New App Brighton trainer Anne Osovski creates fitness apps for adults, children
Rochester–Genesee Valley Healthcare Newspaper
July 2013 • Issue 95
Doctors for Dollars
Some local doctors and health organizations receive money from drug companies to recommend their products raising conflict of interest issues. One doctor has received almost $1 million since 2009.
Which is Healthier?
Subway or MacDonald’s: Where are you going to ﬁnd a healthier sandwich?
Dr. Hart & Dr. Hart Father and son tackling a growing problem: hearing loss
Grilling & Cancer Dana-Farber nutritionist offers tips to reduce cancer risk while grilling Page 13
URMC Student Bikes Across America
Practice is becoming popular but what is it?
New Unity dentist devoted to treating the homeless
Medical Residency The first months are the most stressful for most, according to residents Page 8 July 2013 •
Second-year medical student Cara Hall is taking part in the Big Ride Across America, a seven-week, 3,300-mile bicycle ride across America to raise money and awareness for the American Lung Association and its research. Page 4
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper
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HELP REDUCE ER CROWDING. FOR COLD AND FLU SYMPTOMS, SEE YOUR DOCTOR. A recent study found that each year there are hundreds of thousands of emergency room visits in upstate New York that could be avoided. Minor conditions like cold and ﬂu symptoms, congestion, back pain, earaches and sports injuries are best treated by your doctor. If your doctor isn’t available, consider visiting an urgent care facility. And do your part to relieve ER crowding.
Sponsored by the Monroe County Medical Society, Finger Lakes Health Systems Agency, and Excellus BlueCross BlueShield. A nonproﬁt independent licensee of the BlueCross BlueShield Association
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013
Cancer Side Effect: Higher Bankruptcy Rates Study: Cancer diagnosis puts people at greater risk for bankruptcy; situation is worse for young patients
eople diagnosed with cancer are more than two-and-a-half times more likely to declare bankruptcy than those without cancer, according to a new study from Fred Hutchinson Cancer Research Center. Researchers also found that younger cancer patients had two- to five-fold higher bankruptcy rates compared to older patients, and that overall bankruptcy filings increased as time passed following diagnosis. The study, led by corresponding author Scott Ramsey, an internist and health economist at Fred Hutch, was published in the journal Health Affairs. Ramsey and colleagues, including a chief judge for a U.S. Bankruptcy Court, undertook the research because the relationship between receiving a cancer diagnosis and bankruptcy is less well understood than the much-studied link between high medical expenses and likelihood of bankruptcy filing. “This study found strong evidence of a link between cancer diagnosis and increased risk of bankruptcy,” the authors wrote. “Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients. Our study thus raises important questions about the factors underlying the relationship between cancer and financial hardship.” Among the study’s key findings: • Between 1995 and 2009 there were 197,840 people in western Washington (the population in which the study is based) who were diagnosed with cancer and met the inclusion criteria for the study. Of those, 4,408 (2.2 percent) filed for bankruptcy protection after diagnosis. Of the matched controls who were not diagnosed with cancer,
2,291 (1.1 percent) filed for bankruptcy. • Compared to cancer patients who did not file for bankruptcy, those who did were more likely to be younger, female and nonwhite. • The proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, compared to 0.16 percent within one year for the control group. For bankruptcy filings within five years of diagnosis, the proportion of cancer patients was about 1.7 percent, compared to 0.7 percent for the control group. • The incidence rates for bankruptcy at one year after diagnosis, per 1,000 person-years, for the cancers with the highest overall incidence rates were as follows: thyroid, 9.3; lung, 9.1; uterine, 6.8; leukemia/lymphoma, 6.2; colorectal, 5.9; melanoma, 5.7; breast, 5.7; and prostate. 3.7. The incidence rate for all cancers combined was 6.1. The high bankruptcy incidence rate for those with thyroid cancer may be because thyroid cancer affects younger women more often than other cancers do according to the researchers. “Compared to men, younger women are more likely to live in single-income households and to have lower wages and lower rates of employment, and therefore less access to high-quality health insurance — leaving them more financially vulnerable,” the authors wrote.
Hospitals Profit When Patients Develop Bloodstream Infections
ohns Hopkins researchers report that hospitals may be reaping enormous income for patients whose hospital stays are complicated by preventable bloodstream infections contracted in their intensive care units. In a small, new study, reported online in the American Journal of Medical Quality, the researchers found that an ICU patient who develops an avoidable central line-associated bloodstream infection (CLABSI) costs nearly three times more to care for than a similar infection-free patient. Moreover, hospitals earn nearly nine times more for treating infected patients, who spend an average of 24 days in the hospital. The researchers also found that
private insurers, rather than Medicare and Medicaid, pay the most for patient stays complicated by CLABSIs — roughly $400,000 per hospital stay — suggesting that private insurers would gain the most financial benefit from working with hospitals to reduce infection rates. “We have known that hospitals often profit from complications, even ones of their own making,” says physician Peter J. Pronovost, senior vice president for patient safety for Johns Hopkins Medicine and one of the authors of the research. “What we did not know was by how much, and that private insurers are largely footing the bill.” July 2013 •
The distribution of In Good Health — Rochester-Genesee Valley’s Healthcare Newspaper has recently been audited by the Circulation Veriﬁcation Council.
Here are some of the results
100,000 Readers � Reliable Circulation. Nearly 100% of copies are picked up by readers vs. the national average of 75%.
� Readership. Each issue is read by 3.05 people vs. the national average of 1.8.
� High Retention. Nearly 50 percent of readers keep an issue of In Good Health for a month or more.
