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au g u s t 2 014

Convenient, Comprehensive Heart Care

Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth

T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Also in This Issue

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The Triangle Physician

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Local physician specialists and other professionals, affiliated with local businesses and organizations, contribute all editorials or columns about their respective specialty or profession.

Every issue includes the latest listing of: MDs and PAs who are newly licensed by the NC Medical Board and New MDs and PAs to the area.

We also publish free of charge: • Practice, hospital and other medical facility news, including: • New MDs and PAs; • New facilities, expansions and relocations;

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6

COVER STORY

Convenient, Comprehensive

Heart Care Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth

a u g u s t 2 0 14

FEATURES

12

Weight Management

Educating Patients on Effective Exercise Strategies Lindsay Wojciechowski shares guidance that optimizes health and weight loss.

14

Vol. 5, Issue 5

DEPARTMENTS 9 Gastroenterology

18 UNC Research News

Making the Most of the Office Visit

Discovery May Lead to Safer Alternative to Blood Thinners

10 Practice Management Using Outsourcing Effectively

15 Duke Research News $15 Million Is to Advance Treatments for Autism, Other Brain Disorders

16 Duke Research News Technology

The Digital Age: Improved Patient Communication, Diagnosis and Treatment Tools Dr. Laura Briley explores areas in which the

New Technologies Empower Patients and Enhance Data Collection

19 UNC News $6 million Grant Awarded to Innovative Back Care Program

20 News Welcome to the Area

21 News North Carolina Medical Society Names New Employees

17 News - De Shazo Is Named North Hospital Vice President and Administrator - Wake Radiology Opens Outpatient Imaging Office in Smithfield

Internet supports the health care process. COVER PHOTO: Interventional cardiologist Steven J. Filby (left) shares leadership of the FirstHealth Valve Clinic with cardiothoracic surgeons Peter I. Ellman and Art Edgerton (not pictured).

2

The Triangle Physician


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From the Editor

Specialty Care Close to Home FirstHealth Valve Clinic – this month’s cover story – is bringing new-generation cardiac and vascular care home to residents of the mid-Carolinas region. T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S

Here, patients are treated collaboratively by a multidisciplinary team led by a cardiovascular and thoracic (CVT) surgeon and an interventional cardiologist. The latest technology includes TAVR, transcatheter aortic valve replacement. Read on to learn more about the FirstHealth health care team and the specialized diagnostic and treatment services provided.

Also in this issue, dermatologist Laura Briley reflects on digital technology’s role in creating patients that are more engaged in their health care and how it has enhanced diagnosis and treatment, especially in her specialty. Gastroenterologist Douglas Drossman offers valuable self-management counseling guidelines that can improve outcomes. Nurse practitioner Lindsay Wojciechowski discusses exercise as a weight management strategy and the benefits of interval and strength training.

Consultant Margie Satinsky sheds light on the importance of outsourcing, especially when specialized expertise within a medical practice is lacking in areas like billing and collections, information technology support, human resources and compliance.

Contributors in The Triangle Physician are bringing their messages home, so to speak, straight to their intended target: the more than 9,000 physicians, physician assistants, nurse practitioners and office administrators and staffers throughout eastern North Carolina. Cover story and advertising costs are competitive. Columns offering medical insight and articles on medical and practice news run at no cost, space permitting.

One of this country’s greatest medical communities is in your backyard. For more information about making a direct connection with these referral sources, contact me at heidi@trianglephysician.com.

With gratitude for all you do,

Heidi Ketler Editor

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The Triangle Physician

Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Laura D. Briley, M.D. Douglas Drossman, M.D. Margie Satinsky, M.B.A. Lindsay Wojciechowski Creative Director Joseph Dally jdally@newdallydesign.com

Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com

The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401

Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors. Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information. All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography. Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.


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Cover Story

Convenient, Comprehensive

Heart Care

Heart Valve Clinic, Newest TAVR Technology Available at FirstHealth Comprehensive treatment for patients with

ing or intervention, FirstHealth offers the

Ellman. “Many patients with severe aortic

heart valve disease, including the transcath-

added benefit of local convenience. “Most

stenosis who were thought to be too high-

eter valve replacement, is now available

patients and their families prefer to avoid

risk for conventional surgery did not have

in the mid-Carolinas region at FirstHealth

the traffic of the larger cities, if at all pos-

any viable options in the past. These pa-

Moore Regional Hospital in Pinehurst. Pa-

sible,” says Dr. Filby. “Also, families have the

tients were basically left to be treated with

tients with suspected valve disorders can

convenience of going home at night if their

medicine alone. TAVR has given us an op-

be referred to the FirstHealth Valve Clinic,

loved one is hospitalized, or FirstHealth of-

tion for these historically hopeless patients

which is led by interventional cardiologist

fers the Clara McLean Hospitality House on

who likely would have died from their aortic

Steven J. Filby, M.D., and cardiothoracic

the hospital campus for those families who

valve disease.”

surgeons Peter I. Ellman, M.D., and Art Edg-

have traveled from farther distances. In ei-

erton, M.D.

ther case, families can be part of the recov-

TAVR uses a small catheter that gets striated

ery process.”

over a wire that is then inserted either transfemorally or transapically. This catheter

The FirstHealth Valve Clinic offers a collaborative, multidisciplinary approach to

Newest Technology

goes across the aortic valve, and the bal-

treating valve disease focused on delivering

One of the newest valve treatments on the

loon on which the valve is seated is inflated,

the best treatment plan for each individual

market is now available at FirstHealth. TAVR

expanding and pushing the patient’s valve

patient. Valve disorders that may be appro-

— transcatheter aortic valve replacement —

to the side. The new valve springs open, the

priate for referral to the clinic include aortic

is indicated for patients who are surgically

balloon deflates, and the new valve begins

stenosis, pulmonary stenosis, mitral ste-

high-risk and would not be able to tolerate

to function. Inpatient recovery is typically

nosis and mitral regurgitation. Treatments

traditional open-heart aortic valve replace-

three to four days.

range from observation and medical man-

ment. “We’ve had great success with the TAVR so

agement to surgical interventions.

far,” says Dr. Filby. “Patients who have come “The FirstHealth Valve Clinic is a ‘one-stop

in wheelchair-bound because of shortness

shopping’ model, whereby the patient has a

of breath are up and walking in just a few

dual appointment with both a CVT surgeon

days. Also, in addition to TAVR, there are

and an interventional cardiologist,” says Dr.

more exciting developments on the horizon

Filby. “After seeing the patient and review-

for valve treatment, and we look forward to

ing the diagnostics, the physicians confer

offering them here at FirstHealth.”

privately and return to the patient with an

Transcatheter heart valve device used in transcatheter aortic valve replacement (TAVR) procedures.

As an interventional fellow at the Cleveland

sicians’ experience and skill sets, and gets

“TAVR is a catheter-based aortic valve re-

Trial, a seminal 2010 study that demonstrated

away from one physician making treatment

placement that doesn’t require the use

TAVR’s benefits for United States patients.

recommendations based solely on his own

of the cardiovascular bypass pump, and

skills.”

it’s truly revolutionary in what it can of-

Reid Heart Center

fer patients who are prohibitively risky for

FirstHealth leads the region in advanced

conventional open-heart surgery,” says Dr.

heart care, and that tradition continues with

individualized treatment plan. This multidisciplinary model incorporates both phy-

When valve patients require extensive test-

6

The Triangle Physician

Clinic, Dr. Filby was part of the PARTNER


the Reid Heart Center. All heart services

his medical degree from the University of

fellowship at UNC Hospital in Chapel Hill;

are offered in the state-of-the art heart cen-

Pennsylvania. He completed his residency

and a two-year interventional cardiovascu-

ter, which includes unique operating rooms

in general surgery at the University of Vir-

lar and endovascular fellowship at Ohio’s

that allow cardiologists and heart surgeons

ginia and his cardiothoracic training in

renowned Cleveland Clinic Foundation.

to work together at the same time.

