Dr. Stahl adamantly takes exception to that suggestion. In fact, the advice is misguided, he said.

"The out-of-area referrals have an enormous impact in several ways. When you go out of the area, the patient goes out of his or her comfort zone," Dr. Stahl said.

"The patient and the family have to travel hours and bear the inconvenience of staying in a hotel or at least not being able to sleep in their own bed. More importantly, the care patients receive simply may not be as good as what they could get locally and it likely will cost more."

Top spot

Also, Dr. Stahl pointed to a recent report by the Pennsylvania Health Care Cost Containment Council which noted that, for the third year in a row, Community Medical Center had better-than-expected outcomes for its open-heart surgery program.

The hospital has never had what the council considered "worse-than-expected" outcomes since the inception of the program, Dr. Stahl said.

The report noted that CMC has the lowest mortality for valve surgery and overall mortality for cardiac surgery. It also has the lowest charges, reflecting the best value for cardiac surgery, Dr. Stahl said.

What's more, there are as many as 2,000 local patients who would likely agree with Dr. Stahl that staying local is the way to go. That's because 2,000 is the number of open-heart surgeries Dr. Stahl has performed.

Last year, Dr. Stahl helped lead a team of surgeons at CMC to arguably the hospital's most successful year. No patient was lost to heart surgery during that time.

"That's a huge milestone and it's a testament to the team we have," Dr. Stahl said.

Many of those patients recently came back to the hospital to thank the doctors and staff as a mural, created by the Scranton firm Heart to Art, was unveiled in CMC's main lobby.

The gathering was dubbed a celebration of their road to recovery, Dr. Stahl said.

"The mural shows the beginning of the patients' journey, where they give the doctors their hearts to care for. It shows the strengths and successes of the patients, employees and friends of CMC's cardiac program," he said.

Heart to Art is owned by Donna Doherty and Judith Youshock, who was a patient of Dr. Stahl, he said.

Dr. Stahl, 53, was born in Staten Island and is a product of the New York City school system.

A Cornell University and New York University School of Medicine graduate, Dr. Stahl completed nine years of training in general surgery and cardiothoracic surgery at the Hospital of the University of Pennsylvania.

He moved to the area to head a new heart program at Community Medical Center in 1997 and was named chief of cardiothoracic surgery at CMC in 2000.

Dr. Stahl and his wife, Roz, who is a registered nurse and noted golfer, have five children and five grandchildren.

Asked about the difference of living and working in the Scranton area as opposed to New York and Massachusetts, where he worked on staff at the University of Massachusetts Medical Center for five years, Dr. Stahl said living is easier and less crowded. He also noted the bond residents of Northeast Pennsylvania have.

Small world

"One of the things I love about this area is that it takes people who live here about 11 seconds to establish a mutual friend, acquaintance, church, school, shop, whatever," Dr. Stahl said. "When you hear two people here talking, right away it's, 'You must know my cousin,' or 'I know that doctor, he's good.'"

So, the next time a patient is considering going to Philadelphia, New York or someplace else, Dr. Stahl said, he or she need look no further than home. The doctor is passionate about the subject and blogs about it on his website, www.premieresurgical.com.

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That was one of the messages at a symposium Thursday that attracted more than 100 health care professionals from across the region to discuss the dangers of obesity and how to inspire patients - and each other - to get healthy.

Held at WVIA's studio in Pittston, the discussion featured presentations by six local doctors and a registered dietitian about the dangers of obesity, which is linked to heart disease, hypertension, diabetes and other serious health problems.

In Pennsylvania, 64.4 percent of adults are overweight or obese, according to data from the Centers for Disease Control.

Before presenting information Thursday, Mercy Hospital cardiologist W. David FitzPatrick, M.D., said bringing health care professionals together to learn more about how obesity affects health is extremely important.

"Addressing obesity is the single most important health initiative right now," Dr. FitzPatrick said. "It's a problem of our current, modern society."

People who want to lose weight need only follow two rules: eat less and exercise more.

But experts at Thursday's symposium agreed that putting it into practice is a lot more difficult.

"We all have to lose weight, we all have to eat healthy, but at the end of the day, what does that mean?" said registered dietitian Donna Scott. "You have to take it one step at a time ... because if it doesn't fit your lifestyle, you're not going to do it."

Janet Townsend, M.D., the founding chairwoman of Family Medicine and Community Health at Commonwealth Medical College, told doctors, nurses and other health care workers that they should strive to be role models for patients and advocates in the community.

