february 2016
Johnston Health
Improving Patient Outcomes on Several Fronts
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue Concierge Medicine Independent Appeal
From the Editor
Do it With Passion T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Ah, February – a month to celebrate matters of the heart. So it is a fitting time for Johnston Hospital’s cover story. In it, several vignettes illustrate the power of passion for improving health care delivery and outcomes, whatever one’s job. Intensity of purpose likewise shines in the columns of our contributors, each providing the wise counsel that comes from years of dedication to one’s profession. In this issue of The Triangle Physician, gastroenterologist Michael Thomas offers an in-depth overview of pheochromocytomas, seemingly rare, potentially lifethreatening tumors. Women’s health specialist Lindsay Wojciechowski discusses the nature of celiac disease and the need for a strict gluten-free diet.
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Wendy Coulter Marni Jameson Margi Satinsky, M.B.A. Michael J. Thomas, M.D., Ph.D. Lindsay Wojciechowski, F.N.P.-C. Creative Director Joseph Dally jdally@newdallydesign.com
Advertising Sales info@trianglephysiciancom
Practice marketing consultant Wendy Coulter completes her four-part series on the many ways practices can endear themselves to patients and thrive in
News and Columns Please send to info@trianglephysician.com
a competitive marketplace. Practice management consultant Margie Satinsky explores the benefits and drawbacks of offering value-added concierge services.
The Triangle Physician is published by: New Dally Design
Physician advocate Marni Jameson proposes an approach to educating patients on the value of independent practitioners – a “love letter,” if you will.
Subscription Rates: $48.00 per year $6.95 per issue
All of our readers are welcome to submit their health care-related news and
Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
perspective, which we run free of charge. We also offer competitive advertising rates. Both ways of contributing assure that reaching – and potentially engaging with – more than 9,000 within the Raleigh-Durham medical community makes good economic sense. As always, it is a privilege to produce The Triangle Physician – call it “a labor of love.” Each issue brings us in contact with amazing humans who perform their health care roles with the passion that inspires. With respect and gratitude,
Heidi Ketler Editor
2
The Triangle Physician
Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
“TOP PERFORMER” HOSPITAL
The Joint Commission Has Recognized Our Level Of Services By Naming Johnston Health A “Top Performer” Hospital On Key Quality Measures * *Top Performer recognitions announced Nov. 2015 are based on data compiled from 2014 regarding treatment of: Heart Attack, Heart Failure, Pneumonia, Surgical Care, Perinatal Care
www.johnstonhealth.org
Table of Contents
4
COVER STORY
Johnston Health
Improving Patient Outcomes on Several Fronts february 2016
Vol. 7, Issue 2
FEATURES
10
Practice Management
Perspectives on Concierge Medicine Margie Satinsky explores the challenges and rewards to physician and patient of a practice model based on personalized service.
13
DEPARTMENTS 9 Practice Marketing
20 Powerful Reasons to Brand Your Practice: Part 4 of 4
14 Digestive Health
When to Test for Celiac Disease
15 Gastroenterology
Understanding Pheochromocytomas
16 Duke Research News
Physician Advocacy
Blood Test Can Distinguish Between Bacterial and Viral Infections
17 Duke Research News
Esophageal Cancer Survival Impacted by Race and Socio-Economic Factors
“Dear Patients:” Communicate the Benefits of Independent Doctors
18 UNC Research News
Marni Jameson provides a template for a letter that
20 News
explains how mergers and high hospital costs can hurt the community.
DNA Repair Enzyme Identified as Potential Brain Cancer Drug Target
- WakeMed Key Community Care Chosen for CMS Initiative - 2nd Annual NC Doctors’ Day Contest Gets Under Way
On the Cover: Everyone plays a role in quality at Johnston Health. Clockwise, from top, are: Don Dunbar, phlebotomy supervisor; Kyle McDermott, vice president of support services; Liz Thurston, physician liaison; Ruth Marler, chief operating officer and chief nursing officer; Dr. Manny Gupta, medical director of emergency services; Christy Davis, coordinator of Lean transformation; Vera Barnes, a quality improvement specialist in the quality department; Daniel Register, director of emergency services; and Lee Stikeleather, manager of emergency services. They are among the many administrators, directors and front-line staff who have participated in Lean activities aimed at improving processes to benefit patients.
4
The Triangle Physician
The Magazine for Health Care Professionals
The Triangle Physician
Did You Know? We mail to over 9,000 MDs, PAs, administrators, and Hospital staff in 17 counties in the Trinagle – Not to each practice but to each MD or PA personally
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
We are a LOCALLY dedicated magazine designed primary for MD referrals.
Macon Clay
Haywood Henderson
Jackson
ania sylv
Davie
Alexander
Burke
Rutherford Polk
Lincoln Gaston
Tran
Alamance Davidson
Randolph
Rowan
Catawba
Cleveland
Orange
Guilford
Cabarrus
Stanly
Montgomery
Anson
The Triad Physician Magazine The Triangle Physician Magazine The Eastern Physician Magazine
Edgecombe
Johnston
Greene
n
Dare
Hyde
Wayne
Cumberland Sampson
Scotland Robeson
de
Washington Tyrrell Beaufort
Pitt
Craven
Lenoir Hoke
Martin
m
Wilson
Harnett
Moore
Bertie Nash
Wake
Chatham
Richmond Union
Durham
Ca
Gates Hertford
Halifax
Franklin
Lee
Mecklenburg
Northampton
Warren Vance
ck
Cherokee
Mcdowell
Forsyth
Granville
u rit ur
Graham
Caldwell
Iredell
Buncombe Swain
Yadkin
Person
n wa
Yancey
ell ch
Mit
Madison
Wilkes
Caswell
o Ch
Watauga Avery
Rockingham
Stokes
nk ta s uo an sq uim Pa rq Pe
Surry
C
Alleghany Ashe
Bladen
Duplin
Onslow
Pamlico
Carteret
Pender
New Hanover
Columbus
The Eastern and The Triangle Physician Magazines
Jones
Brunswick
Counties: Alamance, Chatham, Durham, Franklin, Granville, Harnett, Johnston, Lee, Moore, Nash, Orange, Person, Vance, Wake, Warren, Wayne, and Wilson Counties Cities: Raleigh, Durham, Chapel Hill, Smithfield, Roxboro, Henderson, Louisburg, Pine Hurst, Siler City
The Triad and The Triangle Physician Magazines
Local physician specialists and other professionals, affiliated with local businesses and organizations, contribute all editorials or columns about their respective specialty or profession.
Every issue includes the latest listing of: MDs and PAs who are newly licensed by the NC Medical Board and New MDs and PAs to the area.
We also publish free of charge: • Practice, hospital and other medical facility news, including: • New MDs and PAs; • New facilities, expansions and relocations;
• New or updated websites; and • Upcoming events, including CMEs. • Local charity events, ads and articles. • Images for all of the above.
All FREE to the greater Triangle medical community- a vital REFERRAL SOURCE! We also profile the greater Triangle medical community, practices or companies that want to get “in front” of MDs • 1 page with 1 image and text • 2 page with 2 images and text • 4 page with 4 images and text • 8 pages with 8 images and text Long term Advertising is always the most effective way to keep your practice or company in the readers.
