The sooner the care, the better the health outcomes

January 31, 2019
Direct access helps physical therapy patients save time, money and hassle

It’s a fact: Providing patients with direct access to physical therapy services is proven to improve medical outcomes, lower costs and make wiser use of healthcare resources. Now, area residents and visitors can enjoy these benefits with direct access to physical therapists at Aspen Valley Hospital (AVH).
Direct access is the ability for individuals to see a physical therapist without a physician’s order. In the past, for example, a skier who has a sore back or a hiker who sprained her ankle might have to wait a while before receiving specialized therapeutic treatment. That’s because they first had to call their primary care physician for an appointment, wait for the appointment, and then have the physician assess the injury and write the referral for physical therapy.
“The old system was essentially delaying treatment,” said Louie Carder, Director of Rehabilitation Services at AVH. “With direct access, the patient can contact our Quick read more or view full article physical therapy department directly, schedule an appointment and start receiving care within a few days, if not sooner.”
A vital part of a sensible solution
Direct access was introduced in Nebraska in 1957, and it is now available in many nations around the world. Every U.S. state has some form of direct access, although specific rules and policies vary. In Colorado, direct access provides physical therapists with the important advantage of being able to order imaging services as part of a thorough evaluation of the patient’s injury. If the physical therapist determines that the situation requires more intensive care than physical therapy can provide, he or she will send the patient to a physician who can address the larger issues.
“We’re not trying to replace physicians. There are serious injuries and diagnoses where patients do need to see a primary care provider or orthopedist first,” Carder said. “We’re trying to capture musculoskeletal injuries that are not as serious and can be treated effectively through physical therapy with as little delay as possible.”
Patient-focused approach to care
The benefits of direct access are most apparent to patients, who stand to save time and hassle, receive a diagnosis faster and start treatment sooner.
“We’re doing this for the patients,” AVH Physical Therapist James Spencer said. “Not only can direct access lower costs for patients, it can also save them from unneeded imaging and medications that might be ordered. Most important, we’re trying to decrease the time between when the injury occurs and when the patient starts receiving treatment. Studies show that the sooner we can treat the individual, the better the patient’s outcome.”
A growing body of research backs up the efficacy and efficiency of direct access. A study published in the March 2, 2014 issue of the Journal of the American Physical Therapy Association found that “physical therapists practicing in a direct access capacity have the potential to decrease costs and improve outcomes in patients with musculoskeletal complaints without prescribing medications and ordering adjunctive testing that could introduce harm to the patient.”
In addition, a 2016 article in the Journal of Orthopedic & Sports Physical Therapy, which focused on a review of previous research involving direct access for physical therapy patients with spinal pain, concluded, “Studies consistently showed that early receipt of physical therapy was not associated with unfavorable outcomes (more pain/function/disability, increased medical utilization, more physical therapy visits per episode) or with increased cost.”
Putting physical therapists’ skills to use
Direct access’ benefits are evident across the board. It can free up primary care physicians’ time, since some patients can now bypass the referral process. Because it potentially saves money, direct access can also reduce costs for health insurance providers. (Carder cautioned that patients should check with their health plan for specific benefit information. AVH does not currently accept Medicare or Medicaid coverage for direct access.)
Physical therapists also like direct access because it allows them to perform tasks for which they are already trained, such as screening and diagnosing patients.
“It’s a better use of our expertise, because we’re using a broader range of our capabilities,” Spencer said. “When a patient comes to us directly, we get to use the diagnostic skills we developed during our training — being more of an investigator and figuring out the puzzle on the front end. We’re highly trained in musculoskeletal conditions, and an important piece of direct access is that we’re trained to know when a patient needs a higher level of care.”
To learn more about direct access at AVH or to schedule a physical therapy session with one of our therapists, please call 970-544-1177. Read Less
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New Year Roboot: January Detox by Chris Miller, MD

December 28, 2018

It’s a new year, and a great time to reset healthy eating. Call it a reboot, or a detox, but if the holiday decadence leaves you with food cravings, weight gain, fatigue, headaches, joint pains, and basically not feeling your best, it’s time to reset your eating. I’m talking about a healthy detox, and here are a few of my favorite tips to get back on track:

