Volume 12
Issue 4
April 2013
SYSTEMnews CEO’s corner Ralph W. Muller
CEO, University of Pennsylvania Health System
As you probably know, Congress and President Obama were unable to come to an agreement that would have avoided the automatic spending cuts known as sequestration. Unless an agreement is reached soon, this will mean an $85 billion reduction in spending for the remainder of the federal fiscal year, which ends on September 30th. About half of that amount would come from a five percent across-the-board cut in discretionary domestic spending. The other half would come from an eight percent reduction in defense spending Medicaid is exempt from the sequestration cuts, but two-percent cuts in Medicare provider payments and fivepercent reductions in other federal health-care programs, including biomedical research, could soon begin to affect hospitals and health-care organizations nationwide. Naturally, we at Penn are not immune from the effects of such cuts and our hope is that they will be reversed. But if they aren’t, the quality of care that we provide to our patients will still remain exceptional. Because of careful planning and our continuing focus on using resources sensibly, we can weather the reductions triggered by sequestration. We’ve been working hard over the past several months to develop a strategy for addressing potential cutbacks such as the ones that have now been officially put into play. As a result — and because we’re a fiscally sound institution — the Health System is well prepared to continue delivering on its mission. Also, the Perelman School of Medicine will continue providing world-class training of future physicians, and faculty members will still perform high-caliber research that offers fresh hope to patients worldwide. To sustain our ability to address the ramifications of sequestration, we are fully invested in a two-track approach. First, we’ll continue to refine our short-term plan for ensuring that core activities continue in an uninterrupted manner and at a high level. Second, we’re working closely with our peer institutions and professional organizations to help Washington understand the potentially serious national consequences of the healthcare cuts.
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Inside The Envelopes, Please!............2 Rubenstein to Step Down.................................2 New Features Available at myPennMedicine..................2 From Pastels to PDA’s...............2 Penn Medicine@Work..............3 RoundtableFree Skin Cancer Screening......................3 Newsmakers..............................4 Shortakes...................................4 A Focus on Quality & Patient Safety.........................5 Another Title..............................5 Awards and Accolades.............6 SOM Ranked #2.........................6
Penn Orthopaedics
Expanding services to meet all musculoskeletal needs
“There’s one Penn Medicine. Now, there’s one Penn Orthopaedics.” That’s how L. Scott Levin, MD, chair of Orthopaedic Surgery, described the changes occurring in orthopaedics throughout the Health System. With the expansion of orthopaedic services at Pennsylvania Hospital, “we’re working towards a musculoskeletal product line that’s collaborative and multidepartmental.” Noting that both PAH and Penn Presbyterian will provide treatment in 10 orthopaedic specialties (see sidebar on page 2) — and that HUP will provide multiple orthopaedic services as well — he called it “bookends of care... east and west.” With its wide range of services, Penn orthopaedic surgeons can treat any musculoskeletal problem. But, beyond total joint replacement and other routine procedures, its patients are receiving cutting-edge treatments that are unique in the region.
Correcting Imbalances After a stroke or brain injury, a patient may experience a severe loss of movement. As neuro-orthopaedist Keith Baldwin, MD, explained, the signal going from the brain to a muscle gets scrambled. The result: Muscles don’t work as they should. That’s what happened to a woman who suffered a stroke at 48. By the time she came to see Baldwin two years later, she had developed a neuromuscular club foot which had left her unable to walk and in a wheelchair. “The stroke caused her foot to curve inward, with the toes pointing down,” he said. “A club foot is very difficult to walk on. In fact, it’s one of the most debilitating deformities.” A club foot generally results from a muscle imbalance — too much pull on one side and too little on the other. Such was the case with Baldwin’s patient. Correcting the imbalance involved making the overactive muscle relax and performing tendon transfers, which allowed the foot to straighten. “The patient is now able to walk almost totally without assistance.” This approach and others have helped many patients affected by spasticity, fixed muscle shortening, and loss of mobility which left them with problems such as stiff-knee gait, hip and knee deformities, and stiff
shoulder. One patient with a brain injury couldn’t throw a ball due to his arm “catching involuntarily.” Baldwin compared it to how a person’s leg jerks involuntarily when the doctor taps the knee. The patient had a simple goal: being able to throw a ball to his son. Baldwin lengthened the patient’s bicep, which weakened the muscle and eliminated the involuntary movement. “Now the triceps work the way they’re supposed to and he’s reached his goal. “We can’t fix a brain or spinal cord, but, by relaxing or redirecting a muscle or tendon, we can give the patient a better quality of life.”
Helping to Regrow Cartilage Joint cartilage is the flexible connective tissue that coats the ends of bones to keep them moving against one another smoothly. According to James Carey, MD, director of the Penn Center for Advanced Cartilage Repair and Osteochondritis Dissecans Treatment, cartilage is 1000 times more slippery than ice! “That’s why we can take a million steps a year without a problem.” Unlike skin, cartilage cannot heal itself. Therefore, left untreated, tears get bigger and bigger, often leading to arthritis. Cartilage tears most frequently happen when the knee cap dislocates or there’s an injury to the anterior cruciate ligament. “It generally occurs in contact and collision sports,” Carey said, adding that year-round athletes are also more likely to develop osteochondritis dissecans (OCD), a rare — and often misdiagnosed — condition in which a fragment of bone and cartilage separates, causing pain, swelling and mechanical issues. While cartilage isn’t self-healing, certain procedures can help it regrow. But repairing cartilage is not easy. “It requires special training and there’s a steep learning curve,” Carey said. Plus there are specific rehab protocols for these patients. Procedures to repair cartilage differ according to the size of the tear. For example, in smaller defects in the cartilage, Carey uses microfracture, making small holes in the bone to stimulate cartilage growth. “It’s the most common procedure.” An autologous chondrocyte implantation fills a large defect with millions of cells grown from a small piece of the patient’s own cartilage. (continued on page 2)
Celebrating Art & Life.............. 6
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