Premier Pulse

News for Premier Health Physicians

VOLUME 4 | ISSUE 10 | OCTOBER 2017 New Ohio Opioid Prescribing Rules Unveiled By Tammy Lundstrom, MD, JD, interim chief clinical officer and interim president, Premier Physician Network, Premier Health

The Ohio Board of a prescription for acute pain cannot or CPT code to the prescription when of Medicine has exceed an average of 30 MED per day. prescribing opioids for acute pain becomes released the • Health care providers may prescribe effective in December 2017. On June 1, long-awaited opioids in excess of the day supply limits 2018, this will be a requirement for all rules on opioid only if they provide a specific reason controlled substance prescriptions. Our IT prescribing that documented in the medical record. team is working with the EPIC developers track the Centers on strategies to assist providers in meeting for Disease Control The new limits do not apply to opioids these requirements. The OSBM has also and Prevention prescribed for cancer, palliative care, end- announced that it intends to audit providers guidelines. These of-life/hospice care or medication-assisted who exceed the guidelines and promised rules took effect on August 31. They include treatment for addiction. Prescribers should strict enforcement per Gov. John Kasich’s the following basics that apply to the be aware that MED will be calculated direction. first opioid analgesic prescription for the on the maximum use potential on PRN The MED limit is one that will likely trip treatment of an episode of acute pain: prescriptions. Those allowing for more than four Vicodin tablets or the equivalent will be up some doctors. Four 5mg vicodin in a • No more than seven days of opioids can in violation of the limits. More details can be 24-hour period will max out the limit. Many be prescribed for adults. found in the following documents posted of the surgeons write for one to two every • No more than five days of opioids can be on the physician portal: six hours, and that will require supporting prescribed for minors and only after the documentation in the record. State of Ohio Board of Pharmacy written consent of the parent or guardian Ohio State Medical Board More information can be found on the is obtained. Ohio State Medical Association Ohio Automated RX Reporting System • Except as provided for in the rules, the (OARRS) MED calculator at An additional rule requiring the inclusion of total morphine equivalent dose (MED) ohiopmp.gov/MED_Calculator.aspx. the first four digits of the ICD-10 diagnosis

premierhealth.com Delivering Difficult News to Be Focus of Cancer CME

Miami Valley Hospital South will There is no charge to attend this event, but host an upcoming CME program space is limited. Registration is required by intended for primary care physicians, November 2. Call (866) 608-FIND (3463) to and physician specialists, including register. oncologists, cardiologists, dermatologists, This activity has been planned and gastroenterologists, general surgeons, implemented with the Essential Areas and radiologists, internal medicine, Policies of the Accreditation Council for nephrologists, neurologist, OB/GYNs, Continuing Medical Education (ACCME) pathologist, pulmonologists, urologists, and through the joint providership of Wright others who care for cancer patients. The State University (WSU) and Premier program, “Connecting Cancer,” takes place Health. WSU is accredited by the ACCME to in the cancer center’s conference rooms A provide continuing medical education for and B on Thursday, Nov. 9. The evening gets physicians. under way at 5:30 p.m. with registration, networking and heavy hors d’oeuvres. A WSU designated this live activity for a short presentation regarding the role of maximum of 1.0 AMA PRA Category 1 the advance practice nurse will be given Credits TM. Physicians should claim only before the formal program. Innovative Care the credit commensurate with the extent of Solutions will present the formal program, their participation in the activity. “Delivering Difficult News.”

Midwest Health Collaborative Update

Clinical teams from health systems including Premier Health Group’s (PHG) participating in the Midwest Health network of more than 6,000 employed and Collaborative have been meeting regularly independent providers. This network can with the goal of identifying evidence-based cover 90 percent of Ohio’s population. best practices which can be shared across By working together to identify best the systems. In addition, the collaborative practices, the collaborative will be able to is developing cost advantageous ‘big data’ offer a ‘playbook’ for care management and tools to assist systems in risk stratification population health. of their populations – with both Milliman and OptumInsight products. We believe that this work will result in a highly performing statewide network of The collaborative includes six of the largest physician and advanced practice providers health systems in Ohio: Premier Health, and hospitals. The collaborative is working TriHealth, OhioHealth, ProMedica, Aultman, to become a network whose guiding and Cleveland Clinic. The collaborative principle is a commitment to improve aspires to disrupt the Ohio health care the health of the communities we serve market and compete in the shift from through evidence-based population health volume to volume plus value. strategies. We intend to offer patients a The collaborative has created a statewide consistent experience across the system network of more than 17,000 providers, with best-in-class outcomes and efficiency. Wellness Committee Works to Combat Burnout By Tarek Sabagh, MD

