Beacon Health System Physician Quarterly

The Future of Health Care

Spring 2015

Embracing the Clinical Integration Network

PHYSICIAN Q UA R T E R LY

Showing the Way Meet Beacon’s Physician Executives

4

What is a Clinically Integrated Network?

6

Welcome, New Docs

9

Residency Program Expanding Its Reach

13

TABLE OF CONTENTS E D I T ORI A L BOARD Ken Elek, M.D., Chief Medical Information Officer, Memorial Hospital Scott Eshowsky, M.D., Chief Medical Information Officer, Beacon Medical Group Vince Henderson, M.D., Chair, Physicians Governance Council, Beacon Medical Group Genevieve Lankowicz, M.D., Vice President, Medical Staff Affairs, Elkhart General Hospital D. Thomas Mellin, M.D., Chief Medical Information Officer, Elkhart General Hospital Dale Patterson, M.D., Director, Memorial Family Medicine Residency Program Cheryl Wibbens, M.D., Vice President, Medical Staff Affairs, Memorial Hospital

Physician Quarterly is published by Beacon Health System to connect and educate physicians and health care professionals in support of clinical integration, graceful patient transitions and improved quality and safety.

Contact Us

Do you have a story idea? Contact us at MScroope@BeaconHealthSystem.org or call 574.647.3234.

3 Welcome

Phil Newbold, CEO, Beacon Health System

Advanced Pharmacy Services Now in Elkhart

4 5 6 7 9

Showing the Way

Meet Beacon’s Physician Executives

Burnout: Are You at Risk?

What Is a Clinically Integrated Network?

Medical Information Update Welcome, New Docs

New Physician Resource: Physician Liaisons

10 Beacon Bulletin

Continuing Medical Education

General Hospital 1 1 Elkhart Expansion Update Introducton to 12 An Interventional Psychiatry Program 13 Residency Expanding Its Reach Medical Group 14 Beacon Expanding on South Bend’s South Side

Experiences Make 15 “These Our Lives Better”–

Memorial Physicians Providing Catalyst for Haiti’s Rebirth

Dear Physicians, Welcome to the first issue of Beacon Health System’s Physician Quarterly magazine. Our aim is to provide you with a vehicle to tell your story, learn more about your colleagues, and dive deeper into the transformative ways you are empowering health in those you serve.

By connecting physicians and other health care professionals through this publication, we strive to support our shared goal of continued clinical integration, smooth patient transitions and improved quality and safety for our patients and each other.

I hope you enjoy this publication and I encourage you to share your insights with us over the years to come. Thank you for all you do to create health.

Yours in Health,

Philip A. Newbold CEO, Beacon Health System

ADVANCED PHARMACY SERVICES NOW IN ELKHART In January, Beacon Health Ventures, Inc. opened Elkhart General Home Care Advanced Pharmacy Services at 5155 Verdant Drive in Elkhart.

Advanced Pharmacy Services is a compounding pharmacy.

The clinical pharmacists partner with doctors and other medical professionals to customize medicines to meet the individual needs of patients. For example, if a patient is allergic to a certain ingredient in a medicine (such as gluten, dye, sugar, preservatives, alcohol or lactose), the pharmacists can reformulate the medicine without the ingredient to make it safe for the patient to take.

Advanced Pharmacy Services also carries over-the-counter, healthminded products, such as the natural skin care line Derma e® and natural Now ® vitamins.

Turn to the expert problem solvers at Elkhart General Home Care Advanced Pharmacy Services for: • Private consultations • Bioidentical hormone preparations • Specialized pediatric dosage forms • Pain management formulations • Wound care formulations • Podiatry/foot care • Topical medications Advanced Pharmacy Services is open Monday through Friday, 9 a.m. to 5 p.m. Call 574.524.7582 to learn more.

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Showing the Way

QA &

Beacon physician executives, Vince Henderson, M.D., Genevieve Lankowicz, M.D., and Cheryl Wibbens, M.D., share their insights about leadership, the state of health care, emerging issues facing physicians and what’s great about the respective facilities they oversee.

QUESTIONS: 1 What do you enjoy most about your leadership position?

2 What is something about your job that people don’t know?

3 What is the most pressing issue facing physicians today?

Vincent Henderson, M.D. Chair, Physicians Governance Council, Beacon Medical Group

Genevieve Lankowicz, M.D. Vice President, Medical Affairs, Elkhart General Hospital

Cheryl Wibbens, M.D. Vice President, Medical Affairs, Memorial Hospital

ANSWERS: 1 I have enjoyed the interaction with

1 I enjoy facilitating physician leadership

1 I enjoy the opportunity to work with

2 The VPMA position requires long hours

2 In addition to the medical staff

my fellow physicians, administrative colleagues, support services and the nursing staff.

2 I do not think most people know that as

a Beacon physician and as a physician leader we do not have jobs, but rather lifestyles. All of us take messages when we are gone, attend meetings either physically or by teleconference when we are “out of the office” and we take calls when we are supposed to be on vacation.

