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Health Care

Life on the Front Lines

Dr. Andrew Artenstein

Dr. Andrew Artenstein, chief physician executive and chief academic officer for Baystate Health.
Photo courtesy of Baystate Health

Dr. Andrew Artenstein isn’t the first to notice the lack of cars on the roads, but he’s certainly among those most invested in those open roads.

“When I leave work, I’m used to traffic, and there’s no traffic,” said the chief physician executive and chief academic officer at Baystate Health. “Every day feels like Sunday out there. The streets are a lot quieter. Hospitals don’t have visitors, so the hallways are quieter.”

Fewer people out and about means the social-distancing movement has largely taken hold in Western Mass., meaning fewer transmissions of the novel coronavirus and fewer cases of COVID-19 than would be present if people weren’t staying home. The question is, how much difference will it make in the end?

“I can tell you that I don’t know the effect, but I do know anything will help,” Artenstein told BusinessWest. “It’s the right thing to do, and it will hopefully blunt the peak. It will not prevent it totally, but if you can blunt the peak, flatten the curve, we can possibly manage the surge.”

What that surge will represent wasn’t clear at press time, when the state had tallied close to 17,000 cases of COVID-19 — a number that may be much higher as you’re reading this.

Based on expert estimates, Gov. Charlie Baker said Thursday that coronavirus hospitalizations in the state will likely peak between April 10 and April 20, with the total estimate of coronavirus cases in the state ranging from 47,000 to 172,000 over the course of the epidemic, or about 0.7% to 2.5% of the population.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital,” Artenstein went on. “People still need other types of care; people still have cardiac issues or lung issues or kidney issues. That’s not going to stop. But people who don’t need emergency or hospital-level care, for the most part, are finding care in other ways, which is what they’re being told to do. That keeps people from transmitting infection in hospitals, and keeps them away from other patients who might be sick.”

That means patient volume for non-urgent matters is indeed down at Baystate, with some of that work being moved to telephone or telehealth platforms (more on that later), as well as outpatient clinics and urgent-care centers, all of which are also trying to enforce social distancing as best they can.

What is on the rise in the emergency room are cases of respiratory illness, fevers, and coughs, with many of those being admitted and testing positive for coronavirus.

“It appears the community has done a really good job of generally heeding the recommendations from our national and state public-health experts, which is, if you’re not sick, don’t come to the hospital.”

“There’s clearly a lot of transmission going on in the community, which is exactly what you’d expect from a pandemic,” he said. “If you look at the data, the vast majority of people [with the virus] are not sick enough to need to go to the hospital, but they’re still infectious and potentially transmitting it if they’re not isolating themselves.”

Artenstein should know all about the effects of isolation on pandemics. He founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, so “I have a fair amount of experience with these things. But this is a unique experience … a 100-year event.”

It’s an event that has seen Mercy Medical Center, like Baystate, shift from a strategy prioritizing preventive wellness to one that focuses on readiness and the immediate response to coronavirus — and an expansion of capacity where possible, said Dr. Robert Roose, the hospital’s chief medical officer.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase,” he told BusinessWest.

That increase in the number of patients requiring hospitalization reflects what Mercy’s leaders are tracking on a national level, and he expects the trend to increase over the coming weeks.

HCC Police Captain Dale Brown stacks boxes

HCC Police Captain Dale Brown stacks boxes of personal protection equipment for delivery to area hospitals.

“In regard to our local preparedness, we have a robust surge plan that identifies three different levels of escalation to increase our capacity to treat increasing numbers of patients,” he explained. “We’re also coordinating with other local and regional hospitals on a surge-capacity plan in the event we need to share resources among different hospitals in the region.”

Testing, Testing

What would help predict and manage the coming surge is a more robust array of testing resources, but local hospitals are still hampered by a limit on how much is available at the state level.

“At the present moment, we’re prioritizing testing patients who are symptomatic and in need of care in the Emergency Department, as well as healthcare workers and first responders,” Roose said. “We’re prioritizing those groups per the CDC, and as testing capacity increases, then we’ll be able to offer more testing as it becomes more readily available.”

Artenstein reported the same protocol for priority test groups: patients hospitalized with symptoms, employees showing symptoms, and some first responders who are symptomatic. “We know it’s not in our control; it’s a national issue, and we’ve been severely limited in our ability to test. It’s starting to improve because of a tremendous effort by people at Baystate and some of our government officials to help us get more testing and more capacity and more rapid turnaround time. We’re starting to see an improvement, but it’s still not where it needs to be.”

As for the coming surge, Baystate began preparing for that in a number of ways over the past few weeks, including the construction of a rapid-response triage facility just outside the entrance to the ER. It holds around 40 chairs — each of them six feet apart — for individuals entering the ER.

“There’s community transmission of the virus at this point,” said Dr. Niels Rathlev, chair of the Department of Emergency Medicine, when the project was announced last month. “And we really are preparing for more patients showing up for screening. This is not to expand testing; the real issue is to try to keep patients that don’t require admission to the hospital — acute emergency care — and screen them rapidly out here.”

Construction of the triage center is a step that mirrors what is happening in other parts of the country, Rathlev noted, adding that some areas, such as the state of Washington, established such centers weeks ago in anticipation of a surge in visits to the ER and the critical need to triage those coming in. Meanwhile, field hospitals are being created at sites like Worcester’s DCU Center and the Boston Convention and Exposition Center.

Capacity concerns also cross over into the realm of protective equipment like masks and gloves. Roose said Mercy is working aggressively with suppliers to make sure it has what it needs. “I will say we have supplies, but I don’t think any hospital around here feels particularly comfortable with the amount they have because there may be a large influx of patients at any time.”

It’s a problem that has required some creativity. Earlier this month, Patriots owner Robert Kraft sent a team plane to China to pick up 1.2 million N95 masks. In all, Kraft partnered with the state to purchase 1.4 million masks for Massachusetts, and purchased another 300,000 protective masks for New York.

Locally, institutions have stepped up enthusiastically to meet the need. Springfield Technical Community College’s (STCC) School of Health and Patient Simulation donated personal protective equipment — including surgical masks, isolation gowns, and exam gloves — to Baystate Medical Center, Mercy Medical Center, Holyoke Medical Center, and Cooley Dickinson Hospital, in addition to emergency medical services personnel in the West Springfield Fire Department.

“We recognize there is a critical need for personal protective equipment at hospitals and medical centers,” said Christopher Scott, dean of the School of Health and Patient Simulation at STCC. “By donating our supplies, we are doing what we can to protect the healthcare workers who are running short on masks and other protective equipment. The community needs to work together to ensure we defeat this pandemic.”

Holyoke Community College donated similar equipment from its health-science programs to area hospitals. HCC Police Captain Dale Brown spent a day last month conducting an inventory of collected supplies — including boxes of isolation gowns, exam gloves, masks, goggles, hand sanitizer, and microbial wipes — at the Campus Police station. A representative from the Massachusetts Emergency Management Agency picked everything up to coordinate delivery to area hospitals.

“At this point, we have been heavily focused on increasing our available beds and staffing to continue to respond to the needs of the community, and we have been seeing increasing numbers of patients infected with COVID — and the acuity of those cases continues to increase.”

Even Dakin Humane Society pitched in, donating its in-house supply of disposable surgical gowns and booties, along with other personal protective equipment, to Baystate.

“We’ve seen news stories about the need for protective equipment being faced by those in human healthcare, so we reached out to Baystate Medical Center because they’re local,” said Karina King, Dakin’s director of Operations. “We anticipated that human health workers would need these supplies soon, so we recently stopped using disposable items at Dakin and found alternative equipment, including smocks that could be laundered and re-used instead of being disposed of.”

A researcher from UMass Amherst contributed in a different way, with a dose of data. Richard Peltier, a professor in the university’s School of Public Health and Health Sciences, partnered with Dr. Brian Hollenbeck, chief of Infectious Disease at New England Baptist Hospital in Boston, to test in his lab whether used N95 facemasks were still effective at blocking infectious particles after sterilization. They determined that, yes, masks could be safely sterilized and reused.

“While these are ordinarily disposable protective devices for medical workers, these are not ordinary times,” Peltier said, “and this science shows that sterilized face masks will protect our healthcare providers who are working under extraordinary conditions.”

Across the Distance

In short, there’s a lot going on to both help hospitals prepare for the surge and to reduce non-critical traffic as much as possible. To that end, a number of institutions have stepped up their telehealth efforts, including Valley Health Systems, which includes Holyoke Medical Center, Holyoke Medical Group, and River Valley Counseling Center.

“We are expanding our capabilities to meet the needs of our patients, especially those with ongoing health concerns that need to be treated and in contact with their healthcare providers,” said Spiros Hatiras, president and CEO of HMC. “It is important for everyone to maintain their health and safety regarding pre-existing conditions, as much as it is to protect from COVID-19.”

Behavioral Health Network (BHN) introduced a new program, BHNTeleCare, that allows individuals to continue counseling sessions with their therapists from the safety of their own homes.

According to Katherine Wilson, president and CEO of BHN, “this innovation in the way we provide therapy and counseling services is groundbreaking and allows us to render services where people are. This is particularly critical as a result of the needs that have emerged due to the spread of COVID-19. It allows a counseling avenue for those suffering anxiety and in need of support during this time of crisis affecting individuals and families.”

Meanwhile, MHA also introduced its new TeleWell virtual service delivery, which allows mental-health clinicians and their clients make virtual connections using a smartphone, tablet, or computer.

“With social distancing now part of daily life, people who receive therapy for emotional support, or who would like to, may experience uncertainty when it comes to making and keeping office-based appointments,” said Sara Kendall, vice president of Clinical Operations for MHA. “TeleWell provides another option by enabling people to keep their appointments virtually. Every day, more BestLife clients are using this option.”

All these efforts — including simply staying at home to avoid transmission — are helping, Roose said.

“I cannot stress enough how important the efforts of the community are in ensuring that our healthcare providers and resources adequately meet the needs of this crisis,” he said. “Physical distancing, diligent hand washing, isolating and quarantines when appropriate — those are the efforts that will flatten the curve and lessen the impact of this disease, and ensure that our healthcare providers have what they need to provide the care the community needs.

Meanwhile, Mercy’s incident command center continues to keep in contact with the entire Trinity Health system every day. “And every single day, I stress the importance of efforts we can all take to impact this disease. It’s something we all have the power to impact if we take proper precautions and follow the guidelines around physical distancing and quarantines. I can’t stress that enough.”

Those community efforts don’t guarantee Massachusetts won’t become as strained as New York City, Artenstein said, but they help.

“My feeling is that April is going to be very challenging in Western Massachusetts, and after that, I don’t know,” he told BusinessWest. “It quite possibly could extend well into May. I don’t think we’ll be completely out of the woods, and I do think, if you look at epidemics and pandemics, there are second and third waves sometimes.”

For example, he explained, the Spanish flu of 1918 saw a second wave late that year, and an even worse third wave arrived the following spring. COVID-19 has the potential of following a similar track because it’s new, and people haven’t built up the blanket of underlying immunity that keeps seasonal flu, while dangerous as well, under control.

“With each passing day, it becomes clearer we’re living in an unprecedented time, and with that comes uncertainty,” Roose added. “As this pandemic evolves, we are all called upon to learn quickly, work collaboratively, and constantly change how we do things. This is a community crisis, and it takes involvement and the efforts and support of everyone in our community.”

Ready for the Surge

Roose emphasized that he greatly appreciates those efforts, not just in the community, but from the selfless healthcare workers on the front lines.

