The research will focus on Apatone, a drug from San Diego-based IC-MedTech that’s also being investigated for treating cancer and joint inflammation.

As the name would suggest, polycystic liver and kidney disease is a disorder in which clusters of noncanerous cysts develop on those organs. Symptoms can include high blood pressure, back or side pain and headaches.

Rochester, Minnesota-based Mayo Clinic will conduct preclinical and possibly eventually clinical research on the drug’s treatment of polycystic liver and kidney disease, while Summa researchers will lend their expertise.

The drug is nothing new to Summa, which has been researching it for year in its Apatone Development Center in Akron, Ohio.

“We first studied Apatone as a supplement for cancer treatment. It’s currently being researched in a clinical trial for patients with chronically painful joints as a result of a prosthetic knee implant, and now we’re looking at a potential application for polycystic liver and kidney disease,” said Steven Schmidt, vice president of clinical research and innovation for Summa.

IC-MedTech began enrollment for a phase 2b clinical study of Apatone, evaluating pain relief in patients with total knee replacements.

Marc Penn

One of Northeast Ohio’s leading physician-entrepreneurs is leaving Cleveland Clinic to join Akron’s Summa Health System.

Dr. Marc Penn will become director of research for the Summa Cardiovascular Institute and also a professor at Northeast Ohio Medical University (NEOMED) in Rootstown, according to a statement from Summa. Penn will start with Summa next month. His five-person research team will make the transition with him.

At Cleveland Clinic, Penn was medical director of the cardiac intensive care unit, as well as director of the Center for Cardiovascular Cell Therapy. A cardiologist, Penn’s research focuses on helping the heart repair itself after an injury or a chronic disease.

His research has led to the founding of several Northeast Ohio companies that he’s still involved with, including Juventas Therapeutics, SironRx Therapeutics and Cleveland HeartLab. He’s also done work for Cleveland-based stem cell therapy developer Athersys.

Luring a physician who’s had so much success translating research into viable companies represents a big coup for Summa. Joining Summa is likely to create opportunities for Penn and his team to work with researchers from the Austen BioInnovation Institute, which was established in 2008 to bolster the region’s innovation in healthcare. The Institute has set a goal of bringing 2,400 jobs and 60 biomedical companies to Akron within 10 years.

Penn said he was drawn to Akron by the “commitment to collaboration” shared by Summa, NEOMED and the Austen BioInnovation Institute (ABIA).

“What intrigues me is that you have three independent institutions striving to be excellent at what they do, and they’re willing to work together,” Penn said. “Having excellent centers that want to collaborate is better than having one center trying to do everything itself.”

Penn said he holds some intellectual property that hasn’t been started down the commercialization path, so it’s possible that he’ll work with the ABIA to create new companies out of that technology.

Additionally, as a result of Penn’s joining Summa, it’s likely that several clinical trials he’s involved with will take place at the Akron health system. For example, Juventas plans to initiate trials within the next six months or so for patients suffering from heart failure and critical limb ischemia.

The company’s technology, JVS-100, works by recruiting stem cells from the bone marrow to create new blood vessels and prevent ongoing cell death at the site of a patient’s injury. SironRX is built on the same technology, but is applying it to a different clinical area — wound healing.

A lifelong Northeast Ohioan, Penn received his medical degree and a Ph.D. in biomedical engineering from Case Western Reserve University.

Penn’s last day at Cleveland Clinic is scheduled to be July 10.

With at least three local health systems expected to establish accountable care organizations (ACOs), Northeast Ohio will illustrate the potential value — or lack thereof — of the ACO concept “perhaps more than any other market in the nation,” the report states.

“If ACOs can actually improve patient outcomes, increase consumer involvement in costs, provide enough financial incentives for providers, and work in an urban environment, the answers will be found here on the shores of Lake Erie,” according to the report.

“If ACOs are simply reheated HMOs or integrated delivery systems from the last century, we will find out here in (pdf) Cleveland,” it continues.

But it won’t be an easy transformation. Establishing an ACO will require most hospitals to become more integrated, set up new protocols and make new investments in technology. “We shouldn’t underestimate the infrastructure requirements that are necessary to function as an ACO,” said Ben Isgur, director of PricewaterhouseCoopers’ Health Research Institute.

First, though, what does “ACO” even mean? In the most basic terms, an ACO is a network of doctors and (one or potentially more) hospitals that manage the care of a population of Medicare patients. To be considered an ACO, an organization would agree to manage all of the health needs of a minimum of 5,000 Medicare beneficiaries for at least three years, according to proposed federal guidelines. ACOs were a component of last year’s controversial health reform law.

Why would hospitals be interested in setting up ACOs? It could save them money. ACOs that save Medicare money will be eligible to share in some of that savings themselves. The hope is that the financial rewards will provide incentives for all the medical providers involved in an ACO — primary care doctors, any number of types of specialists, hospitals — to cooperate and save money by avoiding unnecessary tests and procedures.

The risk is that if an organization that implements an ACO doesn’t save Medicare money, the organization is stuck with the cost of the investments it made in setting up the ACO, which could involve technology, new hires and the like.

Some critics have argued that ACOs are a rehash of the much-reviled health maintenance organizations (HMOs) of past decades, but the big difference is that ACOs don’t require patients to see only in-network medical providers.

ACOs are expected to formally launch in January. PwC’s Isgur estimates that between 100 and 150 ACOs will be established across the nation, but stressed the figure is “just hearsay out in the marketplace.”

It’s important to note that the Centers for Medicare and Medicaid Services (CMS) in March released proposed rules governing how ACOs would work and be structured, but those rules are expected to change after CMS gathers feedback from hospitals and other health providers.

In Northeast Ohio, Cleveland Clinic and University Hospitals in Cleveland, plus Summa Health System in Akron, have explored establishing ACOs. (Recent concerns expressed by a top Cleveland Clinic official surrounding the proposed ACO rules throw a little cold water on the “Cleveland-is-the-proving-ground” theory, however. A Clinic spokeswoman said the health system wouldn’t make a decision on whether to establish an ACO until CMS issues a final rule.)

“We are very supportive of the idea,” Oliver “Pudge” Henkle, the Clinic’s government relations chief, told Congressional Quarterly. “It’s clearly the right way to go and the journey is a good one. But it’s a matter of recommending ways in which we think  CMS can make the ACO model and its structure better.”

The Clinic will send CMS officials a comment letter outlining what Henkle called “constructive recommendations.”  The Clinic’s concerns involve how ACOs would be governed and how they’d be compensated by Medicare for the savings they provide, CQ reported.

Michael Hillman, Summa Health’s chief medical and quality officer, said establishing ACOs will help large organizations break down their “silos” that exist in different areas– for example primary care doctors and specialists failing to communicate key information about a patient.

“The challenge is to reorganize all of these different silos so that you’re no longer doing what’s most effective for the patient just within that specific silo … but to look at the patient across the continuum of care,” he said.

To that end, Summa has set up partnerships with a number of primary care and other health groups to better coordinate patients’ care as they move through the organization.

Another key part of establishing an ACO involves drawing up “care models,” or as Hillman explains it “a plan of care that clarifies the role of each participant as it relates to the needs of the patient.”

For example, say a patient shows up at Summa experiencing heart failure. Summa’s heart failure care model might provide guidelines around calling the patient’s primary care doctor to arrange a follow-up visit after the patient leaves the hospital, delivering medication instructions to the patient and family, setting an appointment to visit the patient at home to check on her condition and providing coaching to help the patient better manage her condition.

Under ideal circumstances — thanks to the clarity provided by the care model — that process would kick into gear as soon as the patient arrives at the hospital. “It’s about starting to anticipate what the patient will need based on why they presented in the hospital,” Hillman said.

