PHYSICIAN
UPDATE
A newsletter for physicians at University Hospitals
UH Case Medical Center First
in the U.S. to Employ Newly Approved
FFR-CT Heart Imaging Technology
Cardiologists with the UH Harrington Heart
& Vascular Institute at UH Case Medical Center are the
first in the U.S. to use a newly approved imaging test
that promises to revolutionize the diagnosis of coronary
artery disease,the leading killer of men and women. The
noninvasive test could potentially replace the exercise
stress test for nonemergency patients complaining of
chest pain and, in turn, avoid unnecessary diagnostic
cardiac catheterizations.
Exercise stress tests are imprecise diagnostic tools,
UH cardiologists say. Positive results often lead to invasive
cardiac catheterization. However, in about half of these cases, no coronary artery
disease is found. There are over 10 million stress tests performed in the U.S. each
year and at least 1 million diagnostic catheterizations.
“We know that 40 to 50 percent of heart catheterizations performed in the
U.S. show no significant coronary artery disease,” says Hiram Bezerra, MD, PhD,
Director of the Cardiac Catheterization Laboratory, UH Case Medical Center,
and Assistant Professor of Medicine, Case Western Reserve University School
of Medicine, who is leading the implementation of the new technology at UH.
“Now these invasive procedures can be avoided, thereby reducing costs, radiation
exposure and potential complications for patients.”
Developed by HeartFlow, Inc., the new test, or FFR-CT (fractional flow reserve
computed tomography), is the first and only noninvasive diagnostic test
specifically designed to provide cardiologists with both anatomic and functional
information regarding the extent and significance of coronary artery blockages.
CT angiography is combined with supercomputer-derived blood flow
measurements of the three major coronary arteries.
“For the first time, we have access to a diagnostic test that is both noninvasive
and highly accurate in showing us both the extent of coronary artery disease
as well as how it affects blood flow. I believe that FFR-CT has the potential
Continued on page 2
FEBRUARY 2015
Save the date
for these continuing
medical education programs
Intensive Course in Managing Difficult
Communications in Medical Practice
Controlling Anger, Avoiding Outbursts,
Communicating Appropriately
Feb. 18 – Feb. 20, 7:30 a.m. – 4:30 p.m.
Mt. Sinai Skills & Simulation Center,
1551 E. 105th Street, Cleveland, Ohio 44106
For more information, call 216-983-1239 or
1-800-274-8263 or visit casemed.case.edu/cme.
Sponsored by the Continuing Medical Education
Program, Case Western Reserve University School
of Medicine and UH Case Medical Center.
12th All-Ohio Institute
on Community Psychiatry
Integrating Care: Preparing Your
Workforce for the Future
March 27 and March 28
DoubleTree by Hilton, 3663 Park E. Drive,
Beachwood, Ohio 44122
For more information, call 216-983-1239 or
1-800-274-8263 or visit casemed.case.edu/cme.
Presented by UH Case Medical Center and
the Department of Psychiatry at Case Western
Reserve University School of Medicine.
6th Annual Update on Vascular Disease
April 25, 2015, 8 a.m. – 3 p.m.
Corporate College East, 4400 Richmond
Road, Warrensville Heights, Ohio 44128
For more information, call 216-983-1239 or
1-800-274-8263 or visit casemed.case.edu/cme.
Presented by University Hospitals Harrington
Heart & Vascular Institute. Sponsored by Case
Western Reserve University School of Medicine
and Northern Ohio Vascular Association.
FFR-CT Heart
Imaging Technology
Marco A. Costa, MD, PhD, Named
Vice President and Chief Innovation Officer
Continued from page 1
Innovation is the lifeblood of a health care system
– perhaps never more than today.
That is why University Hospitals has created the executive
office of innovation and appointed Marco A. Costa, MD, PhD,
as Vice President and Chief Innovation Officer.
