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Medical record BERKS COUNTY MEDICAL SOCIETY

WINTER 2015


Wynton Marsalis

Yolanda Adams

Incognito

James Hunter Six

April 10-19, 2015 Reading, PA

Dave Koz

Terell Stafford

Spend 10 jazz- and blues-filled days and nights in the Greater Reading area! Over 120 scheduled events, plus great shopping and dining in one area, make the 25th annual Boscov’s Berks Jazz Fest your perfect spring getaway. For tickets, call Ticketmaster toll free at 1-800-745-3000 or visit www.ticketmaster.com to order online.

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JAZZ AT LINCOLN CENTER ORCHESTRA WITH WYNTON MARSALIS • DAVE KOZ • INCOGNITO • BRIAN CULBERTSON • DIANNE REEVES • BONEY JAMES • PIECES OF A DREAM MINDI ABAIR & THE BONESHAKERS WITH SWEETPEA ATKINSON • THE SOUL OF JAZZ FEATURING JEFFREY OSBORNE, NAJEE, MAYSA, NICK COLIONNE, GERALD VEASLEY, BRIAN SIMPSON NEW YORK VOICES AND THE READING POPS ORCHESTRA • BILLY COBHAM ‘SPECTRUM 40’ BAND FEATURING DEAN BROWN, GARY HUSBAND, RIC FIERABRACCI • GERALD ALBRIGHT GOSPEL ACCORDING TO JAZZ CELEBRATION: KIRK WHALUM, YOLANDA ADAMS, KEVIN WHALUM, JOHN STODDART AND THE DOXA GOSPEL ENSEMBLE • MARC ANTOINE • ALEX BUGNON STRINGS ATTACHED FEATURING LARRY CORYELL, JIMMY BRUNO, VIC JURIS, JACK WILKINS, JOE COHN • PHILADELPHIA JAZZ ORCHESTRA DIRECTED BY TERELL STAFFORD REMEMBERING JOE SAMPLE: BOBBY LYLE, WILTON FELDER, RAY PARKER JR., JEFF BRADSHAW, NICHOLAS SAMPLE, LIONEL CORDEW, LIZ HOGUE • BRIAN BROMBERG NICK COLIONNE • JAZZ ATTACK: RICK BRAUN, PETER WHITE, EUGE GROOVE, ELLIOTT YAMIN • MARION MEADOWS • PAUL TAYLOR • JAZZ FUNK SOUL: CHUCK LOEB, JEFF LORBER, EVERETTE HARP • FOURPLAY: BOB JAMES, NATHAN EAST, HARVEY MASON, CHUCK LOEB • KIND OF NEW: JASON MILES, INGRID JENSEN, RAY RODRIGUEZ, MIKE CLARK, JERRY BROOKS PLUS SPECIAL GUESTS LIONEL LOUEKE, GARY BARTZ • PAT MARTINO TRIO WITH PAT BIANCHI, CARMEN INTORRE • LIVE AT THE FILLMORE: TRIBUTE TO THE ORIGINAL ALLMAN BROTHERS • URBAN JAZZ COALITION • TOMMY KATONA & TEXAS FLOOD • FRANK VIGNOLA & VINNY RANIOLO • THE JOST PROJECT: TONY MICELI, PAUL JOST, KEVIN MACCONNELL, ANWAR MARSHALL • ROYAL SOUTHERN BROTHERHOOD FEATURING DEVON ALLMAN, CYRILL NEVILLE, CHARLIE WOOTEN, YONRICO SCOTT, BART WALKER • JAMES HUNTER SIX • MIKEY JUNIOR BAND • ANDREW NEU WITH CAROL RIDDICK, DAVID P STEVENS • DANCE HALL DOCS FEATURING BRENT CARTER • THE UPTOWN BAND FEATURING ERICH CAWALLA & JENIFER KINDER GREG HATZA & TIM PRICE ORGAN QUARTET • PAT TRAVERS BAND • CRAIG THATCHER BAND • THE ORIGINAL GROOVEMASTERS • REGGIE BROWN AND BUNCH A FUNK THE ROYAL SCAM • DJANGOHOLICS ANONYMOUS: JOSH TAYLOR,CHRIS HESLOP, BILL NIXON, MICHAEL NIKOLIDAKIS, TREY LARUE • SAX SUMMIT: NATHAN BELLOTT, SETH EBERSOLE, ANDY MOHLER, GREG WILSON • RANDY HANSEN • CELEBRATE SINATRA: LOU DOTTOLI AND THE SOUNDS OF SUNNYBROOK DANCE BAND • U.S. ARMY JAZZ AMBASSADORS AND MORE!*

