P h y s i c i a n Q u a r t e r l yPublished by Kettering Health Network • Q3 2015

Inside

Patients Help Improve Cancer Care • Fall Medical Staff Dinner • Emergency Center in Preble County Opens

Kettering | Grandview | Sycamore | Southview | Greene | Fort Hamilton | Soin | Kettering Behavioral

2 N e t w o r k

On Our CoverThomas Reid, MD, medical director of the Women’s Cancer Center, talks with Jennie Stockslager, a member of the oncology patient advisory council (read more on p. 4).

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P h y s i c i a n Q u a r t e r l yPublished by Kettering Health Network • Q3 2015

Inside

New Cancer Center Broke Ground in May • Minimally-Invasive Brain Surgery • Smart Rx • Family Medicine for America’s Health

Kettering | Grandview | Sycamore | Southview | Greene | Fort Hamilton | Soin | Kettering Behavioral

Table of Contents

NETWORK4 Patient Advisory Council improves cancer services for network and new Cancer Center6 Emergency update: Franklin’s early impact and Preble opens7 New robot joins the network’s surgery program8 Improving care coordination network-wide by Jody Underwood9 Successful treatment of hepatitis C by Davida Prater, MS, and Jonathan Saxe, MD10 More diabetes locations—and how they can help your patients12 ICD-10 coming October 1 by Charles Watson, DO12 What you need to know about Open Enrollment13 Toothaches are a pain to emergency departments14 Shout outs and save-the-dates

MEDICAL EDUCATION17 Network to expand primary care residency opportunities by David Small, MD

KETTERING/SYCAMORE18 Kettering receives quality stroke award18 Sycamore adding private patient rooms18 Kettering expands NICU19 Coagulation update by Richard Pelstring, MD19 Kettering receives designation for elder care excellence20 Kettering/Sycamore welcomes new physicians

GRANDVIEW/SOUTHVIEW21 Core principles of primary care by Paul Martin, DO22 Grandview adding private patient rooms22 Southview lobby renovation, hand center expansion23 Grandview/Southview welcomes new physicians

SOIN/GREENE24 Soin opens spine center25 Soin opens emergency expansion26 GreeneRuralHealthClinicscompletecertification by Mark Floro27 Soin adds 24/7 laborist coverage27 Soin adding private beds, renovating conference space28 Greene/Soin welcomes new physicians

FORT HAMILTON29 Slow down to speed up by Marcus Romanello, MD30 Hip arthroscopy31 Full range of wound care31 Fort Hamilton welcomes new physicians

KETTERING PHYSICIAN NETWORK32 How 11 primary care practices achieved level three PCMH recognition by David Doucette, MD33 New laser procedure restores vaginal health34 Less invasive options for abdominal aortic aneurysms by James Gebhart, DO, and Jacob Yannetta, DO35 KPN welcomes new physicians

Physician Quarterly is published by Kettering Health Network to support communications between physicians, residents, fellows, alumni, and hospital administration. Managing Editor: Emily Syvertson

Design & Layout: Christie Mildon

Additional Writing: Misha Darcy, Lyndsey LaVenture, Kendra Silvis, Katlyn Stechschulte, Christi Sweigart, Michelle Wesney, Leigh Wilkins

Cover Photography: AGI Studios

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8,900The number of patients seen so far at the new Kettering Health Network Emergency Center in Franklin (p. 6)

81.5%Percentage of diabetic patients seen at Kettering Health Network’s diabetes centers are at glucose target (p. 11)

300,000

The number of primary care professionals in the U.S. (p. 21)

26The total number of treatment rooms in Soin’s expanded Emergency Department (p. 25)

Welcome to the new look of Physician QuarterlyYour average day can be packed full. So we wanted to create some breathing room in Physician Quarterly for you to relax and explore as you get up to date on things happening throughout the network and with your fellow providers. That’s why you’ll see a clean, flexible design that creates room for both words and white space.

Thank you for your readership. We hope you enjoy the next phase of Physician Quarterly!

We love to hear your feedback! Email PhysicianQuarterly@khnetwork.org

Top quality medical care is only the beginning— we are dedicated to caring for our patients’ spiritual, physical, and emotional needs during what is often

one of the most difficult periods of their lives.Thomas Reid, MD, on how the Patient Advisory Council is driving

improvements to the oncology service line (p. 4)

It is great to have this opportunity to collaborate with a national organization of excellence in diabetes care.

This can only result in better outcomes for our patients.Bihu Sandhir, MD, on JoslinPRIME, the primary care provider

certification program that offers diabetes-specific training (p. 11)

These seven core principles are essential to the provision of effective, efficient, and high-quality primary care in the

ongoing context of a person’s life.Paul Martin, DO, on the core principles of primary care (p. 21)

Because neck and back pain can be caused by multiple factors, a comprehensive spine program is needed

to separate these pieces and find the most effective solutions to treating the problem.Jeffrey Hoskins, MD, about Soin’s Spine Center (p. 24)

We should slow down in order to improve our efficiency, raise our level of performance, diminish our stress, and satisfy our patients.

Marcus Romanello, MD (p. 29)

This PCMH recognition is a major achievement in our primary care redesign journey, which will benefit

patients now and for a long time to come.David Doucette, MD (p. 32)

’’’’’’’’’’’’

4 N e t w o r k

Each month, a dedicated group of cancer survivors meets at Kettering Medical Center to talk about their personal experiences and

suggest ways that physicians, nurses, and other care providers can make the journey better for future patients. They are the patient advisory council, and their insights are helping the cancer care team make improvements now—and guide planning for Kettering Health Network’s new Cancer Center, which will open in late 2016.

“Kettering Health Network is committed to creating a culture that cares for patients the way we would want our families to be cared for,” says Thomas Reid, MD, medical director of the Women’s Cancer Center. “We could not begin to meet

that goal without listening to and placing the highest value on the opinions of those who have already traveled cancer’s difficult journey. Top quality medical care is only the beginning—we are dedicated to caring for our patients’ spiritual, physical, and emotional needs during what is often one of the most difficult periods in their lives.”

Making what is good even betterThe council was established earlier this year. Its main objective is to improve patient outcomes by increasing overall patient satisfaction and to further support implementation of One Best Practice for cancer services across the network. Elizabeth Koelker, director of the Oncology Service Line for Kettering Health Network, leads the monthly meetings. Her office also facilitates an online discussion forum, where the council’s 30-plus members share ideas on a variety of topics, from office procedures, to the importance of support groups, to the new center’s interior design.

Listening to the ExpertsPatient advisory council contributes ideas to improve oncology services

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“It’s phenomenal how invested the council members are in helping us improve our cancer program!” Koelker says. “I leave every meeting so proud of the care our doctors and staff provide for cancer patients—and determined to make us even better now and when the new center opens.”

The cancer team is already incorporating some of the council’s ideas. For example, council members felt strongly that medical massage be offered to patients while they are receiving infusions. So Kettering Health Network hired a massage therapist, who provides therapy at the network’s three outpatient infusion centers a couple days a week.

For Milissa Smith, RN, a nurse at Cancer Specialists of Greater Dayton, serving on the council has helped her appreciate the patient experience in new ways. “I am learning that even though many cases seem similar, each cancer patient’s experience is unique,” she says. “The success of our cancer program depends on our ability as a network to listen to what every patient needs, so that we can help each one have the best journey possible.”

Ideas and inspiration Smith says that some of the council’s feedback challenges some of her previous assumptions. “We are learning that when care providers give newly-diagnosed patients a lot of educational material all at once, it can feel very overwhelming to them,” she explains. “Most council members said they would really prefer getting the information in manageable amounts over time.”

As they share their impressions and opinions, patients on the advisory council are also providing inspiration. “The more I get to know these patients, the more I appreciate their resilience and their desire to move forward in their lives and help other people,” says Terri VanZant, RN, a council member who is network director of Oncology Clinical Services. “Their experiences and feelings are always on my mind when I participate in decisions about how we operate and the services we provide.”

A New Era in Cancer CareKettering Health Network broke ground on a new cancer center on May 14. This five-story facility on the campus of Kettering Medical Center is scheduled to open in late 2016, bringing all of Kettering Health Network’s cancer services under one roof.

For details on the center’s progress, visit ketteringhealth.org/cancercenter

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Kettering Health Network is dedicated to providing the largest and most advanced network of emergency care throughout the

region. To increase access to the network’s high-quality care, freestanding emergency centers have been built to reach our surrounding communities.

Franklin’s early impactWith the opening of the new Kettering Health Network Emergency Center in Franklin, the network has been able to provide more patients with much-needed emergency care.

From its opening in February 2015 through August, the center has already seen more than 8,900 patients. The center has cared for patients suffering from cardiac and stroke alerts, supervised several trauma transfers, and even welcomed a new baby into the world. The 12,000-square-foot facility is staffed by emergency-certified physicians and equipped with onsite imaging, laboratory, and clinical services.