“I could not be more inspired and impressed by our teams of providers, clinicians, nurses, everyone showing a commitment to putting patients first and responding to the needs of the community,” he said. “In a crisis like this, people show their true character, and it’s clear to me we’re much stronger together, and our teams are rising to this challenge.”

Artenstein agreed.

“I’ve never seen a group of more dedicated, committed, and compassionate people than I’ve seen here,” he said. “They’re working hard in adverse conditions.”

At the same time, he added, “they’re nervous, scared for their familes, and scared for themselves — and they have the right to be scared. But our people are true to their mission to provide excellent, compassionate care.”

No matter what form the April surge may take.

“This is a very unique point in our history — one that, hopefully, we’ll look back on and not have to relive.”

Joseph Bednar can be reached at [email protected]

Health Care

A New Normal

By Mark Morris

Dr. S. Lowell Kahn

Dr. S. Lowell Kahn says he feels an obligation to the community to offer his services because it’s so difficult for people to get healthcare right now.

At a time when COVID-19 is dominating everyone’s attention and resources, people are still experiencing other urgent health issues such as heart attacks, strokes, and any number of other medical conditions that require treatment.

During the last few days of March, BusinessWest spoke with several area physicians about the challenges they are confronting in trying to serve the needs of their patients who require medical attention that is not related to the coronavirus.

The doctors BusinessWest spoke with have all reduced their normal business activity and only see patients for emergency or medically necessary reasons. They all said they closely follow the guidelines from the Centers for Disease Control and Prevention (CDC), notices from Massachusetts Gov. Charlie Baker, as well as information from their respective medical societies.

“It’s a challenging environment, to say the least,” said Dr. S. Lowell Kahn, president of New England Endovascular Center.

Kahn said he feels an obligation to the community to offer his services because it’s so difficult for people to get healthcare during these times. The procedures he is doing are non-elective, and in many cases essential for patients, as well as their doctors.

“People with cancer still need chemotherapy, and those with bad peripheral veins need a biopsy first,” he explained. “If we don’t provide that biopsy, the oncologist can’t properly treat them.”

Dr. Stephen Jacapraro, a dentist with Family Dental Care, is only opening his office when someone has a dental emergency. He said moving from reduced hours to closing up completely was a fast transition.

“We are filling a need because my patient doesn’t want go to the emergency room, and the ER staff doesn’t want him there at this time.”

“Back on March 16, the Massachusetts Dental Association recommended that we start limiting hours; then, on March 19th, the state became more stringent, and since then, we shut down completely except for emergencies,” said Jacapraro. “If someone has severe pain or swelling, I can diagnose it, but even in normal circumstances, I would refer the patient to the proper specialist, such as an endodontist or dental surgeon.”

Dr. Christopher Peteros, a podiatrist with New England Foot Specialists, is limiting his practice to seeing post-surgical patients who need follow-up attention, diabetics with foot issues, and others with medically urgent foot conditions.

“If I have a diabetic patient with an infection in his foot, I don’t want to send him to the emergency room at this time,” Peteros said, adding that there is less risk involved in taking care of the patient in his office than sending him to the hospital. “We are filling a need because my patient doesn’t want go to the emergency room, and the ER staff doesn’t want him there at this time.”

Not Business as Usual

Even fairly routine procedures that are usually done in a hospital setting have become more difficult due to hospitals preparing to be overwhelmed with coronavirus cases. Replacing a dialysis catheter for patients would normally be handled in a hospital, but Kahn has been doing them in his office.

“Even though this isn’t considered an emergency procedure, for dialysis patients, it really needs to get done,” he noted, adding that patients prefer to go to his office these days rather than risk exposure to COVID-19 at the hospital.

Dr. Christopher Peteros

Dr. Christopher Peteros is seeing patients with urgent issues for two reasons: because they need care right away, and to keep them out of hospitals.

All three doctors spoke of following the latest protocols for constantly wiping down their offices, as well as screening patients more carefully before they arrive. They all said that, if there is any reason to believe a patient has been exposed to the coronavirus, they are kept away from the office.

In the interest of social distancing, the doctors are spreading out appointment times to prevent more than one patient from being in the waiting room at any time. Kahn has taken it one step further, and offers patients the option of waiting in their car until they are ready to be seen.

“We used to let family members come in and sit with the patient in our recovery area after their procedure, said Kahn. “We don’t allow that anymore.”

The safety of their teams is an obvious priority for all three doctors as well. Kahn said all his staff wear masks the entire time they are in the office.

“We screen ourselves every single day using screening questions issued by the CDC,” Kahn said, noting that they go through the entire list of questions to check every staff member for a fever, cough, shortness of breath, etc.

“People are scared these days. It’s not fun being a healthcare worker like it was before,” he told BusinessWest.

Jacapraro said one of his concerns is that he and his staff are “toward the older, more vulnerable age group,” so one upside of seeing only emergency cases is that it limits his staff’s exposure to the public. He also mentioned that, with masks and gloves in such high demand, the limited hours allows him to conserve his supplies.

“We’ve been cohesive as a team, trying to keep each other healthy both physically and mentally. We’re staying strong through it to make sure we can stay open to help patients who need us.”

“Our suppliers are taking care of the hospitals first, as they should,” he said, adding that, even with limited supplies, he has enough in stock to handle emergencies.

With his primary supplier unavailable, Jacapraro has been using a secondary supplier for masks whose price is four times higher. Jacapraro doesn’t believe the supplier is jacking up the price, but that it’s more likely a cost difference between suppliers. “When you’re not making any money, however, you still have to pay them four times as much.”

Back in mid-March, the U.S. surgeon general asked doctors to stop all elective procedures, a move that has proven almost self-regulating as the doctors have said patients are more reluctant to seek services at this time.

“Some of my patients are asking me to push off appointments, and I’m asking the others to do so as well,” said Peteros.

Jacapraro added that, once social distancing was being encouraged, the Massachusetts Dental Assoc. recommended stopping all elective treatments. “Obviously, we have to get closer than six feet to help our patients.”

Some of the most common procedures are being seen in a different light in the environment of the COVID-19 pandemic. The Society of Interventional Radiology (SIR) issued a reminder to doctors about a basic procedure that Kahn had done many times in his office.

The procedure involves inserting a feeding tube through the skin and into the stomach. Before doing that, however, the doctor inserts a catheter into the patient’s nose, through the esophagus, and into the stomach to determine the best location for the feeding tube. When the catheter is being inserted into the patient’s nose, it is common for them to have a gag reflex. The SIR cautioned that the gag reflex could aerosolize the COVID-19 virus, and recommended that, unless the doctor and staff wear N95 masks and full headgear, they could potentially expose themselves to the virus.

“This has always been a quick and safe procedure, but we’ve had to rethink it,” Kahn said. “And for the time being, we have backed off on doing feeding tubes, per these recommendations.”

Carrying On

The doctors who spoke with BusinessWest have all based their COVID-19 protocols on information from the CDC, and they advise consumers do the same.

“There’s a lot of bad information out there on social media, where suddenly, everyone thinks they’re an epidemiologist,” said Kahn, adding that consumers should get their information from reliable sources.

Early on, as they understood the significance of the coronavirus, Kahn met with his staff to allow everyone to voice their concerns about practicing medicine at this time. By the end of the meeting, he noted, everyone was on board with how they needed to proceed.

“We’ve been cohesive as a team, trying to keep each other healthy both physically and mentally,” he said, while seemingly speaking for everyone in the industry. “We’re staying strong through it to make sure we can stay open to help patients who need us.”

Health Care

Back to Basics

By Ashley Tresoline

The World Health Organization has declared COVID-19 a pandemic. We are all trying to navigate through figuring out what is best for ourselves and our families in these uncertain times. As we all stock our homes with extra food, hand sanitizer, and the toilet paper we waited four hours for at the store, we need to be thinking about how we can keep ourselves healthy too: not just by preparing our homes, but by preparing our bodies as well. All of us are facing a new normal for the foreseeable future.

We need to refocus and go back to basics of everyday living to help us support our immune systems. Here are some tips to do just that.

Get enough sleep. I know your latest binge-worthy Netflix show is calling your name, but you still need to be trying to get seven to nine hours of sleep a night. When we are sleep-deprived, we are more likely to get sick. When we sleep, we make proteins called cytokines, which help regulate the immune system.

Stay hydrated. Drinking water seems so simple. Drinking plenty of water ensures that your blood will carry plenty of oxygen to all the cells of your body. This means all of your body’s systems will function properly, because they’ll be getting plenty of oxygen. Your immune system functions best when your muscles and organs are functioning best. If the taste of plain water is hard for you to stomach, add a little lemon, lime, or cucumber.

“Drinking plenty of water ensures that your blood will carry plenty of oxygen to all the cells of your body. This means all of your body’s systems will function properly, because they’ll be getting plenty of oxygen.”

Stay as active as possible. It is so easy to sit around more than we usually do because we are in our houses and don’t have many social activities. Make your workout a priority for your mental and physical health. There are so many gyms and studios that are offering online training and classes for you to do in your own living room. Being active will help you feel less stressed and help keep your immune system functioning in tip-top shape.

Eat your greens. Do you remember when your mom used to tell you to eat your broccoli because it would make you big and strong? Well, guess what? She was right. When you want to boost your body’s immune system, you can do it naturally by eating the most nutritious foods. Dark, leafy greens and cruciferous veggies are recommended by dietitians because these foods contain high levels of minerals, antioxidants, and vitamins. Broccoli is considered one of the most versatile vegetables to buy because you can consume it in a variety of ways, such as raw in salad, steamed, or sautéed.

Eat other foods that help with your immune system. These include citrus fruits such as oranges, limes, and lemons to help with vitamin C, ginger to protect against bacteria and inflammation, sweet potatoes, green and black tea for the amino acids, mushrooms rich in B vitamins and minerals, yogurt for the probiotics and vitamin D, spinach because of its vitamin C and iron, and turmeric for its anti-inflammatory properties and flavonoids to help fight off countless infections.

Avoid alcohol and processed sugar. I know these are difficult times and drinking in moderation in most cases is OK, but an increase in your alcohol intake can increase a person’s exposure to bacterial and viral infections. Processed sugar can weaken the immune system, and we all know we should limit our processed sugar on a normal basis. Realistically, we all will have a treat or two every now and then, but processed foods are nutrient-poor. When we eat a lot of sugar, the immune system is habitually deprived of nutrients. We need nutrient-dense food to help our immune system fight off colds and viruses.

Incorporate supplements and vitamins. A lot of us take a daily multi-vitamin, which is a good way for us to help get the recommended vitamins and minerals we need in our diet. There are many other supplements that claim they can help you boost your immunity but be careful, as they can load you up with vitamins and minerals your body can’t absorb. Loading up on some minerals and vitamins in large doses can cause you to have other health problems, such as nausea, vomiting, dizziness, kidney problems, headaches, and many more serious conditions, depending on your health situation.

There are a few natural cold supplements that aren’t all bad to add to your health regimen, such as elderberry syrup and zinc lozenges. Elderberry contains natural substances called flavonoids, which can help reduce swelling, fight inflammation, and boost immunity. Studies have shown elderberry can ease the symptoms of the flu, bacterial sinus infections, and bronchitis. The benefits seem to be most effective when started 24 to 48 hours after symptoms begin. (However, never consume a product made with raw elderberry.) Zinc lozenges can also help reduce cold and flu symptoms, but they come with the risk of overwhelming your body with too much zinc. If you take too much, you may be at risk for nausea, vomiting, stomach upset, copper deficiency, and risk of suppressing the immune system. Be sure to speak to a healthcare professional before adding any supplements to your healthcare regimen. Some supplements can react with prescription medications and over-the-counter medications you are taking.