In a study published in the Archives of staff. The wellness committee is a medical Internal Medicine, October 2012, physician staff committee chaired by the president- burnout was found to be prevalent among elect of the medical staff and includes U.S. physicians at a rate of almost one in about 20 members of the medical staff. two physicians. The main symptoms are The Physician Wellness Fund is established emotional exhaustion, detachment from through the Miami Valley Hospital patient care, and lack of career satisfaction. Foundation to directly fund our functions. Burnout results in problematic alcohol use, The committee serves both physicians and broken relationships and early retirement. APPs on staff at the hospital. We recently Patient care is also affected in terms of had an evening out attending a Dragons safety, diagnosis and treatment. In the game. More than 100 staff and their study, higher education with master’s families attended. It was a success. We’ve degree or Ph.D. was associated with less a long way to go, but we are determined to burnout in contrast to MD/DO degree, stay the course. which was associated with much higher For information about the wellness burnout. This observation indicates that committee’s social activities, please see it’s not an individual problem but rather a Kelsey A. Pio, internal physician relations system or work-related issue. Physicians on manager in the hospital physician’s lounge. the front line of patient care in specialties like emergency medicine, family medicine For questions or information about the and internal medicine are most affected. wellness fund, vision or committee’s functions, please contact: Keith Bricking, Despite the magnitude of the problem, MD, president of medical staff, MVH at: there is not yet an authority on how to best [email protected]; or Tarek remedy it once it is identified. Fortunately, Sabagh, MD, president elect of medical staff, many attempts are under way to address MVH at: [email protected]. the problem in a structured manner. Miami Valley Hospital restructured its wellness committee to try to create a more collegial and friendly working environment for our SYSTEM NEWS Students Get Up Close; Organ Donation Campaign; and Community Benefit Grants