The convenient location off Interstate 75 and short wait time ensure that more patients are receiving comprehensive emergency care where and when they need it.

Expanding Access to Emergency CareEarly impact and continued growth of new Emergency Centers

Preble open The network is continuing to bring comprehensive emergency care to more areas with the latest Kettering Health Network Emergency Center, located at the Preble County Medical Center in Eaton. It opened August 24, 2015, and is the first and only emergency care facility in Preble County.

The Preble County Medical Center provides the community with a variety of health services. With the addition of the Emergency Center, area residents have access to life-saving emergency care 24/7. This 20,000-square-foot center is staffed by emergency-certified physicians. It also provides additional space for the Kettering Health Network pharmacy, as well as expanded imaging and clinical labs.

William Brady, MD, at the freestanding Emergency Center in Franklin, Ohio

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The Next Frontier in Robotic SurgeryNew da Vinci Xi® Surgical System

The Xi system boasts an expandable technology platform designed to accommodate and seamlessly integrate a range of current technologies, as well as future innovations, in areas such as imaging, advanced instruments, and anatomical access.

In addition to this new robot, Kettering Health Network has two existing da Vinci Si® Surgical Systems located at Kettering and Soin medical centers.

To find a certified robotics surgeon visit ketteringhealth.org/roboticsurgery

Kettering Health Network is offering patients the most advanced robotic-assisted surgery technology, the da Vinci Xi® Surgical System,

located at Kettering Medical Center.

Compared with traditional surgery, robotic surgery offers benefits to certain patients and has the potential to result in less blood loss, less pain, fewer side effects, and a quicker recovery.

The Xi system was designed to further advance the technology used in minimally invasive surgery. The system can be used across a spectrum of minimally invasive surgical procedures and has been optimized for multi-quadrant surgeries in the areas of gynecology, urology, thoracic, cardiac, colon and rectal, and general surgery.

As with all da Vinci Surgical Systems, the surgeon is in complete control of the robot. The new Xi system expands upon core features of robotic-assisted surgery with wristed instruments, 3-D HD visualization, intuitive motion, and an ergonomic design.

Features:• A new overhead instrument arm designed

to facilitate greater access

• A new endoscope digital architecture that creates a simpler, more compact design with improved vision definition and clarity

• The ability to attach the endoscope to any arm, providing flexibility

• Smaller, thinner arms with newly-designed joints that offer a greater range of motion

• Longer instrument shafts designed to give surgeons greater operative reach

8 N e t w o r k

For the last several months, the network quality team has been working on many initiatives in the key results area (KRA).

This multidisciplinary, multi-facility group is making great progress toward establishing new, network-wide care coordination protocols by the end of the year. We receive strong support from Teri Sholder, chief quality officer for Kettering Health Network, and David Small, MD, chief medical officer at Greene Memorial Hospital and Soin Medical Center.

The goal of care coordination is to provide the right care to the right patient in the right location. Our team focuses on making improvements in four key areas that affect care coordination: length of stay, readmission rate, cost of care, and patient/employee/physician satisfaction. In order for Kettering Health Network to be successful, all four areas must be in balance. For instance, if we lower length of stay but subsequently see an increase in readmissions, that is not progress. If we lower the cost of care and see a rise in patient satisfaction, that’s great—unless we see a corresponding decrease in physician satisfaction.

Streamlining care The network quality team has tested and implemented several initiatives. One speeds up the discharge process for patients who transfer care from one of our hospitals to a skilled nursing facility. Until recently, the care team had to delay discharge until it received precertification from the insurance company. We worked with several insurers and quality-screened skilled nursing facilities in southwest Ohio to establish a plan that would allow our hospitals to discharge patients prior to receiving precertification. One concern was that discharging these patients sooner might increase readmission rates, but the opposite proved to be true—the seven-day readmission rate actually went down for these patients. Now all network hospitals are following this protocol.

New Initiatives Improve Care Coordination Network-wide

Another initiative streamlines the process of helping patients select a skilled nursing facility. Previously, a social worker would visit each patient and discuss the options with outdated, photocopied listings of facility choices—a time-consuming endeavor. Now, social workers use an interactive, web-based program that allows them to search for a facility based on different criteria (location, insurance coverage, bed availability, etc.). All network hospitals are using this new tool with positive results.

Improving communication The network quality team also created new nurse care coordinator positions at inpatient units throughout the network inpatient facilities that have higher-than-desired length of stay and readmission metrics. These nurses ensure that clinical team members understand each patient’s plan of care, and they address issues that could impact post-discharge success. One strategy has been to use a large whiteboard that provides a checklist of each patient’s needs prior to discharge and potential barriers to effective follow-up care. Another is for these nurses to support physicians on each unit by co-leading interdisciplinary huddles.

byJody Underwood, RN, CNP, MBA, network director of care transitions

If you are interested in sharing your expertise, please contact me at Jody.Underwood@khnetwork.org

David Small, MD

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Hepatitis C Virus (HCV) is a single stranded RNA virus of the Flaviviridae family. It was first identified in 1989 as Non-A/Non-B

hepatitis. HCV can cause acute and chronic hepatitis C. Acute hepatitis C is self-limiting and only about 15% of infected individuals will clear the virus spontaneously; the other 85% will go on to develop chronic hepatitis C.

HCV has six major, genetically distinct subtypes— genotypes 1-6—specific to geographical locations.

GenotypesGenotype 1 is the primary genotype in North America and Europe, with genotypes 2 and 3 accounting for the remainder of the cases. Approximately 3.2 million Americans are infected with HCV.

Transmission of HCVHCV is transmitted via blood to blood and is commonly found in hemophiliacs, IV drug users, and anyone who had a blood transfusion or organ transplant prior to 1992. It can also be spread through piercing, tattooing, and accidental needle sticks. In 44% of HCV cases, no identifiable risk factors can be identified. Individuals can have the virus for 20-30 years without any symptoms; as a result undetected/untreated HCV can lead to cirrhosis and hepatocellular carcinoma.

Hepatitis C: from Non-A/Non-B to a CureReduced side effects, shortened duration of treatment

Success of recent treatmentsEarly treatment of HCV did not offer much in respect to individuals being cured. Individuals who were treated with Interferon +/- Ribavirin had a 50% chance of being cured if they were Caucasian and 30% chance if they were African American. However, the introduction in the past couple years of direct-acting antivirals (DAA), offers Interferon-free—and in some cases depending on the genotype, Ribavirin-free—treatment with cure rates that range between 95-100%, regardless of race.

Who should be tested for hepatitis C? According to the CDC guidelines:

• Baby boomers born between 1945-1965

• Any current or past IVD or cocaine user

• Those who received blood products prior to 1987 or had an organ transplant before 1992

It is an exciting time in the treatment and cure of hepatitis C due to the introduction of DAA, reduced side effects, and shortened duration of treatment.

American Association for the study of liver disease. (2014). Recommendations for testing, managing and treating hepatitis C. Retrieved from http://www.hcvguidelines.org/full-report-view.

Centers for Disease Control and Prevention. (2014). Hepatitis C: CDC fact sheet.

Heathcote, E.J. (2014). Hepatology diagnosis and clinical management. Hoboken, NJ. Wiley-Blackwell.

Koff, R. (2012). Hepatitis essentials. Sudbury, MA: Jones and Barlett learning.

byDavida Prater, MS, acute care nurse practitioner at Dayton Gastroenterology, Inc.

reviewed byJonathan C. Saxe, MD, boardcertifiedgastroenterologist

Primary care physicians and other healthcare providers refer their patients to Kettering Health Network Diabetes Centers because

of the positive results diabetes patients see after receiving a wide range of specialty services.

In addition, as we make a shift from a fee-for-service model to value-based reimbursement, financial incentives are available for providers meeting certain standards of diabetes management. Our diabetes centers help you meet these standards while providing individualized care based on the Harvard-affiliated and nationally recognized Joslin Diabetes Center.

In response to each patient’s needs, a personalized plan of care can be collaboratively developed and may include services of an endocrinologist and/or other members of our team—nurse educators, dietitians, nurse practitioners, physician assistants—as needed, to promote the successful management of the diabetes disease process.

In all cases, you will receive documentation regarding your patients’ progress toward completing their diabetes plan of care and achieving personal healthcare goals. We look forward to working collaboratively with you to co-manage patients with diabetes.

Delivering Diabetes CareShifttovalue-basedreimbursement,financialincentives

Where are Kettering Health Network Diabetes Centers? Kettering Health Network is growing to meet the needs of our community. Additional Joslin locations will provide convenient and local access for your patients.