Your body is working hard to keep you healthy. Help your body by eating right, getting proper sleep, staying hydrated, and keeping active. Health is a cumulative thing, so keep up your best health and wellness practices while we are in this difficult time — and, of course, wash your hands!

Ashley Tresoline is the founder of Bella Foodie, LLC; [email protected]

Health Care

Vision 2020

Few industries change as rapidly — and as dramatically — as the broad, multifaceted realm of healthcare. From oncologists’ use of cancer fingerprinting and gene therapy to facial transplants for accident victims; from cutting-edge protocols to save the lives of stroke and heart-surgery patients to a dizzying array of new treatments to improve vision … the list is seemingly endless, making it impossible to paint a full picture of where healthcare has come in the past decade.

But we at BusinessWest wanted to try anyway — and, at the same time, look ahead at what the next decade might bring. So, appropriately, here at the dawn of 2020, we invited a wide range of healthcare professionals to tell us what has been the most notable evolution in their field of practice in the past 10 years, and what they expect — or hope — will be the most significant development to come in the next decade.

The answers were candid, thoughtful, sometimes surprising, but mostly hopeful. Despite the many challenges healthcare faces in these times of advancing technology, growing cost concerns, and demographic shifts, the main thread is still innovation — smart people working on solutions that help more people access better care. After all, healthcare is, at its core, about improving people’s lives, even when they seek it out during their direst moments.

Innovation and promise. That’s what we believe a new decade will bring to all corners of the healthcare world — that is, if these leaders, and countless others like them, have anything to say about it.

Administration

Joanne Marqusee

President and CEO, Cooley Dickinson Health Care

Joanne Marqusee

The most significant recent development in healthcare administration has been a recognition of the role patients play in their own healthcare. “Crossing the Quality Chasm: A New Health System for the 21st Century,” published in 2001 by the Institute for Healthcare Improvement, called for a massive redesign of the American healthcare system. Specifically, it provided “Six Aims for Improvement,” five of which focused on safety, effectiveness, timeliness, efficiency, and equity. Not talked about as much, the sixth aim was to make healthcare ‘patient-centered.’

While we still have a ways to go to truly be patient-centered, we have witnessed a sea change in the past decade in this regard. Patients are increasingly active participants in their care, questioning their doctors and other providers to ensure that they understand their options, using electronic medical records to engage in their care, and speaking out about what they want from treatment or forgoing treatment at the end of life. The best healthcare providers — both organizations and individuals — embrace these changes, welcoming patients as more than recipients of care, but rather active partners in their own care and decision making.

My hope for the most significant development over the next decade has to do with providing universal healthcare coverage while controlling healthcare costs. While we almost have universal coverage in Massachusetts, too much of the nation does not. A hotly debated topic, universal healthcare has many benefits, including increasing access to preventive and routine medical care, improving health outcomes, and decreasing health inequalities.

Surgical Technology

Dr. Nicholas Jabbour

Chairman, Department of Surgery, Baystate Medical Center

Dr. Nicholas Jabbour

The most significant development in surgery over the past decade has been the move toward less invasive surgical approaches made possible through advanced technology. These approaches include robotic and minimally invasive surgery, including intraluminal surgery in areas such as gastroenterology, cardiology, and neurosurgery — for exemple, the passage of an inflatable catheter along the channel inside of a blood vessel to enable the insertion of a heart valve instead of making a large opening in the chest. As a result, we have seen a big shift from inpatient to outpatient surgery with shorter hospital stays and improved post-op recovery.

In the next decade, we foresee these innovations in less invasive surgery will be enhanced by better computing and software integration. This interaction will include the merging of radiological and potentially pathological information — which is currently available in a digital format — with real-time visualization of anatomical structure during surgery. This will offer surgeons the opportunity to improve the accuracy and speed of a surgical procedure while minimizing the risks.

The next decade will also see major innovation in the area of transplantation with the development of tissues or whole organs through bio-engineering manipulation of animal or a patient’s own cells. The integration of this bio-engineering manipulation with currently available technology, such as 3D printing and 3D imaging, will provide patients with the needed tissue or organ — including valves, bone grafts, hernia mesh, skin, livers, and kidneys — in a timely manner. This development will revolutionize the field of transplantation and surgery in general.

Behavioral Health

Karin Jeffers

President & CEO, Clinical & Support Options Inc.

Karin Jeffers

Over the past 10 years, we’ve seen a growing adoption within the behavioral-health and medical fields of holistic treatment models. While the two disciplines were once treated as different animals, the entire health field is now moving to treat both the body and the mind — together. The next 10 years are likely to bring these two fields even closer.

Today, you’re seeing behavioral-health clinicians being hired into physical health practices. Likewise, physical health providers are cross-training to better understand behavioral issues. Whereas, a decade ago, a behavioral-health client might be assigned a therapist or a psychiatrist, they are now gaining access to more robust set of supports, including nursing, case management, recovery coaching, and peer support from those with lived experience. Government mandates and payment model changes are forcing outcomes-based integration, too. Pediatricians, for example, must now do behavioral-health screenings of all youth under 21. In the mental-health space, you’re seeing clinicians ask about weight, exercise, and other physical factors.

We’re seeing significant movement on both the state and federal levels to value outcomes over volume. It’s reflected in the criteria set by the Excellence in Mental Health Act for certified community behavioral-health clinics, a designation CSO has earned, and in the work we have done with the Substance Abuse and Mental Health Services Administration. Our ability to tailor programs, like our grant-funded work at the Friends of the Homeless shelter in Springfield, has literally saved lives among those experiencing homelessness and co-occurring conditions, like substance-use disorders.

In the coming years, we hope to see integrated care models become even more mainstream. Things appear headed in the right direction, but government action establishing payment reform within the behavioral-health field needs to be taken — and the integrated models need to be appropriately funded. Such changes would affirm overall health and wellness to include both physical and behavioral health.

Weight Management

Dr. Yannis Raftopoulos

Director, Holyoke Medical Center Weight Management Program

Dr. Yannis Raftopoulos

Weight management is a rapidly evolving field, and I am fortunate to be part of it. One of the most significant innovations this field has experienced in the last 10 years was the development of a new gastric balloon. Packaged in a small capsule and swallowed with water, the Elipse balloon provides satiety while requiring no procedure or anesthesia for its placement and removal. Together with its excellent safety profile, the Elipse balloon is the least invasive and yet effective weight-loss modality available today. Elipse is manufactured in Massachusetts by Allurion Technologies.

I had the opportunity to be an investigator in the European trial which led to the Elipse market approval in the European Union in 2016. Recently, Holyoke Medical Center was among 10 U.S. sites in which an FDA-regulated trial was conducted. The trial was completed successfully, and Allurion has submitted data requesting FDA approval to market Elipse in the U.S. The balloon’s use in Europe shows that patients can lose more than one-fifth of their initial weight.

A New England Journal of Medicine study reported that 107.7 million children and 603.7 million adults, among 195 countries, were obese in 2015. High body-mass index accounted for 4 million deaths and contributed to 120 million disability-adjusted life-years. Obesity is a chronic disease, and its management requires long-term guidance and close patient-physician communication. Successful collaborations between existing best practices with technology innovations that will allow delivery of effective weight-management care on a massive and global scale could be the most significant evolution in the field in the next 10 years.

Cancer Care

Dr. Hong-Yiou Lin

Radiation Oncologist, Mercy Medical Center

Dr. Hong-Yiou Lin

The advent of new medical oncology drugs has improved control of microscopic and, to a lesser extent, macroscopic disease, allowing local treatments, such as surgery or radiotherapy, to increase survival. To cure cancer, we need to eliminate cancer cells where they started, as well as any microscopic cells traveling through the body. The idea of using immunotherapy to fight cancer has been around for decades, but bringing this idea to the clinic has been hampered by the cleverness of cancer cells knowing how to evade detection by our immune system. Recently FDA-approved immunotherapy either takes away that ‘invisibility cloak’ or wakes up our dormant immune cells to start fighting cancer.

The biggest development in oncology in the next 10 years will be personalized precision medicine, which allows the oncology team to tailor treatment to each patient’s unique cancer biology and life circumstances. Meanwhile, improvements in cancer diagnosis will come from novel PET radiotracers and new MRI sequences that allow for more accurate staging and identification of the best site to biopsy. Pathologists will use novel tools such as genome sequencing to supplement traditional microscopy to subclassify the specific type of cancer within a certain diagnosis instead of grouping into broad categories.

Surgical, medical, and radiation oncologists can then use the above information to decide on the best sequencing between surgery, systemic therapy, and radiotherapy to minimize side effects and maximize cure. Medical oncologists will be able to offer more drugs that target new mutations, overcome drug resistance, increase specificity to a mutation, or better fine-tune immunotherapy, targeting only cancer cells by enlisting gene modification as well as natural killer cells. Radiation oncologists will have new radiomic and genomic tools to personalize the radiation dose and volume, and when to offer radiotherapy.

In short, over the next 10 years, cancer care will continue to move away from the traditional one-size-fits-all model toward a more personalized approach.

Allergy and Immunology

Dr. Jonathan Bayuk

Medical Director, Allergy & Immunology Associates of New England

Dr. Jonathan Bayuk

There have been incredible and exciting advances in allergy and immunology in the last two years. However, the unmet needs of allergic and autoimmune-disease-afflicted patients has grown dramatically in the last 20 years. In response to the increasing prevalence and acuity of allergic diseases and autoimmune diseases, the world has launched products to help address these very severe patients. These medications are indicated for many conditions and work very well. They are generally safe, but are very expensive. These medicines are different than traditional pharmaceutical drugs as they are not chemicals, but biologically derived medicines designed to augment or modify the immune response. As such, they are call biologic medications.

In the field of allergy and immunology, we can now dramatically treat and potentially cure many diseases that in the past were very challenging to manage. The biologic medicines that we have now treat asthma, eczema, allergic disease, and hives. The patient selection is based on severity of their condition, and these medicines are only for moderately to severely affected people. If, as a medical profession, we were to place as many people as possible on these therapies, the cost would be astronomical and not sustainable.

However, is it fair to deny any of these patients access to these treatments who truly need them? I would argue that choice is a very difficult one to make, and as physicians, our primary goal is healing at whatever cost. As a nation, we have a dilemma. Can we afford the medicines we have or not? It is unclear that any serious legislative body is willing to tackle that question. For now, the use of these medicines is changing lives dramatically, and it is an exciting time to be able to use these newer tools to help our patients live better lives.

Eye Care

Dr. David Momnie

Owner, Chicopee Eye Care

Dr. David Momnie

What are the most significant advancements in eye care in the last decade? It depends on whom you ask. Retinal ophthalmologists would probably say it’s the treatment of wet macular degeneration, a leading cause of blindness, with anti-VEGF injections. Cataract surgeons would most likely cite small-incision surgery and new lens implants that often leave patients with 20/20 vision. Glaucoma specialists might tell you it’s the development of MIGS, or minimally invasive glaucoma surgery. These operations to lower the pressure in the eye use miniature devices and significantly reduce the complication rate.

Primary-care optometrists and ophthalmologists would no doubt talk about the advances in optical coherence tomography, a remarkable instrument using light waves that gives cross-sectional pictures of the retina. The technique is painless and non-invasive and is becoming the gold standard in eye care because it has revolutionized the diagnosis and treatment of glaucoma and macular degeneration. For optometrists specializing in contact lenses, using newly designed scleral lenses to restore vision in people with a corneal disease called keratoconus has been a major development. There are many other specialists in eye care, including LASIK surgeons, that have seen remarkable changes in technology.