Of course, you can’t talk about ACOs without talking about investing in technology. “There’s almost no way we could see a well-functioning ACO within an organization that doesn’t have electronic health records,” Isgur said.

For Summa, the rough road map for setting up an ACO is in place, and now it’s just a question of executing on the plan.

“We have a pretty good idea of what changes need to be made and we’re in the process of implementing a lot of them, but it’s a very large task and we’re in the relatively early stages of it,” Hillman said.

C. Michael Rutherford brings more than 30 years’ experience in healthcare to his new post. He’ll be responsible for the fiscal management of the center’s clinical operations and business enterprises, according to a statement.

Rutherford has worked at Akron’s Summa Health for the last 10 years. He’ll start at Ohio State on Jan. 4. He replaces the retiring John Stone.

“A search committee spent months looking at several of the country’s top financial strategists, and the members were very excited after talking to Michael,” said Dr. Steven Gabbe, CEO of OSU Medical Center. “He has very impressive experience and is certainly a rising star in his field.”

Rutherford was recognized as “CFO of the Year” by Crain’s Cleveland Business in 2009.

The center features four exams rooms, a waiting room, office space and a laboratory with a centrifuge and freezers, according to a statement from Summa.

The center will support investigator-initiated and industry-sponsored clinical trials. About 400 clinical trials are underway at the health system in areas such as women’s health, infectious disease and cardiology, according to the statement.

“For our clinical researchers, the center provides additional support such as trained medical and research staffs as well as supplies to meet the needs of individual studies, patient screening and enrollment, data management and processing of samples,” said Steven Schmidt, Summa’s vice president of clinical research and innovation.

ClinicalTrials.gov, a site sponsored by the National Institutes of Health, lists 8,495 clinical trials in Ohio. That places the state among the Top 10 in the nation for clinical trials, with California coming in at No. 1. Of the trials listed in Ohio, 3,837 are active, an increase of about 3 percent compared with last year, according to economic development group BioOhio.

MetroHealth System and University Hospitals in Cleveland, and Summa Health System in Akron, are joining Cleveland Clinic, the inaugural network member that helped launch Explorys last year. The regional collaboration is a model for how Explorys hopes to expand nationally in coming months.

“Expanding our network of participating healthcare providers, particularly within the same competitive region, demonstrates our ability to address the privacy and security needs necessary to foster cooperation between health care providers,” said Stephen McHale, Explorys CEO, in a written statement. “Now that we have proven that the model can scale, our next objective is to expand nationally.”

Founded in 2009 by data management veterans McHale and Charlie Lougheed, Explorys provides data services and applications that enable healthcare providers, accountable care organizations, and biotech and pharmaceutical companies to improve treatment, as well as to accelerate research and product development at the same time they measure performance and drug safety.

Explorys has curated more than one billion clinical records from participating healthcare providers in a privacy-protected and HIPAA-compliant platform for high-speed search and analytics.

“In addition to creating a network of peers for conducting break-through research, Explorys provides healthcare providers with a massively scalable and cost effective, dynamic data platform that enables them to leverage their expanding data to identify opportunities for improving care and cost of delivery,” said Lougheed, president and chief technology officer, in the statement.

Making the vast (and growing) amount of medical information searchable and understandable to doctors and researchers is key.

“Every provider continually looks for ways to improve patient outcomes” said Greg Kall, senior vice president and chief information officer for Summa. “This platform will allow us to look at a comprehensive patient data set from across the region in new ways to better understand how to improve the health status of the communities we serve.”

Dr. Achilles A. Demetriou, president of University Hospitals, agreed. “We are very excited to be part of this initiative as we believe it will advance our ability to carry out meaningful clinical research in the future.”

In August, Explorys raised $2.55 million in Series B funding from Sante Ventures and Cleveland Clinic Innovations. The company’s Series A round of $1 million in October 2009 was led by 23Bell LLC of Cleveland, McHale’s and Lougheed’s investment company. And early this year, it snagged a $17.6 million, 10-year job creation tax credit from Ohio for potentially creating more than 300 jobs.

The boards from the two hospitals are expected to approve the deal in separate meetings Thursday. Once approved, Akron Children’s will take over the 21-bed unit for premature and critically ill newborns on Jan. 1.

”We’re excited about bringing the best of both worlds together,” said Lanie Ward, Summa’s vice president of patient care services and chief nursing officer. ”We have an outstanding special-care nursery. This is moving forward with a new enhancement, bringing together these great institutions.”

Akron Children’s already operates the special-care nursery at Akron General Medical Center and another unit at St. Elizabeth Health Center in Youngstown. The deal with Summa helps ”establish one standard of care for neonatal services in the community,” said Shawn Lyden, executive vice president at Akron Children’s.

”The staff is trained and educated in the same way,” he said. ”It results in more standardization of care throughout the region.”

With the acquisition, Akron Children’s will run a total of 140 licensed neonatal beds in Akron and the Mahoning Valley. ”There are some efficiencies with adding these units,” Lyden said.

The special-care nursery is intended for babies who need short-time respiratory and other medical support, typically for one week or less.

Newborns who require more invasive treatments or surgery will continue to be transported to Akron Children’s Hospital’s Level 3 neonatal intensive-care unit (NICU) on the main campus. (Akron City Hospital has a Level 2 nursery.)

Of the 3,100 babies born every year at Akron City Hospital, about 350 require specialized care, Ward said. Each day, an average of 13 newborns are receiving care in the nursery.

Akron Children’s doctors who specialize in the care of premature or critically ill newborns already have been staffing the special-care nursery at Akron Children’s Hospital.

According to Summa officials, the unit wasn’t losing money. ”It was not about the money,” Ward said. ”It was about the patient care.”

Under the agreement, Akron Children’s is purchasing the special-care nursery from Summa and then leasing the space within Akron City Hospital to run the unit. Financial terms of the sale and the multi-year lease were not released.

The pediatric hospital plans to invest $1 million in the unit at Akron City for new newborn respiratory equipment and furnishings for parents and visitors. All but two of the 56 full-time and part-time nurses, nurse practitioners, respiratory therapists and other staff who work in the special-care nursery will be offered positions with Akron Children’s Hospital, Ward said.

Staff will rotate between the main campus NICU and the Akron City Hospital nursery, Lyden said. Some employees of the special-care nursery are expressing concerns about whether their shifts, hours, pay rates and seniority will change after the unit switches ownership.

Many of the employees will get an increase in pay after the transition, Lyden said. In most cases, their years of service at Akron City will be honored by Akron Children’s.

Tom DeBord

Akron’s Summa Health System has made it official: Tom DeBord is president of Summa Barberton and Summa Wadsworth-Rittman hospitals.

DeBord, 47, has been interim president of the hospitals in Summit and Medina counties since July 1.

DeBord leads day-to-day operations at the two hospitals and serves as a member of the Summa Health System leadership team, the Akron health system said in a release. He replaces James Pope, who resigned in August to become president and CEO of Franciscan Health System in suburban Toledo, Ohio.

Started his career at Barberton Citizens Hospital in 1988, DeBord was named chief operating officer in 2002. Summa acquired that hospital in 2007. He added the COO job for Summa Wadsworth-Rittman in 2008, the year Summa acquired the Wadsworth hospital.

“I cannot think of a better person to lead Summa Barberton and Summa Wadsworth-Rittman hospitals than Tom DeBord,” said Tom Strauss, Summa Health System president and CEO, in the release. “His vision remains instrumental in the growth of these two outstanding facilities, and I look forward to continuing our work together as we grow and expand services to meet the needs of the community.”

After cutbacks in recent years, Summa Wadsworth-Rittman is growing again, thanks to a capital project plan of at least $8 million led by DeBord.

