St. Louis Medical News June 2013

s t l o u i s m e d i c a l n e w s . c o m JUNE 2013 > 1

David G. Meyers, MD, MPH

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The Trust Factor ReviveHealth reveals results of 7th annual payor survey; trust represents greater factor than rate

In the wake of national health reform, the trust factor between hospitals and health insurance companies is perilously low ... 4

Lending Voice and Vehicle AARP and RWJF collaborating with select states on national nurse education redesign program

Twenty states, including fi ve in Medical News markets, are working on a dynamic nurse initiative redesigning nurse education to bolster the advancement of nurses ... 5

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By LyNNE JETER

Primary care physicians in St. Louis may rest easier after diagnosing patients with heart anomalies, knowing the cardiac electrophysiol-ogy (EP) team at St. Louis Children’s Hospital (SLCH) treats the most complex cases, includ-ing arrhythmias in children with congenital heart disease.

“A major success story is that more pa-tients with congenital heart disease, some with even the most severe that would cause babies to die within a couple of days of life, are sur-viving well into adulthood,” said George Van Hare, MD, a pediatric cardiologist and EP, and director of the Department of Pediatrics Divi-sion of Cardiology at the Washington Univer-sity School of Medicine (WUSM). “Part of the story of pediatric cardiac surgery is that now all forms of congenital heart disease are ame-nable to some type of corrective surgery. Much of that happens during the newborn period.”

PROUDLY SERVING THE GATEWAY CITY

Mending Small HeartsSLCH provides numerous cutting-edge pediatric cardiology treatments

By LyNNE JETER

In her youth, Carolynn Ingerson-Hoffman, RN, might never have imagined leading a local nurse staffi ng company to national prominence in a 28-year journey.

Under her circumstances, getting an education was a chore. Then, starting a company with negligible assets in the 1980s was a major challenge.

“It was extremely rare to fi nd a woman-owned busi-ness,” said Ingerson-Hoffman, founder and president of Manchester Road-based MediNurse, a leading provider of private duty services, and community and corporate

wellness programs in St. Louis. “From the fi rst day, I ran into many obstacles … getting a business loan, getting credit, and being taken seriously.”

Even though Ingerson-Hoffman knew the odds against an entrepreneurial concept taking root and grow-ing continuously for three decades weren’t good, she was determined.

“Failure wasn’t a word I chose to recognize,” she explained. “But success was. I used the power of visual-ization to picture myself successful: giving presentations, holding meetings with a staff I knew I would have one

(CONTINUED ON PAGE 8)

St. Louis NightingaleCarolynn Ingerson-Hoffman, RN, takes entrepreneurial concept to nationally prominent nurse staffi ng company

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Dr. Van Hare checks monitor readings of one of his small patients.

Carolynn Ingerson-Hoffman

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By LUCy SCHULTZE

For cardiologist David G. Meyers, MD, MPH, leaving a career in academic medicine to adopt something completely different may have been the best trade he’s ever made.

“This has been an utter gift,” said Meyers, who retired as a tenured profes-sor from the University of Kansas School of Medicine to follow his new wife to St. Louis.

He joined Cardio-Pulmonary Associ-ates of St. Luke’s Hospital this past Au-gust, adopting much of the patient load from a recently retired colleague and scaling back his own practice schedule to three days a week.

The group of 11 physicians includes both cardiologists and pulmonologists, and is based on the St. Luke’s campus on South Woods Mill Road in Chesterfield.

“What more can one ask than to go to a part-time practice that you don’t have to build, and to work three days a week with lovely people at a first-rate community hospital?” Meyers said. “I can’t imagine a more wonderful setting than what I lucked into.”

Meyers spent a 30-year career in aca-demic medicine, beginning with a faculty position at the University of Nebraska Medical Center College of Medicine in Omaha. He spent the past 17 years at the UK School of Medicine in Kansas City, where he retired as professor of cardiol-ogy, internal medicine and preventive medicine.

Coming to St. Louis, where his wife, Gay Burns, works as a corporate execu-tive, has brought about a threefold shift for Meyers – a new city, a new work environ-ment, and a new pace.

So far, it’s suiting him just fine.“I have found a three-day work week

to be quite civilized,” he said.A native of Iowa, Meyers was raised

in a small town along the Mississippi River and received his medical degree from the University of Iowa in Iowa City.

He completed his post-graduate training in internal medicine at Creighton University, and in cardiology at the Medi-cal College of Virginia. He also earned a master’s degree in public health and pre-ventive medicine at the Medical College of Wisconsin.

Meyers is board certified in internal medicine, cardiology, preventive medicine and clinical lipidology.

His interest in preventive cardiology began in the 1980s.

“Some very, very ancient Chinese doctor wrote that a good doctor cures dis-ease – but the truly excellent doctor pre-vents it,” Meyers said. “That really is what I’ve tried to do.”

In his practice, that’s meant steering patients away from simply trying to fix their problems with medicines and vita-min supplements.

“Of course, the most important way to achieve good health is by being very selective in choosing your parents,” he quipped.

“But after you’ve done that, then the key really is lifestyle. It’s eating a healthy diet – all things in moderation. Occasion-ally low-dose alcohol, avoiding smoking and being physically and mentally active.”

While Meyers has watched that per-spective become a more popular talking point in healthcare discussions, he doesn’t believe much has really changed over the past 30 years.

“I don’t know that doctors actually

do that much preventive medicine, and among the general public, I don’t know that people are exercising more,” he said. “We smoke less, thank God, but that’s about it.”

In his career in academic medicine, Meyers focused his research on exploring some unexpected connections in preven-tive cardiology. Those included the effects of taking various vitamin supplements, getting flu shots and donating blood on preventing heart attacks.

“Indeed, people who regularly donate blood have fewer heart attacks than those who only occasionally do,” he said. “And several studies have shown the correlation between cold weather and heart attacks, in that having an upper-respiratory disease can increase your risk.”

As stimulating an environment as it can be, Meyers isn’t missing the university hospital setting, with its large scale and po-litical milieu.

“Being in a community hospital where everybody helps everybody and is friendly and collegial, is very nice,” he said. “They are very different places, and I’m reveling in what I’m doing at the mo-ment. My practice life is so full.”

Beyond his new practice, Meyers is continuing his hobby of taking part in Civil War reenactments by playing the role of a surgeon from that era. As one of the original members of the Society of Civil War Surgeons, Meyers has been tak-ing part in reenactments since 1985.

Among large events he’s looking for-ward to taking part in this year are the 150th anniversary reenactment of the bat-tle at Gettysburg.

“One of the key things is really dem-onstrating what medicine was like in that period,” he said. “In those days, equip-ment wasn’t sterile, so your surgical tools had wood, ivory or ebony handles.”

While such relics are hard to come by these days, Meyers employs a collection of tools he acquired years ago from a dealer in medical antiquities.

Demonstrating Civil War battlefield surgery also involves an accurate repre-sentation of anesthesia techniques, he said.

“Virtually everybody got anesthe-sia before surgery, either chloroform or ether,” he said. “You didn’t really have people biting down on bullets to withstand the pain.”

