FRANKFORT These days, the characteristics that come to mind when setting up a medical practice are probably: profitability, stability, employment or independence, and payer mix. But what about: faith, compassion, inclusion, and equality? Those may not be the primary attributes that come to mind when you think of establishing a medical practice, but they are the founding principles of the obstetrics and gynecology practice of Women’s Care of the Bluegrass (WCOTB) in Frankfort, Kentucky.
The practice began in Eastern Kentucky before taking root in Central Kentucky. After completing residency in 1993 at the University of Kentucky (UK), founding partner E. J. Horn, MD, and then partner Steve Roberts, MD, returned home to Eastern Kentucky to set up Women’s Care of Eastern Kentucky in Prestonsburg. As fate, or faith, would have it, Roberts decided to make a life change when he felt called to become a Catholic priest. “We tried to recruit someone to replace him, but it’s hard to recruit good doctors back home unless you’re from there,” says Horn.
After four years in Prestonsburg, the two decided to move the practice to Versailles in Central Kentucky and enlisted another pal from residency, Stephen K. Hall, MD, to join them in anticipation of Roberts’ departure. Hall had taken a different route and located in Murray in Western Kentucky after residency. With Hall on board, Women’s Care of the Bluegrass (WCOTB) continued to grow while recruiting new providers. In 2001, they moved their main office to Frankfort but kept an office in Versailles, in addition to offices in Owenton and Lawrenceburg.
Both Horn and Hall cite Dr. John W. Greene, Jr. from the UK College of Medicine as the mentor who helped shape their practice philosophy. “The founding principles of the practice when Father Dr. Steve Roberts and I started the practice were basically treating people with the compassionate care Dr. Green had instilled in us as residents and the philosophy that we would take equal call, equal time in clinic, and we would all be paid essentially the same,” says Horn. They did so because they believed it was “the physician thing to do but also the Christian thing to do,” offers Horn. Because they share call equally, Angela Saxena, MD, says patients in labor are delivered by the provider on call, unless the patient specifically asks for a particular provider, and that predictability of schedule is one of the things that attracted her to the practice. “Honestly, it helps to preserve our lifestyle to some degree,” says Saxena. At some point, the senior physicians in the group will reach a point where they want to slow down a little, and they will have to address an alternative to the equal call, equal pay philosophy. But for now, it is an approach that has worked for 20 years.
“The other founding principle of the practice is that we wanted to see everyone, whether they had the best insurance, bad insurance, no insurance, or Medicaid, and we’ve continued to do that throughout the years. And hopefully that’s been part of the reason God has blessed us with so much growth,” says Horn. Not only treating all patients regardless of socio-economic status but also treating them with compassion, is a value shared by all of the providers at WCOTB. “I believe we can make a difference in people’s lives as far as providing compassionate and skillful care to anyone regardless their walk of life or economic situation,” says Hall.
From a single location, the practice has grown to cover multiple counties in the area surrounding Frankfort. WCOTB’s locations include the clinic in Woodford County in Versailles, a satellite office in Owen County in Owenton, and a presence in Anderson County in Lawrenceburg. “Another unique aspect of our philosophy has been to provide care where there is a need,” says Mark A. Wainwright, DO, who has been covering the Owenton office since joining the practice in 2001 and has seen its patient base grow over the years, drawing patients from Carrollton, Florence, and Gallatin County. A very rural area, Wainwright says, “It’s worth the 35-minute drive for me to see 20 or 30 patients. It’s been very fruitful.”
According to Wainwright, 99% of WCOTB’s patients deliver at Frankfort Regional Medical Center, although all of their physicians have privileges at Saint Joseph East and UK in Lexington. Another asset is the level 2 NICU at Frankfort Regional that’s been in place almost four years. “Before, we would have to transfer 34 or 35-weekers to Lexington or Louisville. Women who are 28 weeks actually can stay, and we can deliver here in Frankfort. That’s changed the way we’ve practiced and is better for families in our community,” says Wainwright. The neonatologists are the same providers that take care of patients at Kosair Children’s Hospital in Louisville.
United in Faith
When it comes to religious faith, Amanda Hess, DO, says it is a common mindset that helps the physicians practice as good people rather than just a business. “Certainly we’re respective of everyone’s religions, but we all kind of keep [our faith] in mind. It translates into making the providers a little more caring, a little bit more in tune with sensitive situations, and I think that definitely comes across in the way we provide care,” says Hess. “This way we say, ‘What’s the right thing to do?’ and that’s the way we run our practice.”
