Five New Doctors Settling in at Rush
Midwest Orthopaedics at Rush (MOR) is pleased to announce that five new physicians have joined its team. These standout doctors are:
- Jeremy Alland, M.D., a, sports medicine physician
- Nicole T. Boniquit, M.D., a sports medicine physician
- Kamran Hamid, M.D., a foot and ankle surgeon
- Gregory Lopez, M.D., a spine, back and neck surgeon
- Nicholas Ting, M.D., a hip and knee reconstruction and replacement surgeon
Dr. Alland graduated from Rush Medical College. He went on to complete a family medicine residency at the University of Pittsburgh Medical Center St. Margaret Hospital, followed by a sports medicine fellowship at Rush. He is a team physician for the Chicago White Sox, Chicago Fire Soccer Club and Windy City Bulls (Chicago Bulls NBA D-League team).
Dr. Alland told OTW, “Being active is a vital part of a healthy lifestyle. What I love about sports medicine is the ability to help keep people active. I see myself working with patients on individualized plans-of-care that allow them to return to activities or to assist them in finding new forms of exercise that provide fitness without pain. I also hope to expand our offerings for arthritic patients with the ultimate goal of increasing function and decreasing pain.”
Dr. Boniquit graduated from Loyola University Chicago Stritch School of Medicine. She completed a categorical pediatrics residency at University of Chicago Medical Center and a fellowship in primary care sports medicine at Hospital for Special Surgery, where she served as assistant team physician for several sports teams, including the New York Giants, New York Mets, St. John’s Athletics and several local high school football teams.
Dr. Boniquit told OTW, “I understand that staying active has positive influences on health, physical, mental, and social well-being. I look forward to keeping individuals of all ages and all levels as healthy and active as possible. As a Primary Care Sports Medicine physician, I not only address current injuries, but also help prevent future ones from occurring. My role is one of a clinician, educator, and researcher.”
Dr. Hamid earned his medical degree from Texas A&M College of Medicine and went on to complete his master of public health degree in Quantitative Methods at the Harvard School of Public Health. He then completed his residency at Wake Forest University Medical Center and fellowship in orthopedic foot and ankle surgery at Duke University School of Medicine.
Dr. Hamid told OTW, “It is an honor to join the world-renowned physicians at Midwest Orthopaedics at Rush. I plan to carry on the MOR tradition of excellent patient care delivered with compassion and integrity. In the following years, my partners and I will be expanding our orthopaedic foot and ankle research program while continuing to provide cutting-edge clinical care at Rush.”
Dr. Lopez graduated from the University of Notre Dame with a bachelor’s degree in arts, anthropology and pre-professional studies. He earned his medical degree from the University of Texas Health Science Center at San Antonio School of Medicine, then completed his orthopedic surgery residency at University of California Irvine. He then completed a spine surgery fellowship at Midwest Orthopaedics at Rush.
Dr. Lopez told OTW, “I am grateful for the opportunity to be a part of Midwest Orthopaedics at Rush, as the venues to impact patient care are endless. Building from my training on treating complex pathology of the spine, I look forward to taking care of patients in the Chicago area with the latest in cutting edge technology.”
Dr. Ting earned his medical degree from Loyola University Chicago Stritch School of Medicine. He then completed his orthopedic residency at the Cleveland Clinic Foundation and adult reconstruction fellowship at the OrthoCarolina Hip and Knee Center.
Dr. Ting told OTW, “Starting practice at Midwest Orthopaedics at Rush really is somewhat of a homecoming for me. As a medical student, I spent a year with the renowned hip and knee surgeons here doing clinical research that translated directly to patient care. It was here that I found my passion for orthopaedics and learned the importance of being a clinician researcher. I learned that outstanding patient care means not only excellence in surgery and at the bedside, but also in furthering the boundaries of clinical knowledge about complex problems in hip and knee replacement so that our patients—both present and future—can benefit directly.”
Can New Vertebroplasty Study Restore Funding?
Several studies have demonstrated that vertebroplasty is a safe and effective procedure for those with vertebral compression fractures (VCFs). But after the publication of two studies in 2009 some insurers decided to reduce their support for vertebroplasty. Researchers in Australia, where patients were denied access to these procedures by reimbursers, decided that they owed it to their patients who could use vertebroplasty to put any safety or efficacy issues to an updated test.
In their new study, coined VAPOUR (A Controlled Trial of Vertebroplasty for Acute Painful Osteoporotic Fractures), the investigators conducted a randomized, masked trial that involved 120 patients. The results were published in the Lancet, one of the oldest most respected medical journals in the world. In the study, patients received either vertebroplasty or a placebo procedure. The pain reduction results were indeed better for those in the vertebroplasty group (44% vs. 21%). Functional disability was significantly better with vertebroplasty than with placebo.
Joshua A. Hirsch, M.D. is past president of the Society of NeuroInterventional Surgery, Vice Chair and Director Interventional and Endovascular Neuroradiology at the Massachusetts General Hospital. Dr. Hirsch is an internationally recognized expert on these procedures and has published extensively in the space. Dr. Hirsch and his colleague Dr. Ronil V. Chandra wrote the invited expert companion commentary for Lancet readers in response to the study.
