The Whirlybird Anthology of Kansas City Writers
Edited by: Vernon Rowe, Maryfrances Wagner, David Ray, Judy Ray
Cover Photograph by Elizabeth Rowe
The Whirlybird Anthology of Kansas City Writers presents poems, stories, and memoir selections from 95 writers who have lived or worked in the Kansas City area, many of whom have earned widespread recognition in this country and internationally.
“In some of the selections Kansas City itself is subject or backdrop, for example when Richard Rhodes and Hilary Masters recall specifics of their childhood, or when David Owen returns to explore remembered odors, or when poets respond to the influences of jazz. But also found in these pages are subjects and styles as varied as can be imagined—and imagination is not bound by place.” – from the Preface to the Anthology
Other regional collections have been published in previous years. This work stands on their shoulders, highlighting some of the finest examples of widely published authors, but also introducing new voices to the Midwest medley. In addition to a note of biographical information, many of the authors also provide a personal sound-bite observation about Kansas City.
The Anthology will be launched at a celebratory Reading on November 30, 2012 at 7 p.m. at The Writers Place, 3607 Pennsylvania, Kansas City, MO 64111. 816-753-1090
Dr. Vernon Rowe answers a reader's question about sleep disorders:
Question: I am looking for information for a friend who snores loud and stops breathing in their sleep. How should they even start getting their treatment? I don't even know where to begin.
Answer: Your question is a very important one and your friend is very lucky to have someone like you watching out for them. What your friend needs to understand is that snoring is NEVER normal. There can be different reasons why people snore and some reasons are more serious than others but you have clarified that your friend snores loud and stops breathing which is a hallmark sign of sleep apnea.
Of course the only way to truly know is to have a sleep study at a sleep lab (at this time I don’t recommend "at home sleep testing" because of the equipment deficiencies; mainly reduced sensitivity that can result in a false negative polysomnogram). You can find an accredited sleep center near you by entering your zip code at this link.
Schedule a new patient visit with a physician who is board-certified in sleep medicine. While any physician can write an order for a sleep evaluation, a physician board certified in sleep medicine is much more intimately familiar with how various sleep disorders are identified and treated. At the initial visit, a short evaluation will ask many questions about the patient’s sleep habits, medical history and symptoms that may indicate if a sleep disorder is present. If deemed necessary, a polysomnogram (sleep study) will be ordered.
If scheduling at Rowe Neurology Institute's Sleep Center: Our schedulers will verify insurance coverage for the sleep study and review the details with your friend. Once the sleep study has been completed, a board certified sleep medicine physician will review and interpret the data, make a diagnosis and discuss with your friend what the next steps should be. PAP therapy is the most common treatment for sleep apnea (because it is simple and it works) but there are other options that can be discussed as well. The important thing you can do now is not let your friend continue to go undiagnosed and untreated.
Sleep apnea is a real health risk with links to heart disease, stroke, diabetes and other serious health problems. The good news is that sleep apnea is treatable and your friend will wish he/she had done something sooner. Good luck.
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The Headache Center at Rowe Neurology Institute has said over and over that there is no single cure for migraine, because every patient is unique and must be evaluated and treated individually. However, there is a pattern developing of satisfied (former) migraine sufferers that all seem to be singing from the same hymnal. In recording their testimonials, like the one below, a common migraine story is developing.
• Had regular or daily headaches
• Currently on or tried multiple medications with little improvement or bad side effects
• Evaluated at Rowe Neurology Institute
• Found previously undiagnosed sleep disorder (like sleep apnea or RLS)
• Usually a side-sleeper or sleeps on their stomach
• Pinched nerves in the neck (possibly triggering migraines)
After a comprehensive neurological evaluation these migraine sufferers receive an individualized treatment plan developed to fix the root cause(s) of their migraine. Patients are most appreciative that they are not simply getting another drug to treat their symptoms. The common treatment “formula” that has emerged.
