Northern Wisconsin

Stay up-to-date with news from Ministry Healthcare's Northern Wisconsin service area. This area is served by Ministry Eagle River Memorial Hospital, Ministry Saint Mary's Hospital, Ministry Sacred Heart Hospital, Howard Young Medical Center, Flambeau Hospital and Ministry Medical Group Clinics located in Crandon, Eagle River, Laona, Rhinelander, Tomahawk and Woodruff.

New TrueBeam™ Radiotherapy expands cancer treatment options
Ministry Medical Group teams recognized for patient-centered excellence
Telestroke program helps preserve quality of life
Ministry Saint Mary’s Hospital Ranks as Top Acute Care Hospital in Value-Based Purchasing program
Need urgent care? Theresa Bruss, FNP, is there to help
Ann Chizek-Liermann, NP, helps keep you going


New TrueBeam™ Radiotherapy expands cancer treatment options

In a promising development for cancer patients in northern Wisconsin, James Beck Cancer Center in Rhinelander announced that it has acquired a TrueBeam Radiotherapy system, an innovative system that enables a radically different approach to treating cancer with image-guided radiotherapy.

The TrueBeam system, from Varian Medical Systems, was engineered from the ground up to deliver more powerful cancer treatments with pinpoint accuracy and precision. It uniquely integrates new imaging and motion-management technologies within a sophisticated new architecture that makes it possible to deliver treatments more quickly while monitoring and compensating for tumor motion. This new technology opens the door to new possibilities for the treatment of lung, breast, prostate, head and neck, as well as other cancers that are treatable with radiotherapy. It will be operational in November, 2013 at the James Beck Cancer Center.

"The TrueBeam system allows for increased accuracy and outcome of all treatments in every anatomical location," said Peter Heiberger, MS, medical physicist, James Beck Cancer Center. "With the utilization of image-guided positioning, dynamic-dose modulation and faster treatment times, this state-of-the-art equipment creates a wide range of sophisticated treatment possibilities. This investment in technology at JBCC is an investment in our patients and community."

Faster Treatments

With dose delivery rates that are 40 to 140 percent higher than earlier generations of Varian technology, the TrueBeam system can complete a treatment proportionately faster. This makes it possible to offer greater patient comfort by shortening treatments, and to improve precision by leaving less time for tumor motion during dose delivery. "Intelligent" automation further speeds treatments with an up to five-fold reduction in the number of steps needed for image guidance and dose delivery.

Simple treatments that once took 15 minutes or more will be able to be completed in less than two minutes once the patient is in position. "Due to the increased accuracy and decreased treatment times, patient comfort is maximized by decreasing the amount of time the patient needs to lay motionless on a hard surface," added Heiberger. "Every patient appreciates a shorter treatment time."

Enhanced Precision The precision of the TrueBeam system is measured in increments of less than a millimeter. This accuracy is made possible by the system’s sophisticated architecture, which synchronizes imaging, patient positioning, motion management, beam shaping and dose delivery, performing accuracy checks every ten milliseconds throughout the entire treatment. Critical data points are measured continually as a treatment progresses, ensuring that the system maintains a "true isocenter," or focal point of treatment.

Faster Imaging at Lower Doses

TrueBeam imaging technology can produce the three-dimensional images used to fine-tune tumor targeting in 60 percent less time. Additional functionality makes it possible to create images using 25 percent less X-ray dose. "Imaging is the cornerstone to all radiotherapy. Without imaging, it would be impossible to deliver such accurate and effective treatments," explained Heiberger. "The TrueBeam allows us to maximize our imaging effectiveness while minimizing the exposure to the patient."

TrueBeam can be used for radiotherapy treatments including image-guided radiotherapy and radiosurgery (IGRT and IGRS), intensity-modulated radiotherapy (IMRT), RapidArc® radiotherapy and gated RapidArc. "Depending on the location and biology of the tumor, the TrueBeam allows us the capability to apply different methodology and techniques for the most effective treatment of each individual patient," said Heiberger. "These technological advancements have created the new standard for radiation therapy, and we’re excited to bring the TrueBeam to Rhinelander."

The James Beck Cancer Center at Ministry Saint Mary’s Hospital nurtures long, close relationships and ongoing care with cancer patients, whether in the form of future treatments, palliative care, rehabilitation, checkups, support groups or providing new information. The goal is to meet every need of every patient, and to be a trusted resource for their families.



Ministry Medical Group teams recognized for patient-centered excellence

Ministry Medical Group clinics in Crandon, Eagle River, Rhinelander, Tomahawk and Woodruff have received national recognition for their medical home model by the National Committee for Quality Assurance (NCQA). They have received Level 3 Physician Practice Connections® - Patient-Centered Medical Home Recognition (PPC-PCMH™) .

NCQA recognizes primary care practices that function as patient-centered medical homes, a model of care where each patient is at the center of his or her care and has an ongoing relationship with a personal provider who leads a team that takes collective responsibility for patient care.

NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs. There are nine PPC® standards, including 10 must-pass elements, which can result in one of three levels of recognition. Level three represents the highest level of recognition.

Some of the areas PPC-PCMH measure include patient tracking and registry functions; access and communication; care management; patient self-management support; electronic prescribing; test tracking; referral tracking; performance reporting and improvement, and advanced electronic communications.

"This certification is a significant milestone for us," said Ministry Medical Group Regional Vice President, Robert Sookochoff, MD. "Our goal is to not only meet the requirements for certification, but to exceed them as a part of our ongoing work in making the healthcare experience the best it can be for patients in our communities."

Ministry Medical Group launched three medical home pilot sites in 2011. Since then, many Ministry Medical Group clinics have begun transitioning to medical homes. Ministry’s medical home teams consist of physicians partnered with advanced practice providers (APNPs or PAs), RN case managers who coordinate chronic disease management, patient service representatives, and healthcare associates (CMAs or LPNs), and behavioral health specialists.

But Ministry Health Care doesn’t stop at the NCQA certification standards, Ministry exceeds them. Each clinic develops new programs based upon the interests and personal needs of the community, which patients share through a patient-advisory council. The patient advisory council meets monthly with members of Ministry Medical Group, and the team has made a great contribution by sharing stories and ideas on how to improve healthcare in the community.

The patient advisory council plays an instrumental role in building and expanding community partnerships. By including patients in the planning and design of clinic initiatives, we have been able to develop new programs based upon their interests and personal needs. This initiative helps the clinics provide a model of care centered on the patient’s physical and emotional health, supported by the patient’s personal provider and a team of healthcare specialists.


Telestroke program helps preserve quality of life

The emergency departments at Ministry Sacred Heart Hospital and Ministry Saint Mary’s Hospital are piloting an innovative program called Telestroke that provides expert neurology consultation for patients experiencing stroke symptoms.

Using state-of-the-art video telecommunications, Telestroke allows 24/7 access to the stroke neurologists at Ministry Saint Joseph’s Hospital in Marshfield, a Joint Commission certified primary stroke center.

A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to or in the brain or when a blood vessel in the brain bursts. According to the Centers for Disease Control and Prevention, more than 795,000 people in the United States suffer a stroke annually, and almost 130,000 Americans are killed each year from stroke. Eighty-seven percent of all strokes are ischemic strokes, which occur when blood clots block the blood vessels to or in the brain.

Time is critical for effective intervention in an acute ischemic stroke, as approximately two million brain cells die every minute. The use of Telestroke will provide patients the benefit of a neurology consultation any time of day. To implement the program, emergency department rooms were transformed to accommodate the equipment required to support Telestroke.

Ministry Sacred Heart and Ministry Saint Mary’s worked closely with Ministry Saint Joseph’s to launch the program. "To support the effort, order sets were written and approved, and new protocols were developed," said Emergency Department Medical Director, Mark Banas, DO, Ministry Medical Group. "The drug formulary was updated with medications that reflect best practice care for stroke patients, and educational sessions were given to ED providers, and nursing staff on using Telestroke."

The Telestroke program uses Ministry Connect to initiate the consultation. "Despite being in a different location, the patient will be able to interact with the neuro-hospitalist at Ministry Saint Joseph’s as if they were in the same room, thanks to high-resolution cameras and audio equipment," said Dr. Banas. "With assistance from the ED staff, the neuro-hospitalist can perform an exam to assess the patient and rank the severity of symptoms. In addition, they will have access to lab results, past medical and medications history, and will be able to view the patient’s CT scan. This will help them collaborate with the ED provider and decide on treatment options for the patient."

The Telestroke program will be expanding throughout the Ministry system and central and northern Wisconsin emergency departments over the course of the next year.

Stroke is the fourth leading cause of death, and a leading cause of long-term disability. "This is an exciting opportunity for our hospitals to positively impact the health of our communities," added Dr. Banas.

Symptoms of a stroke include: sudden numbness or weakness of the face, arm or leg, especially on one side of the body, sudden confusion, trouble speaking or understanding, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, or sudden severe headache with no known cause. If you suffer from any of these symptoms, seek medical care immediately.


Ministry Saint Mary’s Hospital Ranks as Top Acute Care Hospital in Value-Based Purchasing program

A recent study issued by the Centers for Medicare and Medicaid Services (CMS) reports that Ministry Saint Mary’s Hospital in Rhinelander is one of the hospitals leading the way in Medicare’s Hospital Value-Based Purchasing (VBP) program in Wisconsin.

Ministry Saint Mary’s was one of five Ministry hospitals named in the top 10 acute care facilities. It was joined by Ministry Saint Clare’s Hospital in Weston; Ministry Saint Michael’s Hospital in Stevens Point; Saint Elizabeth Hospital in Appleton; and Mercy Medical Center in Oshkosh.

