MD-UPDATE ISSUE #98

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #98 WWW.MD-UPDATE.COM

BUILDING A BETTER

CARDIAC SURGERY PROGRAM

Baptist Cardiac Surgery is taking a genuine team approach to less invasive cardiac surgery while improving options and outcomes for patients SPECIAL SECTIONS

VOLUME 7•#2•MARCH 2016

CARDIOLOGY/CARDIAC SURGERY PULMONOLOGY/SLEEP MEDICINE

ALSO IN THIS ISSUE  FLOYD MEMORIAL CELEBRATES

10 YEARS OF CARDIAC SURGERY  NEW HELIPAD AND EP LAB EXPANSION IMPROVE ACCESS IN LOUISVILLE  FIGHTING PULMONARY HYPERTENSION  COMPREHENSIVE SLEEP MEDICINE TREATMENT

“It’s about my heart.”

Ronald C. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) PATIENT

When patients are not strong enough for traditional open-heart surgery, Transcatheter Aortic Valve Replacement (TAVR) offers new hope. During this procedure, cardiologists and cardiovascular surgeons work together to implant a new heart valve through a small incision in the groin. Recovery time is greatly reduced, giving patients an improved quality of life. The TAVR procedure is available at Jewish Hospital and Saint Joseph Hospital. When it comes to advanced care for your heart, KentuckyOne Health is the clear choice.

Visit KentuckyOneHealth.org/Heart to learn more.

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COVERING ALL THE BASES

ALSO IN THIS ISSUE

 ONE STOP SHOP FOR SPORTS MEDICINE IN NEW ALBANY  PROBLEM SOLVING FOR MOTIVATED, HEALTHY PATIENTS  FIXING ORTHOPEDIC PROBLEMS IN OWENSBORO  THE PROS OF PROSTATE SCREENING  SEX, POWER, & BOUNDARIES FOR MEN

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LAND OF OPPORTUNITY

Special SectioN

PAIN MEDICINE AND NEUROLOGY

MHA Kendra J. Grubb, MD, on, cardiovascular surge a joins U of L to build

PATIENT-RESPONS IVENESS, INNOVATION, AND COLLABORATION

William O. Witt, MD, uses three pillar s to enhance the patien t experience at Cardinal Hill Pain Institute

ALSO IN THIS ISSUE

RO’S  REBUILDING OWENSBO PROGRAM CARDIAC SURGERY  NEW EP SERVICES IN IN NEW ALBANY, SION  MANAGING HYPERTEN EVOLVES  A HEART TEAM GY  PREVENTIVE CARDIOLO G FOR  CT SCREENIN

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 FAMILY APPROAC H TO PAIN MANAGEM ENT  INJECTIONS FOR  ENDOSCOPIC MIGRAINES ENDONASAL SURGERY FOR SKULL-BASE TUMORS  BUILDING AN INTERVENTIONAL NEUROLOGY PROGRAM  NEUROLOGIST FILLS SERVICES GAP IN GEORGETO WN

Issue #99, March/April  INTERNAL SYSTEMS Transplant, Allergy & Immunology, Rheumatology, Gastroenterology, Endocrinology, Nephrology and Cardiovascular Issue #100, May  GENDER-SPECIFIC MEDICINE OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #101, June/July  MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine Issue #102, August/September  SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine Issue #103, October  CANCER CARE Oncology, Hematology, Radiology Issue #104, November  IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, ENT Pain Medicine, Mental Health Issue #105 – Dec/Jan 2016 PRIMARY CARE AND PEDIATRICS Primary Care, Internal Medicine, Family Medicine, Pediatrics

SURGERY IN THE DIGIT AL AGE  THE IMPA CT OF PLAS TIC SURG ERY DAY GAST ROENTERO LOGY  ENDO SCOPIC GI TECHNIQU  THE CHAL ES LENGES OF APLA STIC ANEM  THE DRAW IA OF VASC ULAR SURG ERY

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Opportunities*

*EDITORIAL TOPICS ARE SUBJECT TO CHANGE.

TO PARTICIPATE CONTACT: Gil Dunn, Publisher • gdunn@md-update.com • (859) 309-0720 Jennifer S. Newton, Editor-in-Chief • jnewton@md-update.com • (502) 541-2666 SEND PRESS RELEASES TO news@md-update.com

ISSUE#98 | 1

CONTENTS

ISSUE #98

COVER STORY 3 PUBLISHER’S LETTER 4 HEADLINES 7 FINANCE 8 ACCOUNTING 9 COVER STORY 13 SPECIAL SECTION: CARDIOLOGY/ CARDIAC SURGERY 18 SPECIAL SECTION:

BUILDING A BETTER

CARDIAC SURGERY PROGRAM

Baptist Cardiac Surgery is taking a genuine team approach to less invasive cardiac surgery while improving options and outcomes for patients

BY JENNIFER S. NEWTON PHOTOS BY ROBERT DENSMORE AND BRIAN BOHANNON ON PAGE 9

PULMONOLOGY/ SLEEP MEDICINE 22 COMPLEMENTARY CARE 25 NEWS 29 EVENTS 32 ARTS

SPECIAL SECTIONS CARDIOLOGY/CARDIAC SURGERY

13 10 YEARS AND BEATING STRONG: FLOYD MEMORIAL

2 MD-UPDATE

15 CARDIAC LANDING ZONE: JEWISH HOSPITAL

PULMONOLOGY/SLEEP MEDICINE

18 A FIGHTING CHANCE: KENTUCKYONE HEALTH LEXINGTON

20 THE SCIENCE OF SLEEP MEDICINE: LEXINGTON CLINIC

LETTER FROM THE PUBLISHER

MD-UPDATE MD-Update.com Volume 7, Number 2 ISSUE #98 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGNER

James Shambhu art@md-update.com

CONTRIBUTORS: Jan Anderson Mary Branham Scott Neal Andrew Shewmaker Mac Stone Sarah Wilder

CONTACT US:

ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

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Breathe Right, Eat Right, and Enjoy!

If there’s a theme to this issue of MD-UPDATE, it’s that Kentucky physicians and providers are leading by example.

The Kentucky Medical Association, the Kentucky Foundation for Medical Care (KFMC), and the Lexington Medical Society, among other medical societies, have partnered in “Commit to Quit,” the smoking cessation program that leverages the physician-patient relationship in an effort to reduce smoking in Kentucky.

The Kentucky Department for Public Health’s Tobacco Prevention and Cessation Program, Quit Now Kentucky, also recognizes the high impact that physicians have when discussing tobacco use with patients.

We have contributions inside this issue of MD-UPDATE from our friend Dr. Shawn Jones of Paducah, Ky., vice-chair of KFMC and an early leader in smoking cessation, as well as from administrators in the Tobacco Prevention and Cessation Program. I invite you to read about their work and get involved.

As this is our cardiology, cardiac surgery, pulmonology, and sleep medicine issue, we profile some of the Kentucky physicians who are doing remarkable work with their patients in those specialties.

Readers of MD-UPDATE know that I am an advocate of healthy living and nutrition, which I’m convinced starts at the food procurement center, aka, the grocery store or farmer’s market. So once again we invited Mac Stone, a nationally recognized leader in organic farming and marketing of farm to home food systems, from Elmwood Stock Farm in Georgetown, Ky., to share some of his homegrown wisdom. From Mac’s experience, being a consumer of the “farm-you-see” is far healthier than being a customer of the “pharm-a-cy.”

Finally, January and February 2016 provided many opportunities for Kentucky physicians to support and enjoy events that support cardiovascular research and the arts. We caught up with some of those doctors, and we thank them for posing for our camera.

Until next issue, all the best,

Gil Dunn Publisher, MD-UPDATE

Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax ISSUE#98 | 3

HEADLINES

Commit to Quit KMA, KFMC Commit to Quit campaign focuses on patientphysician relationship for smoking cessation

BY MARY BRANHAM The Kentucky Medical Association and Kentucky Foundation for Medical Care, the charitable arm of KMA, have some advice for smokers who have made a New Year’s resolution to finally put smoking on pause for good -- talk to your physician to help you find success. KMA and KFMC are teaming with local county medical societies and other healthcare partners to help smokers Commit to Quit through a public relations campaign that focuses on the critical relationship between patient and physician.

KMA, KFMC and their partners launched the campaign in January 2016.

A new beat on life.

Dr. Shawn Jones of Paducah is vicechairman of the Kentucky Foundation for Medical Care and a smoking cessation advocate.

Studies have shown that when smokers work with their physicians, they are more likely to be successful. In fact, the long-term rate for abstaining from smoking jumped from seven percent to 30 percent when smokers seek help from their physicians, a

Health Happens Here.

When it comes to keeping your heart going strong, the Floyd Memorial Heart and Vascular Center delivers the full spectrum of care. Here, you’ll find the latest in noninvasive diagnostics that detect problems sooner.

We offer remarkable treatment options, which can mean faster recoveries.

And thanks to our comprehensive cardiac surgery program, 24/7 cardiac catheterization labs and electrophysiology capabilities, there’s no need to travel far for heart saving care – because heart Health Happens Here.

To find a cardiologist or schedule a screening, call 1.800.4.Source, or visit FloydMemorial.com/Heart.

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PHOTO PROVIDED BY KMA

SM

2007 report from the Association of American Medical Colleges found.

“It just makes sense,” said Shawn Jones, MD, of Paducah, vice-chairman of the Kentucky Foundation for Medical Care and a smoking cessation advocate. “Physicians know their patients best and can recommend what they think will work for individual patients. Physicians can prescribe any needed medication and point smokers who want to quit down a path where they can be successful.”

Smoking is the leading cause of cancer in the United States, and tobacco use increases the risk of many causes of cancer. In Kentucky, 30 percent of adults and 14 percent of teens selfreport as smokers. The Commonwealth leads the nation in the number of cancer deaths, according to the Centers for Disease Control and Prevention. Smoking also contributes to other health problems, including heart disease, stroke, emphysema, and bronchitis.

When people quit smoking, their health improves almost immediately. According to the American Heart Association, a smoker’s blood pressure and heart rate recovers from the cigarette-induced spike in only 20 minutes after quitting. Within 12 hours, the carbon monoxide levels in a smoker’s blood return to normal. One week after quitting, clear and deeper breathing gradually returns, and circulation and lung function begin to improve in as little as two weeks.

“We can’t deny the health problems smoking has caused and the benefits people can attain by quitting,” said Jones.

“Physicians stand ready to help our patients drastically improve their health by kicking the habit for good.”

KMA has long supported statewide smoke-free legislation, but recognizes the best way to cut down on secondhand smoke is to cut the number of smokers by helping people to quit. Studies show that as many as seven in 10 smokers want to quit; physicians can help them find the right path.

“Some people might be able to quit cold turkey,” said Jones. “But others might need something more. Physicians can help them along their journey to better health through quitting smoking.”

For more information and resources, visit www.committoquitky.com. ◆

HEADLINES

Kentucky Fights Tobacco on the Grassroots Level and Beyond The Department for Public Health’s Tobacco Prevention and Cessation Program focuses on stopping the spread of tobacco throughout the state

BY MELISSA ZOELLER FRANKFORT Tobacco and Kentucky have always been synonymous, and the effects have been long-standing and far-reaching.

Each year, more than 8,000 Kentuckians die of illnesses caused by tobacco use.1 Dedicated to addressing tobacco use at all levels and stages of life throughout the state, the Tobacco Prevention and Cessation Program focuses on preventing the initiation of tobacco use among youth and young adults while helping tobacco users, from teens to pregnant women to lifelong smokers, quit.

“From its inception, our program has focused on preventing initiation and promoting quitting among youth and adults, eliminating exposure to secondhand smoke and identifying and eliminating tobacco-related disparities,” states Tobacco Cessation Administrator Bobbye Gray, RN. “The programs we have put in place are working towards these goals.

We need to expand our reach, and medical providers can help us do just that.”

Gray’s primary goal and passion is providing tobacco cessation through Quit Now Kentucky (1-800-QUIT NOW and www. quitnowkentucky.org ). “Since its beginning, our 1-800-QUIT-NOW Quitline has been essential in providing help to individuals from all walks of life and socio-economic backgrounds,” states Gray. “The line is bilingual and can accommodate over a hundred other languages with an interpreting firm. Individuals are immediately assisted with developing a quit plan and strategies to help them become successful. And if the patient is uninsured, we pay for eight weeks

of free Nicotine Replacement Therapy (NRT) to help tobacco users become more successful in quitting.”

Policy Analyst Elizabeth AndersonHoagland knows that education and providing the right tools to quit are key. “It’s a common misconception that everyone in Kentucky smokes,” states AndersonHoagland. “That simply is not true. What is true though is that our high-risk populations such as Latino youth, lesbian, gay, bisexual, and transgender (LGBT) communities, pregnant women, and youth need more tools and education available to help them quit or not even start.”