With his more-flexible schedule, Mey-ers is also looking out for ways to revive other hobbies he enjoyed in Kansas City, such as playing the drums in rock-and-roll bands and playing badminton.

While he’s yet to find either a band to join or a badminton facility to use, he hasn’t had trouble filling his two free days a week.

“I help in a food pantry, and I’ve joined Rotary,” he said. “And I run er-rands for my very busy wife.”

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By LyNNE JETER

In the wake of national health re-form, the trust factor between hospitals and health insurance companies is peril-ously low.

That’s the consensus of 373 hospital and health system administrators respon-sible for negotiating contracts with major health plans in the seventh annual Na-tional Payor Study. Conducted by Nash-ville-based ReviveHealth, the 2013 survey paints an interesting picture of administra-tors’ opinions about various private payor trends, including rates, payment of claims, denials and other actions.

“The trust factor is huge when it comes to hospitals and health plans being able to play nice in the new world order of risk— sharing and improved health outcomes,” said ReviveHealth CEO Brandon Edwards.

For the second con-secutive year, hospital and health system leaders who negotiate managed care contracts with national health insurance companies pointed to

WellPoint/Anthem as the nation’s worst plan, with only a 16 percent favorability rating. WellPoint manages health plans in 14 states, including Anthem Blue Cross in California.

“Even though WellPoint now has a CEO with a strong provider background, he’s got to turn around an aircraft carrier, and that takes time,” said Edwards, noting that business practices and corporate be-havior have contributed to the company’s poor reputation. “Their major imperative has to be improving their reputation and rebuilding trust with providers.”

For the third consecutive year, Unit-edHealthcare exacerbates its perennial poor showing, ranked worst in all areas of contract negotiations except payment plans. The payor held firm as the health plan with the most consistently poor repu-tation among hospitals – and the slowest to pay.

“Honesty and candor represent Unit-ed’s biggest challenges,” noted Edwards. “Hospitals year in and year out cite Unit-edHealthcare’s low rates, slow payments, bureaucracy, and honesty as reasons for their poor rankings.”

Aetna was given high marks for the best rates, followed closely by Cigna.

“Honesty and easy business dealings seem to matter more than rates,” said Ed-wards. “Otherwise, Aetna would be the best rated plan in every category.”

This year, independent Blue Cross and Blue Shield (BCBS) plans and Cigna tied for the top favorability spot, with 49 percent. Last year, Cigna held the spot alone. In this year’s survey, Aetna’s ap-proval rating was 46 percent, followed by Coventry and UnitedHealthcare at 30 percent each, and Humana at 25 percent.

Despite having the lowest rates for three consecutive years, BCBS plans earned top ranking for best overall busi-ness practices.

“Independent BCBS plans, however, ranked well ahead of Cigna (30 percent compared to 19 percent) in terms of over-all best to deal with, despite having the lowest ranking in payment rates to hospi-tals,” said Edwards. “For several years in a row, the survey revealed a complete lack of correlation between payment rates from any payor, and a hospital’s perception of that payor.”

The survey, conducted in partnership with Catalyst Healthcare Research (CHR) and The Godbey Group, is the only one of its kind in the United States to target hos-pital leaders who negotiate managed care contracts with national health insurance companies. Respondents included CEOs, CFOs, and managed care/payor relations executives who negotiate on behalf of about one-third of the nation’s hospitals.

“The goal of the study is to provide a national perspective of hospital leaders’ opinions of large health plans,” said Ed-wards, who initiated the survey after notic-ing a void in payor ratings. “Even though health plans rate hospitals and their phy-sicians routinely, no one was rating the health plans.”

On an optimistic note, nearly half of all participants believe their negotiated rates will improve this year.

Providers have varying strategies for success, with wellness programs a top pri-ority for their employees, and clinical in-

tegration a second focal point. “Hospitals are taking the lead on

wellness and population health programs with their own employees,” said Edwards. “Now they need to take that experience and go out to local employers with solu-tions to keep those employees healthy and costs down.”

Nearly 40 percent of respondents re-ported their hospital had been in at least one public contract dispute in the past five years that resulted in non-participation. Also, the gap between rates for the largest payor and rates for the second and third largest payors have widened considerably.

“This ‘payor cost shift’ drives up profitability for the biggest plans at the ex-pense of the smaller market share plans,” said Edwards. “That’s proven by the fact that more than one-third of hospitals would fail to meet profit margin goals if all private payor rates were the same as their largest payor.”

Contracting priorities for the upcom-ing year – the top three are the same as 2012 – involve:

1. Increasing rates with the largest payor.

2. Producing better language protec-tion against denials.

3. Increasing rates with the second and third largest payors.

4. Balancing the threat and opportu-nity of narrow networks within the hospi-tal’s market.

5. Having better contracting language with the largest payor.

6. Procuring better reimbursement for high-cost drugs, implants and other carve-outs.

7. Expediting claims processing and payments.

8. Improving rates for Medicare Ad-vantage plans.

9. Shifting reliance away from the largest payor.

10. Bundling payments for medical home, ACO, or other population health strategies.

SOURCE: ReviveHealth.

The Trust Factor ReviveHealth reveals results of 7th annual payor survey; trust represents greater factor than rates

Brandon Edwards


By LyNNE JETER

Twenty states, including five in Medi-cal News markets, are working on a dy-namic nurse initiative redesigning nurse education to bolster the advancement of nurses.

The AARP and Robert Wood John-son Foundation (RWJF), developers of the national program, Future of Nursing:Campaign for Action (Campaign), is working with Flor-ida, Louisiana, Mississippi, Missouri, and Tennessee to implement the Institute of Medicine’s (IOM) evidence-based recom-mendations on the next chapter of nurs-ing. (The IOM defines “evidence-based practice” as a combination of best research evidence, best clinical experience, and con-sistency with patient values.) Other states involved in the initiative are Colorado, Connecticut, Georgia, Iowa, Idaho, Kan-sas, Maryland, Michigan, Nebraska, New Jersey, Pennsylvania, Rhode Island, Utah, Wisconsin and Wyoming. The RWJF com-mitted $3 million to help the states prepare the nursing profession to address the na-tion’s most pressing healthcare challenges.

The Future of Nursing State Imple-mentation Program will boost efforts al-ready underway across the nation and the District of Columbia. The Campaign, the foundation explained, provides a voice and a vehicle for nurses at all levels to lead sys-tem change by collaborating with business, consumer, and other health professional

organizations.“This program is designed to spur

progress by supporting action coalitions, most of which are led by volunteers, that are doing promising work to implement the IOM recommendations,” said Susan B. Hassmiller, PhD, RN, RWJF senior ad-viser for nursing and director of the Cam-paign. “The foundation is committed to providing states with the support they need to build a more highly educated, diverse nursing workforce that will improve health outcomes for patients, families and com-munities.”

The initiative provided two-year grants of up to $150,000 to state-based ac-tion coalitions that have made substantial progress toward implementing the IOM recommendations. The grants call for states to match funds.

This pressing issue was addressed at the American Hospital Association’s an-nual meeting April 28-May 1 in Washing-ton, DC, which focused advocacy efforts on transforming the healthcare delivery system, maintaining essential resources, and reducing the regulatory burden.