1.  Add in a green vegetable juice or green smoothie daily to increase nutrient load—I like to make them with different greens, celery, carrots, cucumber, lemon, ginger and turmeric. They’re purposely not sweet, but tart with a kick, are hydrating and refreshing, and really help jump start healthy eating. They are also helpful to break food cravings, which can be really ramped up after holiday extravaganzas.
2.  Enjoy lots of raw veggies and fruit from the color of the rainbow. Red, orange, yellow, green, blue, Quick read more or view full article purple. These will provide the needed vitamins, minerals, and antioxidants necessary to facilitate your liver and kidneys to optimally remove waste and reduce inflammation.
3.  Eat 1-2 cups cruciferous veggies—from the cabbage, kale, broccoli, cauliflower family—every day. Also eat sulfur-containing veggies, such as onions and garlic. These provide necessary nutrients to facilitate the liver to ramp up detoxification and clear out chemicals and waste products.
4.  Drink plenty of water—at least 0.5-1 ounces of water per pound body weight, or 0.5-1 gallons per day. Our cells are bathed in water, and being well-hydrated will help clear waste products and toxins more efficiently.
5.  Exercise and move your body—this is important to get the lymph system moving, as waste is more efficiently picked up and excreted from the body. Walking 10-30 minutes per day is helpful; more intense workout even more so.  

Do we even need a detox?

It certainly can be helpful, as enduring a period of time where we eat less pro-inflammatory foods; reduce intake of food additives and chemicals; consume fewer overall calories; take in nutrient-rich, real whole foods; drink plenty of fluids; get proper movement and rest; and spend time in self-care can help increase cellular repairs, healing and rejuvenation. We can also end those food cravings and resume a healthier way of eating.  

Join us for our healthy “Detox Diet” event at the Plant-Based Recipe Swap on January 3, 2019, from 12-1pm at AVH.

We’ll be discussing top foods and tips for a healthy reboot, sharing favorite plant-based recipes, and supporting each other as we start the New Year on a healthy note.
  Read Less
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AVH Traumatic Brain Injury Program provides healing and hope

December 27, 2018
As an avid skier and mountain biker, Michael Hayes had suffered his share of concussions. So at first he wasn’t surprised when, after a skiing accident in February 2018, he began to experience symptoms such as disorientation and irritability. Images taken in the Emergency Department at Aspen Valley Hospital (AVH) soon after the accident hadn’t revealed any bleeding in Michael’s brain, and he was instructed to go home, rest and return to normal activity slowly. After more than a week, however, his symptoms were still debilitating.

“When I’d had concussions before, I had always returned to typical activity shortly afterward,” Michael said. “With this one, I wasn’t able to do much of anything. I wanted to sleep all the time, overstimulation put me into a serious pain cave, I was disoriented, and I forgot conversations and entire events. I was a shadow of my former self. It was pretty scary.”

Growing Demand

For years, head injuries such as Michael’s have been a growing concern in Quick read more or view full article the Roaring Fork Valley — especially for pediatric patients, as injuries to a developing brain can have significant, long-standing effects. So in 2010, AVH Occupational Therapist Krista Fox began exploring ways to improve the medical outcomes for these patients. “At the time, many people weren’t getting comprehensive follow-up care for a brain injury,” Fox said. “We just didn’t have a good way to manage them.”

All of that changed when AVH launched its Traumatic Brain Injury Program in 2014, allowing physicians, therapists, trainers and others to access best practices when managing adult and pediatric patients. Since then, the need for these services has only grown, and AVH’s program is one of most progressive and comprehensive brain injury programs on the Western Slope.

[Pictured: Krista Fox, OT, works with a patient at AVH using the state-of-the-art Bioness Integrated Therapy System (BITS) technology. The system is part of the progressive care offered at AVH which assesses the physical, visual, auditory and cognitive abilities of individuals with brain injuries, movement disorders as swell as competitive athletes.]

“Our Emergency Department now sees more than 2,000 visits each year for head injuries, largely activity-related but also caused by car accidents, falls and work injuries,” noted Kimber Kurr, a Physical Therapist with the program, who is also a board-certified pediatric specialist. “Fortunately, physicians and patients are much more aware of our ability to truly make a significant difference in recovery from brain injury.”

