Physician'a Practive Nov 2011

St. Luke’s healthbeat for physicians

In this issue Empowering physicians through

leadership training

T

he Physician Leadership Academy Master’s program is among the first in the nation to train practicing clinicians for leadership roles within the health delivery system.

Physicians leading innovation in all aspects of the healthcare delivery system is the vision St. Luke’s and Iowa Health System (IHS) see for the future of their organizations. As both strive to become nationally recognized leaders in innovation and clinical management, the organizations are seeking vehicles to empower physicians. IHS designed the Physician Leadership Academy Master’s program to help integrate physicians into all levels of leadership and management so they become partners in decision-making that affects the quality of care delivered to patients.

Empowering physicians The Physician Leadership Academy prepares physicians for leadership roles.

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A new route to hearing Cedar Rapids’ first Baha implant procedure is performed at St. Luke’s.

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St. Luke’s Heart Failure Clinic Heart failure patients receive support through education and close monitoring.

Physicians complete an intensive course of study and a final project. This years’ projects ranged from leading the implementation of new clinical systems to participating in innovative cross-disciplinary continued

The Physician Leadership Academy Master’s program is an instrumental part of transitioning the Iowa Health System and St. Luke’s to a physiciandriven organization.

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

St. Luke’s Hospital – A1

The Physician Leadership Academy is a graduate-level

program for physicians who have demonstrated great potential as leaders. It allows them to learn and network with their peers from across the Iowa Health System. IHS has partnered with the American College of Physician Executives to present timely, relevant and actionable education to physician leaders.

Courses cover leadership skills, the current healthcare environment and business skills.

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Congratulations St. Luke’s 2011 Leadership Academy graduates American College of Physician Executives (ACPE) With nearly three decades of experience providing physician leadership education, ACPE is a proven partner in developing leaders who can effectively manage challenging healthcare environments and initiatives.

Dustin Arnold, DO St. Luke’s Hospital

Judith Bernhard, MD Cedar Rapids Pediatrics

Todd Langager, MD Cardiologists, L.C.

After successfully completing the Iowa Health System Physician Leadership Academy course work, physicians receive 113 CME credit hours, which they can apply toward a Certificate in Physician Executive, a Master’s degree in Business Administration, a Master’s degree in Patient Safety and Quality or a Master’s degree in Medical Management.

Accreditation

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– St. Luke’s Hospital

John Roof, MD Family Practice Associates

Dennis Rosenblum, MD St. Luke’s Hospital

teams of physicians to advise and counsel system-wide improvements from a local physician perspective. The Academy 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 managing challenging healthcare initiatives and ways to significantly contribute to the strategic direction of IHS. The Academy Program equips physician leaders with the skills required to lead IHS in a transformative environment and is seen as an important part of IHS becoming a physician-driven organization. In his address to Academy graduates, Dr. Alan Kaplan, IHS chief medical officer, said, “The only thing that matters is our patients.

Shannon Throndson, MD Northridge Family Medicine

Your success will not be determined by certification.

Your success will be determined by your sense of purpose.”

Thirty-five participants graduated from the first class of the Leadership Academy on July 22. Six area physicians from St. Luke’s Hospital and St. Luke’s Physicians and Clinics graduated with the class.

The next class of Physician’s Academy participants from Cedar Rapids program are Tracy Reittinger, MD, St. Luke’s Hospitalist Program; Clay Schuett, DO, St. Luke’s Physicians and Clinics Family Medicine; Mohit Chawla, MD, Cardiologists, L.C.; James Bell, MD, St. Luke’s Hospice and Palliative Care.

Applications for the third class will be accepted in spring 2012.

The American College of Physician Executives (ACPE) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing education for physicians.

Designation The American College of Physician Executives (ACPE) designates this educational activity for a maximum of 113 AMA PRA Category 1 Credit™.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

A new route to hearing through bone-anchored implants

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edar Rapids’ first Baha (bone-anchored hearing aid) procedure was performed at St. Luke’s to give patients a higher-quality hearing than traditional hearing-loss treatments.

1. Processor

It’s a simple concept. Just as air conducts sound, bone does too.