Atrium Medical Center As a result of this agreement, we were able Miami Valley Hospital Cincinnati TAP MD students from to consolidate Atrium’s services to one Miami Valley Hospital has earned the throughout the Cincinnati area visited outpatient surgery site at Southwest Ohio Platinum Award in the 2017 Hospital Atrium Medical Center in August and Surgery Center on Breiel Boulevard. This will Organ Donation Campaign, sponsored by their tours followed the case of a stroke make our outpatient surgery scheduling the US Department of Health and Human patient. They learned about recognizing and operations process more efficient and Services. More than 1,000 hospitals across signs and symptoms of stroke, and visited reduce costs. the country participated, working with and heard from staff with emergency, donation organizations and state hospital For any questions about this change, medical imaging, rehabilitation and more associations to promote organ, eye, and please contact Tammy Laine, departments. Cincinnati TAP MD is a year- tissue donation by conducting awareness vice president of market development, at long educational program of The Health and registry activities in their facilities and [email protected] Collaborative, and students interested in communities. Together, MVH and other medical careers apply for a chance to get Good Samaritan Hospital participating hospitals added 26,975 donor up close to area hospitals and medical To equip new employees with the tools and registrations to state registries over a seven- practitioners. tactics for success, Good Samaritan Hospital month period, bringing the total donor launched a new program entitled Essential registrations added through the hospital Cincinnati Eye Institute, which opened a Partners Boot Camp. Class content includes campaign to 419,102. The Platinum Award newly constructed building on our campus information on the importance of patient is the highest level given. within the last year, is planning to partner experience, implementation of the 10/5 Dr. April Anderson from the MVHS with Premier Health and Atrium Medical Rule, what it means to manage up, and emergency department participated on a Center to bring more service offerings to our how to use AIDET, with the opportunity to panel discussing the impact of heroin in our Middletown medical campus. Cincinnati conduct role play exercises. All non-nursing community. The Community Engagement Eye plans to lease Bidwell Surgery Center, new employees are required to attend the Conference is hosted by the Miami Valley where its staff will perform a higher level class, which takes place on the second day Crime Prevention Association. Attendees of eye surgeries previously not offered in of new employee orientation. RNs and PCTs were invited to attend up to three classes. the past in Middletown. Pending regulatory receive this same information during their This was the seventh year for this annual approvals, Bidwell will become a surgery formal orientation programs so are not community event. center for Cincinnati Eye. required to attend this class. The goal is to establish patient experience expectations immediately with new employees. Upper Valley Medical Center UVMC Cancer Care has received a giant In August Upper Valley Medical Center inflatable colon model for use in community awarded $462,073 in Community Benefit education regarding colon cancer and Grants to Health Partners Free Clinic, related conditions. The 12x12’ unit is a Hospice of Miami County, Miami County tunnel that replicates healthy tissue, polyps, Dental Clinic, Miami County Recovery malignant polyps, inflammatory bowel, and Council (MCRC), and Samaritan Behavioral a cancerous mass. A gift from the UVMC Health. Part of the funding to MCRC, in Foundation John J. Dugan Memorial Fund, conjunction with the Miami County Heroin the eye-catching model will be used at Coalition, will support programs designed community events to help engage people in to help in the local battle against the meaningful education about cancer of the opioid epidemic. The grants are made by colon. the UVMC Board of Directors through the UVMC has initiated a new policy to UVMC Community Benefit Fund established differentiate between ACT (Acute Changes The announcement of our new as part of our mission to support local Team) and on-campus response, with ACT to Infant Cuddler Program generated an programs that serve community health be used for acute changes in an inpatient’s overwhelming response from people in the needs. community, and the announcement was status, and on-campus response to be used heard in Washington D.C., most notably by The annual Evening of Appreciation to for non-inpatient (outpatients, visitors, U.S. Congressman Mike Turner (above). He welcome new medical staff and honor employees, etc.) on UVMC properties. The recently visited the Berry Women’s Center to UVMC supporters was hosted Aug. 24 at the change came out of a review of practices speak with staff and volunteers about their Piqua Country Club. The event was attended for responding to emergency situations to work and training and to personally thank by more than 260 physicians, board proactively ensure consistency in scope of everyone for their contributions. members, executive team and community care and practice. leaders/friends of UVMC. SERVICE LINE UPDATE Women’s Health Institute Delivers on Initiatives, Sets Sights on 2020 By Lori Scalise, system vice president, service integration, women’s services, Premier Health

The Women’s recent retirements. Several candidates are • Miami Valley Hospital unveiled its Health Institute visiting between September and October. renovated maternity center on Sunday, (WHI) service line • The obstetrics quality/safety team October 1. The renovations include a continues to make of physicians and obstetrics nursing space dedicated for families with infants progress system- directors from across the system staying in the NICU. It will be named wide with growth developed and implemented several the Ronald McDonald Family Room in initiatives, patient policies and standardized processes. The Emmett’s Place. experience, focus continues to be on safety bundles, • Women’s Health Institute will be research, clinical reducing preterm birth, and lowering the evaluating and developing new initiatives quality, safety, and risk of maternal and infant mortality. to support the new strategic plan for program development. William Rettig, MD, the next three years. This will include a Women’s Health Institute chair, says of the • Obstetrics nursing directors will be focus on developing women’s programs effort, “The collaboration continues to be working on a template in Epic IP to and services to better serve our aging strong as we are beginning to move into standardize triage documentation. population. the next phase of initiatives toward 2020, • AMC’s Natural Beginnings Birthing Center but I would like to recognize physicians and launched May 1 as the first natural • Perinatal Partners Maternal Fetal staff for their efforts over this last year and birthing center in the Cincinnati market. Medicine physicians will be expanding on future initiatives.” Here is a sample of the co-management prenatal/gestational • Physicians and staff worked for many the many projects, recent distinctions and diabetes program in the AMC Mason months on providing clinical content, recognitions for the Women’s Service Line: market later this fall. videos, articles and news releases for • Anthem Blue Distinction Centers + for the new Women, Wisdom and Wellness Preeclampsia (PE) screening and preventive Maternity Care – for all Premier Health consumer centric portal and participating treatment with low dose aspirin (ASA) have maternity centers (AMC, GSH, MVH, in educational speaking engagements been shown to be effective in reducing the MVHS and UVMC) for the second time; within our communities. incidence of early and severe PE and is now the recognition period begins in January recommended by USPSTF and ACOG in high- • WHI member Diane Anderson, DO has 2018. The BDC+ recognizes facilities for risk women. See on the next page the article been reporting out monthly to WHI on their expertise and cost efficiency in written by Jiri Sonek, M.D., medical director, the progress made through the Innovate delivering maternity care. maternal fetal medicine specialist, Maternal breast imaging team on standardizing Fetal Medicine, Miami Valley Hospital. • All Premier Health maternity centers across the system. were among the hospitals recognized for promoting, protecting and supporting breastfeeding through the First Steps for Healthy Babies program administered by the Ohio Department of Health and Ohio Hospital Association. All Premier Health hospitals are on track to reach the highest achievement of five stars in 2017. • OB navigator Epic platform for all ambulatory practices and clinics - a system-wide provider committee worked together to standardize this new platform. The go-live plan began in September and the Epic support team will continue to launch offices through January 2018. • Physician recruitment for obstetrician- gynecologists continues to backfill many Preeclampsia: Screening and Prevention Help Mothers and Babies From: Maternal Fetal Medicine Center, Miami Valley Hospital By Jiri Sonek, M.D., medical director, maternal fetal medicine specialist, Maternal Fetal Medicine, Miami Valley Hospital