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Medical record BERKS COUNTY MEDICAL SOCIETY

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To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

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THE BERKS COUNTY MEDICAL RECORD Lucy J. Cairns, MD, Editor

EDITORIAL BOARD

1170 Berkshire Blvd. | Wyomissing, PA 19610 1.855.THE.VNAs | berksvna.org

D. Michael Baxter, MD John Moser, MD Betsy Ostermiller

BERKS COUNTY MEDICAL SOCIETY OFFICERS

Non-profit 501(c)3, Accredited by CHAP, United Way Agency

Lucy J. Cairns, MD President Andrew R. Waxler, MD, President-Elect D. Michael Baxter, MD, Chair, Executive Council Michael Haas, MD, Treasurer & Chair, Finance Committee Gregory T. Wilson, MD, Secretary Kristen M. Sandel, MD, Immediate Past President Berks County Medical Society

1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610 Phone: 610.375.6555 | Fax: 610.375.6535 Email: info@berkscms.org

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society.

Manuscripts offered for publication and other correspondence should be sent to 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. The editorial board reserves the right to reject and/or alter submitted material before publication. The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices. POSTMASTER: Please send address changes to the Berks County Medical Record, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610.

PUBLISHER:

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Table of Contents WINTER 2015 FEATURES

Cover Feature

Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”

Thank a Member for the Mcare Win

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2014 Annual Meeting Recap: Helping Physicians Adapt to Change 10 Berks Independent Physicians Association Comes to Life 12 Three Members of the Pennsylvania Medical Society’s Resident and Fellow Section Poster Winners 13 Restrictions on Medical Record Copying Charges for 2015 14 Hot HR Topics 20 “Code Black” Documentary a Successful Goggleworks BCMS Partnership 23 Fall Golf Outing 28

DEPARTMENTS

Editor’s Comments

Foundation Update Alliance Update

Legislative Updates Events Calendar

Cover Photo: Lucy J. Cairns, MD, Photographer: Dave Zerbe

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Editor’s Comments

A New Year

Every New Year ushers in change, ready or not. Dr. Kristen Sandel has done a stellar job leading the BCMS as its 2014 President, and I don’t feel as ready as I would like to be as I succeed her in 2015. I don’t have her youth, her energy, or her baseball quotes! But what I do have is the same belief in the vital importance of physicians working together to protect our ability to continue providing the type of care our patients deserve.

Lucy J. Cairns, MD, Editor

Frankly, it can be exhausting just trying to stay informed about these issues and dealing with them as best one can in the course of meeting one’s professional commitments on a daily basis. To go further and become proactive in working with other physicians to obtain the best outcomes for ourselves and our patients takes additional time and energy many of us just don’t have at certain times in our careers. In my case, child-rearing and then caring for aging parents consumed my ‘free’ time until very recently. For many years, I supported BCMS/PAMED with my dues and benefited from the efforts of those members who were actively engaged. Now it is my turn to step up to the plate (nod to Kristen) and take a swing or two for the team.

And to those members who are sitting in the stands, as I did for so long, thank you very much for your support and please stay open to the possibility that you too will find time to join your colleagues on the playing field one day.

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Threats to physician-led, patient-centered, high quality medical care have been coming at us for a long time and just seem to be multiplying and becoming more difficult to beat back. The drive to ensure ready access to care for those newly insured under the Affordable Care Act has breathed new life into some efforts by mid-level practitioners to expand their scope of practice via legislation. Attempts to restrict the questions physicians are allowed to ask their patients and specify information physicians must convey to patients regarding their health cannot go unchallenged. Physicians employed by hospitals and health systems may be subject to incentives that at times conflict with their professional view of a patient’s best interests. We can expect efforts to undo the tort reform measures that have made Pennsylvania a less hostile practice environment during the past decade. And with the advent of electronic health records, employers and insurers are crunching our data to deal out rewards and penalties with the stated goal of improving quality and cost-efficiency, but with the additional effect of constricting our ability to treat people as the individuals they are.


A New Editor I am pleased and excited to announce that Dr. Christina M. Ohnsman will serve as interim Editor of the Medical Record during 2015. Dr. Ohnsman is a Pediatric Ophthalmologist who has been a member of the Berks County medical community since 1994. In 1996 she established her own practice in Wyomissing, and I have always admired her commitment to excellence and independence in the interest of her patients. The addition of her voice to the Medical Record will make a good magazine even better. n

It’s like having 20 of the best ophthalmologists and eye care professionals right in your practice.