Endocrinology & education locations

• Southview Medical Center (Centerville)

• Fort Hamilton Hospital (Hamilton) Education now open, endocrinology open October 2015

Education only locations

• Beavercreek Health Center (Beavercreek)

• Preble County Medical Center (Eaton)

• Trotwood Medical Center (Dayton)

• Sycamore Medical Center (Miamisburg)

• Kettering Medical Center (Kettering)

How to refer to a Kettering Health Network Diabetes Center Diabetes Services cheat sheet

Program Network Epic Users*

Pre-Diabetes Education REF20

Diabetes Self-Management Training (DSMT) REF20

Endocrinology Services REF22

Medical Nutrition Therapy (MNT)** REF50

* For those not on the network’s Epic system, a physician referral form can be found online: ketteringhealth.org/diabetes

** Joslin also provides MNT services for non-diabetes-related needs. Please see REF50.

Reach the Joslin Diabetes & Nutrition Access Center 1-844-251-5465.

10 N e t w o r k

N e t w o r k 11

PERCENTAGE OF PATIENTS AT GLUCOSE TARGET

60

80

100

NATIONAL JOSLIN

AFFILIATES

JOSLIN BOSTON

KHN AFFILIATE

Becoming a Joslin-Certified Provider In late 2014 we introduced you to the Primary Care Provider Certification Program for diabetes-specific training. We are proud to introduce Kettering Health Network’s first group of JoslinPRIME physicians pursuing this certification.

Gail Askew, MD Kathleen Lang, MD Anubhav Mital, MD Chetna Mital, MD

Jodi Van Jura, MD Bihu Sandhir, MD Thomas Sargero, MD Susan Stedje, MD

These providers will earn JoslinPRIME Certification upon meeting core clinical, operational standards and quality measures. During the approximately six-month certification process, the providers and their office staff will complete a detailed office assessment, undergo audits by Joslin, and enhance their education through training.

Because patients sometimes see someone other than the physician, the entire practice goes through training. This means all patients receive better care and more access to diabetes management and education.

“It is great to have this opportunity to collaborate with a national organization of excellence in diabetes care. This can only result in better outcomes for our patients. This training is valuable and time sensitive,” says Bihu Sandhir, MD.

Additional Certification OpportunitiesJoslinPRIME is currently accepting applications to participate in future certification programs. Contact Diana Kennedy at (937) 401-7579.

Above Standard Care Blood glucose control results at Kettering Health Network Diabetes Centers are far above other leading centers. “The Kettering Health Network diabetes care model is something most organizations only dream about, but none have figured out how to master the implementation,” says Holly Gibbons, operations manager for the Joslin Diabetes Center at the Harvard Medical School Affiliate. “Kettering Health Network has the opportunity to shape the national model of diabetes care management. Joslin Diabetes Center is fortunate to have such an innovative member of our affiliate network.”

12 N e t w o r k

The days are counting down until ICD-10 is implemented on October 1, 2015. As you are most likely aware, ICD-10 is the international medical coding that is replacing ICD-9.

Physicians should have completed the eLearning modules, both the general modules and the specialty-specific modules that pertain to them, which are available on HealthStream. We completed our second round of campus roadshows for ICD-10, where we answered questions and demonstrated the Epic Problem List Calculator and the Diagnosis Calculator. Documentation and coding queries to physicians for ICD-10 codes and the documentation to support them have gone out to physicians to help them prepare for the October 1, 2015 implementation nationwide.

Prepare for an Epic Update ICD-10 implementation is October 1, 2015

After October 1,

2015, failure to

respond to ICD-10

documentation and

coding queries will

result in delinquent

charge status.

If you have any questions regarding the ICD-10 project, Medical Informatics, or physician-related information technology, contact me at (937) 914-7361 or charles.watson@khnetwork.org.

Visit the ICD-10 project page under Resources on the intranet.

byCharles Watson, DO, Chief Medical InformationOfficerforKetteringHealthNetwork

November 1 marks the start to 2016 Medicare Open Enrollment for more than 50 million Medicare patients.

While patients can enroll anytime they become eligible, those already enrolled in Medicare can make changes during the open enrollment period. Patients can choose the government-provided Medicare plan or they can choose a private Medicare Advantage plan.

You can help. Inform your patients about the plans you accept and the plans accepted at Kettering Health Network.

What to Know About Medicare Open Enrollment November 1, 2015 — January 31, 2016

Kettering Health Network Medicare Advantage Plans Include:

MediGoldAetnaAnthem BlueCross and Blue ShieldGateway Health

Humana Health Plans of OhioUnited HealthCare/AARPBuckeyeHumanaMolina

N e t w o r k 13

Toothaches Are a Costly Pain to Emergency Departments

Emergency departments are seeing an increase in patients with dental issues, costing taxpayers $1.6 billion annually. The number of patients

has doubled from 1.1 million in 2000 to 2.2 million in 2012, according to a recent study by the American Dental Association. During an 18-month analysis by the Ohio Department of Health in 2010 and 2011, emergency departments received more than 100,000 visits for non-trauma, primary dental diagnoses, totaling $58 million in hospital charges, $48 million of which were for uninsured or Medicaid patients.

In southwest Ohio, dental problems are the top reasons people with Medicaid visit an emergency department, most citing unbearable pain. Few emergency departments, however, are designed to treat underlying dental causes, and most cases are preventable.

Lack of dentists, insuranceThe reason people most often give for putting off dental care until it becomes an emergency is lack of access to dentists or insurance. In Montgomery County, there are 279 dentists, and only 90 accept Medicaid.

While the Affordable Care Act has decreased Ohio’s uninsured from 15% in 2011 to 11% currently, it has done little to address dental coverage for adults. Low-wage earners, seniors, and many self-employed cannot find affordable dental plans. “Through a perfect storm of circumstance, people can find themselves needing help,” says Greg Notestine, DDS. “They are doing their best to make their way through, but don’t know where to turn.”

Help for uninsuredDoctors can refer these patients to Good Neighbor House in Dayton, where Dr. Notestine volunteers as dental director. The not-for-profit organization provides full dental services at a sliding scale fee or payment plans to people with no or insufficient dental insurance. It also offers a food pantry, life and wellness classes, and job seminars. Learn more at goodneighborhouse.org

Volunteers are needed, especially dentists, ophthalmologists, internists, and family practice.

Even a few hours a month helps meet the growing demand for care.

627 East First Street

(937) 224-3442

14 N e t w o r k

Richard Gregg, MD, has accepted the position of chief utilization officer for Kettering Health Network. For the last 10 years, Dr. Gregg led as medical director for informatics. Dr. Gregg is board certified in internal medicine, critical care, neurocritical care, and medical informatics.

Daniel Tryon was promoted to director of Business Development for Grandview and Southview medical centers. Daniel has been with Kettering Health Network since 2011, most recently as the manager of Operations for Grandview Medical Center System’s Medical Education and Ambulatory Training.

Joe Feller has been named chief legal counsel for Kettering Health Network. He is responsible for oversight and handling of all legal matters involving Kettering Health Network and Kettering Physician Network.

Prior to joining the network in 2014 as legal counsel, he was a partner at Bieser, Greer and Landis, LLP in Dayton, where he represented the needs of Kettering Health Network for more than 12 years.

Jody Underwood has been promoted to network director of Care Transitions. Jody will be responsible for achieving top-decile performance in each measure of the care transitions scorecard, including length of stay, readmissions, cost of care and patient experience with discharge planning. She will

also be instrumental in strategy and execution with post-acute care initiatives.

Shout Outs

John Weimer has been promoted to the network director of Emergency and Trauma Services. John will oversee network strategy for the Emergency Departments and trauma services. He will also work with campus emergency leadership to create one best practice operationally.

Jeffrey Weinstein, MD, is now chief quality officer for Kettering and Sycamore medical centers, assuming senior leadership for quality, safety and efficiency. Dr. Weinstein is a board certified infectious disease specialist who has been practicing at Kettering and Sycamore since 1996.

Neurosurgeons Phillip Porcelli, DO, (left) and Richard Gorman, DO, laced up their running shoes and participated in the American Brain Tumor Association 5K in Columbus, Ohio on June 13, 2015. Kettering Health Network was a corporate sponsor of the event, which raised $213,324.74 to help find a breakthrough for brain tumors.

Jody Underwood

John Weimer

Joe Feller

Richard Gregg, MD

Jeffrey Weinstein, MD

N e t w o r k 15

U.S. News & World Report names three network hospitals among the best U.S. News & World Report has ranked Kettering Medical Center and Grandview Medical Center System (includes Southview Medical Center) among the best hospitals for 2015-16.

Kettering Medical Center is ranked #18 out of 210 hospitals in Ohio, and is recognized among the Best Hospitals in the Dayton metro area and the Ohio River Valley region. It is recognized as high performing in orthopedics.

“This is a great honor,” says Roy Chew, president of Kettering Medical Center. “Our staff works hard to provide the best care for our patients. We are deeply gratified to be recognized by such an esteemed organization for our commitment to quality health care.”

Grandview is ranked #25 out of 210 hospitals in Ohio, and is recognized among the Best Hospitals in the Dayton metro area and the Ohio River Valley region. It is recognized as high performing in pulmonology.

