Bronson Methodist Hospital's

West Michigan | November/December 2009 |

■ A Business & Practice Management Magazine | about physicians | from physicians | for physicians ■

Bronson Methodist Special Feature Hospital’s Advanced Radiology Offers Rapidly Growing Robotic Hope for Patients With Surgery Program Uses Previously Untreatable Tumors State-of-the-Art Technology Money Matters Patients Are Customers, Not Case Numbers contents VOL. 12, NO. 6 NOVEMBER/DECEMBER 2009 4

4 COVER STORY DEPARTMENTS Bronson Methodist Hospital’s Rapidly 2 from the publisher Growing Robotic 3 issues in public health Surgery Program Uses State-of-the- 7 med beat

Art Technology hy ap At Bronson Methodist Hospital, 3-D, 8 law matters l Photogr high-definition technology has been in a place since 2008, and surgeons have 15 kudos been using it to perform minimally 16 insurance matters

invasive surgery with the assistance Photo by Anthony Dug of a robotic device called the da Vinci ON THE Cover 19 legal ease Bronson Methodist Hospital’s Rapidly Surgical System. Twelve surgeons Growing Robotic Surgery Program Uses who practice at Bronson Methodist 20 money matters State-of-the-Art Technology Hospital currently use the robot.

12 special feature Advanced Radiology Offers Hope for Patients with Previously Untreatable Tumors Radiofrequency ablation (RFA) offers promise to cancer patients who were previously untreatable. The minimally invasive procedure delivers a good prognosis for many smaller primary site lesions in the lung, kidney, liver and bone. For more advanced cancers that are not at the primary site, RFA can 12 provide palliative care that extends life beyond what was previously possible.

West Michigan md news november/december 2009 | 1 from the publisher

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2 | West Michigan md news november/december 2009 issues in public health Health Disparities in Kalamazoo County Sexually Transmitted Infections By Richard M. Tooker, M.D., Chief Medical Officer

Health disparities between African- 10,000 Caucasian males. These num- to afford treatment of these infections Americans and Caucasians are a bers are for 2008 and represent a sharp and their medical complications. well-recognized problem in most increase in just a few years. These measures of disparity are evi- communities, with Kalamazoo being Further, Kalamazoo rates for gon- dent in the fact that the Kalamazoo no exception. The African-American orrhea and Chlamydia have jumped County HCS Sexually Transmitted infant mortality rate continues to be above the statewide rates for the Infection clinic treats more than 70% three times that of Caucasians. Several last two to three years driven by the of these reportable infections. initiatives and programs are addressing significant disparity in infections Other communities with urban the issue. Another health disparity of among African-Americans. The hid- centers experience these disparities in striking proportions, however, remains den epidemic of sexually transmitted sexually transmitted infections. Some a silent epidemic among African- infections is driven not by racial of these communities have taken sig- American teens and young adults. This disparity alone. It is also due to the nificant steps to end the silence and hidden health threat is also a problem fact that these infections are primar- address the problems resulting in this for most Michigan and U.S. communi- ily among individuals between 15 very serious public health problem. ties, but gets little attention or sense and 30 years of age. Especially hard Kalamazoo County has a great deal of urgency. The problem is high hit are 15-19 year olds, making the to learn from these communities and rates of reportable sexually transmitted issue difficult for our communities the time for action has never been infections. to acknowledge. more critical. n Among the reportable sexually African-American residents in transmitted infections, racial dispar- Kalamazoo are, on average, less able Source: Kalamazoo County Health ity is especially striking with respect to access care for these infections or Surveillance Data Book to gonorrhea, Chlamydia and HIV/ AIDS. HIV infection rates for African- Americans in Kalamazoo are five times the rate for Caucasians. With respect to Chlamydia, African- American/ Caucasian disparity is very significant. The African-American female rate is 412 cases per 10,000 individuals versus 37 cases per 10,000 for Caucasian females. For African- American males, the rate is 288 cases per 10,000 individuals versus 10 cases per 10,000 Caucasian males. The profile for gonorrhea infections is equal- ly disturbing. The African-American female rate is 217 per 10,000 versus eight per 10,000 Caucasian females. The rate for African-American males is 228 per 10,000 versus just two per

West Michigan md news november/december 2009 | 3 cover story Bronson Methodist Hospital’s Rapidly Growing Robotic Surgery Program Uses State-of-the-Art Technology By Gretchen Johnson

Three-D HD was touted as the “next gen immersive TV robotic surgery. experience” at the Consumer Electronics Show in Las Vegas in “The da Vinci system uses traditional laparoscopic in- January. At Bronson Methodist Hospital, 3-D, high-definition struments, held by robotic arms, under the direction of the technology has been in place since 2008, and surgeons have surgeon who is at a console across the room,” explains Anna been using it to perform minimally invasive surgery with Hoekstra, M.D., M.P.H., gynecologic oncologist of the West the assistance of a robotic device called the da Vinci® S HD Michigan Cancer Center. “It works with a 3-D visualization Surgical System. Twelve surgeons who practice at Bronson system, and it mimics the movements of the physicians’ hands currently use the robot. and arms. It has seven degrees of freedom of movement for a The da Vinci Surgical System, from Intuitive Surgical, is more natural operating experience for the surgeon.” part of a rapidly growing robotic surgery program at Bronson Relatively new technology, the da Vinci Surgical System that combines the benefits of laparoscopic surgery with en- was the first robotic surgery system in its class when the hanced graphics and motion capabilities. Its most common FDA approved it for general laparoscopic surgery in the U.S. uses include hysterectomy, colon surgery, the treatment of just nine years ago. For this reason, long-term studies on the gynecological cancers, prostatectomies for the treatment device are not yet available and early research is limited. of prostate cancer, pediatric procedures and kidney surger- “People who do a lot of robotic procedures believe that, as ies. Bronson is the only hospital in Kalamazoo that offers data emerges, the robotic approach will prove to be better

Brandon Rubens, M.D., and Robert Isacksen, M.D., with HealthCare Midwest Urology have been using the da Vinci Surgical System to treat prostate cancer and kidney problems. hy ap l Photogr a Photo by Anthony Dug

4 | West Michigan md news november/december 2009 for preventing impotence and incontinence,” says Brandon Rubens, M.D., of HealthCare Midwest Urology, regarding the da Vinci Surgical System’s use for prostate gland removal for the treatment of prostate cancer. In the field of urology, prostatectomies are one of the most common surgical uses for the da Vinci Surgical System. It is also effective for patients with obstructed kidneys. “Treating a ureteropelvic junction obstruction [UPJ obstruction] is significantly easier with the da Vinci because the surgery involves a lot of suturing, which can be difficult purely laparoscopically,” Dr. Rubens says. The da Vinci Surgical System is also used for radical and partial nephrectomies. “We’re able to perform tasks such as suturing and tying knots, and it makes dissecting structures much easier,” Dr. Rubens says. “It makes laparoscopic surgery more like open surgery in that we have more range of motion with our instruments. The robot has varied instruments for specialized tasks that give us mobility like that of our own wrists and hands. Anything we can do laparoscopically is much easier with the robot.” One of the reasons for the ease of use is the elimination of a “fulcrum effect” found in traditional laparoscopic technology, where movements are mirrored. With the da Vinci Surgical System, when you move your hand to operate, the robotic arm moves in tandem. “The surgeon can almost com- hy ap pletely, independently, perform a surgery using the robot,” Dr. Hoekstra says. “In traditional laparoscopic surgery, there’s l Photogr a heavy reliance on a partner or an assistant.” The da Vinci Surgical System looks like something from a science fiction film. It has three arms that are guided by