- Physical therapy to correct the mechanics of the neck and shoulder complex and to strengthen weaker muscle components to correct movement patterns
- Sleep study to diagnose and properly treat the sleep disorder
- Learning to sleep in a “neutral spine” position that was previously difficult or impossible due to undiagnosed/untreated sleep disorder
- Unparalleled expertise in medication management to eliminate or pare down medications to a bare minimum
This model of care at Rowe Neurology Institute (RNI) is unique in that the care provided from RNI's accredited sleep center, the clinical neurologists, electrophysiologist, neuro-radiologists and physical therapist are all coordinated together. Communication happens seemlessly and easily between the different departments so that ultimately, the patient experiences the most effecitive and cost-efficient care possible.
This weekend you moved your clocks back one hour and, if you listened to the public service announcements, replaced the batteries in your smoke detectors. Hopefully, you slept well knowing you had fresh batteries in the smoke detectors and your alarm went off at the right time and you made it into work and ready for a productive week.
But what if you still feel tired and don’t feel refreshed when the alarm rings. Or your focus and concentration is “off” at work. Maybe you lightly doze off at the red light waiting for it to turn green.
Daylight savings is a good time for a self-evaluation of your sleep. Sleep disorders are one of the most common undiagnosed health problems in our society and the consequences of untreated sleep disorders can be costly. Long term, untreated sleep disorders lead to health problems such as cancer, heart disease, memory loss, depression, and diabetes. Short term, untreated sleep disorders can be deadly on an individual basis or in large scale disasters.
Screening for a sleep disorder can be simple.
One test that physicians use is the Epworth Sleepiness Scale (ESS) which can be self-administered by clicking on the following link. Online EPWORTH SLEEPINESS SCALE test.
What was your score?
If you scored 10 or higher, please consult your physician about your sleep or schedule an appointment to visit a sleep specialist in your area. Don’t expect your family physician to address your sleep during routine check-ups unless you specifically ask.
Find a board certified sleep medicine specialist in your area and schedule an appointment.
If you are in or near the Kansas city area, you can request an appointment online at the Rowe Neurology Institute's Sleep Center.
Don't forget to forward this test to someone you know that snores or is chronically tired... and remind them to change their batteries.
Senior Advisor at Rowe Neurology Institute, Elizabeth S. Rowe, PhD, MBA recently traveled to Washington, DC to participate in MedPAC’s hearings on payment policy. Dr. Rowe’s comments follow:
Comments for: The context for Medicare payment policy 090612
Omitted from last year’s Report is a key cause of the increase of cost of Medicare expenditures: the effect on rising costs of the shift of physicians to hospital employment was not included in the 2012 Report. It is now clear that it is the single most important cause of rising costs that can be easily remedied. Payment policies must be changed to incentivize the low cost providers, and keep them from going out of business.
Outpatient medical services payments should be the same regardless of setting, including both physicians and ancillary testing facilities.
The level of these payments should be sufficient to incentivize the continued existence of low cost physician private practices and low cost free standing facilities for imaging, sleep studies, and all other outpatient testing and services that do not require hospitalization.
- Physicians are rapidly being recruited away from private practice and into hospital employment (in the hospital outpatient department or HOPD).
- The disparate payments for the same services in different settings are driving up costs for both Medicare and beneficiaries with no clinical benefits.
- If this trend continues the result will be a system of self-referring high cost HOPD monopolies for services that could better be provided in the lower cost private practice outpatient setting.
The massive shift of physicians from private practice to hospital employment, coupled with the disparate payment schedules, has several serious aspects and consequences.
- Payments to hospital OPD’s for office visits are 80% higher than for identical visits to privately owned physician offices (MedPAC March 2012 report). These higher payments by CMS also lead to higher co-pays by beneficiaries.
- Payments to hospital outpatient departments for imaging, sleep studies, and other services are 2-5 times higher than to privately owned free standing facilities. For cardiology example see Same Doctor Visit Double the Cost, WSJ Aug 27, 2012.