The U.S. Department of Labor has identified nursing as the fastest-growing oc-cupation through 2012. More than 1 mil-lion new and replacement nurses will be needed to fill the nation’s healthcare needs.

“Current demand for quality nurses far outstrips the supply,” said Sheila Kelly, PhD, project director of the Mississippi Barriers to Nursing Education Survey. “In-creased future needs will only exacerbate the crisis. In 2002, the Health Resources and Services Administration estimated that over 30 states were experiencing nursing shortages, and the shortfall would grow to over 44 states by the year 2020.”

The Center to Champion Nursing in America (CCNA), an AARP initiative, AARP Foundation, and RWJF serve as the national program office for the Future of Nursing State Implementation Program.

“This new program will help action coalitions get the strategic and technical

support required to advance their goals,” said Susan Reinhard, PhD, RN, senior vice president of the AARP Public Policy Institute and CCNA chief strategist. The nonprofit, nonpartisan national organiza-tion with more than 37 million members is one of the nation’s most powerful lobbying groups. “Our hope is that states will get the boost they need to be effective in achiev-ing the triple aim of addressing cost, quality and access.”

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Catheter abla-tions comprise the majority of proce-dures performed by Van Hare and car-diac EPs at SLCH.

“Our success rates are very high; complication rates are very low,” said Van Hare, a pioneer in the use of radio-frequency catheter ablation in children. “Being a high vol-ume center for chil-dren allows us to be highly experienced.”

Two cardiac EPs work in tandem on almost all cases, “an important feature because you often don’t know what you’ll find when you get involved with a patient,” said Van Hare, who often collaborates with junior EP Jennifer Sylva, MD. “We may think it’ll be a straightforward case, but per-haps the patient’s problem is more compli-cated than previously imagined.”

Implantable loop recorders, similar to a halter monitor without the electrodes, is used effectively at SLCH.

“It’s a gadget the size of a USB flash drive that can be implanted under the skin of children and adults in a very minor pro-cedure,” said Van Hare, explaining that “as EPs, we’re referred children who have episodes that may indicate dangerous heart rhythm issues. If the family practice doctor sees a patient in clinic who’s had an episode

of fainting, which is common in teenagers, you don’t want the next episode to be sudden death. So a lot are referred to us because of suspicion that their episodes of fainting or perhaps sensation of a racing heartbeat indicate more malignant cardiac disease that could lead to sudden death.”

Because the electrodes often cause a skin reaction, and a halter monitor is incon-venient to wear, pediatric patients better tolerate implantable loop recorders, Van Hare pointed out.

“A 7-year-old won’t put up with one of these monitors,” he said, explaining that “the loop recorder gives us an opportunity to put something underneath the skin that will continuously monitor heart rhythm for three years, transmitting episodes as needed.”

The implantable loop recorder helps cardiologists determine specific symptoms.

“A child fainted during a wrestling match, but we could never catch an epi-sode,” recalled Van Hare. “We put in an implantable loop recorder and nine months went by before the child had another faint-ing spell. It turned out the recorder showed a very dangerous heart rhythm, which al-lowed us to give the patient specific ther-apy, in this case medication, to keep it from recurring. Another child had episodes of fainting that we couldn’t explain. With the implantable loop recorder, we found out the child’s heart was stopping for 30 sec-onds at a time. If we hadn’t implanted the loop recorder, we might not have made that diagnosis, and we wouldn’t have im-planted a pacemaker to solve the patient’s problem altogether.”

Three-dimensional (3D) mapping sys-tems represent cutting-edge treatment at SLCH.

“The advantages are numerous,” he said. “With the 3-D mapping system, we’re able to construct a virtual 3D model of the heart chamber to allow us to precisely lo-cate an abnormal focus that we’d attack with catheter ablation. This system allows us to locate catheters in 3D space without having to step on the fluoroscopy pedal and therefore, dramatically reduce the amount of radiation exposure associated with these procedures. That’s very important.”

A vital aspect of work being done at SLCH involves complex heart rhythm dis-orders, with the most complex cases occur-ring as a result of corrective cardiac surgery for congenital heart disease, said Van Hare, who was among the nation’s first specialists to perform catheter ablation for complex heart rhythm disorders in the early 1990s, and is often referred pediatric patients from cardiologists across the country to help with cases in which children cannot verbalize heart problems, and those in which an at-tempt has been made to fix a cardiac prob-lem without success.

“Any time you create an incision, you create a scar, which could lead to abnor-mal heart rhythms that rotate around these

scars in a circular pat-tern,” he explained. “Understanding these things often requires the ability to see the entire chamber electri-cally in three dimen-sions.”

Because SLCH is one of the nation’s most comprehensive heart transplant and heart failure programs for children, many pa-tients are transferred to the children’s hospital for consideration of a heart transplant.

“Sometimes, kids are heading down the transplant route because they devel-oped abnormal heart rhythms that are mak-ing their hearts worse.

Often, we’ll evaluate them to see if we can figure out a way to help their heart so they can get by without a transplant because once that’s been done, you’ve introduced a whole host of problems that limit their lives,” said Van Hare. “Some patients awaiting transplants simply need their medication adjusted; others need a differ-ent type of heart surgery to improve the heart. Anytime we can help kids not get transplanted, we consider it a big win.”

The SLCH team is also involved in the pediatric application of a specific treatment for heart failure, an area that was devel-oped in the adult world primarily for adults like Vice President Dick Cheney and others with defibrillator dysfunction.

“The idea is to pace the heart in a way that causes it to function better,” said Van Hare. “Cardiac resynchronization therapy (CRT) is implanted in a particular way in adults, primarily in the catheterization lab. We’ve found that in children, there’s a completely different classification that could benefit from CRT, such as children born with one ventricle. We manage many single ventricle patients surgically. Those with single ventricles ultimately can de-velop heart failure due to dyssynchronous activation of the heart rate. By employing this particular type of pacemaker, CRT, which involves placing two sets of leads on a ventricle instead of one, we’re able to genetically improve heart function and get kids off the transplant list.”

Van Hare’s team is involved in vari-ous national projects, such as the recently FDA-approved national study on CRT is-sues in patients with heart failure that his colleague, Sylva, is leading.

“Cardiology is an incredibly excit-ing field,” said Van Hare, a practitioner since 1983. “Over the last 20 to 25 years, there’s been a dramatic shift from heart rhythm disorders being managed by open heart surgery to being managed by cath-eterization technique. I’ve been riding that wave the entire time. The field continues to evolve rapidly with new technology and knowledge. In our academic setting, we’re fortunate to be at the forefront.”

Mending Small Hearts, continued from page 1

4-1-1 on George Van Hare, MD A native of Connecticut, George Van Hare, MD, graduated from the

University of Connecticut School of Medicine, served as chief resident at Rainbow Babies & Children’s Hospital in Cleveland, Ohio, and completed fellowships in cardiology and electrophysiology (EP) at the University of California-San Francisco.

After teaching at Stanford University for a decade, where he directed the EP program, Van Hare left Palo Alto, Calif., where “the weather is almost perfect year-round” to relocate to St. Louis in 2008.

