WALLINGFORD — MidState Medical Center hosted its annual meeting on November 14 at the Connecticut Hospital Association. During the program MidState presented its annual Crystal Obelisk Award, which since 1991 has honored individuals and groups for outstanding contributions to health care. Radiologist Sherwin Borsuk, MD was named as the 2011 recipient.


Borsuk joined the medical staff of MidState predecessor Meriden-Wallingford Hospital in 1978, and for more than 30 years has served the hospital in multiple capacities. Earlier this year he became an active member of the board’s Quality Committee, which sets quality goals, establishes, monitors and assesses measures of performance, quality of care, clinical safety and adverse events.


Borsuk “is a mentor to his staff, is proactive in making things easier for them to be more productive, and is adamant about providing the highest quality services,” said MidState director Bruce Eldridge, who presented the award.




 BRIDGEPORT — A report released by HealthGrades, an independent source of physician information and hospital quality ratings, named St. Vincent’s Medical Center a recipient of the Coronary Intervention Excellence Award for 2011. The report found that patients treated at five-star-rated hospitals experience a 73-percent lower risk of mortality and a 63-percent lower risk of complications compared to one-star-rated hospitals.


“This third-party endorsement validates the patient care provided by our excellent cardiologists, nurses, other clinical staff and support team,” said Lawrence Schek, the Bridgeport hospital’s vice president and chairman of cardiology.  “St. Vincent’s has a long history of excellent cardiac-care outcomes. We have invested in new technology and expanded and renovated our interventional cardiology area, so we can provide the safest and highest quality care to our patients.”

 NEW HAVEN — The U.S. Green Building Council has awarded LEED (Leadership in Energy and Environmental Design) certification to Smilow Cancer Hospital at Yale-New Haven Hospital (YNHH) in recognition of the hospital’s successful sustainable design and construction strategies.

The LEED Green Building Rating System is the nationally accepted benchmark for the design, construction and operation of high-performance green buildings, providing verification that a building was designed and built using strategies aimed at improving performance across all metrics.

“When planning for Smilow Cancer Hospital began in 2002, sustainable strategies, including LEED certification, were not easily attainable in health-care facilities because of their high energy demands and other constraints,” said YNHH President and CEO Marna P. Borgstrom. “We are very pleased with this recognition knowing that Smilow Cancer Hospital is the largest health-care facility in Connecticut to receive LEED certification.”

Completed in 2009, the 516,000-square-foot Smilow’s sustainable features include optimum circulation of natural light in lobbies, corridors and waiting areas to reduce energy consumption; occupancy sensors in non-patient spaces to further reduce energy usage; pumps with variable speed drives and room pressure monitors to reduce power usage for enhanced air supply.

 BRIDGEPORT — Starting this month Housatonic Community College is offering two non-credit Patient Care Technician courses. The PCT Program, which adds another layer of skills to those earned in a Certified Nurse’s Aide program, prepares students to perform patient-care activities that include such things as lab tests, electrocardiograms, simple dressing changes, phlebotomy, and physical and occupational therapy. Two funding sources are available: the Connecticut Jobs Bill and the Workforce Investment Act.

The training offers a career-ladder pathway that will enable interested people, including unemployed individuals and underemployed health-care workers, to develop the skills necessary to seek higher-level positions in health-care facilities. There are 20 available seats for each course. To learn more phone the HCC Center for Lifelong Learning at 203-332-5057.

 The state's health insurance exchange, a key part of federal health reform, is intended to give individuals and small businesses more options for buying insurance. But for many people in Connecticut, the new marketplace might not bring affordable coverage options when it launches in 2014, according to a consultant to the board developing the exchange.

That's because according to data from Connecticut insurers, the majority of health plans sold to individuals and small businesses provide less generous coverage — most likely, at a lower cost — than plans sold on the exchange will be required to provide.

The analysis suggests that people buying insurance through the exchange could get plans that offer more coverage with lower out-of-pocket costs, but they would likely have to pay more for them.

