The Message January 2011

THE

message A MON T H LY N E W S M AG A Z I N E OF S C M S – J A N U A RY 2011

PRIORITIES & FOCUS FOR 2011

By Brad Pope, MD SCMS President Is there an ACO in YOUR FUTURE? The Beacon Community of the Inland Northwest and Care Coordination

SPOKANE COUNTY M EDICAL SOCIETY

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U Spokane Valley 12606 January East Mission SCMS Message Open2

A d va n c e d O r t h o p e d i c C a r e . R i g h t H e r e .

2011 Board of Trustees Brad Pope, MD President Terri Oskin, MD President-Elect Anne Oakley, MD Vice President David Bare, MD Secretary-Treasurer Gary Knox, MD Immediate Past President Trustees: Keith Kadel, MD Michael Cunningham, MD Paul Lin, MD Randi Hart, MD Gary Newkirk, MD Carla Smith, MD Rob Benedetti, MD Audrey Routt, MD Terry Oskin, MD Editor

TA B L E O F C O N T E N T S

President’s Message: Priorities and Focus for 2011 . . . . . . . . . . . . . . . . . . . . . . . . 1 Medical Education in Spokane – Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Beacon Community of the Inland Northwest and Care Coordination . . . . . . . . . . . . 5 Group Health and Providence collaborate to develop better care system . . . . . . . . . . . . 6 Focus on Hospitals and Physicians – Is there an ACO in YOUR FUTURE? . . . . . . . . . . . . . 8 New Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 FYI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Membership Recognition for January 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Scms Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Meetings And Conferences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Spokane County Medical Society Message Brad Pope, MD, Editor A monthly newsletter published by the Spokane County Medical Society.

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“YOU ARE THE SAME TODAY THAT YOU ARE GOING TO BE IN FIVE YEARS FROM NOW EXCEPT FOR TWO THINGS: THE PEOPLE WITH WHOM YOU ASSOCIATE AND THE BOOKS YOU READ.” CHARLES JONES

All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

January SCMS Message Open3

President’s Message: Priorities and Focus for 2011 Brad Pope, MD SCMS President Happy New Year to all of you. It is an honor to be writing from the President’s page. As we continue to practice medicine during this time filled with ambiguity, my goal is to have the Spokane County Medical Society work to keep us focused and in front of the issues that affect physicians and our patients.

For those of you who haven’t met me, I am a medical director for Group Health Cooperative’s Eastern Washington/North Idaho District. I’ve lived and raised two sons in the Spokane Valley since 1983. I’m a family physician, and in addition to my administrative role, I still practice as an urgent-care provider every week.

Last month, Gary Knox reminded us of our mission: I encourage you to "The Spokane County Medical think about how you Society exists to promote and provide leadership in the art and can personally support science of medicine. Furthermore, the medical school, for the Society strives to improve and example, by offering preserve the health of the citizens in our community." preceptorships or by Leadership in medicine. Improving serving as faculty. and protecting our citizens’ health.

This is our compass and we certainly need it.

Key issues for 2011 Every December we determine SCMS’s priorities for the year, based on your feedback. About 50 of you responded to our annual survey with very candid input. To request the full report, please contact Michelle Caird at 509-3255010 x25.

We asked you what the priorities should be for SCMS in 2011.

Five issues rose to the top: 1. Increasing access to primary care 2. Expanding medical school in Spokane to a four-year program 3. Improving hospital relations 4. Strengthening legislative relationships and Promoting professionalism (tie).

Access to primary care and medical education expansion As one physician wrote, our priorities should include “promoting primary care and recruiting more primary care providers (PCPs) to Spokane. Our PCP population is aging and more than half are approaching retirement age within the next 5-10 years. We need to promote that primary care is vital and should be reimbursed as such.” Many echoed these thoughts.

Another key issue is the expansion of our medical school. I’m confident it will happen—the question is when. Expansion of graduate and postgraduate medical education is a key longterm tactics to improve access to care in this area. Currently, along with business and elected leaders, SCMS advocates for a four-year, local medical school. Washington State University and the University of Washington (UW) are behind it too. We’ve made progress: students already come here for their first, third and fourth years, and we are working to raise the money for the medical school building. The issues now are securing the ongoing budget to pay the faculty and ensuring we provide enough rotational slots for these students in medical practices and developing more residency capacity.

You can help. I encourage you to think about how you can personally support the medical school, for example, by offering preceptorships or by serving as faculty. Our area leaders welcome your participation. To learn more about how to support the medical school, please call Deb Harper, MD, UW School of Medicine Assistant Dean for Regional Affairs and WWAMI Clinical Coordinator for Eastern and Central Washington at 509-358-7796 or djharper@ uw.edu or John McCarthy, MD, UW School of Medicine Assistant Dean for Regional Affairs and WWAMI Clinical Coordinator for Eastern and Central Washington at 509-358-7795 or mccajf@uw.edu.