“I was privileged to have the opportunity to be chief of cardiology at one of the nation’s best medical schools (Washington University School of Medicine) and children’s hospitals (St. Louis Children’s Hospital),” he explained. “It also provided my wife (Michele Estabrook, MD), a pediatric infectious disease specialist, a wonderful opportunity. She’s very interested in medical education and infectious diseases in transplanted patients.”

As a pediatric cardiologist and EP, and director of the Department of Pediatrics Division of Cardiology at the Washington University School of Medicine (WUSM), Hare specializes in the diagnosis and treatment of children with heart rhythm disorders, including non-invasive tests, and also the performance of electrophysiology studies, catheter ablation procedures, and pacemaker and defibrillator implantation. An officer for the Heart Rhythm Society, he also holds the Louis Larrick Ward Chair in Pediatric Cardiology at St. Louis Children’s Hospital and WUSM.

Missourians have embraced Van Hare, recognizing him as a “Best Doctor in America” in the 2012 edition of St. Louis Magazine.

Of three grown children, the eldest is pursuing a psychology degree; the middle son is a Vassar grad who works in Manhattan as a sound designer; and the youngest recently earned an EMT license.

“We love St. Louis,” said Van Hare. “We felt at home as soon as we got here.”


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By LyNNE JETER

The richly talented Steve Martin, an actor, comedian, musician, poet, and writer – and new father at the age of 67, with multiple projects on the books – made time to play with his band, Steve Martin and The Steep Can-yon Rangers, at The Foundation for Barnes-Jewish Hospital’s 2013 illumination Gala that raised nearly $2 million for cancer research at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital (BJH) and Washington Uni-versity School of Medicine (WUSM).

A sold-out crowd of more than 600 guests attended the April 20 event, held at The Ritz-Carlton in St. Louis.

“This event to support cancer research at Siteman is such a meaningful opportunity for each of us to make a difference for our future and our children’s future,” said gala co-chair Ron Kruszewski, chairman, presi-dent and CEO of Stifel Financial Corp., noting that 1,500 cancer patients die daily, and 1.6 million new cases are diagnosed an-nually. “Thanks to research, the progress being made in cancer treatments just in the last few years is phenomenal.”

Kruszewski and Craig Schnuck, chairman of the executive committee with Schnuck Markets Inc., led community sup-port for the gala this year. ACW Alliance and Stifel were presenting sponsors of the event, which included a cocktail reception, dinner, luxury auction, special videos and the musical entertainment of Steve Martin and The Steep Canyon Rangers.

“Siteman is leading the way to more personalized cancer treatments based on an individual’s genes—and the Cancer Frontier Fund is playing a significant part in those ad-vancements,” said Schnuck. “It gives us all hope and I’m humbled to be part of it.”

The illumination Gala supports The Foundation’s Cancer Frontier Fund, cre-ated in 2009 to help Siteman Cancer Center researchers accelerate breakthroughs that will change cancer care and expedite cures.

When award-winning vocalist and ac-tress Minnie Driver headlined the 2012 gala themed “fast-forward to a world without cancer,” $1.9 million was raised. Specifi-cally, the Cancer Frontier Fund supported research to improve treatments and out-comes for pancreatic, cervical, breast, blood

cell and skin cancers; to develop a simple urine test to detect kidney cancer earlier; and to develop a way to stimulate the immune system to destroy tumors.

“Having watched friends and family members battle cancer, it’s such an honor to support research that will get us to cures faster,” Driver said.

A diverse group of entertainers have ral-lied the gala’s success: Christina Applegate, a breast cancer survivor, headlined in 2009; Kareem Abdul-Jabaar, the NBA’s all-time leading scorer and Hall of Famer, spoke in 2010; and Kristin Chenoweth, an award-winning actress whose mother, Junie, is a breast cancer survivor, performed in 2011.

Amy and Bill Koman spearheaded the fundraising initiative.

“Philanthropic support is helping us speed the process of finding more effective, individualized treatments with fewer side ef-fects, as we work to eliminate cancer com-pletely in the future. It’s an exciting time in cancer research,” said Siteman director Timothy Eberlein, MD.

The 350-plus researchers and physi-cians at Siteman Cancer Center hold more than $160 million in research and related training grants. Siteman patients participate in nearly 250 cutting-edge clinical studies.

“We’re so appreciative to all those who attended and supported illumination to make it so successful,” says Rich Liekweg, president of BJH and Barnes Jewish West County Hospital, and group president of BJC HealthCare. “Through the generos-ity of many, we’re able to keep our foot on the accelerator of cancer research so more people can live healthier lives.”

Siteman is the only cancer center state-wide – and within 240 miles from St. Louis – to hold the prestigious Comprehensive Cancer Center designation from the Na-tional Cancer Institute. BJH and WUSM, Siteman’s parent institutions, also are na-tionally recognized, with U.S. News & World Report magazine consistently rank-ing both among the best in the country.

“None of our work is possible with-out continued support from the St. Louis community,” said Eberlein. “Drastically slashed budgets are the norm these days, so the money generated by illumination is like manna from heaven.”

Manna from HeavenAnnual gala to benefit research raises nearly $2 million, thanks to Steve Martin and The Steep Canyon Rangers and the St. Louis community

illumination Gala 2014 is slated for Saturday, April 26, at The Ritz-Carlton.

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day. I even pictured how my offi ce would look and how much revenue we’d generate. I really think visualization is strategic plan-ning of the subconscious because it worked and worked well. I still use the same tech-nique today to achieve something I’m de-termined to achieve.”

Ingerson-Hoffman was born third of seven children – six girls and a boy – to a homemaker who secretly longed to be a nurse.

“She was a feminist before it became popular in the ‘60s,” said Ingerson-Hoff-man, who learned later in life of her mom’s career dream. “She believed and instilled in me that women could do the same as any man – if given the chance. My father worked two and three jobs to provide for us. In addition, he and mom raised chick-ens and grew most of the vegetables we ate.”

As a schoolchild, Ingerson-Hoffman was unable to participate in extra-curricu-lar activities.

“My sisters and I weren’t allowed to stay after school because of our home chores,” she said, rattling off a partial list: cleaning, ironing, cutting the grass and weeding gardens. A few exceptions oc-curred during her senior year: she served as senior maid to the Homecoming Court, and was allowed to attend select after-school sporting events. “If I could have, I would’ve liked to join the choir or been in-volved in the school newspaper, yearbook or student council.”

Initially drawn to law school, a career path she knew she couldn’t afford to pur-sue, Ingerson-Hoffman’s interest in nurs-ing was sparked at the old DePaul Hospital on Kingshighway Boulevard, where her dad was hospitalized several times for pro-longed periods.

“It was during one of these hospital-izations that I decided to become a nurse and started planning what I needed to do to make that happen,” said Ingerson-Hoffman, one of the original DePaul “Paulettes,” teen volunteers on the medi-cal-surgical fl oors.

In her “fi rst career” as a nurse, Inger-son-Hoffman was “a darned good one,” she joked, having achieved the level of as-sistant director of nursing for recruitment and special projects.