She also said helping patients set modest goals and even writing out "exercise prescriptions" that include frequency and types of activity can help patients get started and stick with it.

Other presenters at Thursday's symposium included Russell F. Stahl, M.D., the chief of cardiothoracic surgery at Community Medical Center; Stephen J. Voyce, M.D., chief of cardiology at Moses Taylor Hospital; and Jila Kaberi-Otarod, M.D., internal medicine at CMC.

Symposium brings local health care workers together to discuss obesity, heart disease

There is no denying it: Pennsylvanians are getting fatter.

This afternoon, health care professionals will gather in Pittston to talk about ways to help turn the trend around.

"I think we can do better if we work together," said Russell F. Stahl, M.D., the chief of cardiothoracic surgery at Community Medical Center.

"I'm interested in improving the health of the community, and I think this symposium is a step in the right direction."

In 2009, 27.4 percent of Pennsylvanians were obese, meaning they have a body mass index of 30 or more, according to the Center for Disease Control. Carrying extra weight around can lead to all sorts of medical issues, like arthritis, diabetes, heart disease, hypertension and certain types of cancer, according to Dr. Stahl.

Each year, area cardiologists, cardiac surgeons and cardiovascular nurses hold a symposium to discuss the latest information and technology to manage health issues. Today's event also includes an hourlong television broadcast on WVIA at 7 p.m. featuring medical experts from around the region discussing the problems and solutions of obesity and heart disease.

Dr. Stahl is hopeful that today's symposium will spark discussions in the health care world and in homes across the region to provide information and come up with creative solutions.

What health care workers need to impress upon people is that "even modest lifestyle changes can make a big difference," Dr. Stahl said. "There's no one quick fix."

Topics for the broadcast will include cholesterol and obesity, nutrition, sleep apnea and metabolic syndrome and how each relates to heart disease. Presenters include Dr. Stahl; Stephen J. Voyce, M.D., chief of cardiology at Moses Taylor Hospital; W. David FitzPatrick, M.D., a cardiologist at Mercy Hospital; dietician Donna Scott, R.D.; and Janet Townsend, M.D., founding chairwoman of Family Medicine and Community Health at Commonwealth Medical College.

ONLINE: www.cdc.gov/obesity/data/trends.html

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The remarks came during the second annual Convergence Around Technologies Cardiovascular Health Conference, held in late October at the Radisson Lackawanna Station Hotel in Scranton.

The CATCH '09 Conference - presented by the Community Medical Center, Mercy Hospital, Moses Taylor Hospital and the Commonwealth Medical College as educational partners - has quickly become a major local gathering for health care and community leaders, said Dr. Russell Stahl, an event organizer and CMC's chief of cardiothoracic surgery. Blue Cross of Northeastern Pennsylvania was a major sponsor for the event.

This year's conference focused on treatment of advanced congestive heart failure, particularly in the elderly, as well as palliative care and health care reform. Reinhardt, who teaches at Princeton University, gave the keynote speech before answering questions in a breakout session.

"CATCH '09 really focused on health policy, greater collaboration and technological convergence in the U.S. health care system and locally," Stahl said. "Health care reform is taking us toward global payment reform and an integrated delivery system model with new payment methods."

Next year's conference will discuss local convergence when it comes to how doctors can collaborate to avoid the duplication of services and promote high quality care, Stahl added.

In this year's keynote speech, Reinhardt stressed that the federal government must reform America's health care delivery system soon or risk skyrocketing health care costs that threaten to harm the middle class.

He thinks reforms will fail if they don't include a mandate for all individuals to carry health insurance and public subsidies to allow those who can't afford coverage to buy it.

Plus, he said the government should institute a guaranteed-issue requirement for insurers to cover everyone and a community rating provision so premiums aren't based on health history.

Rather than slapping negative labels on health reform initiatives and dismissing them, Reinhardt said providers, payers, pharmaceutical companies and patients must all collaborate for success. "We shouldn't default to cliches," Reinhardt said.

"We shouldn't just say 'It's socialized medicine, so let's not accept it.'"

If the medical community doesn't work together, "at least a decade of fierce insurgent war among tribal chiefs" will hamper reforms, he said. That's already a likely scenario, said Reinhardt, because any reforms to save the health system money will inevitably come from the bottom-line of one of the medical community's stakeholders.

At the current trajectory of rising health care costs, Reinhardt estimated that health care spending as a percentage of gross domestic product - which currently totals 16 percent - will grow to 40 percent by 2050. Rising health costs aren't primarily spurred by heart disease, the elderly, Baby Boomers consuming more care or "the myth of Medicaid bankrupting the system," said Reinhardt.