What will the next decade bring? Artificial intelligence (AI) is becoming more accurate for screening, diagnosing, and treating eye conditions. AI systems can increasingly distinguish normal from abnormal pictures of the retina. Where there is a shortage of ophthalmologists and optometrists, AI screenings combined with telemedicine, providing remote care using communications technology, may be able to find and treat more people who are falling between the cracks of our healthcare system. The term 20/20 is the most common designation in eye care, and the year 2020 will probably usher in another decade of remarkable developments in our field.

Information Technology

Teresa Grogan

Chief Information Officer, VertitechIT

Teresa Grogan

From the perspective of technology that enables healthcare, the biggest game changer of the last decade has been the iPhone — and now, essentially any smartphone.

Steve Jobs introduced the first iPhone in 2007 (a little over a decade ago), and physicians embraced it quickly. It started as a simple tool for doctors (applications like the PDR, or Physicians’ Desk Reference) for looking up drug interactions. Today, it’s a portable EMR, a virtual visit facilitator, and a remote-monitoring device for many healthcare providers, as many patients have embraced — and insisted on — this technology to improve access to care. As the cost decreases and cellular bandwidth improves, the rapid growth of the IoMT (Internet of Medical Things) will place smartphones at the center of the next wave of healthcare technology breakthroughs.

Looking forward, I’d like to see complete elimination of passwords to access electronic information. While there has been some movement toward this with ‘tap and go’ badges and fingerprint readers, a single standard is needed that would work regardless of the software program used. I hope there are greater strides in the creation, deployment, and adoption of other biometric technologies, like iris, face, or voice recognition, so that a healthcare professional could walk into a patient room — or into a hospital — and the computer systems would know his or her identity in immediate and secure fashion. If access to the data needed by a healthcare provider were as easy as turning on a light switch, the improvements in quality of life and efficiency in work for that provider would translate to improved patient outcomes.

Cardiovascular Care

Dr. Aaron Kugelmass

Vice President and Medical Director, Heart and Vascular Program, Baystate Health

Dr. Aaron Kugelmass

We have seen many improvements in cardiovascular care over the last 10 years, but the development, approval for clinical use, and dissemination of transcutaneous aortic valve replacement (TAVR) stands out as the most dramatic. This new technique allows cardiologists and cardiac surgeons, working together, to replace the aortic valve without opening a patient’s chest or utilizing heart-lung bypass, which has been the standard for decades. This less invasive approach is typically performed under X-ray guidance and involves accessing a blood vessel in the leg and guiding a catheter to the heart.

The TAVR procedure was first approved for clinical use in November 2011. It was initially limited to very sick patients, who were not candidates for traditional surgery because of the risk it posed to them. TAVR allowed patients who otherwise could not receive life-saving valve surgery to have their valves replaced with improvement in longevity. With time and experience, the procedure was approved for lower-risk patients as well, and more recently has been approved for the majority of patients, including those with low operative risk. TAVR has been shown to be equivalent or safer than traditional aortic valve-replacement surgery, and is quickly becoming the procedure of choice for most patients who require an aortic valve replacement. Since the procedure typically does not require open-heart surgery, recovery time is much shorter, with some patients going home within a day or two.

In the next 10 years, we expect that similar less-invasive procedures with shorter recovery time will be developed for other heart-valve conditions in patients who otherwise could not receive therapy.

Memory Care

Beth Cardillo

Certified Dementia Practitioner and Executive Director, Armbrook Village

Beth Cardillo

During the last 10 years, neuroscientists have been researching the causes of Alzheimer’s disease. There has been much discussion about which comes first — the amyloid plaque or the fibrillary tangles that develop in the brain, which are roadblocks to cognition, thus causing the difficulties with Alzheimer’s and other related dementia. That question has not been answered yet. Researchers were able to isolate the APOE gene, which is a mutant gene that is found in familial Alzheimer’s disease, helping us to better diagnose it. We have also better understood how diet, exercising both body and brain, and lifestyle contribute to the disease. Currently there are 101 types of dementia, with Alzheimer’s accounting for 75% of cases.

The next 10 years will result in more preventive actions. One major action will be to help people avoid developing type 2 diabetes, which may be labeled the next cause of Alzheimer’s (this type of Alzheimer’s is already being called type 3 diabetes). There has been a major link between sugar in the hippocampus and Alzheimer’s disease. Though there is no cure yet for Alzheimer’s, we are finding more information based on genetics, diet, and PET scans, which can show shrinkage in the brain.

Every year, researchers are more hopeful that a new drug will be developed to eradicate the disease. The last new drug from Biogen was looking hopeful in clinical trials, but that turned out to be not the case. Prevention continues to be at the forefront, as well as participating in clinical trials. More people who do not have dementia or mild cognitive impairment are desperately needed for clinical trials so comparisons of the brain can be made.

Nursing Education

Ellen Furman

Director of Nursing, American International College

Ellen Furman

As in all healthcare, the one thing that can be ascertained is constant change. The same can be said in nursing education today. No longer is the instructor-led lecture method of teaching considered best practice in education, but rather the shift to using class time to apply learned concepts. One way this is done is through the ‘flipped classroom.’ Using this educational modality, students study the concepts being taught preceding the class, followed by class time where students apply these concepts in an interactive activity, thereby developing students’ abilities to think critically, reason, and make healthcare judgements based upon the application of knowledge.

Another change in nursing education is an expanded focus away from pure inpatient (hospital-based) clinical education to outpatient (community-based) clinical education. While hospital-based education remains essential, the realization that most healthcare provided is in outpatient settings has broadened the clinical experiences required to prepare the graduate registered nurse for care provision.

Additionally, with healthcare as complex as it is, nursing students are being taught to be prepared for entry into practice. Education regarding the use of evidence-based practice, how to apply for the licensure examination, preparation to be successful on the National Certification Licensure Exam, nurse residency opportunities, interviewing techniques, transitioning from student nurse to registered nurse, etc. are all taught using a variety of educational modalities based upon the current best available evidence in nursing education.

As we forge ahead in healthcare, nurse educators will continue to evolve to meet healthcare needs through the education of nursing students so as to prepare them to provide care to meet the needs of those we serve well into the future.

Orthotics and Prosthetics

James Haas

Co-owner, Orthotics & Prosthetics Labs Inc.

James Haas

Advances in prosthetic technology have clearly been the most significant development in my field over the past decade. From knees and feet that adapt to different walking speeds and terrains to hands that send sensations of touch to the brain, every aspect of patient care has changed and continues to change at a rapid pace.

Prosthetic feet, knees, and sockets have been greatly impacted. Once made from multi-durometer foams and wood, the prosthetic feet of today are made from carbon, fiberglass, and kevlar laminated with modified epoxy resins. They store energy and adjust to uneven terrain and hills. Microprocessor knees have on-board sensors that detect movement and timing and then adjust a fluid/air control cylinder accordingly. These knees not only make it safer for a person to walk, they also lower the amount of effort amputees must use, resulting in a more natural gait. Sockets once made from stiff materials are now incorporated with soothing gels and flexible adjustable systems that allow a patient to make their own adjustments to improve their comfort.

As for the next decade, I hope to see national insurance fairness. Devices typically last about three to five years. Some people make them last longer, but others, especially growing children, need replacements more often. Many private insurance plans have annual caps and lifetime limits on coverage for orthotics and prosthetics. The Amputee Coalition of America authored insurance-fairness legislation and has lobbied for its implementation for over a decade. This legislation has been ratified in 20 states, including Massachusetts. The Fairness Act requires all insurance policies within the state to provide coverage for prosthetics and orthotics equal to or better than the federal Medicare program and have no coverage caps and lifetime restrictions.

Dental Care

Dr. Lisa Emirzian

Co-owner, EMA Dental

Dr. Lisa Emirzian

The most significant development in the field of dentistry over the past decade has been the integration of digital technology into our daily practices. There are three components of digital dentistry: data acquisition, digital planning, and, finally, the manufacturing of the restoration to be created. Data acquisition today is accomplished with digital radiographs, paperless charting, intra-oral scanners, cone-beam 3D scanners, and video imaging. For the planning process, we now have the ability to merge the data with software that enables computer-aided design and digital smile design, allowing dentists to perform complex procedures, including guided surgical treatments and smile designs, with optimum results. Fabrication and execution of the final restorations can be done in the office or, more often, in laboratories with highly sophisticated digital milling machines, stereolithography, and 3D printing.

In the next decade, we will see data fusion to ultimately create the virtual patient. The next-generation digital workflow will merge intra-oral 3D data with 3D dynamic facial scans, allowing dentists to create 3D smile designs and engineer the dentofacial rehabilitation. The integration of scanners and software will expedite the delivery of ‘teeth in a day.’ In addition, multi-functional intra-oral scanners will allow for early detection of carious lesions and determine risk levels for different patients.

Above and beyond this foreseeable future, artificial intelligence (AI) will be the next paradigm shift. Companies are already looking for big-data collection and deep machine learning to help the practitioner in their everyday chores of diagnosis and treatment. AI cloud-based design platforms will input data, and AI engines in the background will aid in all parts of dental treatment, including diagnosis, design, and fabrication of final restoration.

Let us not forget one thing: the future is all about us — people utilizing technology to enhance the human connection between doctor and patient.

Rehabilitation

John Hunt

CEO, Encompass Health Rehabilitation Hospital of Western Massachusetts

John Hunt

A significant rehabilitation development from the past includes one that may surprise you. Time. A luxury we once knew, time meant patients could recover in a hospital longer after a surgery, an accident, or an illness. Nurses had more time to assess patients to know exactly what they needed. Insurance companies approved longer patient stays through lengthy consideration. Ten years ago, a stroke survivor could recover for two weeks in a hospital and then join us for a rehabilitation stay that would last several weeks.

Today, a three- to five-day stay in the referring hospital, followed by a two-week stay in rehabilitation, is the norm. We are seeing significant decreases in the age of stroke survivors as well as an increase in the number patients who survive with cognitive and physical disabilities. Yet, we also see medical breakthroughs, including the discovery of tissue plasminogen activator (TPA) — nothing short of a miracle. TPA actually reverses the effects of an evolving stroke in patients when used early on, making recoveries easier.

With new advanced technologies being introduced every year, rehabilitation continues to progress at a rapid speed. Looking into the future, evidence-based research will continue to grow to help us make knowledgeable decisions that ultimately impact patient outcomes. Increased clinical expertise will lead to higher functional gains in shorter amounts of time. As a result, acute inpatient rehabilitation will impact the lives of patients like we’ve never seen before.

Hearing Care

Dr. Susan Bankoski Chunyk

Doctor of Audiology, Hampden Hearing Center

Dr. Susan Bankoski Chunyk

The most common treatment for hearing loss is hearing aids. Although digital processing has been available in hearing aids since 1996, the past 10 years have offered great leaps in technology for people with hearing loss. Each generation of computer chip provides faster and ‘smarter’ processing of sound. Artificial intelligence allows the hearing-aid chip to adjust automatically as the listening environment changes, control acoustic feedback, and provide the best speech signal possible. People enjoy the convenience of current hearing aids’ Bluetooth streaming, smartphone apps, and rechargeable batteries.

These features are ‘the icing on the cake,’ but the real ‘cake’ is preservation of the speech signal, even in challenging listening situations. Since the primary complaint of people with hearing loss is understanding in noise, new hearing-aid technology works toward improving speech understanding while reducing listening effort in all environments. This significantly improves the individual’s quality of life.

