Physician Quarterly - Kettering Health Network



Physician Quarterly - Kettering Health Network
Published by Kettering Health Network • Q3 2015
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
Table of Contents
Patient Advisory Council improves cancer services
for network and new Cancer Center
Emergency update: Franklin’s early impact
and Preble opens
New robot joins the network’s surgery program
Improving care coordination network-wide
by Jody Underwood
Successful treatment of hepatitis C
by Davida Prater, MS, and Jonathan Saxe, MD
More diabetes locations—and how they can help
your patients
ICD-10 coming October 1
by Charles Watson, DO
What you need to know about Open Enrollment
Toothaches are a pain to emergency departments
Shout outs and save-the-dates
17 Network to expand primary care residency opportunities
by David Small, MD
Kettering receives quality stroke award
Sycamore adding private patient rooms
Kettering expands NICU
Coagulation update
by Richard Pelstring, MD
Kettering receives designation for elder care excellence
Kettering/Sycamore welcomes new physicians
Slow down to speed up
by Marcus Romanello, MD
Hip arthroscopy
Full range of wound care
Fort Hamilton welcomes new physicians
• Contribute content ideas
N e t wo r k
Kettering | Grandview | Sycamore | Southview | Greene | Fort Hamilton | Soin | Kettering Behavioral
On Our Cover
Thomas 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).
How 11 primary care practices achieved level three
PCMH recognition
by David Doucette, MD
New laser procedure restores vaginal health
Less invasive options for abdominal aortic aneurysms
by James Gebhart, DO, and Jacob Yannetta, DO
KPN welcomes new physicians
• Author Physician Quarterly articles
New Cancer Center Broke Ground in May • Minimally-Invasive Brain Surgery • Smart Rx • Family Medicine for America’s Health
Are you willing to volunteer your expertise
in any of the following areas?
We need
Soin opens spine center
Soin opens emergency expansion
Greene Rural Health Clinics complete certification
by Mark Floro
Soin adds 24/7 laborist coverage
Soin adding private beds, renovating conference space
Greene/Soin welcomes new physicians
Published by Kettering Health Network • Q3 2015
Core principles of primary care
by Paul Martin, DO
Grandview adding private patient rooms
Southview lobby renovation, hand center expansion
Grandview/Southview welcomes new physicians
• Serve as media spokesperson
• Speak at community events
Email: [email protected]
or call (937) 762-1053
Physician Quarterly is published by Kettering Health
Network to support communications between
physicians, residents, fellows, alumni, and hospital
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
Welcome to the new look of Physician Quarterly
Your 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 [email protected]
The number of patients
seen so far at the new
Kettering Health
Network Emergency
Center in Franklin (p. 6)
Percentage of diabetic patients seen
at Kettering Health Network’s diabetes
centers are at glucose target (p. 11)
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)
The number of primary care professionals
in the U.S. (p. 21)
The total number
of treatment rooms
in Soin’s expanded
Department (p. 25)
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)
Netw ork
Listening to the Experts
Patient advisory council contributes ideas to improve oncology services
ach 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 better
The 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.
N e t wo r k
“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.
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.”
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 newlydiagnosed 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.”
A New Era in Cancer Care
Kettering 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,
Netw ork
Expanding Access to Emergency Care
Early impact and continued growth of new Emergency Centers
ettering 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 highquality care, freestanding emergency centers have
been built to reach our surrounding communities.
Franklin’s early impact
With 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.
N e t wo r k
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
The Next Frontier in Robotic Surgery
New da Vinci Xi® Surgical System
ettering 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 multiquadrant 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.
• 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
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
Netw ork
New Initiatives Improve
Care Coordination Network-wide
Small, MD
or 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.
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 timeconsuming 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.
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.
Improving communication
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.
N e t wo r k
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 postdischarge 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.
Jody Underwood, RN, CNP, MBA, network
director of care transitions
If you are interested in sharing
your expertise, please contact me
at [email protected]
Hepatitis C: from Non-A/Non-B to a Cure
Reduced side effects, shortened duration of treatment
epatitis 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.
Genotype 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 HCV
HCV 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.
Success of recent treatments
Early 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
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
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.
Davida Prater, MS, acute care nurse
practitioner at Dayton Gastroenterology, Inc.
reviewed by
Jonathan C. Saxe, MD, board certified gastroenterologist
Netw ork
Delivering Diabetes Care
Shift to value-based reimbursement, financial incentives
rimary 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-forservice 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.