In fact, bone conduction is the way we hear our own voices when we speak. In contrast, the sounds we hear from the world around us are conducted through air vibrations passing through the ear canal, eardrum and middle ear to the inner ear, where the cochlea converts sound vibrations (whether they’re conducted through air or bone) into neural signals. We hear sound when the brain receives these signals.

3. Titanium Implant

Picture provided courtesy of Cochlear™ Americas, ©2011 Cochlear Americas

“At St. Luke’s, we believe it is our mission to seek out and consider new technologies and procedures to give our patients the kind of care we would want for our loved ones. Working with PCI ENT specialists to bring the Baha System to St. Luke’s demonstrates our ongoing commitment to that mission and to be a healthcare leader in the region,” said

Peg Pickering, director of St. Luke’s Surgical Services.

Baha components Made up of three components, the Baha consists of a sound processor to receive vibrations, a titanium implant, which bonds – or osseointegrates – with the skull bone behind the ear, and

St. Luke’s Hospital – A3

Most hearing aids use air conduction to transmit sound from the external auditory canal to a functioning middle ear. Unfortunately that method doesn’t work for individuals who have damaged outer ears, or blocked, damaged or occluded middle ears. A new procedure performed at St. Luke’s by Kevin Carpenter, MD, Physicians’ Clinic of Iowa, P.C. (PCI), Department of Ear, Nose and Throat (ENT), offers these patients an alternative. The Baha implant bypasses the outer and middle ear, using the jaw and skull bone to transmit sound directly to a working cochlea, where sound transmission continues along its normal pathway to the brain.

2. Abutment

an external abutment, a snap, that protrudes from the head to connect the processor to the implant. Sound is transmitted from the processor, through the abutment and to the titanium implant. Because it has integrated with living bone tissue, the implant causes the skull to vibrate, stimulating the inner ear and its nerve fibers.

“The Baha was actually invented in 1977,” said Carpenter. The Food and Drug Administration (FDA) approved its use for conductive and mixed hearing loss treatment in 1996 then gave its approval for treating unilateral sensorineural deafness in 2002.

Until this summer, when Carpenter implanted his first Baha System in a patient at St. Luke’s, the procedure hadn’t yet been performed in Cedar Rapids. “We were having trouble getting it approved by insurance,” Carpenter explained. However, the trend is changing and insurers are now more willing to give prior authorization for the procedure.

“Marie May, the tech specialist for the St. Luke’s ENT team, has taken an incredible leadership role to ensure the Baha program will be successful. She really cares. She was extradorinary,” Carpenter praised.

Suitable candidates

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– St. Luke’s Hospital

Individuals who have singlesided deafness (SSD) are generally good candidates for the Baha System. Those who have difficulty with a traditional hearing aid because of continuous ear drainage are also good candidates as well as individuals who have conductive hearing loss or mixed hearing loss. Carpenter said, “It’s good for syndromic children as well.

They have funny looking ears that just can’t hear. You can perform it on children down to age five.”

Carpenter’s first implant patient is a young woman with SSD. “She has a complete hearing loss on the right side. It was sudden,” he said. A trial test with a PCI audiologist demonstrated how the implant would affect Picture provided courtesy of Cochlear™ Americas, ©2011 Cochlear Americas

her hearing. “It made a dramatic difference in her hearing quality,” Carpenter explained.

“The Baha vibrates the bone and takes sound to the functioning left side. She can have a conversation at the dinner table or in the car and hear someone on the right side. It is good hearing,” he said. Previous bone conduction hearing aids were strapped onto an individual’s head and required pressure created from a tight strap to transfer sounds from the hearing device to the individual’s skull bones. Carpenter said, “It started to hurt after awhile because the strap had to press so hard against your head. With the Baha, the sound is definitely much better because sound doesn’t have to pass through skin, muscle and fat.”

Easy procedure “It’s nothing more than putting a titanium bolt behind the ear,” Carpenter explained. “It’s about an hour procedure under general anesthesia. The implant is placed behind the ear in the hairline about five centimeters. To keep hair from growing around the implant, you thin out the skin enough so there’s an area of skin without hair.”

The patient then wears a dressing for about a week while the wound heals. “It takes three months for osseointegration to take place,” Carpenter said. Once the implant is stable, the sound processor is snapped into place. “You have to program it to the patient’s hearing loss. The audiologist adjusts the

sound processor so it perfectly mirrors the other ear’s hearing,” he said. “The nice part about the Baha is there’s no risk of losing any hearing. No risk of anything blocking the ear canal.”