“This position, along with my time in the clinical area, gave me the foundation to move to the private sector,” she said. “I be-lieve that my compassion for others helped me with the business. I’ve always said to employees that if they take care of the company, the company would take care of them and I meant it.”

Ingerson-Hoffman’s special focus as a business owner in the healthcare industry involved setting standards that were miss-ing at the time.

“I’m happy to say we did indeed set standards that many of the local hospitals ended up following, not to mention others in my type of business,” she said. “My goal was to make a difference by running a good

business based on business principles, but also with the patient as the center of our business. We’ve never lost sight of that in all these 28 years, and I believe we made a difference in the business, the community and in many lives.”

Indeed, MediNurse employs 100 healthcare professionals to serve families, businesses and hospitals, while also step-ping up as a leader in the medical com-munity by supplying speakers to schools, encouraging teens to consider a nursing career, and mentoring students. For the past decade, she’s gathered friends, fami-lies, colleagues, and student nurses from the Barnes-Jewish School of Nursing to fi ll, pack and wrap hundreds of holiday gifts to soldiers abroad.

“Carolynn defi nes success by helping people,” said Judy Goodman, a MediNurse vendor. “When I was in crisis, she provided a caregiver so my elderly parents could stay in their home.”

Ingerson-Hoffman’s empathic nature stems from overseeing her parents’ care and well-being for more than two decades.

“Like many family caregivers, the responsibility and stress caused my own health concerns,” she said. “On the plus side, I use myself as an example to help oth-ers see the importance of caring for yourself

when you’re caring for someone else.”Since serving as president of the

Barnes-Jewish College Goldfarb School of Nursing Alumni Association, Ingerson-Hoffman has dreamed of starting a non-profi t for Nurses Caring for Nurses.

“I was acutely aware that nurses spend their whole professional career – the ma-jority of their lives – caring for others and not caring for themselves,” she said. “I saw alumni who were alone in later years with many needs. Nurses Caring for Nurses will recruit younger nurses to help those nurses who are ill or elderly. I say ‘will’ because it will happen, of that you can be sure.”

Outside of work, Ingerson-Hoffman saves up spare time to spend with her hus-band, Harlan, for simple pleasures: walking on a beach, and perusing farmers’ markets and art and antique shows in the park.

“Harlan always gives me the gifts of laughter and patience,” she said. “His sup-port has been key. And he’s always shared his experience in business with me and taught me a great deal along the way.”

The couple frequently traveled in-ternationally and spent many evenings socializing. Even though friends remain very important to them, their primary ex-tra-curricular activity these days involves “being at home for a big dose of peace and quiet,” said Ingerson-Hoffman, who loves to cook. “We love being around our Bichon, Versace. We spend a lot of time staying up to date on current affairs lo-cally, nationally and around the world. We read a lot. I couldn’t even guess how many books we have! You’ll still fi nd us holding hands.”

During long beach walks, Ingerson-Hoffman mulls the company’s future and various avenues to pursue.

“My mind is always on,” she said. “My best ideas come during the night and I’ll wake up to write them down or else, I’ll forget them.”

The most valuable life lesson Ingerson-Hoffman has learned involves opportuni-ties that spring from obstacles.

“With every obstacle one faces, there’s an opportunity to be found if you look for it,” she said. “Unlike so many business owners who are throwing in the towel in today’s very challenging economic times, I look for the opportunities and I believe I have one. Stay tuned.”

St. Louis Nightingale, continued from page 1

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By LyNNE JETER

A few dozen approved surgeons specializing in gastroenterology proce-dures across the nation are offering a revolutionary solution for patients with gastroesophageal reflux disease (GERD) that’s so new, many primary care physicians and some spe-cialists aren’t aware of it as an option.

“When the FDA ap-proved the LINX Refl ux Management System, and the New England Journal of Medicine re-cently discussed the effi cacy of the system, word began getting out,” said Sam Pace, MD, a board-certifi ed gastroenterologist with Digestive Health Specialists in Tu-pelo, Miss., director of the Heartburn Center of North Mississippi, and a LINX-approved sur-geon.

Torax Medical opted to launch the procedure nationwide at approved centers, usually one or two per state. Torax Medical develops and mar-kets products designed to restore human sphincter function via its technology plat-form, Magnetic Sphincter Augmenta-tion (MSA), which uses attraction forces to augment weak or defective sphincter muscles to treat GERD that often irritates the esophagus, causes heartburn and other symptoms. Left untreated, refl ux could lead to serious complications, such as esophagitis, stricture, Barrett’s esophagus and esophageal cancer.

“I applaud the medical company for not doing a wholesale release,” said Pace. “Instead, the company is releasing it to centers that do a lot of refl ux work so the proper evaluation can be done.”

The LINX System’s new device is a quarter-sized fl exible band of magnets encased in tiny titanium beads. The mag-

netic attraction between the beads helps keep a weak esophageal sphincter closed to prevent refl ux. Implanted around a weak sphincter just above the stomach, the minimally invasive procedure typically takes less than an hour to complete.

“The force of swallowing breaks the magnetic bond to allow food and liquid to pass through, and then the magnetic attraction closes the lower esophageal sphincter back to form a barrier,” said David Gilliland, MD, FACS, a surgeon with Surgery As-sociates PA, in Tupelo, also an LINX-approved surgeon.

Until now, physi-cians had only two op-tions for treating refl ux: medication or a surgical procedure called laparoscopic Nissen fundoplication, widely used since the early 1990s. In this proce-dure, the top part of the fundus is wrapped around the lower esophagus to improve the refl ux barrier. Even though Nissen fun-doplication may be effective, it has several drawbacks.

“After a patient has fundoplication, he can no longer belch or vomit,” said Gilli-liand. “Some patients report gas bloating because of this.”

Three years after sphincter augmenta-tion with the LINX System, the majority of treated patients were able to substantially

reduce or resolve their refl ux symptoms, while also eliminating their use of refl ux-related medications, according to the New England Journal of Medicine summary.

In 100 percent of patients, severe re-gurgitation was eliminated, and nearly all patients (93 percent) reported a sig-nifi cant decrease in the need for medi-cation. Ninety-four percent reported satisfaction with their overall condition after having the LINX System procedure, compared to 13 percent before treatment while taking medication.

“For years, surgery for refl ux patients would best be described as a static deal,

where you sew everything down,” said Pace. “The LINX procedure is dynamic because opening and closing simulates the normal sphincter, except you’re keeping it closed so you don’t have reflux. Now we have a choice for patients that we can tailor-make the surgi-cal approach to this problem.”

Like Nissen fundoplica-tion, the procedure is done laparoscopically through fi ve small punctures in the abdo-men.

“Once we’re in the OR, we can decide which proce-

dure the patient is better suited for, de-pending on anatomy,” Gilliland said. For example, the LINX procedure cannot be done if the patient has a hiatal hernia larger than three centimeters.

Another benefi t is a quicker return to solid food.

“We try to get LINX patients to eat regular food right away to train the de-vice,” Gilliland said. “With the Nissen pro-cedure, they’re on a prescribed diet for at least two weeks.”

Because the procedure is new, insur-ance coverage varies by provider and is usually approved on a case-by-case basis.