Preeclampsia maternal characteristics (demographic, References: (PE) is a common anthropometric, and medical history) 1. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130–137. disorder in combination with biomarkers (mean 2. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. that affects arterial pressure, uterine artery pulsatility Lancet 2005; 365: 785–799. approximately index, and placental growth factor).10-13 In 3. Pridjian G, Puschett JB. Preeclampsia. Part 1: clinical 2 to 8 percent a recently completed study, we tested the and pathophysiologic considerations. Obstet of pregnancies performance of a modified FMF protocol in Gynecol Surv. 2002 Sep;57(9):598-618 4. Low-Dose Aspirin Use for the Prevention of world-wide. It is screening for preeclampsia at the Maternal Morbidity and Mortality from Preeclampsia: a major cause of Fetal medicine, Ultrasound, and Genetics Preventive Medication. U.S. Preventive Services maternal, fetal, Center (MFMUG) at Miami Valley Hospital in Task Force. September 2016. https://www. uspreventiveservicestaskforce.org/Page/Document/ and neonatal morbidity and mortality Dayton. We found that at a 5 percent screen UpdateSummaryFinal/low-dose-aspirin-use-for- with potentially long-term consequences positive rate (FP), we identified 85 percent of the-prevention-of-morbidity-and-mortality-from- for both the offspring and the mother.1-3 women who developed preeclampsia prior preeclampsia-preventive-medication Though PE develops in the latter half of the to 34 weeks gestation. We also identified 5. Hypertension in Pregnancy: Executive Summary. American College of Obstetricians and Gynecologists second trimester or in the third trimester, 68 percent of women who developed Obstet Gynecol 2013; 122:1122-31 doi: 10.1097/01. it is clear that events that contribute to preeclampsia prior to 37 weeks gestation AOG.0000437382.03963.88 the development of PE occur much earlier and 43 percent of term preeclampsia at a 6. Caron N, Rivard GE, Michon N, et al. Low-dose ASA response using the PFA-100 in women with high-risk in pregnancy. Management of PE, once it 10 percent FP. The high detection rate of pregnancy. J Obstet Gynaecol Can. 2009; 31: 1022- develops, is well described; however, the preeclampsia prior to 34 weeks gestation 1027 only definitive cure is delivery.2,3 is especially encouraging as this group has 7. Bujold E, Roberge S, Lacasse Y, et al. Prevention of the highest maternal, fetal, and neonatal preeclampsia and intrauterine growth restriction A number of maternal characteristics are with aspirin started in early pregnancy: a meta- morbidity and mortality. Additionally, known to be associated with an increased analysis. Obstet Gynecol 2010;116:402-14. births prior to 34 weeks have the highest risk for PE. The U.S. Preventative Services 8. Roberge S, Villa P, Nicolaides KH, et al. Early impact on health care costs: a recent study administration of low dose aspirin for the prevention Task Force (USPSTF) and American Congress of preterm and term pre-eclampsia: a systematic estimated that the combined cost per birth of Obstetrics and Gynecology (ACOG) review and meta-analysis. Fetal Diagn Ther prior to 28 weeks gestation is $311,701 and 2012;31:141-6. have recommended various combinations for births at 28 to 33 weeks, it is $83,866.14 9. Roberge S, Giguère Y, Villa P et al. Early of these markers as a primary screening administration of low-dose aspirin for the prevention tool based on general risk categories.4,5 Results of a prospective multicenter double of severe and mild preeclampsia: a systematic Preventive treatment with low dose aspirin blind study (the ASPRE trial) were recently review and meta-analysis. Am J Perinatol. 2012 Aug;29(7):551-6. doi: 10.1055/s-0032-1310527. (ASA) has been shown to be effective in published in the New England Journal of Epub 2012 Apr 11. reducing the incidence of early and severe Medicine. The purpose of the study was to 10. O’Gorman N, Wright D, Syngelaki A, et al. Competing PE and is now recommended by USPSTF use the FMF algorithm to screen for PE and risks model in screening for preeclampsia by and ACOG in high-risk women. There is now evaluate whether ASA prophylaxis (150 mg maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol 2016;214:103.e1-12. evidence that a higher dose of ASA (150 mg) of ASA at bedtime) in high-risk patients was 11. Wright D, Syngelaki A, Akolekar R, et al. Competing is significantly more effective in preventing effective. The study showed that in the ASA risks model in screening for preeclampsia by PE than the dose of 82 mg that was initially group, the incidence of PE prior to 34 weeks maternal characteristics and medical history. Am J used for this purpose (approximately 30 gestation was reduced by 82 percent and PE Obstet Gynecol 2015;213:62.e1-10. 12. O’Gorman N, Wright D, Poon LC, et al. Accuracy percent of pregnant women are resistant prior to 37 weeks gestation was reduced by of competing risks model in screening for pre- to lower doses).6 For this treatment to be 62 percent.15 eclampsia by maternal factors and biomarkers at effective, it must be started prior to 16 11–13 weeks’ gestation. Ultrasound Obstet Gynecol It is becoming increasingly apparent that 2017 doi: 10.1002/uog.17399, 9 January 2017 weeks gestation; therefore, development of the risk of PE can be reduced by low-dose 13. Park FJ, Leung CH, Poon LC, et al. Clinical evaluation screening tests that perform well prior to ASA administration if started early in of a first trimester algorithm predicting the risk of this point is imperative.7-9 hypertensive disease of pregnancy. Aust NZ J Obstet pregnancy. It is also apparent that screening Gynaecol 2013; 53: 532–539. Over the past few years, studies for PE in the first trimester yields high 14. Werner EF, Hauspurg AK, Rouse DJ. A Cost-Benefit demonstrated that this may be possible. A detection rates for low screen positive rates. Analysis of Low-Dose Aspirin Prophylaxis for the protocol developed by the Fetal Medicine It is for this reason that we at MFMUG have Prevention of Preeclampsia in the United States. Obstet Gynecol. 2015 Dec;126(6):1242-50. Foundation (FMF) appears to produce made the decision to begin this screening 15. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus the best screening performance. This this year. Information regarding the placebo in pregnancies at high risk for preterm protocol is based on a combination of screening is available at our office and can preeclampsia (ASPRE). NEJM.org. DOI: 10.1056/ first trimester markers that include be ordered by calling (937) 208-2516. NEJMoa1704559 Published online June 28, 2017 PHYSICIAN PROFILE An Aspiring Concert Pianist Chose Medicine