� Positive Results. The average for positive ad results in our publication is 51%. The national average for positive ad results is 74%, largely due to manufacturer’s coupons
� Ideal Readership. Over half of In Good Health readers are female. Over half of readers lives in households with incomes of over $75,000.
Health In Good
Mailing Address: P.O. Box 525 • Victor, NY 14564 Phone: 585-421-8109 Web: GVhealthnews.com Email: Editor@GVhealthnews.com
Rochester-Genesee Valley Healthcare Newspaper
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper
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by Jacquelyn M. Bell, CPA, MBA, CSA, PDMM®
ummer is a good time to take stock of your personal ﬁnancial situation. Are you ﬁnding it difﬁcult to keep up with paying your bills, tracking income and expenses, or ﬁnding that form you need to ﬁll out in the piles of paper on your desk? Perhaps you’d like a referral to a long-term care insurance agent or a new ﬁnancial advisor. Maybe you have a son or daughter who just graduated from college, is starting a new job, and needs help setting up a spending plan. A Daily Money Manager (DMM) can help with all of these activities. DMM’s look at your entire personal ﬁnancial picture and can refer you to other professionals when needed. Some DMM’s are certiﬁed in this ﬁeld and are known as Professional Daily Money Managers (PDMM’s). All DMM’s adhere to high ethical standards and commit to providing the best possible service to their clients. For more information, please visit www.aadmm.com or call Jacquelyn M. Bell CPA, PLLC, at (585) 229-4477. Page 4
intensive programs that will offer participants the chance to treat and cure stuttering. The intensive programs are threeweeks in duration and run Monday through Friday. Participants spend six-hours daily with experts and other people suffering from stuttering. At the end of each day, attendees return to their homes to complete assign-
ments with their families and friends. Each adolescent and adult attendee receives a manual, created by Susan M. Cochrane, owner and operator of Freedom to Speak, with the input from various experts. The program typically totals more than 90 hours of treatment. In addition to treatment, an initial evaluation is completed as well as a final summary and recommendations for future work. One month of therapy continues over Skype or in-person if so desired. The programs will take places July 8 through July 26 in Honeoye Lake in the Finger Lakes region; and from July 29 through Aug. 16 in Naples, Fla. Up to eight people will be accepted in each group For more information, call 585-3290616 or visit www.stuttertherapy.com.
URMC Student Bikes Across America To Benefit Lung Association By Maggie Fiala
econd-year medical student Cara Hall is spending her last free summer before medical rotations by taking the ride of a lifetime. Hall, a student at the University of Rochester’s School of Medicine and Dentistry, is taking part in the Big Ride Across America, a seven-week, 3,300 mile bicycle ride across America to raise money and awareness for the American Lung Association and its research. “I knew I wanted to spend my last free summer before studying for the boards doing something somewhat research related, but also doing something more for myself. I have never done an endurance challenge like this, and I knew I wanted to be outside a lot during summer,” Hall said. Hall, 23, first learned about the ride from a fellow U of R medical student, Benjamin Coconougher, who had participated in the ride in 2012. On that trip, he began a research project that studied the development of asthmalike symptoms in fellow cyclists. Hall will be continuing this research by periodically measuring riders’ lung function with spirometry during the course of the ride. Spirometry is a common test of lung function used by physicians in which test subjects breathe into a device called a spirometer. The test is used to assess conditions such as asthma and chronic obstructive pulmonary disease, or COPD. It’s a mission close to Hall. The West Hall Seneca native is riding in honor of her mother’s fiance’s father, Jim Nosbisch, who passed away from lung cancer in 2011. Jim and Hall only met once but she was struck by his kindness. “The thing that struck me is that I have only met him once and he would always send me letters, and his wife continues to send me articles about anything remotely related to medicine or biking. We are a very close knit
family,” she said. Hall battled with childhood asthma and can recall many nights when her mom stayed up with her while she was using her nebulizer, so that she could breathe well enough to sleep. “I never would have thought that I would go from those nights spent wheezing and coughing to now kicking asthma in the butt and riding cross country, breathing in the fresh air of 12 states,” Hall wrote on her blog page, action. lung.org/goto/ CaraHall The bikers started the journey in Seattle, Cara Hall poses after ﬁnishing the Rochester Tour de Cure, Wash., on June 17, and will arrive a fundraising cycling event to beneﬁt the American Diabetes in Washington Association. D.C. on Aug. 3. p.m., riding an average of 83 miles a Hall was most looking forward to the day, six days a week. They camp most first leg of the trip, which spans over nights with a few nights in college two weeks in the Northern Rockies. dorm rooms. Hall, who received her undergraduate Hall, an indoor spin instructor, degree in neuroscience from Pomona started spinning more than four years College in California, fell in the love ago, but recently started outdoor road with the West Coast and has been biking this year. missing it ever since. “They are both challenging in “It will be the most scenic and different ways. Outdoor [biking] offers challenging, and once we finish that its perks in that you can see where you leg, it will be all downhill from there,” are going and experience nature, but at she said. Each day, the group starts the same time there is a whole added biking at sunrise and ends around 4 element of wind and hills that you can’t simulate in the spin room,” Hall said. She sees the ride as an opportunity to accomplish several goals, while To support Cara Hall in the Big Ride helping to raise money and having fun. Across America, visit her personal “I’m excited to be on my bike and webpage at action.lung.org/goto/ just be riding for this cause,” she said. CaraHall.