If you would like to be involved with The Triangle Physician, please contact us
info@TrianglePhysician.com
Cover Story
Quality Matters Johnston Health is improving patient outcomes on several fronts: by engaging staff, physicians in building better processes; helping patients manage their diseases; and keeping the hospital healthy. By Suzette Rodriguez
Detecting,Treating Sepsis as
on a white board to organize thoughts, test
Quickly as Possible
ideas and map strategies.
risk of dying increases by seven percent. More common than heart attacks and
During a typical week, Don Dunbar works from the lab, setting schedules and filling
Rather than finding fault with anyone,
more deadly than stroke, sepsis is such a
in as needed to draw blood. But for a
it would be their intent to build a better
serious concern that UNC Health Care has
particular week in January, the phlebotomy
process, which would give the staff and
taken it on as a system-wide initiative. In
supervisor was asked to apply his know-
physicians a clear, timely and effective
the past year, all eight hospitals, including
how toward a noble cause: To save lives.
route toward aggressively treating the
Johnston Health in Smithfield and Clayton,
patient.
have been working on projects aimed at reducing the number of sepsis deaths.
Specifically, the assignment centered on how to detect and then start treating, as
Why the focus on sepsis? Sepsis is
quickly as possible, the sudden onset of
responsible for about 60 percent of deaths
“It was a great experience,” Dunbar said
sepsis, a life-threatening illness triggered by
among hospitalized patients. It can be
afterward. “I loved the interaction with
the body’s immune response to infection.
difficult to diagnose because symptoms, at
nurses, and I think we put together a great
first, may appear subtle, and then suddenly
process that will improve patient care.”
Dunbar joined a group, made up of nurses,
worsen. By using principles of Lean transformation,
an administrative director and a hospital vice president, in a sort of war room where
With sepsis, time is critical. For every hour
Johnston Health has been able to improve
they posted sticky notes of different colors
that passes, it’s estimated that the patient’s
processes
that
benefit
patients
and
reduce costs. And the approach has been successful largely because it engages the employees who do the work, says Ruth Marler, who is the chief operating officer and chief nursing officer for Johnston Health. “We draw employees from all disciplines— the lab, radiology, pharmacy, finance, nursing, environmental services, and from our medical staff,” she says. “These have been wonderful opportunities to improve quality outcomes for our patients.” When he talks with new hires at orientation, CEO Chuck Elliott defines quality in simple terms: It’s doing the right thing at the right time in the most effective way to get the From left, nurse Brittney Parker reviews a patient chart alongside infectious disease specialist Dr. Octavio Cieza, quality director Cynthia Holloman, and infection preventionist Ronnie Syverson.
6
The Triangle Physician
results you want.
to give feedback right away to staff and doctors. “We’re here to help, not punish,” she adds. “If we’re not meeting a core measure, then it’s more likely that a patient comes back to the hospital for readmission,” she says. “It’s not only costly for us, but it means that the patient is losing time with children or grandchildren.” Dr. S. Robert Bylciw, a retired orthopedic surgeon, chairs the quality committee of the Johnston Health Board of Directors. The committee meets monthly to review reports, clinical measures as well as scores from patient satisfaction surveys. “By all quality standards, we’re continuing to improve,” he says. “I’m proud of what we’ve been able to accomplish.” Indeed, for the second year in a row, Audrey Brescia, an environmental services aide, sanitizes all of the surfaces in the patient room, even the underside of the mattress. Her arsenal includes a nontoxic disinfectant said to be 200 times more effective than bleach at killing microbes.
The Joint Commission has recognized Johnston Health as a Top Performer on Key Quality Measures. Specifically, the
share
audited patient charts and began to realize
health care system excelled on the 2014
information on quality so that everyone
the value of looking at data. Eventually, she
accountability measure sets for heart
knows what and where to improve. Toward
came to understand and appreciate core
attack, heart failure, pneumonia, surgical
that end, the hospital posts its quality goals
measures and how the federal government
care and perinatal care.
for all to see. And behind the scenes,
is leading hospitals to do clinical tasks,
departments work year-long on reaching
such as practicing good hand hygiene, to
“We have a fiduciary responsibility to
the goals they’ve set for their own quality-
affect positive outcomes for patients.
ensure we have high-quality, safe, patient
Elliott
says
it’s
important
to
related projects. The medical staff is actively engaged in improving quality, too. “And if the members of the hospital board don’t see progress, they hold our feet to the fire,” he says.
“Through quality, you can make a difference in so many ways.” – Cynthia Holloman
Identifying What, Where, How, Why to Improve
“Most caregivers love their patients, but
care,” he adds. “Poor quality of care can
Cynthia Holloman enjoyed her many years
don’t like the paperwork,” Holloman says.
result in death and injury, but it also
of bedside nursing. But since becoming
“That’s why it’s so important for us to
contributes to cost.”
director of quality, she’s loved the oppor-
explain why we need to follow processes.
tunity to improve outcomes for all patients.
We all want the same things, just sometimes
Keeping the Hospital Healthy -
for different reasons.”
A New Way to Clean On a bulletin board in his office, Ronnie
“Through quality, you can make a difference in so many ways,” she says. In an earlier role as quality coordinator, she
Holloman says communication goes a
Syverson posts a favorite saying: One good
long way toward helping the hospital meet
housekeeper can prevent more infections
quality goals. She thinks it’s important
than a dozen physicians can cure.
February 2016
7
Syverson, who is an infection preventionist for Johnston Health, thinks the EVS staff is the first line of defense against viruses and bacteria, which can cause serious problems such as pneumonia, blood stream and surgical site infections. Last January, the EVS staff added a new weapon to its germ-fighting arsenal: a disinfectant said to be 200 times more effective than bleach at killing microbes, yet safe enough to drink. Syverson says the product, which is made of salt brine and water through a process of electrolysis, is highly effective. “We did swab testing in rooms, and our results showed a 30 percent decrease in pathogens, down to two percent,” he says.
An outpatient pharmacy at Johnston Health is making it easier for patients to get the medications they need to recover at home. Luis Muniz is one of the two pharmacy techs who deliver to the bedside.
It was a former environmental services director, Darryl Patterson, who introduced
specially trained paramedics are checking
the disinfectant to the hospital. He’s now
in with certain patients at home to see if, for
a vice president for the company that
example, they’re taking their medications
The hospital is assisting in other ways, too.
makes the product, and he developed the
or are well enough to get to their doctor’s
Before going home, patients can choose to
application system to mist the disinfectant.
appointment the next day.
have their new prescriptions filled at the
follow up with their care.”
Johnston Health Outpatient Pharmacy. Because the cleaner is electro-statically
Rather than responding to 911 calls, the
charged, it attaches to all surfaces, he says.
community paramedics try to prevent
It’s convenient for patients because they
One of the products is used to wipe away
them. In short, it’s their job to help
don’t have to make a stop on their way
bio-film, while another is applied through
chronically ill patients proactively manage
home. It also ensures that they have
a wand or a rotating mister to clean areas
their own care after leaving the hospital.
the prescribed medication they need
such as walls and curtains.
to continue their care at home, says Beverly
Legath,
director
of
care
pharmacist Donna Dewberry.