Mary Feldman, Why did you choose medicine as a career? physician, a great mother, and a good D.O., sees patients I wanted to make an impact and a person. difference in people’s lives in a very integral in the Clinical What is the last book you read? and important way. I have always loved Neuroscience Outlander by Diana Gabaldon Institute at Miami science, particularly neuroscience, which I Valley Hospital also majored in as an undergraduate! What is your favorite song in your playlist? “Ballade no. 1 in g minor opus 23,” by South Who are the people who influenced and/or Frédéric Chopin What is your mentored you? specialty? My parents; my dear friend and mentor, iPhone or Android? I am a neurologist neurosurgeon Dr. William Black, who Android with special unfortunately died of complications due to Early bird or night owl? fellowship training in the field of movement Parkinson’s disease; Dr. Tim Cannon; and Dr. Early bird disorders, which deals with any abnormality Anwar Ahmed and Dr. Patrick Sweeney from Beach bum or mountain hiker? of movement (problems with walking, the Cleveland Clinic who continue to be Mountain hiker problems with muscle tightness, tremors, friends and inspirations to me. Parkinson’s disease, etc). How do you describe your bedside manner? What brought you to Premier Health? Warm, caring, and I’ve been told that I’m an I was presented with the opportunity excellent listener and that I explain things to help build and develop a Movement very well to my patients. Disorders Center in the Dayton area to What is one thing most people don’t know offer services for which patients previously about you? had to travel to Cincinnati or Columbus. That I almost became a concert pianist Additionally, we have family in the Dayton instead of a doctor. Medicine won. area. On top of all of that, I joined a fabulous group of neurologists! What could be better How do you want to be remembered? than that?! I consider my life a success if I am remembered as being an upstanding