Kentucky is the second highest in the nation for adult smokers at 26 percent and is the second largest producer of tobacco. Therefore it’s no surprise that Tobacco Cessation Administrator Bobbye Gray has 40 years nursing experience, her Rank 1 teaching certificate, and has been combating tobacco use in Kentucky with the Department for Public Health for seven years.

RIGHT Elizabeth Anderson-Hoagland, policy analyst for the Tobacco Prevention and Cessation Program, has her Masters in Public Health from George Washington University.

ABOVE

22 percent of pregnant women are smokers, making the state’s rate one of the highest in the country. “We have made a concerted effort to focus on maternal and child health and work with other programs on this issue,” states Gray.

“Our quit line has special protocols for pregnant women, offering them a designated smoking coach and gift card incentives for keeping their appointments as they are trying to quit.”

The program has also partnered with the University of Kentucky College of Nursing to do a survey and key informant interviews with healthcare providers about the type of cessation advice LGBT patients receive. “The LGBT community has higher tobacco use and has concerns about finding LGBT-friendly healthcare programs and services. This survey will help us find appropriate programs and give providers tools to provide appropriate care to their LGBT patients,” adds Anderson-Hoagland.

The program also works hand-in-hand with many partners, including the Kentucky Lung Cancer Education, Awareness, Detection, and Survivorship (LEADS) program and the Kentucky Cancer Program.

“The main focus of LEADS and the Kentucky Cancer Program is to reduce the burden of lung cancers throughout our state,” states Gray.

“We are excited to do whatever we can to make the outcomes good here in Kentucky.”

It is important for physicians to know that talking about tobacco cessation and quitting makes a difference. “Research shows that if a medical provider talks to their patient for as little as three minutes about quitting, that person is more likely to make a quit attempt,” states Gray.

Anderson-Hoagland adds, “It’s common for a provider to ask if a patient is a smoker. Many people don’t consider themselves smokers but still might be smoking in a social setting, or using products like hookahs or electronic cigarettes. We prefer the question, ‘Are you using any form of tobacco?’ because it’s more inclusive.”

Combating secondhand smoke is also a major component of the program, and both AndersonHoagland and Gray stress the need for not only tobacco screening, but also secondhand smoke screening as well. Secondhand smoke is linked to respiratory infections in children and adults, sudden infant death syndrome (SIDS), heart attacks, and strokes.

“A person is never too old to quit.

Quitting at any age has positive benefits, and counseling plus pharmacotherapy increases a person’s chances of quitting,” emphasizes Gray.

For more information or resources about the Tobacco Prevention and Cessation Program, visit chfs.ky.gov/dph/mch/hp/ tobacco.htm.

Tobacco Prevention and Cessation Program.

(2015, November 16). Retrieved February 5, 2016, from Kentucky Cabinet for Health and Family Services: chfs.ky.gov/dph/mch/hp/ tobacco.htm ◆

PHOTOS PROVIDED BY KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES

ISSUE#98 | 5

HEADLINES

Inaugural Uof L Optimal Aging Conference Event brings together seniors, caregivers, academics, and professionals

The Institute for Sustainable Health & Optimal Aging at the University of Louisville will host its inaugural Optimal Aging Conference June 12-14 in Louisville. The conference will be held at the Brown Hotel The Optimal Aging Conference brings together academics, professionals, and older adults across a variety of disciplines who are united by a view that aging is an opportunity, not a disease, said Institute Executive Director Anna Faul, DLitt. “This conference supports the dissemination of biopsyLOUISVILLE

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PHOTO BY ROBERT DENSMORE

U of L Institute for Sustainable Health & Optimal Aging Executive Director Anna Faul, DLitt, says the conference supports “the dissemination of biopsychosocial aging research, age-friendly product innovation, and evidence-based practice and education models.”

chosocial aging research, age-friendly product innovation, and evidence-based practice and education models, with participation and input from older adults,” Faul said.

The conference will feature presentations on the latest in aging research and the deadline for abstract submissions is March 18.

Registration will open April 1. The registration fee for students, residents, and senior citizens age 65 and older is $100; $240 for KAG Members; and $260 for all other academics and professionals.

The conference also will feature exhibits from a variety of businesses and organizations involved in the aging profession.

Deadline for exhibitors and sponsorships is April 30.

The conference is sponsored jointly by the U of L Institute for Sustainable Health & Optimal Aging and the Kentucky Association for Gerontology. For information about the conference, visit www.

OptimalAgingInstitute. org or call 502-852-5629.

EDITOR’S NOTE: The U of L Institute for Sustainable Health & Optimal Aging was featured on the cover of MD-UPDATE Issue #97. To view the article, visit www.mdupdate.com. ◆

U OF L OPTIMAL AGING CONFERENCE June 12-14, 2016 Brown Hotel 335 W. Broadway Louisville, KY 40202

FINANCE

The Seat Belt Light Is On One of my favorite books, for many reasons, is The Fourth Turning, by William Strauss and Neil Howe. It begins with the line, “America feels like it’s unraveling.” The book was written in 1997, but its message is relevant yet today. News channels and campaigning politicians make sure that instability in the economy and the markets is in front of us on a daily or even hourly basis.

The markets have certainly been unraveling to start the new year. The S&P 500 ended January down 5.0 percent, including dividends for the month, and lost 0.7 percent for the year then ended. Small, mid-cap, and international stocks fared somewhat worse still. The slide has continued into February as I write. While the declines may be moderate by some measures, the volatility has been significant, causing a lot of tension for investors.

Most pundits are blaming the slide in oil prices and China’s economic decline as the reasons for this. These are certainly factors that matter, but we believe that there is more to the story than this. To find causation, we may have to look a bit deeper.

Dr. Alan Blinder of Princeton wrote for the Wall Street Journal in January that the effect of China’s slowdown on our own economy is probably overblown. Exports to China made up less than one percent of our GDP in 2015. Even if China’s purchases of our goods and services were to drop by 10 percent, which he finds implausibly large, the effect would be a hit to our GDP of a mere 0.1 percent. There could be ripple effect because we have other trade partners that rely upon exports to China, and a slow-down there could adversely those countries, which could in turn hurt us. But even if the rate of decline is doubled, it is still not of huge concern when taken in proper perspective.

The morning news still reports the Chinese stock market results, and it still seems to have an effect on European markets as well as our own. Blinder calls this “slightly nutty.”

The other major morning headline relates to falling oil prices and their effect on our economy. Once again, Blinder: “Ask yourself: When the price of something you buy goes down, does that make you better off or worse off?” We import more oil than we export, so the drop in price is a far bigger problem for

Saudi Arabia and Venezuela than it is for us. Granted, those poor souls who work in Texas and North Dakota may be feeling the pinch as drilling firms cut back, but the impact on the overall growth

BY Scott Neal rate of our economy is still quite small. The fact that large energy stocks have been hit far more than the overall stock market seems to point toward opportunity looming on the horizon, not the doomsday story painted by so many. We will watch this closely. Meanwhile, in an apparent appeal to the fear on Main Street, one big provider of exchange-traded funds has just announced a new ETF that invests in all of the S&P 500 except for energy. Viewed from our fiduciary perspective, that timing seems odd, but understandable given the current level of fear of all things oil.

We have often remarked here that GDP growth is paramount to our future. Most reasonable minds know that a recession is coming someday. But are the current concerns overblown? It truly appears that the U.S. economy is surprisingly stable, albeit at a quite low level of growth. What might cause us to be stable in this environment?

We believe that it has to do with our evolution from manufacturing and farming to services. Services are intrinsically less cyclical than non-service sectors. Manufacturing workers now account for only 10 percent of GDP. Some see a problem with this. We do not. Reminder, there are essentially four factors that add up to GDP: consumption, net exports, investment, and government spending. The evolving service sector supports stability in consumption, which is good for the economy. There are certainly other factors, such as a collapse of global markets that could start of an avalanche of panic here at home that would virtually guarantee a recession. A watchful eye toward sentiment seems appropriate right now. If you are looking for a good leading indicator, it usually can be found in household debt. When household

debt gets too big, people slow consumption, which drags down the economy. For now, there is no boom in household debt like we have known before.

So, if these are not the reasons for current market instability, what are? Chief among the reasons is likely to be slowing of earnings growth. For quite some time, we have said that one should not expect the next decade or two to look like the last three. We are coming off three-plus decades of declining interest rates, which were very high in 1981. This, and other factors, contributed to an unexpected rise in after-tax corporate profits from six percent of GDP to 10 percent from 1981 to 2015. At this writing, 63 percent of the S&P 500 companies have reported earnings for Q4 2015.

The blended earnings decline so far is -3.8 percent. If the index reports a decline for the quarter, it will mark the first time since Q1 to Q3 2009 that we have had three consecutive quarters of decline. Furthermore, the number of companies that are reporting negative guidance for Q1 2016 outnumber those reporting expected increases by about four to one. All of this is to suggest that we investors should probably not rely too heavily on long-run averages for stock and bond returns over the next few years.

If one were to look for a strategy that could be reasonably expected to make money, it would probably not be passive investment in a traditional buy-hold-andrebalance strategy. Many have no choice but to do that with their employer-sponsored retirement plans, but individually managed accounts are a different story. Our friend, Ed Easterling at Crestmont Research often uses a boating analogy for the market and speaks of a time for rowing and a time for sailing.

The time for sailing along in a rising market appears to be over, at least for now. It is time for rowing. That equates to trading portions of the market that are likely to do better than others and having risk controls in place that keep small losses from getting big.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and investment advisory firm. Contact him via email scott@ dsneal.com or by calling 1.800.344.9098. ◆ ISSUE#98 | 7

ACCOUNTING

Revenue Cycle - Back to the Basics

Ensuring that critical revenue cycle fundamentals are strong can improve healthcare organizations’ chances for success amidst a sea of change and reform.

Just like in sports, it’s important to have Documentation, a strong core set of skills or players to documentation, build around. As the healthcare industry documentation. pitches curveballs at us all with marChanges in the healthket reform, insurance mandates, pricing care industry may have transparency, bundled payments, coding no larger impact on a overhauls, etc., the key to success and single group of people mitigating potential risk for healthcare than our professionals in organizations may lie in maintaining the Health Information a strong foundation of critical revenue Management (HIM) cycle fundamentals. arena. As electronic

BY Adam Shewmaker What are some of the key fundahealth records (EHR) mentals that healthcare providers must pay are continually refined and integrated across attention to in order to ensure the core the spectrum of care, clinical documentation is of the revenue cycle remains strong and as important as it has ever been. HIM profesfocused? sionals, including certified coders, will play a vital role in reviewing clinical documentation Effective and streamlined and assigning the appropriate codes. The acufront-end services. ity and complexity of services must be accuPerhaps one of the most important stages of rately represented, not only to ensure proper the revenue cycle is the time prior to deliver- reimbursement, but to also meet guidelines set ing any care or treatment to the patient. It forth through value-based purchasing, patient is during this time that critical information satisfaction, and other critical metrics. is either captured or lost, directly impacting the success and timeliness of creating a clean A strong denials claim, and thus collecting payment for ser- management program. vice. The people, processes, and technology At the core of any successful revenue cycle across the organizations’ patient access areas department is a robust denials management must work seamlessly together to maximize program. From identifying and utilizing the organization’s likelihood of capturing its meaningful denials metrics to creating a crosspotential net revenue. Centralized schedul- departmental denials steering committee, this ing, insurance and benefits verification, point program can prove invaluable in identifying of service collections, and case management trends and strengthening operations across play a vital role in capturing accurate patient the organization. Clinical resources play an data as early in the revenue cycle as possible. increasingly important role in a successful

Stronger together.

denials management program as the healthcare industry shifts its focus from quantity to quality and value rather than volume.

Focusing on what you do well and playing to your strengths.

We’ve all heard the saying “I can’t be everywhere all the time,” and the same adage holds true for the revenue cycle and its limited resources.

Organizations must play to its strengths and develop those skills that provide the most significant return on investment. Conversely, organizations must take a deeper look at their revenue cycle objectives and capacity to determine what they cannot effectively accomplish. For many organizations that may mean outsourcing or co-souring things such as Medicaid eligibility screenings, self-pay collections, or medical coding. No matter the task, determine if your organization can effectively and efficiently handle the responsibility with internal resources or if it makes more sense to partner with someone that can provide that service for you.

Significant change is happening in the healthcare industry and approaches must be tailored to account for the reforms and “curve balls” that are being thrown our way.

Tweaks must be made and processes refined, but in order to give ourselves a better chance at success, we must stay true to our fundamentals and continually strengthen those tasks at the core of the revenue cycle.