The negative effects of untreated hearing loss on quality of life are well-documented. Recent research has also confirmed a connection between many chronic health conditions — including diabetes, cardiovascular disease, kidney disease, balance disorders, depression, and early-onset dementia — and hearing loss. This research shows that hearing loss is not just an inevitable consequence of aging, but a health concern that should be treated as early as possible. My hope for the future is that all healthcare providers will recognize the value of optimal hearing in their patients’ overall health and well-being and, just as they monitor and treat other chronic health conditions, they will recommend early diagnosis and treatment of hearing loss.

Health Care

More Than a Gym

Dexter Johnson says people who work downtown are excited about having the YMCA nearby.

Dexter Johnson can rattle off the amenities found in any chain gym. Weights and cardio equipment. A sauna or pool. Perhaps a playroom for kids to hang out while their parents work out.

But the YMCA offers more than just fitness equipment and childcare for its members — it gives them a community, said Johnson, CEO of YMCA of Greater Springfield, which recently relocated from Chestnut Street in Springfield to Tower Square in the heart of downtown.

The nonprofit recently held its grand opening, and is well underway with programs, fitness classes, and more activities open to members.

The fact that Tower Square, Monarch Place, 1550 Main Street, and other surrounding offices are home to more than 2,000 employees in downtown Springfield is one of several benefits of the YMCA’s move, Johnson told BusinessWest. “The reception has been great. The people that work in this building or in the adjoining buildings have been excited about having us here.”

And it’s no secret why.

The new Child Care Center for the Springfield Y boasts a 15,000-square-foot education center, including classrooms, serving infants through elementary-school students. The Wellness Center continues its popular fitness and health programming with a new, 12,000-square-foot facility on the mezzanine level of Tower Square, complete with a group exercise room, state-of-the-art spin room, sauna, steam room, and walking track.

But Johnson knows the Y is more than just a gym — it’s a cause-driven organization that focuses on giving back to the community through youth development, healthy living, and social responsibility.

“We don’t call ourselves a gym, despite the fact that we have gym equipment,” he said. “We are a community organization, and this is just one of the ways that we serve the community.”

The Bigger Picture

One of the many programs the Y offers is LIVESTRONG at the YMCA, a 12-week personal-training program for adult cancer survivors offered without cost to participants. It also provides families with nearly $700,000 in financial scholarships every year — just two examples of how the Y is much more than just a gym, Johnson said.

“Our goal as an organization is to really make the Y stronger,” he noted, adding that the move to a new facility will greatly reduce costs to allow the organization to expand its services and impact. “The Y is looking to serve the community and to help from the spirit, mind, and body aspects of what people need.”

Before the move, Johnson anticipated the Y would lose about 20% of its members due to lack of a pool and change of location, but added that it has since gained new members and partners that are taking advantage of the services. About 50 new memberships were sold before the move into the new space, just because people knew it was coming.

“Nearly 2,000 people work in these three buildings, so we’re really hoping that those folks will understand the convenience of having something like this right here and not having to go to your car and drive elsewhere to meet your wellness needs,” he said.

Right now, the number of membership units, both families and individuals, is up to about 1,000. In order to increase these numbers, Johnson says the Y is giving tours, reaching out to local businesses and neighbors, and will be offering specials starting in 2020 to get people in the door.

“We’re hoping that we will get a good turnout of people that will give us a try,” he said, adding that a new sauna, steam room, and more than 40 group exercise classes a week are just some of the benefits.

While welcoming those newcomers, Johnson emphasized that the Y is also hoping its long-time members will enjoy the new facility as well.

“Despite the fact that we are heavily focused on the business population, we continue to serve the population as a whole, and we want our members to remember that part because that’s crucial for us,” he said. “We’re really looking to build upon the existing membership by moving here.”

A New Venture

While the new location has more limited space than the original, Johnson says he’s focused on making the most of the new location. That includes utilizing the parking garage by offering members free parking for up to three hours — as well as letting people know what other amenities exist in Tower Square, from retail and banking to UMass Amherst and numerous restaurants, most of them in the food court.

“We understand that the more activity and the more action taking place in this building, the better for everyone,” he said.

Overall, Johnson strongly believes this new facility will help serve the goals of the Y as a whole.

“We think this facility will stabilize the organization,” he said, “while we continue in our other efforts as they relate to our full service at our Wilbraham location, our childcare facilities throughout the city, and all the things the Y is involved with.”

Kayla Ebner can be reached at [email protected]

Health Care

Beyond the Ban

Call it a decisive response to a much less clear-cut problem.

While shop owners may seethe, Gov. Charlie Baker says the state’s four-month ban on selling vaping products is a necessary step while the medical community tries to figure out what’s causing a rash of pulmonary illness among e-cigarette users across the U.S.

“We do not know what is causing these illnesses, but the only thing in common in each one of these cases is the use of e-cigarettes and vaping products,” Massachusetts Public Health Commissioner Monica Bharel said. “So we want to act now to protect our children.”

On Oct. 1, the Massachusetts Department of Public Health (DPH) reported five additional cases of vaping-associated pulmonary injury — two confirmed, three probable — to the U.S. Centers for Disease Control and Prevention (CDC), bringing the statewide total of reported cases to 10. (Five of the cases are confirmed, and five are considered probable for meeting the CDC’s definition of vaping-associated lung injury.) At press time, 83 suspected vaping-related pulmonary cases have been reported to the DPH since Sept. 11.

“While no one has pinpointed the exact cause of this outbreak of illness, we do know that vaping and e-cigarettes are the common thread and are making people sick,” Bharel said. “The information we’re gathering about cases in Massachusetts will further our understanding of vaping-associated lung injury, as well as assist our federal partners.”

Some clarity may be emerging, however, particularly concerning the role of tetrahydrocannabinol (THC), an ingredient found in marijuana. According to the CDC, 77% of the people involved in the recent outbreak reported using products containing THC. In Massachusetts, five of the 10 cases involved THC, while another four vaped both THC and nicotine; just one of the 10 reported vaping nicotine only.

Based on this recent data, CDC recommends people consider refraining from e-cigarette or vaping products, particularly those containing THC.

“CDC is committed to finding out what is causing this outbreak of lung injury and death among individuals using vaping products,” said CDC Director Dr. Robert Redfield. “We continue to work with FDA and state partners to protect the nation from this serious health threat.”

More information is needed to know whether a single product, substance, or brand is responsible for the lung injuries, the CDC noted, adding that the investigation is particularly challenging because it involves hundreds of cases across the country, and patients report use of a wide variety of products and substances.

According to the CDC’s most recent national report, of the patients who reported what products they used, about 77% used THC-containing products, with or without nicotine-containing products; 36% reported exclusive use of THC-containing products; and 16% reported exclusive use of nicotine-containing products.

In addition, the report from Illinois and Wisconsin showed that nearly all THC-containing products reported were packaged, prefilled cartridges that were primarily acquired from informal sources such as friends, family members, illicit dealers, or off the street. THC use is legal and regulated in Massachusetts.

“The main theme seems to be illegal THC products. It’s a mix of chemicals in products to sell on the street that just don’t react that well with the lungs,” Dr. Nico Vehse, chief of Pediatric Pulmonology at Baystate Children’s Hospital, told BusinessWest.

He noted that vaping has posed lung issues since it first emerged in the early 2000s. “Back then, we had a recurrence of what they call popcorn lung. If you get fatty lipids into your lungs, your lung tries to fight it like pneumonia, and that causes a lot of lung damage.”

While much of the vaping news surrounds a lung illness, Dr. Nico Vehse says, nicotine addiction remains a persistent danger, particularly for young people.

Whether the current outbreak is a similar phenomenon or something altogether different is the subject of intense study, at the national level but also in Massachusetts. In mid-September, Bharel mandated that Massachusetts clinicians immediately report any unexplained, vaping-associated lung injury to the DPH. Of the 83 suspect cases reported at press time, 51 are still being investigated, with DPH officials collecting medical records and conducting patient interviews. Twenty-two cases did not meet the official CDC definitions, while the other 10, as noted, were reported to the CDC.

Off the Shelf

Baker went a big step further when, on Sept. 24, he declared a public-health emergency and a four-month statewide ban on sales of all vaping products in Massachusetts. The ban applies to all vaping devices and products, including those containing nicotine or cannabis.

The decision generated some pushback, and not just by retailers. Shaleen Title, commissioner of the state Cannabis Control Commission, assailed the ban in a tweet, posting that it is “purposely pushing people into the illicit market — precisely where the dangerous products are — and goes against every principle of public health and harm reduction. It is dangerous, short-sighted, and undermines the benefits of legal regulation.”

As someone who works with young people, however, Vehse understands the DPH’s concern. Of the 10 reported cases in Massachusetts, five are under age 20. Even absent concern over the current lung illnesses, many vaping products have a much higher nicotine concentration than traditional cigarettes, and some public-health officials are concerned an entirely new generation of young people may be falling prey to nicotine addiction. He noted that some products use salts instead of oils, which may not cause the same kind of lung damage as the oils, but deliver more nicotine.

“They improved on the perfect delivery system for addiction — cigarettes — and made it even more potent for nicotine addiction,” Vehse told BusinessWest. “Nicotine addiction is probably one of the hardest things to quit. I’ve always said you’ll have an easier time quitting heroin than quitting nicotine. It’s the most highly addictive substance we have, legally or illegally.”

As part of its public-health emergency declaration, Massachusetts implemented a statewide standing order for nicotine-replacement products that will allow people to access over-the-counter-products like gum and patches as a covered benefit through their insurance without requiring an individual prescription, similar to what the Baker administration did to increase access to naloxone, the opioid-reversal medication.

Other health organizations praised Baker’s decision, for a variety of reasons.

“In the absence of strong federal action, especially by the FDA, states are being forced to make decisions to protect the health of children and adults from a vaping-related public-health emergency,” said Harold Wimmer, president and CEO of the American Lung Assoc.

“While no one has pinpointed the exact cause of this outbreak of illness, we do know that vaping and e-cigarettes are the common thread and are making people sick.”

“Governor Baker’s announcement reinforces the need for the FDA to clear the market of all flavored e-cigarettes in order to address the youth e-cigarette epidemic,” he went on. “While the Centers for Disease Control and Prevention and state and local departments of health continue to investigate the hundreds of cases of lung injury from e-cigarettes, the American Lung Association once again urges all Americans to stop using e-cigarettes.”

Meanwhile, the Massachusetts Dental Society (MDS) also swung its support behind the ban.

“While vaping is believed to pose fewer health risks than smoking regular tobacco cigarettes — the leading cause of preventable death in the United States — it is by no means harmless,” said MDS President Dr. Janis Moriarty. “E-cigarettes still contain nicotine … which increases the risk of high blood pressure and diabetes. E-cigarettes also can have a significant impact on oral health.”

She cited a study supported by the American Dental Assoc. Foundation that determined that vaping sweetened e-cigarettes can increase the risk of cavities. “Additionally, the nicotine in e-cigarettes reduces blood flow, restricting the supply of nutrients and oxygen to the soft tissues of the mouth. This can cause the gums to recede and exacerbate periodontal diseases. Reduced blood circulation also inhibits the mouth’s natural ability to fight bacteria that can accelerate infection, decay, and other problems.”

Time to Act

The main story, however, remains the recent spate of lung illness. At press time, 805 confirmed and probable cases of lung injury associated with e-cigarette product use or vaping had been reported the CDC by 46 states and the U.S. Virgin Islands. Those cases included 12 deaths, but none in Massachusetts.

Bharel hopes her department’s reporting mandate will bear fruit in getting to the bottom of what has become a national concern.