Adam J. Altman, MD Helga S. Barrett, OD Leslie P. Brodsky, OD Jennifer H. Cho, OD Michael Cusick, MD Gary L. Dietterick, OD David S. Goldberg, MD Dawn Hornberger, OD Y. Katherine Hu, MD Lawrence E. Kenney, MD Edna Z. Mahmood, MD Barry C. Malloy, MD Michael A. Malstrom, MD Thomas L. Manzo, MD Martin F. Miller, OD Mehul H. Nagarsheth, MD Jonathan D. Primack, MD Mitchell M. Scheiman, OD Denis Wenders, OD Elliot B. Werner, MD

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Medical reco

2015 WINTER

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Foundation Update

PHP Evaluation of Healthcare Professionals By: Jon Shapiro, MD, Physicians Health Programs Medical Director

T

he Pennsylvania Physicians’ Health Programs (PHP), part of the Foundation of the Pennsylvania Medical Society, helps individuals suffering from addiction or work-related stress. PHP monitors a variety of healthcare professionals(HCPs) — physicians, physician assistants, dentists, dental hygienists, expanded function dental assistants and medical students, when necessary. The process of assisting HCPs might be broken down to evaluation, treatment, monitoring and advocacy. The process of referral to PHP and evaluation is a step to ensuring better health for HCPs. Professionals are referred to PHP through many sources. We receive referrals from spouses, friends, co-workers, and employers as well as self-referrals. There has been a recent increase in the number of referrals from the Board of Medicine caused by a history of driving under the influence (DUI). These referrals occur when the applicant checks a box on the application/renewal form indicating a history of a DUI. Alternatively, the HCP may be reported to the Board of Medicine by JNET. JNET is a web-based information sharing portal for agencies in the Commonwealth of Pennsylvania. This sharing of information regarding DUI arrests has led to an increase in referrals from the state to PHP.

When the PHP receives a referral for a HCP with a possible problem, they are referred to an independent evaluator. The PHP staff obtains the appropriate releases so that we may report back to the referral source. Our case managers always strive to give the HCP a choice of evaluators that are suited to his/her individual circumstances. The evaluator will interview the HCP, perform drug tests and obtain information from collateral sources. If no

impairment is diagnosed, the PHP will notify the referral source and the individual referred of the outcome. When the referral comes from the State Board, the HCP’s license will be issued and no PHP monitoring will be required. If a substance abuse or psychiatric problem is defined, then the physician or HCP is given a choice of treatment centers suited to his or her problem. Depending on the complexity of the case, an evaluation may take anywhere from one to five days. Evaluations can be an expensive and time-consuming endeavor, but they are an essential step in assisting HCPs in need. The PHP prefers to work with evaluators and treatment centers with experience in dealing with HCPs. We have no affiliation with particular centers or financial conflicts of interest. Whenever possible, the PHP offers a choice of clinicians to support the HCP’s autonomy. n For more information regarding the treatment process for HCPs with substance abuse and psychiatric diagnoses, email us at php-foundation@pamedsoc.org. For counseling or referral service, call the Physicians’ Health Programs at 800-228-7823. PHP is a program of the Foundation of the Pennsylvania Medical Society that provides programs and services for individual physicians and others that improve the well-being of Pennsylvanians and sustain the future of medicine. Visit us at www.foundationpamedsoc.org.

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2014 ANNUAL MEETING RECAP:

Helping Physicians Adapt to Change

A

s the rate of change in our health care system—and our medical practices—continues to accelerate, more doctors are feeling the weight of blame for costs, outcomes, and quality, says Karen Rizzo, MD, FACS, newly installed president of the Pennsylvania Medical Society (PAMED). Dr. Rizzo, an otolaryngologist/ENT from Lancaster, was sworn in as the 165th president of PAMED on Oct. 18 during our annual statewide meeting in Hershey. Several other Pennsylvania physicians also were elected to PAMED’s Board during the meeting. “The cost of health care rests squarely on their [physicians’] backs as their burden,” she said, along with the blame for poor outcomes, ordering too many tests, and not spending enough time with patients.