Dr. Hirsch told OTW, “Vertebroplasty was widely considered an outstanding treatment for osteoporotic and cancer patient suffering from painful compression fractures (or lytic metastasis) until 2009. At that time, two blinded RCTs [randomized controlled trials] were published in the NEJM [New England Journal of Medicine]. These two trials failed to demonstrate a meaningful benefit of vertebroplasty (there was a trend in the larger trial but it did not reach statistical significance) and this had implications. In the case of VAPOUR, the most notable implication was the loss of public funding for the procedure in Australia. That is what led Bill Clark et al. to commence their investigation in Australia.
“Trials assessing procedures for pain vs. sham (as in meniscal or spine surgery), are complex to perform and suffer from many challenges; it is difficult to prove a therapeutic effect. INVEST and Buchbinder (NEJM trials from 2009) were not exceptions to this rule. However, open label RCTs including FREE, VERTOS 2 and CAFÉ did demonstrate vertebroplasty and kyphoplasty to be far better than the real world comparators patients that were no longer being considered for v- or k- pasty were offered. To be clear, far better—very strong statistical evidence—in support of doing the procedure(s) for OP and cancer patients.
“Additional papers by Ediden et al. (though there are contrarian points of view in the literature based on a different kind of statistical analysis, i.e., propensity analysis and Ediden was an employee of Medtronic at the time) point to a mortality benefit of doing these procedures vs. conservative management. If the mortality benefit is a true finding, the implications of not considering augmentation in these patients are quite dramatic and real.
“VAPOUR demonstrated that beyond the pain reduction benefit, additional non-QOL issues were helped with v-plasty. Since the study went out 6 months with X-ray follow-up, we see that vertebral height is better maintained. Having helped stoke the debate years ago with publication of our observational cohort in Radiology, there would also now appear to be compelling evidence that the observation that VCFs increased after augmentation in other vertebrae was incorrect (VERTOS 2/VAPOUR). Moreover, in a point that could be almost linearly connected to a multi-society position statement from 2007 (Jensen et al.) conservative therapy (which includes back braces, pain meds including narcotics and bedrest) is not risk free therapy as the benign name might suggest.
“We published an article in JNIS [Journal of NeuroInterventional Surgery] in 2012 that looked at the CMS [Centers for Medicare and Medicaid Services] database through 2010. The impact of the two NEJM articles was dramatic and quick. We have a follow-up article in press that extends that analysis through 2014—the impact is persistent. My hope is that VAPOUR opens the discussion back up. Patients should be able to make an informed decision and too many, in my opinion, have been denied that opportunity. I believed that before VAPOUR came out, i.e., the two NEJM trials had a disproportionate impact on access to care. It is my sincere hope that all of these trials are seen as learning opportunities to help providers figure out how to best provide care, not, as opportunities to deny these most vulnerable patients treatment.”
Need Surgery? Name Your Price!
You named your price for the airfare and car. Would you like a rotator cuff repair to go with that? Such orthopedic services are now available through ZendyHealth and Kerlan-Jobe Orthopaedic Clinic (minus the travel amenities).
The “Pick Your Price” platform, says ZendyHealth Founder Vish Banthia, has evolved from the company’s involvement in the Techstars Healthcare Accelerator, an entity hosted by Cedars-Sinai (a Kerlan-Jobe affiliate).
Banthia told OTW, “As hospitals are looking to avoid patient ‘leakage’ they are increasingly interested in a platform where patients can purchase services and pay cash. The platform, similar to Priceline, means that patients can bid on services such as knee replacement and rotator cuff repair. It’s a revolutionary way to shop for healthcare.
“Through ZendyHealth we match patients with a Kerlan-Jobe practitioner who is offering discounted treatment options for self-pay patients. Kerlan-Jobe orthopedic surgeons are world-class, and work with several Southern California professional sports teams including the Lakers, Dodgers, Kings and Ducks.
“We are improving access to care, as well as making progress on the issue of price transparency. There are many hospitals and academic centers in the U.S. that are full to capacity; however, some of these institutions may have satellite facilitates with unused capacity. As health systems are looking for ways to become more efficient, it makes sense to optimize capacity.
Asked about challenges, Banthia commented, “There is a sentiment of consumers wanting price transparency, but some hospital systems may be reluctant to disclose these numbers. With our platform, we allow hospitals to creatively create price transparency. One of the reasons why hospitals—even smaller hospitals—are interested in our platform is that they now have a creative, acceptable way to accept cash without having to list detailed pricing information on these procedures. So we are looking to partner with health systems that have unused capacity.
“As we expand into different states, we are open to feedback from orthopedic surgeons. At present we are in talks with other hospital groups to customize our platform for their institutions. At Kerlan-Jobe, for example, we developed a model where patients can access procedures such as PRP (platelet-rich plasma) and stem cell injections, shoulder scope procedures, and more by paying cash. Some of these procedures are not typically covered by insurance and are already cash-based services.
“This platform is the wave of the future and we are proud to be leading the way and providing new options for patients especially as they are bearing more of the financial responsibility in the form of higher deductibles and co-insurance payments.”