"It's going to be very difficult for the exchange to compete in the marketplace based on price," Paul Grady, a partner with the consulting firm Mercer, said during a presentation to the exchange board. He added that small businesses and the uninsured tend to be very sensitive to the price of coverage, which will likely be a driving force in their insurance selections.

But Grady added that the exchange could compete in other ways, such as by offering innovative health plans that can reduce costs by improving health, or by targeting employers that don't provide coverage to workers.

Health reform requires plans sold on the exchange to be offered at four different levels of "actuarial value," which refers to how much of the benefits the plan pays. A plan with a higher actuarial value covers more of the costs of health care, with the member responsible for fewer out-of-pocket costs like copayments or deductibles, while a plan with a lower actuarial value would leave more to the member to pay. Generally, those with higher actuarial values have higher premiums, while those that leave the members to pay more out-of-pocket have lower premiums.

Under the health reform law, plans sold on the exchange must come at four levels: bronze, silver, gold and platinum. The minimum, bronze, must have an actuarial value of 60, meaning the plan would cover an average of 60 percent of a member's health care costs and the member would be responsible for the other 40 percent.

But in Connecticut, a large swath of the population that could buy coverage through the exchanges currently have plans that fall below the bronze level of coverage, the Mercer analysis found. Half of employers with fewer than 50 workers provide coverage below the minimum that an exchange plan would provide.

Larger companies are more likely to offer plans with higher actuarial values, known as "richer" plans. Only seven percent of companies with 50 to 99 workers provide "below-bronze" coverage, as do five percent of companies with between 100 and 499 workers.

But that's not the exchange's target market. When the exchange starts in 2014, it will be required to cover only people who buy coverage on their own and employers with 50 or fewer workers.

If the exchange isn't likely to be able to compete with the rest of the insurance market based on price, Grady said, it could still have an important role.

He noted that larger employers, who tend to have more control over their insurance plan designs, have been able to contain their health care costs without shifting costs to employees by using innovative plan designs, such as by encouraging the use of preventive care or managing chronic conditions.

Small businesses tend to buy their coverage from insurers, rather than designing their own plans, and Grady said products that mirror what large employers do have not been developed for the small-employer market. The exchange board could play a role in encouraging them, he said.

In addition, Grady said, the exchange has an opportunity to reach small employers who don't offer insurance to their workers now, and who don't understand how the insurance marketplace works.

Board member Mary Fox suggested another niche.

"Since we can't compete on price, we could compete on elements like transparency and consumer education and making sure that we have simple products, simply and well explained to the consumer," she said. "Because I think one of the things that would be attractive would be to kind of reduce the complexity in the overall insurance marketplace."

William Van Deventer, a senior associate at Mercer, said that in general, people who have more health risks and need more medical services are going to be attracted to gold or platinum plans that require fewer out-of-pocket costs for getting care, while people who are healthier would tend toward bronze plans.

Federal health reform requires health plans to cover the full cost of preventive services, with no out-of-pocket costs to members, Grady noted. "But the people aren't going to get those preventive services because they're worried if they get to there and they find out that there's something wrong with them, they're not going to be able to afford the care that's necessary," he said.

Grady also spoke of the difficulty of operating a health insurance exchange. Massachusetts has one, known as the Massachusetts Connector, but it has limited options for small businesses; none of the major insurance carriers in the state offer products for small businesses on the exchange, and only about 4,000 small businesses participate.

By contrast, Grady said, Connecticut already has an effective exchange, run by the Connecticut Business and Industry Association, or CBIA. It has about 75,000 members and covers about a third of the small employer market, with a choice of 25 plans.



This story originally appeared in Ctmirror.com.


 SCSU, WCSU to collaborate on new academic program for 2012


HARTFORD — A new academic program that has been under study for some time has finally graduated to the real world.

The doctor of education in nursing degree was approved by the Connecticut Board of Regents for Higher Education earlier this month, making the course of study part of the state-system curriculum. The program will be a collaboration between Southern and Western Connecticut State Universities, with faculty from each used to establish and direct course work.