SCMS is also committed to working with all of you to continue Project Access. It is very clear that whatever happens, there will always be a segment of our community of patients that will benefit from this important program that exists because of your commitment to volunteer your services to patients who are eligible. Project Access is a great example of how our community of physicians and other service providers step up as professionals to improve health.

Improving hospital relations Hospital relations are another issue of concern. There is real and valid tension in our community as hospitals consolidate with new partners. As one physician writes, “I would like to see the County Medical Society responding to the power plays between the hospital systems, which have clearly stopped acting for the benefit of our patients or physicians in the community.”

Many of you suggested that SCMS should be a mediator and facilitate cooperation between hospitals that have enjoyed decades of healthy competition—collegially. Many of you expressed concern that division within the community can harm patients and our professionalism. As a society of professionals we must collegially communicate and work together for our patients, regardless of how our respective organizations interact.

I welcome your ideas on how SCMS can help relieve the tension and division. Please contact me at pope.b@ghc.org. One excellent suggestion is that we focus on the common ground of issues that are important to all of us such as community health, moving data between providers, and care coordination.

We will do this, as there is indeed much common ground.

For example, we all agree that physicians must work together to address the spiraling costs of health care and increase access.

One issue that has very significant impact on spiraling costs Continued on page 3

January SCMS Message 1

Medical Education in Spokane – Update Deb Harper, MD UW School of Medicine Assistant Dean for Regional Affairs and WWAMI Clinical Coordinator for Eastern and Central WA The Spokane County Medical Society is working with the UW, WSU, Greater Spokane Incorporated (GSI) and others to plan for expanding our medical education here.

The plans include trying to have all four years of medical education in Spokane (we currently have years 1, 3 and 4) and expanding our residencies.

GSI has hired Tripp-Umbach, a firm that specializes in communities working to expand medical education to help with the planning. Our own Representative John Driscoll was able to get our area $250,000 to help the UW work with our community to expand residencies. That effort is being chaired by John McCarthy, MD and is being facilitated by the Huron Group. Both of these efforts are being coordinated for maximum efficiency and efficacy.

The impetus for this effort has come from several sources that have simultaneously sprung into existence and now are collaborating. The SCMS has long been a leader in expanded medical education. A few years ago our business community realized that they needed to make sure we would have enough physicians here in the future and they figured out that allopathic medical schools have research facilities that are good for our economy. Community leaders realized that we have too few medical student spots for our population and our children have one-third the chance to get into their state medical school than children in most other states!

These are exciting and difficult times for medical education in Spokane. Difficult times, because of the state’s current dire economic picture, but exciting times to see so many smart and hardworking people from so many parts of our community working together for this common goal. If you’re interested in more information or want to become involved in medical education, please email me. We won’t be able to use all of our physicians this year, but soon we will need many more physician teachers and mentors.

SCMS is interested in assisting our members to participate more actively in key community leadership roles. If you become aware of an open board, a or advisory committee position please notify Michelle Caird at (509) 325-5010 or my email at michelle@spms.org.

In Memoriam

Margaret "Peggy" O'Meara Brink, M.D. Margaret Brink passed away on December 7, 2010 after almost 94 years of adventure and service to others. She was born January 19, 1917 in Edmonton, Alberta to George and Florence O'Meara. After graduating from the L.C.I. High School, she attended the University of Alberta. Upon completing her M.D. in 1943, she enlisted in the Canadian Army, making history as the first female physician ever to join the Canadian Forces. She served as a Major in the medical corps during W.W. II. Peggy returned to Lethbridge to set up private practice and became their first public health officer. On May 9, 1951 she married orthopedic surgeon, Dr. Francis Brink, fellow Lethbridge native and U. of Alberta graduate, who had immigrated to Spokane in the 1940's. Rather than establish her own practice, she focused on raising her family while attaining her Washington State Medical License, filling in locum tenens to physicians in Spokane and northeastern Washington. Her career also included being on staff at Eastern State Hospital, Interlake School and Deaconess Hospital Emergency Room. She was active in the medical community serving as President of the Auxiliary, lecturing at the Sacred Heart Nursing School and mentoring Deaconess Hospital's physician Residents and their families. After retiring from medical practice in 1984, she continued to maintain her license until well into her 80's. She volunteered at the Shriner's Hospital. Peggy and Francis were passionate about world travel and adventure visiting all continents besides Antarctica. Her favorite spot was her cabin at Priest Lake.

She is preceded in death by her parents; her husband of 55 years, Francis; daughter, Madeline; brother, Ted; and beloved sister, Isobel. She is survived by daughters Johanna Flynn (Jim) of Olympia, WA; and Nancy O'Leary (Martin) of Spokane, WA.; grandsons Ian O'Leary (Nichelle) of Seattle, WA; Seamus Flynn of Dublin, Ireland; and Connor Flynn of Portland, OR; granddaughter, Erin O'Leary Hanser (Seth) of Redmond, WA; great-granddaughters, Margaret and Helen Hanser, and many beloved nieces, nephews, and their families.