“We are proud once again to be ranked as one of the best regional hospitals,” says Russ Wetherell, senior vice president of Grandview Medical Center System. “To be counted among the best in the Dayton area by such a well-respected publication, along with our sister hospital Kettering Medical

Center, shows that the residents in the Dayton area do not need to travel far to receive quality care.”

Kettering and Greene recognized for providing outstanding patient carePremier, Inc. has recognized Kettering Medical Center and Greene Memorial Hospital as Citation of Merit recipients for the QUEST® Award for High-value Healthcare for providing outstanding patient care.

Premier, Inc. is a leading healthcare improvement company, uniting an alliance of approximately 3,400 U.S. hospitals and 110,000 other providers to transform healthcare. QUEST is a performance improvement collaborative of approximately 365 hospitals working to make healthcare safer, more efficient and consistently effective.

Only 20 hospitals received a Citation of Merit for achieving top performance in any five of the seven areas measured in Premier’s QUEST collaborative, including cost and efficiency, inpatient and outpatient evidence-based care, mortality, safety, patient experience, and appropriate hospital use.

“We are extremely honored to receive this recognition from Premier, Inc.” says Teri Sholder, Chief Quality Officer for Kettering Health Network. “This award validates the initiatives we are taking to continuously improve patient outcomes and health.”

Kettering Health Network breaks ground for medical office building in SpringboroKettering Health Network kicked off the construction of a new medical office building with a groundbreaking ceremony on Tuesday, July 21. The Springboro Health Center, which is being built on State Route 741 and Pennyroyal Road in Springboro, will offer one more access point for the local community to receive care.

The two-story health center will be approximately 35,000 square feet, and is expected to include a variety of physician practices, including primary care, family practice, internal medicine, and OB/GYN. The center will also offer outpatient services to meet the needs of the community. Construction is expected to be completed by early summer of 2016.

16 N e t w o r k

Kettering, Grandview and Southview named three of America’s Best Hospitals for Cancer CareKettering, Grandview and Southview medical centers have received the Women’s Choice Award® as three of America’s Best Hospitals for Cancer Care.

They are among an elite group of 331 hospitals that have earned the 2015 Women’s Choice Award by meeting the highest cancer care accreditation standards of the American College of Surgeons Commission on Cancer.

“We are very humbled and honored to receive this award,” says Elizabeth Koelker, director of the Oncology Service Line for Kettering Health Network. “Kettering Health Network is committed to providing advanced cancer care with a talented staff dedicated to helping cancer patients through their journey.”

To learn more visit womenschoiceaward.com

to the

Network Medical Staff Dinner

Bring a guest and join us for a special evening.

Tuesday, September 22 at 6 p.m.Dayton Marriott

1414 South Patterson Boulevard Dayton, Ohio

RSVP at khnmedstaffdinner.org

YINVITED ou Are

Southview Hand Center SymposiumUnderstanding hand trauma and care.

September 23, 2015

Register at ketteringhealth.org/hand/education

……………

TAVR Facts and UpdateDiscuss risk factors, advancements, and patient criteria for Transcatheter Aortic Valve Replacement.

October 7, 2015

Email julia.parks@khnetwork.org to register

Visit ketteringhealth.org/ketteringmeded/cme for more opportunities

Shout Outs (cont.)

For the first time in history, the number of graduates from U.S. medical schools and osteopathic schools is equal to or surpassing

the number of residency training positions available to them. At the same time, the United States faces the need for more physicians in the primary care specialties (internal medicine, family practice, and pediatrics) to care for a growing number of patients, particularly seniors. In our own communities, many primary care practices are often full, forcing patients to wait for needed care.

In response to national and regional residency needs, Kettering Health Network is planning to initiate new primary care programs at Soin Medical Center. The family practice residency will be the cornerstone program and will develop over the next three years. These residents will experience not only the significant patient volume at Soin, but will also rotate to a number of other facilities during their training. Psychiatry, pediatrics, outpatient office settings, public health or Rural Health Clinics, and likely others will be in shared environments. At the same time, Soin will host residents from other network programs for select rotations, perhaps including radiology, emergency medicine, and obstetrics. Medical student rotations will also become possible, as well as training for advanced practice providers.

Robert Smith, MD, network director of medical education, is leading the inauguration of these residencies as well as bringing all existing residencies in the network under one organizational umbrella. Along with submission of plans for accreditation of the new program, he is initiating the

search for a dedicated family practice director who will be the on-site leader of residents.

Network to Expand Residency Program Preparing to train more primary care providers

Many of our existing medical staff will become faculty members in our programs and incorporate teaching into their clinical practices. We believe a significant number of medical students are looking for a career in community or rural medical practice, and our programs will provide some unique experiences such as the Rural Health Clinics along with outpatient clinics and hospital-based medicine. Especially in smaller communities with fewer specialist consultants, these physicians will have need for maximum breadth of training, which our facility can provide them.

Our medical staff leadership at Soin is excited about the opportunity to foster this contribution to community medical education.

byDavid Small, MD,ChiefMedicalOfficerforGreene Memorial Hospital and Soin Medical Center

Robert Smith, MD

M e d i c a l E d u c a t i o n 17

18 K e t t e r i n g | S y c a m o r e

Kettering Medical Center was recognized for its commitment to and success in caring for stroke patients by the American Heart Association/American Stroke Association’s Get with the Guidelines®-Stroke Silver Plus Quality

Achievement Award.

The Plus Quality Award is an advanced level of recognition that allows hospitals to be acknowledged for their compliance with the quality measures within the Get With the Guidelines program.

These guidelines measure a hospital’s ability to provide the most appropriate, up-to-date treatment to ensure speed of recovery and reduced risk of death and disability, prevent deep vein thrombosis, and offer smoking cessation counseling.

“When a stroke occurs, time lost is brain lost,” says Libby Herrberg, stroke program coordinator at The Neuroscience Institute. “As the first certified comprehensive stroke center in the Greater Dayton area, this award demonstrates our commitment to providing quality care based on nationally-respected clinical guidelines.”

Kettering Awarded for Quality Stroke Care

With the assistance of the Patient Family Advisory Council, Sycamore Medical Center is implementing a plan for

expansion of the Physician Office Building third floor that will provide better flow, design, and aesthetics with patients and their families in mind.

The $8.7 million project will result in an additional 30 beds in large, private rooms primarily for surgical patients, including orthopedic and bariatric patients. Thanks to patient input, new features such as concierge-level service, a step down unit, and a redesign of patient flow will be key features of this project.

Sycamore is Adding Private Patient Rooms Opening anticipated in January 2016

The football field-sized expansion is the beginning of Sycamore’s initiative to provide more private patient rooms throughout the hospital. Construction began mid-June with an anticipated opening in January 2016.

Kettering Medical Center expanded its Level III B NICU in May, adding five additional beds for a total of 25.

Kettering Expands NICU

K e t t e r i n g | S y c a m o r e 19

Kettering Receives Designation for Elder Care ExcellenceKettering Medical Center has been designated a NICHE Hospital. The NICHE (Nurses Improving Care for Healthsystem Elders) designation indicates a hospital’s commitment to elder care excellence.

Thrombin TimeThe Kettering Hematology Laboratory now offers the Thrombin Time (TT) as an in-house test. The TT reflects the conversion of fibrinogen to fibrin, so it may be abnormal in any quantitative or functional fibrinogen deficiency. This includes congenital fibrinogen deficiency and acquired fibrinogen deficiencies as in disseminated intravascular coagulation, liver disease, and thrombolytic therapy. A prolonged TT may also be caused by products that interfere with fibrin polymerization, such as elevated fibrin degradation products or a paraprotein. Unfractionated heparin will also cause a prolongation of the TT. Low molecular weight heparin typically does not lead to an abnormal value, except in the presence of a very high concentration.

Direct Oral AnticoagulantsSince the network began offering the anti Xa heparin assay, there have been questions posed regarding how the new classes of oral anticoagulants impact our tests of coagulation.

Dabigatran (thrombin inhibitor):Dabigatran can cause a prolongation of both the prothrombin time (PT) and partial thromboplastin time (PTT), but typically has more of an effect on the PTT. As a thrombin inhibitor, Dabigatran causes a prolonged TT. It should not have an effect on our anti Xa heparin assay. None of these tests, however, are recommended to monitor Dabigatran therapy. We currently do not have an in-house method to quantitate Dabigatran.