Gainesville at the University of Florida. He

Dr. Filby is board certified in internal medi-

is certified by the American Board of Sur-

cine, cardiovascular disease and interven-

gery and the American Board of Thoracic

tional cardiology, and is board eligible in

Surgery.

vascular medicine.

John F. Krahnert Jr., M.D., Cardiovas-

Peter L. Duffy, M.D., F.A.C.C.,

two or more procedures combined

cular Thoracic Surgeon, FirstHealth

Interventional Cardiologist,

in one visit

Cardiovascular & Thoracic Center

FirstHealth Cardiology Services-

• 57 private rooms

The founder of FirstHealth of the Carolinas’

Pinehurst

• Cardiac catheterization

heart surgery program, Dr. Krahnert gradu-

Dr. Duffy graduated from Lafayette College

• Bedside registration

ated from Wake Forest University with a

in Easton, Pa., and earned his M.D. from

• The region’s most advanced electro-

B.A. in biology and earned his M.D. from

New York Medical College in Valhalla, N.Y.

the Bowman Gray School of Medicine in

He received his master in medical manage-

Features of Reid Heart Center include: • Six operating rooms with advanced technology • Two multi-use operating rooms for

physiology equipment and procedures

Winston-Salem. He completed both his in-

ment degree from Carnegie Mellon Univer-

Reid Heart Center Team

ternship and residency at the University of

sity. He completed his internship and resi-

Art Edgerton, M.D., Cardiovascular

Kentucky Medical Center, as well as a fel-

dency at St. Vincent’s Hospital and Medical

& Thoracic Surgeon, FirstHealth

lowship in cardiovascular and thoracic. He

Center in New York, N.Y., and then did a

Cardiovascular & Thoracic Center

is certified by the American Board of Sur-

fellowship in cardiology at Georgetown

Dr. Edgerton earned his bachelor’s degree

gery and the American Board of Thoracic

University and the Veterans Administration

in chemistry from Wake Forest University

Surgery and serves as chief medical officer

Medical Center in Washington, D.C. He

and his medical degree from the Bowman

for FirstHealth of the Carolinas.

is board certified by the American Board of Internal Medicine in Internal Medicine,

Gray (now Wake Forest) School of Medicine. He completed his general surgery

Steven J. Filby, M.D., Structural,

Cardiovascular Diseases and Intervention-

residency and a fellowship in cardiotho-

Peripheral & Coronary Interventional

al Cardiology. He is a Fellow of the Ameri-

racic surgery at Wake Forest University

Cardiologist, FirstHealth Cardiology

can College of Cardiology and the Society

Baptist Medical Center. He is certified by

Services-Reid Heart Center

of Cardiac Angiography and Intervention.

the American Board of Thoracic Surgery.

Dr. Filby graduated from Harvard University with a B.A. in biological anthropology

Peter J. Vassallo, M.D., F.A.C.C.,

Peter I. Ellman, M.D., Cardiovascular &

before earning his M.D. from Louisiana

Cardiologist, FirstHealth Cardiology

Thoracic Surgeon, FirstHealth Cardio-

State University Medical School. He com-

Services-Pinehurst

vascular & Thoracic Center

pleted an internship and residency in inter-

Dr. Vassallo graduated from Fordham Univer-

Dr. Ellman attended Dartmouth College,

nal medicine at Stanford University Hospi-

sity in Bronx, N.Y., and earned his M.D. from

where he majored in English. He earned

tal in Palo Alto, Calif.; a general cardiology

Universidad del Noreste School of Medicine.

The FirstHealth Heart Team (from left): Cardiologist Debbie Wright-Thomasson, M.D.; interventional cardiologist Peter L. Duffy, M.D.; cardiothoracic surgeon Art Edgerton, M.D.; cardiologist ‘Jide G. Lawal, M.D.; electrophysiologist Mark D. Landers, M.D.; cardiothoracic surgeon John F. Krahnert Jr., M.D.; cardiothoracic surgeon Peter I. Ellman, M.D.; cardiologist David J. Shin, M.D.; cardiologist Peter J. Vasallo, M.D.; cardiologist H. Allen Strunk, D.O.; and interventional cardiologist Steven J. Filby, M.D.

august 2014

7


He completed his internship, residency and

Va. He completed his internship and resi-

Md., and a medical degree from Tulane

a cardiology fellowship at Bridgeport Hospi-

dency, as chief resident, in the University

University School of Medicine in New

tal at Yale University School of Medicine in

of Connecticut Medicine Program. He then

Orleans, La. He did his internship and

Bridgeport, Conn. He is board certified in

completed a fellowship in cardiology and

residency in internal medicine at Tulane,

internal medicine, cardiovascular diseases

electrophysiology at the University of Colo-

where he also completed a fellowship in

and nuclear cardiology. He is a fellow of the

rado Health Sciences Center in Denver. Dr.

cardiology. He is board certified in inter-

American College of Cardiology.

Landers is board certified in internal medi-

nal medicine, cardiovascular diseases and

cine, cardiovascular diseases and clinical

nuclear cardiology. He is a fellow of the

H. Allen Strunk, D.O., F.A.C.C.,

cardiac electrophysiology. He is a fellow of

American College of Cardiology.

Cardiologist, FirstHealth Cardiology

the American College of Cardiology and a

Services-Pinehurst

member of the Heart Rhythm Society.

Debbie Wright-Thomasson, M.D., F.A.C.C., Cardiologist, FirstHealth

Dr. Strunk graduated from Gettysburg College in Gettysburg, Pa., and earned his D.O.

â&#x20AC;&#x2122;Jide G. Lawal, M.D., F.A.C.C.,

Cardiology Services-Hoke

from Philadelphia College of Osteopathic

Cardiologist, FirstHealth Cardiology

Dr. Wright-Thomasson earned a B.S. de-

Medicine. He completed his internship

Services-Rockingham

gree in home economics from Texas Tech

and residency at Youngstown Hospital As-

Dr. Lawal graduated from the University of

University in Lubbock; an M.S. degree in

sociation in Youngstown, Pa., and Harris-

Lagos, Lagos, Nigeria, where he also earned

nutrition from Texas Womenâ&#x20AC;&#x2122;s University

burg Hospital in Harrisburg, Pa. He then

his M.D. He completed his internship, resi-

in Denton; and her medical degree from

completed a fellowship in cardiology at

dency and cardiology fellowship at Colum-

the University of Texas Medical Branch

Allegheny General Hospital in Pittsburgh,

bia University College of Physicians and

in Galveston. She completed her intern-

Pa. Dr. Strunk is board certified in internal

Surgeons at Harlem Hospital Center, New

ship with the University of Texas Medical

medicine and cardiovascular diseases. He

York, N.Y. Dr. Lawal is board certified in

Branch, John Sealy Hospitals, in Galveston,

is a fellow of the American College of Car-

internal medicine, cardiovascular diseases

and her residency in internal medicine

diology.

and nuclear cardiology. He is a fellow of the

with Texas Tech University Health Sciences

American College of Cardiology.

Center, University Medical Center in Lubbock. She is board certified in cardiology,

Mark D. Landers, M.D., F.A.C.C., Electrophysiologist, FirstHealth

David J. Shin, M.D., F.A.C.C.,

Cardiology Services-Pinehurst

Cardiologist, FirstHealth Cardiology

Dr. Landers graduated from Utah State

Services-Rockingham

University, and earned his M.D. from East-

Dr. Shin earned a B.A. in chemistry from

ern Virginia Medical School in Norfolk,

Johns Hopkins University in Baltimore,

nuclear cardiology and echocardiography.

Reid Heart Center, the FirstHealth Cardiac and Vascular Institute at Moore Regional Hospital, features the next generation of cardiac and vascular care.

8

The Triangle Physician


Gastroenterology

Making the Most of the Office Visit By Douglas A. Drossman, M.D.