January SCMS Message 2

Continued from Page 1 and access is in the way physicians manage chronic pain and chronic narcotic use. Recently SCMS hosted a community forum featuring the perspectives of law enforcement, community health activists, care providers and the judicial system. These stakeholders assert that Spokane has a serious problem, and the medical community must play a leading role to address it. This year SCMS will work to provide direction on how to best manage chronic pain patients with chronic nonmalignant pain and their opiate use. Each of us has a role in addressing this pervasive problem that is currently consuming valuable limited resources of time and money. The SCMS will work toward clarifying a community approach to this serious issue. Each of us has an obligation to learn what the community approach will be and understand and fulfill our individual role in that approach.

Legislative relations You also indicated you want SCMS to continue lobbying with lawmakers about medical liability reform and fair reimbursements for Medicaid and Medicare. You want to be informed about the real impact of federal reform and are concerned about how it could impact on your ability to provide quality patient care. You write, “Keep us informed of the political candidates and their positions on medical issues that affect our community.”

These are universal concerns that we all share. This year SCMS will continue to send delegates to Olympia and Washington, DC to address our issues. I also encourage you to get involved by attending meetings of professional societies or elected officials, attending the Legislative Summit in Olympia, or by writing to your congressional representatives. To learn more about how to get involved, feel free to contact me.

Professionalism The patient relationship, that inspired so many of us to become doctors, continues to be squeezed between malpractice concerns as well as regulatory, insurer, and employer demands. Patients are frustrated and confused by their billing or are shocked at the real costs of their care.

This is where our mission should again speak to us: leadership in medicine. We cannot simply sit back and lament how times are always changing for the worse. Nor can we just show up for work every day and do what everyone else expects us to do as our professionalism erodes. If we do, then we’re at risk of becoming just another skilled laborer tightly managed and regulated by other entities.

I’ve personally chosen to take on physician leadership roles because it gives me the opportunity to influence the type of care that tens and even hundreds of thousands of people get. There are serious problems with our health care delivery and financing system. Physicians need to continue to be leaders in solving these problems and increase our leadership roles if we want to do the best for our patients and preserve the professionalism of the healer role in our society.

I encourage you to think about how you currently lead and how you might increase your leadership role. Hopefully I’ve suggested some tangible ways you can act immediately in our community.

The topics that you have collectively raised as SCMS’s priorities will be our work for the coming year. We need your continuing input and leadership to be effective. Working together as professionals with the interest of our patients at heart I know we can make progress in addressing these important issues.

January SCMS Message 3

Spokane County Medical Society 2010 PHYSICIAN/CITIZEN OF THE YEAR NOMINATION FORM

DEADLINE FOR NOMINATIONS IS FEBRUARY 15, 2011 !

An y me mb er of the Sp o kane C ou nt y Me dica l S o cie t y is eligib le fo r n o minat io n .

Nominee:

Office Address: EXAMPLES FOR EACH OF THE FIVE SECTIONS MUST BE INCLUDED: (Attach pages as needed.)

Contributed to public understanding and appreciation of the role of medicine and to an improved public image of our profession and its members.

Demonstrated high standards of competence, ethics, and professionalism.

Showed outstanding ability in medicine.

Worked for the advancement of the medical profession.

Contributed to the betterment of our community and nation.

NOMINATED BY:

D AT E: Ple a se s u bmit t o: SC MS Physician of the Year Nomination, Orange Flag Building 104 S. Freya St., Ste. 114, Spokane, WA 99202-4868 Or fax to: (509) 325-5409 January SCMS Message 4

The Beacon Community of the Inland Northwest and Care Coordination

We can all agree that our healthcare system has many areas in need of improvement. Agreement on where we begin is often a harder step to take. One might begin with a review of the Institute of Medicine’s Six Aims for Improvement, based on the widely referenced Crossing the Quality Chasm report, and how they relate to care coordination.

Jac Davies, MS, MPH Director, Beacon Community of the Inland Northwest The Beacon Community of the Inland Northwest (BCIN) is working to support the achievement of meaningful use of health IT across 14 counties in eastern Washington and northern Idaho with a focus on prevention and improved management of adult type 2 diabetes.

Over the 36-month project timeline the BCIN intends to accomplish the following goals:

UÊ Patient safety. Coordination of care can improve overall patient

UÊ Increasing meaningful use of health information technology for

UÊ Health care must be patient-centered and include the

safety by managing and compiling information from various caregivers such as prescriptions and lab exams and routing them back to the primary care provider.

UÊ Health care must be effective and based on best practices and medical evidence. Care coordination among providers has become a best practice based on proven strategies that are currently being utilized by many health care organizations. patient in the care process. Patient-centered care also

all medical conditions

means understanding the patient’s culture, literacy needs,

UÊ Promoting cost efficiency by reducing use and costs of

socioeconomic background and environmental needs

emergent and inpatient care for diabetes-related complications

throughout the continuum of care. Through the care

UÊ Improving quality of care by increasing compliance with

coordination process, patients are armed with community

diabetes preventive health services UÊ Improving core preventive measures for individuals with

resources that can assist with other non-medical needs that

diabetes The key mechanism for meeting these goals is the implementation of a common approach to and common tools for care coordination across the region. The National Coalition on Care Coordination defines care coordination as, “… a client-centered, assessment based interdisciplinary approach to integrating health care and social support services in which an individual’s needs and preferences are assessed, a comprehensive care plan is developed, and services are managed and monitored by an identified care coordinator following evidence-based standards of care.” Care coordination can enhance the delivery of health care by providing physicians with the necessary tools and support to more effectively manage their patients’ health conditions.