Adam Shewmaker, FHFMA, is director of Healthcare Consulting Services at Dean Dorton. He can be reached at 502.566.1054 or ashewmaker@ddafhealthcare.com. ◆

Learn more about our healthcare audit, tax, and consulting services: 859.255.2341 deandorton.com

Barr Anderson Roberts joins Dean Dorton, bringing expanded management, consulting, and tax solutions to physicians and practices from nationally recognized healthcare industry experts.

8 MD-UPDATE

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STORY

BUILDING A BETTER

Dr. Sebastian Pagni (left) and Dr. Samuel Pollock (second from right) collaborate on a cardiac surgery case. Collaboration among the cardiac surgeons, as well as with other disciplines, is key to personalizing procedures and optimizing outcomes for patients.

CARDIAC SURGERY PROGRAM Baptist Cardiac Surgery is taking a genuine team approach to less invasive cardiac surgery while improving options and outcomes for patients

BY JENNIFER S. NEWTON

When it comes to complex pathologies of the heart, and the growing number of technological advancements used in treatment, the trio of cardiac surgeons with Baptist Cardiac Surgery at Baptist Health Louisville have set out not only to do it all, but also to simply do it better.

Baptist Cardiac Surgery provides a comprehensive heart surgery program encompassing everything from coronary artery bypass grafts (CABG) to complex valve repairs and aortic dissections to hypertrophic cardiomyopathy and left ventricular remodeling to cardiac tumors. The only exceptions to their program are transplants and left ventricular assist devices (LVADs).

The three surgeons – Samuel Pollock, MD, Sebastian Pagni, MD, and Ahmad Kahn, MD - share a treatment phiLOUISVILLE

PHOTO BY BRIAN BOHANNON

ISSUE#98 | 9

COVER STORY losophy that seeks to not only provide comprehensive services but also to do so with a genuine team approach that tailors each procedure to the patient’s individual needs.

A True Team Approach

Pollock came to Baptist Health in 2002 as part of a private cardiac surgery practice that became employed by the hospital in 2010. He attended medical school at the University of Kentucky and completed his general surgery and cardiac surgery training at the University of Alabama at Birmingham.

Growing up, his father was the manager of the Trover Clinic in Madisonville, Ky., his next door neighbor was a general surgeon, and his first summer job Dr. Sebastian Pagni was at Hopkins County Hospital. initiated Baptist Health’s Those experiences let him know Thoracic Aorta Surgery very early on that he wanted to be Clinic, where they can a surgeon. treat any problem of the Pagni joined Baptist Health in aorta in the chest.

2013. A native of Argentina, he completed medical school in Buenos Aires before a series of vacations in the United States led him to move here. He completed his general surgery residency at the Hospital of Saint Raphael at Yale University and his fellowship in cardiovascular surgery at the University of Louisville and Jewish Hospital. When Pagni joined Baptist Health, he brought with him an affiliation with Floyd Memorial Hospital and Health Services. The three Baptist Health cardiac surgeons are the same physicians that perform surgery at the Floyd Memorial Heart and Vascular Center in New Albany, In. (Editor’s Note: See related story on pages 13-14.)

Khan is the newest member of Baptist Cardiac Surgery, having joined the group in February 2015.

A graduate of New York Medical College in Valhalla, N.Y., he completed his general surgery residency at Christiana Care in Delaware. Khan went on to cardiac surgery training at Maimonides Medical Center in Brooklyn, N.Y. He practiced for eight years in Charleston, W.Va., 10 MD-UPDATE

PHOTOS BY ROBERT DENSMORE

where he says he benefited from being “exposed to difficult cases and complicated clinical scenarios right from the get go.” The potential to grow the thoracic aorta program and build a transcatheter aortic valve replacement (TAVR) program drew him to Baptist Health.

And Khan’s experience in his first year here has reinforced his decision. “I think the cardiac surgery program here is a rarity in that there truly is a team approach. In the same way we discuss patients with our cardiology colleagues, we discuss most surgical cases amongst ourselves,” he says.

As part of their practice, the surgeons utilize nurse practitioners to help monitor post-op patients in the ICU and step-down unit, as well as see patients in the office, allowing the physicians to be in the operating room.

“They provide an excellent extension of what we do,” says Pollock.

Dr. Ahmad Khan, the newest member of Baptist Cardiac Surgery, says, “I think the cardiac surgery program here is a rarity in that there truly is a team approach.”

Less is More

The buzz words “minimally invasive” have become ubiquitous across all surgical specialties. But for the cardiac surgeons at Baptist Health, their “less invasive” approach is about much more than small incisions.

It also means addressing issues that can prolong a patient’s hospital stay and recovery, such as: avoiding transfusions, pain control protocols, optimizing perfusion techniques, avoiding infections, mobilizing patients sooner, and getting patients off the ventilator sooner.

“When you put that all together, that decrease is a less invasive procedure not only because of the incision but because we decrease the impact of the operation,” says Pagni. As a result, minimally invasive valve repair and replacement patients are able to return Dr. Samuel Pollock says, to normal activities in about two “Kentuckians tend to have to four weeks, much quicker than more diffuse coronary those that receive traditional open artery disease,” which heart surgery. leads to greater volumes The surgeons take a similar of bypass grafts in the approach to coronary disease. “In state.

terms of coronary disease, not only do we do the standard operations but also we try to simplify and expedite techniques to have better outcomes and have our outcomes be comparable with the top 10 percent nationally,” says Pagni.

For patients who need both aortic or mitral valve repair or replacement and treatment for single vessel coronary artery disease, hybrid procedures can help patients avoid open heart surgery. “Now, in conjunction with the cardiologists, we can work on those patients, one artery can be stented, and then they can have a minimally invasive procedure later on to repair the valve,” says Pollock.

Baptist Health also takes a minimalist approach to blood transfusions, including a bloodless surgery program for patients such as Jehovah’s Witnesses. “Our blood usage is very low compared to the rest of the country. Our blood transfusion rate is around 10 or 12 percent, and the rest of the country may be 30 or 35 percent if you look at the Society of Thoracic Surgeons (STS) numbers for like hospitals,” says Pollock.

Shifting the Paradigm

The advancements of surgical techniques and tools means that there are more options for patients who used to be told, “There’s nothing more we can do.” According to Khan, “There has been a paradigm shift in terms of who can be operated on and who cannot be and what the appropriate procedure is. The most visible piece of that is the Baptist TAVR program, but that’s really only the tip of the iceberg.”

TAVR or transcatheter aortic valve replacement is FDA-approved for patients in need of aortic valve replacement but who are deemed inoperable or very high risk.

Baptist Health launched its TAVR program in March 2015 and has done close to 30 cases. “For the first year, that’s quite good.

Twenty-plus cases a year for new programs is what’s considered acceptable. I foresee our program volume being much higher than that,” says Khan.

The proverbial “tip of the iceberg” is the potential inherent in TAVR technology.

“The platform we use for this procedure is going to be a springboard for further advances in the field. We want to be at the forefront and be heavily involved in how the future is shaped,” says Khan.

Another treatment paradigm that is

changing is that of arrhythmia surgery.

When patients with refractory or recurrent arrhythmias have not responded to medical treatment or cardiology interventions to restore normal rhythms, the surgeons can offer surgical solutions, such as the CoxMaze procedure. Traditionally the procedure required a lot of “cutting and sewing,” says Khan. “Now we use freezing techniques or radiofrequency technology to get the same results with much less trauma to the patient and more expeditiously.”

Thoracic Aortic Experts

The TAVR is just one component of a high-volume thoracic aortic surgery program. When Pagni joined the practice, he brought with him a wealth of experience in aortic surgery, which led to the opening of a dedicated Thoracic Aortic Surgery Clinic.

The program includes minimally invasive and open procedures for all segments of the aorta in the chest.

Their clinic includes multidisciplinary conferences to discuss all complex valve problems and decide on a course of treatment plan individualized to each patient. Treatment plans also consider the longest term benefits with the lowest impact on the patient. “When it comes to valve disease, we have an emphasis on repairing valves whenever possible. Not all valves are repairable. But we have a repairability rate of over 90 percent for all comers and over 98 percent for patients with degenerative disease,” says Pagni.

When it comes to emergency treatment for conditions such as aortic dissections, the physicians caution that knowing which facilities offer these procedures is critical to survival. “Thirty percent of patients die in the moment of the dissection, and another 30 percent die en route to the hospital, in the operating room, or afterwards,” says Pagni. After the 30 percent initial mortality rate, the rate increases one percent per hour. “Just going to the wrong emergency room can be the difference between life and death,” says Pagni.

Trends in Open Heart Surgery

Even with the advent of minimally invasive techniques, open heart surgery is still a significant part of any cardiac surgery program. Pollock estimates Baptist’s open heart volumes have increased 10 percent each year since he became employed by the hospital.

In 2015, they did approximately 450 open heart cases. With their affiliation with Floyd Memorial, the group did a total of almost 800 hearts last year.

Pollock estimates bypass surgery makes up 50 percent of his practice. “Kentuckians tend to have more diffuse coronary artery disease than I’ve seen in other areas that I’ve practiced in. We have always been a big proponent of complete revascularization for those patients, so our number of bypass grafts tends to be higher than a lot of programs around the country,” he says.

One benchmark in bypass surgery is the use of internal mammary arteries. “We see a lot of patients 20 or 30 years later that their vein grafts have occluded just because of progression of the disease, but the mammary arteries are open. That’s the reason we use the mammary artery on the main artery at the front of the heart and are trying to use more arteries, especially in younger folks,” says Pollock.

Regardless of the type of procedure or the technology the future brings, collaboration will continue to be key. “When I was growing up in the Trover Clinic, there were about 100 physicians and everybody worked together for a common goal to take care of the patients. I think what we have here is as close to that as I’ve seen anywhere. I think within the cardiology and cardiac surgery group here at Baptist that collegial atmosphere really benefits the patients,” says Pollock.

With that mindset, their comprehensive skills, and careful patient selection and treatment personalization, Baptist Cardiac Surgery is poised to be a leader in cardiac care. ◆

2 LOCATIONS: 3900 Kresge Way, Suite 46 Louisville, KY 40207 136 East Cottom Ave. New Albany, IN 47150 (502) 899-3858 www.baptistlouisvilleheartsurgery.com

ISSUE#98 | 11

MINIMALLY INVASIVE

CARDIAC SURGERY. LEADING HEART CARE THAT TREATS YOU LIKE FAMILY. At Baptist Health Louisville, treating you like family isn’t just something we say. It drives everything we do. It’s why our Less Invasive Cardiac Surgery approach involves a comprehensive, multidisciplinary team effort that tailors the procedure to each patient. It’s also why we offer the Thoracic Aortic Surgery Clinic and the latest treatments for mitral valve repair and replacement.

Leading heart care delivered by the team that treats you like family is right here.

LO U I SV I L L E

BaptistHealthLouisville.com/heart

12 MD-UPDATE

SPECIAL SECTION  CARDIOLOGY/CARDIAC SURGERY

10 Years and Beating Strong

Floyd Memorial Hospital and Health Services celebrates the 10th anniversary of its Heart and Vascular Center and cardiac surgery program BY MELISSA ZOELLER Sebastian Pagni, MD, knows a good thing when he sees it. The boardcertified general and cardiothoracic surgeon never planned to practice medicine in the United States until he came here for vacation and fell in love with the country. Pagni completed his general surgery residency at the Hospital of Saint Raphael Yale University and a fellowship at the University of Louisville. He completed his full training in cardiovascular surgery at Jewish Hospital, which eventually led him into minimally invasive surgery, right at the beginning of its era.

In 2006, after a five-year stint at Jewish Hospital, Pagni and his then-partners at Jewish Hospital formed a relationship with Floyd Memorial Hospital and Health Services, launching the Floyd Memorial Heart and Vascular Center, the first cardiac surgery program in Southern Indiana. The first open heart surgery was performed at Floyd Memorial on March 23, 2006, and another 150 followed that year.

“Our initial goal was to have a small, very controlled and outcome-specific program in the community to be able to serve the individuals in the area,” states Pagni.

“For the first three to five years, we worked on only low and medium complexity cases with good outcomes that could set the basis NEW ALBANY, IN

of going across the river.”

In 2013 Floyd Memorial switched its cardiac surgery affiliation to Baptist Health, and Pagni stayed to continue to grow the program with his new partners Samuel B. Pollock, Jr., MD, and Ahmad Khan, MD. The program continued to grow into a full-service cardiothoracic surgery program with an increase in volume and complexity, including the addition of minimally invasive techniques, aortic surgeries, valve repairs, coronary bypass surgery, and other advanced “It’s the dedication, motivation, and procedures. The hospital can now provide almost all carteamwork of all involved that allowed diothoracic surgeries, with us to get to the high standard of care the exception of transplants and artificial pumps. “Before and expertise that we are able to that, the complex surgeries provide today.” were going to other hospitals, and now we are able to show – Dr. Sebastian Pagni great outcomes and excellent patient care and service, staying on par with national stanfor patients in the area to want to stay at dards,” adds Pagni.