- Private practitioners and free standing outpatient testing and imaging centers are being driven out of business by low payments.
- Captive hospital employed physicians refer their patients to their high cost employers’ hospital owned testing centers, facilities and specialties, in a self-referral cycle in which physician salaries are linked to “production”.
- The existing “market” in which patients have choice of primary care physicians, and in which their primary care physicians have a choice for further referrals, based on their professional judgment, is rapidly being destroyed because of the lack of choice of hospital employed primary care physicians in their referral behavior. Once the shift of primary care physicians in an area reaches a critical mass, the free standing private practice “market” will be gone. Patients will no longer have a lower cost physician or facility to choose from.
- This monopolization of outpatient care by HOPD’s also creates a quality of care issue because patients will no longer be referred to the best available care in their areas, but instead to whatever specialist their HOPD system happens to have onboard. And if the trend toward concierge medicine continues, the best physicians will be the ones who are not part of these monopolies run by administrators and will not be available to Medicare beneficiaries.
REASONS FOR THE SHIFT OF PHYSICIANS INTO HOSPITAL EMPLOYMENT:
- Hospitals are clearly incentivized to employ physicians because of all of the above; especially the capture of the physicians’ downstream referrals.
- Physicians are incentivized to accept hospital employment because of the lowering payments in private practice to the point that private practice is untenable.
- Physicians are also incentivized by the salary premiums that hospitals can offer due to 1, 2 and 3 above.
- Physicians may not want to deal with the business aspects of being in private practice, which has been made increasingly burdensome and with ACA is expected to become worse. Costs are skyrocketing while reimbursements are literally shrinking.
- Specialists are forced into hospital employment when their referral base is eroded due to the change to hospital employment of their referring physicians. They are incentivized to go into hospital employment by both reduced payments and reduced referral base.
WHAT CAN BE DONE TO CHANGE THIS ADVERSE TREND?
- Equalize payments for ALL outpatient services to make them independent of setting, as has already been recommended for office visits.
- Set the new equal payments to be sufficient for private practicing physicians so they have a choice, and can stay in or go back to private practice if they prefer. Increase payments
for all outpatient services including imaging, sleep, and other testing for free standing outpatient facilities so that they can also stay in business.
- Immediately include hospital HOPD’s in Stark rules that require patients to be told about available alternative facilities and specialists whenever they are being self-referred by the hospital employed physician.
- Increase payments to hospitals for those services that they are uniquely required to provide, and which are now being subsidized by the overpaid outpatient services. Pay them the real cost of what we really need them to provide: trauma, intensive care, etc.
A recent article in the New England Journal of Medicine disects how “market friendly” ACA or Obamacare and its impact on the US healthcare system. The entire NEJM article can be read here.
Dr. Vernon Rowe, founder and medical director of The Rowe Neurlogy Institute, felt compelled to respond to this article in the NEJM to shed light on the ACA’s implications for patients as well as outpatient physicians:
This is a profound article. It strikes at the heart of the main reasons for escalating health care cost, the main one of which is our institutional and hospital-based system of care. This system is growing ever stronger by the day with the legal purchase of primary care practices, stifling any possibility of market forces operating in healthcare.
“…but they fundamentally misunderstand what it takes to be market-friendly… What is needed are reforms that create clear financial incentives that promote value over volume, with active engagement by both consumers and the health care sector. Market-friendly reforms require empowering individuals, armed with good information and nondistorting subsidies, to choose the type of Medicare delivery system they want.”
Fortunately, this has not escaped the attention of MedPAC, the body which advises congress. It is now obvious to the people on this panel that hospital-owned care (even for the same procedure in the same office) is vastly more expensive than "real" outpatient care for the same diagnosis.
"Unless these institutions find ways to reduce costs, lower Medicare reimbursements will force providers to bargain for higher payments from private insurers. And eventually, seniors' access to services will be threatened."