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UÊ Health care must be timely. The essence of care coordination is timely patient care. Using care coordination as a mechanism for care delivery will arm the provider with resources for a timely and accurate plan of care.

UÊ The healthcare system must be efficient. Coordinating care to manage patients’ health conditions will improve patient outcomes, decrease costs and improve quality.

For more information on the Beacon Community of the Inland Northwest, please visit www.inhs.org or call (509) 232-8148.

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Group Health and Providence collaborate to develop better care system Tom Schaaf, MD Group Health Assistant Medical Director It was a timely coincidence that SCMS decided the January Message would focus on hospitalbased systems of care, because last month Group Health and Providence Health Care announced we will In a nutshell, this collaborate to develop an innovative means sharing clinical health care system in the Spokane information, developing region.

Together our two organizations joint clinical programs plan to develop ways to manage and best practices, and the full continuum of care for exploring new payment patients—everything from health education and prevention, visits models focused on with physicians, hospitalization, providing value, not rehabilitation therapy and home solely producing health services, to end-of-life care.

In a nutshell, this means sharing volume. clinical information, developing joint clinical programs and best practices, and exploring new payment models focused on providing value, not solely producing volume.

Here’s one example of how it can work in practice. Today, a patient goes to the primary care physician (PCP) because of a persistent headache (presuming the patient even has a primary care physician). In most practices, the PCP has, at the most, 10-15 minutes to see the patient. In 15 minutes, the PCP needs to get up to speed on the recent chart notes and discuss the presenting condition (headache) with the patient, leaving no time to do acomplete neurologic work-up on the patient.

What often happens is the PCP refers the patient along to a neurologist, or, if the patient can’t get in to see the neurologist for several weeks, medication or an MRI may be ordered that may not be necessary. The neurologist may or may not get the chart notes from the visit to the PCP or the patient’s medical history.

And, the PCP and neurologist may never talk to each other about the patient condition or the best course of treatment.

The patient must relay the information back to the PCP and be seen again by the PCP for follow-up. In this fragmented process,

the patient gets treated, but unnecessary tests and medication may be ordered. The exam done by the neurologist may not have been necessary.

Imagine every patient has a PCP who has sufficient time to do a thorough history and exam. There’s time to review diagnostic and therapeutic options and do shared decision making with the patient. If neurology input is needed, both the PCP and specialist have the time, methods and inclination to approach diagnosis and treatment as a team. Patient charts are sent electronically to the neurologist, who has the time to review the chart and send back a message about further follow-ups (therapy, work-up, diagnostic, and whether consult is needed). Both the PCP and the consulting specialist are paid to provide care in that fashion.

PCPs are paid for the time spent with the patient to coordinate care and consulting specialists are paid for providing consult to other providers.

Providence and Group Health share a long history of improving patient care together. Thirteen years ago, Providence Hospital helped us pioneer our first full-scale hospitalist program in Spokane. Today Providence hopes to leverage Group Health’s success with the medical home.

I am excited to begin a broader conversation with others who are interested in helping to build this model of care in Spokane.

Tom Schaaf, MD, is the assistant medical director for Group Health Cooperative’s Eastern Washington/North Idaho District.

Board-certified in Family Medicine, Dr. Schaaf has practiced at Group Health in Spokane since 1992 and founded its hospitalist program in 1997. He practiced as a hospitalist until 2004 before becoming medical director.

SCMS is interested in assisting our members to participate more actively in key community leadership roles.

If you become aware of an open board, a or advisory committee position please notify Michelle Caird at (509) 325-5010 or my email at michelle@spms.org.

January SCMS Message 6

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Meet the physicians of Cancer Care Northwest.

View their full profiles at: cancercarenorthwest.com/doctor-profiles es

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comprehensive innovative compassionate integrated

Focus on Hospitals and Physicians – Is there an ACO in YOUR FUTURE? The two sources below look at the key issues that hospitals and physicians are being asked to consider if they are evaluating Accountable Care Organization (ACO) development or participation. Which set of issues makes sense for you and your practice may depend on whether you are affiliated with a system or are freestanding. If you have a perspective, the SCMS leadership would be interested in knowing it. Please contact us at SCMS (yoursociety@spcms.org) regarding your comments.