Patterson, who lives in Clayton, says it’s
management for Johnston Health, says
been rewarding to do the first pilot of the
the program is designed to prevent
Patients receiving behavioral health care,
cleaning system in the hospital of his home
readmissions and reduce non-urgent visits
for example, oftentimes lack the resources
county. And he has enjoyed talking about
to the emergency department.
or transportation to get their prescriptions
the success at Johnston Health as he visits other hospitals across the country.
filled after they leave the hospital, she says. “More importantly, this is an opportunity to deliver care in a more coordinated and
In addition to filling scripts, certified
“We think about getting the patient heathy,”
efficient way,” she says. “We’re helping
pharmacy techs Luis Muniz and Wendy
he tells prospective clients. “But we also
patients maintain accountability for their
Hunter deliver prescriptions to the patient’s
need to think about keeping our buildings
health.”
bedside, and search online for discount
healthy.”
coupons, ensuring that customers have the During the past five years, the hospital
smallest possible co-pay.
Avoiding Readmissions by Helping
has reduced its rate of readmissions by
Patients Manage their Diseases
20 percent, largely by teaching patients
Suzette Rodriguez is the public relations
Johnston County EMS paramedics typically
how to manage their disease, Legath
specialist for Johnston Health.
spend their day en route to 911 calls. But
says. “We’ve also helped by connecting
under a program that began in July, two
patients with family physicians, who can
8
The Triangle Physician
Photography by Sloan Communications.
Practice Marketing
20 Powerful Reasons to Brand Your Practice Part 4 of 4
By Wendy Coulter
As we wrap us this series, remember that
Influence Purchasing Decisions
strong brand equity increases the value of
Without branding, patients would just visit
your practice, and if your practice does not
the most convenient practice. But given a
live up to its brand promises to patients,
competitive environment, differentiating
it will suffer. Below are the last five of 20
your practice through branding can help
Powerful Reasons To Brand Your Practice.
you influence patients’ buying decisions. From expressing a style or character with
Build Trust
which they relate, to expressing benefits
People buy from companies they know
of your practice, you can create an emo-
will take care of them. Creating a brand
tional tie that makes the decision where to
allows your practice to develop a brand
go for care easy for them!
promise. More importantly, as the brand lives up to that promise time and again,
Build an Asset
trust is built. Not only does trust foster
When you develop an effective brand that
loyal patients, but it also leads to refer-
is memorable, easily recognizable and
rals, positive word-of-mouth and goodwill.
superior to the competition, brand equity
And patients interact and share more with
can be built. A strong brand can provide
trusted brands.
value that far exceeds a practice’s physical
Without branding, patients would just visit the most convenient practice.
Wendy Coulter is president of Hummingbird Creative Group Inc. She is a graduate of the School of Design at North Carolina State University with degrees in architecture and industrial design and a minor in communications. She founded Hummingbird Creative Group in 1995, with a desire to put her ideas to work, creatively solving problems for small businesses. Hummingbird Creative Group is an award-winning, full-service branding agency that helps companies define brand strategy, develop sustainable brand messaging and implement marketing tactics through advertising, graphic design, sales enablement, public relations and online marketing services. Awards include “Pinnacle Business Award” from the Raleigh Chamber of Commerce, as well as “Business of the Year,” “Employer of the Year” and “Successful Achievement” awards from the Cary Chamber of Commerce. Ms. Coulter was named a “Top 50 Entrepreneur,” “Woman Extraordinaire,” “Mover and Shaker” and “40 Under 40,” to name a few. She is active in a variety of community and civic endeavors and frequently presents on such topics as branding, marketing, advertising and design.
Rise Up in Times of Trouble
value. For example, Heineken bought Asia
Having a strong brand can help insulate
Pacific Breweries for more than $5 billion,
you in times of crisis and economic un-
because one of APB’s most successful
certainty. By differentiating your brand,
brands is “Tiger,” which is a popular brand
you can avoid problems when competi-
in Asia and has potential to be a popular
tors experience bad times. As Johnson &
brand throughout the world. Heineken
strategy will help your practice stay fo-
Johnson demonstrated after cyanide-laced
bought the company for its brand equity,
cused on these basic principles and stay
Tylenol capsules were found, the strongest
not its physical asset value.
true to them while meeting business goals.
brands can overcome tragedy. By showing
A brand strategy also helps to guide mar-
its commitment to consumer safety as a
Stay Focused
keting initiatives, so they align with busi-
core value, J&J was portrayed in a good
When you embark on branding your prac-
ness goals, which can save your practice
light, and the Tylenol brand was able to
tice, the first step is establishing a mission
time and money. With a strong brand, you
recover.
and vision for the brand. A clear branding
can focus more on caring for patients.
February 2016
9
Practice Management
Perspectives on Concierge Medicine By Margie Satinsky, M.B.A.
Not so long ago, mention of the “concierge
Concierge
model” of medical practice generated
personalized service. Both the physician
medicine
negative feedback. Many people attacked
and the patient anticipate a need for
the concept as immoral, suggesting that it
care in advance. The patient pays a
was elitist medicine suitable only for those
fixed annual retainer or membership fee
wealthy enough to afford a fixed annual
for a specific enhanced scope of care
payment. Some insurance companies
as defined by the individual concierge
refused to allow concierge physicians to
practice. For example, the enhancement
become network providers, assuming they
may
would automatically double dip, charging
without an additional co-payment, less
both the patient and the insurance
waiting time for appointments, easier
company for the same service.
and more immediate access directly to
include
is
unlimited
also
about
office
visits
the physician (e.g. cell phone, texting, During the past few years, we’ve seen
online consultations), easier prescription
a dramatic change. In fact, as of last
renewal, home or hospital visits and
count, there were more than twenty-five
wellness services like annual executive
concierge or private physicians in the
physicals.
Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm that specializes in medical practice management. Her firm has experience with concierge practices and can provide assistance in converting one’s current practice to a concierge model or starting a new concierge practice. For more information, visit www. satinskyconsulting.com, send an email to margie@satinskyconsulting. com or call (919) 383-5998. can be purchased with pre-tax dollars using
Triangle area of North Carolina. Most were primary care, but there were several
Optional Business Models
health savings accounts and/or flexible
surgeons in the mix.
Most concierge medicine practices can be
spending accounts that are attached.
categorized as fee-for-service care (FFC), In this article, we examine concierge
fee-for-service extra care (FFEC) and
The third business model for concierge
medicine from the perspectives of both
Hybrid.
practices is often called a hybrid model. Patients have a choice of paying a
physicians and patients. We begin with a definition, explore alternative business
In the FFC model, patients pay an annual
concierge fee for extra services; services
models, examine pros and cons from both
retainer that covers most of the services
that are not part of the concierge package
physician and patient perspectives and
that the physician provides in the office.
are billed to government or private
suggest practical next steps.
There is an additional patient charge for
insurance carriers. Or patients may opt
vaccinations, lab work, X-rays and other
out of the concierge model and have all
services that fall outside the retainer.
covered services billed to insurance.