Photo by Anthony Dug the surgeon to perform various surgical tasks. A fourth arm Anna Hoekstra, M.D., M.P.H., with the West Michigan Cancer Center is fitted with a camera and magnifies the surgical site 35 treats gynecologic cancers using the da Vinci Surgical System. times. Sitting several feet away from the patient, the surgeon operates from a 3-D console equipped with video game Physicians Who Perform Robotic controller-like instruments that mimic the body’s natural Surgery at Bronson hand movements. Compared to open surgery, benefits of robotic surgery include less blood loss and reduced trauma to the body because the Tempest Allen, M.D. Michael Leinwand, M.D. incisions are smaller and tissue damage is lessened. Hospital Bronson OB/GYN Associates Bronson Pediatric Surgery Services Paul Berkowitz, M.D. Bronson Women’s Service Suresh Potluri, M.D. HealthCare Midwest Urology Michael Chen, M.D. Robert Isacksen, M.D., HealthCare Midwest Urology, received Colon & Rectal Surgery Joseph Riethman, M.D. his medical degree from the University of Michigan. He completed Associates, PC OB/GYN, PC his residency at Loyola University in Maywood, IL. He is board certified by the American Board of Urology in adult and pediatric Anthony Gauthier, M.D. Zylkia Rodriguez, M.D. urology. HealthCare Midwest Urology Bronson Women’s Service Brandon Rubens, M.D., HealthCare Midwest Urology, received his medical degree from Loyola University in Maywood, IL. Anna Hoekstra, M.D. Brandon Rubens, M.D. He completed his surgical and urology residencies at William West Michigan Cancer Center HealthCare Midwest Urology Beaumont Hospital in Royal Oak, Michigan. He is board certified by the American Board of Urology. Robert Isacksen, M.D. Steven Wysong, M.D. Anna Hoekstra, M.D., M.P.H., West Michigan Cancer Center, HealthCare Midwest Urology HealthCare Midwest General received her medical degree from Rush Medical College in and Vascular Surgery Chicago. She completed her residency at Advocate Illinois Masonic Medical Center and a fellowship in gynecology/oncology at Northwestern University Feinberg School of Medicine.

West Michigan md news november/december 2009 | 5 Traditional laparoscopy provides only 2-D images. Dr. Isacksen says the typical blood loss for a robotic prostatectomy is 2 or 3 ounces. For an open surgery, the patient might typically lose 20-30 ounces. “Reducing blood loss translates into a lower risk of requiring transfusion and, I believe, helps patients recover from surgery more quickly because they are not struggling with anemia during the recovery period,” Dr. Isacksen adds. hy

ap After the robotic prostatectomy, most patients are dis- charged the day after surgery. This compares to a two-day l Photogr a hospitalization required for open surgery. “In addition, we’re able to remove the urinary catheter sooner following a robotic prostatectomy, compared to the open surgery. The catheter is a source of discomfort and irritation for patients,” Dr. Isacksen Photo by Anthony Dug Tempest Allen, M.D., with Bronson OB/GYN Associates adjusts one of says. “With the robotic procedure, we can typically remove the da Vinci Surgical System’s robotic arms as she prepares to perform the catheter within five to seven days compared to 12-14 days a hysterectomy. for an open procedure.” Dr. Hoekstra says there are very few contraindications for stays are shorter, and there is a quicker return to normal patients to undergo robotic surgery. Some include pulmonary activity. Additional benefits vary by specialty, and as Dr. Rubens dysfunction, cardiac comorbidities and, sometimes, multiple suggested, doctors have yet to see some of the outcome data. prior surgeries associated with intra-abdominal adhesions. The field of gynecologic oncology has already seen published “Any cardiac or pulmonary indication that would prevent data regarding the use of the da Vinci Surgical System for steep Trendelenburg positioning for several hours would surgical treatment of gynecological cancers. Dr. Hoekstra has exclude robotics as a surgical option,” she explains. published research regarding outcomes of robotic surgery, as Unlike other minimally invasive procedures, morbid obesity well as the use of robotics in academic teaching programs in is not a contraindication for da Vinci Surgical System surgery. association with Northwestern University. “One of the benefits of robotic surgery over laparoscopy — “In the treatment of endometrial cancer, we’ve studied and over open surgery — is that it’s shown to be effective and perioperative outcome data that demonstrates improved out- efficient even for morbidly obese patients,” Dr. Hoekstra says. comes compared to both laparoscopy and open procedures,” “It is sometimes extremely difficult to perform laparoscopy Dr. Hoekstra says. “We’re now taking that data further and on those patients, and the perioperative outcomes of patients studying perioperative pain. The only areas that our field is undergoing robotics are better than with laparoscopy or open waiting for are long-term outcomes and recurrence data, to surgery, due to lack of wound infections and the ease of the establish that there is no increase in recurrence of cancer or surgery with robotics.” a worse overall survival rate from endometrial cancer and Dr. Isacksen, who performed his first robotic procedure at cervical cancer from robotic surgery when compared to other Bronson after the device was put online in March of 2008, surgical modalities.” now performs 98% of his prostatecomies using the robot. Common gynecologic indications for robotic surgery in- “It’s my opinion that this can lead to better results in terms clude endometrial cancer, cervical cancer and complicated of urinary control and possibly preservation of potency — al- hysterectomies. Dr. Hoekstra’s research has shown other though these benefits are not yet proven. As with all surgery, benefits when compared to traditional laparoscopic equip- not all patients have a textbook recovery. Patients have to be ment, including a shorter learning curve for surgeons and a advised of risks beforehand,” Dr. Isacksen says. lower conversion rate to open surgery during the procedure. Use of the robot among area surgeons continues to increase. Another robotic surgery advantage is its ability to enhance Like Dr. Isacksen, physicians who have used the device often visualization during surgery, Dr. Rubens says. “With the ro- prefer it to other surgical options and believe it yields better botic procedure, because we’re inflating the abdomen with results. Dr. Hoekstra says in gynecologic oncology the trend air, we’re compressing the veins. We are able to see the tissue is moving away from open and laparoscopic surgery and to- planes easier, and the 3-D imaging enhances that. You lose the ward robotics for the management of endometrial, cervical tactile feedback from an open procedure, but the magnifica- and some early ovarian cancers. tion and the reduced blood loss make up for it.” “I believe the surgeon’s preference of this surgical modal- Robert Isacksen, M.D., Dr. Rubens’ colleague at ity and the positive perioperative outcomes are driving the HealthCare Midwest Urology, agrees. “We’re seeing the pro- increased use of robotics in my specialty,” she says. “Besides cedure in a highly magnified view and in a high-definition, all the benefits that we’ve been able to measure and publish, 3-D image,” he says. “That is as opposed to open surgery I think my overall gestalt is that, as a surgeon, I feel more where we’re looking at it from farther away in a poorly il- comfortable performing procedures robotically than laparo- luminated space with the problem of bleeding potentially scopically. It feels technically easier and therefore I believe obscuring our view.” it is safer for patients.” n

