Winter 2015 Volume 106/Number 1 TOLEDOMEDICINE. The Journal of The Academy of Medicine of Toledo & Lucas County

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1 Winter 2015 Volume 106/Number 1 TOLEDOMEDICINE The Journal of The Academy of Medicine of Toledo & Lucas County

2 AL IC M ED E & K RIS M P X A S I T M GE A N R E T EN. E From personal to business to malpractice coverage, Hylant protects your assets with risk management and insurance solutions. At Hylant, our talented and proven professionals have the experience working with medical professionals to provide the expertise you need. With our depth of resources, we develop innovative insurance programs dedicated to reducing risk and improving the operating performance of your health care organization. hylant.com 811 MADISON AVENUE TOLEDO, OH MEDICAL DEVICES CLINICAL RESEARCH CLINICAL TRIALS PHARMACEUTICALS BIOTECHNOLOGY PRODUCT & TECHNOLOGY DEVELOPMENT QUALITY INSURANCE SERVICES The OSMA INSURANCE AGENCY is committed to offering quality insurance services to all OSMA members, their families, and their staffs. The OSMA s in-house insurance agency is dedicated to providing useful advice, review and planning on a wide range of insurance products and services, all designed to meet the individual and practice insurance needs of member physicians. NEW OSMA Health Benefits Plan - An ACA Alternative BUSINESS INSURANCE PLANS Group Health HR360 Online HR Library HR 360 Hotline Live Call Center Payroll On-line Enrollments ERISA & Health Care Reform (PPACA) Compliance Flexible Spending, HRA & HSA Administration COBRA Administration Patient Care Advocacy Services - OSMA Health Benefits Plan - ACA Health Plans On and Off Marketplace Workers Compensation Medical Malpractice Group Long and Short Term Disability Dental Vision Life Office Overhead Expense Long Term Nursing and Home Health Care Plans Commercial Liability (BOP s) Voluntary Products INDIVIDUAL INSURANCE PLANS: ACA Health Plans On and Off Marketplace Medical Malpractice Disability Income Dental Vision Medicare Supplements Life Long Term Nursing and Home Health Care Plans Auto and Home Owners PLANNING SERVICES Employee/Employer Benefit HRA Feasibility Study Retirement For details on OSMA insurance benefits call us at (800) or visit

3 TOLEDOMEDICINE Winter 2015 Volume 106 No. 1 Editorial Board Editor S. Amjad Hussain, MD Stephen P. Bazeley, MD Howard S. Madigan, MD Gerald W. Marsa, MD James G. Ravin, MD Stephen J. Rubin, MD Officers President Henry H. Naddaf, MD President-Elect Bennett S. Romanoff, MD Vice President JoDee E. Ahrens, MD Secretary Christopher A. Bates, MD Treasurer William C. Sternfeld, MD Immediate Past President Charles L. Filipiak, MD C O V E R S T O R Y Annual Meeting 2015 Editorial President s Page 4th District Councilor s Report Membership Memo Applause, Applause Alliance Corner In Memoriam Compendium UTCOM Report Hospital Reports 08 F E A T U R E Integrative Medicine History and Overview Mounir B. Elkhatib, MD 06 Riviera Cancun Winter Seminar 2015 Anne Conklin Reynolds, MD 07 Visiual Literacy at the Toledo Museum of Art James G. Ravin, MD 11 D E P A R T M E N T S On the cover: Staff Executive Director Lee F. Wealton, MPH Managing Editor Johanna D. Begeman, JD Advertising Manager Janice M. Schutt Henry H. Naddaf, MD, Academy President TOLEDOMEDICINE is an official publication of The Academy of Medicine of Toledo and Lucas County All statements or comments in TOLEDOMEDICINE are the statements or opinions of the writers and not necessarily the opinion of The Academy of Medicine of Toledo and Lucas County. The Academy of Medicine does not necessarily endorse the advertisements in TOLEDOMEDICINE. Send information to: TOLEDOMEDICINE The Academy of Medicine, 4428 Secor Road Toledo, Ohio Ph Fx Published quarterly during February, May, August and November. Subscription rate $20 per year. Contributions to TOLEDOMEDICINE are due Winter before the 2015 first of the month preceding publication. TOLEDOMEDICINE 1

4 Editorial Dr. Lloyd Jacobs An Appreciation D octor Lloyd Jacobs stepped down as president of The University of Toledo in June 2014 after having led the university for eight years. He came to Toledo in 2003 to lead the then Medical College of Ohio (MCO). Before coming to Toledo he was for 6 years chief operating officer of University of Michigan Health System. At the time of his arrival MCO was at the brink of financial insolvency, many of its residency programs were on probation and accreditation of the medical college was in jeopardy. He hired Dr. Jeffrey Gold as dean of the medical college and within a year the two of them reversed the trend and put the institution on the path of stability and progress. Perhaps his most significant accomplishment was the merger of MCO (at the time called Medical University of Ohio or MUO) with The University of Toledo. It took much effort to convince stakeholders in both institutions as well as state legislature that such a merger was in the best interest of higher education in Ohio. The historic merger was accomplished by an act of the legislature on July 1, 2006 and as a result a bigger and better, third largest public university in Ohio emerged. Dr. Jacobs was able to accomplish a feat that had alluded many leaders in the past. Dr. Daniel Johnson, president of The University of Toledo at the time of the merger, stepped aside and made it possible for Dr. Jacobs to lead the new university, which Dr. Jacobs led with vision and confidence. A university is the subtotal of its individual parts and one of the important parts is the faculty. Historically some faculties around the country and also around the world have had an ownership complex in the sense that they thought themselves as the final arbitrators of what is good for the university. And therefore any attempt to bring about any change in the curriculum and faculty workload has met with resistance. Under Dr. Jacobs watch the gulf between the faculty and the administration widened considerably. Some people have faulted Dr. Jacobs because of his background in medicine (he was a practicing vascular surgeon in the past) and also because he did not come through the ranks of PhD professors. There have been many physicians who have led many American universities with success. University of Utah, University of Louisville, University of California at Los Angeles and University of Southern California are among a long list of American universities that were led by physicians. Though the merger between MUO and UT was historic and overall successful, many folks on the main campus the old UT campus have not embraced the merger with open arms. Somehow in the minds of some faculty on the main campus, the medical school and the Health Science Campus received disproportionate amount of funding compared to the main campus. While it is not true, perceptions are hard to die. Dr. Jacobs is also credited with starting a new trend in higher education. He initiated the process of interviewing candidates recommended for tenure. There was considerable push back on the interview process, but he persisted. He maintained that as president he had to sign off on tenure and thus before committing university resources for an extended period of time, he must also interview the candidates. It is estimated that the university commits anywhere between 2 to 3 million dollars for a tenured professor over the life of his or her employment. This unprecedented initiative was reported by the Chronicle of Higher Education. He was instrumental in building a state of the art Interprofessional Immersive Simulation Center (Sim Center) on the Health Science Campus of the university. The Center has proven useful not only in teaching medical students, residents and physicians in a hands-on approach to patient care but is also extremely valuable in providing training in disparate fields as warfare, industry and oil excavation to name a few. The center will formally be dedicated as the Lloyd Jacobs Interprofessional Immersive Simulation Center this spring. We at The Academy are grateful to Dr. Jacobs for strengthening the links between The Academy and UT college of Medicine and Life Sciences. Dr. Jacobs leaves behind a legacy of unhampered vision and bold initiatives that are badly needed for the future of higher education in America. S. Amjad Hussain, MD 2 TOLEDOMEDICINE Winter 2015