“I am honored to accept this position and excited to continue the great work already underway across the entire system,” DeBord said in the release. “We have an outstanding vision for the future and a tremendous team in place. This is a time of great opportunity as we enter a new era of healthcare and I am pleased to be able to positively impact the communities that we serve and that I call home.”

Dr. Ian Gradisar (right), with father Ivan

Following in his father’s footsteps, orthopedic surgeon Ian Gradisar has returned to Akron.

The younger Gradisar, 36, recently began practicing at the Crystal Clinic Orthopaedic Center, a joint venture between Summa Health System and the Crystal Clinic, a center for outpatient orthopedics care. Gradisar’s father, Ivan, was the Crystal Clinic’s first president and one of the “founding fathers” of orthopedics in Akron, according to Summa.

The elder Gradisar practiced orthopedics for 30 years in Akron, held faculty positions at local universities and was regarded a pioneer in joint research. After following his father to both the University of Notre Dame and The Ohio State University College of Medicine, Ian Gradisar’s journey seems to have come full circle with his position at Crystal Clinic.

Prior to his return to Akron, Ian Gradisar completed an orthopedic surgery fellowship at Cleveland Clinic. He spoke with MedCity News about why coming home to Akron was professionally appealing, the most important lesson he learned from the Clinic and the future of orthopedics.

Q: Were you hesitant to go into orthopedics, knowing you’d always be compared to your father?
A:  I guess that might be a natural concern because he does leave big shoes to fill. For me, it’s always been one step at a time. It just works out that I followed a very similar path as he did. I knew I wanted to go to med school, and when I was done, I wanted to pursue orthopedics. He’d always told me that I’d find my own way. He never expected me to follow him.

Q: Did you learn anything during your time with Cleveland Clinic that you’ll take with you for the rest of your career?
A: I think the most important thing I learned there is that the patients come first, and that seems to be the general philosophy of Cleveland Clinic. Once you do that and take care of patients as if they’re family, everything else seems to fall into place. When you give world-class care, the patients are very appreciative, and it works in the best interests of both the patients and the hospital.

Q: I’m sure there were plenty of personal reasons to return to Akron, but professionally why was it appealing to you?
A: There were several things that brought me back professionally. First, I enjoyed working in the residency program at Summa. As residents, we spent a lot of time with the attending physicians on a one-on-one basis, and I benefited quite a bit from that, so I was anxious to return and give back to the residency program. Also, there are numerous research opportunities here in Akron. We have many groups to collaborate with, such as the musculoskeletal lab at Summa St. Thomas Hospital, NEOUCOM, as well as the University of Akron and Kent State and now just recently the Austen BioInnovation Institute. Having all those groups together in one spot is kind of a dream for an orthopedic surgeon interested in doing research.

Q: How do you see the field of orthopedics changing over the next 20 years?
A: Up until now, we haven’t had a new solution for the treatment of arthritis. We’ve had excellent results with total-joint replacement, but I think in the future there’s going to be a shift to the cellular and molecular level in cartilage research. We’re already harvesting a patient’s own cartilage, growing it in a lab and then implanting it in the patient.  For a patient, that means that perhaps we’ll gain a better understanding of the causes of arthritis and what functions are occurring in a cell that contribute to arthritis. Not that we can completely reverse the process, but perhaps we can find some type of solution that will allow us to get in at the cellular level and slow down the process.

Q: Is there any particular area of research that interests you most?
A: In the past, I worked with Dr. Walter Horton of NEOUCOM, and have looked at some cellular and molecular markers in cartilage that could be the causes for arthritis. So cartilage research is one focus. I’ve also been interested in trying to find the best positioning of components when we implant those components into a person receiving a total hip replacement. That was part of my focus at the Cleveland Clinic.

Summa has teamed up with Medina County-area doctors to build a 100,000-square-foot outpatient center on state Route 18 in Medina County’s Medina and Montville townships. When it opens in mid-November, the Summa Health Center at Lake Medina will offer mammography, CT and MRI scans, ultrasound, neuro-diagnostic services, bone-density testing, lab services and physical and occupational therapy.

In addition, the center will house several primary-care and specialty physician offices, as well as a sleep lab and radiation and medical oncology services. Cancer patients who need radiation treatments now must travel to Brunswick, Akron or Cleveland, said Dr. John M. Surso, medical director and community liaison for the health center. ”This will allow them to, in our community, have state-of-the-art cancer care,” he said.

The following month, a two-suite, same-day surgery center jointly owned by Summa and Medina-area surgeons will open. By the end of the year, Summa will begin construction on the center’s next phase, which will include a full-service satellite emergency department, physician offices and a community room. The second phase is expected to be done a year later.

”Practically speaking, all those things that are done in medicine on an outpatient basis will be done there,” Surso said. The center will serve patients primarily from Medina County and western Summit, southern Cuyahoga and northern Wayne counties, he said.

The cost of the project is about $17 million — $5.5 million for the first phase, $7.9 million in the second for equipment and capital and $3.6 million to acquire the 30-acre property. Construction costs were not available. Signet Enterprises LLC of Akron is developing the project and will own the facility. The center then will be leased under a long-term deal by Summa and the NorthEast Ohio Management Service Organization, a group of about 75 doctors from Medina and surrounding communities.

Medina County is attracting the attention of major health systems in Cleveland and Akron that are looking to draw patients from the growing area. Summa’s outpatient facility is about a mile away from Medina Hospital, which became part of the Cleveland Clinic’s network of regional community hospitals a year ago. Cleveland-based University Hospitals also has an outpatient campus in the area.

Beginning with the new school year, physicians from the Summa Center for Sports Health will provide medical care to Kent State student athletes in all varsity sports, including baseball, basketball, cross country, field hockey, football, golf, gymnastics, soccer, softball, track and field, volleyball and wrestling.

The physicians will perform daily injury checks, provide consultations and attend home events.

“Keeping the student athletes safe, healthy and in peak condition is our No. 1 priority,” Dr. Nilesh Shah, medical director of the Summa Center for Sports Health, said in a Summa release. “And we’ll achieve that by providing each person with comprehensive care — everything from sports health education to injury prevention to treatment and rehabilitation.”

Estimated by MarketResearch.com as worth $1.3 billion in 2003, the sports medicine product market covers everything from wipes to prevent the passing on of skin diseases to specialized splints for athletes.

Many doctors develop specialized practices around sports-related problems. For instance, renowned hand surgeon Dr. Thomas Graham, who recently joined the Cleveland Clinic as chairman of its corporate venturing unit, consults for sports teams nationwide.

The team of Summa physicians includes Shah, Dr. Tom Bartsokas, Dr. James Goff and sports medicine fellow Dr. Robert Crawford. Bartsokas also is the medical director for the Kent State Athletic Training Education Program.

Doctors at the Summa Center for Sports Health also take care of Akron Aeros minor-league baseball players, as well as athletes at 17 area high schools, and those visiting Akron for the Road Runner Akron Marathon and the LeBron James King for Kids Bike-a-thon.

After cutbacks in recent years that included the end of its labor and delivery unit, the community hospital in Medina County is poised for growth and expansion in targeted areas.

Leadership from Wadsworth-Rittman and its owner, Summa Health System, recently completed an intensive review and comprehensive plan for the future of the 113-bed hospital.

The plans include capital projects of at least $8 million beginning this year, including a $2 million new eight-bed intensive-care unit on the hospital’s second floor.

When it opens in November, the new ICU will be double the size of the current unit.

Later this year, the hospital will start another $2 million construction project to create three additional operating rooms in the former ICU, increasing the total ORs in the hospital to seven.

The new ORs are scheduled to open in the spring.

In addition, the hospital recently received approval from the Wadsworth Planning Commission to expand the emergency department by more than 6,000 square feet.

The project will add eight beds to the ER, bringing the total to 20. Construction is tentatively scheduled to begin this fall.