How to refer to a Kettering Health
Network Diabetes Center
Diabetes Services cheat sheet
Network Epic Users*
Pre-Diabetes Education
Diabetes Self-Management Training (DSMT)
Endocrinology Services
Medical Nutrition Therapy (MNT)**
* For those not on the network’s Epic system, a physician referral form can be found
** Joslin also provides MNT services for non-diabetes-related needs.
Please see REF50.
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)
Reach the Joslin Diabetes & Nutrition Access Center 1-844-251-5465.
N e t wo r k
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.”
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
Jodi Van Jura, MD
Kathleen Lang, MD
Anubhav Mital, MD
Chetna Mital, 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 Opportunities
JoslinPRIME is currently accepting applications to participate in future certification programs. Contact Diana Kennedy at (937) 401-7579.
Netw ork
Prepare for an Epic Update
ICD-10 implementation is October 1, 2015
he 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.
After October 1,
2015, failure to
respond to ICD-10
documentation and
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.
coding queries will
result in delinquent
charge status.
If you have any
questions regarding
the ICD-10 project,
Medical Informatics,
or physicianrelated information
contact me at
(937) 914-7361 or
[email protected]
Visit the ICD-10
project page under
Resources on the
Charles Watson, DO, Chief Medical
Information Officer for Kettering Health Network
What to Know About
Medicare Open Enrollment
November 1, 2015 ­— January 31, 2016
Kettering Health Network
Medicare Advantage Plans Include:
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.
Anthem BlueCross
and Blue Shield
Gateway Health
ovember 1 marks the start to 2016 Medicare
Open Enrollment for more than 50 million
Medicare patients.
You can help. Inform your patients about the plans
you accept and the plans accepted at Kettering
Health Network.
N e t wo r k
Humana Health Plans
of Ohio
United HealthCare/AARP
Toothaches Are a Costly Pain
to Emergency Departments
mergency 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.
Help for uninsured
Doctors 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
627 East First Street
(937) 224-3442
Volunteers are needed, especially dentists,
ophthalmologists, internists, and family practice.
Even a few hours a month helps meet
the growing demand for care.
Lack of dentists, insurance
The 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
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.”
Netw ork
Shout Outs
Gregg, MD
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
John Weimer
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
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.
Weinstein, MD
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.
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
Jody Underwood and patient experience with
discharge planning. She will
also be instrumental in strategy and execution with
post-acute care initiatives.
N e t wo r k
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.
U.S. News & World Report names three network
hospitals among the best
Center, shows that the residents in the Dayton area
do not need to travel far to receive quality care.”
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 and Greene recognized for providing
outstanding patient care
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.”
Premier, 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.
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.
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 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
“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 Springboro
Kettering 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.
Netw ork
Shout Outs (cont.)
Kettering, Grandview and Southview named three of America’s Best Hospitals for Cancer Care
Kettering, 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
ou Are
Southview Hand Center Symposium
Understanding hand trauma and care.
September 23, 2015
Register at
TAVR Facts and Update
Discuss risk factors, advancements, and
patient criteria for Transcatheter Aortic Valve
October 7, 2015
Email [email protected] to register
for more opportunities
N e t wo r k
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
Network to Expand Residency Program
Preparing to train more primary care providers
or 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.
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 hospitalbased 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.
David Small, MD, Chief Medical Officer for
Greene Memorial Hospital and Soin Medical Center
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
Smith, MD
program, he is initiating the
search for a dedicated family practice director who
will be the on-site leader of residents.
M ed ical E d u c a ti o n
Kettering Awarded
for Quality Stroke Care
Expands NICU
ettering 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 nationallyrespected clinical guidelines.”
Kettering Medical Center expanded
its Level III B NICU in May, adding five
additional beds for a total of 25.
Sycamore is Adding Private Patient Rooms
Opening anticipated in January 2016
ith 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.
Ke t t e r in g | Syca mor e
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.
Coagulation Update
Thrombin Time
The 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 Anticoagulants
Since 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.
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.
Richard Pelstring, MD
Kettering Receives Designation
for Elder Care Excellence
Kettering 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.
Ketterin g | Syc a m o r e
Welcome Doctors
Kettering | Sycamore New Physicians on Medical Staff
February-May 2015
(937) 293-8228
(937) 836-2424
Kerry Christensen, MD
Adam Montoya, MD
Kettering Anesthesia
Association, Inc.
Ryan Mihata, MD
South Dayton Acute Care
Consultants, Inc.
(937) 433-8990
Anna McGuire, DMD
Anna K. McGuire, DMD, Inc.
(937) 864-5022
Ajay Agarwal, MD
Kettering Network
Radiologists, Inc.