Floyd to have their heart surgeries instead And even though minimally invasive

Sebastian Pagni, MD, a cardiothoracic surgeon with Baptist Cardiac Surgery in partnership with the Floyd Memorial Heart and Vascular Center, helped launch Floyd Memorial’s open heart surgery program 10 years ago.

BELOW: Kelly McMinoway, RN, BSN, MHA, NE-BC, is the director of Cardiovascular and Ambulatory Services at Floyd Memorial Hospital and Health Services LEFT:

surgeries are more complex, requiring specially designed instruments, the support of a heart-lung machine, anesthesia expertise, and non-traditional, small incisions, patients see lower transfusion rates, shorter stays, quicker recovery, and better physical and cosmetic satisfaction, minimizing the overall impact of surgery.

“Patients now have less pain. They can mobilize and ambulate earlier and most are able to go home quicker, which directly relates to a low length of stay for our patients who have had bypass surgery. We have basically optimized all these many, many aspects to make cardiac surgery a less ISSUE#98 | 13

SPECIAL SECTION  CARDIOLOGY/CARDIAC SURGERY

traumatic experience,” states Pagni.

Kelly McMinoway, RN, BSN, MHA, NE-BC, director of Cardiovascular and Ambulatory Services at Floyd Memorial, could not agree more. McMinoway has been with Floyd Memorial for 20 years and has played a key role in helping build the full cardiovascular program and ancillary services.

the patients in our service area the ability to come into our facility and receive the care they need without having to be transferred to another hospital across the river,” states McMinoway. “We’ve grown tremendously in the number of patients we take care of and the number of procedures we do, well surpassing our 300 case goal. To date, we have completed approximately 2,500 cases.”

Floyd Memorial now serves “This program has shed such a positive eight counties and offers three cardiothoracic surgeons, two light on the health of our community. operating suites that are ready for surgery 24 hours a day, a Patients from across the river now 24/7 on-call team, and three know they have a viable cardiac option cardiac catheterization labs, one equipped with electrophysiolin Southern Indiana as well.” ogy (EP) capabilities that was - Kelly McMinoway added in 2014. Another recent addition is that of extracorpo“When we first opened the cardiac sur- real membrane oxygenation (ECMO) techgery program, the long-term goal behind it nology, which allows much riskier patients was to do close to 300 cases a year and give to come off bypass for rescue and go to the

14 MD-UPDATE

FLOYD MEMORIAL HEART AND VASCULAR CENTER CELEBRATES 10 YEARS Sunday, March 13 2 – 4 pm Open to the public Located in the hospital’s main lobby 1850 State Street New Albany, IN 47150 Cardiovascular Care Unit (CVCU).

A unique aspect of the Floyd Memorial Heart and Vascular Center is the cuttingedge universal bed concept in which patients can go directly from cardiac surgery to the CVCU and stay until they are discharged.

While most patients at other hospitals go to a cardiac step down unit, then to a medical floor and then get discharged home, Floyd Memorial patients stay in the same unit for their entire stay while the level of care changes around them.

“It took a lot of dedication, training, and teamwork with the ICU, nurses, anesthesia, and operating room staff to get where we are today,” adds Pagni. “It’s not just with the work of the surgeons, but also the cardiologists, that everyone began to see and understand we could handle these complex surgeries as a regional hospital. At the beginning, it was a big change. But once they understood the program was acquiring better outcomes than other major centers around, they knew the program was acquiring more relevance and more importance, and we were up to that level.”

What is Floyd Memorial’s outlook for the next 10 years? Both McMinoway and Pagni believe that the hospital will continue to grow and continue to be the premiere heart center in Southern Indiana.

“It’s very beneficial for the community as a whole. Our Southern Indiana population is coming to Floyd Memorial because of the trust we’re building as a leader in our field.”

Well said, Dr. Pagni. ◆

SPECIAL SECTION  CARDIOLOGY/CARDIAC SURGERY

Cardiac Landing Zone

Jewish Hospital, part of KentuckyOne Health, zeroes in on improving care for critical cardiac patients with a new helipad and electrophysiology lab expansion, along with new navigation technology BY JENNIFER S. NEWTON In new cardiac care models, the emergency room is often bypassed as the cardiac catheterization lab becomes the entry and triage point for many acute cardiac patients. The trend has precipitated hospitals to streamline cath lab pathways to minimize door-to-treatment times.

Having long been a leader in comprehensive heart care in the region, Jewish Hospital, part of KentuckyOne Health, has once again expanded services and made access for the most critical and high risk patients easier than ever. “Jewish Hospital is the oldest cath lab in Kentucky,” says Naresh Solankhi, MD, interventional cardiologist with KentuckyOne Health Cardiology Associates.

“We were the first hospital to do angioplasty in Kentucky.” Now the state’s oldest cath lab has added direct helipad access, an expanded electrophysiology (EP) suite, and new navigation technology to make the most of every minute in cardiac care.

LOUISVILLE

Flight Path

On October 1, 2015, Jewish Hospital opened the Jack M. and Janis B. Klempner Family Helipad on top of the Jewish Hospital Patient and Guest Parking Garage. The $2.1 million project was funded by the Jewish Hospital & St. Mary’s Foundation.

Prior to October, airlifted patients had to land at University of Louisville (U of L) Hospital and be transported via ambulance to Jewish Hospital. Now the transition is seamless, as a pedway connects the new helipad to an elevator that provides direct access to the cardiac catheterization and EP labs, bypassing the emergency room.

Cardiovascular and Thoracic Surgery at U of L. That group includes patients with acute aortic dissections, acute coronary syndromes, and those in need of extracorporeal membrane oxygenation (ECMO).

Short Circuit

The helipad is just one recent addition to the enhanced cardiac services for KentuckyOne Health.

In July 2015, Jewish Hospital opened its newly expanded EP lab suite, a $1.2 million project fundABOVE: Dr. Mark Slaughter, cardiovascular surgeon with U of L Physicians and executive ed by the Jewish Hospital & St. Mary’s Foundation. director of Cardiovascular Services for the KentuckyOne Health Louisville market, says While Jewish Hospital had the addition of the helipad is “critically two existing EP labs, they important” for acute cardiac patients coming were in different parts of the from 30 minutes or more away. cath lab and at full capacity, LEFT: Dr. Naresh Solankhi, interventional making it difficult to schedcardiologist with KentuckyOne Health ule procedures for five EP Cardiology Associates, says complex procedures performed in the Jewish Hospital physicians. The renovation cath lab include the Stingray™ for chronically transformed an existing EP totally occluded vessels (CTO), the Impella® lab and holding area into ventricular assist device (VAD) for weak heart a three-lab EP suite with muscles, and angioplasty for patients at high a new pre/post procedure risk for open heart surgery. area and 20-bay space to allow for more efficient care Patients can also be transported via elevator delivery and programmatic growth. Prior to the operating room or the intensive care to the expansion, the hospital was doing an units (ICU). average of 90 to 100 EP cases per month.

Timing is imperative for cardiac condi- In July, post-renovation, they did 161 EP tions where mortality is calculated by the cases. minute or hour. “The addition of the heliIn the EP labs, electrophysiologists are pad is critically important for this subgroup able to treat electrical problems of the heart of patients,” says Mark Slaughter, MD, car- with radiofrequency ablations or implanted diovascular surgeon with U of L Physicians, devices such as defibrillators and pacemakers. executive director of Cardiovascular Services One of the EP labs is equipped with for the KentuckyOne Health Louisville Stereotaxis technology, which benefits market, and chair of the Department of patients who need ablations for atrial fibrilPHOTOS PROVIDED BY KENTUCKYONE HEALTH

ISSUE#98 | 15

SPECIAL SECTION  CARDIOLOGY/CARDIAC SURGERY

lation, atrial flutter, or supraventricular tachycardia (SVT). “You can navigate all your catheters in the cardiac chambers using a magnetically guided “driver” system, allowing precise positioning. We have the only Stereotaxis-equipped EP lab in Louisville,” says Solankhi.

Electromagnetic Navigation

Another technology enhancing the accuracy and benefit of EP treatments is MediGuide™ Technology. “The MediGuide is the crown jewel of the newer expansion,” says Rakesh Gopinathannair, MD, MA, FHRS, with U of L Physicians, director of Cardiac Electrophysiology for U of L and KentuckyOne Health, and chairman of the national cardiac electrophysiology clinical standards committee for Catholic Health Initiatives. “We are the 13th center in the country to have this technology.”

The MediGuide is a four-dimensional, electromagnetic navigation system that limits the need for fluoroscopy during a procedure, thereby substantially reducing overall radiation exposure. “Some of these four- or five-hour cases require a lot of live x-ray, as much as 50 or 60 minutes, so radiation exposure to the patient, physician, nurses, and staff can be substantial,” says Gopinathannair.

With MediGuide, the physician takes one three-second x-ray of the patient before inserting catheters into the groin, which the system converts into a background image of the heart. The specialized MediGuide Enabled™ catheters contain tiny sensors that are picked up by the system and allow EP physicians to navigate catheters inside the heart while visible on the pre-recorded image. The system also automatically adjusts for patient movement, breathing, and heart rate. “It allows you to significantly limit the amount of time you need to step on the x-ray pedal. If you look at the data from other centers, many have realized an 80 to 90 percent reduction in their amount of x-ray exposure without compromising the duration of the procedure, safety of the patient, and procedural success,” says Gopinathannair.

For example, in a standard ablation procedure for atrial flutter, the procedure takes 16 MD-UPDATE

On October 1, 2015, Jewish Hospital opened the Jack M. and Janis B. Klempner Family Helipad, which is directly connected via pedway and elevator to the cardiac cath lab, EP labs, operating rooms, and cardiac ICU. LEFT: Dr. Rakesh Gopinathannair, director of Cardiac Electrophysiology for U of L and KentuckyOne Health, says, “The MediGuide is the crown jewel of the newer expansion.”

BELOW: The MediGuide™ Technology is an electromagnetic navigation system that provides realtime, 4-D imaging during electrophysiology procedures with an 80 to 90 percent reduction in radiation exposure.

ABOVE:

about an hour with 10 to 12 minutes of fluoroscopy. “With MediGuide what we’ve been able to do is cut that 11 minutes down to 1.2 or 1.3 minutes. The radiation dose has come down from 100 to 200 miligrays to less than three to five miligrays,” says Gopinathannair.

Jewish Hospital has done between 15 and 20 cases with the MediGuide so far.

Besides ablations, it can be used to place biventricular defibrillators and pacemakers.

However, because it is so new, there are limitations as to what tools are available in the MediGuide format, but Gopinathannair expects that to change in the near future.

Currently Jewish Hospital is prioritizing cases for MediGuide based on what brings the greatest benefit. One such procedure is the placement of a biventricular defibrillator, which has three leads into the heart and is typically one of the highest radiation exposure procedures in EP. The second is ablations for atrial flutter and SVT.

Non-Invasive Maneuvers and Hybrid Technology

In addition to increased access and expanded EP technology, Jewish Hospital

PHOTOS PROVIDED BY KENTUCKYONE HEALTH

is offering a plethora of new minimally invasive techniques. “In the cath lab, we are doing complex procedures like chronically totally occluded vessels (CTO), procedures for weak heart muscles with a ventricular assist device (VAD) called Impella®, the radial approach, the trans-femoral approach, and angioplasty on patients at high risk for open heart surgery,” says Solankhi. One of the newer techniques for CTO is the Stingray™ Coronary CTO Re-Entry System, which allows physicians to open 100 percent blocked arteries that cannot be bypassed.

In research, Jewish Hospital has been participating in the ABSORB Trial, which is studying the efficacy of a bioabsorbable stent that dissolves after nine months. FDA

THE PAIN TREATMENT CENTER OF THE BLuEGRASS abolishing the t yranny oF pain

approval is expected this summer.

From minimally invasive procedures to open heart surgery, Jewish Hospital also has a new $5 million hybrid operating room (OR)/cath lab for patients that need the best of both worlds. With advanced imaging, cardiology, and cardiac surgery capabilities all in one room, the hybrid OR is being used for transcatheter aortic valve replacement (TAVR); MitraClip®, a percutaneous technique for the repair of mitral valves; and the removal of old pacemaker leads. “We are the first in the state and the busiest program for TAVR, and now we do the procedure with the patient awake,” adds Slaughter.

All three physicians foresee advancements continuing to be made as these newer platforms are more fully developed.