”It’s part of our overall growth strategy,” said Tom DeBord, interim president for Summa’s Barberton and Wadsworth-Rittman hospitals.

DeBord, chief operating officer for both hospitals, recently assumed the interim position after Jim Pope accepted a job as president and chief executive of Franciscan Health System, based in the Toledo suburb of Sylvania.

The health system has created a committee to find Pope’s permanent replacement.

The capital projects in Wadsworth are part of a commitment Summa made when it acquired the community hospital in 2008.

The hospital opted to became part of Summa Health System after struggling on its own in an increasingly competitive market.

For Summa, the move marked the health system’s first major presence in Medina County, one of the fastest growing regions in the state.

The health system also is finishing construction of an outpatient medical and surgery center on state Route 18 in Montville and Medina townships that is scheduled to open in November. The project will include a satellite emergency department, which is expected to open sometime next year.

The outpatient medical facility is about a mile away from Medina Hospital, which is affiliated with the Cleveland Clinic.

”For us, it’s a key strategic area of growth,” Summa President and Chief Executive Thomas J. Strauss said.

Wadsworth-Rittman Hospital is considered part of Summa’s southwest region, along with Summa Barberton Hospital, which was acquired by the health system in 2007.

The health system also includes Akron City and St. Thomas hospitals in Akron, partial ownership of Western Reserve Hospital in Cuyahoga Falls and an affiliation with Robinson Memorial Hospital in
Ravenna.

Wadsworth-Rittman continues to lose money, posting an operating loss of about $5.6 million last year, according to hospital officials.

However, Strauss said, the regional operations are profitable and the two Summa hospitals are maintaining their market share.

”We look at the combined finances,” he said.

Wadsworth-Rittman Hospital averages about 30 inpatients per day, but the majority of its business is done on an outpatient basis.

The hospital has about 500 employees — a decrease of roughly 60 in the past year, partially because of the closure of the money-losing labor and delivery unit.

As part of Summa’s growth plans for Wadsworth-Rittman Hospital, the health system has placed 18 employed physicians in offices within Medina County within the last couple years, Strauss said.

In addition, DeBord said, the hospital has added neurologists and an infectious disease doctor to the staff — two specialties that previously often required patients to transfer to other hospitals.

The hospital also is looking to expand its staffing and programs in cardiology, orthopedics, senior services and primary care, DeBord said.

Hospital officials are working with heart doctors in the area to create a ”cardiac center of excellence” on the Wadsworth-Rittman campus that will include physician offices and non-invasive diagnostic tests, such as stress tests and echocardiograms, DeBord said. More invasive tests and procedures will continue to be referred to Akron City and Barberton hospitals.

A similar ”visioning” process for the future of Barberton Hospital now is under way, DeBord said.

”You know that you’re going to work hard and you’re not going to sleep a lot going into it,” she said.

Still, she added, ”You can’t really prepare yourself to be sleep deprived.”

Last year, the Akron Beacon Journal shared the stories of four new doctors-in-training at Summa Health System as they began their medical careers.

All medical school graduates are required to finish a supervised residency program lasting three to five years in the specialty of their choice before practicing on their own.

The first year as interns is arguably the toughest, as new doctors adjust to grueling schedules and begin putting what they learned in medical school to use in a hospital setting.

In fact, the long hours clocked by residents nationwide — particularly first years — are now the focus of scrutiny.

The Accreditation Council for Graduate Medical Education recently proposed limiting shifts for first-year residents to 16 hours. For more senior residents, shifts would be capped at 28 hours, down from 30.

The changes would be effective in July 2011.

Seven years ago, the accrediting body for the nation’s medical residency programs limited shifts to about 80 hours a week, with individual shifts capped at 30 hours. Before then, residents in some spe
cialties logged as many as 120 hours a week.

But studies suggest those limits aren’t enough to prevent resident fatigue and potential errors.

Drs. Thomesha Smoot Barton, Colin and Katie Drolshagen and Chris Myer know firsthand the benefits and challenges of those long shifts, having recently completed the first year in their selected programs.

The doctors-in-training recently looked back on their first year in medicine and shared updates about their new responsibilities as second-year residents.

Dr. Smoot Barton

Smoot Barton experienced both the joy of birth and the sadness of death during her first year as an obstetrics and gynecology resident.

During the intern year, new physicians typically spend some time in their selected specialty but also rotate to other areas of hospital as part of their training.

While working on a rotation in February in the intensive-care unit at Summa Akron City Hospital, Smoot Barton had to pronounce a patient dead for the first time. An internal medicine resident with more experience helped her with the process.

Throughout her first year, the Akron native also helped bring hundreds of babies into the world. Smoot Barton estimates she assisted with about 300 deliveries, about a third of which were Caesarean sections.

”I’m definitely glad I’m doing what I’m doing,” she said.

The toughest were the rare times when a mother had serious complications or a baby died, said Smoot Barton, 26, a graduate of the Northeastern Ohio Universities Colleges of Medicine and Pharmacy.

”You’re never really prepared for a baby to die,” she said.

Smoot Barton relies on her Christian faith to help her with the challenges of residency.

”Truthfully, the whole process is faith-building,” she said.

This year, she’s spending all her time in different rotations within obstetrics and gynecology. As a second-year resident, she’s expected to take more responsibility and manage the care of patients in labor and delivery.

”The main thing with second year is you have a ton more responsibility,” she said. ” . . . Now you’re supposed to know stuff. You don’t have an excuse.”

Drs. Drolshagen

The Drolshagens are sharing their residency experience while also sharing the responsibilities of raising two young children.

Colin Drolshagen is completing a three-year family medicine residency, while his wife, Katie Drolshagen, is in a four-year pathology program.

The couple, both 27, got married after their first year in medical school at Creighton University in Nebraska and have two children: Madeleine, 2, and Audrey, 1.

They’ve been relying on babysitters and her family, who live nearby, to help watch their daughters when they’re putting in long hours at the hospital.

”Balancing is harder than I thought,” Katie said. ”Residency with kids is definitely a big challenge. It’s that balance of trying to find time to learn and study and have some time to be a good parent and spouse.”

During her first year, Katie spent much of her time in the gross lab, where residents document initial or ”gross” impressions of biopsies and specimens. She assisted with about 20 autopsies, well on her way to the 50 she must complete.

She also got exposure to pathology focusing on the study of blood and lymph nodes — a subspecialty she’s now considering pursuing.

As a family medicine resident, Colin spent his first year rotating among different areas, including ER, ICU, surgery, internal medicine, obstetrics and gynecology and pediatrics at Akron Children’s Hospital.

”It’s a pretty steep learning curve,” he said. ”You have a lot of textbook things that you know and then being put in a position to use them, it’s a learning curve. You appreciate having good fellow residents and attendings that first year.”

This year, he spends more time in the outpatient family medicine clinic at City Hospital, where he has patients assigned to him.

”It’s been nice,” he said.

Dr. Myer

No bones about it, Dr. Chris Myer is glad to be spending most of his time these days working in orthopedics.

As a first-year orthopedic resident, Myer, 27, was required to gain experience working in other areas of the hospital, along with his chosen specialty.

The exposure to critically ill and injured patients in the ICU, in particular, was important to help him learn about complications and other conditions his patients might face, Myer said.

”Your comfort level after that rotation grows exponentially,” he said.

He now spends all his time rotating among different subspecialties in orthopedics, which focuses on diagnosing and treating problems with bones, joints or muscles.

This year, he’s getting more opportunities to work with his brother, Dr. Dan Myer, a fifth-year or ”chief” orthopedic resident at Summa.

”I’m getting to scrub in on a lot of cases with him,” he said. ”It’s been a lot of fun.”