In the hospitality world, concierge means
Direct primary care (DPC) is often linked
In all three business models described
personalized service. We ask a hotel
to the FFC model. We like to think of it as
above, the practice determines what
concierge to make dinner reservations,
a low-cost subset.
services are included in the concierge
Hospitality Origins to Health Care Applications
practice. It also decides whether or
obtain theater tickets and make other arrangements to accommodate guests’
In the FFEC model, the patient pays a
not to accept cash and/or credit card
needs and schedules. We say thanks with
retainer and the physician charges the
payment. Finally, the practice decides on
a tip, paid before or after the service is
additional services that fall outside the
the frequency of retainer payments (e.g.
rendered.
retainer directly to the patient’s insurance
monthly, quarterly, annually) and on the
plan. Many but not all FFC and FFEC plans
availability, if any, of discounted services.
10
The Triangle Physician
Practice Management Pros and Cons:
be as large as 3,000 to 4,000 patients. In
marketing to new patients and expansion
Physician Point of View
a concierge model, the panel size may
of the practice.
Let’s examine the pros and cons of
range from 50 to 1,000. Even the most experienced physician will
concierge medicine from a physician perspective. Two major advantages are
A known panel size has a direct impact on
not achieve a 100 percent conversion to the
reduction in size of the patient panel and
net income. The largest share of concierge
concierge model. For both the physician
more control over income.
practice income comes from retainer fees,
and for some patients, that reality means a
so the physician has far more control over
dramatic change in a trusted professional
Several years ago, we assisted a well-
net revenue than in traditional practice
and personal relationship that may be
respected Durham, N.C, solo practice
settings where the dominant factor in
many years old.
internal medicine physician convert his
revenue generation is reimbursement from
traditional practice to a FFEC model
public and private insurance companies.
Concierge medicine thrives on a strong
concierge practice. Our client’s primary
Concierge physicians interviewed for
patient-physician relationship. It’s one
reason for making the change was to
a 2013 Wall Street Journal article on
thing for a patient who trusts his/her
provide higher quality care for fewer
concierge medicine indicated an average
physician to make the switch to the
patients. He has more time to understand
40 percent reduction in overhead costs
concierge model. It’s more difficult to
patient needs and to quickly follow up
when they didn’t take insurance payments
attract new patients who have no prior
with diagnostic testing and treatment. He
at all!
relationship with the concierge physician.
What are the cons of converting to
Adding providers to a concierge practice
concierge medicine? Three potential
may also be challenging. Although the
Other concierge physicians share our
negatives are the inevitability of some
popularity of the concierge practice has
client’s point of view. In a conventional
patients’ opting out and choosing a
grown, many physicians are risk averse.
practice, the average panel size may
different physician, the challenges of
When push comes to shove, they prefer
can make house calls and visit patients in the hospital when needed.
State-of-the-art, expert, cost effective, timely endocrinology care is what Carolina Endocrine has to offer your patients. • Neck Ultrasounds (ECNU certified) • Fine needle aspiration biopsies • Nuclear medicine studies
All in one convenient location behind Rex Hospital at 3840 Ed Drive, Suite 111.
919-571-3661
www.CarolinaEndocrine.com Michael Thomas, M.D., Ph.D. George Stamataros, D.O. Carly Kelley, M.D., M.P.H. Erin Wetherill, PA-C
February 2016
11
Practice Management traditional practice models regardless of
known medical condition that requires
concierge membership might not make
the bothersome shortcomings, such as the
multiple office visits, a concierge practice
financial sense if the patient is covered by
pressure to treat more patients in less time.
that covers unlimited office visits might
an insurance plan with a low deductible
actually cost less than the insurance.
and doesn’t schedule many office visits.
We’ve already identified many of the
Concierge medicine may not meet the
Next Steps for Physicians
advantages
experience
medical or financial needs of all patients.
If the concept of concierge medicine
when they select a concierge medicine
If the package of services available from
is intriguing to you at this stage of your
practice. They are paying for better access
the concierge practice contains items that
career, learn more about the practices
to the physician, greater ease in making
the patient doesn’t need and won’t use,
that are currently in place in your
appointments and renewing prescriptions,
the option may have little benefit.
geographic area. The American Academy
Pros and Cons: Patient Point of View that
patients
of Private Physicians (aapp.org) is a good
expedited testing and results reporting and other services, depending on the
The cost of signing up might be
resource.
Concierge
Medicine
Today
package being offered.
prohibitive, particularly if the membership
(conciergemedicinetoday.org) is a news
is for both a patient and his/her spouse.
resource and information organization.
If the physician has seen a huge influx
Some but not all concierge practices price
of patients as a result of the Affordable
the membership fee by age category or
Explore your options by getting started.
Care Act, these advantages might be
offer a discount on memberships when
Some physicians engage an external
more important than ever before. Some
there is more than one person in a family
consultant for guidance. Others join
patients may even benefit financially
unit. Some offer financial discounts
forces with a larger organization such as
from switching to a concierge model.
program to assist long-time patients
MDVIP (www.mdvi.com), a Florida-based
For example, an insurance policy with a
who want to remain with their trusted
organization that provides administrative
high deductible might not pay for multiple
physician but can’t afford the full cost
support - at a cost, of course.
office visits each year. If a patient has a
of the retainer. Finally, the cost of the
Spend Time c Your Patients, Not Battling IT. Get HIPAA Compliant Solutions
Let’s Talk Tech! Call (919) 296-1089 SAMIT-Medical.com 12
The Triangle Physician
Physicial Advocacy
“Dear Patients”
Communicate the Benefits of Independent Doctors By Marni Jameson
Educating patients about the importance
tients, whom they then direct to employed
of going to an independent doctor is key to
doctors. To compete in this market, indepen-
keeping America’s health care costs down. It
dent doctors need to tell consumers about
is also essential to keeping our doctors inde-
the benefits of seeing a doctor who is not
pendent. At the Association of Independent
financially aligned with the hospital.
Doctors, we think a great place to start that education is right in the doctor’s office.
If you are an independent doctor, we encour-
Marni Jameson is the executive director for the Association of Independent Doctors. You may reach her at (407) 865-4110 or marni@aid-us.org.
age you to include a version of the following
respondence you have with existing patients.
Hospitals spend hundreds of thousands of
“Open Letter to Patients” in all your new pa-
Personalize it as you like, but do spread the
dollars each year to market directly to pa-
tient packets, on your website and in any cor-
word.
Dear Patient:
The same holds true for centers that provide
hospitals acquire these private practices, of-
Congratulations on choosing an indepen-
services like outpatient surgery or imaging
fice workers lose jobs. If the acquiring hospi-
dent doctor for your care. Seeing an inde-
(magnetic resonance imaging – MRI; com-
tal happens to be a nonprofit, the taxes the
pendent doctor – rather than a doctor em-
puted tomography – CT scans; X-rays; and
practice used to pay into the community go
ployed by a hospital – is one of the very best
mammography). Going to an independent
away, because nonprofit hospitals don’t pay
ways you can lower your medical costs and
surgery or imaging center will cost you less,
taxes.
help your community.
sometimes one-fourth the price, of going to one owned by a hospital. This is why we do
Most citizens know that nonprofit hospitals
Here’s why:
our best to refer you only to freestanding, in-
don’t pay income tax, but many don’t real-
When you see a doctor employed by a
dependent facilities.
ize they are also exempt from property and
hospital, the hospital bills for that doctor’s
sales taxes.
services at hospital rates. Those rates are
Many studies that have looked at the impact
much higher than what independent doctors
of hospitals acquiring independent physi-
Unfortunately, figuring out which doctors
charge. Plus, the hospital tacks on what’s
cian practices and facilities have found that
or outpatient facilities are independently
called a “facility fee,” a fee that adds abso-
these mergers drive up health care costs
owned and which ones aren’t can be tricky.
lutely no value, but that hospitals have ne-
dramatically. Everyone pays. Patients pay
You have to ask. Often, when a hospital ac-
gotiated to help cover their overhead. This
more out of pocket. Workers pay higher pre-
quires a doctor’s practice, nothing may have
can increase your cost by three to four times.
miums, and more of our taxpayer dollars
visibly changed in the office – but your bill.
have to go into programs like Medicare and What’s more, hospital-employed doctors an-
Medicaid.