Patients with chronic illnesses have a

Step 5: Know your rights…

better chance of reaching improved

• To be treated with respect.

health outcomes when they understand

• To ask questions and voice your

the role of self-management. Physicians

opinions.

can help their patients adopt a greater

• To disagree as well as agree.

self-management role by offering some

• To say “no” without guilt.

practical guidance during the clinic visit. Step 6: Recognize and accept I have found that the following 10 steps

emotions.

lead to better outcomes for my patients

• Mind and body are connected.

with functional gastrointestinal and believe

• Strong emotion affects pain, for better

they can improve the clinical experience for all providers and their patients.

or worse. • By acknowledging and dealing with your emotions you can reduce stress

Step 1: Accept.

and decrease the pain.

• Accept that your symptoms are there. • Learn all you can about your condition and its management. • Knowledge is therapeutic.

Step 7: Relax. • Stress lowers pain threshold and increases symptoms. • Relaxation helps reclaim control over

Step 2: Get involved. • Take an active role. • Develop with your doctor a partnership in the care. • Understand your doctor’s recommendations and maintain an

one’s body and reduces pain. • Relaxation options to consider: - Deep breathing - Relaxation response - Hypnosis - Yoga and meditation

open dialog. Step 8: Exercise… Step 3: Set priorities.

• Diverts attention from your symptoms.

• Look beyond your symptoms to the

• Increases one’s sense of control in life.

things that are important in your life.

important.

• Share your thoughts and feelings with

• With these steps your symptoms are no • Focus on abilities not disabilities.

• Set goals within your power to

• You will then see you can live a more

manageable steps • Take the time to enjoy the success of reaching your goals

your provider. • Talk and interact with family and

Step 4: Set realistic goals. accomplish

Drossman Gastroenterology P.L.L.C. (www.drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.

Step 10: Reach out. Step 9: Refocus. longer the center of your life.

• Break a larger goal into small

Dr. Drossman is president of the Rome Foundation (www.theromefoundation. org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www.drossmancenter.com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patientprovider relationship.

• Helps you feel better about yourself.

• Do what is important. • Eliminate or reduce what is not

Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment.

normal life.

friends in healthy ways. • Support others and seek support from them as well.

For more information about patient self-management, patients and providers, alike, can benefit from visiting the following blog on our practice website: http://drossmancenter.com/suffering-chronic-gi-symptoms-heres-make-doctor-visit

JULY 2014

9


Practice Management

Using Outsourcing

Effectively By Margie Satinsky

You know how medicine works. You

actual reimbursement; the numbers don’t

provide patient care in the areas in which

always match.

Margie Satinsky is president of Satinsky Consulting, L.L.C., a Durham consulting firm that specializes in medical practice management. Ms. Satinsky is the author of numerous books and articles, including Medical Practice Management in the 21st Century.

you are trained and board certified, and you refer patients to your colleagues when

If you outsource some or all of your

in your collections. Outsourcing billing and

they need care that you can’t provide.

managed

collections could be an attractive solution.

care

work,

ask

potential

consultants about their experience in The same principle applies to practice

North Carolina. Many consultants prefer to

When you talk with vendors that provide

management. As the job of managing a

work on all of your managed care contracts

billing and collections services, ask about

medical practice increases in complexity, it

simultaneously, rather than one at a time.

company ownership, structure, history and

makes sense to determine what’s best done

We prefer that approach, as it provides

long-term goals. Seek examples of results

internally and what might be outsourced to

a broad picture of the entire landscape,

with current clients.

an external professional with expertise that

offering opportunities for leverage. Given your financial situation, what one-

you lack. Select a consultant who will let go of

time savings and long-term results are

Let’s talk about two topics: what functions

the reins, teaching someone in your

projected for your practice? How does the

are often outsourced and how to select a

practice what to do in the future so you

vendor service new accounts, and who will

consultant or vendor. Practices commonly

can eventually do the work yourself.

be your service representative? Will the

outsource the functions of managed

Most consultants charge a fixed rate for a

vendor clean up accounts that are older

care, billing and collections, information

specific number of contract re-negotiations

than 90 days and, if so, will there be an

technology support, human resources and

or an hourly rate. An incentive-based

extra charge for the service? Is the vendor

compliance.

consulting fee that is tied to increases in

available and willing to meet regularly with

reimbursement is theoretically appealing

your practice so that you can identify and

Managed Care

but difficult to implement, because most

correct operational issues?

An external consultant with managed care

practices are not informed on the current

experience can help you review contracts

reimbursement by code and by plan.

Most billing and collections vendors charge a percentage of revenue collected or a flat

that you have in place and verify your current rates of reimbursement. You should

Billing and Collections

monthly fee. Be sure to ask about start-up

already know that insurers don’t knock on

Obtaining managed care contracts that

costs, such as license fees, hardware and

the door offering higher rates; you have to

offer favorable reimbursement doesn’t

network connections. Finally, ask what

ask for better reimbursement and justify

guarantee that the entire revenue cycle

software the vendor uses. If you have

your request with documentation of quality

management process in your office will

already purchased an integrated practice

or other features.

work smoothly. The methodology by

management/electronic health records

which you capture patient demographic

system from a vendor that offers outsourced

Experienced consultants know how each

information, verify insurance coverage,

billing and collections at an additional

plan pays (e.g., percentage of Medicare

code, submit claims, monitor denials and

charge, it may make sense to purchase that

Resource Based Relative Value Scale –

collect all impact the revenue that you

additional service from the same vendor

RBRVS – and/or proprietary fee schedule)

ultimately receive.

rather than choosing a different vendor that uses different software.

and can negotiate increases in your reimbursement. They can review contract

Staffing issues also can have a negative

language and other plan materials to

impact on your bottom line. For example,

Information Technology

ensure there are no hidden bombshells.

if you have frequent staff turnover, your

Successful practice management in the

They can also guide you in developing

accounts receivable statistics may not meet

21st century depends on your ability to

systems for comparing expected with

industry standards, and you may fall behind

select and use a practice management

10

The Triangle Physician


system, electronic health record system

experienced in that aspect of medical

themselves at great risk.

practice management. Consultants other

and an interactive website linked to a You should have a formal compliance plan

than legal counsel can help you with

that addresses Medicare and Medicaid

operational issues, such as policies and

Many small practices lack the internal

issues, and you should also be compliant

procedures. Most attorneys and other

expertise

maintain

with other relevant rules and regulations

consultants charge an hourly rate.

information technology (IT) applications.

such as OSHA, CLIA and HIPAA Privacy

My own IT support vendor ranks closely

and Security. With respect to HIPAA, the

Remember, you don’t have to do everything

behind my family in importance. When

Omnibus Final Rule that went into effect

internally. If the increasing complexity

my system is having problems, my family

in 2013 changed some of the original

of medical practice management feels

drops to second place!

requirements, so make sure you are up to

overwhelming, investigate the outsourcing

date.

option, keeping in mind that your external

patient portal.

to

select

and

partners will work best with internal

Check the experience and stability of the support vendor that you select. How does

The

the vendor recruit and train staff, and are

compliance plan is an attorney who is

best

resource

for

creating

a

support and guidance.

they certified? How does the IT support vendor charge for services (hourly or monthly rate, special “after hours” rate), and what’s the method for prioritizing requests for assistance? Human Resources Your employees are your most important assets.