Scheduling Process to Align More with Pre-Cert Requirements

Premier Health will be modifying its obtained. The result is that Premier Health timely scheduling. We will continue our scheduling process for certain imaging has seen an increase in denials, resulting in current process for scheduling these tests exams to better align the scheduled test frustration for patients, ordering physician based on physician orders. date with the amount of time needed to offices, and radiologists, while limiting In the event a test has been denied or complete the pre-certification process with Premier Health’s ability to collect payment is under review with insurance, Premier insurance carriers. on these services. Health’s pre-certification department As you are aware, to manage costs and The changes will initially apply to MRI’s, will contact the patient and the ordering to ensure appropriate use of testing, CT’s and Nuclear Medicine (including PET) physician’s office and apprise them of the health insurance organizations have been exams. In most instances, these tests will situation. increasing the frequency in which pre- be scheduled three to five business days We appreciate your support of these certification is required. In addition, changes out unless a more urgent need is indicated. changes to better align the scheduling of to payer policies have made it more difficult It is estimated that fewer than 20 percent tests with the anticipated time needed to for health care providers to appeal denied of tests will be affected by this change. We complete the pre-certification process. services when pre-certification is not recognize that certain tests require more A Fib Treatment Comes to Atrium Medical Center Atrium Medical Center now offers an complications, 40 percent of A Fib patients advanced surgical procedure that can be an eligible for warfarin currently go untreated important alternative for patients affected due to trouble tolerating the medicine by atrial fibrillation, or A Fib. or taking it appropriately. Depending on The procedure is the left atrial appendage the drug, side effects can include nausea, closure with the WATCHMAN™ device. The weight loss, abdominal pain, fatigue or procedure targets blood clots that develop weakness, and bleeding. in the heart, elevating the risk of stroke. The permanent device is placed through a A Fib can cause blood to pool and form catheter-based intervention. Implanting the clots in an area of the heart called the left LAA closure device is a one-time procedure atrial appendage (LAA). The LAA is believed that usually takes about an hour. Afterward, to be the source of most stroke-causing patients typically stay in the hospital for blood clots in patients with non-valvular A 24 hours. However, not all patients may be Fib. Clots that form in the LAA sometimes candidates for the procedure; it is important break loose, travel in the bloodstream, and to follow up with a physician to discuss potentially damage the brain, lungs, or eligibility and treatment options. other parts of the body. Atrium Medical Center offers a range of Closing the left atrial appendage is designed cardiology services, including standard to keep harmful blood clots from the and cryoablation for A Fib, cardiac LAA from entering the bloodstream and catheterization procedures and open heart potentially causing a stroke. The most surgery procedures. In addition, Atrium common treatment to reduce stroke risk recently became an accredited Chest Pain in patients with A Fib is blood-thinning Center. Accredited Chest Pain Centers take warfarin medication. an evidence-based, systematic approach By closing off the LAA, the risk of stroke to cardiac patient care, allowing medical might be reduced and, over time, patients staff to reduce time to treatment during the might be able to stop taking warfarin. That’s critical early stages of a heart attack. important because, in addition to bleeding A Simple Act of Kindness By Patrick Larreategui, D.O., FACOS, president, medical staff, Upper Valley Medical Center