“There are many professions, but the thing that being a medical professional and physician allows you to do is, you’re never pitting a human against a human,” says Horn. “You’re always in a partnership with that patient preventing disease or treating disease. There’s never a situation that I choose to help this person more than that person, whether it be a contractual agreement or whatever.”
Frank Donald Farley, III, MD, family practice physician with Family Care of the Bluegrass, a spinoff of WCOTB that was born out of a need for comprehensive care, believes their common faith enhances the level of trust between the physicians. “I’m fairly open with my Christian faith, and I don’t try to push it on people. But I think my patients know that I’m a committed Christian, and I’m able to administer to them not just physically and emotionally but also sometimes spiritually if they are open to that,” says Farley.
Drawn to OB/GYN
A unifying aspect for the physicians of WCOTB is the way they all felt drawn to the specialty of obstetrics and gynecology, even though some of them initially had other plans. Horn was set on becoming a family doctor, but became enthralled by his fascination for surgery when he did his first surgery rotation in medical school. “You see a problem, you fix it, and are able to see almost immediate results,” he says. “Then I did a rotation in OB/GYN and saw lots of surgery being done. One of the greatest things a person can do is bring a new life into the world, and that pretty much sold me right there,” Horn adds.
Hall likes the “good blend of taking care of patients from teenage years through the elderly years,” the mix of endocrinology and internal medicine, and the challenging ethical issues they face.
Thinking she would be a pediatrician and follow in her father’s footsteps, Saxena says, “As soon as I delivered a baby, I knew that was what I wanted to do.” While most people’s attention follows the baby, “I could just tell my draw was more towards that female that had just delivered,” she says. Saxena also values the mix of the technical aspects of surgery and the warm, personal interaction with patients.
Having trained in Chicago, Hess found the practice in Frankfort smaller and more rural than what she had done in the past. “I wasn’t sure that was what I wanted to do, but this group was just an amazing set of very kind doctors. Everything they do has very good values behind it, and that was what brought me to them,” she says.
Wainwright, who also trained in Chicago, was initially drawn to surgery. “But after my first delivery, I was hooked! I found the specialty of OB/GYN to be a perfect blend between primary care and surgery. Joining WCOTB has helped to validate my chosen career,” says Wainwright.
A Challenging Profession
Like any specialty, there are challenges. For WCOTB, their Christian faith serves as a resource for dealing with today’s challenges and attitudes toward assisted reproduction, abortion, and teenage pregnancy. “A lot of issues in today’s climate can be controversial. I find that challenging,” says Hall. To address these issues, he says, “I combine my own personal beliefs along with my professional responsibilities and try to do what I think is best for the patient as a whole.”
Coming from a more urban population and infrastructure in Chicago, one of the frustrations for Hess is the “disparity as far as [patients] just not having access to things a lot of people take for granted,” one of those being not having transportation to get to a doctor’s appointment.
As the youngest practitioner in the group, Hess enjoys connecting with teenagers and correcting misinformation. “I really like educating and empowering younger women to take control of their health and do things to avoid problems in future,” she says.
Midwifery has been an important part of the practice for nearly 20 years. Katie Isaac, ARNP, CNM, has been with Women’s Care since its early days in Eastern Kentucky. In fact, their midwifery service has been so popular that WCOTB currently employs three midwives. “A lot of patients seek out the midwifery part of our practice because of the holistic type view of midwifery,” says Saxena. Hess agrees, “There are some people that really gravitate towards that low maintenance, minimally invasive type of healthcare.” Being able to offer all aspects of the spectrum, from natural birth to epidural births or C-sections, WCOTB is able to provide something for every patient.
While the midwives mostly see obstetrics patients, they also see patients for annual visits and routine gynecologic care. “The comfort level with us and with them is so good. We’re very careful about which providers we have join our practice. We all mesh together very well,” says Saxena.
For more information about WCOTBs midwifery service, see related article by CNM Emily Dial on page 13 of this issue.
Minimally Invasive Surgery and In-Office Procedures
Over the last decade, minimally invasive surgery has transformed the way OB/GYNs practice. WCOTB was on the cutting-edge in Frankfort, says Horn, having performed the first laparoscopic supracervical hysterectomy at Frankfort Regional Medical Center in 2003. Since then, the group has adapted the technique to their own needs, using two five millimeter port sites and one 10 millimeter port site to do the procedure, which Horn claims are “fewer incisions and smaller incisions even compared to the daVinci machine.” Horn cites a Journal of the American Medical Association (JAMA) study that demonstrated no difference in complications rates between traditional laparoscopic supracervical hysterectomy and daVinci robot-assisted surgery. He cautions, “The only difference was that the robot was per case over $2000 more. I think in today’s environment we need to be more cognizant of the cost of medicine. That’s something that’s often overlooked when we just want to go with the newest thing that’s out there.”