In the near future, one of the program’s goals is to be identified as a cardiac resuscitation center. “With the helipad and STEMI (ST-segment elevation myocardial infarction) team and anesthesia and cardiac surgery working as a singular collaborative team, the idea is patients in the field that get CPR have a very high mortality, but there is some suggestion if they can get to a dedicated center that has full capabilities such as putting them on ECMO, cooling them, and having artificial lungs and hearts available for acute temporary support, that many of these patients might be able to be saved,” says Slaughter.

With all these cardiac tools at their disposal, KentuckyOne Health is certainly on target to improve mortality for these critically ill patients. ◆

Ballard Wright, MD, PSC Main Office:

Satellite Office:

2416 Regency Rd., Lexington KY 40503 NEuRoLogY / NEuRoimagiNg Peter D. Wright, M.D. Medical Director Director of Neuroimaging aNESTHESioLogY Ballard D. Wright, M.D. Founder and Medical Director Fred Coates, M.D. Dennis Northrip, M.D. PHYSiCaL mEDiCiNE aND REHaBiLiTaTioN Katherine Ballard, M.D. Lauren Larson, M.D Steven Ganzel, D.O.

Affiliated Surgery Center 280 Pasadena Drive, Lexington

110 Hardin Ln. STE 4, Somerset iNTERNaL mEDiCiNE anand modadugu, m.D.

iNDEPENDENT mEDiCaL EvaLuaTioNS Ballard D. Wright, M.D.

aDDiCTioN mEDiCiNE Traci Westerfield, MD

PHYSiCiaN aSSiSTaNTS Lois Wright, MBA, PA-C Celeste Christensen, PA-C Shari Pierce, PA-C Jing Ye, PA-C Barry Williams, PA-C

FamiLY PRaCTiCE Laura Hummel, M.D. BEHavioRaL mEDiCiNE Narda Shipp, ARNP Kellie Dryden, LCSW Marie Simpson, LCSW

NuRSE PRaCTiTioNERS Becky Moore, ARNP Teri Partin, ARNP Lynne Shockey, ARNP Jeff Eversole, ARNP

Joint Commission Accreditation, The Quality Distinction

A Joint Commission accredited private surgery center where our physicians perform diagnostic and surgical procedures for the treatment of pain, to include: Epidurals Intrathecal Pumps Spinal Cord Stimulation MILD Facet Blocks Vertebroplasty Neurolytic & Sympatholytic Denervation For further information on the region’s largest freestanding pain treatment facility, call: (859) 278-1316 ext 258 • Fax: (859) 276-3847 • www.pain-ptc.com

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ISSUE#98 | 17

SPECIAL SECTION  PULMONOLOGY/SLEEP MEDICINE

A Fighting Chance

KentuckyOne Health Pulmonary Associates is leading the fight against pulmonary hypertension BY JIM KELSEY They say you should fight the battles you can win. Until recently, fighting pulmonary hypertension was essentially fighting a losing battle. There were few treatments, few opportunities for success.

But times have changed, says Mahmoud Moammar, MD, of KentuckyOne Health Pulmonary Associates at Saint Joseph East in Lexington.

“They used to say there’s no treatment for it, so why should we go through this series of tests,” Moammar says. “Now there is a treatment for this disease, and we can do something for the patients to improve their quality of life.”

The lack of treatment options in the past and subsequent hesitancy to test for pulmonary hypertension has led to underdiagnosis and late diagnosis, Moammar says.

“We have to think of pulmonary hypertension as a disease, and there’s a treatment for it,” he says. “You have to initiate a series of tests that can lead you to the diagnosis.

One of them is an echocardiogram. If the patient has elevated pressure there, they have to be referred to a pulmonary hypertension specialist to further diagnose and treat the patient.”

If Moammar sounds passionate about treatment of pulmonary hypertension, it’s because he is. He began his medical journey by attending Jordan University of Technology and Science in Jordan. He completed his residency at Mt. Sinai School of Medicine in New York and his pulmonary fellowship at Seton Hall in New Jersey.

It was during his residency that he became interested in pulmonary disorders.

“During my rotation in the ICU, you see those sick patients that need your help,” he says. “The impact that you have on those patients is huge. The happiness that you feel there after they leave the ICU and they go back to their normal life … you can’t explain it.”

That desire to help patients led him to Kentucky, where the prevalence of smoking LEXINGTON

18 MD-UPDATE

PHOTO BY GIL DUNN

Dr. Mahmoud Moammar, KentuckyOne Health Pulmonary Associates, was voted 2015 Physician of the Year at Saint Joseph East by staff and awarded the honor by the Saint Joseph Foundation.

results in a high incidence of lung disorders.

He practiced in Ashland for three years before moving to Lexington in 2012.

Now in his fourth year at KentuckyOne Health Pulmonary Associates, Moammar was named 2015 Physician of the Year at Saint Joseph East by Saint Joseph Foundation. He and his colleagues see a wide variety of diseases related to the lungs, including asthma, COPD, lung nodules, and pulmonary hypertension.

“About a year ago, we started a center here at Saint Joseph East to treat patients with pulmonary hypertension,” Moammar says. “We work with our colleagues from cardiology and rheumatology to have a multidisciplinary approach to treat the disease. We’ve been very successful in making a change in patients’ lives.”

Moammar points to advancements in treatment for pulmonary hypertension as

the reason for the increased importance in early and accurate diagnosis. “In the last 10 years, we came from maybe one or two medicines available in the market to 14 medicines,” he says. “Before, we were doing intravenous and subcutaneous therapy.

Now we have other options like oral and inhaled therapies that can help patients and have a large impact on their lives.”

Advances in diagnostics have also made the disease easier to identify. If an echocardiogram reveals increased pressure, a right heart catheterization can serve as a diagnostic approach for pulmonary hypertension.

KentuckyOne Health Pulmonary Associates stresses a multidisciplinary approach. The result of these advanced diagnostics and treatments is the ability to improve a patient’s quality of life, Moammar says. “When you diagnose patients with pulmonary hypertension, you have to look at their functional status,” he says. “If they have significant shortness of breath, your target is going to be to push them back to where they have no shortness of breath or have shortness of breath only during extreme exertion.”

To help patients get back to and maintain a high level of functionality, Moammar and his colleagues have an extensive followup care program. “Once you have a patient with pulmonary hypertension, I always say you get married to that patient,” Moammar says. “You have a long-term relationship

with them. You have follow-up tests to see if the pressure is going down and a six-minute walk test to see if their functional status is

“We have to think of pulmonary hypertension as a disease, and there’s a treatment for it.”

– Dr. Mahmoud Moammar improving. We perform those tests in threeto six-month intervals based on patients’ needs.”

In addition to the advances in pulmonary hypertension diagnosis and treatment, Moammar is excited about the technology that now allows for earlier detection and treatment of cancerous lung nodules.

KentuckyOne Health Pulmonary Associates launched a program for early detection and early screening for patients with lung cancer. Any patient who meets eligibility criteria can have the Low Dose Chest CT scan that will help with early detection of lung cancer.

They also started a lung nodule clinic, which employs an advanced technology for faster, more accurate diagnosis. “We started an interventional pulmonary program with advanced technologies including navigational bronchoscopy, which is a kind of bronchoscope which can go further in the lung and diagnose lung nodules that we were unable to reach without it,” Moammar says. “We also brought endobronchial ultrasonography, which is used not only to diagnose the cancer but also to provide staging at the same time. That saves the patient major surgery and major complications later.”

KentuckyOne Health Pulmonary Associates and their patients are fighting serious battles every day. And with advancements in technology, diagnosis, and treatments, they are battles they can win. ◆

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ISSUE#98 | 19

SPECIAL SECTION  PULMONOLOGY/SLEEP MEDICINE

The Science of Sleep Medicine

Lexington Clinic Sleep Center takes comprehensive approach to diagnosing and treating sleep disorders BY SARAH WILDER, LEXINGTON CLINIC LEXINGTON According to the Centers for Disease

Control and Prevention (CDC), most adults need between seven and nine hours of sleep each night. However, only two-thirds of adults in the U. S. actually achieve this, meaning there is one-third of the U.S. adult population that is not getting enough sleep.

“When a patient suffers from insufficient sleep, many problems can occur.

Insufficient sleep has been linked to the onset of chronic illnesses including diabetes, hypertension, obesity, and depression, as well as an increase in the likelihood of motor vehicle crashes and machinery-related accidents,” says Craig A. Knox, MD, a neurologist with Lexington Clinic who also serves as a physician with Lexington Clinic’s Sleep Center. “Insufficient sleep may also lead to a decline in the quality of life, reduced work productivity, and increased mortality rate.”

Knox is one of three physicians at the Lexington Clinic Sleep Center, along with Wayne B. Colin, MD, and John F. Dineen, MD. Together, the three physicians provide a comprehensive approach to diagnosing and treating sleep disorders using their expertise in otolaryngology, pulmonology, and neurology. Services and procedures offered include:  Overnight sleep studies  At-home sleep studies  Professional mask fit and instruction  CPAP titration studies  CPAP instruction and maintenance  Durable medical equipment supplies  Follow-up care for CPAP  Multiple sleep latency test  Maintenance of wakefulness test While the Lexington Clinic Sleep Center treats a wide-range of sleep disorders, the most common condition seen at the sleep clinic is obstructive sleep apnea (OSA).

This condition, which occurs mildly in one in five adults, and severely in one in 15, occurs when the airway of a patient becomes blocked during sleep due to relaxation of the throat muscles and tongue. When the airway is blocked, the patient will cease breathing for short periods of time (10 seconds or 20 MD-UPDATE

“During a sleep study, a patient’s efforts at breathing, oxygen levels, and heart rhythms are measured,” says Dineen, a board-certified physician with Lexington Clinic’s Pulmonary department. “Additionally, an EEG is performed to give insight into the patient’s sleep architecture. Normal sleep architecture is seen as characteristic EEG waveforms and durations at the different levels of sleep. But with OSA, the normal EEG architecture is altered, and the deepest and most restful levels of sleep are mini-

Dr. Wayne Colin performs surgery on a patient.

more) during sleep. This is called an apnea.

“When an apnea occurs, oxygen levels in the patient’s blood may drop, which may result in poor oxygen supply to the brain and heart, increasing the risk of stroke and heart attack,” says Knox. “If left untreated, sleep apnea may also result in poor memory, emotional problems, decreased cognitive functioning, and increased cardiovascular disease.”

“OSA is very much associated with high blood pressure, diabetes, coronary artery disease, irregular heart rhythms, heart failure, stroke, and shortened lifespan,” adds Colin, who is certified by the American Board of Otolaryngology in head and neck surgery, as well as sleep medicine. “Most, if not all, of these conditions seem to be made easier to treat by resolving the OSA.” OSA is characterized by loud snoring; excessive daytime sleepiness; observed episodes of breathing cessation during sleep; abrupt awakenings with shortness of breath; awaking with dry mouth or sore throat; and morning headaches. To accurately diagnose OSA, a polysomnogram, commonly called a sleep study, is conducted. At the Lexington Clinic Sleep Center, these sleep studies can either be performed in a patient’s home or at the facility.

LEFT PHOTO BY ELIZABETH MURPHY, RIGHT PHOTO PROVIDED BY LEXINGTON CLINIC

Dr. Wayne B. Colin, certified by the American Board of Otolaryngology in head and neck surgery and otolaryngology and in sleep medicine, completed a fellowship in head and neck micro-vascular surgery at Barnes Hospital & Washington University in St. Louis, Mo.

mized or gone completely.”

Once diagnosed, OSA can be treated in a variety of ways, both surgical and nonsurgical. With very mild sleep apnea, weight loss or a dental appliance can be considered.

The most common treatment is through the use of a continuous positive airway pressure machine, or CPAP. With CPAP, air pressure is administered by a mask. That air pressure provides support of the airway so as to prevent the airway’s collapse.

“While a CPAP machine offers relief to OSA patients when worn, it is not considered a cure. Indeed, if at any time a patient does

not sleep with the machine, the apneas will still occur. Also, some patients don’t tolerate CPAP. To successfully cure a patient of OSA, surgical treatment is needed,” says Colin.

Surgical options performed at Lexington Clinic to relieve a patient of OSA are often staged and commonly include:  Nasal, septal, and adenoid surgery (including turbinate reduction)  Uvulo-palato-pharyngoplasty (UPPP) and tonsillectomy  Genio-glossus advancement, tongue suspension, and base of tongue reduction  Hyoid suspension  Maxillo-mandibular advancement  Tracheotomy The type of surgical treatment received is designed specifically to meet the patient’s problem, as OSA blockages do not always occur in the same locations. After diagnosis of OSA and trial of CPAP, a consultation with the surgeon can be performed, which allows for a personal treatment plan to be developed.