In addition to Fox and Kurr, the program’s staff includes Physical Therapists Amy Bumgarner and Ellen Barlow, Occupational Therapist Marissa Meinema and Speech Language Therapist Lizzy Ransbottom.

[Pictured below, left to right, members of AVH's Traumatic Brain Injury team: Amy Bumgarner, PT; Lizzy Ransbottom, SLP; Krista Fox, OT; Marissa Meinema, OT; and Kimber Kurr, PT.]

Highly individualized care

When treating brain injury, an aggressive, personalized approach is associated with improved long-term outcomes, with treatment starting within a few days of the injury. Care begins with a comprehensive assessment to identify the affected systems.

“Brain injury can be incredibly complex,” Bumgarner said. “We have to look at different types of impairments — visual, emotional, cognitive, balance, cervical or neck pain, sleep disturbances, changes in activity tolerance and so on — as well as more traditional focuses of rehab, such as general muscle strength.”

From there, the therapy team creates an individualized program that includes regular visits to the program’s home base at AVH, daily exercises at home and, typically, collaboration among the program’s different therapists, as well as other hospital and community resources.

Length of treatment depends on an array of factors, from the severity of the injury to how well the patient responds to treatment. Many patients recover from mild brain injury in a few weeks, while treatment for severe injury may continue for years.

Michael's journey continues

With his fiancé’s encouragement, Michael reported his symptoms to his Neurologist, Brooke Allen, MD, who encouraged him to contact the Traumatic Brain Injury Program.

Although his expectations were low — “I just wanted to feel some degree of normalcy” — Michael saw encouraging signs quickly. “From my first appointment until now, it’s been a slow and steady improvement process,” he said.

“I don’t want to sound like I’m proselytizing, but I am: Don’t mess around with a head injury. I feel incredibly fortunate to have the AVH team beside me to provide strong, evidence-based recovery.”

For more information, call AVH’s Traumatic Brain Injury Program at 970.544.1177. Read Less
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First-time parents grateful for ‘incredible’ AVH maternity care

November 30, 2018
First things first: Kellyn and Erik Wardell’s son, Henry, is now about eight months old, healthy and doing great. However, soon after he was born at the Aspen Birth Center at Aspen Valley Hospital (AVH), his health wasn’t quite as robust. Because he was delivered more than 24 hours after Kellyn’s labor started, Henry had a high risk of infection.

Initially, everything seemed fine. “He was happy, healthy and a little over 7 pounds,” Kellyn said. “I got to be with him right away, he took to breastfeeding and the first night was normal.”

The next day, Henry’s grandparents arrived and, in keeping with an AVH tradition for new parents, Kellyn and Erik were treated to a sumptuous dinner. Everything seemed primed for checkout Sunday morning.

Given the length of Kellyn’s labor, though, the Birth Center staff had monitored Henry’s health closely. Early Sunday, AVH Hospitalist Mike Goralka, MD, ordered blood Quick read more or view full article tests that showed a high level of infection. Henry also started spitting up and acting a little unusual, so he was moved to the nursery, placed in a warmer and started on intravenous antibiotics.

“That was tough,” Kellyn admitted. “He wasn’t in our room anymore; he was unhappy and on oxygen — and this was 48 hours after we had our first baby. As first-time parents, we were definitely emotional.”

At the same time, Kellyn knew her family was in good hands. “The hospital staff was so incredible, so amazing,” she said. “Erik and I felt so supported throughout. The staff did a tremendous job of making us feel comfortable and confident.”

By Monday, Henry had improved enough that he was moved back into his mom’s room where Dr. Goralka and the AVH staff could continue to monitor Henry’s status. By Wednesday, the family returned to their home in Carbondale.

“Henry’s situation ended up not being that serious, but the hospital staff was really cautious and always five steps ahead,” Kellyn said. “We’re very grateful to them.”

For more information about the Aspen Birth Center, including childbirth education classes, lactation services and other resources at AVH, please call 970.544.1130 or visit Read Less
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The best gets better

November 30, 2018

New HSS, OrthoAspen partnership ensures access to the most advanced orthopedic care

When does 1 + 1 = 1? When the nation’s top-rated musculoskeletal hospital partners with one of the nation’s top-rated orthopedic specialist groups to make both organizations even stronger.