3 The most pressing issue facing

because I believe this ensures excellence in patient care overall. and call responsibilities.

3 Physicians are asked to be mindful

of efficiency and cost as they challenge themselves to provide high-quality health care for patients. This represents a relative change in practice philosophy for many physicians.

4 I would like to change the level of

physicians today is information and how to handle it. The real challenge is how do we highlight the good information that will make a difference in the lives of those we care for.

influence of third-party payors, who remain able to set unique payment structures and exclusions seemingly without acceptance or approval from the medical community.

4 If I could change one thing about

5 The medical staff at Elkhart

health care in America it would be to heavily promote education classes about health care coverage and insurance.

5 If I had to pick one it would certainly

be our new electronic health record. By the end of 2015, BMG will have rolled out a completely new Cerner electronic health record to almost all of our providers, and thus to our patients. The great part is future integration.

4 4

4 W hat is one thing you would like to change if you could about the state of health care in the United States?

5 W hat is one great thing you would like to share about Beacon Health System?

General recognizes the importance of collaboration and participation with hospital and health system efforts, bringing about the continuous improvement and clinical excellence that make our programs exceptional.

Physician Quarterly | Spring 2015

physicians across all specialties and in every type of practice situation. operations, I also oversee quality management, medical education, physician relations, infection prevention, safety, medical library, social services, utilization review and spiritual care.

3 The impending shortage of physicians.

Our residency training programs are not keeping up with the retiring workforce of the baby boomer generation, and we find ourselves in a doctor crunch.

4 I would like to see a change in the

overwhelming amount of bureaucracy physicians and hospitals have to deal with.

5 Everything we do and all of our

strategic conversations always have this as the starting point: What is the best thing for our families, friends, associates and neighbors? That drives our decisions and is our passion above all else.

BURNOUT: ARE YOU AT RISK? Michael G. Workman, MSN, MHA, R.N., PMHNP-BC Psychiatric Nurse Practitioner Beacon Medical Group Behavioral Health South Bend

A

ccording to Felton (1998), burnout is described as the exhaustion of your physical or emotional strength resulting from a period of ongoing stress or frustration. Many people have the potential to become burned out in their jobs. All of us have varying degrees of what we would consider physically and emotionally draining. Something that causes frustration or stress with one person may not even faze another. Ideally we should maintain a work-life balance to limit stress and burnout potential.

Due to the demanding nature and responsibilities of their jobs, physicians are often more prone to burnout than those in other careers. Physicians are routinely listed in the top 10 of most stressful careers with a potential for burnout.

There are myriad responsibilities required of physicians that could be daunting to anyone. Highly successful business owners have said if they knew what was required of them to grow their business and all of the hours, stress and demands placed on them they may have never started their business. If most students contemplating attending medical school could see what practicing medicine entailed, perhaps they would second-guess their career choice.

How can we tell if we are becoming burned out? There are a few things to look for such as feeling more tired than usual, having little or no motivation to do things, having an increase in negative or pessimistic thoughts, seeing a decline in your work performance, being distracted at home with thoughts about work, having a feeling of dissatisfaction or lack of joy in your work, and health concerns (increase in weight, feelings of depression, GI or cardiac issues).

Often, we create our own stress by the thoughts we have or the unrealistic expectations we created for ourselves.

This is why we need to set limits on what we can accomplish and delineate what duties or responsibilities we are willing to accept. What can we do to decrease the amount of stress and potential for burnout?

Begin an exercise regimen or learn how to meditate, which have both been shown to decrease stress, aid in relaxing and improve sleep.

Separate work from home life. Make sure you can clearly delineate between the two the best you can. e assertive and limit the duties and responsibilities you B accept. Say no to attending a meeting or function that is not mandatory. Delegate tasks to others who are capable.

ractice what you preach to your patients: eat healthy, P get to a healthy weight, decrease your amount of alcohol consumption, stop smoking, get adequate rest and sleep, and pursue healthy lifestyle choices in general, etc. eek out and pursue having some joy in your life whether it S be setting aside time to read, spending time with your family, having some alone time, going out to dinner or a movie, travel, taking up a hobby, whatever you can think of that would be something you enjoy.

If your stress level is to the point of being burned out you should seek professional help, such as seeing a therapist, someone through your employee assistance plan (EAP) or a mental health professional. Working with them can help you grow as a person and learn to decrease your stress and ultimately develop better coping strategies to improve your life overall as well as increase your life expectancy.

Reference J. S. Felton. Burnout as a clinical entity—its importance in health care workers Occup Med (Lond) (1998) 48 (4): 237-250 doi:10.1093/ occmed/48.4.237

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WHAT IS A CLINICALLY INTEGRATED NETWORK? While the intricacies of health care reform may not always be clear, the overall goal of the Affordable Care Act is: To provide high-quality, evidence-based patient care in a cost-effective way. Around the country, health systems and physicians (employed and independent) are working together to achieve this goal while managing the shift from fee-for-service reimbursement to quality and value-based models.

Clinically integrated networks (CINs) provide a framework to better serve patients in a community.