6 | West Michigan md news november/december 2009 med beat

Lakeland Welcomes New Three Hospitalists Join Taylor manages all areas of otolar- Family Physician to Coloma Lakeland Medical Staff yngology/head and neck surgery and Family physi- Lakeland HealthCare–St. Joseph allergy with a special emphasis in the cian Alexander recently welcomed three hospital- care of pediatric patients. Runowski, M.D., ists, physicians specially trained to has joined the provide hospital-based care to its Bronson Expands medica l sta f f medical staff. Neurology Team a t L a k e l a n d Dr. Stephen Dallas completed an in- Bronson Methodist Hospital wel- H e a l t h C a r e . ternal medicine residency at Michigan comes Karen Freshwater, PA-C, to Dr. Runowski is State University/Kalamazoo Center Bronson Neurology. Freshwater now practicing for Medical Studies. He earned his joins the Bronson Neurology team with Dr. Michael Mayle at Family medical degree from the University of Hisanori Hasegawa, M.D.; Care of Coloma-Watervliet, located of Tennessee College of Medicine in Dennis Jewett, in the newly opened Paw Paw Memphis and also holds a Master of M . D . ; D e a n Lake Medical Center, 6559 Paw Paw Arts degree from Andrews University Kindler, M.D.; Avenue, Coloma. in Berrien Springs. Kelly Y bema, Dr. Runowski received his medical Dr. Wyssem Ramdani graduat- M . D . ; A n i t a degree from Michigan State University ed from Algiers Medical School B u i t e n w e r f , and completed a family practice resi- in Algiers, Algeria. He complet- N.P.; and Lori dency at Sparrow Hospital in Lansing. ed an internal medicine residency Tatay, PA-C. In addition to earning a medical de- at Woodhull Medical and Mental F r e s h w a t e r gree, Dr. Runowski also holds a Doctor Health Center at State University is a certified physician assistant of Pharmacy degree. Dr. Runowski has of New York in Brooklyn. Prior to by the National Commission on more than 10 years’ experience as a arriving in Southwest Michigan, Certification of Physician Assistants. physician and is board certified by the Dr. Ramdani practiced at Gerber She received her master’s degree in American Board of Family Medicine. Memorial Hospital in Fremont, MI. medicine through the physician as- Dr. Uday Paul earned his medical sistant program at Western Michigan New Physician Joins degree from the University of Illinois University and bachelor’s degree Bronson Internal Medicine College of Medicine in Chicago and in animal science from University Hospital Specialists completed a residency in internal of Missouri. Bronson Internal Medicine Hospital medicine at Naval Medical Center in Specialists in Kalamazoo has wel- San Diego. New Physician Joins comed to it s Bronson Rambling practice Karen Grand Rapids Ear, Nose & Road Pediatrics C. Alcaraz, M.D. Throat Welcomes Joseph C. Bronson Rambling Road Pediatrics Dr. Alcaraz is Taylor, M.D. has welcomed to its practice Julie board certified Joseph C. Taylor, M.D., grew up Elias, M.D. by the American in Charlotte, MI. He attended the Dr. Elias is a board-certified Board of Internal University of Michigan for both un- pediatric physician with special inter- Medicine. She dergraduate and medical school. He ests in asthma and childhood obesity. completed her in- continued on at She completed ternal medicine residency at University the University of her pediatric of Illinois College of Medicine at Michigan for his residency and Urbana-Champaign. She received otolaryngology i n t e r n s h i p her bachelor’s degree from University residency and at Ch ild ren’s of the Philippines, Diliman, and her for a pediatric H o s p i t a l a t medical degree from University of the otolaryngology Montefiore in East College of Medicine. fellowship. Dr. See Page 10

West Michigan md news november/december 2009 | 7 law matters law matters Covenant Medical Center Physician Compensation Practices Lead to $4.5 Million Settlement By Alan G. Gilchrist, Foster, Swift, Collins & Smith, P.C.

The Department of Justice an- physician employees’ compensation Waterloo, IA, where physician nounced on August 25, 2009, that was far above fair market value. compensation ranged between the Covenant Medical Center in It is interesting how the gov- $230,000 and $360,000. Three Waterloo, IA, has agreed to pay ernment became aware of the Covenant Medical Center physi- $4.5 million to resolve allegations compensation arrangement. Cedar cians made between $1 million that it violated the federal false Valley Medical Specialists, a medi- and $2.14 million in 2002. The claims statute. cal clinic, obtained Covenant clinic also alleged that this sal- The government alleged that Medical Center’s IRS 990 forms, ary was several times higher than Covenant Medical Center submitted which demonstrated that for the what was earned by physicians at false claims to Medicare as a result tax year 2002, Covenant Medical hospitals in Des Moines, Cedar of improper financial relationships Center’s five highest paid physi- Rapids, University Hospital, clinics with five physicians that the govern- cians made between $633,000 and in Iowa City and the Mayo Clinic ment alleged violated the Stark law. $2.5 million a year, much higher in Rochester, MN. The highest The government alleged that the than a competitive hospital in paid physicians at these other hospitals earned between $325,000 and $657,000. Cedar Valley Medical Specialists expressed concerns to the U.S. Finance Committee, then chaired by U.S. Senator Charles Grassley, as well as the U.S. Department of Treasury. This apparently led to the Department of Justice action. Most financial relationships are not public knowledge. Practically speaking, these cases typically surface through a disgruntled em- ployee, voluntary self-disclosure, or in the case of Covenant Medical Center, a competitor. It is difficult to determine how the parties reached the figure of $4.5 million. The civil false claims statute allows for treble damages as well as a penalty of $10,000 for each false claim. For Stark cases, every claim from a tainted referral, under the government’s theory, is a false claim. The damages in these