“We are beginning to hear from clinicians about what they are seeing in their practice as a result of the health alert,” she said, adding that the mandate “establishes the legal framework for healthcare providers to report cases and suspected cases so that we can get a better sense of the overall burden of disease in Massachusetts. It also will allow us to provide case counts to the U.S. Centers for Disease Control and Prevention as they continue to try to understand the nationwide impact of vaping-related disease.”

In 2018, Baker signed a law that incorporates e-cigarettes into the definition of tobacco, making it illegal to vape where it is illegal to smoke and raising the minimum age to buy tobacco products, including e-cigarettes, to 21.

Still, the latest statewide data shows 41% of Massachusetts high-school students have tried e-cigarettes at least once. About 20% of them reported using e-cigarettes in the past 30 days — a rate six times higher than adults. Nearly 10% of middle-school students say they have tried e-cigarettes.

In the past year, DPH has conducted two public-information campaigns to raise awareness among middle- and high-school-aged youth and their parents about the dangers of vaping and e-cigarettes. The department promises to reprise both campaigns in the coming weeks and include resources for young people to assist them with quitting.

Vehse said it’s easier for teenagers to sneak a vape at school than to smoke cigarettes, which may contribute to their use. “It doesn’t smell; it doesn’t stay in the air. It’s completely covert. Now high schools have started to install some vaping sensors in bathrooms. As young as middle school, kids are vaping.”

He had no answer to why the usage numbers are so high among a population that shouldn’t even be able to purchase e-cigarettes, but deferred to the simple psychology of being young.

“Maybe it’s just because you’re a teenager and want to do something you’re not allowed to do. It’s all part of the teenager feeling indestrictible,” he said. “But whether you’re cigarette smoking or vaping, both are addictive, and you’re inhaling stuff you’re not supposed to.”

In many cases, they’re inhaling products flavored and packaged in such a way to appeal to kids, he added. “They pretty much make them look like candy bars on the shelves.”

Following a report from the CDC that 27.5% of kids are using e-cigarettes and that many are initiated with flavored products, the AMA’s Wimmer said, “we also call on the Massachusetts Legislature to pass a law prohibiting the sale of all flavored tobacco products.”

For now, Baker, Bharel, and other state officials will continue to assess their most recent moves as the national effort continues to learn more about — and prevent — vaping-related lung disease.

“One of the experts said that, ‘we don’t have time to wait. People are getting sick, and the time to act is now,’” Baker said when announcing the sales ban. “I couldn’t agree more.”

Joseph Bednar can be reached at [email protected]

Health Care

Cultural Shift

Michael Taylor and Teresa Weybrew say Christopher Heights of Northampton is striving to be ‘the place’ for LGBTQ seniors.

The average age of a Christopher Heights resident is somewhere in the 80s, says Teresa Weybrew, director of Marketing & Admissions at the assisted-living community in Northampton.

That’s an age group that grew up in a less-open time when it came to gender identity and sexual orientation — and members of that generation often still feel anxiety around their peers. But what’s more surprising, Weybrew said, is that, for many, that fear of being openly themselves is heightened when they move into senior-living communities.

“There’s a statistic that, of people who have come out and lived an authentic life in their sexual orientation, when they come into assisted living or skilled nursing, 86% go back in the closet out of fear,” she told BusinessWest. “They’re in an environment where they don’t know how safe they are because they have some memory loss or physical ailments — they’re already vulnerable because they’re not quite physically themselves — and then they have this added layer of anxiety. We want to help them understand that we get it, and they’re going to be OK here.”

Christopher Heights recently hosted a workshop for staff, residents, and public on LGBTQ (lesbian, gay, bisexual, transgender, queer) cultural competency in the senior-living setting. Presented by Rainbow Elders, an arm of LifePath in Greenfield, the event was also part of the process of being credentialed by SAGE, the nation’s largest advocacy organization for LGBTQ elders.

“I want our community to be accepting of other residents,” said Michael Taylor, the facility’s executive director, “but we also want employees to feel comfortable and respected. I see this as making it a welcoming place for both.”

Not all communities are. Angela Houghton of AARP Research writes that three out of four adults age 45 and older who are lesbian, gay, bisexual, or transgender say they are concerned about having enough support from family and friends as they age. Many are also worried about how they will be treated in long-term-care facilities and want specific LGBTQ services for older adults.

“I’ve been working with SAGE in a conversation for a couple months,” Weybrew added. “But as I got into it, I realized this isn’t just about having a plaque on the wall. We want to live and breathe and walk the talk and really be the facility that does the work and where people can come in and say, ‘yeah, they really do know what they’re doing, and I feel welcome,’ whether it be an employee or someone who comes to live here.”

Subtle Spectrum

For the recent workshop, Rainbow Elders brought in four people — representing gay, lesbian, bisexual, and transgender perspectives — to talk about gender, identity, orientation, and how none of those categories are black and white, but rather a spectrum.

“It was good educational background. Each talked about their personal story,” Taylor said, noting that Christopher Heights already employs a handful of LGBTQ individuals and aims to create a more welcoming environment for staff and residents alike — which is why hearing these perspectives shared aloud is important.

The demographics speak to the importance of this issue. By 2030, the population of American adults ages 65 or older is expected to surpass 70 million, according the U.S. Census Bureau. The National Gay and Lesbian Task Force puts the number of LGBTQ seniors in the U.S. at 3 million and notes that this figure is expected to double by 2030.

However, LGBTQ seniors frequently report concern over the possibility of encountering discrimination from senior-housing staff or other residents. According to SAGE, 48% of lesbian, gay, or bisexual couples experience “adverse treatment when seeking senior housing,” and transgender elders face such treatment at even higher rates.

Meanwhile, a 2016 report from Justice in Aging notes that 78% of LGBTQ residents in nursing homes, assisted-living facilities, and long-term-care facilities responded ‘no’ or ‘not sure’ when asked if they felt comfortable being open about their sexual orientation or gender identity to facility staff.

Then there are cases like Mary Walsh and Bev Nance, a Missouri couple whose housing application at a local senior-living facility was denied because of a cohabitation policy that defined marriage as between one man and one woman. They sued the facility, but their lawsuit was dismissed by a U.S. district judge in January.

Yes, that’s January 2019, not 1959. Clearly, the work of SAGE and like-minded organizations isn’t done. Cases like this certainly help explain why only 20% of LGBTQ seniors in long-term-care facilities are open about their sexual orientation, according to Justice in Aging.

Yet, attitudes have been shifting — and prejudices hopefully diminishing — over the decades when it comes to this population, and facilities should be welcoming them as an untapped market, notes a report by Sodexo titled “Why ‘LGBTQ-welcoming’ Will Soon Be a Hallmark of the Most Successful Senior-living Communities.”

“Developing a marketing strategy that attracts LGBTQ older adults is the right thing to do,” the report notes. “And it’s good business. Given the opportunity for senior-living operators to advance their growth agenda, developing a strategic plan that attracts and retains LGBTQ older adults and allies is a vital lever to business growth and to improve quality of life.”

To help facilities move in that direction, SAGE launched its credentialing program for retirement communities around the country aiming to create more understanding and resources for these marginalized groups. Its program addresses the specific difficulties LGBTQ older adults face, including abuse, neglect and hurtful comments.

“Most people work with older adults because they have a caring orientation,” said Tim Johnston, director of national projects at SAGE. “We are giving them the tools they need to help older adults feel more comfortable.”

Watch Your Language

In developing a culturally competent and welcoming environment, it is important to address a number of factors, including language, inclusive visuals in company materials, programming, and outreach efforts, according to the Sodexo report.

At Christopher Heights of Northampton, it begins with the application, which used to give only two options for gender — male or female. It may seem like a small thing, but it’s a detail that sets transgender and non-binary individuals on edge right from the start.

“If you’re trans, what do you put?” Weybrew said. “That’s your first exposure to us — and you’re already thinking, ‘all right, they expect me to be a man or a woman,’ when you don’t identify as that.”

She recently asked a resident from the LGBTQ community what might have improved her experience, and she did mention the application form, but she also stressed the importance of respectful communication.

“She said, ‘just ask.’ And we are afraid. We don’t want to offend anyone, and yet, in our fear, we are offending people by not asking them the questions. We want to connect, we need to connect, and that’s what I think this training will offer us — ways to have the conversation. Many people have lived their whole lives feeling either offended or accepted or some awkward in-between. It’s not like we’re going to do something that’s going to shock them.”

Sodexo’s report affirms that idea, noting that “one of the simplest ways to cultivate both understanding and respectful relationships with LGBTQ older adults is through appropriate use of language. Keep in mind, however, that some terms still used by older LGBTQ people may be seen as outdated by younger LGBTQ people. Become familiar with key terminology and pay close attention to how residents use terms and how they refer to themselves and others.”

Indeed, the report continues, “the LGBTQ community is not a monolith. This must be kept in mind when addressing the needs of LGBTQ older adults as well, who have a totally different set of life experiences than younger LGBTQ people. The former grew up in a time that was far less welcoming, when LGBTQ people guarded their sexual orientation and gender identity as a dangerous secret that could cause them to lose their homes, jobs, families, and freedom. They risked being labeled anything from criminal to mentally ill. That generation still carries a lot of this baggage today as they attempt to navigate issues related to housing and healthcare.”

That may be an understatement. SAGE notes that, just a few decades ago, homosexuality was still classifed as a mental illness by the American Psychiatric Assoc., not to mention a crime in some parts of the U.S. Housing, employment, and healthcare discrimination were common. As a result, many LGBTQ seniors remain fearful or distrustful of medical and social-service providers.

Weybrew has assembled an advisory board that will continue to meet regularly going forward and bring in educational opportunities for residents, staff, and the larger community.

“It won’t end. It can’t end,” she told BusinessWest. “We have to keep learning, and we have to say, ‘yes, we see you.’”

She knows she’s already dealing with a vulnerable population. “You’re talking about a potential resident who’s scared because they’re leaving their home of 40 years. Their spouse died, they’re losing their health, and they’re coming to a place where they don’t know us. I know what’s like because I did it with both my parents. Now you add that layer of sexual orientation. We want them to know, ‘yeah, it’s cool to be here because we’re going to treat you right.’

“We’re going to have our issues,” she went on. “We might get some pushback from an 88-year-old who says, ‘God says that’s a sin.’ It’s going to happen. And we’re going to learn how to manage that.”

Not Just Seniors

Senior-living facilities aren’t the only ones recognizing opportunities to boost cultural competency among their staffs. For example, Cooley Dickinson Hospital has been recognized as a 2019 Leader in LGBTQ Healthcare Equality by the Human Rights Commission (HRC), the country’s largest LGBTQ civil-rights organization. CDH is the only hospital in Western Mass. and one of only seven hospitals in the Commonwealth to earn this designation.

Among its efforts, Cooley Dickinson has recruited and trained clinicians who specialize in the care of LGBTQ people; implemented changes to electronic medical records that facilitate the use of the patient’s preferred gender, name, and pronouns; and collaborated with local gender-diverse community members, the Fenway Institute, and researchers from Harvard Medical School on the PATH (Plan and Act for Transgender Health) Project, a study that will inform the expansion of gender-affirming health services in Western Mass.

“This designation affirms Cooley Dickinson’s commitment to providing equitable, inclusive, and affirming care for LGBTQQ patients and their families,” said Cooley Dickinson Health Care President and CEO Joanne Marqusee. “We are proud to receive — for the third consecutive year — this honor and to continue our efforts to ensure that our local LGBTQ community has access to respectful, appropriate care.”

Sure, it’s easier for Northampton-based facilities like Cooley Dickinson and Christopher Heights to make these efforts, which are likely to meet with resistance in less progressive areas of the country. But it’s a start.