(937) 297-6306
Andrew Bohn, MD
Zachary Ginsberg, MD
Kevin Juozapavicius, DO
Julie Knott, MD
Stanley Koontz, MD
David Lynn Marcus, MD
Rebecca Perry, DO
Sarah Valentine, DO
Vermillion, MD
Erwin Weber, MD
Emergency Medical
Kattie Amegatcher, MD
Lewis Mahran, DO
Englewood Family
Kelly Arey, DO
Lebanon Medicine Group
(513) 932-4891
Kareem Selim, MD
South Dayton Acute Care
Consultants, Inc.
(937) 433-8990
Soumya Nadella, MD
Sycamore IM & Women’s
Wellness Center
(937) 866-6655
Tina Gabbard, MD
John Merling, MD
Anita Wantz, MD
Wilmington Medical
(937) 382-1616
Schneider, MD
Kettering Acute Care
(937) 395-8556
Michael Swanson, DO
Northeast Surgical
Wound Care
(216) 643-2780
(937) 436-4658
Ke t t e r in g | Syca mor e
Patricia Back, MD
Sirisha Gaddipati, MD
Sudha P. Jaganathan, MD
Robert Moore, MD
Arshad Shah, MD
(937) 395-6665
Matthew Brockman, MD
Himad Khattak, MD
Tarigopula, MD
South Dayton Acute Care
Consultants, Inc.
(937) 433-8990
Cherish Prutzman, MD
Clyo Internal Medicine
(937) 435-5857
Benson Babu, MD
Rebecca Ramirez, MD
(937) 439-6186
(937) 723-4515
Herbert Newton, MD
Dayton Center for
Neurological Disorders
Caroline Peterson, DO
Contemporary OB-GYN, Inc.
(937) 439-7416
Timothy MacLean, DO
Innovative Care Solutions
(937) 252-2003
Erick Michelfelder, MD
Cincinnati Children’s
Hospital Medical Center
(513) 636-1199
(937) 395-6665
Rey Francisco
Arcenas, MD
Melyssa Galloway, MD
South Dayton Acute Care
Consultants, Inc.
(937) 885-4475
(937) 433-8990
Charles Opperman, MD
Sycamore Primary
Care Group
(937) 384-6800
Mary Lou Inwood, MD
Wilmington Medical
(937) 382-1616
Jennifer Sweat, MD
Cornerstone Pediatrics, LLC
Ruth Dooley, MD
Jeffrey Manser, MD
Mary Ann Merling, MD
Lisa Ziemnik, MD
Wilmington Medical
(937) 382-1616
Ron M. Johnson, MD
Wright State Physicians
(937) 208-4955
Brent Crane, MD
Grandview Hospital –
Behavioral Health Unit
Liesl Jacobs, MD
Steven Taylor, MD
Kettering Behavioral
Medicine Center
(937) 534-4651
Carmel Flores, MD
TCN Behavioral Health
(937) 376-8700
Stella Ling, MD
GMH Radiation Oncology
(937) 352-2146
Kirti Agarwal, MD
Kettering Network
Radiologists, Inc.
(937) 297-6306
Juan Palomar, MD
Tri-County Urology
(937) 439-6242
Core Principles of Primary Care
Essentials of effective, efficient, high-quality care
truly 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 highquality primary care starts with the patient/
provider relationship. Patient-centric healthcare
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.
Paul Martin, DO, Chief Medical Officer for
Grandview and Southview medical centers
Gran d view | So u th vi ew
Grandview Expands to Improve Privacy
and Patient Experience
randview 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.
Southview’s Lobby under Renovation,
Hand Center Expanding
he 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
G r a n d v ie w | So u t hv iew
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.
Welcome Doctors
Grandview | Southview New Physicians on Medical Staff
February-May 2015
H. Nicholas
Shamma, MD
(937) 412-4230
Linda M. Rimkunos, MD
(937) 723-3210
Anthony Abdullah, MD
EM Care
(937) 723-3210
David Marcus, MD
Emergency Medicine
(937) 395-8659
Christopher J.
Vermillion, MD
Erwin Weber, MD
Leanna Withrow, DO
Prestige Billing
Kattie Ynez
Amegatcher, MD
Lewis Mahran, DO
Family Medicine
(937) 433-8990
(937) 643-0015
Nathan R. Moody, DO
Wright Patterson
Air Force Base
Kelly Arey, DO
Lebanon Medical Group
Alan R. Fark, MD
Xenia Urgent Care – API
(937) 427-3333
(937) 436-4658
(937) 257-0770
Brooke L. Manocchio, DO
Beavercreek Urgent
Care - API
(937) 458-4200
(937) 836-2424
(513) 932-4891
(937) 352-2850
Larry Weprin, MD
Dayton Gastroenterology
(937) 320-5050
Kaili Fan, MD
South Dayton Acute Care
Consultants, Inc.