5 President s Page Becoming a Doctor The $1,000,000 Mistake That was the title of an article and report done on September 10, 2013 by Kathy Kristof, an award winning financial journalist and author for CBS news Money Watch program. In her report, she lays out a compelling and powerful argument about the cost of becoming a physician in the USA and wonders why bright minded college graduates would ever want to embark on such a career path. I will refer back to her report later, but would venture to say, even though she is spot on with the financials, she missed on why we do what we do: that is, the essence of a healer. WE CARE FOR PEOPLE. Therefore, I personally would choose to think of her point as the $1,000,000 investment. In a recent conversation with Dr. Christopher Cooper, Dean of The University of Toledo College of Medicine, he affirmed what many of us already knew. That is, the cost of a medical education continues to increase and has become a terrible burden for young graduates. His latest information from the 2014 class indicated that nationally the average debt was $178,046 and locally $191,302. He went on to state that this was total debt and in many cases included undergrad costs and that not all students graduated with debt. According to the AAMC data as of October 2014, 86% of public medical school graduates carried debt while 82% of private school grads were burdened. Also according to the AAMC data, the amount paid back on this debt, based on $180,000, ranges from $328,000 to $483,000, depending on types of loans, interest rates and length of repayment. To the point of Kathy Kristof, if we were to add in the lost income from the 7-12 years of medical school and post graduate training to the above debt, it would be well north of the million dollar mark. So, hence we come to the word investment. We need to INVEST in our future. We need these bright, caring, top of the class students to continue to follow their dreams, as we did, and become...she missed on why we do what we do. That is, the essence of a healer. We care for people. the healers that will lead our future profession. We cannot let this million dollar burden deter them into alternate career paths or the quality of care will suffer. This needs to be addressed at multiple levels from local help, state help and federal intervention. This is not an issue that is related to the Toledo area only, but affects every city and town in America and the solution seems to be as complex as the new ICD- 10 codes. Looking for help from a federal or state level seems like a pipe dream at times, especially in view of the constant threat of continued cuts to reimbursement and changes to our profession, whether from Obamacare or how we will deliver care in the future. I find myself asking why they Henry H. Naddaf, MD would help when it feels like we are under constant attack from the federal and state level. However, we can focus more locally and band together, from a multifaceted approach, to INVEST in the future of our community and set examples for others to follow. I would like to see a cooperative effort from all the bright minds in Toledo to help significantly defray these expenses so that our graduates and our students choose to stay here for their careers. There are already a number of programs in place such as the Better Together Program between UTMC and ProMedica, the Choose Ohio First program and the Bellevue Hospital tuition assistance for local students. These are all excellent programs, but are not enough for what our need will be in the near future with the expected influx of baby boomers and Obamacare lives. I am talking about an endeavor including not just physicians and hospital systems and leaders, but also the businessmen and financial experts, the lawyers and accountants, the philanthropists and community leaders, the houses of worship and the universities. The message needs to be delivered that they are all being asked to INVEST in the future health of our community, much like we do for many worthwhile charitable events. If we are able to raise funds for all these causes, do we not also need the best of the best caring for them? If we can cut the debt significantly for graduating students who are willing to stay in our community, is this not a worthwhile INVEST- MENT in our future? After all, who will care for us if we do not care for them? Winter 2015 TOLEDOMEDICINE 3

6 Fourth District Councilor s Report Important Decisions Ahead for Ohio s Leading Physician Organization T he Annual Meeting for the Ohio State Medical Association (OSMA) will be held April 10-12, 2015 at the Columbus Hilton Easton. Leaders from Ohio s largest and oldest physician-led organization will consider important bylaws revisions and organizational changes to continue effectively responding to the needs of doctors whether they work in independent private practices or are employed by health systems. The OSMA Council created a bylaws task force to research what other state medical associations are doing to be more responsive to the needs of physicians. Among their recommendations: eliminate geographic council districts, hold policy forums, and open voting to all OSMA members. Please attend and make your voice heard, be part of the discussion. Register today at Special hotel room rates are available. Also, on April 10, 2015, to help kickoff the OSMA s Annual Meeting, the OSMA will host its Annual Education Symposium which provides physicians, managers and medical staff with inspiration, strategies and tools to prepare for tomorrow s health care environment. This year s agenda offers something for everyone regardless of your practice size, specialty or structure. We will start the morning off with a humorous and energetic guest presentation from Steve Bedwell. He will discuss techniques to recognize emotional triggers, unhook from frustrating situations, and stay focused and productive under pressure. The Symposium will also offer four breakout sessions, to include: Patient Engagement, Data Management, Revenue & Reimbursement, and Management & Hot Topics. The event will be held at the Columbus Hilton Easton. Registration is open now at Busy Year Ahead for Healthcare at the Statehouse 2015 will see a flurry of legislative activity unlike anything in the past few years. Top on the list will be the state fiscal year budget and the renewal of Medicaid expansion for Ohio. The current budget and the state s Medicaid expansion expire on June 30, The OSMA s government relations team will be working on several issues related to the budget such as physician payment reform and Medicaid rate increases. In addition the OSMA will be working on prior authorization legislation, public health issues and scope of practice, which typically dominate during the first few months of the year. Medicaid Expansion and the Budget It is likely Gov. John Kasich will include funding for continued expansion of Medicaid coverage in his next two-year budget proposal. After the governor releases his executive budget in February, his proposals will be vetted by the General Assembly where members could elect to not accept federal funding to pay for the costs of expansion. Ohio Senate President Keith Faber has indicated that it will be difficult for the Senate to pass Medicaid expansion as part of the budget proposal, and said he thinks it will have to be debated on its own. There is also talk that the Governor s budget proposal Anthony J. Armstrong, MD will likely include increased funding for Medicaid physician reimbursements. The Department of Medicaid is considering raising physician payment for primary care services, and the OSMA will advocate for targeted increases in other preventive, highneed, and low-reimbursed areas of the physician fee schedule. The next two-year budget may also change the way that direct Medicaid graduate medical education (GME) funds are paid. This year, Medicaid paid out approximately $100 million in direct GME payments to teaching hospitals. The current formula used to expend Medicaid direct GME payments is based upon a hospital s number of beds and residents. The Kasich administration is considering different ways to target these funds toward primary care training, especially in underserved areas of the state. The OSMA is involved in a taskforce to discuss this topic with the Kasich Administration, and we will actively to talk with legislators about the Governor s proposal after its release in February Prior Authorization The OSMA will be working with state lawmakers to create new rules for how insurers impose prior authorization (PA) requirements. Specifically, the proposal will: 1. Ensure that PA requirements or restrictions are listed on the health insurer s web site. 2. Allow providers and patients to obtain PA authorizations through a web-based system. 3. Ensure that a new or future PA 4 TOLEDOMEDICINE Winter 2015