Supporting Cara Hall
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013
Prediabetes: Do You Have It? How Do You Know? One in every four Americans over the age of 20 are walking around with prediabetes
iabetes is one of the most misunderstood medical conditions. “It’s not just about sugar. It’s about your heart,” says Nancy Ryan, a registered dietitian, board-certified in advanced diabetes management at Greenwich Hospital in Greenwich, Conn. Diabetes is the result of the body’s inability to properly use or make the hormone insulin, which is needed to convert sugar and starch from food into energy. Complications occur when sugar accumulates in the blood instead of going into the cells. This is referred to as high blood sugar or a high glucose level, and it can trigger higher than normal cholesterol and blood pressure, leading to increased risk of heart attack, stroke and vascular disease in the legs. According to statistics from the National Institutes of Health and Centers for Disease Control, about 79 million adult Americans (one in every four over the age of 20; and one of every two Americans over age 65) are walking around with prediabetes. This means they have blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. Although prediabetes has no symptoms it is not benign, says Ryan. People with prediabetes have an increased risk for heart attack, stroke and neuropathy, which creates tingling sensations or numbing caused by changes in nerve function. Ryan adds, ‘If ignored, about half of all people
with prediabetes will go on to develop diabetes that can lead to kidney failure, blindness and serious blood circulation problems.” One factor is genetics; another is where you store your body fat. People with belly fat are at higher risk than those who store fat in their hips and thighs. Fat that surrounds the body’s vital organs presents a greater danger to good health and can cause insulin resistance, rising blood glucose levels, high blood pressure and abnormal blood fats such as high LDL cholesterol, low HDL cholesterol, and high triglycerides. Prediabetes is often diagnosed through blood tests associated with a routine physical exam. “It’s a wakeup call. The condition can often be reversed through diet and exercise. Changing direction can have a profound positive impact on your life,” says Ryan, adding, “The key is to eat well, maintain a good weight, and move, move, move. It’s as simple as keeping a food diary. Write down everything you eat and drink, as well as your physical activity, which should add up to a minimum of 150 minutes every week.” “If you have prediabetes, losing as little as five to seven percent of your body weight, or about 10 pounds for most people, can reduce your risk of developing type 2 diabetes by 58 percent,” says Ryan. “Most people can do that. Whether you have prediabetes or type 2 diabetes, a 10-pound weight loss usually makes you feel better and your clothes fit better. Your blood work reflects your success.”
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Nearly 5 Million Asthmatics Worldwide Could Beneﬁt From Antifungal Therapy
n estimated 4,837,000 asthmatics with allergic bronchopulmonary aspergillosis (ABPA) could benefit substantially from antifungal treatment, say researchers from the University of Toronto and Manchester University. Their work, published in May in the journal Medical Mycology, has also re-estimated the total number of asthmatics worldwide — to reveal a staggering 193 million sufferers. Twentyfour million asthma sufferers live in the
United States, 20 million each in India and China, and seven million in the United Kingdom. Clinical studies have shown that oral antifungal drugs significantly improve symptoms and asthma control in asthmatics with ABPA. This is the first time that a global estimate of ABPA numbers has been made. To view the paper titled, Global Burden of Asthma in Adults and ABPA, visit www.ncbi.nlm.nih.gov/ pubmed/23210682.
SERVING MONROE, ONTARIO AND WAYNE COUNTIES in good A monthly newspaper published by
Health Rochester–GV Healthcare Newspaper
Local News, Inc. Distribution: 30,000 copies. To request home delivery ($15 per year), call 585-421-8109.
In Good Health is published 12 times a year by Local News, Inc. © 2013 by Local News, Inc. All rights reserved. 106 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone: 585-421-8109 • Email: Editor@GVhealthnews.com Editor & Publisher: Wagner Dotto Associate Editor: Lou Sorendo Writers and Contributing Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Ernst Lamothe Jr., Maggie Fiala, Jason Schultz Advertising: Jennifer Wise, Donna Kimbrell Layout & Design: Chris Crocker Ofﬁcer Manager: Laura Beckwith No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.
July 2013 •
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CALL 385-0877 East Rochester, NY IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper
Excellus BCBS Members Benefit from High Portion of Premiums Spent on Medical Care Out of $4.1 billion in premium revenues collected, the health plan paid out $3.8 billion in medical benefits for its customers
xcellus BlueCross BlueShield exceeded federal and state standards by $330 million in the amount it spent on medical benefits on behalf of its membership in 2012, officials reported recently. To cap profits and administrative costs of health plans in order to maximize medical benefits to consumers, the federal Patient Protection and Affordable Care Act and state regulations set certain medical benefit spending levels for insurers. For the second consecutive year of the new rules and reporting, Excellus BlueCross BlueShield exceeded the standards. “Our mission is to provide competitive, affordable access to quality health care,” said Christopher Booth, chief executive officer for the health plan. “What this means is that our members collectively got more hospital and physician services, prescriptions and other medical benefits throughout the year than what federal and state government standards require.” Some health insurers that didn’t meet the standards will be required to pay refunds. State and federal standards, as they apply to New York commercial insurance customers, set the minimum level of benefits to be 82 percent of premium revenues in the individual direct pay market along with small groups and 85 percent for large groups. Excellus BCBS reports that it spent 94.9 percent of premium revenues on medical benefits for its individual direct pay membership, 92.5 percent for small groups and 92.1 percent for large groups. Out of $4.1 billion in premium revenues collected, the health plan paid out $3.8 billion in medical benefits for its customers, about $330 million more than federal and state mandates require. Last year, federal officials reported that hundreds of millions of dollars in refunds were paid by other health plans throughout the country, even in states where the minimum standards are lower than those in New York. Page 6
By Lou Sorendo
Dr. Chaya Carl New dentist at Unity devoted to working with the homeless population in Rochester Q.: Why did you choose dentistry as a profession and what motivated you to work for Unity Health System’s mobile medical unit? A.: From the time I was little, I always wanted to go into something that was health related. My father was a physician, and I enjoyed biology. As I approached college age, I started to intern at dental offices and found that I liked it. The reason I joined Unity and its mobile medical unit is that I had done a job last year with a similar population of people. I felt it was more than just performing dentistry. I was helping people who really need it. When I moved to Rochester recently, I was looking for a job such as that. We see homeless people who are missing teeth and having pain, so there is more of a medical perspective to it. These are people who need it very much because they are underserved in general. Q.: How many homeless people do you see per day? Do you seek them out for treatment or vice versa? A.: We see anywhere from five to 15. It depends on the shelters that we are at and how much need there is. We also have a lengthy intake process that other dental offices don’t have because of government funding. We need to know a lot about their social and financial history and things of that sort. It’s not just one of two papers, but rather a whole packet of materials. We work off a mobile unit and we drive according to a schedule given out every month. We give schedules to different shelters so they know when we are going to be there. They compile a list of whoever needs treatment within their particular location so patients can be ready for a certain day. Some patients require continuous treatment, whether it involves denture work, more fillings and additional cleaning. We will tell them to come meet us the following week at a different shelter. We only go to particular shelters twice a month because there are so many in need.