Coagulation Update

Apixaban and Rivaroxaban (Factor Xa inhibitors):Both Apixaban and Rivaroxaban can cause a prolongation of the PT and PTT, typically with more of an effect on the PT, but they should not cause a prolonged TT. We currently do not have an in-house assay to quantitate these drugs. Our anti Xa heparin assay is specifically designed to measure the level of heparin with results reported as units of heparin/ml. This same method could possibly be used to provide quantitative measurements of Apixaban and Rivaraxaban if the standard curves for those drugs were used; however, such reagents are not available for clinical use with our instrumentation. Only unfractionated heparin and low molecular weight heparin can be quantitated with this test. That said, both Apixaban and Rivaroxaban by themselves can cause a positive result with our anti Xa heparin assay in the absence of heparin. This is a qualitative effect and does not provide a quantitative means to monitor these drugs.

byRichard Pelstring, MD

20 K e t t e r i n g | S y c a m o r e

ANESTHESIAKerry Christensen, MDAdam Montoya, MDKettering Anesthesia Association, Inc.(937) 293-8228

CRITICAL CARE MEDICINERyan Mihata, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

DENTISTRYAnna McGuire, DMDAnna K. McGuire, DMD, Inc.(937) 864-5022

DIAGNOSTIC RADIOLOGYAjay Agarwal, MDKettering Network Radiologists, Inc.(937) 297-6306

EMERGENCY MEDICINEAndrew Bohn, MDZachary Ginsberg, MDKevin Juozapavicius, DOJulie Knott, MDStanley Koontz, MDDavid Lynn Marcus, MDRebecca Perry, DOSarah Valentine, DOChristopher Vermillion, MDErwin Weber, MDEmergency Medical Specialists(937) 436-4658

Welcome Doctors Kettering | Sycamore New Physicians on Medical Staff February-May 2015

FAMILY MEDICINEKattie Amegatcher, MDLewis Mahran, DOEnglewood Family Medicine(937) 836-2424

Kelly Arey, DOLebanon Medicine Group(513) 932-4891

Kareem Selim, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

Soumya Nadella, MDSycamore IM & Women’s Wellness Center(937) 866-6655

Tina Gabbard, MDJohn Merling, MDAnita Wantz, MDWilmington Medical Associates(937) 382-1616

GENERAL SURGERYChristopher Schneider, MDKettering Acute Care Surgery(937) 395-8556

Michael Swanson, DONortheast Surgical Wound Care(216) 643-2780

HOSPITALISTPatricia Back, MDSirisha Gaddipati, MDSudha P. Jaganathan, MDRobert Moore, MDArshad Shah, MDKHN IP Med(937) 395-6665

Matthew Brockman, MDHimad Khattak, MDMadhusudhanTarigopula, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

INTERNAL MEDICINECherish Prutzman, MDClyo Internal Medicine(937) 435-5857

Benson Babu, MDRebecca Ramirez, MDKHN IP Med(937) 395-6665

Rey Francisco Arcenas, MDMelyssa Galloway, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

Charles Opperman, MDSycamore Primary Care Group(937) 384-6800

Mary Lou Inwood, MDWilmington Medical Associates(937) 382-1616

NEUROLOGYHerbert Newton, MDDayton Center for Neurological Disorders(937) 439-6186

OBSTETRICS/GYNECOLOGYCaroline Peterson, DOContemporary OB-GYN, Inc.(937) 439-7416

PALLIATIVE MEDICINETimothy MacLean, DOInnovative Care Solutions(937) 252-2003

PEDIATRIC CARDIOLOGYErick Michelfelder, MDCincinnati Children’s Hospital Medical Center(513) 636-1199

PEDIATRICSJennifer Sweat, MDCornerstone Pediatrics, LLC(937) 885-4475

Ruth Dooley, MDJeffrey Manser, MDMary Ann Merling, MDLisa Ziemnik, MDWilmington Medical Associates(937) 382-1616

PLASTIC SURGERYRon M. Johnson, MDWright State Physicians(937) 208-4955

PSYCHIATRYBrent Crane, MDGrandview Hospital – Behavioral Health Unit(937) 723-4515

Liesl Jacobs, MDSteven Taylor, MDKettering Behavioral Medicine Center(937) 534-4651

Carmel Flores, MDTCN Behavioral Health Services(937) 376-8700

RADIATION ONCOLOGYStella Ling, MDGMH Radiation Oncology(937) 352-2146

RADIOLOGYKirti Agarwal, MDKettering Network Radiologists, Inc.(937) 297-6306

UROLOGYJuan Palomar, MDTri-County Urology(937) 439-6242

G r a n d v i e w | S o u t h v i e w 21

Atruly effective and efficient healthcare system must be built on a strong foundation of primary care. The Institute of Medicine defines primary

care as the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.

According to the 2010 U.S. Census statistics and the Agency for Healthcare Research and Quality, the U.S. primary care workforce includes approximately 209,000 practicing primary care physicians, 56,000 nurse practitioners, and 30,000 physician assistants practicing primary care, for a total of nearly 300,000 primary care professionals. Primary care physicians consist of family physicians and general practitioners, general internists, general pediatricians, and geriatricians.

Seven core principles are fundamental to the discipline and practice of successful primary care in any healthcare-related field according to the Engagement Tactic Team for the Family Medicine for America’s Health (FMAH) initiative. They are as follows:

1. Continuous—The care provided by primary care providers must be continuous over time and provide the context in which the person and the provider can engage in informed and shared decision-making to provide the highest quality healthcare outcomes.

2. Comprehensive—To provide effective and efficient primary care, the provider’s knowledge base must be as broad as possible. This deep understanding of health care and the patient helps primary care providers design care that includes prevention that is appropriate for each individual in the context of their personal life, their family, and their community.

3. Patient-centered—The provision of high-quality primary care starts with the patient/provider relationship. Patient-centric healthcare

Core Principles of Primary Care Essentialsofeffective,efficient,high-qualitycare

information, education, and choices should be provided that meet patients’ needs in their healthcare journey.

4. Accessible—Primary care must be accessible to patients 24/7. This allows patients to gain a clear understanding of their usual source of care and builds a sense of confidence and trust that healthcare problems or concerns can be diagnosed early and responded to appropriately. Accessible care using this approach leads to fulfillment of the Triple Aim—better health, better care, at a lower cost.

5. Integrated—Primary care offers integrated care in which the primary care provider not only helps the patient with his or her particular problems but also knows how, who, and when others on the healthcare team may be able to help the patient.

6. Coordinated—Through broad knowledge of both the patient and the healthcare system, the patient’s healthcare experience can be organized, arranged, and synchronized to ensure that the patient will be seen in the right place, at the right time, by the right person, and for the right reason.

7. Team-based—Collaboration and effective communication among all the members of the primary care team will help ensure maximal patient outcomes, the best possible care experience, and that all members of the care team are valued for what they contribute to the patient’s care.

The provision of high-quality primary care is a complex undertaking. These seven core principles are essential to the provision of effective, efficient, and high-quality primary care in the ongoing context of a person’s life. All seven principles must be in play to maximize the patient care experience, to improve patient outcomes, and to lower overall healthcare costs.

byPaul Martin, DO, ChiefMedicalOfficerforGrandview and Southview medical centers

22 G r a n d v i e w | S o u t h v i e w

Grandview Medical Center is undergoing a 37,000-square-foot expansion to provide more privacy to inpatients. The project will build out

the existing, shelled-out fourth and fifth floors in the five-story tower added in 2013. Grandview Medical Center plans to add 48 new beds—24 on each floor—that will each have a private room.

Grandview identified this opportunity to improve the patient experience through patient surveys. “The number one complaint arises when patients have to share their room with another patient,” says Russ Wetherell, senior vice president and administrator at Grandview Medical Center.

The $4.4 million project is on track to be completed and admitting patients by the end of October 2015.

Grandview Expands to Improve Privacy and Patient Experience

The main entrance of Southview Medical Center is transforming into a welcoming oasis to patients and their families.

The existing high ceilings will be incorporated into an organic, nature-inspired design. A Creation Wall—an eight-panel art installation that depicts the story of creation and the beginning of time—will be installed to add beauty and a source of spiritual reflection.

A fireplace and comfortable seating will form a central gathering place. Registration will also

Southview’s Lobby under Renovation, Hand Center Expanding

be relocated to make room for a new concierge welcome desk, and the gift shop will be moved to a more easily accessible location. The coffee shop, complete with a new lounge area, will include a tech center to meet the mobile needs of patients and visitors.

Southview Medical Center will also be expanding its Hand Center to better serve growing demand for pre-op and post-op space.

This $2 million project will start in October with an anticipated completion in January 2016.