Dr. Rizzo told the more than 300 delegates attending the PAMED House of Delegates and Annual Education Conference, Oct. 18-19, that instead of carrying that blame, they must adopt physicianled solutions to address the changes happening all around us. While continuing to support PAMED’s strong advocacy agenda, she will advocate for three strategic directions during her year in office: • Promote PAMED programs that help physicians learn about and respond to all the changes taking place around them; • Develop and then implement an intentional, thoughtful strategy to engage with insurance companies to understand 10 | www.berkscms.org

how they measure our performance, how they measure quality, and how they measure the costs we generate to their covered lives; • Develop our vibrant and enthusiastic young physician community by creating a Leadership Academy for Young Physicians.

2014 House of Delegates Actions:

As a result of deliberations at the 2014 House of Delegates, PAMED’s already robust agenda for the coming year will add important issues such as:

• Maintenance of Certification (MOC) — Ask the American Medical Association (AMA) to:

• Work with the American Board of Medical Specialties (ABMS) to eliminate practice performance assessment modules as currently written from the requirements of MOC. • Develop and disseminate a public statement, with simultaneous direct notification to the American Board of Internal Medicine (ABIM) and other ABMS sponsoring boards, that their current MOC program appears to be focused too heavily on enhancing ABIM revenues and fails to provide a meaningful, evidence-based, and accurate assessment of clinical skills.

• Investigate and/or establish alternative pathways for MOC. • Report back to the House of Delegates at the Annual AMA Meeting in June 2015.


The PAMED Board was asked to study a recommendation to then ask the AMA to revoke its support for MOC if no action is taken by the ABMS in working with the AMA to make MOC requirements less onerous.

PAMED will continue to support efforts to create a reasonable and economical assessment process that provides physicians with the information necessary to improve the quality and efficiency of their practices. • E-Cigarette advertising/endorsement—Ask the AMA to work through an appropriate federal process to prohibit e-cigarette companies from paying for product placement in films and hiring celebrity spokespersons, and to prohibit e-cigarette advertising on television.

• Ebola preparedness— Continue to provide Pennsylvania physicians with important information, such as local and state guidelines, how to put on and remove personal protective equipment, identification of containment facilities, and access to sensitive and specific surveillance tools. PAMED will continue to work with the Pennsylvania Department of Health and other state preparedness partners to ensure that health care facilities are prepared in the event that Pennsylvania faces an Ebola i. • Medicare coverage of vaccines—Aggressively petition the Centers for Medicare and Medicaid Services (CMS) to include tetanus and Tdap at both the “Welcome to Medicare” and Annual Medicare Wellness visits, and other clinically appropriate encounters, that allows for coverage and payment of these vaccines to Medicare recipients who have not been vaccinated within the past 10 years. • Barriers to getting health care—Work with insurers to provide payments to physicians and physician-supervised designees for medications, vaccines, and their administration, without the burden of prior-authorization or any other administrative barriers.

• Telemedicine—Work with stakeholders to evaluate the different applications and uses of electronic technology to adopt standard definitions of what constitutes telemedicine, identify standards for coverage and payment for the use of telemedicine, and work to establish policy in Pennsylvania for the licensure of providers and payment for services.

• Urgent care clinics—Work to educate urgent and retail clinics on the importance of transmission of point of service patient medical records to primary care physicians and specialists, and investigate any complaints of non-disclosure of medical records by a facility due to alleged financial and network associations.

• Single national narcotic provider number—Ask the AMA to continue to work with the Drug Enforcement Administration (DEA) and Congress to move toward a system in which individual physician DEA registration numbers are personspecific rather than site-specific within a state.

• Unification of GME accreditation standards—Seek legislation to: 1) drop the licensure requirement for DOs to do at least one AOA approved year; and 2) make the number of required GME years the same, whether for DOs or MDs, to get a full, unrestricted license. • Independent practice access to facilities and insurance program participation— Seek legislation to provide access to participation in insurance networks and hospital facilities for independent physicians that meet the accepted quality measures.

• Hospital privileges for private practice physicians—Pursue legislation concerning the enforcement of the Community Benefit Standard in Pennsylvania; research ways to provide legal support to aid PAMED member physicians who are impacted by hospitals’ exclusionary tactics; and work to maintain private physician health care network relationships.

• Contracts with insurers— Pursue fairer insurer contracts and consider support of legislation to provide for contracts between insurers and networks to assure access to care with a level of insurance coverage for patients. • Universal Patient Transfer Form—Work with state government agencies and hospitals to develop a Universal Patient Transfer Form (UPTF) and an understanding of how it will work in Pennsylvania.