Dineen: Dr. John F. Dineen is board-certified in internal medicine/ pulmonary diseases and sleep medicine.

“The unique thing about Lexington Clinic’s approach to treating not only OSA, but also sleep disorders in general, is that we take a multi-specialty comprehensive approach to the diagnosis and treatment,” says Dineen. “Through the combined expertise from physicians representing oto-

Dr. Craig A. Knox, boardcertified in neurology and sleep medicine, completed a fellowship in peripheral nerve surgery at the Mayo Clinic in Rochester, Mn.

laryngology, pulmonary, and neurology specialties, we can more accurately diagnose a patient’s disorder and provide a treatment option that is best for them.”◆

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ISSUE#98 | 21

COMPLEMENTARY CARE

How to Be in a Relationship — Without Losing Yourself Having love in our lives is important to most of us. Numerous studies show that intimate relationships are the single most important source of life satisfaction. Romantic love is a predominant factor in psychological and physical well-being.

We rate love as important to our happiness for good reason: Psychologists have known for a long time that intimate relationships help us cope with personal stress and the vicissitudes of life. It turns out that having someone to love is important — and not just to help us get through the tough times. It may be even more important that our loved one helps us celebrate and take pleasure in the good times.

Joy matters just as much as being there.

Researcher Shelly Gable at USC Santa Barbara found that a partner’s supportive response to good news was rated higher than a partner’s supportive response to unfortunate incidents. Gable and her colleagues suggest that although being there for a partner dealing with a disappointment or distress is undeniably important to a relationship, it may not make a couple feel joy.

Joy matters. As marriage researcher John Gottman famously discovered, when a couple’s positive interactions outnumber the negative by a ratio of 5:1, the marriage is experienced as stable and happy.

The incomparable experience of intimacy.

No wonder one in four adults rate love as important to their happiness. The language of hormones and neurotransmitters will never be able to fully explain the incomparable experience of intimacy — feeling free to be open, even vulnerable, without fear of losing your partner’s affection.

How can we consciously cultivate intimacy? Social psychologists describe the process as something like this: It’s natural to be drawn to people who show us they like us.

The personal validation that is offered by this exchange of positive emotions makes 22 MD-UPDATE

us feel good about ourselves and helps build our self-esteem.

As we risk selfdisclosure and receive validation by our partner, a trust is built that leads to further

BY Jan Anderson, PsyD, LPCC self-disclosure.

When the inevitable relationship conflicts, hurts, or disappointments occur, successful repair attempts heal the rift, re-establish trust, and reconnect us. This process of self-disclosure, validation, and successful repair attempts creates and sustains intimacy.

What if the source of stress is the relationship?

If love is important to our happiness, guess what is the most frequently reported cause of depression. Relationship stress. In fact, recent research suggests that a bad marriage may be even more of a mental and physical health risk factor than being single or divorced.

When we lose the connection to our beloved, what does that really mean? We no longer feel special to that special someone.

We no longer feel interesting and attractive to, or admired and appreciated by, our beloved. We may even feel no longer lovable. We no longer feel safe to be ourselves.

Interactions range anywhere from volatile and hostile to safe, comfortable, predictable, and airless.

Sometimes the relationship ruptures in glaring and obvious ways: open conflict and fighting, a betrayal of trust (often involving money or an affair), or some other form of chronic relationship disloyalty — consistently putting someone or something else before your partner, whether it’s your work, your children, your parents, or how you spend your leisure time.

Taking a relationship for granted puts it at risk.

More subtle (and more common) is the corrosive effect of taking the safety of the connection for granted, and beginning to show our worst sides to those who matter most. One or both partners become dismissive of each other’s feelings and don’t pick up on or respond to signs of distress in the other person.

More often than not, we ignore our partner’s emotional needs and inflict pain — not out of malice or meanness — but pure thoughtlessness.

Trying too hard to save a relationship puts it at risk.

If you’re too invested in a relationship continuing — if you’re too attached — you lose the one thing that made you most attractive to your partner in the first place: We are our most attractive in a relationship when we strike a balance of autonomy and availability — when we project both confidence and emotional openness.

In an attempt to not “rock the boat” we begin to keep our dissatisfactions secret and avoid confiding our needs, thinking this will keep the relationship safe. In fact, our good intentions and playing it safe heads us into dangerous waters that put the relationship at risk, even if it doesn’t feel that way.

Learning to be in a relationship — without losing yourself.

Whether we take the relationship for granted or try too hard to keep it going, small stress fractures begin in the relationship, followed by a gradual erosion of spontaneity, interest, affection, sexuality, and flat-out having fun and enjoying life with your partner.

In tracing back the steps of how a relationship reached the “spontaneous combustion” state, I usually find that the subtle erosion of intimacy is actually the precursor. So in reality, it’s

not “spontaneous” combustion after all.

Overwhelmingly, the set up for an affair is less about sex and more about needing to feel special— admired, interesting, attractive, lovable, appreciated — to someone.

Ditto for most of the other forms of relationship demise, as well.

So what’s the solution? For some of us, the autonomy and confidence is already there — we’re not at risk of losing ourselves in the relationship. What’s needed is more focus on how to be in a relationship. Paradoxically, it starts with selfawareness: learning to understand your own feelings and motivations, strengths, and weaknesses, and to recognize their impact on others. From that foundation of self-awareness, it’s then easier to develop the social skills needed to accurately read other people, pick up on social

cues, and consider other people’s feelings, especially when making decisions.

For others of us, we already have lots of emotional intelligence — about other people. But about ourselves? Not so much.

We’re so tuned in to other people’s feelings that we bypass ourselves, lose track of our own wants and needs, and lose ourselves in a relationship. Interestingly, the process starts the same — with self-awareness. From that foundation, it’s then easier to develop the social skills needed to manage relationships to meet our needs.

The ultimate goal is the same for both people in the relationship: the incomparable experience of intimacy — finding ways to air their dissatisfactions and confide their needs with the assurance that, in doing so, they do not risk losing their partner’s affection. ◆

Relationship and Life Strategy Expert Individual & Couples Counseling Relationship & Life Strategy Coaching Mindfulness-Based Cognitive Therapy

complimentary preliminary Consultation 502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC

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ISSUE#98 | 23

COMPLEMENTARY CARE

The Carrot is Right under Our Noses It’s not a stretch of the imagination to accept that our relationship with food has a direct correlation to our health. That’s why the Organic Association of Kentucky (OAK) is partnering with UK Wellness Program to provide employees a consistent, seasonal supply of wholesome, certified organic fruits and vegetables. Five organic farms in Central Kentucky are participating in a pilot program, managed by Bluegrass Harvest, to incentivize people to contract with a farm to provide the veggies on a weekly basis. UK Health & Wellness is offering $200 vouchers to some UK employees who join a local organic Community Supported Agriculture (CSA) farm share program. This investment is well worth it, based on the preliminary data from last year’s initial research project and follow-up study.

Some farmers sell “shares” of their farm in a CSA program. Customers invest in a farm to ensure they get a “share” of the bounty produced on the farm. Each farm operates a little differently, but the consumer contracts and pays a lump sum of money to the farmer ahead of the season, and the farmer agrees to deliver a weekly share of produce from May to October. This relationship not only helps the growers capitalize seasonal startup costs like seed, greenhouse heat, and labor, it also begins a dialogue about seasonal availability of foods, sharing of recipes, and a sense of commitment to consume all the foods in the share each week. Some farms have informative newsletters with each share or offer tours of the farm for their shareholders. Over

the years, these arrangements have grown to include shares of organic meats and eggs, not just fruits and vegetables.

GEORGETOWN

Why Organic?

Simply stated, funds that incentivize people to consume more fruits and vegetables should not support the use of toxic chemicals, which have often been linked to cancer or other insidious diseases. Additionally, a recent study at the UK College of Agriculture shows that vegetables grown organically had more diverse microbial profiles (aka healthy plant biome) than did conventionally grown produce grown with fungicides, insecticides, and salt-forming fertilizers. (http://journal.frontiersin.org/ article/10.3389/fpls.2015.00490/abstract) The Human Microbiome Project draws a direct link between gut health and natural immunity. A reasonable person would conclude that if healthy soil makes for a healthy plant, a healthy plant will make for a healthy human.

Wholesome Wave, Community Farm Alliance, and others have led successful programs where physicians write prescriptions for fruits and vegetables to patients with diabetes and/or high blood pressure, with some individual success to show for it.

BY

Mac Stone

(http://www.countyhealthrankings.org/ policies/nutrition-prescriptions) As people increase their knowledge of food and food production, they modify their dietary habits, improve their nutrition, and ultimately see healthy outcomes as a result.

Food Rx projects are in conjunction with local farmers markets, which keep those dollars in the community and elevate the conversation about food throughout the community.

In Kentucky, Bluegrass Harvest is available to consult with other healthcare providers, employers, and wellness centers to set up a healthy eating investment on behalf of their customers, staff, and clients. OAK’s partnership with UK Wellness organizes a connection between the growers and the eaters. Clinicians benefit from having healthier patients. CSA members that partner with an organic farm are healthier people. Investing in the “farm you see” may be advantageous over relying on the pharmacy.

Mac Stone, his wife Ann Bell Stone, and extended family operate Elmwood Stock Farm in Scott County, Kentucky. Mac was the executive director of marketing for the KY Dept. of Agriculture, administering the Kentucky Proud program among many others. He is former chair of the U.S. Dept. of Agriculture’s National Organic Standards Board. His focus is on farming and marketing organic foods for the family and working with non-profit agriculture and food organizations.

Mac can be reached at 859.621.0756. ◆

APRIL

Photos by Jeff Busby.

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24 MD-UPDATE

(859) 233-3535 OR

NEWS  EVENTS  ARTS

Boston Pediatric Cardiothoracic Surgeon Joins U of L

A nationally and internationally recognized expert in complex congenital heart disease has joined the faculty of the University of Louisville School of Medicine Department of Cardiovascular and Thoracic Surgery.

Frank A. Pigula, MD, comes to Louisville from Boston where he was the clinical director of the pediatric cardiac surgery program at the Children’s Hospital of Boston, rated number one in cardiology and heart surgery

by U.S. News & World Report. Pigula also was an associate professor of surgery at Harvard University School of Medicine.

Pigula will perform both clinical and laboratory research at U of L. He has ongoing clinical studies to document neurodevelopmental outcomes in neonates using a technique he developed in Boston to reduce circulatory arrest times in an effort to reduce bypass-related neurologic injury.

He also is conducting laboratory research LOUISVILLE

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on protecting the brain from bypass‑related brain injury during surgery.

“We are extremely pleased to bring a world-class clinician and researcher such as Dr. Pigula to U of L. He will be a tremendous asset in training the next generation of physicians in cutting-edge cardiovascular and thoracic surgery,” said Mark S. Slaughter, MD, chair of U of L’s Department of Cardiovascular and Thoracic Surgery.

Pigula also will practice with University of Louisville Physicians and will serve as chief of the Division of Pediatric Cardiac Surgery at Kosair Children’s Hospital. He is expected to begin seeing patients next month. He joins Erle Austin, III, MD, who has been chief of cardiovascular surgery at the hospital for 26 years and will now focus on direct patient care. Pigula and Christopher Johnsrude, MD, chief of cardiology, will serve as co-directors of the Kosair Children’s Hospital Heart Center.

Pigula earned his medical degree from the University of Vermont College of Medicine and completed his residency in general surgery and surgery research fellowship at Medical Center Hospital, College of Vermont and UVM College of Medicine.

He completed a residency in cardiothoracic

HMH Pain Management Clinic Announces two New Providers

Harrison Memorial Hospital announces two new providers at the HMH Pain Management Clinic.

CYNTHIANA

LEXINGTON CLINIC ANNOUNCES 2016 BOARD OF DIRECTORS

LEXINGTON At Lexington Clinic’s annual meeting of the board of directors, held January 27, 2016, the following officers were elected to serve for the year.

1 President - Stephen C. Umansky, MD 2 Vice President - Michael T. Cecil, MD 3 Secretary – J. Elizabeth Lehmann, MD 4 Treasurer – Andrew C. McGregor, MD Other members of the board include Michael W. Eden, MD, Kimberly A. Hudson, MD, Mamata Majmundar, MD, Gregory V. Osetinsky, MD, and J. Sloan Warner, Jr., MD. “Our board of directors is leading a program assuring a culture of value-based care, and of placing the patient first with every decision,” said Umansky.

Lexington Clinic’s 2016 board

surgery at the University of Pittsburgh and a fellowship in congenital cardiovascular surgery at the Children’s Hospital of Boston.