But rest assured, you’ve chosen wisely.
swer to administrators. Independent doctors
Please make sure your loved ones do, too.
remain free of those conflicts. In our prac-
Finally, independent practices are small
tice, our focus remains on you.
businesses that support their communities
Sincerely,
by providing jobs and paying taxes. When
Your Independent Doctor
One way to help patients find an
them to Association of Independent Doctors’
of more than 500 independent doctors in
independent doctor near them is to direct
online directory (www.aid-us.org/directory)
every specialty. It’s a healthy choice.
February 2016
13
Digestive Health
When to Test for
Celiac Disease
By Lindsay Wojciechowski, F.N.P.-C.
Celiac disease is a common, but undiag-
are often mild and include symptoms
nosed autoimmune disorder affecting ap-
of malabsorption, such as steatorrhea,
proximately one in every 100 people world-
bloating and diarrhea. Celiac mimics
wide. It is estimated that up to two and a
irritable bowel syndrome in approximately
half million Americans have undiagnosed
38 percent of patients. The majority of
celiac disease, possibly leading to serious
patients will be asymptomatic or have non-
long-term health complications.
gastrointestinal manifestations.
Numerous Progressive Conditions
When to Test
This common problem results from the
Due to its frequency and array of possible
ingestion of gluten, which then damages
health complications, clinicians need
the villi within the small intestine. If
to keep celiac disease in mind. Testing
untreated, it can lead to malabsorption and
should be considered in patients with: • Gastroenterology symptoms
an array of chronic conditions.
including abdominal bloating,
Lindsay Wojciechowski is a nurse practitioner and consultant to the Women’s Wellness Clinic and the Carolina Women’s Research and Wellness Center (CWRWC). She has worked as a clinical nurse practitioner for Triangle Family Practice at Duke University Medical Center since 2006. She also has lectured and taught courses at the Duke University School of Nursing. Ms. Wojciechowski’s focus is on women’s health and family medicine, and she also is the lead medical writer for the Women’s Wellness Clinic.
Some of these include osteoporosis (due
unexplained weight loss, chronic
to calcium and vitamin D malabsorption),
or recurrent diarrhea, symptoms of
preferred initial test. Studies have shown
iron-deficiency anemia and neurological
irritable bowel syndrome or severe
the sensitivity and specificity of anti-tissue
issues, such as migraine, ataxia and
lactose intolerance or other signs of
transglutaminase (tTG) antibodies to be 95
malabsorption.
percent and 94 percent, respectively.
neuropathy (due to B vitamin deficiencies). Dermatitis herpetiformis is an itchy skin
• Unexplained iron-deficiency anemia,
condition that can develop in undiagnosed
folate or B-12 deficiency, low birth-
For patients with suspected probability
patients.
weight infants or decreased fertility,
higher than 5 percent, total IgA also should
peripheral neuropathy, recurrent
be obtained. These two tests have similar
migraines, short stature or delayed
sensitivity and thus a negative result
gastrointestinal malignancies are more
puberty or elevated aminotransferases.
from either has high-negative predictive
common in patients with celiac disease, as
• Type 1 diabetes mellitus or first-degree
value. Patients with positive serology
is low birth weight of infants with affected
relatives with celiac disease (if they
(or probability greater than 5 percent,
mothers. Gastroesophageal reflux disease,
have signs or symptoms of celiac
regardless of lab results) should have a
inflammatory bowel disease, advanced
disease). Testing in asymptomatic
small-bowel biopsy to help confirm the
liver disease and other autoimmune
first-degree relatives with confirmed
diagnosis.
disorders also have associations with the
cases may also be considered, as 10-15
disease. Studies have suggested that the
percent of patients with a first-degree
The only treatment for celiac is a lifelong
older the patient is at the time of diagnosis,
relative may develop the disorder.
strict adherence to a gluten-free diet.
Intestinal
lymphomas
and
other
the greater the chance of developing
The majority of patients respond well.
another autoimmune condition such as
To avoid false negatives, all testing for
Individuals without improvement generally
autoimmune thyroiditis. Hence, early
celiac disease should start with serology
have poor diet compliance or accidental
diagnosis is crucial but often challenging.
and be done during periods of high gluten
gluten ingestion.
intake. Immunoglobulin A (IgA) anti-tissue Abdominal symptoms of celiac disease
14
The Triangle Physician
transglutaminase (TTG) antibody is the
Endocrinology
Understanding
Pheochromocytomas By Michael J. Thomas, M.D., Ph.D.
Pheochromocytomas are catecholamine-
as an elevation in serum chromogranin A,
family history of endocrine disease(s) or if
secreting tumors, usually arising from the
can support the diagnosis of pheochromo-
multiple endocrine syndromes occur in the
neural chromaffin tissue of the adrenal me-
cytoma but are not helpful in the setting of
patient. Some of the genetic syndromes that
dulla or occasionally from outside the adre-
normal catecholamines.
include pheochromocytoma are: • Multiple endocrine neoplasia 2A (med-
nal gland, where they are usually referred to Tumor localization usually begins with an
ullary thyroid carcinoma, pheochro-
adrenal computed tomography scan or
mocytoma, hyperparathyroidism) and
These are relatively rare tumors, present in
magnetic resonance imaging. Pheochromo-
2B (mucosal neuromas and intestinal
about three to eight people per million; how-
cytomas often enhance on T2-weighted im-
gangliomatosis);
ever, the actual incidence is underreported,
ages due to their increased water content.
• Von Hippel-Lindau syndrome (heman-
based on the observed frequency in autopsy
Localization of extra-adrenal pheochro-
gioblastoma of brainstem and retina,
studies of 0.3-0.95 percent. They occur with
mocytomas can employ the use of a ra-
renal cell carcinoma and pancreatic
equal frequency in males and females and
diolabeled 123I-metaiodobenzylguanidine
neuroendocrine tumors);
become more common with age.
(MIBG) scan. MIBG, which resembles the
as paraganglionomas.