• Membership dues—The PAMED Board, working with the Membership Task Force, will be studying alternative dues models. At the annual meeting, members provided a lot of good feedback and ideas that will be incorporated into the task force’s discussion.

Watch for more information on these issues from PAMED in the Daily Dose and other member communications. n

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Berks Independent Physicians Association

Comes to Life

By: Louis La Luna, MD, Berks Independent Physicians Association

I

n 2013, the Reading Health System introduced the concept of clinical integration in Berks County. The concept was new to many in the county and appeared to have the potential to significantly change the interaction between independent physicians and their hospital partners. As a result, a group of independent physicians came together to discuss how this new model would affect their groups and could be incorporated into their practices. A byproduct of the initial meetings of the group was that the members quickly realized there were many unexpected benefits of sharing ideas and information with similarly situated physicians and that their groups could also manage costs related to the proposed clinically integrated structure and their participation therein through a common legal review of the proposal. This collegial effort and discussion ultimately evolved into the concept of forming an independent physician association, i.e. the Berks Independent Physicians Association (BIPA). Excited by the prospects of this new group, physician representatives of some of the larger independent groups came together to form a steering committee with a dozen or so physicians representing various fields of medicine. The steering committee developed Bylaws and a mission statement:

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Mission Statement

The Berks Independent Physician Association is an organization comprised of private medical practices in Berks County, which, through promoting collaborative relationships with healthcare delivery systems, payers, and colleagues, seeks to ensure the highest standards of ethical, compassionate, cost effective and quality healthcare for all participants of our community.

The Berks Independent Physicians Association, attorneys from the law firm Fox Rothschild, leaders from the Reading Health System and Reading Health Partners and their legal counsel have developed a collaborative working relationship through the common effort to develop a clinically integrated organization in the county. The guidance that the legal representatives of this collaboration have offered during these talks has also allowed independent physicians to work together more openly and with confidence in the legality of their discussions, thus opening the door to better understanding and the resolve to move forward in the process with a unified voice. This effort helped bring to life the concept of clinical integration in Berks County. Without the buy-in and participation of the independent physicians, clinical integration as a concept was facing a difficult road to success. Now, however, BIPA continues to work with Reading Health Partners (RHP) as well as St. Joseph’s PHO in the evolution of clinical integration and development of an ACO. Many of the BIPA members sit on the RHP and St. Joseph’s PHO Board as well as other committees that are a part of these organizations. This allows for effective communication between the two hospitals and the independent physicians. Having this type of formal organization in place allows independent physicians to be better prepared and organized for the ever-changing landscape of healthcare. n

BIPA has over 250 members and is currently being run by its steering committee. However, in early 2015, the group will move to install a more formal board in line with the dictates of the organization’s bylaws. If you are an independent physician in Berks County and would like to join or learn more about BIPA, please contact Lisa Rosselli at berksipa@gmail. com or 610-374-4401, ext. 125.


Three members of the Pennsylvania Medical Society’s Resident and Fellow Section (RFS) took home cash prizes at the section’s annual poster contest held Oct. 18, 2014, in Hershey. The contest was part of PAMED’s House of Delegates and Annual Education Conference Meeting.

The top prize of $500 was awarded to Ranjan Pathak, MD, from Reading Health System, for his poster “Meta-analysis on Efficacy and Safety of New Oral Anticoagulants for Venous Thromboembolism Prophylaxis in Elderly PostArthroplasty Patients.”

“The Residents and Fellows Poster Contest is a great platform to showcase and share your research work,” said Dr. Pathak. “I would love to participate again.”

Ayana Allard-Picou, MD, from Geisinger Medical Center, won the second-place prize of $350 for her poster, “PopulationBased Study of Regional Disease and Overall Survival in Patients with Thin Melanoma Using the National Cancer Database.” Chirag Mathukia, MD, from Easton Hospital, won the thirdplace prize of $200 for his poster, “The Cat that MEWS Saves Well Over Nine Lives.” There were a total of 23 presenters at this year’s poster contest. Approximately 39 member physicians helped judge the posters this year. n

See more at: http://www.pamedsoc.org/ postercontest#sthash.HfkL38Bo.dpuf

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THANK A MEMBER FOR THE MCARE WIN By: Lucy J. Cairns, MD

The favorable settlement of the suit brought by the Pennsylvania Medical Society (PAMED) and the Hospital and Healthsystem Association of Pennsylvania over the state government’s transfer of $100 million from the Mcare fund to the general fund in 2009 represents a huge return-oninvestment for Pennsylvania physicians who support the state society with their dues, and a windfall for non-members because they will benefit equally. Agreement was also reached on a related complaint regarding overcharges by the state for Mcare assessments in 20092012 and 2014. This agreement provides for $200 million in overcharges to be returned to the health care community. If you are a member, the time has come to urge your non-member colleagues to contribute their fair share of support to the only organization that represents the interests of all Pennsylvania physicians.