Recruiting,

hiring,

firing,

supervising, training, performing regular evaluations, making sure you comply with state and federal law, reviewing your benefit package and upgrading your salary scales are some of the tasks that you should be doing on a regular basis. You have three options for outsourcing. You can ask an external consultant to do one or more of these tasks. You can also ask a single vendor to help with multiple human resource tasks in what is called business process outsourcing (BPO). You can also partner with a professional employer organization (PEO). With the PEO option, your employees are actually on the payroll of the PEO and you “lease” them back. Compliance If managed care ranks first as the aspect of practice management that physicians hate, compliance ranks a close second. Believe it or not, some practices don’t pay any attention to compliance at all, putting Womens Wellness half vertical.indd 1

12/21/2009 4:29:23 PM

august 2014

11


Weight Management

Educating Patients on Effective Exercise Strategies By Lindsay Wojciechowski

Health care professionals nationwide are

• An equivalent mix of moderate and

struggling to manage the overwhelming

vigorous-intensity aerobic activity and

epidemic of obesity. Within an ever-chang-

muscle strengthening as mentioned

ing health care system, providers are chal-

above.

lenged with the need to see more patients in less time, and few of us have the time

Moderate-intensity aerobic activity, de-

or the background to educate our patients

fined by the CDC (www.cdc.gov) is physi-

about effective weight-loss strategies.

cal activity done at three to 5.9 times the intensity of rest, or a 5-6 effort on a 0-10 scale

Patients have more co-morbidities than

relative to the person’s capacity. Vigorous-

ever, most of which require complex man-

intensity exercise is defined as a 7-8 effort.

agement and significant patient education. Many of these co-morbidities are directly

Working Up to Aerobic Activity

or indirectly related to obesity.

After you determine that the patient is medically clear to exercise, obese adults

Currently in North Carolina, 64.9 percent of

not currently exercising should start by

adults are overweight (body mass index,

building their capacity to do work.

Lindsay A. Wojciechowski is a nurse practitioner and consultant to the Women’s Wellness Clinic and the Carolina Women’s Research and Wellness Center (CWRWC). She has worked as a clinical nurse practitioner for Triangle Family Practice at Duke University Medical Center since 2006. She also has taught courses at the Duke University School of Nursing. Ms. Wojciechowski’s focus is on women’s health and family medicine, and she also is the lead medical writer for the Women’s Wellness Clinic.

by periods of rest. Interval training is more effective than long, steady cardio exercise,

or BMI, greater than or equal to 25) and 27.8 percent are obese (BMI greater than

Matthew Alegre, an experienced certi-

because it results in greater weight loss

or equal to 30).

fied strength and conditioning specialist

(specifically lower overall fat percentage),

(CSCS) and BioSignature practitioner in

while retaining/gaining lean muscle mass.

Effective weight management requires a

Chapel Hill (www.carpediemstrong.com),

Increased muscle mass leads to more

proper diet, behavioral modification and

advises walking at approximately 60 per-

long-term energy expenditure, facilitating

physical activity. This article addresses

cent of maximum heart rate three to four

further weight loss.

how providers can help guide weight loss

times a week (for a total of 150 minutes).

through exercise, especially for those pa-

Exercise

tients frustrated with their lack of weight

After three weeks, the patient has accli-

(EPOC) – the “after-burn,” or the calories

post-oxygen

consumption

loss from their exercise plan.

mated to this exercise and should switch

expended (above resting level) after exer-

to a higher intensity pace (80 percent of

cise – is greater in those doing short, in-

The Centers for Disease Control and Pre-

the maximum heart rate for 20 minutes,

tense, repetitious intervals. EPOC increas-

vention (CDC) suggests these guidelines

three to four times a week). After six to

es after most types of exercise, but the

for adults age 18-64:

eight weeks of this traditional “cardio” pro-

higher the intensity of the exercise inter-

• Two hours and 30 minutes (150

gram, few body composition changes are

vals, the greater the EPOC and the greater

minutes) of moderate-intensity aerobic

expected as the patient gains efficiency of

the post-exercise caloric burn.

activity (like brisk walking) a week

those movements. Mechanisms involved with this increased

and muscle strengthening on two or more days a week that works all major

Mathew recommends switching at this point

metabolism include lactate removal, in-

muscle groups or

to an interval-based routine for the “aerobic

creased blood circulation, ATP-PC (ad-

activity” to optimize health and weight loss.

enosine

• Seventy-five minutes of vigorous-

triphosphate-phosphocreatine

system) resynthesis and replenishment of

intensity aerobic activity every week and muscle strengthening on two or

Interval Training Is Best

oxygen stores1. In addition, patients who

more days that works all major muscle

Interval training incorporates alternating

do long-distance and constant-pace exer-

groups or

periods of high-intensity exercise followed

cises experience higher chronic inflamma-

12

The Triangle Physician


tion due to oxidative stress. This can add to

ACNE • MOHS SURGERY • SKIN CANCER • PSORIASIS • ECZEMA • DERMATITIS • ALOPECIA

already heightened inflammatory states for patients with diabetes, hypertension, etc.

Skin so

Conveniently for patients, interval training

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also takes up significantly less time than more traditional methods of exercise (2025 minutes vs. 45-50 minutes).

Southern Dermatology’s Skin Renewal Center offers state-of-the-art skin rejuvenation procedures and medical grade skin care products to make your skin as smooth as jazz. Including:

Examples of interval-training workouts: • Track workout: Sprint 400 meters followed by a four-minute rest, sprint 300 meters followed by three-minute rest,

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Mathew is adamant that a combination of interval and strength training is ideal.

DER131_AD_Triangle Physican 1_3.indd 1

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a certified trainer is the best way to start the strength-training component to avoid injury. If interval workouts are done in conjunction with strength training (recommended), then one to two interval sessions per week are enough. If interval training is the only feasible form of training for your patient, three to four sessions per week is advised. This however should always be based on the patient’s ability to recover from one session to the next.

Drossman Gastroenterology

Both Andrea Lukes at the Women’s Wellness Clinic and myself strongly recommend Mathew for his knowledge and expertise. More information visit Mathew’s website (www.carpediemstrong.com) or send an e-mail (matthew@carpediemstrong.com). Reference 1 Vella, C.A., & Kravitz, L. (2004). Exercise AfterBurn: Research Update, IDEA Fitness Journal, 1(5), 42-47.

august 2014

13


Technology

The Digital Age

Improved Patient Communication, Diagnosis and Treatment Tools By Laura Briley, M.D.

These days, digital technology is used in

The Internet is an important resource for

virtually all aspects of the health profession.

practitioners when, as part of treatment plans, we need to rapidly get information

In terms of the health and care of the skin,

about interactions between certain drugs,

the Internet and digital technology, in

for example. Sophisticated digital technol-

general, have been of enormous benefit

ogy underlies many tools used in South-

both to dermatologists and the patients

ern Dermatology’s practice every day, in-

we treat. The Internet has served as a vast

cluding laser treatments for a wide range

learning resource, empowering patients

of applications, from removal of age spots

to become well informed about health

and facial veins to laser hair removal.

conditions that need attention. In fact, Southern Dermatology’s Skin RePatients will come in and tell me what

newal Center was one of the first in the

they or their child are dealing with, be-

Triangle to offer a highly effective fat-

cause they saw photos on the Internet

reduction process called CoolSculpting,

that seem to mirror the condition. After an

which, not surprisingly, relies on digital

exam, I may agree with their conclusion

technology. CoolSculpting is not meant as

and sometimes not.

a treatment for the seriously overweight, but works really well in the removal or re-

Though digital technology is sometimes

duction of “fat pockets” on the hips, above

the cause of a disease (a rash called ery-

and below the belly button and the thighs.

Dr. Laura Briley, a board-certified dermatologist at Southern Dermatology Skin Cancer Center & Skin Renewal Center in Raleigh, specializes in dermatologic surgery and cosmetic dermatology, among other specialties. She earned her bachelor of science degree from Wake Forest University and her medical degree from The Brody School of Medicine at East Carolina University. She completed her internship at Roger Williams Medical Center in Providence, R.I., and residency at The Brody School of Medicine. Dr. Briley is a member of the American Academy of Dermatology, American Medical Association and Alpha Omega Honor Society. them often. But when I tell a mom that her

thema abigne caused by heat sources, such as laptop computers, or the “cell

Digital technology is especially helpful

child has a condition she’s never heard of

phone rash” caused by nickel allergies),

with dermatology, because we have so

before, it’s very reassuring to guide her to

it has, by and large, helped patients to be

many disease conditions that are very un-

a website where she can see photos that

more proactive about their health care.

common and that most people have nev-

look just like what her daughter is deal-

It also provides valuable diagnostic and

er heard about. As a practitioner these

ing with, along with detailed information

treatment tools for physicians.

conditions may not be rare, because I see

about symptoms and treatment.