• Neurofibromatosis. (See Table below.)
structure of norepinephrine, is taken up Most pheochromocytomas are benign, but
and stored by adrenal and extra-adrenal
Many paraganglionomas (30-40 percent)
if they are malignant, they can metastasize,
pheochromocytomas and paragangliono-
may have germline mutations in the succi-
making management/cure difficult. Diagno-
mas. Fluoro (18F)-deoxyglucose (FDG)-PET
nate dehydrogenase genes (SDHB, SDHC
sis and treatment is imperative to prevent
is also very sensitive at detecting these tu-
and SDHD). Because these are autosomal
a life-threatening hypertensive crisis. Pheo-
mors.
dominant genetic disorders, the presence of
chromocytomas should be considered in the evaluation of any incidentally discovered adrenal mass. The classic clinical presentation is an
Condition
Gene
Frequency of Pheochromocytoma
MEN-2A, 2B
RET
~50%
Von-Hippel Lindau
VHL
~10-20%
Neurofibromatosis
NF-1
~5%
episodic “paroxysmal” triad of headache, diaphoresis and palpitations/tachycardia; however, several other symptoms may accompany the paroxysm, including tremor,
Pre-op medical management includes al-
a genetic mutation can identify first-degree
flushing, anxiety, nausea, chest pain, flank
pha blockade, with either doxazosin or
patients at risk for developing these tumors
pain and generalized weakness. A spell typi-
phenoxybenzamine. Additional therapy
and enter them into a clinical surveillance
cally lasts several minutes.
with calcium channel blockers and/or beta
program for early detection and treatment.
blockers can proceed after alpha blockade. Diagnosis may be made by either mea-
Surgical resection is usually curative and
Reference
surement of 24-hour urine catecholamines
can sometimes be done with a cortical-
Lenders, J.W.M., Duh, Q.-Y., Eisenhofer, G.,
(either
sparing procedure, particularly if bilateral
Gimenez-Roqueplo, A.-P., Grebe, S.K.G., Mu-
pheochromocytomas are present.
rad, M.H., Naruse, M., Pacak, K., and Young,
metanephrine/normetanephrine
or epinephrine/norepinephrine) or serum metanephrine/normetanephrine,
Jr, W.F. Pheochromocytoma and Paragangli-
which
should be drawn after the patient has been
As many as 35-40 percent of pheochromocy-
oma: An Endocrine Society Clinical Practice
supine for 15 minutes. Several medications
tomas are genetic. Screening of first-degree
Guideline. J Clin Endocrinol Metab, June
can influence the accurate measurement of
family members for genetic mutations can
2014, 99(6):1915–1942
catecholamines. Other tumor markers, such
be pursued, particularly if the patient has a
February 2016
15
Duke Research News
Blood Test Can Distinguish Between Bacterial and Viral Infections Researchers at Duke Health are fine-tuning a test that can determine whether a respiratory illness is caused by infection from a virus or bacteria, so antibiotics can be more precisely prescribed. The team of infectious disease and genomics experts at Duke has developed what they call gene signatures – patterns that reflect which of a patient’s genes are turned on or off, to indicate whether someone is fighting infection from a virus or bacteria. Results can be derived from a small sample of the patient’s blood. The signatures were tested in an observational study described in the Jan. 20 issue of Science Translational Medicine. They were found to be 87 percent accurate in
Ephraim Tsalik, M.D., Ph.D., assesses a patient for respiratory symptoms. Credit: Shawn Rocco/Duke Health.
classifying more than 300 patients with flu viruses, rhinovirus, several strep bacteria and other common infections, as well as
Participants with respiratory problems
(the predominant cause of the common
showing when no infection was present.
were enrolled during visits to emergency
cold), and guiding treatment choices will
departments at five hospitals, including
be even more important.”
With these findings, Duke researchers are
Duke, the Durham VA Medical Center and
a significant step closer to developing a
UNC Hospital in Chapel Hill. The tech-
Dr. Ginsburg and colleagues at Duke have
rapid blood test that could be used in clin-
nique is more accurate than other tests
been studying gene signatures in respira-
ics to distinguish bacterial and viral infec-
that look for the presence of specific mi-
tory infections for nearly a decade, but
tions and to guide appropriate treatment.
crobes, the authors report.
only recently has technology allowed
“A respiratory infection is one of the
More precise ways of distinguishing infec-
makeup, 25,000 genes at a time, he said.
most common reasons people come to
tions could not only reduce unnecessary
The team had previously identified gene
the doctor,” said lead author Ephraim L.
use of antibiotics but also lead to more
signatures associated with viral infections,
Tsalik, M.D., Ph.D., assistant professor of
precise treatments of viruses, said senior
but this is the first study to distinguish non-
medicine at Duke and emergency medi-
author Geoffrey S. Ginsburg, M.D., Ph.D.,
infectious illnesses and viral from bacterial
cine provider at the Durham VA Medical
director of Duke’s Center for Applied Ge-
infections at the patient’s molecular level.
Center. “We use a lot of information to
nomics & Precision Medicine.
scientists to analyze a person’s genetic
make a diagnosis, but there’s not an effi-
Still, with current technology, measuring
cient or highly accurate way to determine
“Right now, we can give patients Tamiflu to
a person’s gene expression profile from
whether the infection is bacterial or viral.
help them recover from an influenza infec-
blood could take as long as 10 hours.
About three-fourths of patients end up on
tion, but for most viral infections, the treat-
Study authors are currently working with
antibiotics to treat a bacterial infection de-
ment is fluids and rest until it resolves,” Dr.
developers to create a one-hour test that
spite the fact that the majority have viral
Ginsburg said. “In the next five to 10 years,
could be used in clinics.
infections. There are risks to excess antibi-
we will likely see new antiviral medica-
otic use, both to the patient and to public
tions for common bugs like respiratory
“The ideal scenario, should this test ulti-
health.”
syncytial virus (RSV) and even rhinovirus,
mately be approved for broad use, is you
16
The Triangle Physician
Duke Research News would go to the doctor’s office and receive
In addition to Drs. Tsalik, Ginsburg and
This research was supported by the United
your results by the time you meet with your
Woods, study authors include Ricardo
States Defense Advanced Research Proj-
provider,” said senior author Christopher
Henao, Marshall Nichols, Thomas Burke,
ects Agency (contracts N66001-07-C-2024;
W. Woods, M.D., professor of medicine
Emily R. Ko, Micah T. McClain, Lori L. Hud-
N66001-09-C-2082), by the National Insti-
and associate director of Duke’s genomics
son, Anna Mazur, Debra H. Freeman, Tim
tutes of Health (U01AI066569; P20RR016480;
center. “We are working to develop a test
Veldman, Raymond J. Langley, Eugenia B.
HHSN266200400064C; K24-AI093969), the
that could be run in most clinical labs on
Quackenbush, Seth W. Glickman, Charles
Agency for Healthcare Research and Qual-
existing equipment. We believe this could
B. Cairns, Anja K. Jaehne, Emanuel P. Riv-
ity, the U.S. Department of Veterans Affairs
have a real impact on the appropriate use
ers, Ronny M. Otero, Aimee K. Zaas, Ste-
Office of Research and Development (1IK-
of antibiotics and guide the use of antiviral
phen F. Kingsmore, Joseph Lucas, Vance
2CX000530; 1IK2CX000611) and an in-kind
treatments in the future.”
G. Fowler and Lawrence Carin.
contribution bioMérieux Inc.
Esophageal Cancer Survival Impacted by Race and Socio-Economic Factors African-American patients with esophageal
author Loretta Erhunmwunsee, M.D., who
combination treatment that is considered
cancer survive fewer months after diag-
is now at City of Hope in Duarte, Calif., stud-
optimal.”
nosis than white patients, but only if they
ied outcomes of 6,147 esophageal cancer
also have low incomes, according to a new
patients who underwent surgery. Of those,
“The finding that African-American patients
study from Duke Health researchers.