200 Million to be returned to Pennsylvania physicians, hospitals, and other health care providers

The settlement provides protections to ensure that physicians do not have to pay until the funds are needed and that there are no further diversions of Mcare funds.

MCARE: WHAT’S IT GOOD FOR? Physicians who have been in practice for a short time or who are new to Pennsylvania may well ask why the Mcare fund exists at all. The answer lies in the fact that Pennsylvania physicians have long faced great difficulties in securing adequate professional liability insurance, due in large part to an unusually unfavorable state legal environment and the resulting reluctance of insurance companies to issue policies in Pennsylvania. To ensure the availability of insurance, and thereby reasonable compensation for people found to have been harmed, a staterun program referred to as the CAT fund was established in 1975. In the ensuing decades PAMED, along with other physician 16 | www.berkscms.org

and health care provider organizations, devoted a great deal of time and resources to educating state lawmakers and the general public about the consequences of our state’s poor medical liability climate. Pennsylvania is fortunate to be home to a large number of post-graduate medical education programs, and historically a high percentage of newly-qualified physicians choose to practice close to their training site. But in Pennsylvania, more and more young physicians were leaving the state entirely. Even physicians with established careers were leaving or taking early retirement, and recruitment of new talent – especially for high-risk specialties such as neurosurgery, obstetrics, and orthopedic surgery – became ever more difficult.


Raymond Truex, M.D., addressed the worsening crisis in availability of physician services in an article published in the April 2001 Medical Record. Dr. Truex, who was serving as President of the BCMS at that time, reported that the number of neurosurgeons in Pennsylvania had dropped by 20% just in the preceding two years. In a survey of BCMS members, 30% of responders said they planned to limit the types of services they offered or had already done so, and 32% said they had experienced difficulty attracting new physicians to their practice due to the hostile liability climate. Tireless efforts to communicate the severity of this problem and the need to address it through legislative reform finally bore fruit. In 2002 the state legislature passed Act 13, the Medical Care Availability and Reduction of Error Act, which included multiple provisions designed to improve patient safety and protect access to medical care for Pennsylvanians. Replacement of the CAT fund by the Mcare fund was one of those provisions. A number of key tort reform provisions which PAMED had been advocating for were also included.

TIMELINE OF THE MCARE RAID (2009) Sept. 17 — The medical society first learns legislators are considering using Mcare fund money to balance the state budget. An urgent call goes out to members to contact state lawmakers. Oct. 8 — A measure in the state House challenging the constitutionality of the Mcare raid fails by one vote. Oct. 9 — The Senate and House pass the fiscal code legislation transferring the money to the general fund. Later the same day the budget is passed and signed into law by Governor Rendell. Oct. 13 — PAMED and the Hospital and HealthSystem Association file a lawsuit in Commonwealth Court challenging the legality of the state’s action.

continued on next page >

Every physician licensed in the state who conducts more than 50% of his or her practice within the state is required to pay into the Mcare fund every year. Other health care providers, hospitals, and health systems are also required to pay this insurance surcharge. Payouts from the fund go to satisfy professional liability judgments in excess of the amount covered by the ‘primary’ insurance policies physicians must purchase in the private market or through the Joint Underwriting Association.

MCARE: RAIDED BY THE STATE The Mcare fund was designed as a ‘pay-as-you-go’ system, so in theory each year’s surcharge is calculated to cover just the payment of claims which became final in the preceding year, as well as the operating expenses of the fund and a 10% reserve. Nevertheless, by 2009 the balance in the fund had grown large enough that it was an irresistible target for a state government looking to plug a big gap in its budget. The actual raid took place at lightning speed, and so did the medical society’s response.