Positioning hospitals to become successful ACOs The Washington State Hospital Association submitted a comment letter in response to the Centers for Medicare and Medicaid Services' request for information about Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Based on The Accountable Care the most serious concerns Organization (ACO) program of member hospitals, health becomes effective in 2012. systems and clinics, WSHA's It is important that hospitals comments addressed two key issues for Washington State: interested in developing the calculation of "shared or joining an ACO position savings" and the need to themselves under this model consider variation in spending of providers and the required by assessing their ability to flexibility for rural health care. coordinate care to achieve The Accountable Care Organization (ACO) program savings. becomes effective in 2012.

It is important that hospitals interested in developing or joining an ACO position themselves under this model by assessing their ability to coordinate care to achieve savings.

Key issues recently raised by Becker’s Hospital Review (available at www.spcms.org at Our Bookmarks) include: UÊ Assessing relationships with physicians UÊ Evaluating and possibly expanding primary care provider services.

UÊ Determining which additional providers to incorporate into an ACO. UÊ Exploring partnerships with other physician groups, hospitals and health systems.

UÊ Preparing for the possibility of reduced admissions.

The AMA makes recommendations to CMS for physician-led, patient-centered ACOs. The AMA submitted its most detailed comments (available at www.spcms.org on our Facebook page) to date to the Centers for Medicare & Medicaid Services (CMS) on how Medicare should structure physician-led and patient-centered accountable care

organizations (ACOs). The recommendations were submitted on December 2, in response to a specific request from CMS for comments on how to ensure that solo and small group practices have the opportunity to actively participate in Medicare's ACO program.

The AMA's recommendations to CMS on structuring physicianled ACOs include: UÊ Developing new payment models for physicians that move Medicare away from today's dysfunctional physician payment system—the threat of Medicare physician payment cuts will impede physicians' efforts to improve care coordination, such as employing case managers and investing in infrastructure to monitor and improve quality.

UÊ A range of specific new payment methods that CMS should consider in addition to shared savings, including an accountable medical home payment system and bundled payments for specific medical conditions, such as congestive heart failure.

UÊ Increased access to loans and grants for small physician practices.

UÊ Easing of antitrust restrictions that prevent physicians from collaborating.

UÊ Timely access to quality data.

The AMA also urges CMS to allow patients to voluntarily select a Medicare ACO and to undertake a proactive effort to educate and encourage beneficiaries to take steps that will help make ACOs successful. For example, patients should be able to: UÊ Choose and consistently use a primary care physician as a medical home.

UÊ Select specialty physicians, hospitals and other providers that coordinate effectively with their primary care medical home and each other.

UÊ Engage in shared decision-making processes with their physicians about appropriate treatments for their conditions.

UÊ Participate in other types of programs developed by their physicians to maintain and improve their health at an affordable cost.

This education effort should be developed in cooperation with physicians and launched well in advance of the ACO program's initiation.

The AMA also makes recommendations on the types of quality measures ACOs should use. At least in the initial years of the program, CMS should avoid making ACOs collect and report quality measures beyond those already required under other CMS programs, such as the Physician Quality Reporting System (PQRS), formerly known as the Physician Quality Reporting Initiative.

Although additional quality measures may ultimately be warranted, it is impractical to develop a single national set of such measures prior to implementation of the Medicare Shared Savings Program, because the areas where ACOs will focus their cost reductions will likely vary significantly from region to region.

Furthermore, measures that may be appropriate for one ACO model may not be appropriate for another. ACOs should be allowed to report on a hybrid of nationally and locally focused quality measures related to their particular patient population.

Comments? Send them to yoursociety@spcms.org.

January SCMS Message 8

The following physicians/physician assistants have applied for membership, and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIAN ASSISTANT Weidner, Philip L, PA-C Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Rockwood Clinic beginning 1/2011

PHYSICIAN ASSISTANTS PRESENTED A SECOND PHYSICIANS

TIME

Borden, Rodney B., MD Anesthesiology Med School: U of Texas Medical Branch (1994) Internship/Residency: John Sealy Hospital (1998) Practicing with Anesthesiology Associates, PS beginning 1/2011

Holmstrom, Timothy E., PA-C Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Rockwood Clinic in the near future McLeod, Pamela S., PA-C Physician Assistant Med School: Cornell Medical School (1980) Practicing with Inland Neurosurgery and Spine Associates since 10/2010

Dajnowicz, Anthony M., MD Pediatrics/Neonata-Perinatal Medicine Med School: Wayne State U (1985) Internship: St Francis Medical Center (1986) Residency: Loma Linda U (1990) Fellowship: Loma Linda U (1993) Practicing with Pediatrix Medical Group beginning 2/2011 Freter, Mark A., MD Family Medicine Med School: U of Missouri (1991) Internship/Residency: U of Missouri (1994) Practicing with Northwest Pacific Emergency Physicians beginning 1/2011

Wilson, Sarah L., PA-C Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Inland Cardiology Associates since 12/2010

Quisano, Melissa A., MD Family Medicine Med School: Loma Linda U (2006) Internship/Residency: Family Medicine Spokane (2009) Practicing with Columbia Medial Associates since 3/2010 Ruiz, Veronica G., MD Family Medicine Med School: U of Texas Medical Branch (2000) Internship/Residency: Via Christi Hospital (2003) Practicing with Rockwood Quail Run Clinic in the near future