7 requirement is disclosed at least 60 days prior to the new requirement being implemented. 4. Guarantee that once a PA has been approved the insurer will not retroactively deny coverage for the approved service. 5. Develop a single PA form, not to exceed two pages. 6. Guarantee a 48 hour turnaround time on PA requests, with automatic approval in the event a decision is not rendered in 48 hours and 24 hour turnaround for more urgent requests. Scope of Practice Team-Based Approach to Care: Support inter-professional teams managing patient populations to prevent and manage illnesses, based on a model that has physicians in the lead, with care provided by all professionals performing up to their level of training, at the discretion of the physician leader. Provider Credentials: Require all medical professionals, including physicians, to wear a nametag identifying the license they hold. Allied Profession Scope Expansions: We will see legislation in the following areas: 1. Advanced Practice Nurse s looking to expand their scope of practice 2. Pharmacist medication management 3. Permitting chiropractors to independently manage youth concussions - The Youth Sports Concussion and Head Injury Guidelines Committee was established in September 2014 to review the current return-to-play guidelines. OSMA s government relations team will be monitoring these issues very closely and will be working to ensure proper physician oversight remains in place on the final versions of these legislative items. Governor Appoints New Medical Director for State Health Department Mary Seitz DiOrio, MD, MPH was appointed by Gov. John Kasich as the state medical director for the Ohio Department of Health. While most recently serving as ODH s state epidemiologist, Dr. DiOrio s strong background in public health policy will serve her well in her new position and should make her a champion of Ohio physicians who advocate for their profession and healthier communities. Dr. DiOrio earned her medical degree from The Ohio State University. She has experience as a family practice physician. She has been employed by the Ohio Department of Health since 2001 serving various roles in epidemiology. She is board certified in preventive medicine and previously certified in family practice. She replaces Mary Applegate, MD, who had served as interim state medical director since August. Dr. Applegate will return to her permanent position as medical director for the Ohio Department of Medicaid. Medical Board Names Executive Director Anthony (A.J.) Groeber has been named Executive Director of the Medical Board effective Nov. 16, The Medical Board announced that, Mr. Groeber brings to the Medical Board expertise in strategic planning and increasing operational process efficiency. He will be a tremendous asset to the Medical Board as we continue to strive to increase the level of service we provide our licensees and the public. Groeber comes to the Medical Board from the Ohio Board of Tax Appeals, where he has served as Executive Director since March Groeber holds BS/BA degrees from Ohio University and earned his MBA from the Fisher College of Business at The Ohio State University. The Ohio State Board of Pharmacy Names Executive Director The Ohio State Board of Pharmacy announced the selection of Steven W. Schierholt, Esq. as its new executive director. Mr. Schierholt joins the Board with extensive law enforcement and leadership experience. He previously served as the Assistant Superintendent of the Bureau of Criminal Investigation with the Office of Ohio Attorney General Mike DeWine. Mr. Schierholt has also served in numerous capacities at the Ohio Attorney General s Office, including Executive Director of the Ohio Peace Officer Training Commission, Assistant Attorney General and Special Agent. A U.S. Army Veteran, he has also held positions as an Adjunct Professor of Criminal Justice, Deputy Sheriff and Assistant County Prosecutor. Winter 2015 TOLEDOMEDICINE 5

8 Feature Integrative Medicine History and Overview I ntegrative Medicine is a recent development in health care delivery in the United States. Integrative Medicine is a comprehensive system that combines allopathic and complimentary alternative therapies in an evidence-based practice. It attends to the physical, emotional and spiritual aspects of a person s life. It attempts to work with the body s natural potential for healing. Until the early nineties, the practice of alternative medicine was done mainly by non-medical persons, using a large number of modalities including herbal medicines, supplements and vitamins, and eastern practices such as massage, healing touch, etc. In 1993, David Eisenberg from Harvard University published his national survey on the use of CAM therapies by the American adult public in NEJM. The study captured national attention because it showed that over a third of American adults used CAM therapies, yet 70% of them also saw their allopathic physician at the same time mixing both prescription medicine and herbs and not telling their physician about it. Soon after that the NIH established the office of complementary and alternative medicine, which was converted to the National Center for CAM that continues to fund research, education and training on complementary and alternative therapies both at the NIH and through multiple academic centers across the country. While all this was happening, Dr. Andrew Weil of the University of Arizona coined the term Integrative Medicine to more accurately describe what was going on in the field and established the Integrative Medicine Fellowship, and several hundred physicians and allied health practitioners have graduated from his program. Since then a large number of medical schools have added courses in Integrative Medicine to their curriculum and established centers for that purpose. They are all involved in active research evaluating different areas of health promotion and disease management, assessing the efficacy and/or lack of certain modalities, herbal medicines and supplements. In spite of the popularity of Integrative Medicine in the public arena, it has been difficult for physicians trained solely in allopathic medicine to embrace Integrative Medicine for multiple reasons, including lack of good research in many areas and the fact that this field had been plagued by quackery and unfounded health claims. Even in the US Congress there are people who are working to close down the NC- CAM. Why Integrative Medicine? The simple fact is that many people are using these therapies on a wide scale, many of these therapies have biological activities and may interact with prescribed medication potentially causing serious health problems and as health care providers we are often uninformed of these practices. Hence we need a mechanism on the ground to help us guide patients through an already complex health care arena. What are the pit falls? 1. At present, we do not have sufficient research to guide us in the use of these CAM therapies. 2. The herbal medicines and supplements are not under the FDA jurisdiction and manufacturers are not required to prove quality or potency of their products. This area needs work. 3. Even in cases where there is sufficient proof of efficacy, we have no dose titration studies to determine appropriate dose. What can people do to get proper advice? 1. Always discuss any CAM therapy with their health care providers before use. 2. Get informed by reading. Mounir B. Elkhatib, MD 3. Seek advice from qualified practitioners. There are several regulatory agencies. The FDA regulates product labeling and good manufacturing practices. The FTC regulates advertising. The Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 requires adverse event reporting. The American Board of Integrative Medicine is also involved in regulation. 6 TOLEDOMEDICINE Winter 2015

9 Riviera Cancun Winter Seminar 2015 by Anne Conklin Reynolds, MD E nlightening, collegial and relaxing are words that come to mind after attending the recent 2015 Academy of Medicine Winter Seminar at Secrets Maroma Beach Resort, Riviera Cancun, Mexico. The Winter Seminar has been expertly organized by Dr. S. Amjad Hussain for the last twenty years. Dr. Hussain is able to encourage several attendees to give lectures in their own areas of interest or specialty. This results in a varied program suitable for all physicians. This year s seminar included such diverse topics as Hepatitis C, traveler s diarrhea, surgical and medical management of diverticulitis, diseases of the eye, breast and lung cancer, upcoming changes in graduate medical education and evaluation as well as Purloined Parts. All of the talks were informative and generated lively discussion among the participants, Chefs for a day. From left, Nancy Ravin, Katie and Terry Loh and Denise Colturi. From left, Lee Wealton and Drs. Kenneth Saydel (Waukesha, WI), Amjad Hussain, Vincent Lobo (Bethany Beach, DE), Anne Conklin Reynolds, Thomas Colturi, Lachman Chablani, William Sternfeld, Terry Loh, Phillip Stiff, Jr., James Ravin and Lance Talmage. especially the clinical pathologic correlation cases presented. The knowledge and experience of our local colleagues, as displayed in these lectures, was impressive. Equally impressive, was the beauty of Secrets Maroma Beach Resort with its many restaurants, fountains, pool and expansive white beach on the edge of the Caribbean Sea. The resort provided a lovely winter respite for the attendees and their guests. Patti Tuschman, of Central Travel, provided expert organization and guidance throughout, from registration to the voyage home. Golfers also enjoyed rounds on two different near-by courses after the lectures. Many members of The Academy have taken advantage of the educational and travel opportunity offered by the Winter Seminar in past years. As a first time participant, I look forward to attending again and hope others would consider this worthy activity of The Academy of Medicine of Toledo and Lucas County. Dr. Thomas Colturi giving a lecture on travelers' diarrhea. Winter 2015 TOLEDOMEDICINE 7