293 patients, or 5 percent, were black.
have higher death rates after esophagectomy isn’t new,” Dr. Erhunmwunsee said. “But
The researchers analyzed data from the
Before adjusting for in-
our study adds to this finding, showing that
National Cancer Data Base to assess what
come, black patients
black patients are most vulnerable when
effect the combination of race and low
had
overall
they are poor and that they may actually
socio-economic status has on cancer sur-
survival
white
be protected when they have higher socio-
vival. They focused on esophageal cancer,
patients, living a me-
economic status. This finding suggests that
dian 33 months after
targeting socio-economic differences may
diagnosis compared to
help combat racial health disparities.”
because it historically has had higher death rates among blacks and has a high overall
Loretta Erhunmwunsee, M.D.
mortality.
worse than
46 months for whites. Once income was factored in, there was no
Dr. Hartwig said the research team now
The findings were pre-
significant difference in overall survival be-
plans to study what the disparities are that
sented at the annual
tween white and black patients in the two
lead to differences in survival.
meeting of the Society
highest income brackets. Median survival
of Thoracic Surgeons in
in the higher income groups was 52 months
“Our study suggests that disparities in sur-
Phoenix Jan. 26.
for blacks and 61 months for whites.
vival for esophageal cancer are less likely
“In lower socioeconom-
But significant difference in survival
sons and more likely due to disparities in
ic groups, outcomes for esophageal cancer
emerged between white and black patients
health care,” Dr. Hartwig said. “Based on
vary by race, but not in higher socio-eco-
in the two lowest income groups. Median
our findings, we are now able to focus re-
nomic groups,” said senior author Matthew
survival for low-income African-Americans
sources on studying lower socio-economic
G. Hartwig, M.D., assistant professor of sur-
was 26 months vs. 40 months for low-in-
status among black patients as a way to al-
gery at Duke. “This has implications for all
come whites.
leviate health disparities.”
and should be further examined to eliminate
“One of the findings of the research is that
In addition to Drs. Hartwig and Erhunmwun-
health care disparities.”
black patients were much less likely than
see, study authors include Brian C. Gulack,
white patients to undergo surgery,” Dr. Er-
Cristel Rushing, Donna Niedzwiecki and
hunmwunsee said. “Surgery is part of the
Mark F. Berry.
Matthew G. Hartwig, M.D.
due to underlying genetic or medical rea-
sorts of cancers, not just esophageal cancer
Dr. Hartwig and colleagues, including lead
February 2016
17
UNC Research News
DNA Repair Enzyme Identified as Potential Brain Cancer Drug Target Rapidly dividing cells rely on an enzyme
the context of the developing brain or even
cells’ DNA, leading to cell death. Removing
called Dicer to help them repair the DNA
in brain tumors, despite the fact that the
a key enzyme that repairs DNA in cancer-
damage that occurs as they make mistakes
protein has been extensively studied,” said
ous cells could help prevent DNA repair.
in copying their genetic material over and
Mohanish Deshmukh, Ph.D., a UNC Line-
over for new cells. UNC Lineberger Com-
berger member and professor in the UNC
“We found that cancer-
prehensive Cancer Center researchers have
School of Medicine Department of Cell Biol-
ous
built on the discovery of Dicer’s role in fix-
ogy and Physiology and also the Neurosci-
Dicer,” said Vijay Swa-
ing DNA damage to uncover a new poten-
ence Center. “We have found that targeting
hari, M.B.B.S., M.S., a
tial strategy to kill rapidly dividing, cancer-
Dicer could be an effective therapy to either
postdoctoral fellow at
ous cells in the brain.
prevent cancer development or to actually
cells
upregulate
the UNC Neuroscience
sensitize tumors to chemotherapy.”
Vijay Swahari, M.B.B.S., M.S.
port that when they removed Dicer from
Scientists have understood for more than
think tumors upregulate Dicer because its
preclinical models of medulloblastoma, a
a decade that Dicer plays an important
function is to repair DNA.”
common type of brain cancer in children,
role in the cell for processing microRNAs,
they found high levels of DNA damage in
which regulate the expression of genes in
In their study, Dr. Deshmukh and his team
the cancer cells, leading to the cells’ death.
cells. But Dr. Deshmukh said it was in 2012
studied the effect of deleting Dicer in sever-
The tumor cells were smaller and also
that scientists discovered a direct role of
al types of rapidly dividing cells, including
Dicer in repairing DNA damage.
of preclinical brain cancer models. They de-
In the journal Cell Reports, researchers re-
more sensitive to chemotherapy.
Mohanish Deshmukh, Ph.D.
Center and the first author of this study. “We
leted Dicer in the normal, rapidly dividing That function is of importance for cancer
developing brain cells in the cerebellum of
“This is the first time that
research because rapidly dividing cells –
animal models, finding spontaneous DNA
the specific function of
such as cancer cells – incur DNA damage as
damage in the brain cells, leading to severe
Dicer for DNA damage
they divide. And chemotherapy and radia-
degeneration of the cerebellum. They also
has been looked at in
tion treatments often work by damaging the
tested whether Dicer had a similar effect on
However much you value wildlife conservation in North Carolina,
DEC NC
11
1234
quadruple it.
That’s right! Your conservation effort is increased by a 3-to-1 matching gift. So, when you are one of the first to display the new North Carolina Wildlife Habitat Foundation NCDMV license tag, your $10 tag contribution to the organization becomes $40 in lands preserved. The all-volunteer North Carolina Wildlife fe Habitat Foundation assists in acquisition, on, management, and protection of land in North Carolina for the conservation of habitats needed to preserve wildlife
18
The Triangle Physician
right here in the Old North State. Conservation education efforts are preparing future generations to sustain your concern for the lands we protect today. At www.ncwhf.org, download the license tag application and see the good works in process. pp Your new tag shows your support and your n contribution is put to work…times four. co
www.ncwhf.org w
UNC Research News rapidly dividing cells outside of the brain. Upon deleting Dicer from embryonic stem cells, the authors found a similar effect. To test whether they could exploit the role of Dicer to kill cancerous cells, Mr. Swahari and his collaborators also deleted Dicer in
BOTOX® COSMETIC • COOLSCULPTING® • FACIAL FILLERS • MICRODERMABRASION
“She wanted a doctor who is also an artist.” I REFERRED HER TO SOUTHERN DERMATOLOGY
medulloblastoma models and found that these cells also had high DNA damage levels and degeneration. The tumor load was lower, and the cells were more sensitive to chemotherapy. “We found that when you delete Dicer,
WI
these tumors are more sensitive to DNA damage,” Mr. Swahari said. “We also took RADAR: BAY15001 the next step by injecting chemotherapy Ad: Version 1
into models where DicerDate: was deleted, 6/15 finding that not only are the tumors smaller, but the tumors are also more sensitive to chemotherapy.” “We are excited about these results because of the implication that Dicer inhibi-
THE SKIN RENEWAL CENTER AT S O U T H E R N D E R M AT O L O G Y
FOR THE MOST ADVANCED SKIN CARE TREATMENTS, REFER YOUR PATIENTS TODAY!