Refl ux KOTorax Medical rolls out LINX procedure for GERD patients to select specialists

Refl ux LINX closed Swallowing

Dr. Sam Pace

Dr. David Gilliland

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By CINDy SANDERS

Nearing retirement in an era when 70 is the new 50, it can be dif-ficult to picture a time when you won’t be able to hop in your car to run er-rands, swing a club or a racquet, attend an exercise class, or enjoy an evening out with good friends. Per-haps in the recesses of your mind the possibility exists that you might need a little assistance at some point in the very distant future … but that time is certainly not now.

Still, in your most prudent mo-ments, you know the big house and big yard are really too big now that the children are grown and gone. And you hate the thought of your spouse or the kids hurriedly having to make criti-cal decisions should something happen to you.

Still, you just aren’t ready to give up your self-sufficiency. And why should you when a solu-tion exists that allows you to keep your indepen-dence while having a contingency plan in place?

For a growing number of senior

adults, continuing care retirement com-munities (CCRCs) provide the best an-swer – supporting active, independent lifestyles while offering increasing levels of care when required. That continuum al-lows residents to age in place.

Headquartered in Des Moines, Iowa, Life Care Services has been developing and managing senior living communities for more than four decades. As the na-tion’s leading manager of full-service se-

nior living communities, the company owns or operates more than 80 com-munities in 28 states and the District of Columbia and serves nearly 30,000 residents.

Erik Gjullin, vice president/direc-tor of marketing & sales for Life Care

Services, explained that residents arrive while independent with the knowledge that assisted living, skilled nursing and memory care facilities are avail-able onsite. Key draws for living in CCRCs are

the socialization aspect and knowing that

once you are in, you have a home for life. Yet, Gjullin said, the focus of their com-munities is on maintaining wellness and independence.

“The driver for our prospects, who are looking for solutions to senior hous-ing, is to live somewhere where it’s easy

to participate in a lifestyle that enhances health,” he said.

Gjullin explained Life Care Services takes a ‘whole person’ approach to wellness. “Our HealthyLife™ Services program is really the overall health and wellness program that we practice in all our com-munities. It’s not just fitness,” he continued, “It’s nutrition. It’s socialization. It’s educa-tion. It’s ongoing lifestyle that really creates the wellness for the whole person.”

While a number of programs and ser-vices are consistent across Life Care Ser-vices developments, the communities are far from ‘cookie cutter.’ Gjullin said, “The unique part of it is people live in different geographic regions for a reason. They like the lifestyle. They like the architecture. So if you go into our community in Phoenix, Ariz., it looks like it belongs in Phoenix. It’s got local architecture, spaces and cui-sine. It’s got the flavor of the southwest.”

Residents enjoy a range of living op-tions from apartment-style residences to garden villas to detached cottages. Mani-cured lawns, gardening plots, walking and biking trails, guest accommodations, a clubhouse with restaurant-style menus, day spa, putting green, cocktail lounge, fitness center, library, convenience store, weekly cleaning service, 24-hour security and more are part of the well-appointed surroundings.

Luxury, of course, does come with a price. Gjullin said residents pay a one-time entrance fee and ongoing monthly fee, both of which vary depending on the size of the residence selected. The monthly fee, he continued, “covers everything you could possibly think about that you would be paying if you were living in your own residence.”

At death or upon moving, there are two return-of-capital plans that give back either 80 percent or 90 percent of the en-trance fee to the resident or the estate. If residents needs to move to a higher level of care … either temporarily or perma-nently … they are guaranteed a bed, and the monthly fee remains the same as in the independent living phase.

“As you move through the contin-

A Sense of Independence

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Erik Gjullin



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By CINDy SANDERS

Preventing America’s seniors from falling is a national health priority both in terms of injury and cost. Yet, fall preven-tion programs have only proven to be mar-ginally successful over the long term.

Cathleen S. Colón-Emeric, MD, MHS, and colleagues focused on the gap between quality improvement (QI) proto-cols and sustained bedside implementation in the nursing home setting. An associate professor of Medicine in the Division of Geriatrics at Duke University School of Medicine, Colón-Emeric said previous studies found the desired improvements oc-curred when outside trainers and research-ers stepped in to create interventions. The external staff addressed multiple risk factors to help lower fall rates, recurrent falls and injurious falls. However, she continued, “When you try to train the existing nurs-ing home staff to do those things, it doesn’t seem to work.”

Based on social constructivist theory, complexity science, and prior studies, the research team believed there was a direct link between the failure to successfully de-ploy fall interventions and the hierarchical culture present in most skilled nursing fa-cilities. Colón-Emeric, who also serves as associate director – clinical program for the Durham VA Geriatric Research, Edu-cation & Clinical Center (GRECC), noted the vertical command structure doesn’t

foster broad-based, interdisciplinary staff interaction.

“They lack the connections with their coworkers that they need to share informa-tion and problem solve,” she said. “Nursing home staff tend to work in silos.”

Colón-Emeric continued, “Coordi-nation of a multi-factorial risk reduction program requires a great deal of commu-nication. Older adults don’t fall because of one risk factor … they fall because of five or six factors. To reduce risks, you have to intervene on all of those things.”

She added reasons for a fall might in-clude any number of factors from a long, diverse list ranging from poor vision and tripping hazards to a drop in blood pres-sure upon standing or suboptimal choice of an assistive device.

“In order to improve fall rates,” Colón-Emeric said, “the team needs to know what the resident’s behavior is like.”

However, the person with the most hands-on knowledge often isn’t the one creating that resident’s specific care plan. Colón-Emeric pointed out aides deliver the majority of care in the nursing home setting. Yet, nurse aides aren’t typically part of the decision-making process and are often expected to communicate only within the chain of command. “They are less likely to implement the care plan if they haven’t been involved in making it in the first place,” she noted.

In an article published in Implementation

Science last year, the research team said QI programs could not reach optimal levels of staff behavioral changes unless the context of social learning was present. The team developed the CONNECT educational in-tervention to foster improved connections within and between disciplines, heighten communication flow and encourage cogni-tive diversity in solving problems on behalf of residents.

The next step was to see if the ‘all hands on deck’ approach made a difference in fall rates in comparison to traditional QI initiatives that focus on an individual’s mas-tery of content and process change.

Colón-Emeric said eight nursing homes in North Carolina and Virginia were selected with half randomized to re-ceive three months of CONNECT training followed by three months of a traditional falls QI program and the other half receiv-ing only the QI program training. The eight participants included a mix of com-munity nursing homes and VA facilities.

The CONNECT intervention in-cluded interactive in-class learning sessions, unit-based mentoring and relationship mapping. All activities were focused on helping the staff build networks and rela-tionships for problem-solving activities. “We designed the CONNECT interven-tion to show staff where their communica-tions weren’t working … where gaps existed … and to teach them some practical tools to better communicate,” she explained.

Post-intervention, three areas were reviewed for both the CONNECT and control groups — staff communications measures, charting, and fall rates. Colón-Emeric said to measure communication, the team used surveys before, during and after the intervention. The team also re-viewed documentation of the types of pre-vention interventions in the medical record. Fall rates, she added, were viewed as an exploratory outcome in light of the small number of study sites.