His father, Dr. Tim Myer, also is an orthopedic surgeon who practices at Summa and occasionally gets to supervise him.

”He really doesn’t treat me any different than he does anyone else,” he said.

Myer continues to be on call about eight to nine times per month.

Those 30-hour shifts spent at the hospital are draining but beneficial, he said.

”After a 30-hour day, you just feel wiped out at the end of it,” Myer said. ”But when I’m on call, I feel that’s when I see the most and learn the most. You see everything.”

The gift comes from the family of Robert and Judy Rice, according to a statement from the Summa Foundation.

The fellowship is named in honor of Dr. Robert Kepley, a veteran orthopedist of 31 years who practices at Crystal Clinic Orthopaedic Center, a partnership between Summa and Crystal Clinic established last year.

The fellowship will go to a Summa orthopedic resident who focuses on patients who undergo and recover from hip, knee, hand, spine, foot, ankle and shoulder care.

Summa Health CEO Thomas Strauss said the gift would have “a remarkable impact on orthopedic training and research” at the health system for years to come.

Jim Pope recently accepted a job as president and chief executive of Franciscan Health System, based in the Toledo suburb of Sylvania.

In his new post, Pope will oversee a Catholic health system that owns seven hospitals in Ohio and Texas, two social services in Ohio and more than a dozen ”aging-in-place” and nursing facilities in several states.

Tom DeBord, chief operating officer at Barberton and Wadsworth-Rittman hospitals, is serving as interim president for both hospitals.

Pope is staying with Summa until Aug. 12 to assist DeBord during the transition.

Pope, 52, said the decision to leave Summa was difficult.

”This is a great place to be,” he said.

But, he added, ”there aren’t that many system CEO jobs in the country. When you get a chance to take over a seven-hospital system, you jump at that chance.”

Pope joined Wadsworth-Rittman Hospital in 2005as president and chief executive of the then-independent hospital.

He expanded his role to president of both Wadsworth-Rittman and Barberton in 2008, after both hospitals were acquired by Summa.

The two hospitals have nearly 2,000 employees.

”What has differentiated my experience here versus other places I’ve been over the years is the people,” said Pope, praising the staff at both hospitals.

Pope was ”instrumental in bringing Wadsworth-Rittman Hospital into the Summa family and his vision has been instrumental in the success and growth that we have seen in both Barberton and Wadsworth,” said Thomas J. Strauss, Summa’s president and chief executive. ”He is a true friend and gifted colleague. And while I am sad that he is leaving, I could not be happier for him and his family.”

DeBord, 47, has been with the Barberton hospital for nearly 22 years. He was named chief operating officer in 2002 and expanded his role to include Wadsworth-Rittman Hospital in 2008.

”I cannot think of a more qualified person than Tom DeBord to take over the responsibilities of interim president for Summa Barberton and Summa Wadsworth-Rittman hospitals,” Strauss said. ”He is a trusted leader in our organization. I look forward to working with him in this new role and continuing to meet the health-care needs of people throughout our community.”

DeBord will continue to oversee day-to-day operations at both hospitals while serving as interim president.

”The transition should be pretty smooth,” DeBord said.

The health system has created a committee to find Pope’s permanent replacement.

The health system announced on Wednesday that it is buying Physicians Urology’s outpatient prostate cancer treatment center on West Exchange Street near the hospital campus, effective Aug. 1.

Under the deal, Akron General will contract with the 12-physician practice to staff the center.

The facility provides radiation therapy for prostate cancer, a disease of the male reproductive system that affects one in six men in their lifetime.

The multiyear professional services agreement also calls for the doctors to provide leadership for Akron General’s urological services, which the hospital intends to expand, said Dr. Tim Stover, Akron General’s president of outpatient services.

The specialty of urology focuses on diagnosing and treating diseases of the male and female urinary tract and the male reproductive organs.

‘‘Our goal is . . . to develop a center of excellence for men’s health,’’ Stover said.

The new partnership should help convince more patients to stay in Akron rather than seeking care from hospitals in Cleveland, Stover added.

The physician partners opted to align with Akron General as a way to expand services, said Dr. Ray Bologna, a partner in the practice and chair of urology for Akron General.

‘‘We really looked at a partnership as an opportunity to grow the urologic care in Summit County and surrounding counties,’’ he said. ‘‘We were looking for ways that we could really expand.’’

Physicians Urology opened its Center for Urologic Health and cancer treatment center in 2006 after the merger of two Akron-area physician practices.

The center offers diagnosis, treatment, education and support for patients with prostate cancer.

At the time, leaders of the practice estimated that the partners invested between $3 million and $4 million to open the center.

After the doctors opened their cancer treatment center, virtually all the outpatient radiation treatment for prostate cancer in Akron shifted away from the hospitals, Stover said.

Bologna said the center provides radiation treatments for 130 to 150 men with prostate cancer each year.

The new deal with Physicians Urology ‘‘expands our outpatient location,’’ Stover said. ‘‘It takes advantage of their expertise in developing and growing the urologic service line.’’

Financial terms of the deal between Akron General and the physician practice weren’t disclosed.

Hospitals here and nationwide increasingly are joining with physician groups, particularly those that compete for outpatient services.

Summa Health System, for example, last year entered a deal with the Crystal Clinic, a dominant orthopedic practice in the Akron area.

The health system and the 32-physician practice are equal partners in the venture, which includes inpatient orthopedic services at St. Thomas, the Crystal Clinic’s outpatient surgery center in Bath Township and physician practice locations throughout the region.

Physicians Urology will remain independent, Stover said. The dozen specialists will continue to practice at other hospitals in the region, including those owned by rival Summa.

The doctors with Physicians Urology perform about 30 percent of their hospital-based procedures at Akron General and the remaining at Summa facilities, including Akron City Hospital.

Akron General and Summa also share a residency in urology.

The likely reason: Few endometrial cancer survivors eat a balanced diet, quit smoking and get enough exercise, according to new research by Dr. Vivian von Gruenigen, department chair of obstetrics and gynecology for Summa Health System.

Von Gruenigen presented her findings this month during the American College of Obstetricians and Gynecologists’ annual clinical meeting in San Francisco.

Her research found only 1 percent of 120 endometrial cancer patients in the study followed all three of these recommendations for survivors from the American Cancer Society: Don’t smoke, eat at least five servings of fruit and vegetables a day and participate in 150 minutes per week of moderate to strenuous physical activity.

About 22 percent didn’t follow any of the guidelines, von Gruenigen said.

”When you look at survivor groups across the country, those are the worst numbers,” she said.

Among the survivors studied, 43 percent had high blood pressure and 21 percent had diabetes, von Gruenigen said.

More than 90 percent were found to have risk factors for cardiovascular disease, she said.

”I think it’s an underserved cancer population,” she said.

Endometrial cancer forms in the tissues that line the uterus.

Each year, an estimated 42,160 U.S. women are diagnosed with endometrial cancer, making it the most common cancer of the female reproductive organs, according to the National Cancer Institute. About 7,780 patients die each year from the disease.

According to the National Cancer Institute, obese women have two to four times greater risk of developing the disease compared to women who maintain a healthy weight.

Endometrial cancer typically is found during its early stages when it’s curable, von Gruenigen said. But obesity and other factors put women at risk for cardiac and other health problems if not addressed.

”We as physicians, when we diagnose endometrial cancer, need to tell these ladies that this is a sentinel event in their health care and if they do not change their lifestyle, they have a significant risk of death within five years,” she said.

Von Gruenigen is pursuing national funding to conduct a multisite study to research the effectiveness of using physical therapists, nutritionists and psychologists to help endometrial cancer patients adopt healthier lifestyles.

”These women need support, and they need education,” she said.