A CIN can legally contract for the delivery of health care services.

“A clinically integrated network focuses on delivering the right patient care at the right time, in the right setting,” explains Genevieve Lankowicz, M.D., Vice President, Medical Affairs, Elkhart General Hospital. “The interconnectedness of the CIN allows for seamless transitions in a patient’s continuum of care.”

A COLLABORATIVE APROACH TO HEALTH CARE

Beacon Health System and Healthways, the world’s largest independent provider of well-being improvement solutions, are partnering to deploy population health management strategies in our region. Part of this work is exploring the development of a clinically integrated network.

Why Are We Talking About This Now? Right now, local insurers are not requiring health care providers to follow a clinically integrated network structure, but that doesn’t mean they won’t in the near future, according to Kreg Gruber, Interim President, Beacon Medical Group.

“Payment models are changing. Employers, insurers and consumers are demanding better outcomes at a lower cost. We need to begin to pilot these sorts of structures to gain experience.

We want to start with inclusivity [with physicians] and learn as we go,” Gruber explains.

Around the country, the CIN model of care delivery is gaining a foothold. One pioneering CIN in Chicago, Advocate Physician Partners (APP) Clinical Integration Program, has existed for more than 10 years and includes over 4,500 physicians serving over 1 million patients. In its 2014 Value Report, the organization outlines 2013 Clinical Integration performance measures as well cost savings, including these: • Generic drug utilization: $31.3 million • Asthma management: $11 million • Diabetes care (HbA1c only): $4.9 million • Childhood immunization (rotavirus-related): $4.4 million As is true for many things, there isn’t a one-size-fits-all methodology in developing a clinically integrated network.

Understanding, patience, hard work and a vision for the future are necessary for a successful implementation.

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Physician Quarterly | Spring 2015

“We are working together on a clinically integrated network design, something that works for providers and payors,” says Diane Maas, Vice President, Managed Care and Business Development, Beacon Health System.

Physicians to Take the Lead One key ingredient in the success of a CIN is that it must be physician-led and governed.

“A clinically integrated network allows physicians to participate in the delivery of care,” says Greg Losasso, President, Elkhart General Hospital. “Many physicians think that with the way health care is going nationally, they have little to no control over what happens. By being part of a CIN, they can look at data and outcomes and have a voice in how we manage patients, or the population that we’re going to manage.

Physicians should be the drivers of the clinically integrated network.”

The physician members of a CIN define quality measures and establish standards of care, particularly in the management of chronic conditions (e.g., congestive heart failure, COPD, diabetes). Physicians in the network agree to meet or exceed quality goals established by the group.

“As we go down the path of quality, most physicians will measure up to it,” says Losasso. “But there’s the potential that if somebody is not a high-quality provider they may not be a part

Predict & Prevent

We Are Always Near You

Physician–Centric

Health Model

Paid for Value

Health, Well-Being, Potential

Retail, Consumerism

Sick, Ill, Injured

Credentials, Professions

You Come to Us

Medical Model

Hospital–Centric

After the Fact

of the panel or network. That’s always a possibility. But what is more likely is that physicians, who are faced with data, will step up and change their practice, resulting in better care.”

Building on Our Strengths What does Beacon Health System bring to the creation of a clinically integrated network? Losasso points to the strengths of Beacon Medical Group, which includes 242 physicians across northern Indiana and southwestern Michigan; a proven history of innovation and innovative thinking; and, now, added expertise and valuable data about the true cost of episodes of care across

INVESTIGATING Clinical Integration Beacon Health System has formed a work team to evaluate the formation of a clinically integrated network for St. Joseph and Elkhart counties. Presentations about such a network have been made to the boards of Community Health Alliance (CHA) and Michiana Medical Associates (MMA). The team will be reaching out to area physicians for potential participation in a clinically integrated network.

Paid for Volume

the continuum for our region through Healthways. Losasso believes these factors will help bolster a CIN: “Across Beacon, we have a large group of physicians — both employed and independent — who are very effective in their management of care. What a clinically integrated network should allow us to do is to become even more focused on outcomes and examining our costs. I believe we already have excellent physician care. Now it’s just a matter of making sure that care is more coordinated. And I believe that between the health system and the physician groups you can build some alignment that will make us an even more effective medical society.”

Kreg Gruber

John Mathis, M.D.

Interim President Beacon Medical Group

Michiana Gastroenterology, Inc.

Joseph Kowalenko

Compliance Officer Beacon Health System

Population Health Project Lead Beacon Health System

Genevieve Lankowicz, M.D. Vice President, Medical Affairs Elkhart General Hospital

Warren R. Mattson, CPA, J.D. Carolyn A. Nemes Controller Beacon Health System

Greg Losasso

President Elkhart General Hospital

Diane Maas

Vice President of Managed Care and Business Development Beacon Health System

For more information, contact Kreg Gruber, Beacon Health System, at kgruber@beaconhealthsystem.org or at 574.647.1652.