Previous treatments Any of the PCI ENT physicians can perform the procedure.

Though it’s called a boneanchored hearing aid, it doesn’t

compare to previous hearing aids that addressed single-sided deafness, such as the boneconduction hearing aids worn with a strap or the CROS hearing aid, which used a microphone to pick up sound from the side of the head experiencing hearing loss and wires to carry the sound to the functioning ear. Carpenter calls the CROS cumbersome and the quality of sound poor in

comparison to the Baha. “The breakthrough came with the titanium implant. The science isn’t that hard. I think it will become more and more popular,” Carpenter said.

To learn more about the ■

Baha implant, call Peg Pickering, St. Luke's Surgical Services at 319/369-8996.

“ The nice part about the Baha is there’s no risk of losing any hearing. No risk of anything blocking the ear canal.”

Kevin Carpenter, MD, Physicians’ Clinic of Iowa, P.C. Department of Ear, Nose and Throat (ENT)

Physicians’ Clinic of Iowa (PCI) Physicians performing the Baha procedure

Kevin Carpenter, MD

Ryan Dempewolf, MD

Scott Huebsch, MD

Jeffrey Krivit, MD

Mary Susan Pruzinsky, MD

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St. Luke’s

Heart Failure Clinic A resource for heart failure patients and their physicians

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t. Luke’s Heart Failure Clinic educates and monitors heart failure patients for another level of support.

Heart failure patients can quickly end up in the emergency room and stay for an extended time in the hospital. Nearly one in four will return to the hospital within 30 days, according to a 2009 American Heart Association journal report. Nationally institutions with heart failure clinics report a significant decrease in readmissions for patients in their programs.

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– St. Luke’s Hospital

Peg Bradke, Heart Care Services director, said, “Some heart failure clinics we talked to reported their hospital readmission rates were 30 to 40 percent lower than the national average.” St. Luke’s new Heart Failure Clinic opened in August to help heart failure patients and their families improve self-management as they treat and improve their symptoms.

“We’re a specialized center with providers whose focus is to reduce the number of unnecessary visits to the emergency room, prevent hospitalizations and help patients live a full and productive life,” said Michael Muellerleile, MD, a member of the Clinic team and a cardiologist at Cardiologists, L.C. Sue Halter, ARNP, clinical director St. Luke’s Heart Failure Clinic

“ We’re a specialized center with providers whose focus is to reduce the number of unnecessary visits to the emergency room, prevent hospitalizations and help patients live a full and productive life.”

Michael Muellerleile, MD, cardiologist Cardiologists, L.C.

Every St. Luke’s patient who receives a discharge diagnosis of heart failure is seen by clinic staff three to five days after they’re discharged. Physicians and cardiologists refer chronic heart failure patients to the clinic when a patient needs close follow-up.

“We want our patients to fully live their lives without repeated hospitalizations or frequent trips to the doctor and ultimately optimize the quality of their life. We can do that by closely monitoring them and keeping them out of trouble, that’s our goal,” said Halter. “Being located at the hospital allows us to direct our patients to resources that may help, like home health care, cardiac rehabilitation and pulmonary rehabilitation if needed.”

“We communicate closely with the referring and primary care physicians and consider our clinic to be a resource to the physician, not a replacement. We can ease the burden of the physician and yet increase quality of life for the patient. This partnership of care helps ensure the patient has effective, seamless attention from their medical providers,” Halter said.

The heart failure team consists of Clinical Director Sue Halter, ARNP, Drs. Todd Noreuil and Michael Muellerleile, and Amy Schweer, RN. The clinic is located on the fifth floor of St. Luke’s Hospital.

For more information contact St. Luke’s Heart Failure Clinic at 319/369-7842.

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

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“We’re able to see heart failure patients quickly because all we do is heart failure,” said Sue Halter, ARNP, clinical director for St. Luke’s Heart Failure Clinic.

“We know physicians’ offices are extremely busy. Heart failure patients can be challenging and need very close supervision. We combine not only medication management but, more importantly, education, referral to services if needed, sometimes daily monitoring by our heart failure nurse. Our goal is to keep patients out of the hospital and improve their quality of life at home.”