8 | West Michigan md news november/december 2009 law matters Business Strategists Technology Solutions cases can approach infinity and the Certified Public Accountants draconian penalties force providers to settle. To date, the only case Echelbarger, Himebaugh, Tamm & Co., P.C. alleging the Stark-as-a-false-claim theory that was actually tried was Strategic Business Solutions for running in the Eastern District of Michigan your practice efficiently and profitably: in 2004. It involved a group of or- thopaedic surgeons and McLaren Hospital and resulted in a no-cause · Operations Analysis verdict, exonerating both the hospi- · Practice Management Services tal and the physicians. · Finance, Accounting, and Tax Services Once again, the government has seen fit to use the federal false · Accounting & Finance Software and Consulting claims statute rather than the remedies available under the Stark statute itself. For many years, the Contact Melinda DeMarse, Director of Healthcare Services, government has successfully argued at [email protected] that providers, when submitting claims to the Medicare program, certify that they are in compliance 5136 Cascade Road SE, Suite 2A / Grand Rapids, MI 49546 / 616-575-3482 [email protected] / www.ehtc.com with all federal laws that would affect payment. Since Stark prohib- its payments under Part B of the Medicare program in the event of a violation, the argument follows that THE KALAMAZOO SYMPHONY ORCHESTRA billing for services stemming from PRESENTS a tainted Stark referral constitutes a false claim. With the combination of new in- Friday, November 20 centives in all of the amendments 8:00 p.m. Miller AuditoriumConductor to the federal false claims statute, the state of Michigan false claims Raymond Harvey, statute and the public disclosure re- DianaGuest Cohen, Violinists Edith Hines, quirements by tax-exempt hospitals Renata Artman Knific, Christopher Takeda on their IRS 990 forms, these cases could become a cottage industry in PROKOFIEV Overture on Jewish Themes* themselves. There are now websites BLOCH Three Jewish Poems* that individuals can join that will VIVALDIIn collaboration Four with Seasons the Michigan distribute the 990 forms on most Festival of Sacred Music * tax-exempt organizations. Providers must be increasingly diligent in TICKETS establishing fair market value in : Call (269) 387-2300 or online KalamazooSymphony.com compensation arrangements, because the competition is clearly paying attention. n SPONSORS:

West Michigan md news november/december 2009 | 9 Continued from Page 7 med beat

New York and received her medical Creek, received the 2009 Dale G. EMT certifica- degree from University of Pittsburgh Griffin Healthcare Leadership Award. tion at Portland School of Medicine. She also re- This accolade, which recognizes exem- C o m m u n i t y ceived her bachelor’s degree from the plary contributions that improve the College. Daniels American University. quality and accessibility of health care r e c e i v e d h i s in greater Battle Creek, is presented an- b a c h e l o r ’ s New Physician Joins nually by Battle Creek Health System. d e g r e e i n Bronson Internal Medicine mechanical en- Hospital Specialists gineering from Bronson Internal Medicine Hospital University of Michigan. Specialists has welcomed to its practice Sarah Simpson, Four Pediatric Specialists N.P., M.S.N. Join Helen DeVos Simpson com- Children’s Hospital pleted her master’s The medical staff at Helen DeVos degree in nurs- Children’s Hospital welcomes new ing at Michigan physicians Leslie Jurecko, M.D.; State University Surender Rajasekaran, M.D.; and her bachelor’s New Physician Sharon Smith, M.D.; and Olufemi degree in nursing Assistant Joins Soyode, M.D. from Western Michigan University. She Bronson Internal Medicine Dr. Jurecko is a hospitalist. She also received her R.N. diploma in nurs- Hospital Specialists provides care for hospitalized pa- ing from Bronson Hospital School of Bronson Internal Medicine Hospital tients who do not have a primary Nursing. Specialists has welcomed to its prac- care physician or whose primary care tice Jeff Daniels, P.A. physician prefers the hospitalist team A.J. Jones receives health Daniels completed his master’s to care for their patients while in the care leadership award degree in medicine and physician hospital. A.J. Jones, M.D., President and CEO assistant at Western Michigan Dr. Jurecko is board certified in of the Family Health Center of Battle University. He also completed his pediatrics. She earned her medical degree from Wayne State University and completed a pediatric residency at Northwestern University, Children’s Memorial Hospital in Chicago, IL. Dr. Rajasekaran is a critical care specialist. He provides care to infants, children and adolescents with traumatic injuries or life-threatening illnesses or following major surgery in the region’s largest pediatric critical care unit. Dr. Rajasekaran comes to Grand Rapids from St. Jude Children’s Research Hospital in Memphis, TN, where he served as an assistant professor. He also provided care at LeBonheur Children’s Hospital, where he was an assistant professor of pediatrics at

1 0 | West Michigan md news november/december 2009 med beat the University of Tennessee Health North in Carmel, IN, where she was Center in Seattle, WA. Science Center. a professor of clinical pediatrics at He is board certified in pedi- Indiana University. Two Dermatologists Join atrics and pediatric critical care. She is board certified in pediatrics Lakeland Medical Staff He earned his medical degree and and pediatric hematology/oncology. Lakeland HealthCare recently completed a pediatric residency at She earned her medical degree and welcomed two dermatolo - Ogun State University in Nigeria. completed a pediatric residency gists, Clarence William Brown, He also completed a pediatric resi- and fellowship in pediatric hema- M.D., and Vassilios (Bill) dency at Metropolitan Hospital in tology/oncology at the University Dimitropoulos, M.D., to its New York City where he served as of Michigan. medical staff. chief resident. He completed a pedi- Dr. Soyode is a neurologist. He pro- Dr. Brown completed his dermatol- atric critical care fellowship at the vides medical care for children with ogy residency at Rush-Presbyterian University of Florida. brain and nervous system disorders. St. Luke’s Medical Center in Chicago. Dr. Smith is a hematologist/oncolo- He is board certified in pediatrics. At Baptist Medical Center in Kansas gist. She provides comprehensive, He earned his medical degree at City, he completed a fellowship in multidisciplinary specialty care, the University of Lagos in Nigeria. Mohs micrographic surgery, a spe- treating infants, children, teens and He completed a pediatric residen- cialized technique used to treat skin young adults with hematology, coagu- cy at Michigan State University/ cancer. Dr. Brown graduated from lation and oncology disorders. Kalamazoo Center for Medical the University of Pittsburgh School of Dr. Smith comes to Grand Rapids Studies followed by a pediatric Medicine. He is board certified by the from Center for Children’s Cancer neurology fellowship at Children’s American Board of Dermatology and and Blood Diseases at Riley Hospital Hospital and Regional Medical See Page 17

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West Michigan md news november/december 2009 | 11 Patient 1 success rate and minimal complications. It’s very gratifying to see kids up and around within a day.” RFA treatment for a patient with metastic kidney cancer, which has spread to her ribs. A Patient’s RFA Experience A B Last June, RFA changed Christopher Jones’ life. He had been suffering for nearly 12 months. The pain started on the first day of school of his freshman year and quickly became chronic. Chris describes the sensation he felt as that of someone hitting his leg with a baseball bat. It hurt all the time, whether he was moving or not. Sometimes the pain would go away, so he