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Reactions to the Mcare Win Christina Ohnsman, M.D. Pediatric Ophthalmology

“The Pennsylvania Medical Society tirelessly advocates for every physician in the state. The Mcare settlement would never have happened without their efforts. They have been a great resource to my practice, answering legal questions and offering a wide selection of health insurance plans. With that in mind, I always feel that my dues are well spent.” Susan J. Probst, M.D. Obstetrics/Gynecology

“Just another of the many benefits associated with BCMS/PAMED membership! Thanks to our dedicated staff and officers for their hard work and diligence in obtaining our long “overdue.” Looks like we (the membership of BCMS/PAMED) will all have smiles on our faces come the new year!” Gregory T. Wilson, D.O. Cardiology

“As the practice of medicine becomes increasingly busy and hectic, physicians may not be aware of policies that may affect them. I feel fortunate that organizations such as the Berks County Medical Society and Pennsylvania Medical Society remain steadfast advocates working for the benefit of physicians.” Anne M. Rohrbach, M.D. Internal Medicine

“Berks County Medical Society allows me to meet new physicians in the area that I might not get to meet otherwise. Also, at their social events I am able to connect with old friends who are physicians. With the changes in health care these days, the Pennsylvania Medical Society has a great deal of free information to update us on all of the news!” Adam J. Altman, M.D. Ophthalmology/Cornea and External Disease

“The Pennsylvania Medical Society has been helping to protect our ability to take care of our patients for many decades. Recently, their tireless advocacy resulted in the state legislature returning money taken from us to feed the already overfunded Mcare fund that they had misappropriated and used to fill other holes in the state budget. The return of these funds will allow our practice to hire additional staff and invest in technology that we can use to improve the health and welfare of our patients. We are grateful to the PA Medical Society and urge all Pennsylvania physicians to join and help them advocate for the health of the citizens of the Commonwealth.” Dan Kimball, M.D. Hematology/Oncology

“This is a tremendous ‘Win’ for PAMED and all PA physicians, whether they are members or not! I would hope that many of the nonmembers would see this as an example of what PAMED is doing for all PA physicians and decide to join in the collective effort to support them and their patients. As a retired physician, I applaud PAMED for what they have accomplished with their partners in this settlement and I will continue my membership in support of these types of efforts. It not only means meaningful rebates to physicians who paid into the Mcare fund but lesser payments and a more secure fund in upcoming years until we can succeed in eliminating the Mcare Fund.” 18 | www.berkscms.org

THANK A MEMBER FOR THE MCARE WIN continued from page 17

MCARE SETTLEMENT: WHAT DOES IT MEAN FOR YOU? The Mcare assessment for 2015 is set at roughly half the rate charged in 2014, in part because $61 million of the stipulated refund will be used for this purpose. The other factor is a reduction of almost 20% in claim payments from the fund in 2014 compared to 2013. Each provider who paid Mcare assessments in the years where it was determined there was overcharging (2009, 2010, 2011, 2012, and 2014) is entitled to a refund check from the remaining $139 million portion of the settlement. The amount will be calculated as the percentage overcharged each year, and due to the number of eligible providers and the complexity of the calculations, PAMED estimates that the checks will be issued some time in 2016. Notices about the refund checks will be mailed to the address on file with the PA Department of State, so keep your address current with the appropriate state licensing board. Once the details of the refund process are available, PAMED will communicate this information to members.

WHERE ARE THE REFUND DOLLARS COMING FROM? These are dollars physicians and other Mcare fund participants have paid into the fund as annual assessments and which have accumulated there as a result of overcharging. No tax money is involved.

FUTURE BENEFITS OF THE SETTLEMENT

More important than the refund victory are other provisions in the settlement which will have the effect of avoiding future assessment overcharges and reduce the risk of additional raids on the fund by the state. The settlement stipulates that, going forward, any projected year-end balance in the fund be used to reduce the subsequent year’s assessment. This change will prevent accumulation of money in the fund which could be viewed as ‘surplus.’ In addition, the state has agreed to hold the Mcare fund ‘in trust’ and not consider it part of the state’s general revenue.


...More Reaction to the Mcare Win Elliot B. Werner, M.D. Ophthalmology/Glaucoma

“Several years ago a colleague of mine remarked that the only organization that he belonged to that ever did anything for him was the Triple A. While our county and state medical societies may not do anything as immediately obvious as coming and starting our cars on a cold morning, these societies are constantly in the background fighting the good fight to protect doctors, patients and the practice of medicine. A case in point is the benefit to physicians from the recent Mcare settlement. We owe the officers and staff of the BCMS and PAMED a tremendous debt of gratitude for their efforts. I am proud and happy to support them.” Michael Haas, M.D. Radiation Oncology Therapeutic Radiology

“Specialists are quick to suggest that their specialty societies are more representative of their interests. However, the Mcare settlement is an example of what all specialties can achieve when they come together with a common cause. The Pennsylvania Medical Society provides that bond, without which the Mcare settlement simply would not have been realized. With a higher percentage of Pennsylvania physician participation, the Pennsylvania Medical Society will continue to be empowered to represent our common interests.”