The patient was critically ill in the intensive she referring, I asked. She said that a doctor in scrubs bought her care unit. After reviewing his labs and breakfast this morning in the cafeteria. She did not remember his X-rays I entered his room. His wife was name but was moved by the gesture. sitting by his bedside, as she had been since After some investigation, I found out that this doctor is an his admission five days earlier. I assessed anesthesiologist who routinely buys meals for patient families all of his lines, tubes, and examined him. several times per month. He does not seek recognition or accolades. After completing my exam, I updated her He is not trying to improve his patient satisfaction scores. He does it regarding his condition. The prognosis was because he is a kind and caring person. Simple acts of kindness such not good. She thanked me for taking care as this occur at Upper Valley Medical Center and throughout our of him. As I turned to leave, she said to system every day. They are not measured by metrics but make a huge thank the other doctor, too. To whom was impact on everyone they touch.

Premier Health Physicians Publish Articles Through some of our own research in reperfuse distal tissue beds. However, therapy and pharmacotherapy may help PubMed, we found the following physicians anecdotal evidence suggests that this reduce the risk of arrhythmic events or have published recently: approach may still result in unpredictable sudden cardiac death. aortic flow rates and hemodynamic Dr. Sarah-Ashley Ferencz, a surgery resident Drs. Kevin Kravitz, T. Tun Aung, and E. instability. We sought to characterize at Miami Valley Hospital, was a collaborator Roberto collaborated on the published aortic flow dynamics following REBOA as in the published article “The effect of article “Cardiogenic Shock, Acute Severe the balloon is deflated in accordance with resuscitative endovascular balloon occlusion Mitral Regurgitation and Complete Heart current practice guidelines. of the aorta, partial aortic occlusion and Block After Cavo-Tricuspid Isthmus Atrial aggressive blood transfusion on traumatic Dr. Peter Ekeh was a collaborator in the Flutter Ablation” in Cardiology Research, brain injury in a swine multiple injuries published article “Paying it forward: Four- April 8, 2017. Abstract: Radiofrequency (RF) model” in the Journal of Trauma Acute year analysis of the Eastern Association for ablation is the first-line management of Care Surgery; July 2017. Summary: Despite the Surgery of Trauma Mentoring Program” cavo-tricuspid isthmus dependent atrial clinical reports of poor outcomes, the degree in the Journal of Trauma Acute Care Surgery, flutter. It has been performed with 95 to which resuscitative endovascular balloon July 2017. Summary: Mentorship programs percent success rate. Adverse events are very occlusion of the aorta (REBOA) exacerbates in surgery are used to overcome barriers rare. We report the first case of acute severe traumatic brain injury (TBI) is not known. to clinical and academic productivity, mitral regurgitation (MR) and complete The group hypothesized that combined research success, and work-life balance. The heart block developed after successful atrial effects of increased proximal mean arterial team sought to determine if the Eastern flutter ablation. pressure (pMAP), carotid blood flow Association for the Surgery of Trauma (EAST) Dr. Gary Fishbein was a collaborator on the (Qcarotid), and intracranial pressure (ICP) Mentoring Program has met its goals of article “Lower Extremity Revascularization from REBOA would lead to TBI progression fostering academic and personal growth in Using Optical Coherence Tomography- compared with partial aortic occlusion (PAO) young acute care surgeons. Guided Directional Atherectomy: Final or no intervention. Dr. T. Tun Aung was a collaborator on Results of the EvaluatIon of the Pantheris Dr. Ferencz also collaborated on the published article “A classic case OptIcal Coherence Tomography Imaging “Incremental balloon deflation following of arrhythmogenic right ventricular Atherectomy System for Use in the complete resuscitative endovascular balloon cardiomyopathy (ARVC) and literature Peripheral Vasculature (VISION) Study” in occlusion of the aorta results in steep review” in the Journal of Community the Journal of Endovascular Therapy, June inflection of flow and rapid reperfusion in a Hospital Internal Medicine Prespective. 24, 2017. Abstract Purpose: To evaluate large animal model of hemorrhagic shock.” June 6, 2017. Abstract: Arrhythmogenic the safety and efficacy of a novel optical Published in the Journal of Trauma Acute Right Ventricular Cardiomyopathy (ARVC) coherence tomography (OCT)-guided Care Surgery, July 2017. Introduction: To is a relatively under-recognized hereditary atherectomy catheter in treating patients avoid potential cardiovascular collapse after cardiomyopathy. It is characterized with symptomatic femoropopliteal disease. resuscitative endovascular balloon occlusion pathologically by fibro-fatty infiltration If you have published articles you would of the aorta (REBOA), current guidelines of right ventricular (RV) myocardium and like to share, please email Ben Sutherly at: recommend methodically deflating the clinically by consequences of RV electrical [email protected]. balloon for five minutes to gradually instability. Timely intervention with device GI Symposium Accepts Registration