Photo A: Tumor, kidney could stand up for a minute, but it would quickly return and cancer has spread to the he would have to sit down as it intensified. Chris was 14 at C bone. Photo B: RFA needle the time and needed painkillers to get through the day. He extended into the tumor. Photo C: Post RFA, the tumor couldn’t focus in class, and to complicate matters, his school has been destroyed. wouldn’t allow him to carry pain pills. Climbing stairs to get to classes exacerbated the problem. This went on for months, as his parents took him from doctor to doctor. Once an MRI was ordered and he was referred to Dr. Fedeson, a solution and improve the quality of life. Only 30% of liver cancer was in sight. patients in the United States are candidates for resection, Chris was suffering from osteoid osteoma, a benign bone and among those patients who have surgery, up to 75% of tumor. “It was such a relief to find out there was a cure for them have recurrent disease. “People with liver cancer who used to be told they had Patient 2 six months to live can often add quality years to their life,” RFA treatment for a patient with metastic colon cancer which has says Advanced Radiology Services’ Brian Fedeson, M.D. spread to the liver. “Some patients come in every six to 12 months to have tumors removed with RFA and require no other interven- A B ing palliative care.” Along with prolonging life, RFA also makes the patient more comfortable by easing the pain caused by tumors pressing on their organs. Traditional treatment for patients with localized kidney cancer is surgical removal. However, the tissue sparing advantage of RFA, along with other previously outlined advantages, has led to its rise. RFA is beneficial in cases C D diology that involve high surgical risk, underlying illness, recur- Ra nced rent tumors, only one kidney or marginal kidney function. a One of the most exciting conditions to treat with RFA is osteoid osteoma. The benign bone tumor afflicts young people and can cause debilitating pain. RFA is usually per- Photos courtesy of Adv formed on an outpatient basis for osteoid osteoma patients. Photo A: Liver tumor before RFA Photo B: RFA needle extended into tumor. “The effect on the bone is stunning,” says Dr. Fedeson. Photo C: Post RFA, ablation zone “Patients experience almost instant relief with a very high Photo D: Post RFA, tumor is gradually reabsorbed by the body.

West Michigan md news november/december 2009 | 13 special feature Advanced Radiology Offers Hope for Patients With Previously Untreatable Tumors Radiofrequency Ablation Delivers Nonsurgical Localized Treatment

Radiofrequency ablation (RFA) offers promise to cancer an option to treat certain tumors since 2004. The procedure patients who were previously untreatable. The minimally is increasingly in the spotlight due to its ability to destroy invasive procedure delivers a good prognosis for many tumors of the liver, lung, kidney, adrenal gland and bone smaller primary site lesions in the lung, kidney, liver and without requiring dissection. RFA offers a nonsurgical, bone. For more advanced cancers that are not at the pri- localized treatment that can be given without disrupting mary site, RFA can provide palliative care that extends life the patient’s overall health and allows them to resume beyond what was previously possible. their normal activities within a few days. Depending on Advanced Radiology Services has been offering RFA as the circumstances, local or general anesthesia is used and patients typically return home the After a nearly a year of suffering from a benign bone tumor, Chris was virtually pain free within hours of RFA treatment. same day or within 24 hours. One of the keys to successful treatment is probe placement. Interventional radiologists specialize in image-guided procedures, which makes them especially well suited to perform RFA. During the procedure, the tumor is identified with a CT scan or ultrasound. A nick in the skin is made as an entry site for a needle-like RFA probe that is image-guided into the tumor. Upon penetration of the tumor, radiofrequency waves heat up and destroy it. Afterwards, the tumor is reabsorbed by the body. For small primary site tumors of the lungs, kidneys, adrenal glands and bones, RFA may be the only curative treatment needed. In more complex cases, RFA is performed in conjunction with other procedures such as surgery, radiation and/or n a chemotherapy. elicz T In advanced cases, such as second- ary liver cancer, RFA can extend Photo by Ann

1 2 | West Michigan md news november/december 2009 Patient 1 success rate and minimal complications. It’s very gratifying to see kids up and around within a day.” RFA treatment for a patient with metastic kidney cancer, which has spread to her ribs. A Patient’s RFA Experience A B Last June, RFA changed Christopher Jones’ life. He had been suffering for nearly 12 months. The pain started on the first day of school of his freshman year and quickly became chronic. Chris describes the sensation he felt as that of someone hitting his leg with a baseball bat. It hurt all the time, whether he was moving or not. Sometimes the pain would go away, so he

Photo A: Tumor, kidney could stand up for a minute, but it would quickly return and cancer has spread to the he would have to sit down as it intensified. Chris was 14 at C bone. Photo B: RFA needle the time and needed painkillers to get through the day. He extended into the tumor. Photo C: Post RFA, the tumor couldn’t focus in class, and to complicate matters, his school has been destroyed. wouldn’t allow him to carry pain pills. Climbing stairs to get to classes exacerbated the problem. This went on for months, as his parents took him from doctor to doctor. Once an MRI was ordered and he was referred to Dr. Fedeson, a solution and improve the quality of life. Only 30% of liver cancer was in sight. patients in the United States are candidates for resection, Chris was suffering from osteoid osteoma, a benign bone and among those patients who have surgery, up to 75% of tumor. “It was such a relief to find out there was a cure for them have recurrent disease. “People with liver cancer who used to be told they had Patient 2 six months to live can often add quality years to their life,” RFA treatment for a patient with metastic colon cancer which has says Advanced Radiology Associates’ Brian Fedeson, M.D. spread to the liver. “Some patients come in every six to 12 months to have tumors removed with RFA and require no other intervening A B palliative care.” Along with prolonging life, RFA also makes the patient more comfortable by easing the pain caused by tumors pressing on their organs. Traditional treatment for patients with localized kidney cancer is surgical removal. However, the tissue sparing advantage of RFA, along with other previously outlined advantages, has led to its rise. RFA is beneficial in cases C D iology Rad that involve high surgical risk, underlying illness, recur- d nce a v

rent tumors, only one kidney or marginal kidney function. d One of the most exciting conditions to treat with RFA is osteoid osteoma. The benign bone tumor afflicts young people and can cause debilitating pain. RFA is usually per- Photos courtesy of A formed on an outpatient basis for osteoid osteoma patients. Photo A: Liver tumor before RFA Photo B: RFA needle extended into tumor. “The effect on the bone is stunning,” says Dr. Fedeson. Photo C: Post RFA, ablation zone “Patients experience almost instant relief with a very high Photo D: Post RFA, tumor is gradually reabsorbed by the body.