PHYSICIANS PRESENTED A SECOND TIME Fernandes, Neville O., MD Anesthesiology Med School: U of Texas Medical Branch Practicing with Anesthesiology Associates, PS beginning 1/2011 Hercl, Grace, DO Internal Medicine Med School: Ohio U College of Osteo Medicine (1999) Practicing with Sound Physicians since 12/2010 Klarnet, Jay P., MD Medical Oncology Med School: SUNY (1980) Practicing with Rockwood Clinic since 11/2010

January SCMS Message 9

FYI

Health Reform Law Provides New Center to Test Payment

Survey Results Published Our congratulations to Drs. Doug Weeks, Cynthia Corbett and Glen Stream for their recent article published in the October 2010 issue of the Journal for Healthcare Quality titled “Beliefs of Ambulatory Care Physicians about Accuracy of Patient Medication Records and Technology-Enhanced Solutions to Improve Accuracy” In 2008 Inland Northwest Health Services (INHS) received funds from the Washington State Health Care Authority to explore possible solutions for inaccurate or unavailable medication information often seen in the ambulatory care setting. One of the Medication Reconciliation project’s first steps was to survey physicians and mid-level practitioners (who have prescribing authority) about the scope of the problem.

It was recommended that the Informatics Committee serve as a venue for a one-hour pre-planning focus group that could provide valuable input on the issues and impacts that would help to define the survey process. The SCMS membership was then surveyed in early 2009 based on those recommendations. The full text article is available at www.spcms.org Seven Healthcare Organizations Launch Data-Sharing Collaborative Andis Robeznieks Seven health organizations will work together in an effort coordinated by the Dartmouth Institute for Health Policy and Clinical Practice to share data on outcomes, quality and costs associated with common conditions and treatments with the goal of determining best practices. The six health systems participating with Dartmouth Institute are the Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, Geisinger Health System, Intermountain Healthcare and the Mayo Clinic. They have a combined patient population of 10 million people.

The organizations will share data on knee replacement, diabetes, heart failure, asthma, weight-loss surgery, labor and delivery, spine surgery and depression. Noting that costs range from $16,000 to $24,000 per surgery, according to a Dartmouth news release, knee replacements will be the first item on the agenda, with data-sharing initiatives for diabetes and heart failure to begin early next year.

Unveiling of Implementation Plan for Health Insurance Exchanges The Washington State Health Care Authority (HCA) recently convened a Health Insurance Exchange Stakeholder Meeting to discuss issues surrounding the possible creation of a state-based health insurance exchange. The meeting also made public a draft of the Governor's request for legislation to create a health benefit exchange development board. The board would be tasked with creating a business plan, making recommendations about key elements, and establishing a timeline for the implementation of a state health benefits exchange. Legislation is expected to be introduced during the upcoming state legislative session.

and Delivery Models CMS formally launched the Center for Medicare and Medicaid Innovation this week. Created by the Affordable Care Act, the innovation center will test new delivery and payment models aimed at improving care and reducing costs. The well-funded innovation center could provide opportunities in addition to or outside of Accountable Care Organizations.

Obama Signs Red Flags Bill Dom Nicastro President Obama signed the bill that changes the Red Flags Rule's definition of "creditor" and relieves some physicians of having to comply with the Federal Trade Commission's identity theft prevention law.

Earlier in the month, the House and Senate passed the bill officially titled "Red Flag Program Clarification Act of 2010."

The enforcement date for the Red Flags Rule is Dec. 31, 2010.

The FTC said earlier this year on its website that it delayed enforcement at the request of Congress as it "considers legislation that would affect the scope of entities covered by the rule." Compliance date was November 1, 2008.

Red Flags calls for "creditors" to establish a program to protect patients from medical identity theft.

The bill calls for changes to the FTC's definition of "creditor."

Smaller entities such as physician practices and doctor's offices have long debated they should be let off the hook from complying. Some have filed lawsuits. Jeff Drummond, health law partner in the Dallas office of Jackson Walker LLP, says the law doesn't actually "remove physicians from the Red Flags Rule." It clarifies in a reasonable way, he says, what a "creditor" is.

"I think the FTC went way overboard with their definition of 'creditor' including anyone who takes payment after providing the service," Drummond says. "Taken to its logical extreme, McDonald's and Burger King are not creditors, but Chili's is. So, it's a good change to rein in an overbroad regulatory agency."

Some physicians will still be creditors; plastic surgeons and lasik surgeons, for example, if they take payments over time from their patients.

Drummond adds it's not that hard to establish an identity theft prevention program, as the Red Flags Rule require; doctors have to have HIPAA programs in place anyway.

"It's just good practice, and good customer service, to have an ID theft prevention program in place," Drummond says. "So, even if you don't have to, you ought to."

Dom Nicastro is a senior managing editor at HCPro, Inc. in Marblehead, MA. He edits the Briefings on HIPAA and Health Information Compliance Insider newsletters. E-mail him at dnicastro@hcpro.com.

