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 Feature Profiles

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Through the years Dr. Mike Pagnani has also served as team physician for several professional, collegiate and high school football teams as well as professional baseball teams.
Physician Profile: Mike Pagnani
Dr. Mike Pagnani is one of those rare people who has always known what he wanted to do. Early on he knew his dream job would have to combine two things about which he is passionate: sports and taking care of others. As the team physician for the Nashville Predators, he seems to have made that dream into a reality. Pagnani, an orthopedic surgeon with the Nashville Knee and Shoulder Center, began caring for the Predators in 1998, but it was not his first time to work with a major sports team. During his fellowship at the Hospital for Special Surgery in New York, he was the assistant team physician for the New York Giants and the New York Mets. He has also provided medical expertise for the Chicago White Sox, Pittsburgh Pirates, Miami Dolphins and Nashville Kats. "I had been a Giants fan my whole life, so that was really fun for me," Pagnani said. "Working in pro sports is a really incredible experience. The professional sports world is an amazing world to be around. If you're someone who loves athletics and has been around it your whole life, it's really a dream come true."
By Kathy Whitney

 Nashville Archives

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Benefits and the Bottom Line
Physicians are all too well aware of the insurance cost crunch … after all, they are simultaneously receiving reduced reimbursements and notices of premium increases, causing a squeeze at both ends. Still, providing health insurance for employees is a key factor in attracting and retaining a highly qualified staff. So what are an employer's options? Ron Perry, president of LBMC Employment Partners, LLC, an affiliate of Lattimore Black Morgan and Cain, says, "There's just not any silver bullet out there, really." Despite that, he adds, there are options open to employers that can shift or partially mitigate some costs. Employment Partners has clients in all industries, including healthcare, and works with businesses on a full range of management and operational issues.
By Cindy Sanders

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Dr. Ming Wang
Nashville Corneal Specialist Debuts Procedure to Delay Transplantation
Tracian Meikle, a 20-year-old student attending The University of the South, has become the state's first patient to fight the debilitating affects of advanced keratoconus with a combination procedure utilizing the laser implantation of IntacsĀ® prescription inserts with CK radio wave treatment. Last month, Dr. Ming Wang, clinical associate professor of ophthalmology and director of Wang Vision Institute in Nashville, performed the combination procedure as an alternative to corneal transplant in an effort to restore Meikle's sight. Prior to the procedure, her condition had progressed to a point where she only had 10 percent vision remaining in her left eye. Not long ago, her only real option would have been corneal transplant, which carries with it the associated risks of major surgery, infection, blindness and graft rejection. Keratoconus is a progressive disease impacting approximately 300,000 people in the United States. Patients with the condition, which causes a thinning of the cornea, can get by with standard corrective lenses for awhile. As the corneal wall sags over time, it protrudes forward into a cone shape. Eventually, the disease progresses to a point where traditional lens options offer little functional vision.
By Cindy Sanders

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David P. Carbone, MD, PhD, Harold L. Moses Professor of Cancer Research at Vanderbilt and Principal Investigator of the NCI-supported grant.
Nashville Research Advance Treatment of Deadliest Form of Cancer
Both of the major research institutions in Nashville are currently involved in lung cancer research that may lead to earlier diagnoses and more effective treatment of the disease. The Vanderbilt-Ingram Cancer Center is leading a study supported by the National Cancer Institute (NCI) to identify the molecular signatures of lung cancer. By evaluating changes in the patterns of proteins, the researchers hope to find ways to diagnose lung cancer earlier. "There are six grants funded by the NCI," says David P. Carbone, MD, PhD, Harold L. Moses Professor of Cancer Research at Vanderbilt. "The grants are for identifying molecular signatures for six kinds of cancer. We have the only one funded in the U.S. for lung cancer. Partnering is an important part of this grant so we invited other institutions to join us in the study." This particular grant is part of the NCI-supported Specialized Program of Research Excellence (SPORE). The $7 million, five-year long lung cancer award supports a collaboration of 11 medical centers and two large cancer clinical trial groups who will evaluate different technologies for improving diagnosis and monitoring response to therapy.
By Nick Charles

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Dr. Douglas Kamerow
An Ounce of Prevention to Cure Pounds
Obesity has become a national epidemic. With nearly 30 percent of the adult American population defined as obese (a body mass index of 30 or more) and 65 percent considered overweight or obese, it is a problem that impacts every state, every race and every socioeconomic level. Furthermore, the onslaught of co-morbid conditions attached to obesity — diabetes, hypertension, heart disease, arthritis — not to mention the increased risk for even more diseases including many forms of cancer, means that weight gain has a far-reaching impact on Americans' health and the nation's healthcare system. Overweight and obesity are not just adult problems, however. Prevalence rates in youth have also been steadily rising. To combat the current problem and work to stem the tide, both the Institute of Medicine (IOM) and the American Academy of Pediatrics (AAP) have formed study groups.
By Cindy Sanders