they haven’t seen a dentist in a long time or because of lack of finances. Some of them also have a history of doing drugs at some point and show the effects of that. Others are on the street and have not sought shelter and are unable to access healthy food. In general, it’s poor. However, we do get people who just need cleaning. But for the most part, they need a lot of work. We do see people who need their teeth pulled because they are to that level where there is not much more we can do with them. We do a lot of denture work, tend of cavities and also see severe cases of periodontal disease that requires in-depth cleaning. Sometimes it is so bad we need to take all their teeth out and give them dentures. Q.: Does administering dental health also uncover other physical problems homeless people are suffering from? A.: Definitely. During our intakes, we take patients’ blood pressure. I would say on average, we send a per-
Q.: How would you rate their overall dental health? What are some of the more common maladies they present? A.: In general, it’s poor. It’s mostly because
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013
son to the hospital by ambulance once a month because their blood pressure is so high they can have a stroke or heart attack at any minute. Q.: If homeless patients require oral surgery to correct problems, how does that happen without health coverage? A.: Our mission is to treat all patients regardless of whether they have insurance or not. We will refer them if something more complicated arises, such as major jaw surgery or cancer biopsies, things of that sort that we find orally. Q.: What are the foremost challenges involved in administering dental health to the homeless? A.: It can be frustrating when patients don’t come back for treatment when they definitely need it. If it’s not bothering them, they don’t come back. When it bothers them, it’s already too late. However, there are definitely a lot of motivated patients who don’t want their teeth to get worse or want to get dentures. They are motivated in that sense and we continue to see them. For a lot of people, their teeth might not be bothering them or they have a fear of the dentist and might not want to continue with the needed treatment. Q.: What is the most gratifying aspect of your job? A.: I feel like I am really able to help people who need it. These are people who have a lot of problems dentally. When you pull out a tooth that really hurts them and they are feeling better after, they thank you and that means a lot. I see that on a routine basis. Q.: What skills sets do you feel are necessary to be an effective and excellent dentist? A.: I think it actually doesn’t have much to do with the dentistry you perform. It has to do with how much compassion and social skills you have toward patients. You have to be understanding when performing dentistry, understanding the patient’s needs and what they are feeling at the time. In addition, no one likes going to the dentist, especially knowing that at some point something is going to hurt. However, a big component of it is administering that shot without them feeling it and making procedures as least painful as possible.
Lifelines: Birth date: November 1983 Birthplace: New York City Current resident: Rochester Education: Doctor of Dental Surgery from New York University College of Dentistry (2010); residency, New York Hospital of Queens Afﬁliations: American Dental Association; New York Dental Association Personal: Married with two children Hobbies: Taking care of her children and doing fun things with them; cooking; swimming
Strong Memorial Hospital’s facade.
Strong and Highland fare better than other local hospitals in new survey and get rewarded with more money from Medicare By Ernst Lamothe Jr.
he new Medicare reimbursement system can be summed up in one word: accountability. The federal government is launching several new initiatives to make sure hospitals provide more quality service and earn their public money instead of simply being given the funds with few strings attached. They also want to reduce the flow of patients being readmitted to the hospital soon after their original visit. One in five elderly people return back to the hospital within 30 days costing $26 billion annually, according to the U.S. Department of Health and Human Services. And federal officials say two-thirds of that figure would be slashed if patients received proper treatment in the first place. “Health care reform is all about making health care work better for patients and families,” said physician Brad Berk, University of Rochester Medical Center CEO. Medicare began reducing payments in October to hospitals because too many patients were readmitted within a month. In all, $964 million was reduced in Medicare payment to hospitals nationwide, according to analysis of records released by the Centers for Medicare & Medicaid Services. Local hospitals that saw reductions include Unity of Rochester, Rochester General Hospital, Lakeside Healthcare in Brockport and F.F. Thompson Hospital in Canandaigua. On the other side, Strong and Highland hospitals fared well and were the only two hospitals in the
Rochester region that received more money back because of their dependable services. The Centers for Medicare & Medicaid Services tracks hospitals on three conditions; heart failure, heart attack and pneumonia. Any time a patient with one of these conditions is readmitted to any hospital within 30 days of being discharged, the original hospital is at fault. The government withholds 1 percent of each hospital’s Medicare revenues into a pool. A patient satisfaction survey — along with other quality measures — determines how much each hospital can earn back or lose. The hospital surveys consist of 27 questions about nurse and doctor communication with patients, hospital staff responsiveness, pain management along with the cleanliness and quietness of the hospital. The survey polled adult patients who had been discharged between 48 hours to six weeks after their hospital visits. Hospitals were judged on their timely and effective care, which accounted for 70 percent of the score. That included percentage of heart attack patients given medication to avert blood clots within the 30 minutes of arrival, whether patients received antibiotics when necessary and the quality of information given to patients when they were discharged. The measures also judged the patients experience and whether doctors and nurses communicated with them effectively, which accounted for 30 percent of the score. Hospitals could
1,427 Hospitals Across the Country See Reimbursement Reduced In all, Medicare is reducing payments to 1,427 hospitals, according to the Centers for Medicare & Medicaid Services. The maximum amount any hospital could lose was 1 percent of its regular Medicare payments. To view every hospital’s bonuses and penalties when related to Medicare go on www. kaiserhealthnews.org/Stories/2012/ December/21/value-based-purchasing-chart.aspx lose or gain up to 1 percent of their regular Medicare reimbursement in the first year. Some of the survey aspects can be viewed as slightly flawed because the majority of questions ask if the patient was “always” happy with a certain service instead of asking more nuanced questions. But many appreciate the survey. “We think that tying how much hospitals get paid to how well we deliver quality care and satisfy patients makes good sense, and it’s completely consistent with our emphasis on patient and family-centered care.” said Berk.