14

The Triangle Physician


Duke Research News

$15 Million Is to Advance Treatments for Autism, Other Brain Disorders Duke Medicine has been awarded a

Medicine. “With the foundation’s help, we

Cord blood cells are collected without risk

$15 million grant to support an innovative

hope to give untold numbers of people

to the mother or baby from the placenta,

research program that explores the use of

with autism and related disorders hope for

which is otherwise discarded as medical

umbilical cord blood cells to treat autism,

a better outcome.”

waste after a baby is born. After collection,

stroke, cerebral palsy and related brain dis-

the cells can be frozen and stored for fu-

orders.

ture use in blood stem cell transplantation or cellular therapies.

The award from The Marcus Foundation, an Atlanta-based phil-

Dr. Kurtzberg’s previous research has

anthropic organization, will fund

shown that cord blood cells can reduce

the first two years of a planned

inflammation and signal normal cells to

five-year, $41 million project by

repair damage in areas of the brain affected

Joanne Kurtzberg, M.D., chief

by inherited pediatric brain diseases. A

scientific and medical officer of

recently published Duke study indicates

Duke’s Robertson Cell and Trans-

that treating children with their own cord

lational Therapy Program; and

blood cells can have similarly beneficial

Geraldine Dawson, Ph.D., director

results in cases of hypoxic ischemic

of the Duke Center for Autism Diagnosis and Treatment.

Geraldine Dawson, Ph.D., (left) and Joanne Kurtzberg, M.D.

encephalopathy.

There are approximately two million peo-

Building on those research results, the

Dr. Kurtzberg and Dr. Dawson hope to de-

ple in the United States with autism spec-

new study will try to determine whether

velop cell-based therapies that can poten-

trum disorder, a group of conditions affect-

cord blood cells will have the same effect

tially restore brain function in people with

ing social communication and behavior.

in cases of autism and stroke. Using meth-

the disorders for which there currently are

Stroke kills an average of nearly 130,000 in

ods developed by Dr. Dawson, the study

no cures. If successful, the study could

the United States every year, while cerebral

will examine whether the therapy not only

identify therapies for further evaluation in

palsy currently affects an estimated 764,000

improves behavioral outcomes in children

clinical trials to potentially decrease dis-

children and young adults.

and adults with autism, but also reshapes the patterns of brain activity.

abilities and improve the quality of life for millions of children and adults.

The initial phase of the program – a preliminary trial involving 20 pediatric sub-

Dr. Kurtzberg and Dr. Dawson also will

The project will consist of a series of clini-

jects with autism using their own banked

explore the key question of whether the

cal trials using umbilical cord blood cells

cord blood – is already under way. It will

beneficial effects of cord blood can be

to treat a total of 390 children and adults

conclude with Phase II trials using donated

achieved by treating patients with donated

with autism, 100 children with cerebral

cord blood in children with autism and ce-

cord blood rather than only with their own

palsy and 90 adults with stroke. Based on

rebral palsy and adults with stroke.

banked blood cells. If that is found to be true, it could make cord blood treatment

previous research, Dr. Kurtzberg and Dr. Dawson hypothesize that cord blood may

“The whole program has enormous po-

available to the largest numbers of patients

promote repair of dysfunctional or dam-

tential,” said Dr. Kurtzberg, who is also

in need.

aged areas of the brain.

director of the Pediatric Blood and Marrow Transplant Program and the Carolinas

“We all wanted to have a treatment that, if

“Funding for this type of research is very

Cord Blood Bank. “Autism, stroke and ce-

it’s effective, would be accessible to every-

scarce, so the only way we can truly make

rebral palsy are all neurologic conditions

one,” said Dr. Dawson, who was the found-

progress is with support from private phil-

that impair function and quality of life for

ing director of the University of Washing-

anthropic organizations like The Marcus

these children and adults. If we can make

ton Autism Center and then chief science

Foundation,” said Nancy Andrews, M.D.,

that better, it will have a huge personal and

officer at Autism Speaks before joining the

Ph.D., dean of Duke University School of

societal impact.”

Duke faculty in August 2013.

august 2014

15


Duke Research News organization in 2005.

Established by Bernie Marcus, the co-

pies to bear on disorders without existing

founder of The Home Depot, The Marcus

treatments, and that are unlikely to receive

Foundation has a long-established inter-

funding from traditional sources, such as

Families interested in enrolling a child in

est in autism, stroke, cerebral palsy and

the National Institutes of Health.

the study should contact Duke via e-mail to cordbloodtherapyinfo@dm.duke.edu or

other neurological conditions, and in stem cell research. It focuses on biomedical re-

Mr. Marcus also opened the Marcus Autism

search projects that are close to clinical

Center in Atlanta in 1991 and donated the

application, which may bring novel thera-

funds to start the Autism Speaks advocacy

(844) 800-CORD/(844) 800-2673.

New Technologies Empower Patients and Enhance Data Collection The changing dynamic of health studies

perspective that big data and comparative

With the increasing availability and popular-

driven by “big data” research projects will

effectiveness research have the potential to

ity of wearable monitoring devices that track

empower patients to become active par-

greatly enhance the health of both individual

such outcomes as heart rate, blood pressure

ticipants who provide real-time information

patients and whole populations.

and blood sugar levels, patients are now able to be active participants in their daily health

such as symptoms, side effects and clinical outcomes, according to researchers at Duke

They argue that using new ways of acquir-

needs, while also adding to the broader data

Medicine.

ing and aggregating data directly from clini-

collection.

cal care offers an alternative to randomized The analysis, published in the July issue of

controlled trials, which are currently the gold

The researchers noted that this new reliance

Health Affairs, lays out a new paradigm for

standard of medical studies, particularly for

on patient-driven data is already being incor-

health research, particularly comparative

new therapies.

porated into studies funded by the PatientCentered Outcomes Research Institute, the

effectiveness studies that are designed to assess which therapies work best in routine

“Generalizing data from these trials to larger,

clinical practice.

more heterogeneous populations to deter-

NIH Collaboratory and many others.

mine treatment effectiveness can be prob-

“The value of engaging with patients to gen-

Fueled by new technologies – including

lematic,” Dr. Abernethy said. “Further, it takes

erate the information needed to provide care

electronic health records and monitoring

years – often more than a decade – for a trial

that is truly patient-centered and individual-

devices that people can wear as clothing or

to progress from the idea stage to actionable

ized will benefit society as a whole,” Dr. Ab-

accessories – health studies are now poised

information, and cost and complexity mean

ernethy said. “With this kind of information,

to integrate data from a much larger pool of

that some important questions go unan-

health care and health care research can be

information. The new data is immediate and

swered.”

truly patient-centric.”

terial, but also clinical information that can

Dr. Abernethy said electronic health records

In addition to Dr. Abernethy, the paper’s au-

improve the patient’s care in the short term.

provide a huge volume of information from a

thors include Lynn Howie, Bradford Hirsch

much wider and diverse pool of participants

and Tracie Locklear.

actionable, providing not only research ma-

“When linked to the rest of the available elec-

than has typically been available. The clini-

tronic data, patient-generated health data

cal information can be used for research to

Dr. Abernethy reports research funding from

completes the big-data picture of real peo-

improve care for current patients as well as

the National Institutes of Health, Agency for

ple’s needs, life beyond the health care sys-

future patients.