G r a n d v i e w | S o u t h v i e w 23

DERMATOLOGY/PATHOLOGYH. Nicholas Shamma, MDAmerican Dermatopathology Laboratory(937) 412-4230

EMERGENCY MEDICINELinda M. Rimkunos, MD(937) 723-3210

Anthony Abdullah, MDEM Care(937) 723-3210

David Marcus, MDEmergency Medicine Specialists(937) 395-8659

Welcome Doctors Grandview | Southview New Physicians on Medical Staff February-May 2015

Christopher J. Vermillion, MDErwin Weber, MDLeanna Withrow, DOPrestige Billing(937) 436-4658

Nathan R. Moody, DOWright Patterson Air Force Base(937) 257-0770

FAMILY MEDICINEBrooke L. Manocchio, DOBeavercreek Urgent Care - API(937) 458-4200

Kattie Ynez Amegatcher, MDLewis Mahran, DOEnglewood Family Medicine(937) 836-2424

Kelly Arey, DOLebanon Medical Group(513) 932-4891

Alan R. Fark, MDXenia Urgent Care – API(937) 352-2850

GASTROENTEROLOGYLarry Weprin, MDDayton Gastroenterology(937) 320-5050

INFECTIOUS DISEASEKaili Fan, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

INTERNAL MEDICINESheila T. Cheruvelil, MDBeavercreek Commons Family Practice(937) 427-3333

Manish Sheth, MDDayton Physicians(937) 293-1622

James Howard Galbraith, MDRichard Groger, MDSouth Dayton Acute Care Consultants, Inc.(937) 433-8990

NEPHROLOGYJabulani Sidile, MDArthur Tsai, MDKidney Care Specialists (937) 643-0015

ONCOLOGY/HEMATOLOGYEmily Vannorsdall, MDKettering Cancer and Blood Specialists(937) 897-6971

PEDIATRICSJennifer Sweat, MDCornerstone Pediatrics(937) 885-4475

24 G r e e n e | S o i n

Soin Medical Center now provides spine procedures to patients suffering from chronic back pain. Soin’s comprehensive spine center

focuses on delivering quality spine care from the preoperative phase through recovery. The new Spine Center has board-certified orthopedic spine surgeons who are fellowship-trained in surgery of the spine.

Back pain affects millions of people every year and is one of the leading causes of disability. Relieving back pain can improve everyday life for those who suffer. Pain can be caused by an injury, degenerative changes, or osteoporosis, and can be triggered by actions as simple as bending, reaching, or lifting.

“Because back and neck pain can be caused by multiple factors, a comprehensive spine program is needed to separate these pieces and find the most effective solutions to treating the problem,” says Jeffrey Hoskins, MD, Soin Spine Center.

A focused physical examination and detailed history of symptoms are crucial to pinpoint the affected areas of the spine. Medical imaging is used to diagnose structural reasons for the pain.

“Spending the necessary time to identify what causes neck and back pain is the first step. Then both non-operative and operative treatment options can be presented as solutions,” says Nicolas Grisoni, MD, Soin Spine Center.

Soin Opens Spine Center Delivering quality spine care from preop through recovery

Non-operative treatments are usually recommended first. These could include physical therapy, medications, exercise and stretching, and spinal injections. Surgery may be offered when an anatomic reason for the symptoms is identified and function does not improve with non-operative treatments.

The Soin Spine Center care team includes spine surgeons, physician assistants, a spine coordinator, an internal medicine physician, a pain management physician, operating room staff, anesthesia staff, nursing staff, physical and occupational therapy, respiratory therapy, pharmacy, and social services.

“Our goal is to mentally and physically prepare our patients for spine surgery and guide them through each step of the way by providing the highest quality care resulting in the best possible outcome to improve function and quality of life,” says Lisa Meiring, CNS, spine coordinator at Soin Spine Center.

For more information call (937) 702-4670.

25G r e e n e | S o i n

To meet the burgeoning need of emergency services in the area, Soin Medical Center expanded its Emergency Department almost three years ahead of original forecasts. The expansion was completed and opened for

patients with a formal ribbon-cutting ceremony in June 2015.

In order to accommodate more patients, Soin added 12 treatment rooms, nearly doubling the number from 14 to 26, with four bariatric-friendly rooms and two that are geriatric-friendly. The project also expanded cardiology coverage to provide more cardiac catheter capabilities, reducing the patient’s risk of permanent brain cell damage. A new and enhanced EMS squad courtesy suite will better serve the increasing number of arriving squads from surrounding communities.

Soin operates one of the busiest Emergency Departments within Kettering Health Network, and its emergency stroke program offers the highest level of care for acute heart patients with the availability of intravenous TPA, or “clot busting drugs.”

Soin’s Emergency Department Expansion Now Open

Matthew Freyhof, MD, and Prashanth Bhat, MD, at the Ribbon-Cutting Ceremony

26 G r e e n e | S o i n

On June 1-2, the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) conducted its final review of our clinic operations for certification as fully-certified Rural Health Clinics,

operating as outpatient departments of Greene Memorial Hospital.

The surveyor shared that our clinics had “passed the survey” and was tremendously complimentary of our operations and detailed preparation. Full certification will come through CMS in late summer.

I would like to thank Medical Director Lawrence Udom, MD, for his leadership throughout this process, as well as Neha Patel, DO; David Hyde, MD; and all our nurse practitioners we rely so heavily on in our rural health program—Lauree Lawler, Clif Fawcett, and Rosemarie Morasco. A special thanks to our practice manager, Jane Miller, who spent many hours developing the necessary Rural Health Clinic manuals, policies and procedures, and documentation, as well as our incredible clinical staff that made the difference in our certification process.

Furthermore, I want to thank the depth of our resources at Greene and throughout the network, which were instrumental in making this survey a success—laboratory, bio-medical, facilities, safety, pharmacy, and so many more. And thanks to Kettering Physician Network for making our physician coverage a reality.

Join me in congratulating the team.

Greene Completes Successful Rural HealthClinicCertificationSurveys

byMark Floro, director of clinical services for Soin Medical Center and Greene Memorial Hospital

Lawrence Udom, MD

Neha Patel, DO

David Hyde, MD

27G r e e n e | S o i n

Laborists started providing on-site coverage at Soin Medical Center 24/7 on May 19, replicating the full level of service provided

at Kettering Medical Center.

“This addition enhances physician support and our culture of safety. It’s what’s best for patients, staff, and physicians,” says Ron Connovich, vice president of finance and operations at Greene Memorial Hospital and Soin Medical Center.

Soin Adds 24/7 Laborist Coverage Full level of service provided

“This is just one of many services being added at Soin as we continue to grow.”

Specialists also provide 24/7 coverage at Soin for urology, gastroenterology, anesthesiology, cardiology, hospital medicine, and surgery (general, orthopedic, trauma, and vascular).

Soin Builds Out Fifth Floor with Private Beds Soin Medical Center is completing its shelled fifth floor one year ahead of schedule. This $10 million project began mid-June and is expected to be completed by spring 2016.

The project will provide approximately 30 beds—each in a private room—and additional therapy space to support the hospital’s orthopedic, hernia, and cardiac programs.

“This latest build-out reflects a continued increase in demand for medical surgical and therapy services,” says Terry Burns, senior vice president of Soin Medical Center. “Since the hospital opened, it has been our desire to provide comprehensive, advanced health care to our neighbors in Greene, western Clark, eastern Montgomery and Miami counties, and improve their quality of life. This latest project helps us do just that.”

Soin Expands Private Bed Count and Conference Space

Ollie Davis Pavilion Renovating Fifth and First FloorsThe Greene Medical Foundation has been working with generous donors to renovate the fifth floor of the Ollie Davis Pavilion, where construction crews will install a conference space that will accommodate 225-275 people, complete with a serving kitchen.

The first floor of the Ollie Davis Pavilion will then become a patient care area, continuing Soin Medical Center’s dedication to providing convenient, high-quality service to its patients.

28 G r e e n e | S o i n

ANESTHESIOLOGYGustavo Collins, MDDavid Tibbits, MDKettering Anesthesia Associates, Inc.(937) 293-8228

CARDIOVASCULAR & THORACICMark Anstadt, MDMiami Valley Heart & Lung Surgeons, LLC(937) 208-6060

Najeeb Ahmed, MDSpringfield Cardiology(937) 398-0354

DENTISTRYAnna McGuire, DMDAnna K. McGuire, DMD, Inc.(937) 864-5022

Kyle Jackson, DDSStacey Zaikoski, DDSCenterville Pediatric Dentistry, Kyle R. Jackson, Inc.(937) 586-7729

James Mason, DDSJames F. Mason, DDS(937) 848-1116

Welcome Doctors Greene | Soin New Physicians on Medical Staff February-May 2015

EMERGENCY MEDICINEDavid Marcus, MDEmergency Medicine Specialists(937) 395-8659

Andrew Bohn, MDZachary Ginsberg, MDKevin Juozapavicius, DOJulie Knott, MDStanley Koontz, MDChristopher Vermillion, MDErwin Weber, MDEmergency Medicine Specialists/Prestige Billing(937) 436-4658

FAMILY MEDICINEBrooke Manocchio, DOBeavercreek Urgent Care – API(937) 458-4200

Ronnie Tan, MDUrgent Care of Hamilton(513) 896-9700

Letitia Thompson-Hargrave, DOWells Institute(937) 293-2157

GENERAL SURGERYChristopher Schneider, MDKettering Acute Care Surgery(937) 395-8556

Michael Keller, MDMichael Keller, MD(937) 859-3294

HOSPITALISTSirisha Gaddipati, MDKHN IP Med(937) 395-6665

Todd Ignarski, MDHimad Khattak, MDMadhusudhan Tarigopula, MDSouth Dayton Acute Area Care Consultants, Inc.(937) 433-8990