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Dr. Al Spaw, laparoscopic surgeon with the Metabolic Surgery Center at Baptist Hospital (right) predicts the LAP-BAND prcoedure will become the most popular weight loss sugery in the next five years.
More Options Available for Weight Loss Surgery
The number of bariatric surgeries for weight loss performed in the United States is on the rise. According to an article in the December issue of Archives of Surgery, that number increased by 450 percent between 1998 and 2002. The authors of the article, researchers from the University of California, Irvine Medical Center, believe the growth could be linked with the use of minimally invasive laparoscopic techniques. Local surgeons who routinely perform weight loss surgery agree. "There is no question that the laparoscopic procedure has made it more palatable for patients and has been one of the major reasons for the increased numbers of procedures being performed," said Dr. Bill Richards, director of laparoendoscopic surgery and medical director of the Bariatric Surgery Center at Vanderbilt University Medical Center. "The laparoscopic procedure is associated with much less pain, hospitalization and risk of incisional hernias. It is, however, not a simpler procedure because the same exact procedure is performed in the open and laparoscopic gastric bypass operations. It is much easier on the patient, but the technical difficulty for the surgeon is immense."
By Kathy Whitney

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Greg Plemmons, M.D., director of the new obesity clinic at the Monroe Carell Jr. Children's Hospital at Vanderbilt.
Childhood Obesity Must Be Addressed
Tennessee ranks 43rd in the nation in terms of the overall state of health of its children. Childhood obesity, a major contributing factor to this statistic, is rapidly on the rise and brings with it a host of potential health risks and even a lower life expectancy. Dr. Gregory Plemmons is the director of the pediatric weight management program for the Vanderbilt Children's Hospital and an assistant professor of pediatrics. He answers a few questions regarding how to best prevent and treat childhood weight problems.The following are the questions and answers:
By Kathy Whitney

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TennCare and Weight Watchers Join Forces to Address Obesity
In what is being touted as a unique and groundbreaking initiative, the state of Tennessee is partnering with Weight Watchers to provide weight loss services to TennCare enrollees — adults and children — who are obese. "We are not aware of any other Medicaid program that is doing a partnership like this with a commercial weight loss program," said TennCare's Marilyn Elam. TennCare provides insurance coverage for 1.2 million people, and the bureau had reached a point of stability, after a rather unstable year, where it could begin to look at improving the quality of life for its enrollees. Since Tennessee ranks fifth in the U.S. in the rate of adult obesity, weight loss seems to be a good starting point. "We wanted to not only provide that access to insurance, but also find ways to improve the quality of care and quality of life in general for the enrollees in our program," Elam said. "Obesity contributes to a number of disease states, some of which are ones we added to our medication short list such as asthma, heart disease and diabetes. All of these are complicated or brought on by obesity. The idea is that if we could attack that underlying cause or factor in those three high disease states, we could lower dependence on medications and improve overall health."
By Kathy Whitney

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Kelly Victory, Whole Health CMO
Companies Switching To On-Site Medical Clinics
For the past year, the 13,500 workers at Sprint's sprawling corporate campus in Overland Park, Kansas have had a choice when it came to seeing a doctor. They could sign out, drive to their own doctors somewhere in the region, and typically come back the next day. Or they could walk across the campus to the 2,800-square foot company health clinic, see a physician in one of the clinic's three exam rooms and make it back to their desk — often with a prescription — in about a half hour. Increasingly, the on-site clinic has been winning the competition hands down. "We estimated productivity savings at conservatively one hour (per visit), but we're getting much more than that," says Collier Case, Sprint's director of health and productivity benefits. "People were pretty much gone for the day. They would schedule their visits and just wouldn't come back." But that's just one of the gains for Sprint. Workers can see a physician at the on-site clinic for a lower co-pay, and often pay nothing for a quick visit. And the company gets to deliver healthcare service on a more cost-effective basis. Family members can take advantage of the clinic in the afternoon and evening hours as well.
By John Carroll

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Giving Your Practice the Same Attention as Your Car
Your Lexus … your Volvo … or your Caravan … it really doesn't matter what you drive, everyone knows the occasional tune-up is an important step toward keeping your vehicle in top running condition. Preventative maintenance often stops little problems from becoming big ones. Certainly physicians are familiar with this notion, which is as true for your health as it is for your car. Why then does the concept seem so foreign to so many when applied to their practice? Surely your practice deserves the same consideration as your car to ensure that the source of your livelihood and that of your employees remains viable. With looming reimbursement cuts, making sure you are running at maximum efficiency has never been so important. Kenneth Hertz, CMPE, a senior staff consultant for the Medical Group Management Association's Health Care Consulting Group, says January is the perfect time to reflect on the year that just ended and reassess business practices to prepare for what's to come.
By Cindy Sanders