7 7

MEDICAL INFORMATION UPDATE In my nearly five years as Chief Medical Information Officer at Memorial, I have worked with our team to bring the physician’s perspective to what I hope are positive changes to the way orders are processed and charting is kept.

Ken Elek, M.D.

Memorial Chief Medical Information Officer

The first big project was CPOE (Computerized Provider Order Entry) which started in the Emergency Care Center and then rolled out to the rest of the hospital. While not yet fully implemented, we are mostly electronic with orders and continue to work toward moving as much as possible into the CPOE realm.

Next was bringing in PowerNotes and adding dictation for progress notes which allowed for the elimination of paper notes in the chart. We

Beacon Medical Group, with its two EHRs, underwent an extensive search for the right EHR to adopt for the future. Ultimately, the emphasis Cerner has recently placed on the provider experience, coupled with the obvious benefit of a shared platform with both of Beacon’s hospitals, made Cerner PowerChart Ambulatory the final choice.

Scott Eshowsky, M.D. Beacon Medical Group Chief Medical Information Officer

D. Thomas Mellin, M.D. Elkhart General Chief Medical Information Officer

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Beginning in August of 2014, Beacon Medical Group took its first set of clinics live in Cerner. This experience illuminated the many areas in the health system that we have not yet achieved standardization.

As a result, we have recruited a variety of multidisciplinary teams from both hospitals and the medical group to rethink some of our long-standing (and dearly held) processes and workflows. Happily, we can report that we’ve eliminated significant variation and continue to improve on the processes that allow for a more seamless passage of patients, orders, results and communications back and forth from the inpatient and outpatient settings.

Eighteen months ago Elkhart General Hospital experienced a major change housewide with the adoption of Cerner’s electronic medical record and CPOE. For the most part this has gone quite well, thanks to the hard work and patience of our doctors and nurses. There are many aspects of EMR adoption that are easy to appreciate: • Ability to review the patient chart from anywhere in or out of the hospital • No more “missing” charts • No competition for access to the chart, several users can be in the chart at once • Legible orders and progress notes • Quicker turnaround times for tests and medication orders • Standardization of processes facilitating improved patient management

Physician Quarterly | Spring 2015

continue to work toward eliminating the need for a paper chart.

As we joined with Elkhart General Hospital to become Beacon Health System, we added Elkhart General to our PowerChart record. We are still identifying areas where we can learn from each other and come together with best practices.

I look forward to this continuing process and encourage you to bring us your concerns. Patient safety is the ultimate goal of this process and any help you can bring in this area is greatly appreciated.

574.647.3070 kelek@beaconhealthsystem.org

We are also moving in the direction of specialty specific provider positions within Cerner. This will enable us to tailor the EHR experience to providers of a given specialty—as opposed to grouping all providers into a single position or view.

Beacon Medical Group is scheduled to complete the migration to Cerner for all of its providers and clinics before the ICD-10 transition. As an integrated health system, there will be an emphasis on the development of EHR usage standards and reducing waste, ambiguity, redundancy and confusion when reviewing and documenting in a patient’s chart.

We still have a lot of outstanding work to complete as we travel the path towards ONE BEACON EHR. We plan to use the EHR to facilitate our efforts towards population health, accountable care and the transition from “pay for volume” to “pay for value.”

574.647.1500 seshowsky@beaconhealthsystem.org

Yet there have been many challenges: • Steep learning curve, complex technology • Non-intuitive processes and naming conventions • Mastering a keyboard and mouse instead of using the trusty ink pen Change will again be part of our lives in 2015. We will be switching to ICD-10 this fall with the rest of the country. We will be attesting for Meaningful Use Stage 2. The Cerner EMR will continue to undergo refinement and improvement. We will be moving toward increased standardization of processes within Beacon that will cause both hospitals to improve quality outcomes.

574.524.7455 dmellin@beaconhealthsystem.org

BEACON

Health System

Welcomes New Docs (October – December 2014)

DENTISTRY / PEDIATRIC Kevin Ludwig, DDS, MSD EMERGENCY MEDICINE Duane Miller, M.D., FCEP, MRO FAMILY MEDICINE Justin Schwalbe, M.D. GENERAL/VASCULAR/ TRAUMA SURGERY

New Physician Resource

Scott Thomas, M.D., FACS HOSPITAL MEDICINE Stephanie Waldrop, M.D. MATERNAL FETAL MEDICINE Mureena Turnquest Wells, M.D. NEPHROLOGY Lily Sunio, M.D.

Four new Physician Liaisons are helping educate all physicians and their staff on the various new services, programs, procedures and technologies within Beacon Health System. Under the direction of Diane Maas, Vice President of Managed Care & Business Development, the four-member team includes Cindy Bellina, R.N., BSN, Elizabeth Campbell, Michael Marchi and Casey Norton, R.N. In addition to working with all physicians at Elkhart General Hospital and Memorial Hospital, they are enhancing the communication between Beacon and the physician offices, including Beacon Medical Group facilities, in St. Joseph County, Elkhart County and surrounding counties. The liaisons are a resource in the referral process for several service lines.