WCOTB also performs in-office procedures, and contracts with an outside company to provide nurse anesthetist services. According to Wainwright, this provides a cost savings that “benefits insurance companies and patients, and patients can actually get home a little quicker.”
Wainwright has a particular interest in urogynecology procedures. He performs suburethral slings for incontinence and traditional anterior/posterior colporrhaphy, as well as the Burch procedure for incontinence if a patient is having an open hysterectomy.
Other in-office diagnostics include bone density scans, ultrasounds for GYN and OB patients, and colposcopy to examine the cervix in-depth and take biopsies for patients with abnormal pap smears.
Minimally invasive procedures in the office are available for sterilization, endometrial ablation, urodynamics, hysteroscopy, and treatment of pre-cancer or early cervical cancer. The Essure is a sterilization procedure that forgoes traditional anesthesia and lessens down time for patients. Endometrial ablation of the uterine lining to combat heavy bleeding is also done in office, offering a cost savings and quicker recovery for patients. “For treatment of pre-cancer or early cervical cancer we do a LEEP procedure, where you remove a small portion of the cervix,” says Hess. If invasive cancer is discovered or if further treatment is necessary, patients are referred to an oncologist in Lexington or Louisville.
Family Care of the Bluegrass
“One of the issues we had with a philosophy of taking care of all patients regardless of payer, was that we would see patients who, whether obese, hypertensive, or whatever, we would take care of them during pregnancy. Then after delivery we would try to find primary care physicians to take care of them. It became extremely difficult and often impossible to find primary care doctors who were accepting Medicaid at that time,” says Horn. Rather than succumbing to the frustration, WCOTB created its own solution. With prompting from their accountant, Porter Roberts, of Barr, Anderson & Roberts, they established their own primary care center called Family Care of the Bluegrass (FCOTB) in 2008. They initially recruited one family practice physician and one PA-C to staff the center. When that physician left, WCOTB sought the assistance of Frank Donald Farley, III, MD, who already had an established practice in town. At first it was a temporary solution, recalls Farley. “But everything worked out so well we became the full time doctors, and my practice that was across town became the east location for Family Care and the original location here at the hospital became the west location,” he says. Now Farley is the sole physician servicing both locations, with a physician’s assistant at each.
It is a reciprocal relationship that benefits both practices. Among the advantages for WCOTB’s patients is that women who are often the gatekeepers of their families’ health, have easy access to care for their entire family. The physicians benefit as well. “Communication is half the battle in medicine,” says Saxena. “There are many capable doctors out there, but if you don’t have the information and communication between physicians and nurse practitioners and between nurse midwives, it’s all lost in that transition. I think that is a huge value in our practice.”
Having practiced in Frankfort for 13 years, Farley had an established patient base that included a large population of elderly patients, many of whom he had been following since middle age. “Coming into this relationship with Women’s Care, it’s served to give an infusion of youth into my primary care population because we’re seeing more women of childbearing age and more new babies too because when they deliver a baby who doesn’t have a doctor or pediatrician already, they refer to us,” says Farley.
Trends in his population include a large number of COPD patients, due to the propensity of tobacco use in the state, and a large number of diabetes patients, a nationwide epidemic. Controlled substance abuse is another problem prevalent in Kentucky. “With us taking Medicaid and Medicare with a lot of disabled patients, it’s a fine line we have to walk, distinguishing those patients who legitimately need controlled substances to treat pain and psychiatric problems versus those who are drug seeking,” says Farley.
Because of the Affordable Care Act, in recent months FCOTB has partnered with Cumberland Family Medical Center, which is a federally qualified health center. While their business arrangement has changed, day-to-day operations have not. Horn offers that the relationship provides them new advantages they did not have as a primary care center, such as a mobile dental unit that visits schools for dental screening and a high school scholarship program. “Now moving into a federal healthcare center status, we are able to take care of those who don’t have insurance and use a sliding scale fee schedule that is much more affordable for them,” adds Farley.
WHAT MAKES US UNIQUE IS OUR PARTNERSHIP AGREEMENT WHERE WE ALL GIVE EQUAL TIME AND RECEIVE EQUAL COMPENSATION.
Women’s Care of the Bluegrass and Family Care of the Bluegrass are first and foremost committed to delivering the highest quality patient care. We pledge to achieve this by providing compassionate care in all areas of prevention, wellness, and treatment of illness and disease
We will pledge to respect life, all patients, and one another. We provide care regardless of social or economic background.