10 Cover Story Annual Meeting 2015 T he Academy of Medicine of Toledo and Lucas County's 113th Annual Meeting on January 8 went as planned, even though it was very cold during the day and a clipper system came in as the guests were arriving at 6 pm. However, the weather had very little effect and there was the largest attendance in several years. Dr. Mounir B. Elkhatib, Academy Vice President, began the evening with the invocation followed by Academy President Dr. Charles L. Filipiak welcoming the attendees and making a number of introductions. Following dinner, Dr. JoDee E. Ahrens, Academy Secretary, led a moment of silence in tribute to those Academy members who passed away since the last Annual Meeting, including Drs. Kenneth L. Akins, Thomas P. Bowlus, Stephen P. Camacho, Robert F. Cooke, Marvin E. Gottlieb, Samuel L. Karr, Charles M. Klein, Richard B. Peoples, Bernard B. Shuer, Ajay R. Shah, Robert N. Smith and Cawilie G. Vergara. One of the events during the evening was presentations to the 50- Year Award recipients acknowledging the 50th anniversary of graduation from medical school. OSMA Fourth District Councilor Dr. Anthony J. Armstrong presented a 50-Year Award to Dr. Lance A. Talmage who received a standing ovation following the presentation. Other 50-Year Award recipients who could not be at the meeting include Drs. Duane B. Gainsburg, Anthony R. Geraci, Mustafa Guvendi, Robert J. Huss, Nasr A. Mansour, Sarah From left, Dr. Christopher A. Bates, Secretary; Dr. Benn Immediate Past President; Dr. Henry H. Naddaf, Preside C. Sternfeld, Treasurer; and Dr. JoDee E. Ahrens, Vice P G. Pope, Michael J. Rench, Om P., Sharma and Rajni B. Sharma. In a tradition of support to medical education that began in 1972, Dr. Filipiak presented a check for $3,000 to Dr. Christopher J. Cooper, Senior Vice President for Clinical Affairs and Dean of The University of Toledo College of Medicine and Life Sciences, for Richard D. Ruppert, MD Scholarships for medical students at The University of Toledo College of Medicine and Life Sciences. Academy President Dr. Henry H. Naddaf will present the scholarships at the Awards Dinner. Dr. Anthony J. Armstrong, OSMA Fourth District Councilor, presents a 50 Year Award to Dr. Lance A. Talmage. Each year one of the highlights of the evening is the formal induction of the new members who were approved during the year. 8 TOLEDOMEDICINE Winter 2015

11 The 2014 new members include Drs. Salil Avasthi, Mirza M. Baig, Lindsey J. Bostelman, Stephanie J. Cole, Christopher J. Cooper, John V. Houghtaling, Nicole A. Hubbard, Nadine C. Kassis, David M. Lewis, Robert S. Myers, Wael M. Otaibi, Dino Santacroce, Jason L. Schroeder, Anthony V. Songco and Siva R. Yechoor. Dr. Filipiak welcomed the new members and also recognized the Associate Members who were elevated to Fellow Membership status in The new Fellows include Drs. Johan D. Aasbo, Ransford S. Brenya, Daniel M. Buerkel, Arjun Das, Brian A. Dolsey, Rania A. Fahoury, Thomas L. Flanigan, Kadra A. Ganim, Robert D. Grande, M. Shahzad Hasan, Helen C. Mabry, Robert R. Mrak, Richard C. Phinney, Ranvir S. Rathore, Mark Richards, Carl A. Sirio, Sarah C. Stierman and Rick A Vidovich. Dr. David L. Grossman, Health Commissioner for the Toledo~Lucas County Health Department, was the keynote speaker. Dr. Grossman gave an excellent presentation on Public Health Who We Are and What We Do. He said the Health Department spent the last year looking at some very serious issues, including the water crisis, Ebola and the very bad year for the flu. Dr. Grossman said the Health Department is made up of two divisions, Health Services and Environmental Services, and discussed what they do. He said prevention is what the Health Department is all about. Dr. Grossman s presentation was not only very educational and informative, but also extremely entertaining. ett S. Romanoff, President-Elect; Dr. Charles L. Filipiak, nt; Dr. David L. Grossman, Guest Speaker; Dr. William resident. Dr. Filipiak thanked Dr. Grossman and presented him with a copy of The First 150 Years -- A History of The Academy of Medicine of Toledo and Lucas County He thanked the spouses and families who put up with physicians lives. He also thanked Mercy and ProMedica for their support in helping put The Academy in a good financial position. Dr. Filipiak thanked The Academy and the OSMA for being the only place where physicians have a voice in state and federal government. He said all physicians need to stay involved. Dr. Filipiak thanked the members for the honor of serving as President over the past year. As Dr. David L, Grossman, Health Commissioner, and Dr. Donna A. Woodson, President, Toledo~Lucas County Health Department. Winter 2015 TOLEDOMEDICINE 9

12 his last formal action, Dr. Filipiak passed the gavel to Dr. Henry H. Naddaf. Dr. Naddaf said he would like to thank all of his fellow physicians, said he was humbled by the trust they have put in him and thanked them for the honor of serving as Academy President. Dr. Naddaf thanked Dr. Filipiak and presented a presidential shadow box and gavel to him to commemorate his excellent year as Academy President. He said with the winter storm warning he was going to keep it short. Dr. Naddaf introduced his family members who were present and thanked all spouses who know how many hours physicians are away from home. He said without his family s support, he would not be here and said his wife, Sahar, has been his rock and backbone and again thanked all spouses. Dr. Naddaf said physician involvement at any level is important and said we need it to save our profession. He said if physicians are not part of it, they will be left out. Dr. Naddaf asked all present to get the word out that we must be involved. The meeting concluded with Dr. Naddaf announcing the 2015 Academy election results. Officers elected include Dr. Bennett S. Romanoff, President-Elect; Dr. JoDee E. Ahrens, Vice President; and Dr. Christopher A. Bates, Secretary. Councilors elected to a two-year term include Drs. Ted E. Barber, Constance P. Cashen, Gregory D. Haselhuhn, Ameer Kabour, Gretchen E. Tietjen and David C. Vicente. Newly elected members of the Nominating Committee include Drs. Michael S. Applebaum and Susan M. Federman. MembershipMemo MembershipMemo The following physician was approved for Associate membership in The Academy of Medicine. Nicole A. Hubbard, MD 3170 W. Central Ave. Pathology Indiana University. Pathology residency and medical microbiology fellowship at Indiana University. Nadine C. Kassis, MD 3425 Executive Pky. Urogynecology The University of Toledo College of Medicine. Obstetrics and gynecology residency at Brown University/ Women & Infants Hospital. Female pelvic medicine and reconstructive surgery fellowship at Indiana University/Methodist Hospital. Sanjay Sangal, MD 2600 Navarre Ave. Anesthesiology Wright State University. Obstetrics and gynecology internship at Miami Valley Hospital, Dayton. Internal medicine residency at Akron Medical Center and anesthesiology residency at Medical College of Ohio. Siva R. Yechoor, MD 7640 Sylvania Ave. Psychiatry Armed Forces Medical College, Pune, India. Internship at UHS/ Chicago Medical School and psychiatry residency at The University of Toledo Medical Center. Applause, Applause Applause... Applause... Kris A. Kostrzewski, MD, PhD, FAAFP was elected to Fellowship in the American Academy Family Physicians. Frank P. Manning, Jr. Chartered Property & Casualty Underwriter Professional Liability Coverage for the Medical & Dental Professions g Brooks Insurance Agency 1120 Madison Avenue Toledo, Ohio TOLEDOMEDICINE Winter 2015