Registration is open for the 27th annual Continuing Education William Wilson, MD Gastroenterology This activity has been planned and Symposium on Wednesday, November 1, at implemented in accordance with the Sinclair Ponitz Center. accreditation requirements and policies of the Accreditation Council for Continuing This event is scheduled from 11:30 a.m. Medical Education (ACCME) through to 5 p.m. and is designed especially for the joint providership of Wright State physicians who care for patients with GI University (WSU) and Premier Health. diseases, to include the specialties and WSU is accredited by the ACCME to sub-specialties of gastroenterology; hospital provide continuing medical education for and office-based primary care physicians, physicians. advanced practice and registered nurses, other allied health care professionals, as WSU designated this Live activity for 4.00 well as residents, fellows and students. AMA PRA Category 1 Credits ™. Physicians should claim only the credit commensurate Featured speakers this year include Stuart with the extent of their participation in the Sherman,M.D., Indiana University; Khurram activity. Bari, M.D. and Nadeem Anwar, M.D., University of Cincinnati; and local physicians Successful completion of this CME Jeff Weinstein, M.D., Chris Barde, M.D., Ben activity, which includes participation in Wheeler, M.D., and K. Mohan Bhoopa, M.D. the evaluation component, enables the participant to earn up to 4.0 MOC points in At least 11 exhibitors are scheduled to the American Board of Internal Medicine’s participate. Lunch and refreshments at (ABIM) Maintenance of Certification (MOC) break are included in your registration fee. program. Participants will earn MOC points To register and view complete agenda, equivalent to please visit the registration page at the amount https://medicine.wright.edu/continuing- of CME credits medical-education/william-wilson-md- claimed for gastroenterology-symposium the activity. It For additional information, feel free to is the CME activity provider’s responsibility contact Theresa Cory, CME Coordinator, at to submit participant completion (937) 208-2144. information to the ACCME for the purpose of granting ABIM MOC credit. Our NewPhysicians the medicalstaff eachfacility? at Are you interested inknowingwhojoined staff at each of the Premier Health hospitals. New physicians routinely jointhemedical Chief Consumer Officer: ChrisButler; ChiefCommunications Officer: DianeEwing;Director, System Communications: BenSutherly; Editor: Kara Hitchens Editorial Board: Dr. Marc Belcastro, Dr. Atindra Chatterji, Dr. Clark, Dr. Jerry Jennifer Hauler,Dr. Dr. Kanag, Scott Tammy Lundstrom, Dr. Matthew Reeves call 9-1-1 or go to the nearest emergencythe nearest room.to call 9-1-1orgo anyIf at yoursymptomsworsen oryoufeel point like youare having a medical emergency, local pharmacy. even helpyou care findanewprimary physician. Any prescriptions canbecalledinto your throughyou your canget onlineaccount, andmake plansfor follow-up ifneeded. We can 20minutes. about VirtualWe visitstypicallylast willprovide ofyour asummary visit,which GETTING HELPFAST anappointment,through without videochat available 24hoursaday, 7days aweek. physicians andnursepractitioners can Our teamofboard-certified evaluate andtreat you Premier Virtual Care bringsahealthcare provider toyou whenandwhere you needit. 24/7 CARE PREMIER VIRTUALPREMIER CARE PREMIER VIRTUAL CARE. 24/7 CARE, FAST ANDEASY. Upper Valley MedicalCenter gotouvmc.com/ournewphysicians Miami Valley Hospitalgotomiamivalleyhospital.org/ournewphysicians Good SamaritanHospitalgotogoodsamdayton.org/ournewphysicians Atrium MedicalCenter gotoatriummedcenter.org/ournewphysicians You canfindthelistsinPhysician Portal. patients open to new andexisting needed; No appointment leaving homeinOhio Be treated without rateFlat pricing-$45 Care Premier Virtual youWhat with canexpect (844) 658-8317 PremierVirtualCare.com GET CARENOW

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