Marco A. Costa,
MD, PhD
to completely change the way we
diagnose coronary artery disease
globally,” adds Daniel Simon, MD,
President of UH Harrington Heart &
Vascular Institute, Chief of the Division
of Cardiovascular Medicine at UH Case
Medical Center, Herman K. Hellerstein
Chair in Cardiovascular Research, and
Professor of Medicine, School of Medicine.
In this new role, Dr. Costa will build a culture of innovation,
working with people throughout the system to spur initiatives
that maximize quality, patient experience and performance.
“Innovation is the intersection of different disciplines,” says Dr. Costa. “Creativity,
ideas, research – all are ingredients, but not in themselves innovation. For that, you
need execution and value creation.”
Dr. Costa is an internationally renowned expert in cardiovascular medicine with
many years of experience at UH, most recently as the Director of the Intervention
Cardiovascular Center and as Director of the Research & Innovation Center at
UH Harrington Heart & Vascular Institute.
In addition to his medical degree and a PhD in interventional cardiology, Dr. Costa
is receiving his MBA from the Massachusetts Institute of Technology this year.
HeartFlow’s FFR-CT technology was
approved by the U.S. Food and Drug
Administration in November 2014.
It uses a standard noninvasive coronary
CT angiography scan, uploaded to the
cloud, and combines it with proprietary
computer algorithms to create a
three-dimensional model of the patient’s
coronary arteries. Because it takes
HeartFlow case managers about 24 hours
to analyze the patient’s data and create
the 3-D model, the technology is intended
for elective cases only and is not approved
for heart attack or unstable angina.
“Innovation demands discipline and teamwork, and I will call upon all my
colleagues to participate,” says Dr. Costa. “Our mandate at UH is to create
25,000-plus innovators.”
Dr. Costa has been a Professor of Medicine at Case Western Reserve University
School of Medicine for the past seven years; he is the recipient of the Angela
& James Hambrick Master Clinician in Innovation endowment. He has several
patents in the fields of stem cell therapy, optical coherence tomography and
medical device development.
To offer your suggestions for innovation within UH, email Dr. Costa
at Marco.Costa@UHhospitals.org.
For more information or to refer
a patient, call 216-983-5746.
Getting Ready for ICD-10
ICD-10 is coming October 1, 2015,
replacing the 30-year-old ICD-9 code set.
University Hospitals is preparing for the
transition to ICD-10 across the health
system to make it as seamless as possible
for our physicians.
To date, the ICD-10 IT team has updated
over 80 percent of UH IT applications
to ensure their ability to process ICD-10
transactions. The team has tested and
updated 100 percent of UH applications
used to submit claims and is continuing
claims testing with various payers that
began in 2014. Additionally, UH coding
staff completed ICD-10 training courses
in 2014. Coders currently are practicing
ICD-10 by applying both ICD-9 and
ICD-10 codes to patient health records,
an ICD-10 readiness strategy called
dual coding.
ICD-10 Facts to Know
•
Contains > 68,000 diagnosis codes
•
C
ontains > 72,000 inpatient
procedure codes
•
< 5 percent of ICD-10 codes match
ICD-9 codes exactly
Training for physicians and other
providers on new documentation
requirements to support ICD-10 will
be offered in the coming months.
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Second Pediatric Telehealth Site Now Open for After-Hours Care
UH Rainbow Babies & Children’s Hospital
has opened a second HealthSpot®
station in the Slovenian National Home
facility in Cleveland’s St. Clair-Superior
neighborhood. The HealthSpot connects
patients to pediatric experts seven days
a week through a private, walk-in kiosk
with high-definition videoconferencing
and interactive digital medical devices.
It is available for patients age 2 to 18,
accompanied by a parent or guardian,
Monday through Friday from 5:30 to
11 p.m. and Saturday and Sunday from
1 to 11 p.m.
system and a two-way high-definition
video screen. The kiosk provides a trueto-life “virtual visit” that brings patients
a face-to-face experience with a boardcertified pediatrician from UH Rainbow
Babies & Children’s Hospital who is miles
away. Each station is also staffed by an
on-site accredited medical assistant who
can help the patient as needed.