13 Visual Literacy at the Toledo Museum of Art T he International Visual Literacy Association (IVLA) held its 47th annual conference at the Toledo Museum of Art from November 5-8, The theme of the conference was The Art of Seeing: From Ordinary to Extraordinary. IVLA describes itself as an eclectic organization of professionals working toward a fuller understanding of the way we derive meaning from what we see and the way we interact with our visual environment. This organization has been in existence for more than 30 years. Although many fields are narrowing their focus, IVLA has been going in the opposite direction. Its website notes that its members come from a very wide range of disciplines, including the arts, sciences, communication theory, semiotics, graphic design, photography, videography, media studies, architecture, business, education, educational technology, instructional design, health, psychology, linguistics, philosophy, cultural anthropology, brain research, and computer applications. What is visual literacy? The definition provided on Wikipedia (accessed 11/12/2014) is the ability to interpret, negotiate, and make meaning from information presented in the form of an image, extending the meaning of literacy, which commonly signifies interpretation of a written or printed text. Visual literacy is based on the idea that pictures can be read and that meaning can be communicated through a process of reading. While some consider visual literacy a broad concept that incorporates ideas from many knowledge bases, with a basis in ancient philosophy, 1 there is disagreement on a precise definition of the field. In fact, some researchers have rejected the whole concept of visual literacy and instead focus on the communication design, information design, or message design. 2 Putting the semantics aside, the conference included some most interesting aspects. One lecturer, who had created his PhD thesis totally in the form of cartoons, described his special interest and his technique. Curious sessions included Reading Without Words, Seeing Things: Visual Rhetoric and Our Wordless Stories, Visual Preference and Clothing Fit: Do Standards Apply? and DADA: An Online Social Platform for Visual Conversations. The introduction for the session on DADA began with this provocative statement: Visual artists have long lived under the dictatorship of the written word. A fascinating talk was given by Joseph Rosen, MD, a plastic surgeon at Dartmouth Medical School, who was a philosophy major in college and is now a professor of surgery as well as an adjunct associate professor of engineering. He says Whenever I look at a problem, I look at it through the lens of philosophy. Plastic surgery is about applying philosophical principles to the body. 3 He likes to quote the famous French 16th century surgeon Ambroise Paré, who wrote a book entitled On Monsters and Marvels, and described individuals who suffered from congenital defects and war injuries. Rosen notes people five centuries ago were challenged to make sense of these unfortunate people while at the same time maintaining an idea of a benevolent deity. Rosen likes to consider contemporary scientists from Paré s point of view and what we may not be noticing today. He also questions the ethics of some contemporary surgical procedures, such as augmentation mammoplasty for elderly women. He notes that facial injuries during World James G. Ravin, MD Wars I and II were similar, but during the war in Iraq the blast injuries have involved a substantially greater order of magnitude. He sees current surgical reconstruction as the first aspect of treatment, and envisions a future that will include regeneration of missing body parts through tissue engineering. This will be an improvement beyond transplantation of an extremity or the face, in his opinion. He is fascinated by Frankenstein s monster and Picasso s Guernica. He has also published on more mundane subjects, such as reconstructive flaps and rhinoplasty for adolescents. In an interview with him published in Harper s Magazine, Rosen said plastic surgery is the intersection of the surgeon s imagination with human flesh and human flesh is infinitely malleable. People say cosmetic surgery is frivolous in altering the shape of breasts and noses. But it is so much more than that! When you change what you look like, you change who you are. 4 This conference was provocative and was intended to promote critical thinking. Beyond considerations of plastic surgery, the audience learned that the theory behind the concept of visual literacy is still evolving and that we must ask the right questions in order to obtain appropriate explanations. 1. Petterson R. Information design theories. Journal of Visual Literacy 2014; 33: Braden RA. Visual literacy. Journal of Visual Literacy 1996; 16: Brown NM. Joseph Rosen, M.D.: Facing the Future. Dartmouth Medicine Spring, 2007; 1 4. Slater L. Dr. Daedalus. Harper s Magazine July 2001; Winter 2015 TOLEDOMEDICINE 11

14 Looking Forward to 2015 I hope that everyone had a fun and joyous holiday season. I would like to wish everyone a very Happy New Year filled with good health, happiness and prosperity. I enjoyed a relaxing Christmas at home with my whole family and feel very thankful that now that they have all moved back to the area, we can more easily gather to celebrate the holidays. Community service is a hallmark of our Alliance and the holidays are always a great time to share some Christmas cheer. Alliance members dressed up in fun Santa hats and met at the Kids Unlimited Lake Erie Academy in west Toledo in mid- December to share a bit of holiday fun. Kiran Rai and her daughter Ahalya Rai and friends, Lynn Ali, Lela Rashid, Katie Loh, Mary Geiger, Susan Doukides and Debi Lewis provided all of the art materials and assisted thirty-five after-school students in creating adorable personalized picture frames and Christmas ornaments for the students to gift to family and friends. The event was such a success thanks to Debi Lewis, our Community Service Chair, who planned and organized this fun activity for these kids. She is great at finding projects to help the community. Our Alliance member Chelsey Gupta (also my daughter-in-law) and her family provided meals to Ronald McDonald House on December 19. The residents very much appreciated and enjoyed the dinner. The Alliance also participated in the Read for Literacy Community/Corporate Spelling Bee this year. There were some pretty tricky words, but our team of Maria Diment, Sherry Wainz, Kiran Rai and Chris Brochin finished strong in fourth place. Thanks to them for participating in this great fundraiser for Read for Literacy, an organization that Manju Gupta teaches people to read through oneon-one coaching experience. Moving forward into the New Year, the Alliance has been planning several events for the upcoming months. First, Lela Rashid (membership development chairperson) and Jackie Zakeri planned a New Member event, which was held on Wednesday, January 14. It was held at La Galleria de America s, where we had a cooking class with Chef Saundra Irvine, who demonstrated new techniques and gave us some helpful tips. Our General Membership meeting/ lunch occurred on February 10. We also have our annual Euchre tournament planned for March 14 this year. Kiran Rai and Myung Armstrong are working on the details. It will be held at Highland Meadows at 6pm. Please save the date, as this is one of our most popular activities, so you won t want to miss it! I am looking forward to 2015 as we in the Alliance work harder to gain more members and to help our community in different ways. If you are not yet a member of the Alliance, please consider joining. We host many different types of events and activities throughout the year, so there is truly a place for everyone. Susan Doukides and Debi Lewis at Kids Unlimited activity. 12 TOLEDOMEDICINE Winter 2015