Sheila T. Cheruvelil, MD
Beavercreek Commons
Family Practice
Jabulani Sidile, MD
Arthur Tsai, MD
Kidney Care Specialists
Emily Vannorsdall, MD
Kettering Cancer and
Blood Specialists
(937) 897-6971
Manish Sheth, MD
Dayton Physicians
(937) 293-1622
James Howard
Galbraith, MD
Richard Groger, MD
South Dayton Acute Care
Consultants, Inc.
Jennifer Sweat, MD
Cornerstone Pediatrics
(937) 885-4475
(937) 433-8990
Gran d view | So u th vi ew
Soin Opens Spine Center
Delivering quality spine care from preop through recovery
oin 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
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.
Gr e e n e | So in
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.
Soin’s Emergency Department
Expansion Now Open
o 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.”
Matthew Freyhof, MD, and Prashanth Bhat, MD, at the Ribbon-Cutting Ceremony
Green e | So i n
Greene Completes Successful Rural
Health Clinic Certification Surveys
n 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.
Udom, MD
Patel, DO
Hyde, MD
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.
Mark Floro, director of clinical services for Soin Medical Center and
Greene Memorial Hospital
Gr e e n e | So in
Soin Adds 24/7 Laborist Coverage
Full level of service provided
aborists 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.
“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 Expands Private Bed Count
and Conference Space
Soin Builds Out Fifth Floor with Private Beds
Ollie Davis Pavilion Renovating Fifth and First Floors
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 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 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.”
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.
Green e | So i n
Welcome Doctors
Greene | Soin New Physicians on Medical Staff
February-May 2015
Gustavo Collins, MD
David Tibbits, MD
Kettering Anesthesia
Associates, Inc.
(937) 293-8228
Mark Anstadt, MD
Miami Valley Heart &
Lung Surgeons, LLC
(937) 208-6060
Najeeb Ahmed, MD
Springfield Cardiology
(937) 398-0354
Anna McGuire, DMD
Anna K. McGuire, DMD, Inc.
(937) 864-5022
Kyle Jackson, DDS
Stacey Zaikoski, DDS
Pediatric Dentistry,
Kyle R. Jackson, Inc.
David Marcus, MD
Emergency Medicine
(937) 395-8659
Andrew Bohn, MD
Zachary Ginsberg, MD
Kevin Juozapavicius, DO
Julie Knott, MD
Stanley Koontz, MD
Vermillion, MD
Erwin Weber, MD
Emergency Medicine
Prestige Billing
(937) 436-4658
Brooke Manocchio, DO
Beavercreek Urgent
Care – API
(937) 458-4200
Ronnie Tan, MD
Urgent Care of Hamilton
(937) 586-7729
(513) 896-9700
James Mason, DDS
James F. Mason, DDS
Letitia ThompsonHargrave, DO
Wells Institute
(937) 848-1116
(937) 293-2157
Schneider, MD
Kettering Acute
Care Surgery
(937) 395-8556
Michael Keller, MD
Michael Keller, MD
(937) 859-3294
Gr e e n e | So in
(937) 395-6665
(937) 432-9810
Sirisha Gaddipati, MD
Todd Ignarski, MD
Himad Khattak, MD
Tarigopula, MD
South Dayton Acute Area
Care Consultants, Inc.
(937) 433-8990
Rebecca Ramirez, MD
Sycamore Primary
Care Group
(937) 384-6800
Keith Perrine, MD
Preferred Plastic Surgery
Ron Johnson, MD
Wright State Physicians
(937) 208-4955
Steven Taylor, MD
Kettering Behavioral
Medicine Center
(937) 293-8300
Dale Drollinger, MD
Martin Ambrose, MD
Dayton Lung and
Sleep Medicine, Inc.
(937) 436-1854
(937) 832-5292
(937) 428-0400
(937) 297-6306
Matthew Lawless, MD
Wright State Physicians
(937) 294-1489
David Propst, DO
Orthopedic Association
of SW Ohio, Inc.
(937) 208-2091
Christopher Learn, MD
Lindsay Rogers, MD
Wendy Whiteside, MD
Cincinnati Children’s
(513) 636-6977
Kirti Agarwal, MD
Kettering Network
Radiologists, Inc.
Edward Jacobs, MD
South Dayton
Urological Associates
Slow Down to Speed Up
Maintain long hours without wilting under the burden of stress
he 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.