“What we found was that the staff communication levels improved a little bit in the CONNECT group but decreased in the control facilities,” she said, adding the net result was significant. Among the CONNECT group, increased communi-cation was more pronounced in the com-munity settings, as Colón-Emeric said the VA facilities already had high levels of com-munication.

Charting turned out to be a non-fac-tor. “Both groups improved a little bit and neither was significant,” she said, adding improved documentation did not correlate with decreased falls. “We don’t think the chart measures are really a good measure of what is happening at the bedside … at the site of patient care.”

As for the most important outcome — preventing falls — Colón-Emeric said the team saw the desired trajectory. “There was no change in fall rates in the control group, but the fall rate in the CONNECT facilities improved … they went down about 12 percent,” she said.

Colón-Emeric was quick to temper the significance of the outcome in light of the small number of participating study sites.

However, she said the group is now in the second year of a larger trial of 24 nursing homes with 12 each in the CONNECT and control groups.

“If we see the same magnitude of ben-efit, that would be statistically significant.” She continued, “We should be finished with our last nursing homes in 2014 and have the results out shortly thereafter.”

Colón-Emeric added that if the im-proved collaboration is proven to positively impact falls QI initiatives, then it would be reasonable to apply the same tactics to other multi-factorial issues facing America’s growing senior population.

CONNECTing Caregivers to Prevent Patient Falls

Falls Hurt Physically & Financially

According to the Centers for Disease Control & Prevention, one in every three adults age 65 and older falls each year. In this age group, falls are the leading cause of injury death and are the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2010, 2.3 million nonfatal fall injuries among older adults were treated in the emergency room with more than 662,000 requiring hospitalization. The direct medical cost of these falls, adjusted for inflation, was estimated to be $30 billion.

uum of services, your monthly fee does not increase,” Gjullin said of a unique as-pect of Life Care Services. In comparison to a skilled nursing facility where a room could cost $300-$400 a day, those who transition within the CCRC continue to pay their monthly fee … for a couple in an apartment-style residence that typically runs under $200 a day and under $100 a day for an individual in a one-bedroom apartment. “If you wanted to preserve your assets, what other program would you select?” he questioned.

Again, Gjullin stressed, the goal is to keep seniors spiritually, physically, men-tally and emotionally healthy for as long as possible to enjoy the array of options that come with this type of community. On any given day, seniors can be found attending a yoga class, planning commu-nity outings, choosing from chef-inspired cuisine, working out in the fitness center, sipping cocktails with friends or enjoying a relaxing manicure.

“Our philosophy is choice, flexibility, and control,” Gjullin said. “That’s what we offer people who live here. That’s what seniors want. They didn’t get to the point where they could afford to live in a com-munity like this and not have that as a basic philosophy.”

A Sense of Independencecontinued from page 10


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GrandRoundsTwo St. Louis Doctors Elected to MPM Insurance Company of Kansas Board of Directors

Two distinguished St. Louis-area physicians have been elected to the board of directors of MPM Insurance Company of Kansas, a subsidiary of St. Louis-based Missouri Professionals Mu-tual (MPM), Missouri’s leading provider of medical professional liability insur-ance. The new board members are:

• Jacques A. Her-zog, M.D., of Chesterfield, an Assistant Professor of Clinical Otolaryngology at the Washington University School of Medicine, and a member of the Board of Managers of the Central Institute for the Deaf.

• Lawrence E. Samuels, M.D., also of Chesterfield, a Board Certified Dermatologist, Chief of Dermatology at St. Luke’s Hospital, and a member of the teach-ing faculty at Washington University Medical School. He has provided expert dermatological care to pa-tients for nearly 30 years, and is widely respected as a leader in his field.

MPM-Kansas was formed in 2010 and acquired last year by St. Louis-based MPM, which was founded in 2003 to help control the escalating costs of pro-fessional liability insurance for medical practitioners across the state. It focuses on support services and competitive pricing for doctors’ liability insurance.

Mercy Clinic Welcomes New Physicians

Mercy Clinic, the multi-specialty physician group affiliated with Mercy Hospital recently added new doctors.

Leonard D. Gaum, MD, previously in private practice, joined Mercy Clinic forming Mercy Clinic Urology, located on South New Ballas Rd. Dr. Gaum will continue in his role as chairman of the Department of Urology for Mercy Hos-pital St. Louis.

Paul Angleton, MD, joined Mercy Clinic and opened Mercy Clinic Family Medicine Wentzville, located on West Meyer Rd. He most recently served as family physician with Willamette Health Partners, part of Salem Health, in Salem, Ore.

Edward Ferguson, MD, joined Mercy Clinic Emergency Medicine and will care for patients in the Emergency Depart-ment at Mercy Hospital St. Louis. He previously served as medical director for the emergency department at St. An-thony’s Medical Center and as president of Emergency Physicians of St. Louis.

Gayathri Dundoo, MD, joined Mercy Clinic Adult Hospitalists St. Louis and will care for hospitalized patients at Mercy

Hospital St. Louis. She most recently served as a hospitalist at Christian North-east Hospital.

Three faculty elected to National Academy of Sciences

Three Washington University in St. Louis scientists are among the 84 mem-bers and 21 foreign associates elected to the National Academy of Sciences this year. Election to the academy is consid-ered one of the highest honors that can be accorded a U.S. scientist or engineer..

The university’s new academy mem-bers are:

• Stephen M. Bev-erley, PhD, the Marvin A. Brennecke Professor of Molecular Microbiology and chair of the Depart-ment of Molecular Micro-biology in the School of Medicine;

• Robert D. Schreiber, PhD, Alumni Endowed Professor of Pathology and Immunology and pro-fessor of molecular micro-biology in the School of Medicine and co-leader of the Tumor Immunology Program at Siteman Can-cer Center;

• Joan E. Strassmann, PhD, professor of biology in Arts & Sciences.

Beverley studies the biology of the protozoan parasite Leish-mania, including virulence factors, host response and basic metabolic functions of the parasite.

Beverley earned his PhD in biochem-istry from the University of California, Berkeley, and did postdoctoral research at Stanford University. In 1983 he moved to Harvard Medical School, where he eventually became the Hsien and Daisy Yen Wu Professor and interim chair of the Department of Biological Chemistry & Molecular Pharmacology. In 1997 he joined the faculty at Washington Univer-sity School of Medicine as head of the Department of Molecular Microbiology.

Schreiber studies the intricate re-lationship between cancer and the im-mune system. With his colleagues, he has revived a century-old model of how the immune system interacts with tu-mors.

Schreiber earned a doctorate from the State University of New York at Buf-falo in 1973. After a stretch as a postdoc-toral fellow and faculty member at the Research Institute of the Scripps Clinic in La Jolla, Calif., he was recruited to Wash-ington University in 1985. He received a Washington University Faculty Achieve-ment Award in 2008.

Strassmann’s work focuses on coop-erative alliances that have occurred at several important steps in the evolution of life that have proven evolutionarily and ecologically successful.