That occurred on August 13, when the Aspen Valley Hospital (AVH) Board of Directors approved a co-management relationship between AVH and its OrthoAspen orthopedic practice with Hospital for Special Surgery (HSS), the New York-based orthopedic hospital that U.S. News & World Report has ranked No. 1 in orthopedic care for nine consecutive years.

As one of the world’s premiere communities for year-round sports activities, Aspen has long been a place where state-of-the-art orthopedic care was particularly important. For that reason, geography was also one of the factors that led to AVH/OrthoAspen becoming HSS’ first stand-alone partner. As HSS expands nationally and globally, partnering with OrthoAspen ensures that Aspen residents and visitors will Quick read more or view full article have access to the most advanced orthopedic care.

A convergence of cultures
The seeds for the agreement were planted nearly two decades ago, when several key individuals became acquainted through their association with Aspen. One was Todd J. Albert, MD, now Surgeon-In-Chief at HSS, who over the course of frequent visits to Aspen formed a lasting relationship with Tomas Pevny, MD, Orthopedic Surgeon at OrthoAspen. In addition, a few members of the HSS Board of Directors had second homes in Aspen.

All of those natural ties informed the formal discussions that began about a year ago when Louis A. Shapiro, President and CEO of HSS, reached out to AVH about HSS and AVH/OrthoAspen establishing a relationship.

“The timing was right — we were looking for someone who had experience in improving practice efficiencies,” Dr. Pevny said [pictured at left]. “Moving forward, we are interested in having a teaching and research role. Plus, if OrthoAspen gets to the point of needing to hire a subspecialist in orthopedics, HSS could help us identify an ideal candidate. In every way, this association is good for us and the Aspen community.”

Waqqar Khan-Farooqi, MD, Medical Director of OrthoAspen, agreed [pictured at right]. “As the organizations began exploring partnership possibilities, the agreement felt more and more natural and organic,” he said. “Both are nonprofit hospitals with long histories of community service and a commitment to providing the best possible care for their patients.” 

“Our physicians and AVH’s physicians know each other and have mutual respect, and we started to have a natural dialogue,” Shapiro added [pictured below]. “This is a relationship where two organizations can come together to take something already outstanding to the highest level.” 

A bridge to a healthier future
The partnership will create a “medical bridge” between HSS and AVH with specific goals of improving orthopedic care, research, training and innovation. Transforming those goals into reality will involve clinical knowledge transfer, medical staff development, practice quality enhancement, professional education and academic programming.

Consider this: In 2017, HSS staff treated more than 135,000 patients and performed more than 31,000 surgical procedures. With such vast and ever-growing experience, HSS is uniquely positioned to make recommendations to AVH in areas such as clinical policies and procedures that can improve cost efficiency, quality, outcomes and overall patient experience.

“OrthoAspen has exceptionally well-trained physicians. What they don’t have is access to the massive knowledge that exists at HSS because of our history and volumes,” Shapiro said. “Everything about clinical practice is knowledge you get from seeing the same things over and over again. AVH will have access to all that information; it will seep into the organization and help extraordinary doctors become even more extraordinary.”

Many areas of cooperation
With the agreement in place, HSS will send a team to assess AVH/OrthoAspen from an operational standpoint and determine how to begin sharing people, knowledge, data and more.

While HSS physicians probably won’t provide direct care in Aspen, they will be available for consultations. Also, AVH/ OrthoAspen may host HSS residents and fellows, and AVH/OrthoAspen staff may spend time at HSS facilities observing procedures, performing research and accessing educational programs.

“This is an exciting time for all of us at OrthoAspen,” Dr. Khan-Farooqi said. “We’re eager to tap into HSS’ innovative, high-quality, research-oriented culture and implement best practices in caring for orthopedic patients.”

Visit OrthoAspen in two convenient locations:

Aspen Valley Hospital
0401 Castle Creek Road, Suite 2100
Aspen, CO 81611

Midvalley Medical Center
1450 E. Valley Road, Suite 201
Basalt, CO 81621

To book an appointment in Aspen or Basalt, please call 970.544.1289 or visit Read Less
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