University Hospitals

The “implementation” collaborative to which these hospitals belong is one of two being started by Premier, a hospital-owned company in Charlotte, North Carolina, that until now has functioned mostly as a purchasing group for hospital supplies and consultant on quality improvement.

Premier is trying to get its 2,300 member hospitals together to share information about the quality and cost of patient care so they can create successful accountable care organizations (ACOs) by 2012. That’s when the Centers for Medicare & Medicaid Services will start awarding Medicare contracts to these organizations.

The “accountable care organization” is a construct of healthcare reform and is aimed at paying healthcare providers in ways that encourage them to work together to lower costs and raise care quality, according to Jason Shafrin, an economist and research associate at Acumen LLC who blogs as the Healthcare Economist.

Senate Finance Committee Chairman Max Baucus, a Montana Democrat, included the organizations in his proposed reform legislation last year. “I applaud the Premier alliance and its member health systems for their collaborative work to improve their patients’ care and reduce costs by offering patients access to a wide range of healthcare providers and settings,” Baucus said in Premier’s press release about its collaboratives.

“Accountable care organizations like those in the Premier alliance put the new and innovative ideas in the healthcare reform law into practice to improve healthcare quality while reducing inefficient and wasteful spending,” said Baucus, who also attended a media teleconference on the Premier announcement today.

The organizations would be a departure from the current fee-for-service model, which some say, encourages providers to do more procedures rather than the procedures that lead to the best and most cost-effective care.

In addition, accountable care organizations take accountability for patient care out of the hands of insurers and put it in the hands of care providers, who are either paid for increasing care quality or share in its cost savings.

A typical Medicare ACO would include a hospital, primary care physicians, specialists and potentially other medical professionals, according to the American Medical Association. Members of the organizations would coordinate care for their shared Medicare patients with the goal of meeting quality benchmarks. However, there are several types of potential ACOs, according to a table posted by economist Shafrin.

About 100 representatives from the 19 member hospitals are attending a Premier event in Washington, D.C., today to start figuring out what kind of organizations they want to have, said Alven Weil, senior public relations and communications manager for Premier. Eventually, collaborative members will share best practices so they can share in the savings generated by those practices, Weil said.

Sharing information also should lead to increases in the quality of care, said Janice Guhl, media relations director at University Hospitals in Cleveland.

The study’s goal is to understand why heart failure patients often have trouble managing their complex medical regimen, according to a statement from Kent State University.

The other collaborating institutions on the project are the Case Western Reserve University School of Nursing, Summa Health System of Akron and University Hospitals Case Medical Center in Cleveland, according to a statement from Kent State.

The researchers hope to lower health system costs associated with hospital re-admittance of heart failure patients, as well costs associated with patients’ failure to adhere to their medication instructions.

Little is known about how the cognitive status of heart failure patients affects management of their illness , according to Dr. Joel Hughes, a Kent State psychology professor and the study’s co-principal investigator.

“We know there’s impairment,” Hughes said. “If you have a mild cognitive impairment, we think it’s harder to manage your illness, but there is no clear evidence of this.”

The study is expected to involve 400 Northeast Ohio patients aged 50 to 85 years old.

Fitch Ratings

Fitch assigned its BBB+ rating to $175 million of fixed-rate hospital facilities revenue bonds to be issued on behalf of the Akron, Ohio-based system during the week of April 26. The BBB rating means “expectations of default risk are currently low. The capacity for payment of financial commitments is considered adequate, but adverse business or economic conditions are more likely to impair this capacity.”

Proceeds from the bond sale will be used to pay for capital projects, as well as to reimburse Summa for past capital expenditures, repay short-term bank notes and fund a debt-service reserve account, Fitch said in a written statement. Summa may issue up to $24 million more in bonds to refund outstanding debt, Fitch said.

At the same time, Fitch lowered its A- rating on $39.2 million in bonds issued in 1998 and $46.9 million in bonds issued in 2004 to BBB+. The rating firm changed its outlook on Summa to “stable” from “negative” with the rating downgrade.

“Although Summa’s growth strategy is expected to generate increased volumes and improved profitability over the long-term, Summa’s current profile no longer reflects appropriate levels expected of ‘A-’ rated entities,” Fitch said in its statement. Fitch also said Summa’s “ambitious capital plans” are likely to limit liquidity and add to debt in the near term.

“Given the fact that Summa Health System is currently experiencing a lot of growth, we were not surprised that our Fitch rating was affected,” the system said in a written statement. “As we continue to implement our strategic plan, we fully expect our rating to be upgraded.”

On the positive side, the system anchored by Summa Akron City Hospital and Summa St. Thomas Hospital has historically had adequate or more than adequate debt coverage. That’s important as the system grows.

Already, Summa has become the market leader with 58 percent of primary service patients through hospital acquisitions and doctor alignments, Fitch said. Summa’s revenue was $1.31 billion last year, excluding revenue from two joint ventures, the rating firm said.

Summa also has “a robust integrated delivery platform through its physician alignment strategy and health plan,” which lends additional strength. This platform also “demands management rigor and discipline to ensure the benefits are fully realized, which Fitch believes is achievable,” the firm said.

As for its operating performance, Summa’s growth, its health plan–SummaCare–and the lingering effects of the economic recession “have combined to blunt Summa’s operating performance over the last few years,” Fitch said. Summa’s operating margins were 0.6 percent in 2009, -1 percent in 2008 and 3.7 percent in 2007. That compared to other Fitch A-rated hospitals that had a median operating margin of 2.7 percent over those three years, the rating agency said.

Moving forward, Fitch will look for improved operating performance and a rebuilt balance sheet before it upgrades Summa debt, the firm said.

Rep. Stephen Dyer

Updated 5:10 p.m.

A proposed Ohio law would prohibit employers from refusing to hire people who smoke tobacco.

House Bill 470 would fine employers who violate its terms $25,000 on the first offense, $50,000 on the second and $100,000 for each subsequent violation. Rep. Stephen Dyer, a Democrat from Green and former Akron Beacon-Journal reporter, sponsored the bill.

Under the terms of the proposal, employers couldn’t fire “without just cause,” refuse to hire or “otherwise discriminate” against Ohioans because they smoke tobacco.

The proposal isn’t likely to sit well with employers such as the Cleveland Clinic, Summa Health System, Parma Community General Hospital and Medical Mutual of Ohio, all of which have adopted nicotine-free hiring policies in an attempt to cut health spending.

Dyer said he introduced the bill because he was concerned that, as nicotine-free hiring policies become more prevalent at hospitals around the state, smokers would be increasingly limited in their employment opportunities.

“In this economy, we can’t afford to be cutting off a whole swath of our population to job opportunities in a growing industry,” said Dyer, who described himself as “very anti-smoking.”

The Cleveland Clinic, in particular, has drawn attention in recent years for its policy of not hiring smokers. That controversy intensified last year when Chief Executive Toby Cosgrove said he’d also prefer to not hire obese people and lamented that it’s illegal to apply the same hiring standards to the obese as it is to smokers. The Clinic administers a urine test to prospective hires to determine if they smoke tobacco.

In a memo on the Cleveland Clinic’s Web site, Cosgrove said more than 6,000 companies across the country have adopted hiring bans on smokers “to promote a healthy workplace.” He disputed claims that the policy is more about saving money than encouraging health.

Ed Byers, a spokesman for Medical Mutual, said he wasn’t familiar with the legislative proposal and couldn’t comment on it. Medical Mutual began its hiring ban on smokers in 2006 and “we’ve had no complaints from any employees about our policy,” he said. The company doesn’t test employees for nicotine after they’ve been hired.

Laws protecting smokers rights vary by state. Some states–though it’s not clear how many–prohibit discrimination against those who smoke outside of work hours, American Medical News reported.