OCCUPATIONAL MEDICINE Anthony Harris, M.D., MBA, MPH, MRO Stephen Lantz, M.D., MRO PEDIATRICS Mikael Howard, M.D. PEDIATRIC CARDIOLOGY Adam Kean, M.D. Hyun Kim-Shin, M.D.

Cindy Bellina, R.N., BSN cbellina@beaconhealthsystem.org Office 574.647.1072 Mobile 574.274.4783

Elizabeth Campbell eacampbell@beaconhealthsystem.org Office 574.647.1826 Mobile 571.425.0349

Michael Marchi MMarchi@beaconhealthsystem.org Office 574.647.8206 Mobile 574.360.7188

Casey Norton, R.N. cnorton@beaconhealthsystem.org Office 574.647.8207 Mobile 574.261.0256

PSYCHIATRY Vinicius Teixeira, M.D. RHEUMATOLOGY Natalie Sessions, D.O. UROLOGY Jeffrey Cooper, M.D.

For more information about the new physicians, check out either egh.org or QualityOfLife.org.

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Bridge Builders

Ensuring new physicians are integrated into the way of life at Beacon is critical to building bridges between physicians and the health system. Former Physician Liaisons Jeanne VanPutten, R.N., and Tawnn Hoover are the right people for the job.

Jeanne now serves in a part-time role as Elkhart General Physician Relations Coordinator and has joined the Medical Staff Services Department. She oversees hospital orientation for all new physicians and allied health professionals with privileges and provides support for new physicians and clinicians.

In her new role as Physician RelationsAdministration at Memorial Hospital, Tawnn continues to be a resource for physicians, including the oversight of the medical staff on-boarding and orientation process. Tawnn also leads the physician integration process for new hospital-based specialists.

Jeanne VanPutten Office: 574.296.6427 Cell: 574.903.4993 jvanputten@beaconhealthsystem.org Tawnn Hoover Office: 574.647.7677 Cell: 574.229.9809 thoover@beaconhealthsystem.org

Hospital of the Year Award Given to Elkhart

Apogee Physicians, Inc., the nation’s leading hospitalist group, awarded Elkhart General Hospital the Hospital of the Year award at a ceremony in late 2014.

Genevieve Lankowicz, M.D., Elkhart General Vice President of Medical Affairs, accepted the award at an annual event in Arizona.

Apogee recognized Elkhart General for establishing both exceptional physician engagement for the hospitalist team and producing excellent patient outcomes.

“Elkhart General is a shining example of what can be accomplished when a hospital is passionate about patient care,” says Apogee Chairman Michael Gregory, M.D.

Dr. Strycker Given “Hot Doc” Honor

Congratulations to Kyle Strycker, M.D., for being named Memorial Hospital’s “Hot Doc” this year for having the most patients in 2014 with the ideal body temperature of 98.60F following surgery.

Patients heal faster and experience fewer complications when the body temperature is 98.60F after surgery.

Dr. Strycker is an anesthesiologist with Michiana Anesthesia Care. Previous Hot Doc recipients include Jeffrey Steele, M.D., Maurice Hurwich, M.D., Shane Ditty, M.D., (twice), Hugh Hedman, M.D., Ike Trinh, M.D., and Venkata Musunuru, M.D.

Wai Lee M.D.

CONTINUING MEDICAL EDUCATION Memorial Hospital of South Bend Hospital Auditorium 12:10 to 1:10 p.m.

Lunch available at 11:30 a.m.

Registration is not required.

Call 574.647.7381 with any questions.

April 22 Dale Patterson, M.D. Director, Memorial Family Medicine Residency Program

“Adult and Pediatric Vaccinations: Who Gives a Shot?”

Receives Certification in Advanced Heart Failure Transplant Cardiology

April 29

Wai Lee, M.D., FACC, FACP, cardiologist at Elkhart Cardiology, recently achieved board certification for Advanced Heart Failure/Transplant Cardiology by the American Board of Internal Medicine.

Currently, only 488 physicians hold the certification worldwide. Dr. Lee is also board-certified in cardiovascular disease, adult echocardiography, nuclear cardiology, clinical lipidology, geriatrics and internal medicine. He is the CoDirector of the Heart Failure Clinic at Elkhart General Hospital. Dr. Lee is a diplomat of the American Board of Internal Medicine and the American Board of Cardiology, as well as a member of the American College of Ethical Physicians.

Brandon Hardesty, M.D.

Elkhart General Hospital

is accredited as a Chest Pain Center from the Society of Cardiovascular Patient Care (SCPC) The SCPC is focused upon improving care for patients with acute coronary syndromes (ACS) and other heart conditions. The Society promotes protocol-based medicine to address the diagnosis and treatment of acute coronary syndromes, acute decompensated heart failure and to promote the adoption of process improvement. Studies show that accredited Chest Pain Centers can reduce mortality rates by nearly 40 percent.