“HealthSpot stations are an innovative
step in providing better care for children
at a more appropriate level,” says
Andrew Hertz, MD, Medical Director for
UH Rainbow Care Connection. “Our goal
with HealthSpot stations is to improve
the quality of outpatient care for children
and decrease unnecessary emergency
visits and hospitalizations.”
The pediatrician is easily able to review
medical information with the patient,
discuss symptoms, diagnose and treat,
and recommend follow-up care. The
doctor can capture, save and even
annotate the images with notes and
share with the patient’s primary care
physician, specialist or for the patient’s
own records. HealthSpot stations
automatically create a complete
electronic medical record of each
visit, supporting continuity of care
and collaboration among the health
care providers.
The HealthSpot station is an eight- by
five-foot enclosed kiosk furnished with
a desktop with a touch screen, audio
For more information, contact
Dr. Hertz at 216-991-4180 or
Andrew.Hertz@UHhospitals.org.
UH MacDonald Women’s Hospital
Earns Elite “Baby-Friendly” Designation
UH MacDonald Women’s Hospital is among an elite eight Ohio hospitals
and 9 percent of hospitals nationwide to achieve “Baby-Friendly” designation
by Baby-Friendly USA, Inc. This distinction recognizes excellence in providing
evidence-based maternity care with the goal of achieving optimal infant
feeding outcomes and mother-baby bonding.
To prepare the hospital for the designation process, UH MacDonald Women’s
Hospital was selected by Best Fed Beginnings, a collaborative including the
National Institute for Children’s Health Quality and the Centers for Disease
Control and Prevention (CDC). Best Fed Beginnings was a first-of-its-kind,
nationwide quality improvement initiative to help a select 89 hospitals
across the country improve maternity care and increase the number of
Baby-Friendly designated hospitals in the United States.
HealthSpot Locations
Friendly Inn Settlement House Inc.
2386 Unwin Road
Cleveland, Ohio 44104
Slavic Village
6413 St. Clair Avenue
Cleveland, Ohio 44103
HealthSpot name and logo are
registered marks of HealthSpot Inc.
U.S. News Voting
Continues This Month
If you’re a member of Doximity.com, the
secure social networking site for physicians,
you may have the opportunity to vote for
UH Case Medical Center as part of the
2015 “Best Hospitals” survey by U.S. News
& World Report. Doximity members who
are board-certified in one or more medical
specialties relevant to the 16 adult and 10
pediatric specialties ranked by U.S. News
are eligible to participate.
U.S. News ranks adult hospitals in cancer,
cardiology and heart surgery, diabetes
and endocrinology, ENT, gastroenterology
and GI surgery, geriatrics, gynecology,
nephrology, neurology and neurosurgery,
ophthalmology, orthopedics, psychiatry,
pulmonology, rehabilitation, rheumatology
and urology.
It also ranks children’s hospitals in cancer,
cardiology and heart surgery, diabetes
and endocrinology, gastroenterology and
GI surgery, neonatology, nephrology,
neurology and neurosurgery, orthopedics,
pulmonology and urology.
The 2015 survey marks the first time
pediatric specialists who are Doximity
members are being surveyed via Doximity.
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Creutzfeldt-Jakob Disease Consults Available
to rapid neurodegeneration, causing the
brain tissue to develop holes and take on
a sponge-like appearance.
“CJD is mostly seen in the clinical
context as an atypical, rapidly progressive
dementia,” Dr. Appleby says.
“As the incidence of CJD is 1 per million
individuals per year, many clinicians
may never see a case in their lifetime.
However, many treatable illnesses may
resemble CJD, so an in-depth workup
by someone familiar with these
conditions is essential.”
One of just a few physicians in the
country who specializes in CreutzfeldtJakob disease (CJD), UH neurologist
Brian Appleby, MD, sees patients with
this disease Tuesday through Friday
at UH Foley ElderHealth Center.