West Michigan md news november/december 2009 | 13 diology Ra nced a Photo courtesy of Adv Advanced Radiology Services physicians performing RFA (L-R): Farid Aladham, M.D.; Todd Durham, M.D.; Michael Doherty, M.D.; Peter Nye, M.D.; Brian Fedeson, M.D.; William Rozell, D.O.; Manish Varma, M.D.; Robert Davis, M.D.

took a little more than an hour. “I was really surprised to see Advanced Radiology RFA Contact Numbers how quick it was, and shocked that he came home within hours virtually pain free, with only a band aid on his leg Grand Rapids: (616) 459-7225 Metro Health Hospital and no stitches,” Vikki adds. The next day, Chris felt good Spectrum Health, Blodgett & Butterworth Campuses enough to go to a friend’s house and was running for the Holland: (616) 459-7225 first time in a year. Holland Hospital (starting in 2010) “I felt so relaxed and relieved once this was over and Kalamazoo: (269) 388-4570 grateful to have my life back,” says Chris. “I’m so glad I don’t Bronson Methodist Hospital need pain pills any more and that I feel normal again. I Lansing: (616) 459-7225 Sparrow Hospital want people who have osteoid osteoma to know about this so they can get help like I did.” Not all patients with tumors are candidates for RFA. Chris,” says his mom Vikki. “Within a week of contacting However, the procedure can avert unnecessary complica- Advanced Radiology Services, they had Chris treated and tions for many lesions that were previously considered feeling better.” The procedure itself was on a Thursday and untreatable or needed significant surgical resection. Many of these people can now avoid surgery and have a positive outcome. “We are finding that many of the oncologists are Interventional Radiology Quick Facts very savvy users of RFA,” says Dr. Fedeson. “We are also increasingly seeing patients referred to us by urologists.” Interventional radiologists are board-certified physicians with additional advanced training in image-guided procedures. They have Patients may be referred from any site, many of whom completed a one-year internship, followed by a four-year diagnostic travel from all over Michigan. They are usually seen within radiology program and then a one- or two-year fellowship in interventional radiology. a week and treated within two weeks. Advanced Radiology The procedures they perform are for both diagnostic and treatment Services helps streamline RFA by handling paperwork and purposes. Many conditions that used to require surgery can now be taken care of nonsurgically by these highly trained subspecialists. coordination with the appropriate treatment location. There are also disorders that can be treated where there is no surgical alternative. Typically, CT or ultrasound imaging is used to locate disease and treat it through a catheter or tiny instrument, rather than Advanced Radiology Services, P.C. is a medical practice open surgery. This approach improves recovery time and reduces risk, pain and cost. owned by radiologists. The practice has a unique structure, Many common, as well as rare conditions, may now be treated which maintains the rich history and integrity of its individual interventionally. Some of the conditions appropriate for interventional consideration include uterine fibroids and other tumors, abdominal divisions while providing the resources only possible through a aortic and other aneurysms, carotid artery disease, deep vein thrombosis, heart disease, renal disease, peripheral arterial disease, large group. Their focus on subspecialization provides strong stroke, varicose veins and spinal pain caused by osteoporosis. Most leadership at the leading edge of the profession. Learn more patients are dismissed within 24 hours and often the same day. about the practice at www.advancedrad.com. n

1 4 | West Michigan md news november/december 2009 iology Rad d nce a v d Photo courtesy of A Advanced Radiology Associates physicians performing RFA (L-R): Farid Aladham, M.D.; Todd Durham, M.D.; Michael Doherty, M.D.; Peter Nye, M.D.; Brian Fedeson, M.D.; William Rozell, D.O.; Manish Varma, M.D.; Robert Davis, M.D.

1 4 | West Michigan md news november/december 2009 kudos

Lakeland HealthCare Cancer Care Services for its success in rais- CEO Named Excellent C e n t e r a t ing organ donation rates. Borgess Administrator of Battle Creek Medical Center received this hon- the Year H e a l t h or on September 30 during the Joseph Wasserman, President System has Fifth Annual National Learning and CEO of Lakeland HealthCare, been named Congress on Organ Donation and St. Joseph, MI, has been honored to the board Transplantation in Grapevine, Texas. with the Excellent Administrator of o f d i r e c - the Year Award from Health Care Wayne Young tors of t he Spectrum Health Receives Weekly Review. Michigan Cancer Consortium Five-Star Ratings for Under Wasserman’s leadership (MCC). His three-year term begins Key Services over the past 25 years, Lakeland January 1, 2010. Spectrum Health has received HealthCare transformed from four Young has served on both the five-star ratings for quality in community hospitals into a com- Susan G. Komen for a Cure na- more than a dozen clinical areas prehensive health organization, tional board of directors and the from HealthGrades, the leading with more than 3,300 employees SW Michigan affiliate board and is independent health care ratings or- at locations throughout Southwest a member of the Calhoun County ganization. The recognition is based Michigan. At the end of this month, Cancer Control Coalition. on HealthGrades’ twelfth annual Wasserman will retire from the or- Hospital Quality in America study, ganization, where his colleagues say Borgess Medical Center which analyzes patient outcomes at he will be greatly missed. Receives Organ Donation all of the nation’s hospitals. Medal of Honor from U.S. Spectrum Health Blodgett and Premier Vein Center Department of Health Butterworth hospitals also have Physician Becomes and Human Services been named recipients of the 2010 First To Earn Board Borgess Medical Center has been Gastrointestinal Surgery Excellence Certification Here awarded a silver Organ Donation Award, ranking among the top 10% The American Board of Phlebology Medal of Honor from the U.S. of hospitals in the nation for gastro- (ABPh) has announced that Scott Department of Health and Human intestinal surgery services. n Piereson, M.D., has earned board certification in the specialty of phlebology from the American Board of Phlebology, becoming the first physician in the Kalamazoo area to earn board certification in the medical specialty in veins and vein diseases. Dr. Piereson, as a member of Premier Empowering Radiology, serves as the Medical Director of Premier Vein Center on the campus of survivors Borgess Medical Center. of sexual violence and enhancing Less than 1% of all phlebology professionals in the U.S. have earned the public’s understanding and certification from the ABPh. acceptance of rape victims.

BCHS Cancer Director Named To State Board 817-A Virginia Dr. • Orlando, FL 32803 (407)898-0693 • www.soar99.org Wayne Young, Director of The

West Michigan md news november/december 2009 | 15 insurance matters

Protection as a Medical Director or Medical Directorships By Robert G. Wilson

If you act as a medical director Following are some recommended by defense costs). for a health care entity, whether actions to determine the appropriate- • It is highly recommended the policy for profit or a nonprofit, you ness of an entity’s D&O policy. contain a “consent to settle” clause. should have concerns about proper • The definition of “covered person” Inasmuch as most D&O policies are insurance protection. should include medical director. written through the excess market Your homeowner’s policy may • D&O policy coverage should extend (not subject to Michigan insurance provide you with some very limited to physicians making administrative laws), it would be unrealistic to expect protection, if you are serving in a non- decisions for the medical director in every policy to satisfactorily address remunerative capacity. If you carry a the medical director’s absence. each point made above, and particu- personal umbrella policy then that • There should at least be legal defense larly the last two points. may provide a little broader scope of coverage for regulatory issues (such Three points need to be accounted coverage. However, those policies will as (COBRA). Legal defense means for not in a D&O policy, but in the oftentimes contain a “professional just that, coverage for attorneys contract for services between the services” exclusion. fees, but not indemnity (fines physician and entity. Assuming the You may think that your medi- or penalties). policy will contain a deductible, is it cal professional liability policy • The policy should be written on a made clear that the facility will pay would respond to a suit alleging “duty to defend” basis, meaning that? The facility should be required improprieties as a medical director. that when a claim is made for an to notify the medical director in writ- Those policies typically only trigger alleged wrongful act, the insurance ing 30 days prior to any policy change coverage for allegations involving company has the right and duty to (or cancellation). Finally, tail coverage patient care — direct, one-on-one, defend a claim, even if it is ground- should be provided if the policy is patient care. less, false or fraudulent. cancelled, or if the medical director While specific medical directorship • There should be coverage for the leaves, the facility should continue to liability policies exist (usually avail- medical director regardless of carry protection retroactive to when able only in the “excess” market), the facility culpability. the physician became medical direc- most typical place to find coverage for • It is best that the policy cover claims tor. The deductible, cancellation and a medical director would be the expenses in addition to, or beyond, tail issues are so important they should entity’s4-5/8x2-1/4StutFdReduceStut Directors & Officers (D&O) 1/11/05 the6:26 limits AM ofPage liability 1 (versus having each be mentioned in the contract liability policy. the policy limits potentially eroded for services. Always have legal counsel review any contract for services as medical There are many proven,effective ways director prior to that contract being executed. If necessary, require the to reduce stuttering. facility to add an indemnity clause to the contract. These steps will help to THE ensure your financial security. STUTTERING ® If you have questions regarding Doing nothing is not FOUNDATION A Nonprofit Organization the information presented, please one of them. 1-800-992-9392 feel free to call Robert G. Wilson at www.stutteringhelp.org Michigan Professionals Agency at (269)