10 10 Physician Quarterly | Spring 2015

IU Health Physicians

“Emergency Management of the Bleeding Patient”

May 13 Noon to 1 p.m

Oncology Update for Primary Care on Prostate Cancer: Controversies in Screening Speakers include:

Randall Suttor, M.D. Prostate Cancer Screening

David Hornback, M.D. Radiation Oncology Treatment for Early Stage Prostate Cancer & Staging of Prostate Cancer

Jeffret Cooper, M.D. Surgery for Early Stage Prostate Cancer

Thomas J. Reid, III, M.D., Ph.D., FACP Treatment of Patients with a High Risk for Prostate Cancer, the Role of Genetics in Prostate Cancer and Prostate Vaccine Clinical Trials

Ivan Bedoya, M.D. Treatment of Metastatic Prostate Cancer

May 27 Daniel Livorsi, M.D. Indiana University, Clinical Assistant Professor of Medicine, Division of Infectious Diseases

“Antibiotic Stewardship”

ELKHART GENERAL HOSPITAL

E X PA N S I O N

W

ith the exterior nearly complete, anticipation is growing for the new $80 million, 165,000-square-foot surgery expansion project at Elkhart General Hospital. Set to open in late fall this year, the project will bring many exciting changes for the community, physicians and staff, including: • E leven total operating rooms, each averaging 700 square feet, affording ample space to accommodate the latest in surgical and information technology • A 1,000-square-foot hybrid operating room equipped with X-ray capabilities and 3-D imaging for use primarily with heart and vascular procedures • 43 private patient rooms

Elkhart General President Greg Losasso anticipates continued growth in surgical volumes once operations are moved into the expansion.

“Our staff does a great job every day – whether it’s the surgery staff, PACU staff, pre-op, the floor nurses, the support staff, and everybody else – but they’re working in an old model of delivery,” explains Losasso. “The exciting thing about the surgery center is that it’s going to allow us to move into a new place where we can do things truly state-of-the-art.”

Moving in tandem with the new spaces at the facility will be a new way of how care is delivered there, too. Losasso expects those changes to flow into other parts of the organization as well.

“ A building is just a building.” It’s the

people we have who are going to deliver the services who will

”

make a difference.

Elkhart General President Greg Losasso

EXPANSION PROJECT

FA ST FACTS A helistop on the roof of the expansion will speed the care of critically injured patients in Elkhart County.

Operating rooms will have LED surgical lights, which last longer and emit less heat.

Following surgeries, surgeons can meet with families in private consultation rooms and share digital images from the procedures.

A skywalk will connect the new surgery floor and Obstetrics Unit with the Emergency Department.

Family members will be able to track their loved one’s progression through the surgical process via monitors in the waiting room and/or text messages.

Project architect Anderson Mikos Architects was one of the architects for the Ann & Robert H. Lurie Children’s Hospital in Chicago, the tallest children’s hospital in the world.

3rd

Floor

MAJOR MECHANICAL SYSTEMS

4th

Floor

SURGERY 11 total operating rooms (ORs), including 1 hybrid OR

ENDOSCOPY 3 total procedure rooms POST-ANESTHESIA CARE UNIT (PACU) 14 total beds

5th

Floor

43 TOTAL BEDS 23 post-surgical 15 total joint 5 swing beds

SURGERY PREP/HOLD 23 total beds/chairs CENTRAL STERILE PROCESSING

11 11

An Introduction to Interventional Psychiatry

By Ahmed Elmaadawi, M.D. Child and Adolescent Psychiatrist & Director of The Interventional Psychiatry Program Beacon Health System

Psychiatry is a rapidly evolving specialty. For decades, psychiatrists were trying to close the gap between the brain and mind, using the most up-to-date neuroscience research and finding evidence-based medicine to support the diagnosis and best management for many patients coping with mental illness. However, as we all learned in neurophysiology, the brain’s neurons communicate via neurotransmitters but also with electrical activity that can be detected using electroencephalography (EEG).

Traditionally, clinicians focused on using psychotropic medications to alter neurochemicals in the brain. Medications may need time to show benefits and treatment resistance to medication may emerge. Therefore, there was a need for a new era of psychiatric intervention that would provide an alternative treatment option that had the potential to help our patients. Thus emerged a subspecialty that became recognized by major academic centers, known as “Interventional Psychiatry.”

“ Interventional Psychiatry is a new subspecialty that uses brain stimulation techniques to modulate dysfunctional brain circuits that are causing psychiatric disease.”

Interventional Psychiatry is a new subspecialty that uses brain stimulation techniques to modulate dysfunctional brain circuits that are causing psychiatric disease. This specialty includes transcranial magnetic stimulation (TMS) and modern electroconvulsive therapy (ECT), ketamine infusion therapy and using pharmacogenetic testing for personalizing medicine. It is important to mention that this new subspecialty is not intended to replace current psychiatric care using medication and psychotherapy, but rather to enhance the practice of psychiatry with an additional set of tools. It can be viewed much in the same way that interventional cardiologists do not replace general cardiologists.