January SCMS Message 10

MEMBERSHIP RECOGNITION FOR JANUARY 2011 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

50 Years Charles R. Wolfe, MD

1/12/1961

40 Years John M. Collins, MD Terrance P. Judge, MD L J. Wiwatowski, MD

1/26/1971 1/26/1971 1/26/1971

30 Years Douglas G. Norquist, MD R. Steven Brisbois, MD Robert H. Gersh, MD William R. Osebold, MD

1/27/1981 1/28/1981 1/28/1981 1/28/1981

10 Years Jamie L. Kooy, MD Kawal D. Chester, MD

1/1/2001 1/2/2001

Physician Health is Important.

Eastern Washington Physician Health Committee We are available to assist you in the following areas: t t t t t t t t t

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ɨJT DPNNJUUFF B GVTJPO PG UIF GPSNFS 4$.4 DPNNJUUFF BOE POF JODMVEJOH NFNCFST PG NFEJDBM TUBĊT PG $PNNVOJUZ )FBMUI 4FSWJDFT BOE 1SPWJEFODF )FBMUI $BSF )PTQJUBMT NFFUT RVBSUFSMZ UP FEVDBUF PVSTFMWFT BCPVU QIZTJDJBO IFBMUI JTTVFT SFWJFX VUJMJ[BUJPO BOE TBUJTGBDUJPO XJUI UIF 8FMMTQSJOH &BSMZ "TTJTUBODF 1SPHSBN &"1 BOE QMBO BDUJWJUJFT QSPHSBNT BOE SFTPVSDFT UP BEESFTT OFFET JO UIFTF BSFBT 4PNF PG UIF HVJEJOH QSJODJQMFT PG UIJT DPNNJUUFF BSF The medical profession and healthcare community should foster physician well-being A sense of community with one’s peers is vital to personal well-being Changes in the healthcare environment and contributing to personal and professional challenges and new stressors for physicians Physicians should have resources available to them to anticipate and manage episodic personal issues

COMMITTEE MEMBERS Jim Shaw, MD, $IBJS Steve Brisbois Michael Metcalf Paul Russell Phil Delich Michael Moore

Robert Sexton Jim Frazier Mira Narkiewicz Patrick Shannon Deb Harper January SCMS Message 11

Sam Palpant Alexandra Wardzala Mike Henneberry Tad Patterson Hershel Zellman

SCMS CONTINUING MEDICAL EDUCATION 2011 Program Schedule In 2011, SCMS will hold 5 Category I CME Programs.

(Schedule subject to change) FEBRUARY Neurology Update 2011 Wednesday, February 9 Sacred Heart Medical Center (Mother Joseph Room) 5:30 – 9:15 pm (Three one-hour topics will be presented)

CONTINUING MEDICAL EDUCATION Neurology Update 2011: This three-hour seminar is sponsored by the Spokane County Medical Society. Conference held on February 9, 2011 at the Sacred Heart Medical Center in the Mother Joseph room (near the cafeteria). Contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org for more information.

Update in Internal Medicine 2011: This seminar is sponsored by the Spokane Society of Internal Medicine. Conference will be held on February 25-26, 2011 at the Spokane Convention Center.

Contact Merry Maccini at (509) 468-0236 or email spokanesim@ gmail.com for more information.

APRIL Update in Pain Management Evening Seminar for the Primary Care Update Conference Thursday, April 28 Red Lion Inn at The Park 5:30 – 9:15 pm (Two one and one-half hour topics will be presented)

How Physicians Can Make the Most of the New World Order - WSMA/WSMGMA Joint Conference Thursday, February 3, 2011 SeaTac Hilton Conference Center. This program addresses a host of factors which now define the physician practice context— clinically and financially. Contact Jenelle Dalit at (206) 441-9762 or (800) 552-0612 or email jcd@wsma.org.

OTHER MEETINGS AND CONFERENCES

JUNE Endocrinology Update 2011 Wednesday, June 8 Deaconess Health and Education Center 5:30 – 9:15 pm (Three one-hour topics will be presented)

Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

OCTOBER Moderate (Conscious) Sedation and Analgesia Wednesday, October 5 Deaconess Health and Education Center 5:30 – 9:15 pm (SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety.)

NOVEMBER Topic TBD Tuesday, November 8 Deaconess Health and Education Center 5:30 – 9:15 pm (Three one-hour topics will be presented)

Meetings and Conferences

Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery.

Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8 p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous personal sharing; No dues or fees. Guided by Drs. Bob and Carol Sexton. The contact phone number is (509) 624-7320.