Instead, the 6 percent annual growth is driven by all Americans receiving ever more sophisticated and pricey tests and treatments, which represents our "passionate, promiscuous and illicit love affair" with medical care. Americans must now turn their relationship with medical consumption into a "mature" and "stable marriage," he added.

At the same time, health care spending is not a bad thing per se, said Reinhardt, because it's the "economic locomotive for America now." But he doesn't think we should lead industrialized nations in our rate of health care spending growth.

That's because the U.S. medical community can generate savings by installing electronic health systems and educating Americans to take better care of themselves from a young age, Reinhardt said. Other ways to reduce health system costs include using the most cost effective and appropriate treatments, lowering administrative costs, lowering profits, creating integrated medical delivery systems and cutting mistakes, Reinhardt added.

Until health care reforms are enacted, the 5 percent to 8 percent of Americans who buy individual health plans will continue to shoulder a disproportionate share of rising insurance costs, Reinhardt said. And the dwindling spending-power of the middle class will keep eroding precipitously, which ultimately will harm America, Reinhardt added.

Reinhardt's remarks dovetailed in part with the palliative care message of Dr. Eric Cassell. Though Cassell mostly stayed away from talk of money, the former Cornell University professor of public health stressed that resources devoted to palliative care are often the best spent. That's because doctors commonly focus on helping failing patients survive in pain rather than finding ways for them live in comfort as their lives end, Cassell said.

Cassell described a medical system in which doctors often think of very sick patients "in the language of disease." Such doctors see patients less as people and more as a set of vital signs that need to be improved at any cost. Yet, patients should be considered in the language of "well being, goals and functions," Cassell added. Cassell raised the proverbial question: at what point does the suffering a person is enduring to feel well cease to be worth it given the likelihood of recovery? That occurs, he said, "when a patient hasn't gotten better in the average time it takes for a patient to get better" given their age, condition, medical history and all the resources a doctor has expended.

For his part, Dr. John Boehmer, a cardiac transplant specialist at Penn State College of Medicine, outlined technological advances in ventricular assist devices that may improve the cost/benefit ratio of treating sick patients. Most of the expensive pulsatile and nonpulsatile devices require more research and refinement before they become mainstream treatments. But more surgeons are using them as destination therapies, Boehmer said.

"Dr. Boehmer reinforced the need for this technology and the fact it is evolving to the point it might become commonplace," said Dr. Richard Abramowitz, who heads Wilkes-Barre General Hospital's cardiology department. "Dr. Cassell discussed knowing when the need isn't there to implement the technology - that's the art of medicine."

In a separate conference breakout session, Dr. Stahl screened a film of his patient Charlie Flynn, now 83, who underwent valve replacement surgery. Flynn's strong will to live and his health history made the surgery possible even for an older patient in failing health. Yet, Flynn's story represented one of the tough choices doctors face daily about whether to continue treatment.

"CATCH '09 was successful because it really probed the questions surrounding when a doctor should intervene with cutting-edge technology and when it's time to stop and just make the patient comfortable," said Dr. Christopher Dressel, director of Mercy Hospital's cardiac cath lab. "This year's speakers provided their fascinating take on these questions amid the backdrop of Uwe Reinhardt's broader discussion on health care reform."

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Community Medical Center physicians gathered for the opening of CMC's cardiac/peripheral angiography state of the art 3-D imaging system in the new cardiac catheterization lab. In Attendance, Standing left: Stephen J. Voyce, MD, CMC Cardiologist, Joseph Wrobleski, DO, Vascular Surgeon and Charles Stivala, DO, Cardiovascular Surgeon.

Coronary artery bypass graft (CABG) surgery is a surgical procedure used to treat patients with blockages in the coronary arteries. According to PHC4 data, the most common reasons for readmission following these procedures are infections and congestive heart failure. We have minimized these and other adverse outcomes, leading to improved overall results from open heart surgery.

"CMC results regularly surpass many providers in our area, as well as some top academic centers in Pennsylvania," states Dr. Russell Stahl. "There is a notable consistency to our product. CMC and its physicians have always been marked as 'expected' or 'better than expected' in PHC4 analyses."

We invite anyone to visit and see why we provide excellent cardiac surgical care in NEPA, and will do so for years to come. For more information on Community Medical Center and the PHC4 report, visit: www.phc4.org.

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