15 In Memoriam Compendium Fallen Healers. Our losses to the Grim Reaper T wo thousand fourteen was a good year, a tough year, and a sad year. We physicians of Northwest Ohio lost some valued comrades, some well into their golden years, two before what we would consider their time but all left behind a rich legacy. Bernard B. Shuer, M.D. was born in1916, and served in World War II as a Battalion Surgeon. He attended The Ohio State University College of Medicine and did his Neurosurgery Residency at Brooklyn Jewish Hospital in New York City. He married his wife Estelle in 1949 and moved back to Toledo to set up his Neurosurgery practice. He and his wife had 4 children, though one of his daughters preceded him in death. He practiced Neurosurgery at most of the hospitals in Toledo, and was active on multiple committees at the hospitals and at The Academy. Hobbies included playing golf, and he will always be remembered for wearing his sporty bow ties! He wore the bow ties to avoid incidental contact with his patients which would make all of our Infectious Disease colleagues proud, as this haberdashery statement was truly way before its time! He died June 23, Samuel L. Karr, M.D. was born in Philadelphia on July 1, 1928, and attended Temple University School of Medicine, graduating in He did his Internal Medicine residency at the V.A. Hospital in Philadelphia, and his Cardiology fellowship at Bergen Pines County Hospital in New Jersey. He married his wife Annora Sue in 1954, and was a First Lieutenant in the Navy during the Korean War. He practiced 37 years with esteemed physicians Eli Abramson, M.D. and Harold Poneman, M.D., was Chief of Staff at Riverside Hospital, and was instrumental in establishing the first CCU (Coronary Care Unit) in Toledo at Riverside. He volunteered as faculty at The University of Toledo College of Medicine after his retirement. As a pilot, he and his wife flew over 3000 hours in the air, and as a member of the Volunteer Pilots Association he transported patients to medical treatment if they didn t have the means to get there otherwise. He played trumpet, bugle, piano and later French horn with several community orchestras, and was an avid arborist. On a more personal note, Sam was my original landlord when I set up practice in South Toledo at the Suburban Medical Center, and I was always impressed with his kind and gentle manner. As Dr. Abramson stated, Sam was an old-fashioned, chivalrous kind of guy. He is survived by his loving wife of 60 years, Annora Sue, three sons and four grandchildren. Marvin E. Gottlieb, M.D. was born in Cleveland on August 1, He received Bachelor s and Medical degrees from what is now Case Western Reserve University, completed his Psychiatry residency at Strong Memorial Hospital in Rochester, New York, and served in the Navy. He moved to Toledo in 1968 to join the faculty of the fledgling Medical College of Ohio, and he was in charge of the first residency program in psychiatry at MCO (to address the profound shortage of psychiatrists in Northwest Ohio.) He lectured and mentored students and residents for many years, and was always actively seeing patients, avoiding the commonly accepted practice of having an unlisted phone number to be always available to his patients. Marvin was a passionate runner, logging over 2000 miles a year for over 20 years, highlighted by a 61 mile run at the age of 61! He loved to watch harness racing at Raceway Park, and collected watches, pens, lighters, and tobacco pipes. On another personal note, I was fortunate to interact with Marvin (I always called him Dr. Gottlieb ) as a medical student, a Family Practice resident, and as a referring physician. I can still see him working to keep his pipe burning as we discussed our patients with anxiety and depression on Monday afternoons at Mercy Hospital. He was a superb teacher, an excellent clinician in sorting out the appropriate pharmacotherapy, and a caring physician he has left his legacy in the many physicians he has helped train! He spent his last years in the St. Francis Home in Tiffin. He leaves behind his wife, Jill, whom he married in 1997, two sons and two grandchildren. Ajay R. Shah, M.D. was born November 30, 1960 in Sambalpur, Orissa, India, and moved to California in He achieved his undergraduate and medical degree at Michigan State Univer- Winter 2015 TOLEDOMEDICINE 13

16 sity where he met his wife, Judy Macy, M.D. He completed a Pathology residency and Cytology fellowship at Henry Ford Hospital in Detroit, and worked at The Toledo Clinic as a Pathologist. He developed an exceptional reputation in Northwest Ohio for his prowess in fine needle biopsies to detect cancer. Balancing profession with parenthood, he became involved as a Boy Scout Leader, a soccer coach, and a cross country assistant for Trinity Lutheran Church in Monroe. Ajay was an innovative physician, fought valiantly against his cancer, and will be remembered by his colleagues as a special, gifted practitioner. Leaving us much too early at the age of 53, Ajay s absence is felt most dearly by his family Dr. Judy Macy, Nicholas, Julia, and Joshua. We pray for them, asking the Lord to bless them with sweet memories of this fallen medical comrade. Stephen Phillip Camacho, M.D. passed away unexpectedly on November 29, He was born in Toledo on March 6, 1973, and received his combined Bachelor s Degree and Medical Degree from Kent State University and Northeastern Ohio University College of Medicine in He completed his Family Practice residency at Shadyside Hospital in Pittsburgh and came back to Toledo as Assistant Director at the Flower Hospital Family Medicine Residency. He later joined The Toledo Clinic Family Practice in Holland with Nicholas Lopez, M.D. and Jonathan Rohrs, M.D. He was Medical Director of Spring Meadows Senior Community, a Councilor for The Academy of Medicine of Toledo and Lucas County, and quite involved with the Academy Mentorship Program to increase interest in the practice of medicine. He was a board member for SCORE, the humanitarian foundation of the Filipino Association of Toledo and traveled on many medical missions to all parts of the world. He was generous with his time and talents to family, friends, patients, and colleagues. He was passionate about life from cooking, camping, singing, fishing, playing tennis and basketball, cycling, and running. He was often found cheering on his boys on the team of Kodiak Attack Wrestling. I first met Phil on a medical mission trip to Biloxi, Mississippi after Hurricane Katrina with Dr. Rich Paat. All of the physicians were christened Captains by the Salvation Army who supported our efforts in the sweltering heat, and so whenever I saw Phil later on medical missions to Tanzania and Guatemala, the Medical Staff Lounge at St. Luke s it was always Captain Phil. I can still see the look on his face after a makeshift shower in Biloxi restored his soul Death at the age of 41 is much too young, and we marvel at his accomplishments for the few years he was in Toledo practicing medicine. Of course the loss beyond comprehension is that of his wife Jennifer (who I met on the Tanzania trip) and his five macho sons Brandon, Alex, Derek, Jack, Archer and stepchildren Joey, Cody, and Ashlyn. Their grief unimaginable, we cannot help, but we too have memories of this special man. We do pray for their present and future and the excellent memories of the past. If a comet is a bright light that leaves too quickly, that could be a Camacho. Lastly, Richard B. Peoples, M.D. died December 11, 2014 at the age of 86. He attended Jefferson Medical College in Philadelphia, and did his internship in the Navy. He came to Toledo and did an Orthopedics residency at St. Vincent s Hospital, eventually going into practice with James Pollex, M.D. and Carl Herkimer, M.D. He practiced Orthopedics conservatively, compassionately, and honestly. In 1977 he moved back to California where he lived for 18 years. He came back to Toledo in1995, then moved to Texas in 2012 when his wife Sharon retired. Dick enjoyed life and loved his family with a passion. His gregarious nature earned him friends that were forever. He also loved theatre, singing, classical and jazz music, fine dining, good wine, golf and people. He was a joke teller, loved stories, and gave great hugs. He is survived by his wife of 25 years, Sharon, two daughters, two sons, three stepchildren, seventeen grandchildren and nine greatgrandchildren. Truly, one of the bright lights in our medical past. So, in the words of the poet Robert Herrick, Gather ye rosebuds while ye may Love your family, enjoy your profession as best you can, and thank your Creator for your many blessings! Stephen P. Bazeley, M.D. 14 TOLEDOMEDICINE Winter 2015