July 2013 •
Strong Memorial Hospital, which
is under the University of Rochester Medical Center umbrella, fared well in the survey and the Medicare readmission evaluations. In total Strong received $212 million from Medicare in the fiscal year ending June 2012, $6 million more than the previous fiscal year. The increase was due to many factors, including Strong Memorial’s solid readmission patient surveys. About $120 million in any year comes directly from the Centers for Medicare & Medicaid Services, a figure that is at risk every year if hospitals don’t meet readmission goals. The pressure for hospitals to improve their quality will increase, and by October 2014, up to 3 percent of that figure or $3.6 million will be at risk as part of the Patient Protection and Affordable Care Act. Strong and Highland hospitals received high marks in the patient survey for effective heart attack care. Upon discharge, heart attack patients should be given aspirin and a possibly a prescription for statins, which are a class of medicines that are frequently used to lower blood cholesterol levels. That was done to near perfection by both hospitals. In addition, Strong and Highland scored almost 100 percent in always giving heart failure patients instructions during discharge. When it came to timely surgical care, both hospitals scored 98 percent or higher in outpatients receiving antibiotics at the right time and making sure preventive antibiotics were stopped within 24 hours after surgery. More than 75 percent of patients said they would recommend the hospitals to others. “The survey provides a valuable tool for hospitals to measure how well we are doing in meeting patients’ needs and benchmarks that against our peers, so we welcome the survey,” said Berk. Even before the survey became a factor in how much hospitals receive, the University of Rochester Medical Center launched an intensive patient care initiative. The hospitals have addressed relaxing visitor hours and creating a quieter, more welcoming environment. Berk said studies show involving patients and families in the process reduces the chance of medical errors and makes patients feel more invested in their recovery. “I certainly know this to be true from my own personal experiences as a patient,” said Berk. “We’re not just doing this to score better grades. We know that this is the pathway to better medical care.” Rochester General Hospital also received high marks for pneumonia patients whose initial emergency room blood culture was performed prior to first hospital dose of antibiotics. More than 79 percent of the surveyed patients said doctors and nurses did a solid job communicating with them and 76 percent said they would recommend the hospital. There are several areas where the hospital can improve. Almost 40 percent reported that the staff didn’t always explain the medication they were given. And only 64 percent reported always receiving help as soon as they wanted. “Rochester General Health System always looks for opportunities to improve the patient experience by fostering a culture of safety and excellence,” said Marty Aarons, public relations officer for the health system. In 2009, RGH formed the Institute for Patient Safety and Clinical Excellence, an internal group that took the lead in developing programs and processes to improve quality and safety.
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper
Medical Residency The first months of medical residency are the most stressful, residents say
By Jason Schultz
n 2012, approximately 25,000 firstyear residents were matched to a residency program in the United States, out of almost 40,000 applicants. The University of Rochester Medical Center at Strong hospital each year welcomes dozens of first-years, or interns, to a variety of medical disciplines. A recent visit to the hospital shed light on the duties and challenges faced by newly-minted M.D.s. One of the newest members of the Strong medical resident staff is Lauren Loss, an intern in the neurology program. Loss says a usual day for her begins around 5:45 a.m., when she signs out patients from the overnight shift interns, ensuring the care of her patients is transferred properly. Then it is off to the lab to check on her patient’s medical tests from the day before. After checking the charts and taking notes, Loss makes her rounds, spending time with up to eight patients to whom she is assigned. Around 9 a.m., Loss and the other residents in her group meet with Don Gullickson III, the attending physician overseeing their team. Along with Gullickson, the group does its rounds in the emergency room, meeting with several patients to give care and offer a teaching opportunity to residents. During rounds, one resident reviews the patient’s chart, along with any new information and changes in condition. Gullickson next asks questions of the residents to help them determine the best course of action in caring for each patient. One patient visited that morning was Margaret Murphy, who was recovering from a serious heart infection. The residents were checking up on her condition and tending to some sideeffects following her health problem. Murphy said she was feeling much better, though she complained of some swelling in her legs. “You guys are all awesome,” Murphy said. “You are all doing a fantastic
job with your care. The teamwork is amazing here. You are the reason I am back to where I am today.” This hands-on interaction is vital, Loss said, to developing interpersonal skills. “Having a good bedside manner is very important; if you have a bad rapport with patients, they won’t want to work with you in managing their healthcare issues,” she said. “People want to be proactive with their own care, as a physician you have to nurture that desire.” Hands-on training also fosters confidence for interns, said third-year resident Amy Becker, who manages her younger cohorts. Becker explains the first few months of residency are the most stressful for interns. “It takes three or four months to get your footing,” Becker says, adding that as she advanced in her residency,