Nicotine-free hiring policies can help employers reduce costs during a time of rapidly rising health insurance premiums, advocates say. But opponents argue that employers are overstepping their bounds when they attempt to prevent workers from consuming a legal product in their own homes.

“It seemed wrong to me that people would be not hired because they choose to do something that’s perfectly legal on their own time,” Dyer said.

A report published last year in the journal Tobacco Control said hiring bans on smokers may bring unintended consequences and could do more harm than good, the Los Angeles Times reported. As more companies adopt nicotine-free hiring policies, it could make smokers nearly unemployable, cause them to lose their health insurance and negatively affect their health and that of their families, the report’s authors said.

Rep. Dyer’s proposal wouldn’t prohibit employers from adopting policies that forbid employees from smoking tobacco, or smelling like tobacco smoke, during hours of employment.

A spokeswoman for the Ohio Hospital Association said the group doesn’t have a “formal position” on the legislation. At least six hospitals in the state either don’t employ or don’t hire tobacco users, according to the OHA.

Some portions of the legislation could go into effect in as soon as three months, while others will take until 2019 to be fully implemented.

While many of the details still are unclear, area industry leaders shared these thoughts Monday about what they think the effort to extend health care to tens of millions of uninsured Americans will mean for consumers and businesses in the region.

• Ed Byers, spokesman, Medical Mutual of Ohio

Medical Mutual of Ohio, one of the state’s largest health insurance companies, still is evaluating what the reform bill will mean for its 1.6 million enrollees.

”Until we understand the details of the rules brought about by the proposed law, it’s very difficult to predict how they will be implemented or their impact,” Byers said. ”It’s going to take time and effort to understand the implications.”

• Bill Considine, president and chief executive, Akron Children’s Hospital

Akron Children’s frequently sees families who can’t get coverage for a child with a pre-existing condition, Considine said.

The hospital also treats patients who surpass their lifetime insurance maximum because of conditions such as cystic fibrosis, sickle cell disease, blood disorders, congenital heart defects and other serious problems, he said.

The health-reform measure passed addresses both those issues.

”There are more people now that will have access to insurance, and there’s also going to be more of a focus on prevention,” Considine said. ”That’s a plus from our perspective.”

However, Considine said, he’s disappointed the bill doesn’t address Medicaid funding for pediatric specialists and hospitals, which typically get paid less through Medicaid than adult hospitals get from the Medicare program that covers Americans 65 and older.

• Dr. Richard Ellison, an Akron ophthalmologist and president-elect of the Ohio State Medical Association

Ellison said he’s concerned that while more people will get insurance coverage, ”having coverage doesn’t necessarily mean they’ll have access to care.”

Initially, he said, the measure will increase Medicaid funding for primary-care doctors, which should help provide access to health care as more people become eligible for the public insurance program.

”I have some concerns about that lasting long enough for people to maintain access,” he said.

Another aspect that will allow children nationwide to remain on their parents’ insurance until age 26 should help younger individuals who can’t afford coverage, he said.

Ohio already has a measure to allow children to stay on their parents’ plan until age 28, effective in July.

Doctors also are concerned that the bill didn’t include provisions to address tort reform, nor did it address scheduled cuts in federal payments to physicians, he said.

• Marty Hauser, president, SummaCare

SummaCare, an Akron-based health insurer that’s part of Summa Health System, is dedicated to continuing to offer Medicare managed-care plans, even though insurers are anticipating reductions in federal payments, Hauser said.

SummaCare also supports plans to forbid insurers from denying coverage because of pre-existing conditions, as long as people are required to get coverage, Hauser said.

The mandate for most individuals to have insurance coverage doesn’t go into effect for several years.

”We think it’s a good thing to do,” he said of eliminating pre-existing condition exclusions. ”The challenge is going to be how they expand the coverage or in some cases require coverage so there’s a pool of healthy people who can help offset the expenses.”

Overall, Hauser said, ”I think they’re going to accomplish that intent of getting people covered. The question that remains uncovered is how is it going to be paid for and who’s going to pay for it.”

• Dave Petno, health insurance broker from Hudson and media chair, Ohio Association of Health Underwriters

Petno said he’s convinced the new rules will drive up the cost of health insurance.

The requirement to cover pre-existing conditions ”basically means that people can have no insurance and then when they get sick, they can have access to insurance and get insurance right away with no denial,” he said.

As a result, he said, healthy people might opt to wait until they get costly illnesses to seek coverage — an action that would raise the cost of health insurance for everyone.

”The pre-existing condition exclusion is one of the few things that gave people an incentive to actually buy insurance,” Petno said.

A requirement that most individuals obtain coverage or face penalties starting in 2014 won’t help because it won’t be enforceable, he said.

”Insurance premiums are going up,” Petno predicted.

• Richard F. Rebadow Jr., executive vice president, Greater Akron Chamber

The Greater Akron Chamber has been in support of ”market-driven solutions that control growth in health-care costs,” Rebadow said.

But local business leaders — particularly small employers — have a lot of unanswered questions about how the new rules will affect them if fully implemented, Rebadow said.

”They’re not sure what that really means until the process plays out a little bit more,” he said.

It also remains unclear what will happen if most employers are required to provide coverage or pay penalties starting in 2014, as written in the bill.

”The way the bill is written, as I understand it, some companies could pay the penalty, which would be a lot less than paying for the coverage,” he said. ”Time will tell.”

• Marsha Schofield, program director, Access to Care

The Access to Care program links about 1,750 uninsured Summit County residents with volunteer doctors who agree to provide care for free.

Schofield estimates about 70,000 Summit County residents (about 13 percent) lack insurance. Many simply can’t afford it, even if it’s offered through an employer.

The subsidies and other provisions ”should reduce the number of people who are uninsured in the community and eligible for our program, which, from our standpoint, is a good thing,” she said. ”There were already many, many more people eligible for our program than we could serve.”

• John Sniezek, chief executive, Akron Community Health Resources

At Akron Community Health Resources (ACHR), almost half the patients lack health insurance. ACHR provides medical and dental care on a sliding fee scale for the uninsured.

The federal measure should help more patients get coverage, particularly those who have been denied insurance because of a pre-existing medical condition, Sniezek said.

The health reform bill also includes funding to help federally qualified health centers such as ACHR expand their services and add new locations so more people can get help, Sniezek said.

”I think what it does is it provides a firm safety net in time for the medically needy who have been reluctant to seek medical care because of lack of insurance,” he said.

• Mike Stull, regional vice president, Employers Health Coalition of Ohio

Employers Health is a national employers coalition based in North Canton that provides prescription drug group purchasing and other efforts to improve health-care cost, quality and access.

The health-reform bill ”will certainly improve access for people who don’t have insurance today,” Stull said. ”The subsidies that are part of this bill will help make insurance more affordable.”

However, he said, the provisions most likely will result in higher premiums in the short term because of provisions that eliminate annual caps and restrict deductibles.

The reform bill also will affect employers who offer retiree coverage. Changes in federal subsidies will likely result in higher costs for businesses.

”It’s just a matter of will it cost them so much that they don’t want to continue coverage,” he said.

Two years ago, her life was saved by something most hospitals treat as trash — the umbilical cord blood from a newborn.

A baby’s cord blood is rich with stem cells, which increasingly are being used to cure cancer and other blood disorders.

”I am a living, breathing end product of the most exciting, amazing recycling program on the face of the earth,” she said. ”It’s recycled blood. What better way of recycling than that?”

A nonprofit program is trying to expand throughout Northeast Ohio so more parents can donate their babies’ potentially life-saving gift of umbilical cord blood.

The Cleveland Cord Blood Center is working with Summa Health System in Akron and MetroHealth Medical Center in Cleveland to add those hospitals as donation collection sites.

The only hospitals currently collecting umbilical cord blood for the public bank are the Cleveland Clinic’s Hillcrest Hospital in Mayfield Heights and Fairview Hospital in Cleveland.