17 UTCOM Report Hospital Reports Dean s The University of Toledo College Of Medicine Report Area Hospitals Chiefs of Staff Reports The University of Toledo Medical Center recently received a positive evaluation from the Joint Commission. We are very thankful to our UTMC staff and faculty for their commitment to continuous improvement. During the exit conference the accreditation surveyor complemented our staff and said, Northwest Ohio should be proud of the care delivered at UTMC. I am proud to work with our faculty and staff who provide highquality and safe care, while educating the next generation of health-care professionals. We don t view the Joint Commission visit as a test we need to pass, but rather as a step in our journey to improve patient care. R. W. Mills, MD Mercy Children s Hospital longstanding relationship between A Mercy Children s Hospital and the University of Michigan Congenital Heath Center has resulted in the successful placement of a subcutaneous implantable cardioverter-defibrillator (S-ICD). David Bradley, MD, the director of Pediatric Electrophysiology and Pediatric Device Services at C.S. Mott Children s Hospital at the University of Michigan, placed the device in a 16-year-old patient who had experienced cardiac arrest. The patient continues to follow up with Dr. Bradley, who spends one day a month visiting patients at Mercy Pediatric Cardiology, as well as Mercy specialists, Dingding Xiong, MD, and William Suarez, MD. This patient is just one of hundreds who receive lifesaving electrophysiology care close to home thanks to this collaboration. Heart rhythm problems in our youngest patients may be cared for with the use of pacemakers, implanted defibrillators and other devices. In his monthly heart rhythm clinic, Dr. Bradley joins Mercy colleagues Dr. Xiong and Dr. Suarez to address their subspecialty needs. Infants experiencing the devastating effects that can result from hypoxic- (continued on Page 16) The College of Medicine and Life Sciences continues to benefit from the opening of the Interprofessional Immersive Simulation Center. We recently completed the first semester of the new longitudinal interprofessional course with 552 students from eight professions: medicine, nursing, occupational therapy, pharmacy, physical therapy, physician assistant studies, respiratory care and speech language pathology. Using the new facility, the students gain an understanding and appreciation of the roles and scope of practice of different professions and the impact of team on patient care and quality improvement. The College of Medicine has received more than $8.1 million in external research funding for the current fiscal year that includes basic science research, largely funded by the National Institutes of Health, as well as clinical research sponsored by pharmaceutical (Dean s Report continued on Page 20) Home offered by Anita Mirra A BEAUTIFUL HOME ON A MAGICAL SETTING Large 2.5 acre wooded site with a stream meandering along the rear property line. In the secluded area of Fair Hills off of Corey Road. Custom brick home with many high ceilings, open feeling, lots of windows and great views. Large home built in 1989 with a very modern, comfortable feeling First floor Second floor 5536 Golf Creek Drive Sylvania Township/Sylvania Schools Walk out basement 4475 square feet 1185 square feet square feet (finished) 7270 total finished square feet Winter 2015 TOLEDOMEDICINE 15

18 (from on Page 15) ischemic encephalopathy, or HIE, at birth continue to be treated at Mercy Children s Hospital with whole body cooling, a practice that significantly reduces the risk of death and disability. The protocol, which involves lowering the body temperature within six hours of birth to between 33.5 C and 34.5 C, has been in practice for many years in instances when the benefit of induced hypothermia is supported about two or three times a year. By using cooling techniques and strict monitoring, we have seen much success in the thriving of our youngest patients. Another procedure we are looking forward to bringing to the NICU is NAVA, or Neurally Adjusted Ventilatory Assist, which is an invasive ventilation mode that provides ventilator support proportional to the electrical activity of the diaphragm. This procedure enables physiological variations in tidal volume and inspiratory time from breath to breath. It has been shown to improve patient-ventilator synchrony and assist in earlier extubations. Ted E. Barber, MD Mercy St. Anne Hospital I m excited to report that the Mercy Heart & Vascular Center at St. Anne Hospital is now fully operational and is offering a full range of cardiac services, providing patients in western Lucas County and southeast Michigan with more convenient access to cardiac care. Since expanding cardiac services to St. Anne, Mercy has more than 100 patients in the catheterization lab, performing procedures such as diagnostic catheterizations, stent placement, peripheral interventions, and pacemaker insertions. The Mercy St. Anne cardiology team performed the first open heart surgery at St. Anne on Sept. 23 and has successfully completed several more. Upgrades were also made in cardiology outpatient and diagnostic services and a dedicated inpatient cardiac floor was developed to help bring specialized care to our patients. Cardiac services will continue to expand in early 2015 with the treatment of STEMI heart attacks. Despite frigid mid-november temperatures, Mercy officially broke ground on a new free-standing emergency and outpatient diagnostic center in Sylvania Township. Mercy had previously announced the construction of Mercy Medical Center Sylvania, mirrored after the successful center in Perrysburg. When opened in fall 2015, the 18,000- square-foot, full-service facility will bring emergency care services closer to many communities. I m also pleased to share that Mercy has introduced a physician supervised outpatient ambulatory clinic to help those patients who are no longer hospitalized but who could benefit from palliative care services. The Mercy Outpatient Ambulatory Clinic will be offered one day a month at Mercy St. Anne under the direction of Mohammad Al-Nsour, MD, who is board certified in palliative care. Dr. Al-Nsour will manage the symptomatic care for the patient while remaining in communication with the patient s physician. Karl S. Fernandes, MD Mercy St. Charles Hospital After months of planning and construction, Mercy is pleased to announce that the new Behavioral Health Institute at Mercy St. Charles Hospital is on schedule to open for patients early this year. The state-of-the-art facility will offer 24-hour crises and emergency screening as well as acute care services, including group psychotherapy, medication management, psycho-educational groups and recreational activities. The 90-bed, two-story building will also house a partial hospitalization program, an intensive outpatient program, and an outpatient clinic. As true partners in compassionate behavioral healthcare and recovery, our team is excited to begin offering these crucial services to our community after the facility s grand opening slated for late March. I am also pleased to share that over an eight month period, St. Charles medical staff leaders have worked collaboratively with the medical staff leaders throughout the Mercy Health Northern Market to draft a consolidated set of Bylaws. This initiative is intended to update the content of these guiding documents to better reflect current organized medical staff responsibilities, while establishing governing documents that support equitable and consistent member expectations. We are now working through the final approval process with the other six regional facilities. The medical staff continues to use CAREPATH via the EPIC program in order to achieve a higher percentage of compliance with computer order entry. This continues to be one of our main goals as we enter into Medical Staff members were able to gather and enjoy a night of retro fun this past November as the theme of the St. Charles medical staff annual dinner commemorated the 80s. Period attire was encouraged and many attendees outfits depicted fashions that were en vogue during that era. Gregory C. Kasper, MD Mercy St. Vincent Medical Center Already a leader in providing graduate medical education, Mercy now offers a three-year Cardiovascular Disease Fellowship, showing Mercy s commitment to take education to the next level. The fellowship, which began July 1, is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee 16 TOLEDOMEDICINE Winter 2015