Attending hysician Don Gullickson III, left, and resident Amy Becker. the article to personal work experithe workload and demands of the job ences, and discussed common probbecame more manageable. lems such as communication with the Finding confidence, Loss added, patient, family and outside healthcare was an important step in becoming an providers, proper education on posteffective resident. discharge treatment, and simple things, “The biggest challenge is learning such as ensuring a patient’s prescripto feel confident making decisions,” tion is filled out before they leave the she said. “After years of learning and hospital. reading about medicine, it is a big Marc Berliant, Strong’s chief of change when you actually start the general medicine and director of the practice of medicine and caring for resident-faculty practice at Strong, was patients.” present at this meeting to direct the Becker said interns are responsible discussion. Berliant said his role is to for providing primary care to patients oversee the education ambulatory (outand reviewing documentation on their condition. In the second and third year, patient) care to Strong’s residents, who follow a panel of patients over a period residents take on supervisory roles for of time learn to how outpatient care new interns, and manage multiple patients in the team’s care. Depending on differs from their morning rounds. “The biggest difference in inpatient their specialty, residents either continue vs. outpatient care is that in the hospiwith up to four years in a residency tal, you are treating patients with acute program or begin a fellowship. Becker conditions very briefly, with the goal said she will begin her geriatrics felof getting them out of the hospital and lowship next year. back home,” Berliant said. “With outAfter their morning rounds, patient care, the goal is on longitudinal another group of residents met with care, which requires much more folsenior physicians to address different low-up, coordination with healthcare aspects of providing care. This day’s providers and communication with the session involved reviewing an article Third-year resident Nick Paivanas speaks on the problems patients face once they patients and their families.” To foster teamwork, Berliant elicduring a review of a medical article. “That are discharged, and developing best practices at Strong to improve post-dis- ited input from nurses and pharmacists ﬁrst year is terrifying; people are calling present at the meeting to give their percharge care. you ‘doctor,’ and looking to you to know spective on improving post-discharge Residents related information from what to do,” he said. treatment. Sitting in on this discussion was Nicholas Paivanas, a third-year resident and Georgetown med school graduate. Originally from Fairfax, Va., Paivanas was drawn to Strong for its excellent cardiology program, and the opportunity to be with his wife, who is in the obstetrics and gynecology program. Paivanas said he is excited to complete his third year in the program, as he will begin the next three years of his cardiology concentration, and also assume the duties of chief resident. With three years under his belt, Paivanas was able to give perspective on how he has grown as a doctor. “That first year is terrifying; people are calling you ‘doctor,’ and looking to you to know what to do,” he said. “But by the end of that year, you start to get comfortable and gain confidence. In the second year, you start to supervise interns, and I liked that transition, because it gives you a better overview of how the hospital is run and the third year gives you time to focus on electives and branch out to private clinics Medical student residents, from left, Lauren Loss, Jaclyn Burch, Laura Mekher, Sabrina MacDuff and Amy Becker prepare for morning that focus on your specialty.” rounds at Strong Memorial Hospital
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013
Though the mix of excitement and anxiety has always been a part of an intern’s initiation into life as a physician, Berliant said many things have changed since he went through Strong’s resident program himself in the late ‘70s. “The biggest change in caring for patients is that we now approach patients more holistically, in both in and outpatient care,” Berliant explained. “There is more emphasis on team-based care, and working with the patient, family and outside care providers to provide longitudinal care both during a hospital stay and after discharge.” Another change Berliant has seen over the years is the notoriously grueling work schedule for residents A typical day for Strong’s residents. usually lasts 10–12 hours, a result of the 80 hours-per-week duty restrictions instituted in 2003, though those in the ICU still work 24-hours shifts to better manage patient care. The duty-hour restrictions make life better for residents, but the number of patients they treat and the hours they gain experience are lessened, and due to the increase in hand-offs, there is very little evidence these restrictions have improved patient safety, Berliant said. That a greater emphasis be placed on teamwork, Berliant concluded, was a natural outgrowth of more patient care transfers. A strong focus on teamwork at Strong has both improved patient care and been a boon to the resident’s training. “I was very impressed with the teaching programs at Strong,” Loss said of her experience so far. “At every level of your education, you feel like you have access to expert’s opinions; it is a true privilege to have that ability.” Becker stated Strong’s residency program was her top choice after graduating from SUNY Buffalo’s medical school. “I was drawn to the tight-knit residency feel vs. the bigger cities I was applying to.” Becker added Strong’s familyoriented approach to patient care, which recognizes the importance of the patient’s relatives in managing health problems, helps build rapport and improve care once patients are discharged from the hospital. That feeling of family extends to the support system around the residents themselves, ensuring teamwork in dealing with patient care. “One worry I had when I left medical school was that I would be alone if something serious happened to one of my patients, and I wouldn’t know what to do,” Becker said. “But there has always been someone there to assist me and work as a team on a complicated medical issue.” Berliant said Strong is transitioning to a block model for residency scheduling, in which blocks of time are set aside to work on outpatient and inpatient care alternately. He said this allows for more immersion, opportunities for teamwork and more ambulatory training, which makes up 70 percent of a resident’s preparation. Berliant added that despite years of working with residents, he still gets inspired by being their passion and enthusiasm. “The exciting thing about teaching residents is that they are bright and excited about taking care of patients,” he concluded. “They have pure motives and it is refreshing to be around their energy.”