Transplants and research using stem cells from umbilical cord blood avoid the ethical and political baggage that goes along with human embryonic stem cells, said Dr. Mary J. Laughlin, founder and medical director of the Cleveland Cord Blood Center in Warrensville Heights.

With umbilical cord blood donations, the blood isn’t collected until after the delivery of a full-term, healthy baby.

”Umbilical cord blood has been quietly emerging in the field,” said Laughlin, an associate professor of medicine at Case Western Reserve University in Cleveland and a pioneer in the field of cord blood transplants.

During a transplant, the stem cells in a baby’s cord blood respond to proteins released by the recipient’s damaged bone marrow cells, Laughlin said.

The stem cells ”hone to the bone marrow, set up shop and start making blood cells,” she said.

In Tirpak’s case, the 68-year-old Boston Heights resident was told she would die within months without a transplant to cure her leukemia.

When a bone marrow donor couldn’t be found, her doctors at University Hospitals Ireland Cancer Center found a cord blood match.

Tirpak doesn’t know the identity of the baby who saved her life; recipients aren’t provided that information.

But her 9-year-old grandson has nicknamed the baby ”Mary Calls.”

”It sounds like ‘miracles,’ ” he told her, ”and that’s what’s going to make you well.”

”It’s a marvelous thing,” she said. ”I’ve been blessed with many days and I hope for many more still yet to be.”

The Cleveland Cord Blood Center is one of 16 public cord blood banks in the United States, according to the National Marrow Donor Program.

The program maintains a registry of available cord blood units in public banks and potential bone marrow donors that transplant centers can search for matches for their patients.

Public cord blood banks differ from private banks, which allow new parents to pay to store a newborn’s cord blood in case it’s needed by the child or another family member in the future.

There is no charge to donate a newborn’s cord blood to a public blood bank, said Dave Clements, the Cleveland Cord Blood Center’s director of business development, government relations and community affairs.

Each donated unit is tested to make sure it is disease-free and contains enough stem cells. A unit must have at least 1.3 billion stem cells to be frozen in liquid nitrogen and stored for future transplantation.

Units ineligible for transplants can be used for research.

If a baby whose umbilical cord blood has been donated later needs stem cells for a transplant, the unit can be returned to the patient if it was stored and not used, Clements said. If the unit is no longer available, the center will work with the patient to find a suitable match worldwide for free.

Cord blood banks charge about $30,000 per unit to help cover the costs of testing, collection and storage, Clements said.

The hospital conducting the procedure pays for the unit and charges patients or their insurer.

Since starting the voluntary collection program at the two Cleveland-area hospitals in 2008, the center has obtained about 5,500 donated units of cord blood, of which 1,800 were able to be banked, Clements said. More than half of new moms at the hospitals now are opting to donate cord blood after delivery.

There is no compensation to the donor family.

The delivering physician collects the blood for donation from the umbilical cord only with parental consent, said Dr. Marcus Tower, chairman of the Department of Obstetrics and Gynecology at Hillcrest Hospital. The process takes about two minutes.

”Every time we collect this, this is basically one life we can be saving,” he said. ”It’s very altruistic. This is something that could save my life, your life or anyone’s life.”

So far, five units have been shipped overnight from the Cleveland Cord Blood Center to transplant centers in the United States and worldwide.

The Cleveland Cord Blood Center relies heavily on financial donations to help cover its $3 million annual budget.

The center is trying to partner with area businesses and philanthropic groups to raise money to cover the cost of adding more collection site hospitals, estimated at $250,000 per site, Clements said.

By expanding to different hospitals, the cord blood bank can boost its donations, as well as increase the diversity of its available cord blood units.

”One of our missions is to make sure everybody has an opportunity to donate, regardless of their ethnicity,” Clements said.

Cord blood donations can be particularly important for African-Americans and patients from other minority groups who need a transplant but often have a difficult time finding a bone marrow match.

White adult patients have a 60 percent chance of finding an unrelated match among potential bone marrow donors, compared to a 5 percent to 15 percent chance among some minority groups, Laughlin said.

”Your tissue typing follows your ethnic background,” she explained.

Unlike donations from adults, cord blood donations don’t need to be a perfect match, Laughlin said. The baby’s immature immune system isn’t as likely to have a strong negative reaction to the recipient’s body.

About half of the 3,000 to 3,500 babies born each year at MetroHealth Medical Center are from minority populations, said Dr. Brian Mercer, the hospital’s director of obstetrics and maternal-fetal medicine.

The cord blood donation program offers ”a great opportunity to provide this for a broad range of people,” he said. ”It’s very exciting because it’s a public cord blood bank. That means it will make stem cells available to anybody and makes it available not just nationally but internationally.”

Summa’s Akron City Hospital — another site that could be added as a donation center in the future — had 3,480 births in 2009.

”We are involved with discussions with the Cleveland Cord Blood Center about the possibility of beginning a donation program at Summa,” spokesman Mike Bernstein said. ”It’s our hope that we will find opportunities to work together, but we are very early in the process and it is premature to discuss the specifics.”

The new free-standing, 24-hour emergency departments will be built in Green, where the health system already has a Summa Health Center outpatient facility; and in Medina County, where the Summa Health Center at Lake Medina campus is currently under construction.

Both are expected to open next year, according to Summa.

The plans to expand emergency services also include a two-story addition to the Akron City Hospital ER and expansions and renovations at Barberton and Wadsworth-Rittman hospitals.

The health system is spending $65 million to expand its emergency services, according to a release from Summa.

”This is one more example of our commitment to ensure our communities will always have superior, reliable and timely care in convenient settings,” Summa President and Chief Executive Thomas J. Strauss said in a prepared statement.

The Akron City Planning Commission is reviewing site plans on Friday for the proposed two-story addition to the north of the existing emergency room at Akron City Hospital.

Construction of the estimated $43 million project on the City Hospital campus is expected to begin this spring and take about two years to complete.

The project will increase the ER size from 43 beds to 75.

Last year, the emergency department treated about 78,000 patients — or roughly 26,000 more patients than it was designed to handle.

Systemwide, Summa’s six owned or affiliated hospitals provided emergency care to more than 227,000 patients.

The Akron City Planning Commission is reviewing site plans on Friday for a proposed two-story, 84,000-square-foot addition to the north of the existing emergency room.

The project will increase the ER size from 43 beds to 75, Summa spokesman Mike Bernstein said on Tuesday.

Construction of the estimated $43 million project is expected to begin this spring and take about two years to complete.

Summa will borrow money to finance the project.

Last year, the emergency department treated about 78,000 patients — or roughly 26,000 more patients than it was designed to handle, Bernstein said.

Systemwide, Summa’s six owned or affiliated hospitals provided emergency care to more than 227,000 patients.

”It certainly stands to reason we want to expand our ability to treat the community,” he said.

Akron City Hospital’s ER patient volume is expected to increase in the coming years, when Summa and the Crystal Clinic will be constructing the new Crystal Clinic Orthopaedic Center on the hospital campus.

Orthopedic services now are housed in Summa Health System’s St. Thomas Hospital.

The partners halted construction of the new orthopedic hospital in late 2008 until the financial markets improve.

”We remain committed to the project, along with our physician partners,” Bernstein said. ”It is our hope that we will resume construction in the near future.”

Construction is under way for a temporary sheltered entrance to the City Hospital ER, just east of the hospital’s surgical pavilion, according to documents from the Akron Department of Planning and Urban Development.

When the ER expansion project is completed, ambulances will access the department from Arch Street on the east side of the building, according to plans filed with the city.

The public entrance will be from North Adolph Avenue and North Forge Street to the west of the building.

The ER will remain open with no interruption to services during the construction project, Bernstein said.