19 (RRC.) Mercy St. Vincent Medical Center, which has the region s only established Regional Heart and Vascular Center, is the primary teaching facility for the fellows. The curriculum is designed to train the fellows in all aspects of acute and chronic cardiovascular diseases, in both inpatient and outpatient settings. Also recently established is a collaboration with area post-acute care facilities, designed to better coordinate the transition of patient care between providers, reduce unnecessary re-hospitalizations, and enhance patient satisfaction. Mercy s Post-Acute Care Collaborative (PAC) is a pilot program involving 12 area skilled-nursing corporations, who have committed to improving care transitions and patient care quality while reducing readmissions, length of stay and cost of care. We are also working with area Long Term Acute Care Hospitals, Hospice and other providers across the continuum as a part of the broader effort to meet these objectives. Another successful pilot program spearheaded at Mercy St. Vincent is the Bundled Payments for Care Improvement Initiative for Coronary Artery Bypass Grafting (CABG) through the Centers for Medicare and Medicaid Innovation (CMMI) within CMS. The Bundled Payment involves a set total cost of care target for all care related to the CABG surgery. Mercy takes responsibility for all costs from three days prior to admission through 30 days post-discharge and has a predetermined total cost of care target price that includes an upfront 3 percent discount to Medicare. Within the first quarter, the readmission rate for patients dropped from more than 22 percent down to 8 percent and the total cost of care came in less than the target and discount combined. This is a three year pilot program with CMMI and the project will continue through (continued on Page 18) ARE YOUR ACCOUNTANTS HEALTHCARE SPECIALISTS? As regulatory, economic and technological changes influence the healthcare industry, GJM s Healthcare Specialists group can be an invaluable partner in maximizing your productivity and profitability. We have committed significant resources to the area of healthcare financial management, and our professionals have extensive experience helping over 900 healthcare providers and hospitals increase cash flow, manage costs and improve reimbursements. Call us today at so you can spend more time doing what you do best - treating patients - with GJM s innovative ideas and trusted advice by your side. ASSURANCE TAX CONSULTING GJMLTD.COM Winter 2015 TOLEDOMEDICINE 17

20 (from Page 17) Agha Shahid, MD ProMedica Flower Hospital ProMedica Flower Hospital completed the education phase for ProMedica acute care facilities in its Culture of Safety initiative, with nearly all physicians and staff receiving training on errorprevention techniques. This follows ProMedica s policy to ensure safety, quality and excellence remain wrapped together for the good of our patients, whose expectations in order are simple: Don t harm me. Heal me. Be nice to me. Employees and physicians alike are committed to ensuring there is no harm done to any patient, employee, family member, friend, or other visitor to our facilities. I am extremely proud of the commitment the medical staff at Flower Hospital has shown to this initiative by attending and participating in the training that has been made available. It is through this Culture of Safety that we can learn from any errors and start reducing them. The renovations to the 6th floor at Flower Hospital are complete, and patients were successfully moved and caregiving continued on the new floor on Dec. 9. The number for the 6th floor nurses station is The former 6th floor phone number, , has been assigned to the 7th floor. As we look to 2015, Flower Hospital will be celebrating its 40th anniversary in its current location on the Sylvania campus and I m sure many other wonderful accomplishments. Rajendra R. Kattar, MD ProMedica St. Luke s Hospital t. Luke s Hospital awaits to hear on SProMedica s appeal to the Supreme Court regarding the FTC ruling in the ProMedica-St. Luke s merger. There is some apprehension amongst the employees and Medical Staff, but however it turns out there is confidence that St. Luke s Hospital will come out strong whether independent or remaining a part of the ProMedica system. The Supreme Court should decide by March whether to hear the case. The commitment to our patients and the local community has been and will be the driving force to our continued success. There has been a major commitment to strengthening our already strong culture of safety at St. Luke s. As of December 1st, 93% of our physicians on staff have completed the safety training program. Medical Staff leadership has teamed up with nursing leadership to work on improving a standardized check out process from shift to shift. This will include pertinent past medical history, active problems and treatment plan. This is an important step in communication and will also assist the nurses when rounding with the physicians and discussing the patient on the phone with cross covering physicians. Importantly, this will help everyone taking care of the patient. Many primary care physicians and consultants no longer round at the various hospitals. When admitted the patients are now taken care of by well qualified hospitalists. This has given less opportunity for physicians to interact with each other on a personal level. To help bridge this gap, Medical Staff leadership arranged an end of summer tent party with food and entertainment. It was attended by many and a huge success. It gave the opportunity for physicians and their significant others to interact with each other in a casual setting. Our physicians at St. Luke s are very dedicated to St. Luke s on all levels. The relationship between Administration and the Medical Staff is unparalleled. This teamwork has fostered our commitment to putting Patient First. Howard M. Stein, MD ProMedica Toledo Children s Hospital ProMedica Toledo Children s Hospital s pediatric sedation service continues to provide invaluable support to ensure successful and safe procedures and imaging studies for some of our youngest patients. Deep sedation services started in 2010, and although relatively new, the pediatric sedation team has a wealth of experience. Pediatrics nurses Jillian Golich and Corrie Nill have more than 13 years of pediatric nursing experience and more than five years of sedation experience. The dedicated scheduler, Debbie Welton, has been scheduling patients for more than two years. Sedation is provided by several pediatric intensivists: Dr. David Marquardt, Dr. Nicholas Rivera, Dr. Jama Sy and Dr. Susan Tourner, who have been employed by TCH for a combined total of more than 17 years. This past year, more than 300 inpatient and outpatient deep sedations were completed for MRIs, nuclear medicine scans, BAER, echocardiograms, bronchoscopies, VCUGs, lumbar punctures, and joint injections. Safety is the primary objective, and our skilled nurses judiciously select patients for trial without sedation, employing distraction techniques such as video goggles, bubble light toys and play therapy. Approximately 100 patients were able to complete studies and procedures without sedation medications. The moderate sedation service had 15 successful sedations and 10 successful studies utilizing distraction techniques. Thank you to our dedicated staff for constantly employing new techniques and best practices in an effort to ensure effective and safe procedures for our patients. Peter F. Klein ProMedica Toledo Hospital The new ProMedica Toledo Hospital Imaging Services department opened in early December Modern (continued on Page 20) 18 TOLEDOMEDICINE Winter 2015

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