TMS received FDA approval in 2008 for the treatment of depression. However, TMS is used also in research and off-label for treating bipolar, anxiety, autism, ADHD, OCD, eating disorders and dementia. TMS uses a focused magnetic field in the outpatient office setting for 37 minutes daily for a four- to six-week course. It is noninvasive and does not involve anesthesia (unlike ECT). It can be used safely during pregnancy, for postpartum depression, as well in the elderly.

Modern ECT as well has become much safer with fewer side effects. The brain stimulation by ECT lasts from 20 to 70 seconds; the total procedure is done in outpatient surgery in 15 minutes. The patient is asleep during the procedure by a short-term IV hypnotic, and there is no pain involved. ECT is the most effective treatment for depression with a response rate of 75 percent to 90 percent. It is also used for the treatment of bipolar, psychosis, delirium and intractable seizure disorders.

Beacon Health System is one of the few centers in the region that started an interventional psychiatry program to help patients with treatment-resistant mental illness, and also for providing alternative options to mental health providers in the community. Since the program started last year, we have evaluated over 70 patients from the greater Michiana area, southern Illinois and Chicago, as well as from the Indianapolis region. We are committed to upholding the highest standards of excellence in patient care and to serving as a leading resource for mental health care.

For more information about Interventional Psychiatry, contact Ahmed Elmaadawi, M.D., at 574.647.8470 or at aelmaadawi@beaconhealthsystem.org.

12 PhysicianQuarterly Quarterly| |Vol. Spring 2015 12 Physician I, Issue I

RESIDENCY Residency Program Expanding its Reach

PROGRAM

EXPANDING ITS REACH Memorial Family Medicine Residency Program faculty and staff were on hand for the tear down of the old facility.

Memorial Family Residency Program and the adjoining Beacon Medical Group E. Blair Warner are nearly doubling their size in 2015 with a $4.5 million expansion that will feature 10 new exam rooms, additional patientcare areas, larger teaching rooms and radiology services. E. Blair Warner will see its patient volume jump from a projected 22,000 patient visits this year to an estimated 33,600 in 2020.

It’s the largest expansion for the Family Medicine Residency since the program moved to the E. Blair Warner, located in a two-story building at 714 North Michigan St., South Bend, in 1994. Two, unused existing buildings were demolished. The 13,500-square-foot addition will match the exterior design of the existing facility.

Much of the existing E. Blair Warner, located on the first floor, will be renovated to improve patient flow and access. Part of the second floor will be revamped to better accommodate the needs of the residency program.

“We have run out of space to meet the growing needs of our residency program and the health needs of our community,” says Dale Patterson, M.D., Memorial Family Medicine Residency Program Director. “By expanding, we are improving upon our care capabilities and providing much-needed space and doctors to serve our patients and our community.”

The E. Blair Warner Family Medicine Center was designed to be the home of the Family Medicine Residency and has served the program well for 20 years.

During the three-year program, residents receive a high-quality education by learning on the job. The residents provide medical care to their primary care practice which includes children, pregnant women, the elderly, athletes and more.

Together, both the residency program and the clinic have added staff and grown considerably over the last 20 years, leading to overcrowding both upstairs and downstairs. Eight residents a year has grown to nine, with plans to expand to 10. Three fellowship programs have been added in recent years, including Obstetrics, Sports Medicine and Health Services Management.

The E. Blair Warner Family Medicine Center is a Patient Centered Medical Home, a cutting-edge facility in which care is provided in the right place, at the right time and in the way that best meets a patient’s needs, including wellness, prevention, acute care and chronic care.

“The services that our residency program offers are very substantial,” says interim Memorial Hospital President Steve Huffman. “Dr. Patterson and his team have built a program that attracts some of the brightest medical school graduates, and many times those graduates, post residency, stay within the region.”

Inside the Numbers: Building expanding from

16,500 square feet to 29,500

Project completion slated for December 2015 $4.5 million expansion and renovation Family Medicine Residency Program started in 1971 E. Blair Warner opened in 1994

More than 300 residency graduates

149 graduates

practicing in Indiana 40 percent of family medicine physicians at Memorial Hospital are graduates 47 percent of family medicine physicians at Beacon Medical Group are graduates 11 of 14 faculty are Family Medicine Residency Program graduates

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“

We are excited to bring more services to our patients on the south side of South Bend and nearby communities.

See photos of Beacon Medical Group Ireland Road’s expanded space at bit.ly/irelandroad.

”

Cathy Barwick,R.N., Practice Manager Beacon Medical Group Ireland Road

BEACON MEDICAL GROUP EXPANDING ON SOUTH BEND’S SOUTH SIDE An expansion project at Beacon Medical Group Ireland Road is now complete, bringing more ways to care for families in our community.

The 28,000-square-foot addition includes a new wing for specialty services including pediatrics, urology, rheumatology, neurology and dermatology (coming in fall 2015).

Physical therapy is now available at the location, too, providing easy access for adults needing orthopedic or other types of physical therapy.

“Patients can see their physician at the practice, receive a referral for physical therapy, and just walk across the hall to schedule an appointment or even possibly take advantage of a

walk- in appointment,” says Brock Haut, Director of Rehabilitation Services at Memorial Hospital.

