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Indiana's specialty clinics.

Time was when most specialty clinics were freestanding units. That's changing.

It used to be that most specialty clinics were freestanding units. That's changing. To keep up with the competition, Indiana hospitals are getting into the act. "There is a general tendency toward outpatient services as alternative sources of revenue," explains David B. Dann, president and CEO of Methodist Occupational Health Centers, which is affiliated with Indianapolis-based Methodist Hospitals of Indiana.

Ball Memorial Hospital in Muncie, for example, operates three specialty clinics that are staffed by residents in the hospital's teaching program and by private physicians with privileges to practice at Ball. A player in the specialty game since 1969, Ball maintains clinics that serve the areas of family practice, internal medicine and obstetrics and gynecology, with treatment on an outpatient basis.

An unusual clinic in Fort Wayne is the Clinic for Children with Special Health Care Needs at the Lutheran Hospital of Indiana. Physicians on the clinic's staff include pediatricians, dentists, cardiologists, orthopedists, neurologists and plastic surgeons. Lutheran also maintains its renowned heart-transplant clinic as well as a multidisciplinary muscular-dystrophy clinic that it operates in conjunction with the Muscular Dystrophy Association.

Mulberry Center at Evansville's Welborn Baptist Hospital, a comprehensive hospital-based mental health facility, offers the only chemical-dependency program in the tri-state area solely for adolescents. The only short-term mental health facility for children in the three-state region is represented by the Pediatric Mental Health Services at Mulberry Center.

Why does an acute-care hospital branch out into the realm of mental health? "People are realizing that physical problems have psychological repercussions," explains Suzanne R. Haug, Welborn's director of community and media relations. Mulberry Center has been providing mental health services to children, adolescents and adults since 1970. Its emphasis is on treatment of eating and codependency disorders as well as chemical dependency and sexual abuse. Referrals to its codependency and sexual-abuse treatment programs have come from as far away as California and South Carolina.

People who must learn to live with chronic pain can get counseling and treatment at the Pain Management Center at Saint Margaret Hospital and Health Care Centers in Hammond. According to figures from the center, millions of Americans are victims of chronic pain. Each year, chronic pain translates to 700 million work days lost and $60 billion in litigation, worker's compensation and treatment.

Since it opened in 1980, the center has been treating pain sufferers by reducing their pain levels so they can maintain functional and productive lifestyles. It was the first in Indiana to use an implantable pump that automatically disperses pain medication to ease pain from cancer. It also was the first in the Calumet region to use a patient-controlled analgesia device that enables post-operative patients to administer prescribed pain medications themselves.

Another clinic in Northwest Indiana helps its clients overcome pain before they feel it. The 3-year-old Indiana Dental Care Center at Our Lady of Mercy Hospital in Dyer is one of a handful of university- and hospital-related clinics across the country that treat dentally anxious people. The Journal of the American Dental Association estimates that nearly half the people in the United States are afraid of going to the dentist. About 30 million people have such deep-seated anxieties that they avoid going to the dentist altogether.

It is this phobic group that a team of 11 specialists at Our Lady of Mercy sees. To be accepted into the program, patients must not have been to the dentist for three years. "Most haven't seen one in eight to 10 years, and some top 30 years," says the program's director, Dr. James Lipton. Dentists perform such corrective procedures as root canals, extractions and gum surgery under a general anesthetic, but the ultimate goal of the program is to ease the patient's fears through psychological counseling so he or she will go to the dentist thereafter on a regular basis.

Easing a patient's fear of the unknown also is one of the goals of the Indiana Heart Institute at St. Vincent Hospital in Indianapolis. The institute makes every effort to create a homelike environment in its common areas and to reassure its clients and their families through preoperative counseling and education.

The institute, organized in 1986, is a consortium of the hospital and three physician practices. "Cardiology has advanced as rapidly within the past 10 years as the computer," comments Susan Alden, assistant director of the institute. Today, there are alternatives to open-heart, or coronary bypass, surgery. Options include interventional techniques such as balloon and laser angioplasty for dilating clogged blood vessels, and atherectomy, in which plaque is reamed out with a cutting tool.