3100 Walnut Grove Road, Suite 603 • P.O. Box 11749 • Memphis, TN 38111-0749 344-8910, or by e-mail at rgw_mipro- [email protected]. n

1 6 | West Michigan md news november/december 2009 Continued from Page 11 med beat is a Fellow of the American Academy at Michigan State University College University School of Medicine. of Dermatology. of Human Medicine and served his Dr. Dimitropoulos received his residency at Gundersen Lutheran Two physician assistants — medical degree from Rush University Medical Center in La Crosse, Gary Bissonette, in Chicago. He completed his WI. He served a vascular surgery PA-C, and Michael West, dermatology residency at the University fellowship at the University of Kansas PA-C will also make the of Michigan, where he also studied in the Medical Center. transition to The Spectrum University of Michigan’s Multidisciplinary Dr. DeKryger earned his medical Health Medical Group Melanoma Clinic. Dr. Dimitropoulos fol- degree at the University of Michigan Gary Bissonette received his bach- lowed his residency with a fellowship Medical School. He completed a gener- elor’s degree from the University in Mohs micrographic surgery at Rush al surgery internship and residency at of Alabama-Birmingham and University. He is board certified by the Pontiac General Hospital, as well as a his master’s degree in physician American Board of Dermatology and general surgery residency at Spectrum assistant studies from the University is a Fellow of the American Academy Health Butterworth Hospital. He of Nebraska. of Dermatology. also completed surgery service in the U.S. Navy. Family Medicine Physician Vascular Surgeons Dr. Gorsuch earned her medical Joins Spectrum Health Join Spectrum Health degree at Michigan State University Medical Group Medical Group College of Human Medicine and Kristi Demock, D.O., a family medi- The vascular surgery and served her residency through the cine physician, has joined the Spectrum VeinSolutions practices of Robert Grand Rapids/Michigan State Health Medical Group. Cali, M.D.; Christopher Chambers, University General Surgery Residency Dr. Demock earned her medical M.D., Ph.D.; Robert Cuff, M.D., RVT, Program. She also completed a pe- degree at Michigan State University FACS; Lewis L. DeKryger, M.D.; ripheral vascular surgery fellowship College of Osteopathic Medicine. Jill Gorsuch, M.D.; M. Ashraf Mansour, through Michigan State University She completed a family medicine M.D.; and Peter Wong, M.D., are and received additional endovascu- internship and residency at Metro now part of The Spectrum Health lar training at Greenville Hospital Health Hospital. Medical Group. System in Greenville, SC. Dr. Cali earned his medical degree Dr. Mansour earned his medical OB/GYN Physicians at SUNY Upstate Medical University degree at Cairo University School Join Spectrum Health in Syracuse, NY. He completed a gen- of Medicine in Egypt. He completed Medical Group eral surgery internship and residency his surgical internship and residency Spectrum Health Medical Group has at Cleveland Clinic Hospital. He also at the University of Colorado Health added two new physicians who will help completed fellowships in critical Sciences Center in Denver. After provide increased support for obstetric care, peripheral vascular surgery and serving in the U. S. Army as a major and gynecological patients at Butterworth endovascular surgery at Cleveland in the Medical Corps, he completed Hospital and in the community. Clinic Hospital. a fellowship in vascular and endovas- Michelle Backus-Walzer, M.D., and Dr. Chambers earned his medical cular surgery at the Southern Illinois Rebecca Caldwell, M.D., are joining the degree from the University of South University School of Medicine. medical group this month. Florida College of Medicine, as well as Dr. Wong earned his medical Dr. Caldwell earned her medical a Ph.D. in biochemistry and molecu- degree from the Chicago Medical degree at Michigan State University lar biology. He completed a general School. He completed a general sur- College of Human Medicine and surgery internship and residency at gery internship at Loyola University served her residency in OB/GYN Washington University in St. Louis, Stritch School of Medicine and a through the Grand Rapids Medical MO. He also completed a vascular and general surgery residency at Rush- Education and Research Center/ endovascular surgery fellowship at Presbyterian-St. Luke’s Medical Michigan State University College of Washington University. Center. He also completed a vascular Human Medicine. Dr. Cuff earned his medical degree surgery fellowship at Wayne State Dr. Backus-Walzer earned her medi-

West Michigan md news november/december 2009 | 17 med beat cal degree at Michigan State University psychiatrist John B. Mitchell, M.D., has York University. While at Jefferson College of Human Medicine and served joined the staff at Pine Rest Christian Medical College in Philadelphia, PA, her residency in OB/GYN at New York Mental Health Services. Dr. Mitchell received his doctoral de- University School of Medicine in New In his work with clients, Dr. Mitchell gree and was recipient of the Keyes York, NY. specializes in medication management Prize for his outstanding work in of mood and anxiety disorders. psychiatry. Dr. Mitchell assisted in PINE REST HOLLAND Dr. Mitchell completed his un- various research projects during his CLINIC WELCOMES dergraduate degree at Harvard psychiatry residency at the Hospital of NEW PSYCHIATRIST University and received his master’s the University of Pennsylvania, Pine Rest is pleased to announce that degree in molecular biology at New where he received the Resident Medical Education prize for medical student teaching.

Lakeland Welcomes New Family Physician in Niles Dr. Shannon (Keith) Twiddy has joined the Lakeland HealthCare medical staff and will be caring for families at Southwestern Medical Clinic in Niles. Dr. Twiddy received his medical degree from Northeastern Ohio Universities College of Medicine. He completed a residency in family practice at East Carolina University in Greenville, NC. Since 1998, Dr. Twiddy has been practicing family medicine in North Carolina.