At the Children’s Hospital of Boston, Pigula served as the clinical director of the pediatric cardiac surgery program since 2004, the director of the neonatal surgical program since 2010, and surgical director of the pediatric cardiac neurodevelopmental program since 2007 before moving to Louisville. He is a member of the American Association for Thoracic Surgery Scholarship Committee and Education Committee.

Pigula is widely published and is a nationally and internationally recognized expert in complex congenital heart disease. He is on the editorial board of Pediatric Cardiology, Journal of Thoracic and Cardiovascular Surgery, and Case Reports in Medicine, and is an ad hoc reviewer of The Annals of Thoracic Surgery, Pediatrics, The Journal of Heart and Lung Transplantation, Circulation and Journal of the American College of Cardiology.

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of directors is comprised solely of physicians from Lexington Clinic and its associate practices. It is appointed to govern and oversee all programs of Lexington Clinic in alignment with the core values and mission statement. ◆

Patrick Duff, CRNA, and Cristina Lamar, DO, join Anjum Bux, MD, in providing treatment options and management techniques to patients with either acute or chronic pain. Both providers began seeing patients in the fall of 2015.

The HMH Pain Management Clinic was established in February 2015. The clinic will diagnose acute and chronic pain and create individualized treatment plans for patients, based on a number of considerations, including the cause and level of pain.

ISSUE#98 | 25

NEWS

Patrick Duff, CRNA, is a certified registered nurse anesthetist. He earned his bachelor’s degree from Southern Adventist University, Collegedale, Tn. Duff then completed his CRNA certification program at Erlanger Medical Center, Chattanooga, Tn. He completed additional advanced pain management courses and training under Dr. O. C. James, II, in Lexington, Ky. Cristina Lamar, DO, has joined HMH Pain Management as well. Lamar earned a bachelor’s degree in biological sciences from University of Georgia, Athens, Ga. She then earned her Doctor of Osteopathic Medicine degree from the Georgia campus of Philadelphia College of Osteopathic Medicine, Suwanee, Ga. Lamar went on to complete her residency in anesthesiology and a chronic pain fellowship at University of Kentucky Chandler Medical Center, Lexington, Ky. The providers will create a plan of care tailored specifically to each patient— through medication, interventional procedures, and physical therapy. They commonly perform interventional procedures, such as epidural steroid injections, facet joint injections, selective nerve root blocks, and radiofrequency ablations.

Harper Named to U.S. Preventive Services Task Force

University of Louisville’s Rowntree Professor and Endowed Chair of Family and Geriatric Medicine, Diane Medved Harper, MD, has been appointed to the U.S. Preventive Services Task Force, an appointed panel that issues evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

Harper is one of four new members to the 16-member task force. Other new members are: John W. Epling, Jr., MD, State University of New York Upstate Medical University; C. Seth. Landefeld, MD, University of Alabama at Birmingham; and Carol M. Mangione, MD, University of LOUISVILLE

26 MD-UPDATE

BAPTIST HEALTH BOARD OF DIRECTORS ADDS NEW MEMBERS Baptist Health has added four new members to its board of directors for 2016.

The new board members are:

co-chair of the Greater Cincinnati Read On! Campaign.

LOUISVILLE

BRENT COOPER, President of C-Forward Information Technologies in Covington, Ky. He also serves on the Kentucky State Chamber Board, Covington Partners Board, and NKY Education Council Board. In addition, Cooper serves on the Fort Thomas Planning Commission and is

TERRY LESTER, recently retired pastor of First Baptist Church in London, Ky., now living in Frankfort. Dr. Lester continues to serve as a member of the board of directors of Baptist Health Corbin.

GLENN LEVERIDGE, market president for Central Bank in Winchester, Ky. He is a resident of Lexington and continues to serve on the board of Baptist Health Lexington.

AARON THOMPSON,

California, Los Angeles.

The task force is an independent volunteer panel of national experts in prevention and evidence-based medicine. Members come from throughout health-related fields, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. Members are appointed to serve four-year terms by the director of the Agency for Healthcare Research and Quality, a part of the U.S. Department of Health and Human Services.

In addition to holding an endowed professorship and chair, Harper also serves as a professor of obstetrics and gynecology in the Department of Obstetrics, Gynecology and Women’s Health; a professor of bioengineering at the Speed School of Engineering; and a professor of epidemiology and population health and of health promotion and behavioral health sciences in the School of Public Health and Information Sciences.

Her expertise and primary research focus is prevention, diagnosis, and treatment of diseases related to human papillomavirus.

PhD, Executive Vice President and Chief Academic Officer for the Kentucky Council on Postsecondary Education.

A resident of Richmond, he previously had been a member of Baptist Health Richmond’s board.

The Baptist Health Board of Directors is the governing board for the entire Baptist Health system to include its hospitals, healthcare facilities, programs, and affiliated corporations. The role of the Baptist Health Board of Directors is to provide oversight of the Baptist Health organization and ensure that it fulfills its mission. ◆

Ratajczak Honored by President of Poland

Mariusz Z. Ratajczak, MD, PhD, DSci, was presented with a Gold Cross of Merit by the President of Poland, Andrzej Duda, on January 22 in Warsaw. Ratajczak, a professor in the University of Louisville LOUISVILLE

Mariusz Z. Ratajczak, MD, PhD, DSci, received the Gold Cross of Merit from the president of Poland on January 22, 2016 in Warsaw.

NEWS

Department of Medicine, was recognized for his work in stem cell research and transplantation.

Ratajczak, a native of Poland, received the award at a ceremony marking the opening of the National Transplantation Congress in commemoration of the 50th anniversary of the first kidney transplant in Poland and the 30th anniversary of the country’s first bone marrow transplant. The Cross of Merit is a civil state award presented by the government of Poland to citizens who have gone beyond the call of duty in their work for the country and society as a whole. The award was established in 1923 to recognize services to the state and has three grades: gold, silver, and bronze.

Ratajczak is an internationally known specialist in the field of adult stem cell biology and is director of the Stem Cell Program at U of L’s James Graham Brown Cancer Center, a part of KentuckyOne Health. His 2005 discovery of embryoniclike stem cells in adult bone marrow tissues has the potential to revolutionize the field of regenerative medicine. These very small embryonic-like cells (VSELs) may lead to new treatments for cancer, heart disease, eye disease, diabetes, and neurodegenerative disorders.

“My work would not be possible without the longstanding support of Donald Miller, MD, PhD, director of the Brown Cancer Center, to my program,” Ratajczak said. “I also consider the award as recognition to my team of collaborators: Magda Kucia, PhD, DSci; Janina Ratajczak, MD, PhD, DSci; Malwina Suszynska, PhD; and Gabriela Schneider, PhD, who are working with me to employ VSELs in regenerative medicine.

Recently, Ratajczak’s research team has developed a promising strategy to expand VSELs, opening a door for using the cells in regenerative medicine as an alternative to other stem cells.

Ratajczak also is known for his work on novel mechanisms of mobilization and homing of stem cells, the biological role of extracellular microvesicles and molecular mechanisms of cancer metastasis. His work is supported by two R01 grants. He holds the Stella and Henry Hoenig Endowed Chair in Cancer Biology.

Ganzel Recognized for Army Medical Department Support

Lt. Cmdr. J. Patrick Staley, right, presents a U.S. Army Medical Recruiting Brigade certificate of Appreciation to Toni Ganzel, MD, dean of the University of Louisville School of Medicine, Thursday (Jan. 28) at the University Club on the U of L campus. The recognition was granted for the support shown by Ganzel and the medical school across a variety of activities, including partnership with U of L’s Paris Simulation Center with the brigade for education and training; the provision by U of L of discounted training supplies and training to uniformed personnel; access to medical school grounds for Brigade-sponsored Deployable Rapid Assembly Shelter or “DRASH” exercises showing field medical operations; interaction between Brigade personnel and U of L students and residents; and more. Ganzel also received a battalion coin in recognition of the relationship that continues through the U of L Office of Military Initiatives and Partnerships and the Patriot Partnership Program.

LOUISVILLE

SB 33 Passes KY Senate; Goes to House

THE Kentucky State Senate passed legislation today aimed at improving Kentuckians’ chances of surviving sudden cardiac arrest. The legislation passed by a vote of 32 to 6 with strong bipartisan support.

Senate Bill 33, sponsored by Senator FRANKFORT

Max Wise from Campbellsville, would ensure that Kentucky high school students receive basic CPR training as part of high school health education, physical education, or a Junior Reserve Officers Training Corps course that meets the physical education graduation requirement.

This bill is a major initiative of the American Heart Association both in Kentucky and nationally. In 2011, the association released a Scientific Advisory stating that bystander CPR training and an overview of AEDs should be required for all high school students. Such training would rapidly increase the number of people ready to respond to sudden cardiac arrest, a leading cause of death in the United States. If passed, Senate Bill 33 will make Kentucky the 28th state with such a law. Already more than a million students are being trained in CPR each year because of this initiative.

The bill now heads to the House for consideration.

Ten Kentucky Healthcare System Form Statewide Healthcare Collaborative

On January 28, 2016, 10 healthcare systems across the Commonwealth of Kentucky, collectively known as the Kentucky Health Collaborative, announced their primary objectives of raising the standards of care across the state, addressing the Commonwealth’s poor health statistics, and reducing the cost of care through greater operational efficiencies.

The founding health systems’ chief executive officers or appointed executives are serving on a steering committee guiding the formation and development of the collaborative.

The initial health systems that have signed on as charter members of the collaborative are: Appalachian Regional Healthcare (Lexington, Ky.)* Baptist Health (Louisville, Ky.) Ephraim McDowell Health (Danville, Ky.) LifePoint Health (Brentwood, Tenn.)

Norton Healthcare (Louisville, Ky.) Owensboro Health (Owensboro, Ky.) St. Claire Regional Medical Center (Morehead, Ky.) COMMONWEALTH OF KENTUCKY

ISSUE#98 | 27

NEWS

St. Elizabeth Healthcare (Edgewood, Ky.) The Medical Center (Bowling Green, Ky.) UK HealthCare (Lexington, Ky.)

*Parentheses designate location of organization’s headquarters Kentucky Health Collaborative is still in its early stages of development, and there are many details yet to be finalized, such as which issues and opportunities for improvement the group will tackle first.

As the collaborative develops the systems and infrastructure needed to accomplish its goals, the opportunity to join will extend to a wider pool of potential members across the Commonwealth.

In addition, the collaborative’s steering committee has hired William “Bill” L. Shepley as the organization’s inaugural executive director. Shepley, who has more than 25 years of experience as a health-

care executive at organizations such as the Southern Atlantic Healthcare Alliance and the Coastal Carolinas Healthcare Alliance, has devoted his career to developing and managing multi-facility alliances and networks to guide organizations through changes in the healthcare delivery system.

Hospitals Join Medicare ACOs

On January 11, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants – representing 49 states and the District of Columbia – in an innovative initiative – Medicare Accountable Care Organizations (ACOs) – designed to improve the care patients receive in the healthcare system and lowers costs.

KentuckyOne Health Partners was selected as one of nearly 150 renewing Medicare Shared Savings Program ACOs, LOUISVILLE

providing Medicare beneficiaries with access to high-quality, coordinated care across the United States, CMS announced today.

That brings the total to 434 Shared Savings Program ACOs serving over 7.7 million beneficiaries.

Doctors, hospitals, and healthcare providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow healthcare cost growth. KentuckyOne Health Partners will be one of 434 ACOs participating in the Shared Savings Program as of January 1, 2016. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs receive a portion of the Medicare savings generated from lowering the growth in healthcare costs as long as they also meet standards for high quality care. ◆

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--- J.B. Hunter, MD, Lexington Clinic “Why refer patients, family and friends elsewhere when we have such outstanding healthcare here in Kentucky? MD-Update keeps me abreast of the quality treatment programs in our region, facilitating expert care in our community.

--- John Stewart, MD, Fayette Surgical Associates Be part of Kentucky’s only Multimedia Magazine for Physicians, Healthcare Professionals and Decision-makers.

Contact MD-Update at: gdunn@md-update.com or (859) 309 0720.

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Lexington Medial Society Installs 2016 President, Recognizes Past Presidents Lexington Medical Society’s (LMS) annual President’s Inaugural Address and Past Presidents’ dinner was held Tuesday, January 19, 2016 at the Hillary J. Boone Center on UK’s campus. New LMS president Thomas K. Slaybaugh Jr., MD, a Lexington urologist, officially took office.

Rice C. Leach, MD, the commissioner of health for Lexington-Fayette County Health Department, was recognized for his outstanding leadership as LMS President in 2015.

Among those attending the presidential inauguration were 18 LMS past presidents, the most senior being David B. Stevens, MD, the 1968 president.