“We realize it’s going to be an ongoing process, but we as a company are committed to it,” Taylor said.

Weybrew said Christopher Heights is a corporate sponsor of the Out! for Reel film festival, which focuses on LGBTQ-themed films and recently kicked off its season. “I had a chance to get up and speak. The word is getting out that this is going to be a welcoming place, and it starts with us internally asking, how do we make it that place every day? How do we make people feel comfortable?”

The answer is an evolving one — and begins with asking the right questions of those who have felt marginalized for too long.

Joseph Bednar can be reached at [email protected]

Health Care

Baby Steps

Rachel Szlachetka, Jazz, and Cindy Napoli play in the kids’ room at the Center for Human Development facility on Birnie Ave in Springfield.

When looking at 2-year-old Jazeilis “Jazz” Jones, she seems like any normal toddler who loves to eat and play. But what you can’t tell from looking at her is that Jazz, born a month prematurely, has overcome several developmental hurdles to get to where she is today.

When Diany Dejesus gave birth to Jazz, she was already fighting her own battle with anxiety and depression. A newborn baby who wouldn’t latch to her breast or drink from a bottle only added to her stress and made it nearly impossible for Dejesus to sleep at night. After talking with her therapist, she was referred to the Early Intervention program at the Center for Human Development.

Today, Jazz could seemingly eat all day if you let her, and Dejesus is exponentially more confident as a mother.

This success story, like others similar to it but unique in some ways, wasn’t written overnight, but rather over time and through perseverance — as well a partnership, if you will, between the parent and the 22 staff members of the Early Intervention program.

Erinne Gorneault, a licensed clinical social worker and program director, explained how it works. She told BusinessWest that each child is unique and grows at his or her own pace. But sometimes a child needs help.

“It’s the best feeling in the world to feed your kid. Everybody should be able to have that joy in feeding, and it can be so stressful for our kids who are developmentally delayed or on the autism spectrum.”

With a caseload of 230 families, CHD’s Early Intervention program works with infants and children from birth to age 3 who have, or are at risk for, developmental delays. A CHD team can assess a child’s abilities and, if indicated, will develop an individualized plan to promote development of play, movement, social behavior, communication, and self-care skills. Staff members work with children and their families in their own environment.

The work is extremely rewarding, said Cindy Napoli, an occupational therapist and program supervisor of Early Intervention, who cited, as just one example, how the program can help give parents the gift of being able to feed their child.

“It’s the best feeling in the world to feed your kid,” she said. “Everybody should be able to have that joy in feeding, and it can be so stressful for our kids who are developmentally delayed or on the autism spectrum.”

For Jazz, her biggest challenge was with feeding. At one point, she was labeled as “failure to thrive,” meaning she was unable to grow or gain weight. Even when Napoli and other CHD staff found a solution by having her drink through a straw, she was still struggling. Now, Jazz is thriving, eating more than enough food to keep her healthy, and speaking in full sentences.

“She’s doing so great, I’m so amazed. At the beginning, it started off so slow, I was really afraid for her. I didn’t know what I was going to have to deal with, but she’s way ahead of herself now.”

Erinne Gorneault says that being receptive to parents’ wants and needs is a critical part of the early-intervention process.

For this issue, BusinessWest takes an in-depth look at CHD’s Early Intervention program and that aforementioned partnership between team members and parents to achieve life-changing results for both the child and the parents.

Food for Thought

Gorneault said parents often contact CHD’s Early Intervention program because they are concerned about their baby or toddler’s development in the areas of speech delays, or delays in walking or crawling.

The experienced team can assess the possibility of a delay and work with parents and their children to help them attain their milestones — essentially, to catch up — if that’s what’s needed.

Program staff members also work with children diagnosed on the autism spectrum, infants and toddlers with feeding concerns, toddlers with sensory issues, and infants and toddlers with medical needs. They support the family by providing education and improving developmental milestones through teaching parents to interact with their infant or child while building strong emotional relationship. In all cases, staffers work with families to connect them with other community services that might be helpful and provide several playgroups for both community members and CHD Early Intervention families to participate in without interactive team members.

Although the 22 staff members in the program may be the experts, Napoli said the most important part of their work is going at the parents’ pace and empowering them to be advocates for their child.

“It’s about enabling and empowering the parents to be the lead person and the specialist,” she said. “We believe the parents are the specialists. It’s about empowering them and teaching them how to be advocates.”

Gorneault agreed, adding that the trans-disciplinary approach used at Early Intervention allows them to guide parents effectively while also keeping them in the driver’s seat.

Diany Dejesus says that one of the most beneficial things that has come out of her participation in the Early Intervention program with daughter Jazz is that it has built up her confidence as a mother.

“We just help; the parents are the ones doing all the work,” she told BusinessWest. “They’re the ones working on the outcomes; they are making the difference.”

With occupational therapists, physical therapists, and speech therapists in the program, staff members use a trans-disciplinary approach to work with families and find the best way to help achieve milestones.

“You don’t go in there with blinders on, thinking, ‘I’m only here for feeding,’ or ‘I’m only here for walking,’” said Napoli. “It’s about where the child is at, where do we want them to go, what are the priorities of the family, and how can we all do it together?”

One of the most important aspects of this program, said those we spoke with, is that the specialists work with the families in their most natural environment, usually the home or a day-care facility, in order to get the most successful outcomes.

“Being in the home, you’re able to adapt the environment,” said Napoli. “You’re able to see what they’re cooking. I can’t say enough about the natural environment.”

One of the priorities during the hour-long sessions staged over several weeks is working on what is most difficult for the parents, said Napoli. Once staffers have made their suggestions, their goal — and their hope — is that parents continue to practice the suggested strategies on their own.

“You’re modeling in hopes to encourage the parent to do the same thing,” she explained.

This is important, she said, because while CHD staff see the child for only one hour a week and specialists may visit a family at different times, parents are with the baby daily, almost 24/7.

Gorneault agreed, adding that being receptive to the parents’ wants and needs is a critical part of the process.

“They run the show,” she explained. “We make recommendations, but if they’re not ready for that, we slow down and just stay at their pace and support them and build their confidence as parents.”

A Matter of Confidence

And a confidence boost was exactly what Dejesus needed.

“I started off doubting everything, due to the fact that I have anxiety and depression; it just made it so much harder for me,” she said. “Little by little, with a lot of help from here and from my therapist, I just got reassured more, and it made me that much more confident.”

Dejesus said the people she interacts with at CHD are like another family, and have helped her achieve the confidence she needs to be a great mother.

“Having more people that can help you and guide you, that really did help me a lot,” she said. “Now, I trust myself and my instincts as a mom when it comes to Jazz.”

Kayla Ebner can be reached at [email protected]

Health Care

Taking Important Steps

By Mark Morris

Dr. Christopher Peteros prepares a patient for laser therapy.

Dr. Christopher Peteros prepares a patient for laser therapy.

Spring weather in New England is a great time to shake off winter’s cabin fever and head outside to take a walk, go for a run, or play a sport. Spring also means an increase in foot injuries from people being too active, too soon.

While overdoing it can cause aches and pains in many areas of the body, it’s easy to overlook our feet, which support everything else and are key to overall quality of life. Those who specialize in this realm of care have a simple word of advice: don’t.

They stress the importance of taking care of one’s feet, listening to them when they are sore and need attention, and fully understanding how it’s not unusual for foot pain to be the cause or the result of other pain in the body.

“Sometimes foot pain causes knee, hip, or back issues, and by the same token, if someone has pain in their knees or back, it puts the foot in an awkward position, resulting in foot pain,” said Dr. Christopher Peteros, a podiatrist with New England Foot Specialists in Longmeadow, who stressed the importance of paying attention to pain, calling it our body’s early-warning system.

“If you feel pain in your foot, knee, or ankle, it’s telling you to stop what you’re doing,” he told BusinessWest. “It’s like the ‘check engine’ light in your car.”

When we walk or run, the foot’s natural movement is known as pronation (the inward roll of the foot) and supination (the outward roll of the foot), both of which move us forward while providing support, cushioning, and balance. Too much or too little of either pronation or supination can cause pain in the feet and other parts of the body.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies.”

Terrance McKeon, a physical therapist with Cooley Dickinson Health Care’s Rehabilitation Services in South Deerfield, refers to the foot as the ‘victim,’ because it’s often the one in pain while the culprits can be nearby or as far away as the hip or pelvis. To carry the analogy further, McKeon said that, when investigating the cause of foot pain, the calf muscle is often a prime suspect, because when the calf muscles are tight, the body adjusts by collapsing the foot.

“Your foot tries to maintain balance by unnaturally scrunching the toes,” he explained. “Then the fascia gets stretched, the Achilles tendon gets overstretched, and you may even wiggle your pelvis, all because your calf muscles aren’t letting you get over your foot.” 

Brianna Butcher, a physical therapist at Select Physical Therapy in Enfield, agreed. “When someone walks in with foot issues, the first thing I check is their hips,” she said, adding that, since the glute muscles tend to be weak in many people, it causes more strain to be put on the leg and foot to compensate and maintain balance.

For this issue, we take an in-depth look at what causes foot pain and discomfort and how to prepare your feet for activity.

Walking the Walk

Those who spoke with BusinessWest there are a number of factors that contribute to one’s overall foot health — or lack thereof. These include everything from the level of exercise to the type and condition of the shoes being worn, to the surface that people walk or run on.

Terrence McKeon demonstrates an orthotic insert for a patient.

Terrence McKeon demonstrates an orthotic insert for a patient.

People should be thinking about all of them and making smart decisions, said Butcher, who noted, for example, that serious runners opt for an asphalt road instead of a concrete sidewalk, because the asphalt surface is slightly less harsh on our bodies than concrete.

“I’m not telling people to go walk in the middle of the street, but if you know of a neighborhood with a cul-de-sac or a circular street, those are better choices than sidewalks, which are a harder force on our bodies,” she said, adding that, for those who live near a track, that’s an even better option than walking on the street.

While sidewalks can be too hard on our feet, Peteros said treadmills can create the opposite problem and result in repetitive-motion injuries.

“Some treadmills can be too soft, so as your foot sinks in, it creates an abnormal amount of repeated pronation while the person is walking, which can lead to tendinitis or plantar fasciitis.”

One of the most common causes of foot pain, plantar fasciitis affects the band of tissue that runs along the bottom of the foot from heel to toe. The plantar fascia acts like a shock absorber to support the arch of the foot. Too much strain on it leads to a stabbing pain in the heel.

Many factors can contribute to plantar fasciitis, but it often results from a change in activity levels that puts more stress on the heel. Peteros said likely candidates for plantar fasciitis include the person who hasn’t run in years and then decides to pursue it again, as well as the person who goes on vacation and does more walking than normal while wearing flimsy shoes.

Peteros said a person with plantar fasciitis tends to experience severe pain in the morning after just waking up. The pain subsides a little after moving around, and then, by the end of the day, it increases. He said the pain can move into a cycle that won’t easily go away.

“It’s a very difficult thing to treat in some cases,” he said, “because you’re using that sore foot for every other step you take, unlike a sore hand where you can just carry it around.”  

The first remedy Peteros suggests for plantar fasciitis and other foot injuries is the easy-to-remember acronym RICE: rest, ice, compression, and elevation. People can do this on their own, and in many cases RICE along with good, supportive shoes is enough to solve the problem. If that doesn’t work, he has a variety of treatments to further care for plantar fasciitis.

Anti-inflammatory medicines or cortisone shots are two possible treatment options. While cortisone can be effective for some, Peteros said, he cautions against its overuse because the shots can create ruptures in the plantar fascia instead of healing it.