Dr. Elizabeth Knefelkamp Joins Lakeland Medical Staff Dr. Elizabeth Knefelkamp has joined the medical staff at Lakeland HealthCare and is practicing at Southwestern Medical Clinic Surgical Specialties. Her special interests include minimally invasive surgery and surgical oncology, including breast care. A graduate of Central Michigan University in Mount Pleasant, Dr. Knefelkamp obtained her medical degree from Wayne State University School of Medicine in Detroit. She completed a residency in general surgery from St. John Hospital and Medical Center in Detroit, in addition to a residency in obstetrics and gynecology at William Beaumont Hospital in Royal Oak. n

1 8 | West Michigan md news november/december 2009 legal ease

The Care and Keeping of Medical Records By Martha Rabaut Boonstra, Miller-Canfield

Recent news reports have revealed the or a record retention company for the request, as well as a per-page charge. The mishandling of medical records and the remainder of the retention period. The permissible fee changes in accordance resulting serious consequences. Medical medical records must remain accessible with the consumer price index. For the records are subject to many state and for the duration of the retention period. 2009 permissible record charges, see federal laws and regulations. A provider Once the full record retention period www.michigan.gov/documents/2006 who handles medical records — whether has passed, the records may be destroyed memofromdirectorreflectingCPIincrea an independent practitioner or a health in a manner that protects the confiden- se2_154629_7.pdf-2009-03-24. care facility — should be aware of the tiality of the records and permanently The mishandling of medical records obligations regarding the proper care destroys the confidential medical in- can lead to substantial civil fines and, and keeping of medical records. formation. For example, shredding in some instances, criminal prosecution. The creator of the medical record, not paper records and permanent electronic If you would like additional informa- the patient, owns the medical record. deletion of electronic medical records tion about compliance or protecting your Under Michigan law, private physicians are suitable methods of destruction. In medical records, contact the author or and health care facilities are required contrast, throwing medical records in meet her at the upcoming Medical Records to maintain their medical records in a the office trash or in a facility dumpster Law Seminar on Tuesday, December 8, manner that protects the confidentiality is an inadequate method of destruction. 2009, at the Hilton Garden Inn, Detroit of the records and assures accessibility to Practitioners and facilities are al- Metro Airport in Romulus, MI. Details the information when required. Under lowed to charge for providing copies of and registration can be found at www.lor- the Michigan Public Health Code, medical records. Certain requestors like man/ID385081. Martha Rabaut Boonstra medical records must be retained for a the Worker’s Disability Compensation specializes in a broad range of health care minimum period of seven years follow- Agency or the Social Security Disability -related matters including reimbursement ing the last date of service provided to a Determination Service pay for the and payment provider appeals, health patient. However, this recommendation medical records in accordance with care corporate governance and health care is a very general guideline that is sub- a set fee schedule. In the absence of a compliance issues. Martha also assists ject to multiple modifications. Certain fee schedule, the provider may charge with health care-related administrative records, like dental records, must be a fee in accordance with the Michigan and litigation matters. Contact her at maintained for longer periods. Other Medical Records Access Act. That act (734) 668-7660, or boonstramr@miller- records, like those concerning HIV or provides for an initial fee for the record canfield.com. n mental illness, require very specific retention and destruction periods. Statutes of limitations for false claims and health I work. Eye strain from computer use care-related actions might extend the is the number one complaint of recommended retention period, as well. Therefore, office workers. Talk to your eye- Medical records must be retained for eye strain. care professional about computer the full required retention period, even if eyewear to help prevent eye strain. a provider or a facility ceases to operate. For example, prior to retiring, a physician in a private practice must arrange The Vision Council of America for the continued retention of patients’ recommends regular eye exams for you and your family to ensure medical records. The records may not be healthy vision. sold. Instead, they should be transferred www.checkyearly.com to the patient, another practitioner

West Michigan md news november/december 2009 | 19 money matters

Patients Are Customers, Not Case Numbers By Pierre L. Hulsebus, EHTC Technology Solutions

Patient retention is key for maintaining a financially Similar concepts can be used to establish patient re- successful health care practice. Pay-for-performance pro- lationship management (PRM) systems in health care grams are springing up across the nation. For example, organizations, from small practices to large hospital some payers are using patients’ evaluation of care and organizations. With a PRM system in place, clinicians service in awarding bonuses or withholding a percent- find it easier to establish ongoing relationships with age of payment. California is currently considering their patients, increase their focus on preventative legislation aimed at mandating minimum wait times, tactics and make use of techniques proven to improve reducing the current average from 20 to 15 days. Finally, patient satisfaction. In patient-centric organizations, patients can now vote with their feet if they feel dissatis- clinicians pay more attention to education, prevention fied, taking their business away from medical practices and overall patient well being. Patient care becomes altogether and going to the growing number of readily coordinated across departments and organizations, accessible walk-in clinics. and this helps decrease potential gaps in care and leads Satisfied patients are less likely to file a malpractice to increased patient satisfaction. Instead of requiring claim, thereby lowering insurance premiums. Satisfied patients to conform to each health care organization’s patients tend to stay with a practice longer, thus reduc- unique procedures, processes are streamlined from end ing the practice’s administrative and patient acquisition to end, resulting in more efficiency across the medical expenses. It becomes obvious that practices filled with practices and ultimately, improved convenience for pa- happy patients have a better financial picture than ones tients. Clinicians also have access to and can securely that struggle to retain their good patients and work even share information and resources that help patients better harder to gain new patients. manage chronic diseases. What is fueling this drive towards improved patient/ A dramatic shift needs to occur in most health care customer satisfaction? Over the past 10 years, consumer organizations to address this increasing pressure expectations have evolved to seek increased customer to improve satisfaction. The long-term benefit of intimacy. Overall, we are more savvy consumers and using a PRM system is measured by reduced adminis- expect our service providers to remember who we are, trative costs, happier patients and improved payer and suggest additional relevant services and do this in a referral relations. timely and convenient manner. I call this the “Amazon Pierre L. Hulsebus is the customer relationship prac- Effect” because Amazon.com was one of the first tice manager at EHTC Technology Solutions, a division organizations to track customer activities and use that of Echelbarger, Himebaugh, Tamm & Co. PC. He can be information to improve interactions with repeat custom- reached at (616) 575-3482, or [email protected]. n ers. When organizations build “institutional memory” of their customers (tracking their likes, dislikes and advertisers’ index predicting the next event that should happen in their evolution as a customer), customers are more likely Advanced Radiology Services ...... Inside Front Cover to be satisfied and stay loyal. Organizations that have Anthony Dugal Photography...... Inside Back Cover Constance Brown Hearing Centers...... 3 become customer-centric are more profitable and con- David C. Bos Homes...... Back Cover tinue to win in highly competitive markets. For many Echelbarger, Himebaugh, Tamm & Co., P.C...... 9 Foster Swift Collins & Smith, P.C...... 11 years, commercial organizations have realized the Kalamazoo Symphony Orchestra...... 9 benefits of deploying customer relationship Michigan Professionals...... 10 Miller Canfield...... 18 management (CRM) systems that help them build long- Pinkus Dermatopathology Laboratory, PC...... 8 term customer relationships.

2 0 | West Michigan md news november/december 2009 West Michigan md news november/december 2009 | 21 2 2 | West Michigan md news november/december 2009