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 YerkesDodson 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
Good Stress
rest. If I had spent the
extra few minutes asking
important questions like,
“What are you worried
Stress Management Increasing
The Performance Level
about?” and “How can I
Actual Performance
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
Adapted from Nixon P, Practitioner, 1979
feeling short on time
during their daily
practice had higher rates
So how can we maintain such long hours without
we’re all very aware of
wilting under the burden of stress, decision fatigue,
inverse relationship
administrative chores, and never-ending attempts
between time spent and patient litigation.
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.
Ill Health
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.
Marcus Romanello, MD, Chief Medical
Officer for Fort Hamilton Hospital
Fort Hami l to n
Hip Arthroscopy Offers Benefits
to Patients
rthroscopy 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.
F o r t Ha m il t on
“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
Welcome Doctors
Fort Hamilton New Physicians on Medical Staff
February-May 2015
Brooke Barnes, MD
Children’s Hospital
(513) 636-7216
Letitia ThompsonHargrave, DO
Courtney Stroble, MD
Urgent Care KPN
(513) 896-9700
Fort Hamilton Offers Full Range
of Wound Care
ort 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.
Liberty Pointe Wound
Care Center celebrated its
grand opening with a
ribbon-cutting ceremony
and open house in
May 2015.
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 Hami l to n
Eleven Primary Care Practices
Achieve NCQA PCMH Recognition
Next group must achieve even higher standards
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
ongratulations 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
Village Green Primary Care
• Care coordination (and tracking) across
the continuum
* achieved recognition February 2015
• 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
K e tt e r in g P h ys ic ian Net wor k
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.
To learn more about the PCMH model, primary care
redesign, or Kettering Physician Network, please
contact me at [email protected]
or (937) 558-3221.
David Doucette, MD, Chief Medical Officer
for Kettering Physician Network
New Laser Procedure Restores
Vaginal Health
Improving the quality of life for postmenopausal women and certain cancer survivors
Ashby, MD
Evans, MD
omen 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.
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.”
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.
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.
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.
Is MonaLisa Touch laser
therapy right for your patients?
MonaLisa Touch laser therapy treats vaginal symptoms such as:
• Dryness
• Painful urination
• Itching
• Painful intercourse
• Burning
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.
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.
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.
Ketterin g Ph ysici a n N e two r k
All About Access
Newer-generation medical devices provide less invasive surgical option for abdominal aortic aneurysms
he 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
K e tt e r in g P h ys ic ian Net wor k
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
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.
James Gebhart, DO, and
Jacob Yannetta, DO,
vascular surgeons at Kettering
Vascular Surgery Associates
Welcome Doctors
Kettering Physician Network New Physicians
February-May 2015
Liesl Jacobs, MD
Kettering Behavioral
Parasram Ramdeo, MD
Kettering Medical
Center Hospitalist
Ashlee Ames, MD
Kettering Medical
Center Hospitalist
Robert Moore, MD
Kettering Medical
Center Hospitalist
(937) 395-6665
Schneider, MD
Kettering Medical
Center Trauma
K. Shahid Baig, MD
John Lynch III, MD
Raja A. Nazir, MD
M. Niranjan Reddy, MD
Reginald Sequeira, MD
Kettering Physician
Network Cardiovascular
Sherif Zihni, MD
Fort Hamilton Hospital
Urgent Care
Caitlin Harris, DO
Kettering Medical
Center Hospitalist
Aram Donigian, MD
Kettering Physician
Network Orthopedics
Edward Jacobs, MD
South Dayton Urology
Dilip Bearelly, MD
Kettering Surgical
Sylvia Polenakovik, MD
Kettering Medical
Center Hospitalist
(937) 534-4651
(937) 298-8058
(937) 395-6665
(513) 896-9700
(513) 737-3690
(937) 395-6665
(937) 395-6665
(937) 395-6665
Arshad Shah, MD
Kettering Medical
Center Hospitalist
(937) 531-0114
(937) 395-8556
(937) 294-1489
Joseph Scheidler, DO
Kettering Physician
Network Orthopedics &
Sports Medicine
(513) 867-4165
(937) 395-6665
Shout Outs
ettering 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.
Douglas Gula, DO; Joseph Scheidler, DO; Jon Moore, DPM;
Todd Grime, MD; Krista Migliore, DO
Ketterin g Ph ysici a n N e two r k
Dayton, OH
3535 Southern Blvd
Kettering OH, 45429
First Name Last Name, Degree
Office Name
Address 1
Address 2
City, State Zip Code
Your Voice Matters
Coming 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.

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