Dr. Appleby also specializes in youngonset dementia and other atypical
dementias. He is on the board of
directors of the CJD Foundation and
co-director of the National Prion Disease
Pathology Surveillance Center at
Case Western Reserve University. He
also helps lead a local CJD support
group in association with the CJD
Foundation and Cleveland chapter
of the Alzheimer’s Association.
CJD is a degenerative neurological
disorder that is incurable and invariably
fatal. It’s a human form of prion
disease, similar to mad cow disease
in cows. Although CJD is well-known
for its association with acquired risk
factors (e.g., mad cow disease), about
85 percent of cases of CJD have sporadic
etiologies, with the remaining 15 percent
having genetic causes. The disease leads
According to Dr. Appleby, management
of CJD is mainly supportive. Referral
to the CJD Foundation (cjdfoundation.
org), local CJD support groups, hospice
and the National Prion Disease Pathology
Surveillance Center for a CDC-funded
autopsy and genetic testing
(cjdsurveillance.com) are all part of the
management plan for patients treated
with CJD at UH.
To refer a patient for CJD management,
call Dr. Appleby at 216-464-6445. He
can be reached directly at 216-464-6412.
New Observation Unit Opens at UH Ahuja Medical Center
A new 10-bed observation unit is
now open at University Hospitals Ahuja
Medical Center, where hospital staff can
closely monitor patients and expedite
testing and treatment. The unit opened
last month.
In most cases, a decision on admission
is made within three to 23 hours.
This allows physicians to determine
if admission is called for, or whether the
patient should be discharged to go home
with follow-up care scheduled through
his or her own doctor.
“The observation unit is another way
UH Ahuja Medical Center can best serve
a patient’s clinical needs, at the right
level of care,” says Susan Juris, President
of UH Ahuja Medical Center.
Conditions that commonly require
observation include abdominal pain,
asthma and other respiratory conditions,
chest pain, dehydration, neurological
symptoms, kidney stones, fainting and
minor infections.
Patients in the observation unit at
UH Ahuja Medical Center are in
a semiprivate area, where they can
be more comfortable, and where
there are amenities, including food
service. The observation unit is adjacent
to the emergency department.
Those who need observation now
move much more quickly through
the emergency department and into
a bed in the observation unit. This
also has the advantage of reducing
emergency wait times and avoiding
unnecessary hospital admissions.
For more information about the new
unit, call 216-593-5500.
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Robotic Surgery Expanding at UH
New tools and techniques are taking robot-assisted minimally invasive surgery to the next level
Robot-assisted minimally invasive
surgery (MIS) has been shown to reduce
recovery time and pain after surgery.
Although not all open surgeries can be
performed in this way, the opportunities
are growing. “We are currently
conducting many robotically assisted
surgeries,including prostatectomies,
partial nephrectomies, cystectomies
and ureteral reimplantations,” says
Robert Abouassaly, MD, MSc, a urologic
oncologist at UH Case Medical Center,
and Assistant Professor of Urology,
Epidemiology and Biostatistics at
Case Western Reserve University
School of Medicine.
For the past several years, Dr. Abouassaly
has been building a strong robotics
surgery program at UH. “The advantage
of robotically assisted surgery over
laparoscopic surgery is that the robot
provides a greater degree of freedom,
facilitating surgeries that require a lot
of suturing,” says Dr. Abouassaly.
“The dexterity of the robot allows us
to convert a wider range of surgeries
from open to minimally invasive.”
Last fall, UH welcomed the daVinci® Xi,
the newest model in robotic surgical
systems. The new system has improved
optic resolution to help visualize
structures during surgery. It also includes
novel components, such as a stapler that
will allow bowel work and a vessel sealer
for prostatectomies and cystectomies.
“A nice feature called ‘firefly’ allows
us to see blood vessels at the flip
of a switch,” Dr. Abouassaly says.
“This is particularly useful to check
perfusion during bowel surgeries
and partial nephrectomies.”
The robotically assisted MIS program
at UH is led by a steering committee
responsible for driving the systemwide
shift to support robotics. In the past
year, Dr. Abouassaly has seen a greater
interest by thoracic and general surgeons
in using the system. To further develop
the program, UH has recruited both a
colorectal surgeon and a general surgeon
who specialize in robotically assisted MIS.