Rebecca Ramirez, MDSycamore Primary Care Group(937) 384-6800

OBSTETRICS/GYNECOLOGYDale Drollinger, MD(937) 436-1854

ORTHOPEDICSDavid Propst, DOOrthopedic Association of SW Ohio, Inc.(937) 428-0400

Matthew Lawless, MDWright State Physicians(937) 208-2091

PEDIATRICSChristopher Learn, MDLindsay Rogers, MDWendy Whiteside, MDCincinnati Children’s Hospital(513) 636-6977

PLASTIC SURGERYKeith Perrine, MDPreferred Plastic Surgery(937) 432-9810

Ron Johnson, MDWright State Physicians(937) 208-4955

PSYCHIATRYSteven Taylor, MDKettering Behavioral Medicine Center(937) 293-8300

PULMONARY/CRITICAL CAREMartin Ambrose, MDDayton Lung and Sleep Medicine, Inc.(937) 832-5292

RADIOLOGYKirti Agarwal, MDKettering Network Radiologists, Inc.(937) 297-6306

UROLOGYEdward Jacobs, MDSouth Dayton Urological Associates(937) 294-1489

F o r t H a m i l t o n 29

Slow Down to Speed Up Maintain long hours without wilting under the burden of stress

The practice of medicine is at once a brilliant art form, an inspiring intellectual endeavor, and a demanding physical event. Focusing on the

latter, most physicians work between 40 and 60 hours per week, and 25 percent of us work between 61 and 80 hours per week, according to the American Medical Association. The same survey also found that half of us would prefer fewer work hours per week.

So how can we maintain such long hours without wilting under the burden of stress, decision fatigue, administrative chores, and never-ending attempts at patient satisfaction?

I submit that we should slow down to speed up. We should slow down in order to improve our efficiency, raise our level of performance, diminish our stress, and satisfy our patients.

The Stress Response Curve, published by Nixon in 1979, details the effects of arousal stress on task performance and physical health. Nixon’s work added an important layer to the original Yerkes-Dodson law.

In my own practice in the Emergency Department, I’ve many times come to find that, after an hour spent obtaining blood tests and X-rays, all my

patient really wanted was a work excuse so they could stay home and rest. If I had spent the extra few minutes asking important questions like, “What are you worried about?” and “How can I best help you?” I could have discharged the patient in 20 minutes instead of an hour.

Interestingly, studies have found a positive correlation between shorter visits and rates of medication prescriptions. Furthermore, physicians who personally expressed feeling short on time during their daily practice had higher rates

of prescription writing. And we’re all very aware of the frequently demonstrated inverse relationship between time spent and patient litigation.

So I encourage each of you to take a minute for self-assessment. Are you moving too fast? Slow down for the benefit of yourself and your patients.

byMarcus Romanello, MD, Chief Medical OfficerforFortHamiltonHospital

DistressGood Stress

COMFORTZONE

FATIGUE

Stress Management IncreasingThe Performance Level

Actual Performance

Exhaustion

Ill Health

FATIGUE

BREAKDOWN

PE

RF

OR

MA

NC

E

AROUSAL STRESSAdapted from Nixon P, Practitioner, 1979

THE STRESS RESPONSE CURVE

30 F o r t H a m i l t o n

Arthroscopy is most commonly used for knees and shoulders but can also be a useful treatment option for hips. This procedure

involves placing a small camera in the joint where treatment can be administered in the most precise manner.

Hip arthroscopy is a good option when nonsurgical treatment has not provided enough pain relief. This procedure may relieve painful symptoms of many problems that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. Patients often experience pain as the result of an injury, but other orthopedic conditions can lead to problems such as femoroacetabular impingement, hip dysplasia, snapping hip syndromes, synovitis, loose bodies, or hip joint infections.

Procedures can be done using a hip arthroscopy such as repairing or smoothing off torn cartilage, trimming bone spurs, or removing inflamed synovial tissue.

Hip arthroscopy is not recommended for arthritis. The best candidates are active people under the age of 55 suffering from hip pain not due to arthritis.

Krista Migliore, DO, Kettering Physician Network Orthopedics and Sports Medicine, is fellowship trained in hip arthroscopy procedures and has found the procedure successful in helping patients eliminate pain and return to activity.

“This procedure is significantly easier on the patient. They experience limited blood loss, the hip does not have to be dislocated, and an overnight stay in the hospital is not necessary,” says Dr. Migliore.

Dr. Migliore is the only surgeon at Fort Hamilton Hospital that performs hip arthroscopy and one of the few in the Northern Cincinnati area.

Source: American Academy of Orthopaedic Surgeons

HipArthroscopyOffersBenefits to Patients

F o r t H a m i l t o n 31

Fort Hamilton Hospital’s Wound Care Center has extended its award-winning wound care to a new location—the Liberty Pointe Wound

Care Center in Liberty Township.

More patients can now receive the same level of care that earned Fort Hamilton Hospital’s Wound Care Center the Center of Distinction award from Healogics™. This program, lead by William

Dickhoner, MD, as medical director, boasts a 96% heal rate with 28 days to heal and 95% patient satisfaction.

Though the center has been open since February, it became fully operational when it received two new hyperbaric

oxygen chambers in April. With the addition of the HBO chambers, the center is able to treat a wide variety of chronic wounds, such as those relating to diabetes, radiation, or trauma. The

Fort Hamilton Offers Full Range of Wound Care

PEDIATRICS/NEONATOLOGYBrooke Barnes, MDChildren’s Hospital Neonatal(513) 636-7216

Welcome Doctors Fort Hamilton New Physicians on Medical Staff February-May 2015

URGENT CARELetitia Thompson-Hargrave, DOCourtney Stroble, MDUrgent Care KPN Hamilton(513) 896-9700

Liberty Pointe Wound Care Center celebrated its grand opening with a ribbon-cutting ceremony and open house in May 2015.

32 K e t t e r i n g P h y s i c i a n N e t w o r k

To learn more about the PCMH model, primary care redesign, or Kettering Physician Network, please contact me at david.doucette@khnetwork.org or (937) 558-3221.

Congratulations to the 11 Kettering Physician Network primary care practices that were recently awarded level three recognition by

the National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Program. This accomplishment represents countless hours of hard work by physicians and their staff, as well as by Christine Peterson, project manager, and Jeanette Ikan, MD, Epic physician specialist. I also want to extend special thanks to three physicians who provided excellent leadership in this effort: Kathleen Lang, MD, David Page, MD, and Robert Sawyer, MD. Dr. Sawyer serves as the primary care service line medical director and chaired the primary care redesign committee, which was instrumental in making decisions that guided the transformational changes for PCMH implementation.

This PCMH recognition is a major achievement in our primary care redesign journey, which will benefit patients now and for a long time to come. To receive level three recognition—the highest level—the primary care practices met stringent criteria in six standard categories:

• Enhanced access and continuity of care

• Population health management

• Care planning and management

• Self-care support and community resources

• Care coordination (and tracking) across the continuum

• Performance improvement and measurement

Specific improvements While pursuing recognition is an intensive exercise in bureaucracy, it also helps us take important steps to achieve improvements in outcomes, quality of care, patient satisfaction, and cost effectiveness. One such step is the addition of two new clinical positions: the care navigator and nurse care manager. Both of these positions are designed to support primary care physicians in helping coordinate the transition between health

Eleven Primary Care Practices Achieve NCQA PCMH RecognitionNext group must achieve even higher standards

care providers and focus on communication and coordination of quality patient care.

Care navigators are certified medical assistants or licensed practical nurses embedded within each practice. Their job is to work with high-risk patients and those who have multiple health care coordination needs. This might include a diabetic patient who has a high A1C level and is not returning to the practice for follow-up care, for example. Care navigators support such patients by providing pre-visit planning, making sure the patient has the necessary support to comply with the care plan, and more.

Nurse care managers work with multiple practices. Their caseload includes patients who are referred by their physician. The nurse care manager’s role is to provide assessment, planning, care management, and evaluation to meet these patient’s needs across the continuum of care.

What’s next? The next step in our journey will be to pursue PCMH recognition for Kettering Physician Network’s remaining primary care practices (24 and counting). Achieving recognition will involve meeting additional factors in the six standard categories, most of which focus on behavioral health, care management, and quality improvement measurement. We are in the planning phase, which involves meeting with project leaders and building workflows into Epic to support changes in patient care that will set us up for success.

byDavid Doucette, MD,ChiefMedicalOfficer for Kettering Physician Network

The following KPN Practices have achieved level three PCMH recognition:

Far Hills Medicine & Podiatry

Franklin Medical Group

Greystone Family Care

Heritage Health—Rossgate

Heritage Internal Medicine

Heritage Primary Care—Washington Blvd.

