Issue link: https://beckershealthcare.uberflip.com/i/627546
12 SPINE LEADERSHIP D aniel Ivankovich, MD, is one of a kind. For years, his physician colleagues thought he was crazy for establishing his practice among the most impoverished Chicago neighborhoods and treating almost exclusively Medicaid patients. He made house calls and was known for his personal style and connection with patients. In 2015, he was honored for those very attributes. Dr. Ivankovich is among 2015's CNN Top 10 Heroes of the Year, sharing company with Jim Withers, MD, a Pitts- burgh-based physician who care for the city's homeless; Rich- ard Joyner, who manages Conetoe Family Life Center with 20 plots of land operating community gardens in a North Caro- lina nutritional desert; and Sean Gobin, who created "Warrior Hike," a nonprofit to help combat veterans cope with their war experiences. Dr. Ivankovich co-founded OnePatient Global Health Ini- tiative and currently performs more than 600 surgical proce- dures per year. His program has benefited more than 100,000 people. "I'm a throwback, misplaced from the older generation," says Dr. Ivankovich. "If you talk to surgeons in their 80s, this concept isn't alien to them. is is stuff they did every day. ey never asked whether the patient had money; they brought patients in and did the best they could." Practice philosophy — Treating the underserved Dr. Ivankovich is a second-generation physician; his moth- er and father's approach to practicing medicine had a huge impact on his practice philosophy. Patients travel from around Chicago and the Midwest to see Dr. Ivankovich aer providers in their home communities turned them away due to insurance status. ese patients are oen in advanced stages of degenera- tion or injury because they weren't able to receive immediate or preventative care. "I see many patients who have gone through 12 physicians over several weeks and then their injury is far more complicat- ed to manage," says Dr. Ivankovich. "ey have a broken wrist or hand and were put into a splint, but that didn't fix the prob- lem. Nobody else will treat them and now they've contracted major disabilities." is disparity is all too common for Dr. Ivankovich, who grew up on Chicago's North Side and played basketball with young men from around the city, including those living in the city's Public Housing Projects. Aer an injury sidelined his basketball career, Dr. Ivankovich attended medical school and became an orthopedic surgeon. He trained at both the old Cook County Hospital and Rush University Medical Center and saw the care level differences there as well. At Cook County, surgeons performed a low volume of joint replacements per year with hundreds of people on the waiting list; at Rush, the surgeons performed a much higher volume of joint replacements. Rush was adding surgeons while Cook County was doing fewer procedures, yet caring for a population in need. Minority patients historically haven't had as good of out- comes in complex procedures like heart and spine surgeries. e expected outcome for the average patient demographic Dr. Ivankovich treats is 18 percent success rate; his practice is at the 85th percentile. "It's hard to be around this on a day-to-day basis and not have it totally impact you," says Dr. Ivankovich. "In the city of Chicago, there are a million people living in poverty, but most Chicagoans don't see them. Surgeons choose to practice in suburbia or on the Gold Coast, but if you travel two miles west and three miles south, Chicago is home to the most challenged, marginalized and violent communities in America." He opened a clinic at Provident Hospital of Cook County and performed more than 200 surgeries in the first year. At one point in his career, Dr. Ivankovich was the only orthopedic surgeon covering a community of about half-a-million people and was on call all day, every day. "I'd drive hospital to hospital and PAs would line up with stretchers and we'd treat the patients," says Dr. Ivankovich. "We have gotten those numbers down now, we are doing prevention with many people, but where we are constantly slammed now is patients coming from other communities where doctors aren't doing their part." Caring for Medicaid patients Every licensed physician has a Medicaid number and can take Medicaid patients. ese patients require more paper- work now than in the past — the Affordable Care Act added a layer of paperwork to the Medicaid HMO — and the reim- bursements are lower, but treating a few Medicaid patients per month could have a huge affect on the community. "ere are surgeons who go on medical mission trips one week out of every year, but maybe instead each month they could do a charity case in their own back yard," says Dr. Ivan- kovich. "Take a few Medicaid patients every month and you can help. I'm not telling people to do thousands of Medicaid patients. I have fun with those cases because they are challeng- ing; I'm interested in the challenging diagnosis and these cases Population Health on a Budget: How One Orthopedic Surgeon Succeeded in Chicago's Most Impoverished Neighborhoods By Laura Dyrda