Brighton Trainer Creates Fitness App By: Maggie Fiala
oes your workout routine need a shake up? Brighton personal fitness trainer Anne Osovski has an app for that. Osovski, a certified fitness instructor and co-owner of F.I.T. Gym in East Rochester, created the mobile applications, “Workout in a Bag” and “Workout in a Bag for Kids,” to create fun and challenging workouts for adults and kids. You set your time, fitness level, and then “shake the bag” to randomly select an exercise. Moving photos and audio demonstrate each exercise. You can track your calories burned, store your favorite workout bags and link with your iTunes music library. The apps are available on iTunes for $2.99 each. “The most exciting part has been how many people I can help impact through social media and this amazing technology,” said Osovski. She came up with the concept six years ago. She wrote a hand full of exercises and tossed them in a brown paper bag. During class, she asked her clients to shake the bag and draw out the next exercise. Osovski threw in some relaxing exercises too — smile for 50 seconds or pay a compliment to someone else in the group. The response was great, she said. “I was trying to make it engaging and fun,” she said. Osovski replicated the concept for her personal clients whom she only saw a few days a week. It became a big hit at
Anne Osovski, a certiﬁed ﬁtness instructor in East Rochester, recently created the mobile applications, “Workout in a Bag” and “Workout in a Bag for Kids,” to create fun and challenging workouts for adults and kids. the gym, Osovski said. “I thought to myself, ‘Gosh how can I package “Workout in a Bag” so other people can benefit from it?” she said. At first she wanted to create an off-theshelf product, but her husband suggested she create an app instead. “I said to him ‘I don’t even know how to do something like that’,” Osovski said. She turned to Facebook to ask for help. She connected with a high school friend, Sam Carini, who owns Net360 Technologies in Fairport, to develop her app. In 2012, she launched “Workout in a Bag” for adults and in April released the app for kids. ”I had to make it even more engaging for the kids,” she said. “Hopefully, it will be an entertaining game, so they want to keep doing it.” Osovski developed it alongside her daughters Madeline, 11, and Samantha, 7, who urged their mom to make the app more of a game; users can win gold coins when they complete a bag, unlock special badges and new workout buddies the more they exercise. Her daughters helped pick out the exercise names and drew the workout buddies. For every download in July and August, Osovski is donating 15 percent to the Rochester chapter of the Juvenile Diabetes Research Foundation. Osovski’s hopes to create more apps that target different groups, including brides and new moms. Osovski. eated by Anne She also hosts “Workout in a Bag” cr ps ap o ct tw le se of s” is one randomly id to K r g” fo challenges on her Facebook page, ba ag e B th a “shake “Workout in level, and then s www.facebook.com/WorkoutInABag. es tn ﬁ e, tim You set your an exercise. July 2013 •
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper
Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
How Do You Want to Feel Six Months From Now?
n last month’s column, I talked about “silver linings” and how life-changing it can be to adopt a positive attitude, anchored in gratitude. I agree with Norman Vincent Peale who said, “Change your thoughts and you change your world.” But I know, too, that it takes more than a sunny attitude to create the life you want. It also takes action. In my “Live Alone and Thrive” workshops, I lead the group through an empowering three-step exercise that has helped many participants get “unstuck” and on the road to a happier, more contented life. The first step is to put it all out there. I ask everyone to share their worst fears, their self-doubts, and the negative inner-talk that gets in the way of their feeling better and finding contentment. It sounds like this: • I fear being so lonely • I fear I’ve lost my confidence for good • I fear no one cares and that I won’t be missed • I’ll die alone, penniless, and miserable • I’ll forever be eating alone • I fear the holidays • I feel helpless when it comes to home repairs • I may never find love again or feel special, as if I’m “Number One”
• I fear for my safety and feel vulnerable alone • I don’t have the know how to manage my finances • I fear losing all my energy and motivation • I worry that no one will be here to care for me if I get sick • I dread a “quiet house” • I may never enjoy touch and affection again, no one to kiss me goodnight • I fear making big decisions all alone • I’ll become stagnant and not take risks • I fear I’ll never feel joy again I’m always struck by the depth of the anguish. All these negative thoughts — while very real — are distressing. And depressing. This is when I remind the group that healthy change and personal growth is next to impossible when one is immersed in negative thinking. And so, we change direction. I next ask the group, “How would you like to feel six months or a year from now?” The response is heartening: • I want to feel at peace, calm, and
settled • More confident and courageous • More “me” — in touch with myself and who I really am • Able to accept my circumstances • I want to feel more forgiving — of others and of myself • Proud of my behavior and to be a role model for my children • Safe and willing to take risks, maybe travel on my own • Willing and able to help others — I will have “graduated” from self-pity • I want to feel competent, able to make decisions big and small • Happier and able to enjoy things • More in control and secure financially • Adventuresome and open to life in general • Healed and hopeful about the future • Strong enough to reach out and invite people into my life, perhaps even date • More trusting of others and in my own abilities and instincts • Joyful, light, and free • More content!
Now that’s more like it. The energy in the room has changed (for the good!) at this point, and we’re on a hopeful, more optimistic path. In the third and final step of this exercise, I ask participants to identify an action step or steps they can take that will help them realize their six-month goal. Each participant is unique and each outlines an action step specific to her particular goal or goals. Some share their next steps with the group, others choose not to. But all are committed to taking an action step that will lead toward feeling better in the future. The good news? This exercise really works. I’ve been moved and inspired by the success stories I’ve heard from participants who have embraced living alone and taken deliberate steps to improve their life circumstances and overall well-being. If what I’ve shared today resonates with you, I encourage you to give this exercise a try and see what comes of it. I’d love to hear how it goes, and hope you’ll share your experience with me at the email address below. You can also contact me at this email address for a copy of my “Next Step — Goals Worksheet” and “Goal Setting Guidelines.” Chances are, you’ve heard the expression, “Actions speak louder than words.” Well, they also speak louder than loneliness, helplessness, and hopelessness. Take some action today and I’m confident you’ll feel better six months from now. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon. For information about her workshops or to invite Gwenn to speak, call 585-624-7887 or email email@example.com.