She received her PhD in 1979 from the University of Texas at Austin. From 1980 to 2011, Strassmann was on the fac-ulty of Rice University in Houston, Texas,

where she was the Harry C. and Olga K. Wiess Professor in the Department of Ecology and Evolutionary Biology. In 2011, she became a professor of biology at Washington University.

St. Louis Senior Care Organizations Improving Healthcare Delivery and Cost

While U.S. hospitals and physicians have moved rapidly to install electronic medical records (EMR), the senior health services sector has moved more slowly. In St. Louis, Missouri, two leading long term care organizations are making strides to advance the cause of digital records. St. Andrews Resources for Seniors System and St. Agnes Home have jointly formed the LTC Collaborative for EMR. With their IT strategy partner, INNOVA Health Solu-tions LLC, the providers are proceeding to identify their priority needs and busi-ness requirements for an EMR.

The LTC Collaborative joins six prominent long term care facilities; the majorities are members in the Leading Age professional association for Long Term Care facilities. The facilities total more than 520 Skilled Nursing or Inter-mediate Care Facility beds. St. Andrews and St. Agnes Home also offer Assisted Living Facilities that serve 330 residents. St. Andrews also offers retirement liv-ing facilities and home and community based service programs.. The long term care facilities include Brooking Park, The Sarah Community, Villa Theresa, St. Paul’s Home, New Florence and St. Ag-nes Home. The LTC Collaborative was formed as a Joint Operating Committee (JOC) arrangement allow the entities to jointly fund the study and selection an EMR.. The project is governed by senior management from both St. Andrews and St. Agnes Home. The LTC Collaboratve project has been developed as follows:

1. Three work teams were formed to reflect the major functional areas of clini-cal, operations and finance/information technology.

2. Each work team has developed an extensive list of over 150 detailed needs and business requirements from an EMR system ranging from patient as-sessments to MDS tracking, guest meal requests and financial reporting.

3. The work teams have then devel-oped “scripts” or scenarios presenting de-identified complex cases. Each bid-ding EMR vendor then showed the pro-vider reviewers how their system would support the loading of information and tracking of care delivery throughout the resident’s stay. Scenarios included func-tionality needed for clinical, operations and finance areas.

St. Andrews and St. Agnes Home are seeking to prevent costly returns to acute care hospitals and generally keep seniors healthy as possible through improved care coordination. Electronic records and communications can greatly support this effort. When physicians, nurses and managers can all access a common care plan of action to treat and support critical patients, health care providers can best eliminate the costly gaps in care that also allow patients to deteriorate.

Dr. Jacques A. Herzog

Dr. Lawrenc E. Samuels

Dr. Paul Angelton

Dr. Edward Ferguson

Dr. Stephen M. Beverly

Dr. Robert D. Schreiber

Dr. Joan E. Strassman


SSM Health Care is committed to providing a better way to health

SSM Health Care has announced plans to invest $180 million over the next several years to transform and improve the health care experience for patients across St. Charles, Warren and Lincoln counties. The plan includes a number of interdependent projects that will make it even easier for members of the commu-nity to receive the care they need, when and where they need it.

SSM Health Care will begin to intro-duce aspects of this new model of care over the next several years. At the same time, the health system will focus on building the infrastructure necessary to support this vision.

Some of these planned investments include:

A complete redesign of the campus at SSM St. Joseph Hospital West in Lake Saint Louis. A new patient tower with 70 additional beds and much needed expanded parking will complement ex-panded outpatient and acute care servic-es. Specific focus is being placed on cre-ating world-class maternity and pediatric programs in partnership with SSM Cardi-nal Glennon Children’s Medical Center.

A new state-of-the-art emergency department and outpatient center at SSM St. Joseph Health Center – Wentz-ville at the Wentzville Parkway entrance to the campus. The new facility will open in 2014 and meet the needs of this growing population.

The development of a new state-of-the-art outpatient campus in eastern St. Charles. Many of the outpatient ser-vices currently located at SSM St. Joseph Health Center will be expanded and re-located to this new highly visible and ac-cessible campus. When this center opens, it will be designed to incorporate every detail necessary to provide a whole new patient experience to the community.

Opening additional SSM Urgent Care sites to provide even more conve-nience of location and hours for care.

Aggressive recruiting of additional exceptional physicians who view health care as a partnership and are ready to take their patient relationships to the next level.

SSM Health Care has been serv-ing and growing with the community for more than a century; most recently com-pleting $40 million in renovations on the campus of SSM St. Joseph Health Center in St. Charles. This vision is the next step in the organization’s commitment to the community.

Siteman Director Appointed Vice Chair of National Cancer Network

Timothy Eberlein, MD, director of the Siteman Cancer Cen-ter at Barnes-Jewish Hos-pital and Washington Uni-versity School of Medicine, has been named vice chair of the National Compre-hensive Cancer Network (NCCN) board of directors.

The network, which comprises 23 of the world’s leading cancer centers, devel-ops and updates guidelines for treating breast, lung, prostate and other types of cancer.

Siteman is Missouri’s only member of the NCCN, formed in 1995 to improve the quality, effectiveness and efficiency of cancer care.

Eberlein has been director of Site-man since its inception in 1998. He also serves as the Bixby Professor and Spencer T. and Ann W. Olin Distinguished Profes-sor and chairman of the Department of

Surgery at the School of Medicine, as well as surgeon-in-chief at Barnes-Jewish.

Nerve stimulation for severe depression changes brain function

For nearly a decade, doctors have used an implanted electronic stimulator to treat severe depression in people who don’t respond to standard antidepres-sant therapy.

Now, preliminary brain scan studies conducted by researchers at Washington University School of Medicine in St. Louis

are beginning to reveal the processes occurring in the brain during stimula-tion and may provide some clues about how the device improves depression. They found that vagus nerve stimulation brings about changes in brain metabo-lism weeks or even months before pa-tients begin to feel better.

The findings will appear in an up-coming issue of the journal Brain Stimu-lation and are now available online.

PHYSICIANS BUSINESS CONFERENCE Tools for Success

Conference Committee

Seminars will address business issues practitioners face on a daily basis as well as arm practitioners with the tools to solve future challenges. Companies and Institutions involved in creating seminars for the conference include:

Washington University Physicians

New York Life | Missouri Professional Mutual

Numerof & Associates | St. Louis University

Sandberg, Phoenix & Von Gontard

Keystone – IT | MD Real Estate Advisors

Brown, Smith & Wallace | Evans & Dixon

Clifton, Larson, Allen | Fifth Third Bank

SAVE THE DATESOctober 26 and 27, 2013

The complete Physicians Business Conference seminar program with details on each seminar along with registration information will appear in the July issue and on the web site of St. Louis Medical News.

Sponsored by St. Louis Medical News, this unique educational conference will include more than 25 hours of individual seminars focused on multiple business topics needed by health care physicians and health care business managers.

Seminar attendees will receive Tools for Success…knowledge and insight into solutions for the many challenges and changes facing today’s health care providers.

Seminars are sold on an individual basis, giving attendees the ability to create their own educational experience. Early seminar registration is encouraged since seating is limited for each seminar.

LOCATIONSheraton Westport Lakeside Chalet

GrandRounds

Dr. Timothy Eberlein

Documents

St. Louis Medical News June 2013