Slaybaugh addressed the membership emphasizing LMS’s new mission and vision statements focusing on the goal of “relevance and serving the community.” Slaybaugh promised to work to achieve goals of recruiting younger physicians for membership and promoting the LMS Physician Wellness Program, which is designed “as a safe harbor for physicians to address normal life difficulties in a confidential and professional environment.”

Kentucky Medical Association (KMA) Vice President Pat Padgett also addressed the gathering. Padgett made note of several KMA initiatives including Physicians Day at the Capitol, KMA’s effort to promote legislative policy action in tort reform, maintenance of certification, fair and transparent contracting, changes in third party reimbursement, and outdated state regulations. Padgett stressed KMA’s effort to affect public policy by being involved in Kentucky judicial elections The 2016 LMS leadership includes Danesh Mazloomdoost, MD, vice-president and Charles L. Papp, MD, beginning his second year as the secretary/treasurer. Robert P. Granacher, Jr., MD, is president-elect, and V. Theresa Little, MD, is the vice president-elect. Mamata Majmundar, MD, Khalil U. Rahman, MD, Tuyen T. Tran, MD, and Thomas H. Waid, MD, were appointed to the LMS Executive Board.

The Lexington Medical Society is a nonprofit 501(c) (6) organization that supports physician members to improve the practice of medicine and the health of the community. The LMS, established in 1799, is the second oldest medical society in the country. Learn more about the LMS and its programs at www.lexingtondoctors.org. ◆

EVENTS

LEXINGTON

LMS Past Presidents (l-r) Drs. Farhad Karim, Bruce Belin, Terry Clark, John White, Terry Grimm, Dan Kenady, Susan Spires, David Stevens, William Gee, David Bensema, Allen Grimes, Mike Moore, Harry Faulconer, Gary Wallace, Rice Leach, Andy Moore, Lisle Dalton, Bruce Broudy, John Collins, and Dale Toney.

(l-r) New LMS President Thomas K. Slaybaugh Jr., MD, with Past President Bruce Belin, MD.

LMS Vice President Danesh Mazloomdoost, MD, addressed the audience and introduced LMS past presidents.

(l-r) Jerry Suhl, MD, wife Sylvia Cerel-Suhl, MD, with Thomas Wayne Jr., MD, and wife Genie, came to honor new and past LMS presidents.

(l-r) Surgeon Dennis Newton, MD, with Jody and Terry Clark, MD, Pathology & Cytology Labs of Lexington.

George Privett, MD, Lexington Diagnostic & Open MRI, chatted with Bill Wheeler, MD, (ret) at the LMS past presidents’ dinner meeting.

(l-r) Former LMS president John Collins, MD, Lexington Clinic, and wife Peggy with Kitty and Andy Moore, MD, Plastic Surgeons of Lexington, LMS past president, founder of Surgery on Sunday, and recipient of Muhammad Ali Humanitarian award, joined the celebration.

Pat Padgett, KMA VP, urged the gathering to attend KMA Physicians Day in Frankfort in February.

PHOTOS BY JOE OMIELAN

ISSUE#98 | 29

EVENTS

Local Foods: Celebrate, Educate, Commemorate, and Inspire On January 29-30, 2016 nearly 1,400 enthusiastic farmers, market managers, researchers, service providers, and community food activists from all over the country arrived for Southern Sustainable Agriculture Working Group’s (SSAWG) 25th anniversary conference in Lexington, Kentucky.

The weekend event offered an extensive program of sessions, intensive courses, and field trips. SSAWG is committed to promoting sustainably and organically grown produce, which has been shown to be a healthier, more nutritious alternative to the industrial, genetically modified, and chemically treated foods so widely available to American consumers.

Farm to school – a local food procurement movement – and sustainable school garden projects were among the hot topics discussed at the conference. Farm to school food procurement is LEXINGTON

(l-r) Jo Carol Stephens and Anna Goodlett, staff at KentuckyOne Health Healthy Lifestyle Center at the Saint Joseph Hospital, officially open the Center with the ceremonial ribbon-cutting with Dr. Stephen Lin standing by.

KentuckyOne Health Opens Healthy Lifestyle Center at Saint Joseph Hospital Dignitaries, staff, and stakeholders gathered on Thursday, January 7, 2016 to celebrate the opening of the newest KentuckyOne Health Healthy Lifestyle Center at Saint Joseph Hospital, in Lexington.

The Healthy Lifestyle Centers are a new concept in prevention and wellness introduced by KentuckyOne Health in Louisville in 2014. The Healthy Lifestyle Centers provide medically supervised exercise, nutrition counseling, LEXINGTON

stress management, and more to help people get and stay healthy.

“This is a bold endeavor, building on the tradition of Saint Joseph heart care that includes the rehab center and the Ornish Reversal Program, which has been proven over three decades of testing to prevent heart disease and other chronic conditions as well as reverse cardio disease,” said Alice Bridges, vice president, healthy communities, KentuckyOne Health. ◆

KentuckyOne Health Office Park 1401 Harrodsburg Rd, Suite A-480 859.313.4793

John B. Lally CardioPulmonary Rehabilitation

(l-r) Bruce Tassin, president, Saint Joseph Hospital, and Steve Lin, MD, KentuckyOne Health Cardiology Associates, at the opening of the KentuckyOne Healthy Lifestyle Center at Saint Joseph Hospital.

30 MD-UPDATE

Saint Joseph East Medical Office Building 160 N. Eagle Creek Dr., Suite 300 859. 967. 5806 KentuckyOneHealth.org/ healthylifestyle

LEFT PHOTOS BY GIL DUNN, RIGHT PHOTO BY SHARI HAWLEY/ SSAWG

(l-r) Alex Hitt, author Wendell Berry, and Mac Stone, owner of Elmwood Stock Farm in Scott County, Ky., discuss some of the sustainable farming challenges they’ve overcome in the last 25 years.

an important effort in the fight against childhood obesity.

Students with access to local foods demonstrate a willingness to try new foods and show improved eating behaviors.

School gardens show students how food is grown and provide increased physical activity. Educational programs empower children and their families to make better-informed food choices. Another outcome is enhanced overall academic achievement in K-12 settings. In addition to improving child health, when schools buy local, they create new markets for local and regional farmers and contribute to vibrant communities.

Learn more about sustainable agriculture at www.ssawg.org. ◆

EVENTS

Central Kentucky Heart Ball Raises Funds for Local Research and Health Education

Over 680 corporate and medical professionals celebrated the accomplishments of the American Heart Association (AHA) at the 28th Annual Central Kentucky Heart Ball on Friday, February 5, 2016 at Lexington Center in downtown Lexington.

The black tie event honored the work and mission, the donors and volunteers and lives saved and improved because of the efforts of the AHA. The event honored Lexington native Laura Bell Bundy, a country music artist, Broadway star, and heart disease survivor. Also featured at the event was former UK basketball player Reggie Warford and local entrepreneur Tom Jones, both heart survivors.

Organizers say that over $500,000, a record for Central KY, was raised. All proceeds from the Heart Ball support the AHA which funds public and professional education, advocacy, and scientific research.

Research funded by the association has yielded important discoveries such as CPR, life-extending drugs, pacemakers, bypass surgery, surgical techniques to repair heart defects, and more.

The AHA has donated $15 million to medical research in the state of Kentucky in the last 10 years. ◆ LEXINGTON

(l-r) Courtney and Nick Abedi, MD, vascular surgeon with Kentucky One Health Surgery Associates.

(l-r) Michael Dobbs, MD, director of UK Stroke Center, with Gil Dunn, publisher of MD-UPDATE.

(l-r) The stylish couple Thomas Von Unrug, MD, internal medicine in private practice in Lexington, and wife Esther Von Unrug.

(l-r) Bruce Tassin, president of Saint Joseph Hospital, and wife Hallie, with Robert Salley, MD, executive director of Cardiovascular Services for Saint Joseph Hospital, and his wife Kristy Salley.

Melanie and Dermot Halpin, MD, cardiovascular surgeon with KentuckyOne Health Cardiovascular and Thoracic Surgery Associates.

(l-r) The always dapper Bill Henkel accompanies wife Mary Henkel, MD, Family Practice Associates of Lexington. (l-r) Amy and Michael Rukavina, MD, Lexington Cardiology at Baptist Health Medial Group, were ready to enjoy the Heart Ball.

(l-r) Gil Dunn, publisher of MD-UPDATE, with Dan Goulsin, MD, VP of Quality & Medical Affairs, CMO, Saint Joseph Hospital.

PHOTOS BY JOE OMIELAN

ISSUE#98 | 31

ARTS

Artist: Body at Lexington Art League

Curator Julien Robson and LAL reinvigorates their examination of the figure through the lens of self portraiture in contemporary art.

With the triumphant return on January 29, 2016 of the signature Fourth Friday series, Lexington Art League’s ‘A Figure Study, ushered in one of the most anticipated exhibitions of the organization’s season. Establishing the framework for themes in Artist: Body, ‘A Figure Study’ intimately explored the foundational and timeless subject of the body with exciting, interactive components.

Within the larger exhibition of Artist: Body, guest curator Julien Robson — former curator of Contemporary Art at The Speed Museum in Louisville — has explored major private collections and galleries from London to Cincinnati to translate the traditional figure show through the lens of self-portraiture in contemporary art. An unprecedented exhibition of iconic 20th and 21st century works, the LEXINGTON

ABOVE: (l-r) Enjoying the Fourth Friday at the Lexington Art League were Gil Dunn, publisher MD-Update, Amy and Rick Lozano, MD, with Pathology & Cytology Labs, Lexington.

ABOVE: Trying their hands at human figure

sketching at January’s Fourth Friday are Danesh Mazloomdoost, MD, Pain Medicine & Management and fiancé Andrea Omiday, Psy, PhD. LEFT: (l-r) Long time supporters of the arts, John Stewart, MD, Fayette Surgical Associates and wife Magdalene Karon, OB/GYN with Gil Dunn, MD-Update

cycle opens with the Artist: Body Opening Preview Party on February 19, 6-10pm, and Artist: Body Fourth Friday on February 26, 6-9pm. Both events are scheduled at the historic Loudoun House. The exhibition will close March 27.

A compelling survey of the artists’ image of themselves, Robson states, “Throughout the ages, images of the human body have been used by artists, often to explore allegory, beauty and sexuality. Time has witnessed many shifts in the way the body is portrayed and in recent decades, influenced by contemporary thinking and the availability of different visual technologies, artists have increasingly employed themselves as both the subject and object of their works.”

Much of the work in Artist:Body portrays the artists’s sense of ownership of her 32 MD-UPDATE

or his body and, most importantly, how it is represented. While the themes explored within the exhibition are vast and multi-layered, one prominent connecting fiber is the vulnerability each artist shares as they expose viewers - and in many cases showcase - their most intimate selves in working with their

PHOTOS PROVIDED BY LEXINGTON ART LEAGUE

own bodies. “In this context the image of the artists’ body is open and vulnerable, subject to self analysis and intimate dissection, while at the same time resisting a comprehensive interpretation.” Robson further added.

Among others, Artist: Body includes works by Louis Zoellar Bickett, John Coplans, Julius Deutschbauer,Bryce Hudson, Thaniel Ion Lee, Gabriel Martinez, Cynthia Norton, Cindy Sherman, Xaviera Simmons, Kiki Smith, Annie Sprinkle, Hannah Wilke, and Sam Taylor Wood.

“The examination of the figure has long been a foundational practice for LAL and we are thankful to Julien for lending a new perspective to this timeless subject. Through an extraordinary collection of self-portraits that illustrate the daring practice of depicting the self and its changing identities through art, Robson has curated an intense and thoughtful exhibition with the highest level of conceptual integrity” said Stephanie Harris, Executive Director LAL. “We are also thankful for the continued support of our longstanding partners at qx.net for their generous commitment through their sponsorship of this exhibition cycle.” Harris further stated.

MD-Update is a media sponsor of the Artist: Body exhibit and Preview Party at the Lexington Art League. ◆

Lexington

Art League

Artist: Body February 19 through March 27 Fourth Friday: Curator Conversations with Julien Robson March 25, 6-9pm

Louis Zoellar Bickett What I Read (Holy Bible), 2015 Inkjet print

All Lexington Art League programs are made possible through the generous support of LexArts. LexArts allocation of $ All Lexington Art League programs are made possible through the generous support of LexArts. LexArts allocation of $50,000 represents the largest single donation to the operations of the Lexington Art League.The Kentucky Arts Council, a state arts agency, provides op single donation to the operations of the Lexington Art League.The Kentucky Arts a state agency, operating support to the Art League withCouncil, state tax dollars andarts federal funding provides from the National Endowment for the Arts.Lexington Additional support provi Recreation.

Art League with state tax dollars and federal funding from the National Endowment for the Arts. Additional support provided by Lexington Parks & Recreation.

net

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