Established by the Affordable Care Act and launched in October of 2012, the VBP program implemented a new approach to the payment system where hospitals are paid for inpatient acute care based on the quality of care, not the quantity of services provided.

It is a significant step to linking Medicare’s payment system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting. Hospitals are rewarded based on how closely they follow best clinical practices and how well hospitals enhance patients’ experiences of care.

The program implements value-based purchasing to the payment system that accounts for the largest share of Medicare spending, affecting payment for inpatient stays in over 3,500 hospitals across the country. Only the largest hospitals in the nation are taking part at this time and it does not apply to the smaller critical access facilities. The program is funded by a withhold that will eventually increase to 2 percent from all participating hospitals’ Diagnosis Related Group (DRG) payments.

According to Stewart Watson, MD, President of Ministry Medical Group, "The Values-Based Purchasing program was designed to promote better clinical outcomes for hospital patients, as well as improve their experience of care during hospital stays. We work hard to continually improve the overall patient experience. Our teams at Ministry Saint Mary’s and all across our healthcare system should be proud of these achievements."

Specifically, Hospital VBP seeks to encourage hospitals to improve the quality and safety of care that Medicare beneficiaries and all patients receive during acute-care inpatient stays by:

  • Eliminating or reducing the occurrence of adverse events (healthcare errors resulting in patient harm)
  • Adopting evidence-based care standards and protocols that result in the best outcomes for the most patients
  • Re-engineering hospital processes that improve patients’ experience of care

According to the latest report, 24 of 64 Wisconsin hospitals that qualified for the VBP program will see a decrease in their payments as a result of the scores which balance clinical care and patient experience. The VBP program releases results once per year with adjustments of DRG reimbursement taking effect in October.


Need urgent care? Theresa Bruss, FNP, is there to help

Theresa Bruss, Family Nurse Practitioner, joined Ministry Medical Group to provide services in Ministry Saint Mary’s Hospital urgent care and emergency departments located at 2251 North Shore Drive in Rhinelander. As an urgent care nurse practitioner, Bruss provides care for patients with urgent, but not life-threatening conditions.

Theresa Bruss, FNP
Bruss earned her master’s degree in nursing from Indiana State University in Terre Haute, Indiana, and her bachelor’s degree in nursing from Florida Hospital College of Health Sciences in Orlando, Florida. She earned an associate’s degree in nursing from Nicolet Area Technical College in Rhinelander. Bruss is certified in advanced cardiac life support and basic life support and has completed the emergency nurse pediatric course.

"I am passionate about caring for people in urgent situations," said Bruss. "I started out as an emergency medical technician (EMT), then I was a paramedic, an emergency room nurse, and now I’m an urgent care nurse practitioner. The one thing I have learned is that in an urgent situation, you need to slow down and really listen to the patient in order to come up with the right treatment plan." In her spare time, Bruss enjoys being in the outdoors with her family and pets, hiking and spending time around the campfire. The urgent care clinic at Ministry Saint Mary’s Hospital, adjacent to the emergency department, sees patients for problems related to earache, sore throat, cough, cold, headache, fever, toothache, urinary tract infection, vomiting, diarrhea, simple lacerations, minor burns and wound care.

Board-certified physicians, nurse practitioners and physician assistants are on staff from 7:30 a.m. to 7 p.m., Monday - Friday and 9 a.m. to noon on Saturdays. For more information on urgent care services available at Ministry Saint Mary’s Hospital in Rhinelander, please call 715.361.2510.


Ann Chizek-Liermann, NP, helps keep you going

Ministry Health Care is pleased to welcome Ann Chizek-Liermann, NP, to Ministry Medical Group Northland Orthopedic & Sports Medicine. She will be providing care in the orthopedics department of Ministry Medical Group, located at 444 East Timber Drive in Rhinelander.

Ann Chizek-Liermann, NP
Chizek-Liermann is an orthopedic nurse practitioner who can assist patients with a variety of issues, including osteoporosis treatment and prevention. She is experienced in applying casts and splints, and can provide injections necessary to treat orthopedic injuries.

Chizek-Liermann earned her master’s degree in nursing from Concordia College of Nursing in Mequon, and her bachelor’s degree in nursing from Carroll College/Columbia College in Milwaukee. She is certified in basic life support.

"Orthopedic problems can be difficult to treat," said Chizek-Liermann. "That’s why I emphasize prevention whenever possible. I don’t just make recommendations; I strive to get buy-in from the patient and their family. I want them to actively participate in the decision-making process so that they are comfortable with the plan of care."

When she’s not taking care of patients, Chizek-Liermann enjoys gardening, quilting, kettlebell workouts, spending time at her parents’ cottage and participating in her daughter’s activities.

To schedule an appointment with Ann Chizek-Liermann, NP, or another member of the Northland Orthopedic & Sports Medicine Ministry Medical Group team, please call 715.369.2300.


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