What to Consider Before Joining a Clinical Trial
ach year, hundreds of thousands of Americans participate in clinical trials in hopes of gaining access to the latest, and possibly greatest, but-not-yet-on-the-market treatments for all types of illnesses. But you need to be aware that clinical trials can vary greatly in what they’re designed to do, so be careful to choose one that can actually benefit you. Here’s what you should know along with some tips for locating one.
A clinical trial is the scientific term for a test or research study of a drug, device or medical procedure using people. These trials — sponsored by drug
companies, doctors, hospitals, federal government and private companies — are conducted to learn whether a new treatment is safe and if it works. But keep in mind that these new treatments are also unproven, so there may be risks too. Also be aware that all clinical trials have certain eligibility criteria (age, gender, health status, etc.) that you must meet in order to be accepted. And before taking part in a trial, you will be asked to sign an informed consent agreement. You can also leave a study at any time.
Things to Know
Before deciding to participate in a
trial, you need to first discuss it with your doctor. Then, schedule an appointment with the study’s medical team and ask lots of questions. Here are some to get you started. • What’s the purpose of the study and can it improve your condition? You may be surprised to know that many drug or procedural trials are not designed to find a cure or improve a patient’s health, but only to provide scientific data. • What are the risks? Some treatments can have side effects that are unpleasant, serious and even lifethreatening. • What kinds of tests and treatments does the study involve, and how often and where they are performed? • Is the experimental treatment in the study being compared with a standard treatment or a placebo? Keep in mind that if you get the placebo, you’ll be getting no treatment at all. • Who’s paying for the study? Will you have any costs, and if so, will your insurance plan or Medicare cover the rest? Sponsors of trials generally pay most of the costs, but not always. • What if something goes wrong during or after the trial and you needs extra medical care? Who pays? • If the treatment works, can you keep using it after the study?
Find a Trial
Every year, there are more than Page 10
IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013
See clinical research conducted in the Rochester area on pages 2 and 24 100,000 clinical trials conducted in the U.S. You can find them at conditionfocused organizations like the American Cancer Society or the Alzheimer’s Association, or by asking your doctor who may be monitoring trials in his or her specialty. Or, use the National Institutes of Heath’s website at clinicaltrials.gov. This site contains a comprehensive database of federally and privately supported clinical studies in the U.S. and abroad on a wide range of diseases and conditions, including information about each trial’s purpose, who may participate, locations, and phone numbers for more details. If, however, you don’t have Internet access or could use some help finding the right trial, use the Center for Information and Study on Clinical Research Participation (ciscrp.org). This is a nonprofit organization that will take your wife’s information over the phone and do a thorough clinical trials search for you, and mail or email you the results in a few days. Call 877-6334376 for assistance. By Jim Miller The Savvy Senior
Subway Not Much Healthier Than McDonald’s S
ubway may promote itself as the “healthy” fast food restaurant, but it might not be a much healthier alternative than McDonald’s for adolescents, according to new UCLA research. In a study published May 6 in the “Journal of Adolescent Health,” the researchers found that adolescents who purchased Subway meals consumed nearly as many calories as they did at McDonald’s. Meals from both restaurants are likely to contribute toward overeating and obesity, according to the researchers. “Every day, millions of people eat at McDonald’s and Subway, the two largest fast food chains in the world,” said physician Lenard Lesser, who led the research while a Robert Wood Johnson Foundation Clinical scholar in the department of family medicine at the David Geffen School of Medicine at UCLA. “With childhood obesity at record levels, we need to know the health impact of kids’ choices at restaurants.” The researchers recruited 97 adolescents aged 12 to 21 to purchase meals at McDonald’s and Subway restaurants at a shopping mall in Carson, Calif. The participants went to each restaurant on different weekdays between 3 p.m. and 5 p.m., and paid for the meals with their own money.
Researchers used the participants’ cash register receipts to record what each customer ate and estimated calorie counts from information on the chains’ websites. The researchers found that the participants bought meals containing an average of 1,038 calories at McDonald’s and an average of 955 calories at Subway. “We found that there was no statistically significant difference between the two restaurants, and that participants ate too many calories at both,” said Lesser, who is now a researcher at the Palo Alto Medical Foundation Research Institute. The Institute of Medicine recommends that school lunches not exceed 850 calories. An adolescent should consume an average of about 2,400 calories in a day. Among the researchers’ other findings: • The sandwiches purchased by participants contained an average of
784 calories at Subway vs. 572 calories at McDonald’s. • Participants purchased sugary drinks averaging 61 calories at Subway, and 151 calories at McDonald’s. • Customers in the study purchased side items such as French fries and potato chips that added an average of 35 calories at Subway compared with 201 calories at McDonald’s. • Participants consumed 102 grams of carbohydrates at Subway; 128 grams at McDonald’s. • The meals contained an average of 36 grams of sugar at Subway; 54 grams at McDonald’s. • Meals contained an average of 41 grams of protein at subway; 32 grams at McDonald’s. • Sodium intake averaged 2,149
mg at Subway; 1,829 mg at McDonald’s. “The nutrient profile at Subway was slightly healthier, but the food still contained three times the amount of salt that the Institute of Medicine recommends,” Lesser said. Lesser recommends that McDonald’s customers eliminate sugary drinks and french fries from their meals. “And if you go to Subway, opt for smaller subs, and ask for less meat and double the amount of veggies,” he said.