During the past year alone, the institute performed more than 9,000 heart catherizations, including interventional procedures. It also has a heart-transplant team. Dr. Bruce F. Waller, a cardiac pathologist on the institute staff, has a national reputation as an expert on sudden death.

The institute maintains a research and development department as well. Among other medical devices, the institute is field-testing an intracoronary stent, which is a fine-wire coil that is inserted into the blood vessel to dilate it permanently. The stent, which is manufactured by Cook Inc. in Bloomington, has not yet received approval from the U.S. Food and Drug Administration, but the FDA has authorized further research, which is being carried out at the institute.

Besides offering diagnostic and treatment services, the institute operates a cardiac rehabilitation unit where a team of professionals oversees a monitored exercise program that includes blood pressure and heart rhythm checks. Treadmills, stationary bikes and exercise equipment make it look like a health club, but there is a difference. Every patient in the institute's rehab unit has suffered a cardiac event.

Rehabilitation of a different nature is the focus of the Methodist Occupational Health Care Centers in Indianapolis. "We handle the full spectrum of work-related injuries from a speck in the eye to severe lacerations," says Dann. This is how the centers differ from a rehabilitation hospital. "A rehabilitation hospital takes all comers," explains Phillip M. Harman, the centers' director of marketing.

The clinic has expanded into five industrial areas in Marion County. Methodist Occupational Health Care Centers is one of the top five occupational health services in the nation in terms of client visits, which average more than 110,000 a year.

Although the primary emphasis at Methodist is on getting the injured worker back on the job as soon as possible to save money and to increase productivity, it will provide pre-employment drug screenings and isometric strength tests to determine whether a prospective worker has the physical capability to perform a specific job. It also does comprehensive key-executive physical examinations. Methodist has doctors available to evaluate the ergonomic aspects of the workplace and an industrial hygienist to monitor air quality and hazardous-waste operations to bring the site into compliance with standards mandated by the Occupational Safety and Health Administration.

Today, the centers are seeing fewer of the crushing injuries sustained in heavy industry and more that are associated with materials handling and keyboarding tasks, says Dann. State-of-the-art computerized equipment detects malingering, although, notes Dann, "95 percent are highly motivated to get back to work." It also can determine the extent of an injury and whether an employee should have the permanent partial impairment rating that is needed for worker's compensation.

The goal of Methodist's work-hardening program is twofold: rehabilitation and refamiliarization with the workplace. Injured employees are eased back on the job in a work-like environment. Participants in the program wear normal work clothing and are given tasks that simulate those in the workplace. Coffee and lunch breaks are even part of the package.

Preventing reinjury is another objective of a work-hardening program, points out Sandy Huge, spokeswoman for VitaCare Inc., which has treatment centers in Terre Haute and Lafayette. VitaCare is the provider of athletic rehabilitation at Indiana State University in Terre Haute.

Huge defines the work-hardening process as "a transition from convalescence to the workplace." Patients come to the VitaCare program upon physician referral. While they are undergoing treatment, they are monitored by rehabilitation nurses who are employed by insurance companies to make evaluations as to whether a patient is malingering or returning to the workplace before he or she is ready.

Whether we will see more consolidation or fragmentation of medical services in the future remains to be seen. But take the example of Dr. Merrill A. Ritter, director of the Center for Hip and Knee Surgery, a 26-bed facility at Kendrick Healthcare Center in Mooresville. Ritter practiced at Methodist Hospital in Indianapolis for 12 years, then left in 1986 because he wanted to specialize in joint replacements. Today, he and two other physicians at the center do about 800 hip and knee replacements a year.
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Title Annotation:health care industry
Author:Hughes, Ann
Publication:Indiana Business Magazine
Article Type:Industry Overview
Date:Jan 1, 1992
Previous Article:Who's insuring the insurers?
Next Article:Northwest Indiana update.

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