Cathy Barwick, R.N., Practice Manager of Beacon Medical Group Ireland Road and MedPoint, says the expansion will help coordinate all aspects of patient care in one convenient location.

Beacon Medical Group Ireland Road | 1815 Ireland Road, South Bend | 574.647.1700 Ireland Road staff pictured from left to right: Front Row – Jamie Kazmierzak, M.D., James Tieman, M.D., Ruchita Kachru, M.D., Jerome Skelly, M.D., Mary Kate Oatman, N.P., William Farabaugh, M.D.; Back Row – Douglas David, M.D., Mark Toth, M.D.

14 14 Physician Quarterly | Spring 2015

“ These Experiences Make Our Lives Better” M EMORIAL PHYSICIANS PROVIDING CATALYST FOR HAITI’S REBIRTH

Donny Zimmer, M.D. | Mark Walsh, M.D. | David Denis Jr., | Richard Skupski, M.D. Haitian medical student

It’s amazing to consider how a community-owned hospital in northern Indiana is helping to transform the level of care in the impoverished yet resilient country of Haiti. But that’s exactly what is happening 1,800 miles away in Port-au-Prince, Haiti.

Memorial physicians, nurses and other clinicians have been on the frontline of a worldwide humanitarian effort to assist people on an island wrought by major hardships like the 2010 earthquake and cholera outbreak. Not only are they experiencing enormous, in-the-moment satisfaction by delivering outstanding medical care to the people of Haiti who remain hopeful and dedicated to improving their country, but their contributions are laying the groundwork to help improve the quality of health for future generations.

400 and Counting

Memorial physicians and staff, have conducted more than 400 surgeries, including hernias, appendectomies, keloid and tumor removal and hydrocele repair.

Memorial medical staff primarily provides direct medical care at Saint Luke’s Hospital in Port-au-Prince. The hospital, despite its program and resource shortcomings, is delivering worldclass care and safety to its patients, thanks to Memorial physicians and support from Mayo Clinic, Maryland Shock Trauma Center and the American Academy of Neurology, among others.

Memorial staff has also been instrumental in developing the surgical program and intensive care unit at Saint Luke’s. Using their medical expertise, they also provide additional training to Haitian physicians in surgery; critical care, emergency medicine and anesthesia. Medical skills taken for granted in the United States, such as intubation, have been taught. And as the Saint Luke’s staff gains more medical expertise, Memorial’s focus will transition to more a consultant’s role.

All Hands on Deck Emergency medicine physicians, Donny Zimmer, M.D., and Mark Walsh, M.D., anesthesiologists Richard Skupski, M.D., and Arthur Toth, M.D., and surgeon Tim Noveroske, M.D., have made it their mission to address the extensive medical needs of the Haitian people by performing surgeries, evaluations, resuscitation, pre-op, post-op, administering anesthesia and even performing the occasional house call. In fact, since 2012, they, along with the expertise of other

The always-passionate Dr. Walsh described the visits to Haiti like a military mission.

“We are like Marines and these are my band of brothers,” he explains.

That’s because the trips are usually only a week to 10 days; there is a large number of people waiting on surgery and the often-turbulent environment of Haiti means physicians always need to be vigilant about where they are going and who they are with.

It can be quite a frenzied scene at Saint Luke’s.

“Typically the day we land there will be at least six people laying in the bed with IV lines already in, hoping to get their surgery done,” says Dr. Skupski.

Never the Same Again

Though the trips resemble a military operation, physicians make it a point to embrace face-toface engagement and relationship building.

“We aren’t in Haiti to use a paternalistic approach but a familial approach,” explains Dr. Zimmer. “We are not there to solve all of their problems. We are there to work with the people, to grow together and to work hand-in-hand to find creative solutions to challenges.”

Providing direct medical care in a third-world country cannot help but change a person. Dr. Skupski says he looks at the world differently because of the Haitian travel experiences.

“The challenges of working with very little resources allows us to challenge ourselves as physicians to do what we can to help take care of people,” he says.

The physicians plan to keep going back to Haiti because they know their work isn’t done, and there is more they want to give.

“These experiences make our lives better. It enriches our practice of medicine back home,” says Dr. Zimmer. “At the end of the day it all comes down to this: We have the power to do amazing and transformative things, to alter, and potentially save lives, but no action we take is unidirectional and we who are involved are – often unwittingly – transformed and altered in the experience.”

More medical trips to Haiti are being planned for 2015 and beyond. If you are a physician or clinician interested in offering your expertise in Haiti, contact Dr. Zimmer at zimmer.donaldf@gmail.com.

To learn more about the amazing work being done at Saint Luke’s, you can visit: http://stlukehaiti.org/medical/

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615 N. Michigan Street South Bend, Indiana 46601

Happy Doc’s Day! TODAY, WE CELEBRATE YOU. You take time to listen.

We are in this together.

You are here when we need you.

You want to keep us healthy.

You are here to guide us.

Thank you!