Administrators at the two universities “saw this need for creating educators to teach,” says Paul Steinmetz, WCSU’s interim associate vice president for institutional advancement.

“There’s a nursing shortage in Connecticut,” adds Bernard Kavaler, the Connecticut State University System’s assistant vice chancellor for public affairs. “We need more educators.”

The inaugural class of up to 25 students will begin course work in the fall of 2012. Students studying on a part-time basis are expected to take four years to complete degree requirements, which include 51 credits and hands-on teaching experience.

“It’s easier to do a full program with two schools working together,” Steinmetz says, adding, “We both have excellent resources and excellent faculty. There are more benefits, and we can offer a more robust program.”

All courses will be conducted online, giving degree candidates — many of whom will be working full- or part-time — greater flexibility, Steinmetz says. “We thought more people would be able to take advantage of it that way.”

While a Ph.D. (doctor of philosophy) degree is geared more towards academics and research, an Ed.D. is oriented more towards examining a subject area and applying knowledge from a practitioner standpoint, Steinmetz explains.

In considering new Connecticut State University System initiatives, says Kavaler, “We look to see if there is demand and interest for the program, if there is a need for the program in the state, and if there is a capacity to deliver on the program.” The Ed.D. in nursing program met those criteria “across the board,” says Kavaler, adding that a number of potential students already have expressed interest in the new program.

 NEW HAVEN — Axerion Therapeutics is investigating potential treatments for neurological injuries and diseases such as Alzheimer’s using technology licensed from Yale University.

Axerion’s prion protein (PrP) project is developing a biological and a small-molecule approach to block the binding of amyloid beta oligomers to PrP in the brain to prevent brain dysfunction. The results could prove to slow or halt the progression of cognitive decline in Alzheimer’s patients.

The company’s Nogo platform, meanwhile, is developing treatments to re-grow axons, which play vital roles in neurological function. This potentially could restore function in patients with spinal cord injuries and other nervous-system disorders.

Annual costs of spinal cord injuries, stroke and Alzheimer’s disease in the U.S. is estimated at $228 billion.

Axerion was founded in 2009 by New Haven-based Scheer & Co. and Yale University, along with Yale faculty members Stephen Strittmatter and Sylvia McBrinn.

The biotech company’s efforts recently attracted a $400,000 investment from Connecticut Innovations Inc., which previously also awarded the company a $600,000 grant.

Peter Blume, MD

Affiliated Foot & Ankle Surgeons

New Haven


Pioneering podiatric surgery — and saving diabetics’ limbs


“You’re going to lose your leg. Or, you can see Peter Blume.”

It may sound dramatic, but for diabetics faced with the bleak prospect of losing a limb, Peter Blume, MD might be their only hope.

The podiatric surgeon finds himself at the forefront of diabetic limb preservation and reconstruction, and has worked and traveled tirelessly to keep patients here and abroad standing on their own two feet.

Blume practices at Affiliated Foot and Ankle Surgeons on Blake Street, a practice started 54 years ago by his podiatrist father, James Blume, who still practices there at age 79.

His schedule is exhausting even to think about. He sees upwards of 50 patients at Blake Street three days a week, operates two days a week at Yale-New Haven Hospital, does the rounds there over the weekend, and teaches surgical residents. This is in addition to a massive amount of research and a long list of publications (current count is 119) that he and his team put out.

While evidence of his awards, certifications and recognitions are made visible upon entering his office, he speaks altruistically of his work, while a deep concern for his patients’ well being is evident in his speech.

“I do it all — bunions and basic foot surgeries, and arthritic surgery — but my excitement is in diabetic limb preservation,” Blume says. “You’re rewarded when a patient comes back and they’re walking in a shoe, and they have returned to a somewhat more stable life.”

