago. The couple wanted a family friendly environment to raise their sixyear-old and two-month-old sons.

To refer a patient to Dr. Madhavaram, please call 319/363-3565.

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– St. Luke’s Hospital

Associate member American College of Physicians American Association of Clinical Endocrinologists Endocrine Society

internistspc.com

Pulmonologist

Endocrinology Clinic Treats patients for the following health issues: Diabetes/hypoglycemia: type 1 and type 2 diabetes mellitus, pregnancy-induced diabetes, hypoglycemia, other types of diabetes Calcium and bone: hypercalcemia, hypocalcemia, osteoporosis, Paget’s disease, osteomalacia and rickets and other bone disorders Thyroid: hyperthyroidism, hypothyroidism, solitary nodules and nontoxic multinodular goiter, thyroid cancer Adrenal: disorders of glucocorticoids, mineralocorticoids, adrenal androgens, adrenal medulla, adrenal incidentaloma, adrenal cancer Pituitary: disorders of prolactin, growth hormone, thyroid-stimulating hormone, gonadotropins, ACTH, antidiurectic hormone, nonsecreting tumors, hypopituitarism, empty sella, hypothalamic syndromes, pituitary incidentaloma

Obesity Female reproduction: amenorrhea/PCOS, hirsutism/ virilization, endocrine causes of infertility Male reproduction: hypogonadism, endocrine causes of infertility, gynecomastia

Muhammad Anwer, MD, began practicing at IPC in early October, where he specializes in pulmonology and critical care.

He often uses his experience with sleep disorders while treating patients because a significant number of pulmonary patients have sleep apnea, he explained.

Originally from Pakistan, Anwer describes his medical training there as driven by passion.

“I treat every patient as my family member regardless of anything,” he said. Six years ago he came to the U.S. to pursue advanced medical training in New York City, where he developed his interest and expertise in intensive care (ICU).

“You see extremely critical care patients who need your dedicated attention and extra care. And, you see them coming back to life – that’s amazing. It’s a passion not a profession,” Anwer said.

He and his wife, Saira Ubaid, brought their two young children to Cedar Rapids for a better balance between work and family life.

“I don’t want to be rushing while seeing patients as it is in a big city,” Anwer said. “I prefer seeing patients when I can dedicate time to them and provide quality care and offer excellent communication with referring physicians.”

To refer a patient to Dr. Anwer, please call 319/363-3565.

Education and training MBBS (MD equivalent), AIlama Iqbal Medical College, Lahore, Pakistan Internal medicine resident, Shalamar Hospital, Lahore, Pakistan Ear, Nose, Throat (ENT) resident, Jinnah Hospital, Lahore, Pakistan Internal medicine residency, Bronx Lebanon Hospital Center, Bronx, New York Pulmonology fellowship, Bronx Lebanon Hospital Center, Bronx, New York Critical care fellowship, Montefiore Hospital, Bronx, New York Critical care residency, Bronx Lebanon Hospital Center, Bronx, New York

Certifications Education Commission for Foreign Medical Graduates Advanced Cardiac Life Support Basic Cardiac Life Support Professional Memberships American College of Chest Physicians/Society of Critical Care Medicine

St. Luke’s Hospital – A5

Lipids: management of primary and secondary disorders of lipid metabolism

Muhammad Anwer, MD

General surgical care for children provided at St. Luke’s

J

effrey Nielsen, MD, Physicians’ Clinic of Iowa (PCI), general surgeon, performs general pediatric surgeries on infants and children of all ages.

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– St. Luke’s Hospital

Cedar Rapids surgeon Jeffrey Nielsen, MD, PCI, Department of Surgical Specialists, enjoys working with children. “I’ve been performing general surgeries for 26 years in Cedar Rapids and I’ve done kids all along,” he said. “Taking care of kids is very rewarding. They tend to get better in a hurry and that’s always good to see.”

Some general surgeons shy away from taking on cases with very young patients, but Nielsen takes on all age ranges. He developed an interest in pediatric surgery during his residency at the University of Iowa College of Medicine, where he spent six months working with Robert Soper, MD, in pediatric surgery.

Soper was a great role model, and though Nielsen chose not to pursue pediatric surgery as a specialty, performing procedures on children has always appealed to him. “Complex surgery is done in the University setting where it should be, but the common pediatric surgeries I do here in Cedar Rapids,” Nielsen said.

“I handle the more general aspects of pediatric surgery, including appendicitis and hernias, which are fairly common through all ages. I’ll also perform a pyloromyotomy for pyloric stenosis and occasionally I’ll put a feeding tube in a child. We see more and more infants and children with skin abscesses from MRSA, so we’ll drain those. Those are the basics. I’ll evaluate kids and anything that is very advanced I’ll send to the University.”

“ Taking care of kids is very rewarding.

They tend to get better in a hurry and that’s always good to see.”

Parents often prefer the convenience of staying in town for their child’s surgery and they can get excellent care in the Pediatric Unit at St. Luke’s or Surgicare for outpatient surgery.

Nielsen focuses on helping parents feel comfortable by explaining the procedure thoroughly, talking about his experience with the specific illness and procedure, explaining the risks and offering parents options, including referrals.

He said anesthetics often pose greater risks for children than the surgical procedure. “All kids need to be evaluated preoperatively. We have very good anesthesiologists who are comfortable taking care of kids that we use for these cases. That’s another thing that parents are oftentimes concerned about is putting their child to sleep, sometimes they’re more worried

Jeffrey Nielsen, MD, Physicians’ Clinic of Iowa (PCI), Department of Surgical Specialists

General surgeries Dr. Nielsen performs Infants: • Hernia surgery • Pyloromyotomy • Gastric feeding tubes

Children 2 years old and older: • Several types of hernia surgery • Appendectomies • Gastric feeding tubes • Remove skin abscesses resulting from MRSA

Case Report: A 42-week-old female patient, born at 25 weeks’ gestation at about 1000 grams of weight, could not maintain satisfactory oral feedings. Her prematurity did not cause any other ongoing issues. She was receiving 30 percent of her calories by mouth each day and the remaining calories through a nasogastric (NG) tube. Her weight gain was up to 4.5 kg. She was referred to Jeffrey Nielsen, MD, Physicians’ Clinic of Iowa, general surgeon, by Scott Nau, MD, for gastrostomy tube placement.

about that than the procedure itself,” Nielsen said.

The patient was given general anesthesia.

A 12-French Malecot catheter was inserted into the stomach and the gastrostomy tube was secured. There were no complications.

Patient is currently at home with the hope she will learn to eat normally.

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St. Luke’s Hospital – A7

“Oftentimes operating on someone’s child is more stressful for the parents than undergoing the surgery themselves, which is understandable.

My kids had procedures when they were young and I’ve been in the operating room a million times. It’s just different when you’re on the other end,” Nielsen explained. “It’s important to spend the time to talk with parents, inform them and reassure them.”

The patient had never been home from the hospital and had a detailed past medical history. Her exam revealed no distress. After hearing details about the procedure, risks and alternatives, the patient’s mother agreed to proceed with the gastrostomy tube placement.