Healthcare Research and Quality, PatientCentered Outcomes Research Institute,

tem, and how changes in health and health care lead to meaningful changes in people’s

Electronic health records can also be aug-

DARA Bioscience, GlaxoSmithKline, Cel-

lives,” said senior author Amy P. Abernethy,

mented with patient-driven data, with real-

gene, Helsinn, Dendreon, and Pfizer. At the

M.D., Ph.D., professor of medicine and direc-

time reporting directly to the health record

time of this press release, Dr. Abernethy will

tor of the Center for Learning Health Care at

during a clinical visit or via the patient’s per-

be employed by Flatiron Health Inc., in addi-

Duke.

sonal input of symptoms, side effects, quality

tion to Duke University. She is on the board

of life assessments and other factors.

of directors for athenahealth Inc. A full list of

Dr. Abernethy and colleagues advance the

16

The Triangle Physician

disclosures is provided in the publication.


News

De Shazo Is Named North Hospital Vice President and Administrator Sheri De Shazo, M.B.A., M.H.A., R.N.,

“We are very pleased to welcome

the newly-completed Piedmont Newnan

has been named vice president and

Sheri to the WakeMed team. She is an

Hospital. She then worked closely with

administrator of WakeMed North Hospital,

innovative thinker with a strong history

physicians, staff and other leaders to build

effective Aug. 11.

of relationship-building with physicians,

relationships with the community while

nursing and hospital staff and other health

overseeing all clinical, nursing, ancillary

She brings 20-plus years’ experience

care professionals, as well as business and

and support services.

in health care management, including

community organizations,” said Donald

previous roles as hospital administrator

Gintzig, WakeMed president and chief

Prior to Piedmont, Ms. De Shazo was the

and chief nursing executive.

executive officer. “As we look forward to

chief operating officer and chief nursing

providing exceptional women’s services

executive

In her new role, Ms. De Shazo will be

to northern Wake County and surrounding

Systems’ Kings Mountain Hospital in

involved in all major operational and

communities, we are fortunate to have

Cleveland County, N.C.

management

found an administrator with these skills

decisions

as

WakeMed

prepares for the Mother’s Day 2015 opening

along with a proven track record.”

for

Carolinas

HealthCare

Ms. De Shazo, who is Lean Six Sigma Green-

of North Hospital, a 61-bed acute care

belt certified, earned a master’s in health care

hospital with a focus on women’s specialty

Ms. De Shazo comes to WakeMed from

administration and a master’s in business

services. In addition, she is responsible for

Piedmont Health Care, where she served

administration from Pfeiffer University in

overall operational leadership, including

as the chief clinical officer and vice

Charlotte, N.C. She also holds a bachelor’s in

administration, clinical outcomes and

president of administration for Piedmont

nursing from Winston-Salem State University

financial performance.

Newnan Hospital in Newnan, Ga. In

and an associate’s in nursing from Bluefield

2012, she helped open and establish

State College in Bluefield, W. Va.

Wake Radiology Opens Outpatient Imaging Office in Smithfield Wake Radiology opened a new

One in eight women in the

outpatient imaging office in

United

Smithfield that offers screening

invasive

mammograms.

mammograms are considered

States breast

will

develop

cancer,

and

the best way to detect breast the

cancer early when it is most

Smithfield community for 25

treatable. The American Cancer

years while running the radiology

Society

department at Johnston Memorial

mammograms

Hospital until 2010.

starting at age 40.

Wake

Radiology

served

A

“Wake Radiology has a long

recommends

Wake

for

annual women

Radiology

press

history in Smithfield, and we’re excited

to make it as convenient as possible for

advisory reports that a mammography

to continue serving this community,”

women to have a mammogram.”

appointment

only

lasts

30

minutes

from check-in to exam completion. To

said Lyndon K. Jordan III, M.D., Wake Radiology’s president and managing

The office, located behind Carolina

schedule a screening mammogram at

partner and a Smithfield native. “We know

Premium Outlets at 218 Venture Drive, is

Wake Radiology’s Smithfield office, call

that the best protection against breast

open Monday through Friday from 8 a.m.

(919) 232-4700 or visit www.wakerad.com.

cancer is early detection, and we want

to 4:30 p.m.

august 2014

17


UNC Research News

Discovery May Lead to Safer Alternative to Blood Thinners For the first time, scientists at the University of North Carolina School of Medicine have shown that eliminating the enzyme factor XIII reduces the number of red blood cells trapped in a clot, resulting in a 50 percent reduction in the size of the clot.

bolism. DVT often occurs during periods of restricted movement, such as prolonged sitting common during a long trip. Also, pregnancy, cancer, genetics, certain kinds of injuries, surgeries and medications can raise the risk of developing DVT.

The finding, featured July 2 in the Journal of Clinical Investigation, has major implications for people at high risk of deep vein thrombosis (DVT), a condition that – together with its deadly cousin pulmonary embolism – affects 300,000 to 600,000 people in the United States every year. Between 60,000 and 100,000 people die from these conditions every year in the United States, according to the Centers for Disease Control and Prevention.

Many patients at high risk for developing clots regularly take blood-thinning drugs, such as warfarin, which stifles the body’s ability to make fibrin – the fibrous protein that binds a clot together. But these drugs can raise the risk of excessive bleeding, can cause side effects and aren’t appropriate for all patients.

“If we can develop a treatment that exploits this discovery to reduce the size of blood clots, it would represent a whole new approach to treating thrombosis that’s different from anyAlisa Wolberg, Ph.D. thing else on the market,” said Alisa Wolberg, Ph.D., associate professor of pathology and laboratory medicine and senior author of the JCI paper. “We think reducing factor XIII activity could be helpful to a large number of people, perhaps including some who cannot take existing ‘blood-thinning’ medications.”

“What’s needed is a drug that reduces the risk of forming large clots but still allows you to form a clot when you need one to stanch bleeding,” Dr. Wolberg said. “The biological pathway we’ve discovered may make it possible to strike that balance.” In experiments using mice and human blood, the researchers examined the role of a protein called factor XIII in clot formation. To their surprise, they found that mice incapable of producing factor XIII formed clots that were half the size of the clots produced by normal mice.

“That difference in itself was extremely striking,” said Maria Aleman, Ph.D., first author of the JCI paper and a graduate student in Dr. Wolberg’s lab at the time of the study. Maria Aleman, Ph.D. “Then, the second surprise was discovering that the size difference was actually due to a reduced number of red blood cells in the clot. Since no previous studies had suggested that it was possible to manipulate the number of red blood cells, we knew we had found something new.” Factor XIII appears to play a crucial role in helping the fibrin matrix keep its integrity during clot formation. Normally, the fibrin matrix forms a strong mesh in and around the clot, trapping red blood cells within. Without factor XIII, some red blood cells are squeezed out, resulting in a much smaller clot. Unlike existing drugs that reduce the formation of fibrin, a drug that reduces factor

The ability for blood to clot is crucial to our health; by stanching bleeding long enough to allow healing, clots keep us from bleeding to death from injuries. But in the wrong circumstances, clots can pose a significant health hazards. In patients with DVT, clots that form inside blood vessels, usually in the legs, obstruct the flow of blood, leading to pain and swelling while raising the risk of pulmonary em-

18

The Triangle Physician

At left, a normal blood clot. At right, a blood clot in which factor XIII activation is reduced. As a result of reducing factor XIII activity, red blood cells are not retained in the clot, making the clot 50 percent smaller.


UNC News At left, a normal blood clot. At right, a blood clot in which factor XIII activation is reduced. As a result of reducing factor XIII activity, red blood cells are not retained in the clot, making the clot 50 percent smaller.

sacrificing the ability to produce small, beneficial clots.

XIII could potentially cut the body’s ability to produce large, dangerous clots without

Dr. Aleman, who earned an Impact Award from the UNC Graduate School for her research, is now a postdoctoral research associate at UNC’s Center for Environmental Medicine, Asthma, and Lung Biology. Additional UNC co-authors of the JCI paper include graduate student James Byrnes;

postdoctoral fellow Jian-Guo Wang, Ph.D.; and Nigel Mackman, Ph.D., the John Parker Professor of Medicine. Authors from other institutions include graduate student Reginald Tran of Emory; Wilbur Lam, Ph.D., from the Georgia Institute of Technology; Jorge Di Paola, M.D., from the University of Colorado at Denver; and Jay Degen, Ph.D., and Matthew Flick, Ph.D., both from the Cincinnati Children’s Hospital Medical Center. The study was funded by the National Institutes of Health and the American Heart Association.