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Siloam Family Health Center Opens New Facility
Siloam Family Health Center, once a 1,000-sq.-ft. neighborhood clinic in Edgehill, now has a new home on 820 Gale Lane and a lot more space — 11,000 square feet more space, to be exact. The brand new center was dedicated in October and it already feels like home, said executive director Nancy West. Located just off Franklin Road, the new facility encompasses 12 exam rooms, pastoral counseling space, a large space for physical and occupational therapy, room for an X-ray machine (which will be coming in the near future), patient education space, a chapel and plenty of room for the staff and volunteers to spread out. All of this is a far cry from the two apartments that once housed Siloam. The new center is large enough to care for the projected 16,000 to 18,000 patients that West expects to cross Siloam's doorstep in a year's time, but not too large to lose the personal feel of the place. "With the quality of care we want to give — the physical, spiritual and mental counseling — if we get too large we can't offer the quality of care we want to," West said.
By Kathy Whitney

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Vaccine Makers Push Congress For A Liability Shield
With fears of an avian flu crisis growing worldwide, Republicans in Congress have been pushing legislation that would shield vaccine makers against liability suits. And the proposal has sparked fierce debate between the drug industry and many of healthcare's most influential advocacy groups. Drug makers say that liability reform is essential to encourage companies to research and develop the kind of vaccines that are needed to protect millions of people from a potentially lethal bird flu virus. Critics, including unions that represent many of the nation's first responders, counter that the liability shield for any vaccine-related injuries would stop a national immunization program from vaccinating all but a small percentage of the people who need protection. Federal officials, led by Health and Human Services Secretary Mike Leavitt, have led the charge for liability protection, saying that drug developers would be unwilling to bear the expense of rushing new vaccines through the R&D process to protect 297 million Americans from a potential pandemic unless they knew that they would be shielded from claims for any adverse events. And speed, they say, is crucial. Currently, the U.S. has only a few million doses of Tamiflu on hand to counter a possible human-to-human outbreak of the lethal H5N1 virus. And even Tamiflu could have little or no effect on a virus that had mutated into a deadly infectious disease.
BY TRACY STATON

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Scott Serota, CEO of the BCBS Association.
Blues Create A Healthcare Bank
The big push to spread acceptance of consumer-directed health plans is spurring the Blue Cross Blue Shield Association to start a unique new bank for members of the Blues. Dubbed Blue Healthcare Bank, the institution is designed to provide the kind of financial support consumers will need when they sign up with a consumer-directed health plan, a health savings account, a health reimbursement arrangement or a flexible spending account from any of the BCBS companies scattered throughout the country. Increasingly, consumers are expected to put up a larger share of their own funds to pay for their insurance. And the Blue Healthcare Bank gives them a way to manage their health funds to maximum advantage. Consumers and companies can deposit money into the accounts. A checkbook or debit card will be available to pay for specific health expenses, which will also make it easier to handle tax-sheltered funds and budget their share of deductibles.
By John Carroll

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Experts Provide Long List Of Reasons For Steady Rise in C-sections
There's one point about Caesarean-sections that all health experts can agree on: The numbers keep going up. After that, though, the reasons they give for what's driving the steadily expanding rate of C-sections in America break up into a host of competing explanations. First, the numbers. According to the government's National Center for Health Statistics, a record high of just about 1.2 million C-sections were performed in 2004. That accounts for 29.1 percent of all births. And the rate is up from 27.5 percent in 2003 and 20.7 percent in 1996. Depending on who you ask, though, the cause for the steady rise in C-sections may lie largely with today's mothers — a group that includes a large number that like to keep to a schedule as well as other women who are driven to stick with the Caesarean procedure due to growing weight problems and a history of earlier C-sections. Some suggest that the growing sources of public information on childbirth include so many sensational stories of births gone wrong that many women choose a C-section out of fear. Or it could be the doctor, who turns to C-sections as a simple way to avoid the kind of natural childbirth problems that can complicate a delivery and breed liability suits.
BY TRACY STATON

New UnitedHealthcare Premium Program Draws Doctors' Ire
When Tenet Healthcare was notified a few weeks ago that a group of its hospitals had been designated by UnitedHealthcare as Premium cardiac care centers, the Dallas-based hospital group wasted no time in trumpeting the information to a broad audience. And for good reason. After all, according to UnitedHealthcare, Tenet's hospitals should be sought out by patients who are looking for a provider that aims to deliver high quality care when they need it the most. "Patients who require cardiac care need to know that they are getting quality treatment," said Dr. Lewis Sandy, executive vice president of clinical strategies and policy at UnitedHealthcare at the time of the announcement. And the insurer's Premium designation program did just that.
By John Carroll