January SCMS Message 12

January SCMS Message 13

service lease. Starting lease length 5 years that includes an $8 sq/ ft tenant improvement allowance. Available space: *Suite 210 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 - 2190 sq/ft

CLASSIFIED ADS RE AL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

FOR SALE with Lease Option. MUST SEE!!! Beautiful custombuilt Lake home with attached “daughter house.” Main home has two bedrooms, two baths and complete office. Rock Garden, private driveway with security gate, two car garage, AC, wood floors, central VAC, fireplace, washer & dryer. “Daughter” house includes 2 bedrooms, 1 bath, office and separate carport. Lease option - $1,200 for main house; $800 for in-law suite or $2,000 for both. Country living but close to Cheney and Spokane. Contact Jerry Krause, jerrykrause3@aol.com or krausej@athletics.gonzaga. edu or cell #, 509-280-8179.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side.

(Owners rarely in residence) This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor. One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.

Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth College. Please call 954-8339 for details.

Also willing to rent "unfurnished.”

MEDICAL OFFICES/BUILDINGS Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community. If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $24 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a fullservice medical building with lab and full radiology services. For more information, call (509) 981-9298.

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling.

Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

Indian Trail Professional Building has medical space available for lease. A 11,243 sf professional medical / office building located in the growing Indian Trail Community directly across from the new Sundance Shopping Center. Address is 5011 W. Lowell Ave or the SWC of Indian Trail and Lowell Avenue, Spokane, WA. The main floor space located off of the main floor entrance consists of 4,389 sf of Class “A” General Medical Practice or Urgent Care Center space. A Tenant Improvement Allowance is Available, subject to terms of lease. Floorplans and marketing materials can be emailed upon request. Please contact Patrick O’Rourke, CCIM with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 9992720. Email: psrourke@comcast.net.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue.

The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors, and stairways. Other tenants in the building include, pediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease. Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

January SCMS Message 14

POSITIONS AVAILABLE EASTERN STATE HOSPITAL PSYCHIATRIST – ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

EASTERN STATE HOSPITAL PHYSICIAN – ESH, the 287 bed state psychiatric hospital in eastern WA, is recruiting for a family practice or internal medicine physician to provide medical care on the Adult Psychiatric Unit with a caseload of 30 patients.

The physician would be part of the treatment team, which is comprised of the attending psychiatrist, social worker, RN, and recreation therapist. The physician will treat common medical conditions and refer for consultation to providers in the community for care that cannot be provided at ESH. Will supervise two certified physician assistants who provide care on other patient care units. Salary: $149,952 annually with competitive benefits. Twenty minutes southwest of Spokane, WA. Join a stable Medical Staff of 30 psychiatrists, physicians and Physician Assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@dshs.wa.gov. Eastern State Hospital, PO Box 800, Medical Lake, WA 99022-0800.

EMERGENCY ROOM PHYSICIAN POSITION OPENING – NorthEast Washington Medical Group is currently recruiting for a full-time ER physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane. NorthEast Washington Medical Group consists of 27 providers that serve a surrounding area of approximately 30,000 in the very rural tri-county area. We offer flexible hours for an ER physician or FP physician with Emergency Room experience. Our ER physicians enjoy working in the new emergency department at Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ed Johnson, MD, ER Medical Director, via phone at 509-685-7831 or e-mail at edjohnsonmd@hotmail.com or Ron Rehn, DHA, Chief Executive Officer, via phone at 509-684-7723 or e-mail at rrehn@newmg. org. Mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville, WA 99114. Visit our website at www. newmg.org for more information.

INTERNAL MEDICINE POSITION OPENING – NorthEast Washington Medical Group is currently recruiting for a full-time (Monday through Thursday) Internal Medicine physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane. NorthEast Washington Medical Group serves a surrounding area of approximately 30,000 in the very rural tri-county area. This is an outpatient

based Internal Medicine position with call. There is supporting physician call in Family Practice, OB, surgery, and orthopedics.

Our clinic physicians have privileges at Providence Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ramon Canto, MD, Internal Medicine Medical Director, by phone at 509-684-7706 or Ron Rehn, D.H.A., Chief Executive Officer at 509-684-7723 or e-mail at rrehn@ newmg.org. The mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville WA 99114. Visit our website at www.newmg.org for more information about Colville Medical Center P.S. PHYSICIANS – Are you looking to expand your clinical horizons?

Here’s an opportunity to serve your community and our nation’s veterans. We are looking for physicians to provide night coverage, weekends and holidays to do admissions and hospital coverage. 12 to 16 hours shifts are available. For additional information, please contact VA Medical Center, Jim Erickson, Administrative Assistant to the Chief of Staff, 4815 N. Assembly, Spokane, WA 99205. 509-434-7211. An Equal Employment Opportunity.

PHYSICIAN OPPORTUNITIES AT CHAS – At Community Health Association of Spokane (CHAS), we believe doctors should practice what they are passionate about: serving patients and the community. We are looking for physicians to join our great team!

Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. Experience pure patient care at CHAS. To learn more about physician employment opportunities, contact Kelly McDonald at (509)444-8888 or kmcdonald@chas.org.

OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509)325-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821.

URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA. We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position. Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call. Please contact Evelyn Torkelson at torkele@empirehealth.org or (509)473-7374.

January SCMS Message 15

January SCMS Message 16

PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum速 Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

January SCMS Message 17