After finishing his residency at Georgetown Medical Center in 1994 he decided to pursue a plastic surgery fellowship — not for the face, but for reconstructing extremities in those with diabetes or gangrene. It was an “unheard of” move at the time. Even 15 years ago, he said, treatment was relatively rudimentary and the amputation rate was high.

“I learned how to do skin grafting and flaps, and all sorts of reconstruction, and then applied those principles to limb preservation,” he says. “When I started, this whole process was quite limited. There were very few institutions that had limb teams.”

With staggering diabetes statistics — just over eight percent of the U.S. population now has the disease and more than 60 percent of non-traumatic lower limb amputations occur in those with it — the need is greater than ever. Up to 40 percent of Blume’s patients are diabetic. And while amputation is necessary for some, he views it as a last resort, since those that lose one limb are 50 percent more likely to lose the other within five years.

He relays the story of a train conductor patient, now on a hopeful path to recovery.

“He’s maybe 51 years old, and was told he was going to lose his foot. He’s got a wife and family; we’ve got to do something,” he says. “Our goal is to get him back to work. Otherwise, he can’t support his family, he’ll have to go on disability and Medicare and sit at home. He’ll be devastated.”

His use of an external fixating device called the Ilizaroff apparatus, which sets a patient’s foot in place with the aid of metal wires that pass through the bone (think of the spokes on a bicycle wheel), earned him the Ilizaroff Award of Excellence at the International External Fixation Symposium last year.

Blume traveled to Siberia, and later Greece and Italy to hone his skills with the device.

“I’m one of maybe two in the state that uses them at the volume I do,” he says. “I’m known in the community and the Northeast at large as the guy that does Ex-Fix and limb preservation. That’s my forte.”

This is evident by the number of referrals he gets from hospitals all over the region, even New York and New Jersey. While it might seem a no-brainer for these tools to be used more broadly, Blume says being centered at Yale provides the finances, manpower and skill set that other hospitals may not have.

“You have to remain at a big academic center — it takes a lot of hands,” he says. “I may have a colleague with me, then three residents. Someone has to hold the frame, then drill. It takes a lot, plus needing a team of residents and big staff to manage the diabetic problems, the cardiac issues and the vascular surgery issues .

“That’s why I like where we are,” Blume concludes. “I want to be in New Haven, because I get to see patients from everywhere.”

But the technological advances don’t necessarily make treating patients easier. Some of the biggest obstacles he’s faced with lie in an overall lack of education and attentiveness in some patients and the larger population.

Lifestyle and healthy eating habits are key, but with most his patients not even having sensation in their feet, detecting a problem becomes that much more difficult. Something as simple as checking your shoes to make sure you don’t spend the next few days with debris bruising your feet can make all the difference.

He often will have to talk with patients ahead of time to make sure they have an adequate support system at home.

“There are a lot of social issues that play a role here. We always say, ‘Don’t do the surgery unless you can do the post-op, because we don’t want a disaster,” he says. “The easy route is, we can cut your leg off. But we can save it. It’s going to take time and you have to work with me. I can’t achieve this on my own.”

He acknowledges all this is compounded by social and economic issues.

“Some people are just trying to work and stay afloat; the last thing they care about is how much they eat, and checking their sugar,” he says. “That’s why this isn’t just a disease, it’s a social issue.”

While government regulations and expanding insurance coverage make seeking treatment easier, Blume says he still treats some patients without insurance — including at a once-a-month orthopedic indigent clinic at Yale for no cost.

“It’s part of what we do,” he says. “Let’s just get you better.”

Blume has lent his expertise all over the world, and even visited Cuba last year to look at a breakthrough epidermal compound being developed there. Next spring he’ll lecture in China, where he says the meat-and-carbohydrate-centered Western diet is becoming more common.

Blume is determined to help his patients through the disease intact, and is all the more grateful to have the resources New Haven has to offer at his fingertips.

“We’re not just saying, ‘Hey, we do diabetic foot surgery and we’re really great, so you should come here.’ We put our heart and soul into it through research, education, teaching, and a comprehensive approach.”