Integrated Medical Group*

Miamisburg Family Practice—Byers

South Dayton Internists

Springboro Primary Care

Village Green Primary Care

* achieved recognition February 2015

K e t t e r i n g P h y s i c i a n N e t w o r k 33

New Laser Procedure Restores Vaginal Health Improving the quality of life for postmenopausal women and certain cancer survivors

Women of all ages can experience vaginal symptoms such as dryness, itching, painful urination, pelvic pressure, and pain during

sexual intercourse, which can be debilitating, impacting everything from daily activities to personal relationships. Vaginal atrophy affects 50% of postmenopausal women and nearly 70% of premature menopausal and postmenopausal breast cancer survivors, according to a study in the Journal of Personalized Medicine.

Traditionally, treatment options for these issues were limited. Hormone replacement therapies carry risks and are not always effective. Topical treatments are messy and inconvenient. Now, an innovative laser therapy, recently approved by the Food and Drug Administration, provides a painless, non-invasive treatment that can restore vaginal tissue to its natural state.

The first practice in the Dayton area to offer the treatment—called MonaLisa Touch® laser therapy—is Southwest Ohio Urogynecology. Urogynecologists Marc Ashby, MD, and Janelle Evans, MD, began offering the therapy in June.

They closely followed the therapy’s clinical trials at the University of Cincinnati, which showed early and consistent signs of therapeutic success. “This new therapy is remarkable—it is painless, requires no anesthesia, causes no side effects, involves minimal recovery, and provides amazing results,” says Dr. Ashby. “In clinical trials, women reported symptom relief after the first treatment, and even greater improvement after treatments two and three.”

Vaginal symptoms of dryness, pain, and the like are caused by collagen loss in the vagina, the result of decreased estrogen levels. The science of MonaLisa Touch is straightforward: the therapy revitalizes the body’s own tissues, stimulating cells to make more collagen. During the five-minute procedure, the doctor inserts a small probe emitting CO2 laser energy into the vaginal canal. The CO2 triggers epithelial and lamina propria tissue to restore healthy levels of collagen to the vaginal walls. Patients receive three treatments, spaced six weeks apart, and may need one maintenance treatment per year thereafter.

MonaLisa Touch is appropriate for women who have experienced natural menopause, certain cancer therapies, an oophorectomy, or any condition that has a contraindication for hormonal therapies. “This is a breakthrough treatment,” says Dr. Ashby. “We are seeing dramatic tissue changes that translate into significant, lasting improvements in women’s lives.”

The therapy currently is not covered by insurance. The out-of-pocket cost is $1,500 for three treatments. An annual maintenance treatment costs an additional $500.

Is MonaLisa Touch laser therapy right for your patients?MonaLisa Touch laser therapy treats vaginal symptoms such as:

• Dryness• Itching• Burning

• Painful urination• Painful intercourse

It is appropriate for any female who is experiencing vaginal symptoms as a result of natural menopause and menopause induced by a hysterectomy, breast cancer treatments, or other causes. The therapy also is indicated in the treatment of lichen sclerosus, a skin condition that mainly affects the vulva. It is not appropriate for women with untreated vaginal prolapse.

Southwest Ohio Urogynecology, located at 7700 Washington Village Drive in Centerville, specializes in female pelvic medicine and surgery. For more information or to refer a patient for a consultation, please call (937) 436-9825.

Marc Ashby, MD

Janelle Evans, MD

34 K e t t e r i n g P h y s i c i a n N e t w o r k

All About AccessNewer-generation medical devices provide less invasive surgical option for abdominal aortic aneurysms

The first endovascular aneurysm repair (EVAR) took place in South America in 1991 and was a great advancement in vascular surgery

for abdominal aortic aneurysm. But in recent years, percutaneous endovascular aneurysm repair (PEVAR) has gained wide acceptance, with good reasons.

Open surgical repair of an abdominal aortic aneurysm is still necessary in some elective and emergent cases. The advantage of open repair is that the surgeon removes the damaged section of the aorta and replaces it with a graft. This is in contrast to an endovascular procedure, which uses a stent-graft to reinforce the weakened section of the aorta to prevent a rupture; the aneurysm still exists, but it is no longer pressurized. That said, open procedures come with significant risks, as well as a lengthy recovery time.

Comparing EVAR and PEVAR In most cases, endovascular surgery — either EVAR or PEVAR — is preferred. In fact, in our practice, about 95 percent of abdominal aortic aneurysm repairs are done this way. EVAR involves making a small incision on each groin to access the common femoral artery. A cannula is inserted into the artery under direct vision. Using fluoroscopy, the surgeon runs a guide wire to the aneurysm site, then uses progressively larger sheaths to deliver the closure device and stent-graft.

PEVAR is made possible by the newer-generation sheaths and closure devices, which have smaller profiles. The surgeon uses ultrasound guidance to insert a needle into each femoral artery in the groin, then uses fluoroscopy to introduce the cannula, wire, and sheaths, just as in an EVAR procedure. The surgery itself is faster than with EVAR. Patients receive a local anesthetic, rather than general, and almost always go home the next day. Readmission for infection and the rate of other complications are also better with PEVAR than with EVAR or an open procedure. In our

practice, about 70 percent of endovascular cases are performed using percutaneous access.

For the vast majority of patients who undergo surgery for an abdominal aortic aneurysm, EVAR or PEVAR is preferred to an open procedure. However, both endovascular procedures carry a risk for blood leakage into the aneurysm sac; for this reason, patients must be followed very closely post-surgery.

What about outcomes? The short-term morbidity and mortality of an endovascular repair are lower compared to that of open surgery. The durability of endovascular and open repair is the same—to a point. After about six years, the durability of an open repair is better. Therefore, younger patients who meet certain criteria should be considered for an open procedure.

Surgical repair is indicated for aneurysms that are symptomatic, leaking, large (>5 cm) or growing rapidly (>.5 cm/6 mo.). Men are more likely to get an aneurysm, and the risk increases with age.

Abdominal aortic aneurysms are not usually symptomatic, but can involve unexplained low back pain (abdominal pain is a rare entity). Most of our referrals for non-emergent abdominal aortic artery repair come from primary care physicians whose patients have an aneurysm that was discovered during a CT scan for some other abdominal problem.

For more information or to make a referral, call (937) 458-0085.

byJames Gebhart, DO, and Jacob Yannetta, DO, vascular surgeons at Kettering Vascular Surgery Associates

K e t t e r i n g P h y s i c i a n N e t w o r k 35

BEHAVIORAL HEALTHLiesl Jacobs, MDKettering Behavioral Medicine(937) 534-4651

CARDIOLOGYK. Shahid Baig, MDJohn Lynch III, MDRaja A. Nazir, MDM. Niranjan Reddy, MDReginald Sequeira, MDKettering Physician Network Cardiovascular Care(937) 298-8058

Welcome Doctors Kettering Physician Network New Physicians February-May 2015

FAMILY MEDICINEParasram Ramdeo, MDKettering Medical Center Hospitalist(937) 395-6665

Sherif Zihni, MDFort Hamilton Hospital Urgent Care(513) 896-9700

GASTROENTEROLOGYDilip Bearelly, MDKettering Surgical Associates(513) 737-3690

INTERNAL MEDICINEAshlee Ames, MDKettering Medical Center Hospitalist(937) 395-6665

Caitlin Harris, DOKettering Medical Center Hospitalist(937) 395-6665

Sylvia Polenakovik, MDKettering Medical Center Hospitalist(937) 395-6665

Arshad Shah, MDKettering Medical Center Hospitalist(937) 395-6665

NOCTURNIST/FAMILYRobert Moore, MDKettering Medical Center Hospitalist(937) 395-6665

ORTHOPEDICSAram Donigian, MDKettering Physician Network Orthopedics(937) 531-0114

Joseph Scheidler, DOKettering Physician Network Orthopedics & Sports Medicine(513) 867-4165

SURGERYChristopher Schneider, MDKettering Medical Center Trauma(937) 395-8556

UROLOGYEdward Jacobs, MDSouth Dayton Urology(937) 294-1489

Kettering Physician Network Orthopedics and Sports Medicine (formerly MidWest Orthopedics) moved to a new location serving

Hamilton, Ohio. Their new address is 840 NW Washington Boulevard, Suite 6 (no longer scheduling patients at 1010 Cereal Avenue, Suite 103).

The practice has additional office locations in Hamilton, Cincinnati, and Oxford. Visit the KPN website to learn more.

Therese Slyby is now director of Patient Care Services for Kettering Physician Network. Therese has served as Quality manager with KPN since June 2014, providing direction for the design, development, implementation, evaluation, and continuous improvement of the KPN quality program.

Shout Outs

Douglas Gula, DO; Joseph Scheidler, DO; Jon Moore, DPM; Todd Grime, MD; Krista Migliore, DO

First Name Last Name, Degree Office NameAddress 1Address 2City, State Zip Code

3535 Southern BlvdKettering OH, 45429

NONPROFITORGANIZATIONUS POSTAGE

PAIDDayton, OH

PERMIT No. 45

Your Voice MattersComing October 26, the Physician Engagement Survey will give you an opportunity to confidentially share your ideas and concerns with Kettering Health Network leadership.

Watch for upcoming details on how to take this short survey.