919-863-0073
southernderm.com
LASER HAIR REMOVAL • CLEAR + BRILLIANT® • THERMAGE®
• FRAXEL® DUAL
tors could be developed as a potential therapy for treating rapidly-dividing tumors like
DER131_AD_Triangle Physican I Want 4.indd 1
4/10/15 10:22 AM
medulloblastoma,” Dr. Deshmukh said. The study was supported by grants from the National Institutes of Health. In addition to Dr. Deshmukh and Mr. Swahari, other authors include: Ayumi Nakamura of the UNC Neuroscience Center and Neurobiology Curriculum; Jeanette Baran-Gale of the UNC School of Medicine Department of Genetics; Idoia Garcia of the UNC Neuroscience Center and Department of Neurology; Andrew J. Crowther of the UNC Neuroscience Center and Department of Neurology; Robert Sons of the Department of Cell Biology and Physiology; Timothy R. Gershon of the Neuroscience Center, the Neurobiology Curriculum, Department of Neurology and of UNC Lineberger; Scott Hammond of UNC Lineberger and Department of Cell Biology and Physiology; and Praveen Sethupathy of the Curriculum of Bioinformatics and Computational Biology, Department of Genetics
Do you have lower abdominal pain due to
Endometriosis? Women’s is currently conducting a clinical research study and (CompanyWellness Name) Clinic is currently conducting a clinical research study and is isininneed needofofqualified qualifiedvolunteers. volunteers.To Toqualify, qualify,you youmust mustbe beaawoman woman between between the ages ages of 18-65 18-65 who has lower abdominal abdominal pain pain due due to toEndometriosis. Endometriosis. Compensation up to $840 is available for study-related time andand travel. Compensation up to $XXX is available for study-related time travel.
Interested? Call
919-251-9223 0-000-00-00000
249 NC Highway 54, Suite 330ST 0000EStreet Name, Suite 000, City, Durham, NC 27713 www.companywebsite.com
www.cwrwc.com Find Us On Facebook
The Women’s Wellness Clinic offers Radiant Research or Clinical Research many opportunities for you to Advantage or Comprehensive Clinical participate in clinical trials. In addition Development Logo and Tagline Here. to the endometriosis study, there Radiant Tagline: We Can’t Do It Without are trials on birth control, migraines, YOU! CRA Tagline: Enhancing bacterial Patient Care urinary tract infections, Through Clinical CCD Tagline: vaginosis, andResearch. heavy periods. Call The Proof is in more the Performance. 919–251–92234 information.
and UNC Lineberger.
February 2016
19
News
WakeMed Key Community Care Chosen for CMS Initiative WakeMed Key Community Care has been
WKCC medical director. “The Next Genera-
tem toward one that delivers better care,
selected by the Centers for Medicare &
tion Model is the next step in how WKCC
smarter spending and healthier people,”
Medicare Services to participate in a new
will provide the Triangle community with
said Patrick Conway, deputy administrator
accountable care organization model called
high-quality, coordinated services for the
for innovation and quality and chief medical
the Next Generation ACO Model, which be-
best value.”
officer for CMS.
The Next Generation ACO Model is part of
The 21 ACOs participating in the NGACO
Through the Next Generation ACO Model
the Department of Health and Human Ser-
Model in 2016 include Trinity Health ACO
(NGACO Model), the Centers for Medicare
vices’ goal of tying 30 percent of traditional,
Inc. and Triad HealthCare Network L.L.C.
& Medicare Services (CMS) will partner with
or fee-for-service, Medicare payments to
All NGACO organizations were selected
accountable care organizations (ACOs) that
alternative payment models, such as ACOs,
through an open and competitive process
are experienced in coordinating care and
by the end of 2016. Sights are set on 50
from a large applicant pool that included
rewarding value over volume for Medicare
percent by the end of 2018. Alternative pay-
many qualified organizations, according
fee-for-service beneficiaries and whose pro-
ment models pay providers based on the
to a WakeMed Key Community Care press
vider groups are ready to assume higher
quality rather than the quantity of care they
advisory.
levels of financial risk and reward.
provide.
“We are proud to be selected by CMS to
“We look forward to working with our new-
participate in the first cohort of Next Gen-
ly selected Next Generation ACO model
eration ACOs, said Brian Klausner, M.D.,
participants to move our health care sys-
gan on Jan. 1.
For more information on the Next Generation ACO Model, visit innovation.cms.gov.
2nd Annual NC Doctors’ Day Contest Gets Under Way Nominations Accepted through March 4, Voting Is March 18-27 For the second year, the North Carolina Med-
voting will run from March 18-27. The winner
ical Society is leading the NC Doctors’ Day
will be announced and presented his or her
campaign to spotlight the state’s doctors.
award on March 30.
been practicing for more than 50 years. “We’re asking you to thank doctors for keeping us healthy and making a positive impact
The award is presented to the physician who
on our community,” said NCMS Chief Execu-
garners the most online votes and comes
tive Officer Robert W. Seligson. “We are all
with a $5,000 check to further a professional
patients at one time or another, and many of us have a story about a dedicated physician
cause or project in the winner’s community. This homegrown celebration honoring phy-
who made a huge positive impact in our life
Doctors may be nominated at ncdoctorsday.
sicians was a huge success last year, with
or that of a loved one or friend. Please take
org. through March 4. Those who are mak-
more than 140 doctors across the state be-
a moment to show your appreciation by par-
ing the nomination are asked to explain why
ing nominated for the NC Doctor of the Year
ticipating in NC Doctors’ Day.”
this doctor should be named NC Doctor of
Award, according to the North Carolina Med-
the Year.
ical Society (NCMS).
Ten finalists for 2016 NC Doctor of the Year
Last year’s winner was Gloria Graham, M.D.,
contact the North Carolina Medical Society
will be posted on the website, and online
a dermatologist in Morehead City who has
at (919) 833-3836.
NC Doctor’s Day is on FaceBook and Twitter using #thxdocnc. For more information,
20
The Triangle Physician
Sporting Clay Course
• Open Tuesday–Saturday 8a.m. till 6p.m. • Sunday 1p.m. till 6p.m. •Monday by appointment only • Over a mile course • 14 Stations • Covered 5 Stand • Wing Shooting- Quail/ Pheasant/ Chukar Hunts • Driven Pheasant Hunts • European Tower Hunts • Shooting Instructions • Gun Rental • Ammo Available • Dog Training
• Fishing • Corporate Events/ Retreats/Team Building • Birthday Parties, Bachelor/ Bachelorette Parties • Church Groups , Individual Outings • Complete Packages Available
NO ONE SEES YOU LIKE WE DO. The way we see it, image is everything. So we specialize in everything imaging. From prevention and detection to diagnosis and intervention. All provided in 20 Triangle locations by more than 150 certiďŹ ed technologists and subspecialty radiologists. Every one of them with the unique ability to see beyond the patient to the person inside.
G
BO I
G MA
IN
DY
RO
I
MA G
NEU
IN G
VA
VE
IN
T
TH
-C
ERA
PET
PY
MRI
P E D I AT
ST IMAGING
RIC I M AGIN G
BREA
SC
R
PH
Y
U
LA
IM
AG
IN
G
ORT
HO PEDIC I M AGING
M
M AM
OG
RA
Be seen by people who specialize in you at WakeRad.com.