“Given the new tools and interest among
my colleagues, I am excited about
innovating in this field and converting
more diverse surgeries to a minimally
invasive approach, such as a radical
nephrectomy for large renal tumors,”
says Dr. Abouassaly.
Neuromuscular Ultrasound
Imaging Now Available at UH
The Neuromuscular Center,
part of the University Hospitals
Neurological Institute, is now offering
neuromuscular ultrasound imaging.
This noninvasive imaging technique
is validated as a diagnostic tool
in the evaluation of entrapment
neuropathies, myopathies and certain
demyelinating neuropathies. It is also
useful in evaluating nerve trauma
and diaphragmatic function, among
other neuromuscular conditions.
UH neurologists Bashar Katirji, MD,
and David Preston, MD, are directing
this new service.
For more information, contact
Dr. Katirji at 216-844-4854 or
Dr. Preston at 216-844-7776.
To learn if minimally invasive surgery
might be right for your patient or to
request a referral, call Dr. Abouassaly
at 216-844-3009.
Advanced Diagnostic Testing for Lung and Breathing
Conditions Expands to UH Concord Health Center
University Hospitals Geauga Medical Center has again expanded its
outpatient capabilities. Our highly trained pulmonary team now offers patients
the latest advancements in diagnostic testing for lung and breathing conditions
at UH Concord Health Center. Pulmonary function testing (PFT) and blood gas
testing is available on Wednesdays from 8 a.m. to 4:30 p.m. in Suite 1300 of
the health center. UH Concord Health Center is located at 7500 Auburn Road,
Concord Township, Ohio 44077. If you have questions, call 440-285-6355.
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UH Elyria Medical Center Offers an Array
of Hand Surgery and Hand Therapy Options
Complex injuries or conditions of the
hand require the care of specially trained
surgeons or therapists, often both.
University Hospitals Elyria Medical Center
offers patients who live in the western
suburbs access to these experts, close
to their homes.
Orthopaedic surgeon John Krebs, MD,
of UH Elyria Medical Center, Center for
Orthopedics, is fellowship-trained in
hand and upper extremity surgery. He
routinely performs procedures such as
replacement of the carpometacarpal
(CMC) joint of the thumb due to arthritis,
flexor tendon laceration repairs and wrist
replacements. “Therapy with a certified
hand therapist is very important in order
to regain range of motion, strength and
function,” said Dr. Krebs. “In the case of
flexor tendon laceration repair, dynamic
splinting – in which tendons are moving
but not stressed – is an excellent example
of how surgeons and therapists work in
concert to ensure the highest functional
outcomes for patients.”
Rehabilitation Services department at
UH Avon Health Center. As a certified
hand therapist, Ms. Hampton sees
patients for hand conditions such as
arthritis, mallet finger, trigger thumb,
finger fractures and dislocations,
lacerations, Dupuytren’s contracture
and more. When appropriate, she
makes custom orthotics and splints
to aid in her patients’ recovery.
Physicians in family practice, pediatrics,
orthopaedics, rheumatology and
internal medicine often refer to her
for conservative treatments that reduce
pain, control swelling and enhance
or retain range of motion. Plastic,
reconstructive and hand surgeon
Roland Reyes, MD, FACS, whose
office is also located within UH Avon
Health Center, can simply walk his
patients across the hall for hand therapy.
To contact Dr. Krebs, please call
440-329-2800. To contact Dr. Reyes,
please call 440-988-6880. To contact
KC Hampton, please call 440-988-6890.