For several years, he has used laser therapy to treat plantar fasciitis. As an alternative to anti-inflammatory medications, laser therapy uses a beam of light so it’s painless for the patient, works to reduce inflammation, and allows for faster healing. He said the success rate for healing injuries by laser therapy is about 80%.

“Depending on the injury, most patients will need between five and 10 treatments, which take about 10 minutes each. It may not always lead to a cure, but it speeds up the process,” he said.

For chronic foot issues, Peteros also uses shock-wave therapy, which treats plantar fasciitis with sound waves. He said it functions much like the technology that uses sound waves to break up kidney stones, adding that the same company makes the two machines.

When taken care of quickly, he said most people will get great results and no longer need treatment for their plantar fasciitis.

“Some patients may get an occasional flare-up, usually because they did something they shouldn’t have done. The key is to be aware of it, protect yourself, and stop as soon as you feel any pain.”

Getting to the Bottom of Things

That bit of advice applies to all aspects of foot care, said McKeon, who told BusinessWest that, overall, it’s best to best to be proactive and avoid the energetic enthusiasm of taking too much advantage of a nice spring day.

“Your brain says, ‘I used to run five miles a day,’ but when you’ve gone all winter without running even one or two miles, that’s breaking the 10% rule,” he said, explaining that the best way to prevent injury when approaching spring activities is to take it easy in the beginning and gradually increase activity levels no more than 10% a week.

Physical therapists have used the 10% rule for years, and recent studies have supported the idea that the body can react and get stronger from a 10% increase each week for nearly any activity.

“If you can obey the rule, especially for weight-bearing activities like walking and running, you’ll be fine,” said McKeon.

Brianna Butcher inspects a patient’s foot for injury.

Brianna Butcher inspects a patient’s foot for injury.

This can require some pre-planning, he added, noting that simple heel-raising exercises for the calf muscles are a good way to get ready for a walking or jogging routine.

“Strengthening calf muscles is easy because you just go up and down on your toes. Go up on your toes to hit full height, then back down, and do them until you get tired,” he said, adding that the yoga position downward-facing dog is an effective exercise for tight calf muscles. He then stressed that the 10% rule also applies to the stretches.

As essential as good conditioning is to prevent foot injury, these proactive steps can easily be undone by cheap or worn-out shoes — or the wrong kind. McKeon said serious runners should consider new shoes every six months because the foam in the shoe that absorbs the energy of running will lose its ability to bounce back with heavy use.

Peteros also emphasized the importance of protecting the feet with good hygiene and proper shoes. “Whether you are a runner, walker, or any type of athlete, good, supportive shoes are the foundation of healthy feet.”

Peteros recommends shoes designed for the specific activity in mind, with a stiff sole. “If you can bend the shoe in half, it’s not offering support.”

One of the best examples of warm-weather shoes that provide no support are the ever-popular flip-flops. Peteros did not condemn them, necessarily, but referred to them as “purpose-built.”

“If you’re sitting around the pool, or at the beach, or even on your back deck with an iced tea, they’re perfectly fine to wear,” he said, adding that problems arise when people continually wear flip-flops around town, because the feet have to work hard just to keep them on. “Your toes are scrunching as they’re trying to grip the flip-flop, and there’s just no support; they’re actually more trouble than they’re worth.” 

Peteros also mentioned the dangerous practice of people who wear flip-flops to mow the lawn, adding that yardwork is another place where good, supportive shoes matter.

“A lot of people retire their old, beat-up sneakers to wear in the yard, but when you’re doing yardwork, you’re often on uneven ground, when your feet need support the most.”  

A work boot or hiking boot is a great choice for yardwork, he said, because they are lightweight and supportive. Meanwhile, high-top or low-cut shoes are both fine, he noted, stressing that these shoes should be kept just for yardwork; don’t retire them to the yard only after they’ve worn out.

Because every foot is different, people with overly high arches or flat feet often need additional support from custom orthotic inserts. Peteros admits that some people can get good results with over-the-counter insoles and advised that, when shopping for inserts, firmer is better. When a custom orthotic insert is needed, he said the old methods to make them have given way to 3-D digital imaging that results in an orthotic that fits the exact contours of the person’s foot.

“We used to make casts and molds and have people step in foam. I haven’t done those things in at least nine years; it’s all digital now.” 

McKeon said finding the right footwear for those at one extreme or another can be tricky, while people whose feet are more in the middle range may be able to slowly build up strength in their feet and avoid using an insert.

“I tell people that, if they gradually increase their activity levels following the 10% rule, they can improve the strength in their foot,” he explained. “This works well with athletes who don’t like wearing orthotic inserts.”

So, before taking on outdoor activities this spring, remember supportive shoes, the 10% rule, and RICE. You’ll prevent injury to your feet and better enjoy the spring weather.

Health Care

Leveling the Playing Field

Spiros Hatiras

Spiros Hatiras says the Massachusetts Value Alliance has created what he called a “virtual system” for the state’s independent hospitals.

Spiros Hatiras was asked about the Massachusetts Value Alliance and, more specifically, how it improves the buying power of its members, including the one he serves as president and CEO — Holyoke Medical Center (HMC).

He handled the assignment by referencing the hospital’s ongoing work to implement a new electronic medical record (EMR) system, and with an analogy that puts this concept in its proper perspective.

“Let’s say you went to Ford and asked them to build you a car, but told them that, instead of putting the power-switch buttons on the window side, you wanted them on the center console — the cost to customize the car the way you wanted it would be enormous,” he explained. “It’s the same with EMR; what hospitals used to do, and still do, is go to an EMR vendor and ask them to come in and build and install a system for that hospital.”

The Massachusetts Value Alliance, or MVA, as it’s called, is a coalition that is enabling its members to depart from that expensive scenario.

Indeed, several members of the alliance, which now includes 14 community hospitals, have come together to order an EMR system that will be customized for a group — with minor tweaks for each specific facility — and not one hospital. The savings will be substantial — in fact, Hatiras pegs the cost at roughly $5 million for HMC, close to half of what the cost might have been.

“Instead of us individually customizing, we get three hospitals to come together and say, ‘what are the features that make sense for all of us, and let’s build it one time and implement it in three locations.’”

“Our patients are not that different; in fact, they’re not different at all from the other hospitals, and the processes that we use are very similar — the order set, the treatment protocols, are all very similar,” he told BusinessWest. “So, instead of us individually customizing, we get three hospitals to come together and say, ‘what are the features that make sense for all of us, and let’s build it one time and implement it in three locations.’”

This is the very essence of the MVA, which was formed three years ago by founding members Emerson Hospital in Concord, Sturdy Memorial Hospital in Attleboro, and South Shore Health in South Weymouth. It has added new members steadily since then, and the alliance now also includes HMC, Berkshire Medical System, Harington Healthcare System, Heywood Healthcare, Lawrence General Hospital, Signature Healthcare, and Southcoast Health.

These are smaller, independent hospitals that enjoy the benefits of being independent and the ability that gives them to be focused on the needs of their respective communities, said Dr. Gene Green, president of the MVA board of trustees and president and CEO of South Shore Health. But they don’t enjoy the buying power and other cost-saving benefits of being in a larger healthcare system.

Dr. Gene Green

Dr. Gene Green says the MVA gives its members a very potent commodity in these challenging times — buying power.

The MVA, operating under the slogan “Health Care Is Better When We Work Together,” was created to level the playing field in at least some ways.

“There’s always greater bargaining power with numbers,” Green explained, adding that the MVA has helped its members reduce the cost of everything from laboratory services for their patients to health insurance for their employees. “Although a lot of people do group purchasing on common things, there are other things, especially within hospitals and healthcare systems, that are specialized, and so the question was, ‘how do we help each other bring our numbers together and help each have more bargaining power with third-party vendors?’”

The MVA was the answer to the question. It was in many ways inspired by a similar system in Connecticut called the Value Care Alliance (VCA), said Green, and today, the two alliances are collaborating to create additional economies of scale.

For this issue, BusinessWest takes an in-depth look at the Massachusetts Value Alliance and at how it is benefiting its members across the state during what remains a very challenging time for all hospitals, but especially the smaller, independent institutions.

Group Rates

Hatiras told BusinessWest that he was approached by the president of Sturdy Memorial not long after the MVA was created and encouraged to become part of the new group.

As he recalls the conversations, it wasn’t a very hard sell.

That’s because the value — yes, you’ll be reading that word a lot during this discussion — was readily apparent. And value is something these hospitals certainly need.

“We were quick to join — we’ve been a member almost from the beginning,” said Hatiras. “This is something we ought to be doing because, as independent hospitals, our resources are much more limited.

“This was a way to bring these hospitals together and join forces in terms of acquiring resources without merging assets or governance,” he went on, recounting two of the obvious downsides to becoming part of a large healthcare system. “We’re creating an almost virtual system.”

And within this virtual system, there exists that all-important commodity of businesses of all kinds, but especially hospitals that purchase a seemingly endless array of products and services — buying power. The alliance uses it with everything from laboratory services — there’s a contract with Quest Diagnostics — to elevator services, Green explained.

“The question was, ‘how do we help each other bring our numbers together and help each have more bargaining power with third-party vendors?’”

“It was a way for us to help each other find cost reductions and efficiencies to help drive down the cost of care, hopefully — unfortunately, revenues are declining at the same time we’re doing the cost cutting — and serve our communities.”

Hatiras agreed.

“We don’t have the benefits of a, quote-unquote, system,” he said, referring to the independent hospitals in the MVA. “But we replicated a lot of the those benefits with this alliance.

“We don’t have a mothership that can come to the rescue if one of its members isn’t doing so well — we don’t have that backup,” he went on. “But aside from that, all the other benefits of a system are there — the sharing of information, the sharing of best practices, collaboration, shared negotiation on resources, and more.”

And the alliance enables its members to enjoy greater buying power while also remaining independent, meaning decisions are made locally, a quality these hospitals covet.

“As independents, we’re very focused on our communities, and we’re very proud of that,” said Green. “That’s one of the reasons we came together — to see how we could help one another through cost-effective measures to be able to carry on our missions. We all have the same mission and focus on patient care, patient experience, and high quality.

“All of us are good at partnering with people in our own communities,” he went on, “which made us naturals to be able to partner with one another.”

Green said the group will collectively decide where opportunities to collaborate may exist, and then individual members have the opportunity to opt in or not, an operating mindset that provides members with a good deal of flexibility.

“We didn’t want to force anyone into doing something,” he explained. “If you had a contract that was good for five years, when that expires — and we have one — you can opt in, or you can stay with your own, depending on the relationship.

Which brings us back to that example of EMR that Hatiras mentioned. It’s a perfect example of just how and why the alliance works.

This is a project that involves HMC, Harrington Healthcare System, and Heywood Healthcare, all working with EMR-system designer Meditech.

“This allows to take advantage of tremendous economies of scale because we work on a common build and share common resources, which allows to do this build at a significantly lower cost than if we did it alone,” said Hatiras, adding that HMC will go first, with the other hospitals to follow, with an August 2020 ‘go live’ date for the system.

Bottom Line

Green told BusinessWest that, as reimbursement rates for care decrease, or hold steady, and as the price of technology and everything else hospitals buy continues to increase — the savings generated by the MVA are even more important.

“They enable us to stay afloat,” he said in a voice that clearly conveyed just how challenging these times are for all hospitals, but especially those who have chosen to remain independent.

That choice has left them without a safety net, if you will, but in the MVA, they have something that replicates a system in so many ways.

As that chosen slogan suggests, healthcare is better when people work together.

George O’Brien can be reached at [email protected]

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