So keep the hospitals out of the outpatient care market. When physicians employed by hospitals recommend testing or surgery, require that those physicians make patients aware of lower cost options in the non-institutionalized sector. Make Medicare and Medicaid beneficiaries aware that there are lower-cost options available for the limited healthcare dollars (voucher or otherwise) that they spend. And fund the Public Health Departments for preventive medical care for the poor. It's really pretty simple.
PRESS RELEASE September 2012
After nearly three decades of service to the Kansas City area, and in honor of its founder, the MidAmerica Neuroscience Institute is announcing a name change to Rowe Neurology Institute.
The management and board of the institute proposed the name change to reflect the vision and quality of the founding neurologist, Vernon D. Rowe, MD who received his training at Duke University and Johns Hopkins.
Dr. Rowe said; “I am honored by the name change, but also humbled at the same time. Our name is changing but our commitment to provide the highest quality, most comprehensive care possible to our patients and their families will remain.”
As in most areas of the country, neurology is underserved in Kansas City and initial appointments can take months to schedule. The institute’s goal has always been to see new patients within 3-5 days of their inquiry or referral. The Rowe Neurology Institute will continue to focus on four centers of excellence: Headache Center, Sleep Disorders Center, Multiple Sclerosis (MS) Center and Memory Loss Center
The Rowe Neurology Institute has grown significantly since its inception and has treated over 50,000 patients in a multitude of locations in and around the Kansas City region. There are currently 10 providers within the group and approximately 50 employees. The institute has locations in Johnson County and in North Kansas City and has agreements with all insurance companies.
For more information visit: www.neurokc.com 913.894.1500
Hear her tell her own story in the video below:
This chronic migraine sufferer describes how Dr. Dana Winegarner cured her migraines after 25 years of failed treatments by "doctor after doctor." Dr. Winegarner then explains the approach he takes in his practice to get a very high success rate, even with patients who have been to many doctors before and consider their headaches incurable. The Headache Center at the MidAmerica Neuroscience Institute achieves 70% elimination of headaches, and in most other cases a significant improvement in the patient's ability to manage headaches.
To learn more, please click through to the MidAmerica Neuroscience Institute Headache Center, located in Lenexa, KS, where you can learn more about our philosophy of integrated care for headaches, schedule an appointment, or find out about our other Centers including Sleep Medicine, Multiple Sclerosis, and Memory Loss.
For more videos and articles, peruse the categories at right, or call (913)894-1500 for an appointment.
Drugs often fail because they don't fix the underlying causes of headache triggers, such as pinched nerves in the neck that can be a result from years of side-sleeping. Dr. Rowe presents the connection between cervical spine and headache, and how the solution to headaches must consider the whole patient.
If you would like to learn more, please click through to MidAmerica Neuroscience Institute, located in Lenexa, KS, where you can learn more about our philosophy of integrated care, schedule an appointment, or find out about our other Centers including Sleep Medicine, Multiple Sclerosis, and Memory Loss.
For more videos and articles, peruse the categories at right, or call (913)894-1500 for an appointment.
3RD ANNUAL MS PT NIGHT
Wii BOWLING TOURNEY
Event Style: Open House
Date: October 11th, 2012
Time: 5pm to 8:30pm
Please bring your caregiver, spouse or friend!
Join us for our 3rd annual multiple sclerosis physical therapy night!! We are continuing our tradition of the Wii bowling tournament with prizes for 1st and 2nd place. This year we are adding a nutrition spin to our event and will have a specialist to speak with you in regards to MS and diet. We will also have a representative from Bioness coming in to display and demonstrate the L300 (plus) and H200.
Rowe Neurology Institute (formerly MidAmeria Neuroscience Institute)
8550 Marshall Dr. Suite 100
Lenexa, KS 66214
Food and Drinks will be provided
Bayer Health Care Pharmaceuticals