KC Hampton, OTR/L, CHT, CLT,
is a new addition to the staff of the
UH Sheffield Health Center
Offers Innovative Walk-in
Orthopaedic Clinic
At UH Sheffield Health Center, the
Center for Orthopedics features a
walk-in clinic that is staffed daily with
one of six orthopaedic surgeons or a
medical orthopaedist. Patients – even
those who have not yet received an
X-ray – are seen on a first-come, firstserved basis between 8 – 11:30 a.m.
and 1 – 4:30 p.m. Like an orthopaedic
clinic, patients are evaluated by a
physician in a cast room and treatment
is prescribed. If surgery is required, the
scheduling occurs before the patient
leaves the office.
New Faces of UHMP: Gary Dinger, DO
Gary Dinger, DO,
joined University
Hospitals Elyria
Medical Center
in December 2014,
having practiced in
Northeast Ohio since
1999. Board-certified
Gary Dinger, DO
in family practice,
Dr. Dinger sees patients of all ages
– from infants to seniors – at his office
in Elyria. A new office at UH Amherst
Health Center is under construction.
When it is complete, Dr. Dinger will
permanently move to that location.
A native of Pennsylvania, Dr. Dinger
was educated at the Ohio University
College of Osteopathic Medicine.
He became interested in the medical
profession in high school after observing
a friend’s father who was a family
practice physician. “He was a very caring
man,” says Dr. Dinger. “He cared for his
patients the same way he treated his
family, and that’s how I do it as well.”
Dr. Dinger focuses on many areas of
health care, including office procedures,
preventive health, routine exams, wellchild and well-woman care, behavioral
health and immunizations. He also sees
many patients with chronic illnesses such
as hypertension, cardiovascular disease
and diabetes. “I enjoy family medicine
because of the diversity of conditions
I see,” Dr. Dinger says. “From diabetes to
dermatology and colds to cardiovascular
disease – I never know what my day
will bring.”
In his spare time, Dr. Dinger enjoys
spending time with his wife, Jill, and their
three daughters: Audrey (9), Brianna (6)
and Caroline (3). An avid deer hunter,
Dr. Dinger has introduced his two oldest
daughters to the bow and arrow; they
often set up targets in the backyard and
practice their shots.
For more information about Elyria Family
Practice or Dr. Dinger’s future location
at UH Amherst Health Center, please
call 440-934-2650.
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New UH Physicians Continued on page 8
Courtney Borruso, DO
Internal Medicine
Stefan Dupont, MD, PhD
Neurology
Seth Levine, MD
Internal Medicine
440-964-3733
Ashtabula Primary Care
216-285-5115
UH Ahuja Medical Center
216-663-8686
Internal Medicine Center,
Garfield Heights
Timothy Chirdon, DO
Family Medicine
Michael Grusenmeyer, MD
Family Medicine
Heidi Morris, DO
Family Medicine
440-238-7676
Family Medicine
Center of Strongsville
440-250-5370
UH Westlake Health Center
Westlake Family Medicine
440-329-4940
Grafton Family Practice
Edward Craft, DO
Family Medicine
J. Martin Leland, MD
Orthopaedic Surgery
Jennifer Rossi, DPM
Podiatry
440-327-2680
North Ridgeville Primary Care
440-285-5004
University Orthopaedic Specialists,
Chardon
440-884-4114
Salvatore Sidoti, DPM, Inc., Parma
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New UH Physicians Continued from page 7
Salvatore P. Sidoti, DPM
Podiatry
Maria Tomaszewska, MD
Neonatology
Sharon Van Nostran, DO
Family Medicine
440-884-4114
Salvatore Sidoti, DPM Inc., Parma
216-844-3387
UH Rainbow Babies & Children’s Hospital
330-239-4455
Sharon Family Physicians, Wadsworth
UH Sharon Health Center
Margaret Apostol, MD
Family Medicine
Shahrazad Saab, MD
Pathology
Charles Winans, MD
Transplant Surgery
440-358-5440
UH Concord Health Center
216-844-8643
UH Case Medical Center
216-844-3020
UH Case Medical Center
Not pictured:
Among the nation’s leading academic medical centers, University Hospitals Case Medical Center
is the primary affiliate of Case Western Reserve University School of Medicine, a nationally
recognized leader in medical research and education.
© 2015 University Hospitals COR 00791
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