$6 million Grant Awarded to Innovative Back Care Program The University of North Carolina School of Medicine has been selected by the Centers for Medicare and Medicaid Innovation Center for a $6 million prospective award for its Better Back Care program.

guidelines and is subject to overuse of diagnostic imaging, injections and surgery,” said Brian A. Casazza, M.D., director of the UNC Hospitals Spine Center and program director for Better Back Care.

UNC is one of only 39 awardees nationally, and its Better Back Care program is the only spine program to be chosen among the second-round winners of the Health Care Innovation Awards. UNC’s Better Back Care program creates a new model of care for patients with back pain that is designed to improve the patient’s experience and outcomes, reduce the cost of care and deliver an innovative method of financing care , according to a UNC press advisory.

The Better Back Care program will create a medical neighborhood linking approximately 60 primary care providers with the UNC spine program, an existing multidisciplinary team of 10 specialty providers employing evidence-based, patient-centered approaches. This medical neighborhood will adopt evidence-based, coordinated care of demonstrated effectiveness for patients with new-onset low back pain through guideline adherence, patient education and shared decision making, improved access to care and care coordination. Nursepatient navigators will ensure patients receive the right care at the right time.

“Back pain is common, debilitating and expensive, and its contribution to poor patient outcomes and increasing health system expenditure has grown Brian A. Casazza, M.D. rapidly in the last decade alone. Treatment for back pain often does not follow evidence-based

“The UNC Hospitals Spine Center provides Amy Shaheen, M.D. back care that is patient-centered, high quality and cost effective. With this $6 million award, we will

be able to expand this approach to the patients of 60 top primary care physicians in the Triangle. The impact to patients, their families and the North Carolina economy of spine disease can’t be understated. This is a terrific opportunity to improve care of patients suffering from back pain,” said Matthew G. Ewend, M.D., chair of neurosurgery in the UNC School of Medicine. “We know the primary care providers in our area provide excellent care for many conditions,” said Amy Shaheen, M.D. “This award will allow us to demonstrate that high quality and high value can be delivered seamlessly all the way from the primary care office to the subspecialist office when needed.” The Better Back Care program will be directed by Drs. Casazza and Shaheen, an associate professor in the UNC School of Medicine. It was developed with support from UNC Health Care and UNC School of Medicine Center for Innovation. Collaborators for the program include the Cecil G. Sheps Center for Health Services Research, Blue Cross and Blue Shield of North Carolina, the North Carolina Area Health Education Centers Program and Community Care of North Carolina. august 2014

19


News Welcome to the Area

Physicians

Clarissa Jonas Diamantidis, M.D.

Tanya Tabassum Khan, M.D.

Matthew Allan Popa, M.D.

Lee Michael James, D.O.

Internal Medicine - Nephrology

Facial Plastic Surgery; Ophthalmology

Orthopedic Surgery, Adult Reconstructive

Duke University Division of Internal Medicine Durham

Duke University Eye Center Durham

Central Carolina Orthopaedic Associates, PLLC Sanford

Physical Medicine and Rehabilitation

UNC Hospitals Chapel Hill Gina Elyse Miller, D.O. Family Medicine; Family Practice

Cbell University Jerry M. Wallace School of Osteopathic Medicine Lillington Keren Aviva Bashan, M.D. Surgery - Surgical Critical Care

UNC Hospitals Chapel Hill Andre Barranda Bautista, M.D. Diagnostic Radiology; Diagnostic Ultrasound; Interventional and Vascular Radiology

Duke University Hospitals Durham Thomas George Caranasos, M.D. Abdominal Surgery; Cardiovascular Surgery; Critical Care Surgery; General Surgery; Thoracic Surgery

UNC Division of Cardiothoracic Surgery Chapel Hill Jacquelyn Sara Carr, M.D. Abdominal Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Pediatric Surgery; Plastic and Reconstructive Surgery; Surgical Oncology; Thoracic Surgery; Vascular Surgery

UNC Hospitals Chapel Hill Danny George Cheriyan, M.D. Durham Anika Shannel Cherry, M.D.

Mary Claire Kimmel, M.D. Mary Adel Elmasri, M.D.

Psychiatry

Lauren Prats Porras, M.D.

Internal Medicine; Pulmonary Disease and Critical Care,

UNC Department of Psychiatry Chapel Hill

Internal Medicine; Sports Medicine

Duke University Durham Samuel Jarrod Francis, M.D. Emergency Medicine

Duke University Hospitals Durham Bronwen Halstead Nussloch Garner, M.D. Internal Medicine

Duke University Hospitals Durham Jonathan Andrew Gehlbach, M.D. Critical Care Pediatrics; Pediatrics

Duke Medical Center Durham Daniel Tyler Goodberry, M.D. Emergency Medicine

Sandhills Emergency Physicians Southern Pines Paige Josephine Halvorson, M.D.

Andrew Brian Kleinberg, M.D. Pediatrics

Jeffers, Mann and Artman Pediatrics Raleigh Sarah Christine Leeper, M.D. Emergency Medicine

UNC Hospitals Chapel Hill Elmer Philip Lehman IV, M.D. Cardiovascular Disease, Internal Medicine

Duke University Hospitals Durham Amy Amenawon-Ohen Mauritz, M.D. Anesthesiology

Duke University Hospitals Durham

Audrey Elaine Herrin Metz, M.D.

Christopher Gale Hauck, M.D. Infectious Diseases, Internal Medicine

Duke University Durham

UNC Hospitals Chapel Hill

Kunal Mitra, M.D.

Internal Medicine

Pediatrics Child Neurology; Pediatrics

Duke University Hospitals Durham

Encompass Womenâ&#x20AC;&#x2122;s Care Burlington

Duke University Hospitals Durham

Jason Robert Mock, M.D.

Matthew Harmon Collins, M.D.

Heath Christopher High, M.D.

Pulmonary Disease and Critical Care, Internal Medicine

Infectious Diseases, Internal Medicine

Critical Care-Internal Medicine

UNC Infectious Diseases Clinic Chapel Hill

CaroMont Health Gastonia

UNC Division of Pulmonary Diseases and Critical Care Medicine Chapel Hill

Michelle Suzanne Collins, M.D.

Christine Jeanne Horton, M.D.

Ann Marie Gonzalez Munoz, M.D.

Angiography and; Interventional Radiology; Body Imaging; Diagnostic Radiology; Diagnostic Roentgenology Radiology; Diagnostic Ultrasound; Musculoskeletal Radiology; Neuroradiology; Nuclear Imaging and Therapy; Nuclear Radiology; Pediatric Radiology

Gynecology; Obstetrics and Gynecology

Ophthalmology

Wake Ophthalmology Cary Kareem Charles Cooper, M.D. Family Medicine; Hospitalist

Wayne Memorial Hospital Goldsboro Anna Vergun Cuomo, M.D. Orthopedic Surgery, Pediatric

UNC Orthopedics Chapel Hill Claire Gordon Dakik, M.D. Anesthesiology; Surgery (general)

Duke University Hospitals Durham

20

The Triangle Physician

Anesthesiology - P.A.in Medicine

UNC Hospitals Chapel Hill

Raleigh

Tammy Hall Jenkins, M.D. Raleigh

Neurological Surgery, Critical Care; Neurology with Special Qualifications in Child Neurology

Christa Lynn Jillard, M.D.

UNC School of Medicine Chapel Hill

Kim Jiramongkolchai, M.D. Ophthalmology

Duke University Hospitals Durham Joici Job, M.D. Radiology

Duke Medical Center Durham Yubin Kang, M.D. Hematology, Internal Medicine; Internal Medicine; Medical Oncology

Duke University Hospitals Durham

Joseph Harran Rabinowitz, M.D. Family Medicine; Family Practice

Sanford Medical Group Sanford Samina Saadia Raja, M.D. Psychiatry; Psychiatry, Geriatric

Duke University Hospitals Durham Taher Reza Kermanshahi, M.D. Pathology

Lucas Brandon Romine, M.D.

Ophthalmology

Duke University Hospitals Durham

Duke Medical Center Durham

WakeMed Raleigh

Pradeep Mettu, M.D.

Tammy Lynn Hennika, M.D.

Michael Wilder Compton, M.D.

General Surgery; Surgical Critical Care

Marlboro Chesterfield Pathology Pinehurst

Obstetrics and Gynecology; Oncology; Urogynecology

Abdominal Surgery; Colon and Rectal Surgery; General Surgery; Surgical Oncology

Crystal Michaela Pressley, M.D.

Duke University Hospitals Durham

Obstetrics and Gynecologic Surgery; Obstetrics and Gynecology

Duke University Hospitals Durham

UNC Chapel-Hill Department of Family Medicine Chapel Hill

Casey Olm-Shipman, M.D.

David Isaias Ortiz Melo, M.D. Internal Medicine - Nephrology

Duke University Hospitals Durham Sumir Suresh P.A.tel, M.D. Diagnostic Radiology; Diagnostic Roentgenology Radiology; General Practice; Neuroradiology; Nuclear Medicine; Nuclear Radiology

Duke University Hospitals Durham Joanna Kristine Pearson, M.D. Psychiatry

HRC Chapel Hill

Orthopedic - Surgery of the Hand; Orthopedic Sports Medicine; Adult Reconstructive; Musculoskeletal Oncology; Orthopedic Surgery, Pediatric; Orthopedic Surgery, Trauma; Orthopedic, Ankle Foot; Orthopedic, Hand Surgery

Triangle Orthopedic Associates Durham Elizabeth Marie Ross, M.D. Anesthesiology

UNC Anesthesiology Chapel Hill Stevie Michelle Rowe, M.D. Neonatal-Perinatal Medicine; Pediatrics

Duke Medical Center Durham Jessica Marian Furr Saricicek, M.D. Hospitalist; Pediatric Critical Care Medicine; Pediatric Emergency Medicine; Pediatrics

Duke University Hospitals Durham Jay Christopher Sellers, M.D. Infectious Diseases, Internal Medicine

Raleigh Infectious Disease Associates Raleigh Asad Ali Shah, M.D. Abdominal Surgery; Cardiovascular Surgery; Colon and Rectal Surgery; Critical Care Surgery; General Surgery; Surgery; Thoracic Cardiovascular Surgery; Thoracic Surgery

Duke University Hospitals Durham Neil Devendra Shah, M.D. Gastroenterology, Internal Medicine; General Practice; General Preventive Medicine; Internal Medicine

UNC Department of Gastroenterology Chapel Hill Christine Shieh, M.D. Ophthalmology

Duke Eye Center Durham


News Rahul Prasad Sinha, M.D.

Laura Ann Vickers, M.D.

Warren Umandap Everett, P.A.

Pediatrics

Ophthalmology

Emergency Medicine

Duke University Hospitals Durham Anthony Derek Sung, M.D. Internal Medicine; Hematology/Oncology

Duke University Hospital Durham

Duke University Eye Center Durham

Maria Parham Medical Center Henderson

Joseph Lane Wilson, M.D.

Allison Courtney Gilboy, P.A.

Family Medicine; Family Practice

UNC Hospitals Chapel Hill

Duke Radiology Durham Elizabeth O’Toole Tegins, M.D. Ophthalmology

Raleigh Lindsay Gossage Terrell, M.D. Pediatric - Allergy/Immunology; Pediatric Critical Care Medicine; Pediatric Dermatology; Pediatric Emergency Medicine; Pediatric Rehabilitation Medicine; Pediatric Transplant Hepatology; Pediatrics; Pediatrics - Child Abuse Pediatrics

Duke University Hospitals Durham

Stephen Roy Todd, P.A. Orthopedic Surgery

Family Medicine

Cary

Durham VA Medical Center Durham

Thu Anh Le, P.A.

Erin Elizabeth Woody, P.A.

Emergency Medicine; Urgent Care

Ronak Kiran Talati, M.D. Radiology

Erik Svensen Stubberud, P.A. Duke University Health System Durham

Physician Assistants John Francis Cassidy, P.A. Addiction Psychiatry; Child and Adolescent Psychiatry; Child Psychiatry; Child/ Adolescent Psychiatry; Geriatric Psychiatry; Psychiatry; Psychosomatic Medicine

Thoracic Cardiovascular Surgery

Wake Med Raleigh

Duke University Hospital Durham

Christian Paul Marocco, P.A. Emergency Medicine

Orthopaedic Specialists of North Carolina Raleigh

Carolina Partners in Mental Health Raleigh

Jessica Danielle Stevens, P.A.

Danielle DiLorenzo, P.A.

Orthopaedic Specialists of North Carolina Raleigh

Critical Care Surgery

Raleigh

Cecilia Zebedeo, P.A. Durham

General Practice; Orthopedic Sports Medicine

North Carolina Medical Society Names New Employees North Carolina Medical Society (NCMS) reports the following staff additions: Kristina “Tina” Natt och Dag is the new director of the Kanof Institute for Physician Leadership at the NCMS Foundation. Ms. Dag has a doctorate in workforce and human resource education from North Carolina State University and a master’s degree in human rights from Lund’s University in Lund, Sweden. She has been working in training and development in the corporate and non-profit sectors for the past two decades, working with leaders at all levels around the world. Denna Suko is the new deputy director of specialty society, meeting and education services, supporting 10 state medical societies and one county medical society contracting with the NCMS for management services. A veteran association man-

ager, Ms. Suko brings more than 15 years of experience to the job, including positions with FirstPoint Management Resources, the American Academy of Ophthalmology, the National Association of Letter Carriers and the National Committee for an Effective Congress. Ms. Suko holds a master’s degree in political science from American University and a bachelor’s degree from Indiana University of Pennsylvania. Jennifer Gasperini is the new director of health policy. Ms. Gasperini served most recently as the senior government affairs representative for the Medical Group Managers Association in Washington, D.C., focusing on federal legislative and regulatory issues pertaining to physician payment and quality. She also worked as a senior account executive at Ketchum, a D.C. public relations firm, with government clients, such as the Center for Medicare and Medicaid Services. She holds a bachelor’s degree in journalism with a minor in political science from Pennsylvania State University and a master’s degree in

legislative affairs from George Washington University. The North Carolina Medical Society represents approximately 12,500 physicians and physician assistants across the state. Founded in 1849, the society seeks to promote access to quality health care for in North Carolina and champions initiatives that seek to improve quality of care and promote patient safety.

2014 Editorial Calendar September Bariatrics Neonatology October Cancer in women Wound management November Urology ADHD December Otorhinolaryngology Pain management august 2014

21


SCREENING MAMMOGRAPHY. NOW IN SMITHFIELD.

THE BEST PROTECTION IS EARLY DETECTION. For 25 years, we served Smithfield from Johnston Memorial Hospital. Now we’re back. In a new location. And we bring with us more than 60 years as the region’s premier provider of outpatient imaging. We also bring screening mammography to your community. And, because early detection is what it’s all about, access and scheduling couldn’t be easier. What’s more, the appointment itself is just 30 minutes from check-in to exam completion. So there’s never been a better time (or place) for a checkup.

At your request, Wake Radiology can easily obtain your most recent mammogram from other practices.

TO LEARN MORE, CALL 919-232-4700 OR VISIT WAKERAD.COM.

Wake Radiology | 218 Venture Dr. Smithfield, NC Behind the Carolina Premium Outlets Hours: Monday-Friday 8:00am-4:30pm Appointments: 919-232-4700 | wakerad.com

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