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All Berks County physicians have benefited tremendously over the years from the efforts of society members willing and able to play an active role, and also from the accomplishments made possible by every physician who supports these societies with their dues. Many of the achievements of the county/state society partnership in protecting the physician-patient relationship and promoting the best possible environment for the practice of medicine in Pennsylvania are not as easily quantifiable as the Mcare settlement, but are equal in importance. If you are a member, do not lose sight of the need to continue making these achievements possible. If you are not a member, now is the time to thank your colleagues who are members by adding your support. n

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In Pennsylvania, one reason we have a strong and effective state medical society is that the state and county societies are unified. Physicians who join pay both county and state society dues and enjoy the benefits of both memberships. The Berks County Medical Society has a long tradition of contributing leaders to the state society, and these leaders have taken a very active role in shaping the agenda of the state society.

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HOT HR TOPICS

in the Workplace

Recently, there have been several items in the news that are keeping HR professionals hopping! In the alphabet soup of employment law, there are two “E”s that are at the forefront of employer concerns.

Ebola and the workplace Occupational Health and Safety Risks U.S. workplaces will generally fall into two areas of concern – healthcare workplaces and all other workplaces.

Within the U.S., healthcare workers are at the greatest risk of infection. Because their workers may come into direct contact with Ebola, healthcare employers need to review their infectious disease protocols to ensure they are prepared for the specific risks associated with the virus. The risk of business travelers becoming infected with the Ebola virus during a visit to the affected areas and developing the disease after returning is extremely low, even if the visit included travel to the local areas in which primary cases have been reported. Although the U.S. Department of State has issued warnings, it has not issued travel restrictions for these areas.

Preventing Ebola in the Workplace

Healthcare workers at all levels of the health system – hospitals, clinics, laboratories, health posts, laundries and transport – should be briefed on the nature of the disease and how it is transmitted, and strictly follow recommended infection control precautions. All staff handling suspected or confirmed cases of Ebola or contaminated specimens and materials should use special personal protective equipment for working with biohazards, and apply hand hygiene measures according to WHO recommendations. If the recommended level of precaution is implemented, transmission of the disease should be prevented. For all other workplaces, returning travelers are the primary concern. Affected countries are requested to conduct exit medical screenings of all persons at international airports, seaports and major land crossings for unexplained febrile illness consistent with potential Ebola infection. Nevertheless, returning business travelers from the affected areas should be notified of the symptoms and asked to be alert to their surfacing within 21 days after return. continued on page 22 >

20 | www.berkscms.org


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HOT HR TOPICS

in the Workplace continued from page 20

Rights, Duties and Responsibilities of Workers and Employers Employers, workers, and their organizations should collaborate with health authorities in the prevention and control of the Ebola outbreak. Healthcare employers will have the greatest responsibilities in this area. Healthcare and other employees have the right to remove themselves from a work situation that they have reasonable justification to believe presents an imminent and serious danger to their life or health. When an employee exercises this right, he or she must be protected from retaliation for expressing a safety concern.

Under the Americans with Disabilities Act, U.S. employers may make inquiries into medical conditions only where they are job related and consistent with business necessity. Because there are not international travel restrictions and because the risk of transmission is very low, requiring a medical examination for returning travelers would likely not be considered a necessity. Employers should be aware that the Public Health Department in each locality has the primary authority and responsibility in this area. The Public Health Department will be tracking any illnesses

and exposures and will notify employers when necessary. Nonetheless, employees should be required to report to their immediate supervisor any situation in which they present a danger to their co-workers. The Equal Employment Opportunity Commission (EEOC) has accepted that addressing communicable illnesses is a legitimate area of inquiry. Thus, requiring reporting diagnosis of a contagious illness (albeit without requiring specific identification of the illness) would be a legitimate action.

If an employee is actually diagnosed with Ebola, communication with other employees for the protection of their health and safety will likely be necessary. In such situations, the medical privacy of the sick employee will need to be honored. Employers should seek guidance from counsel and follow the direction of the Public Health Department in any such situation.

2014 Mid-Term Election Results

Regardless of your political persuasion, employers should be encouraged by the November election results. Employers have borne witness to an increasingly aggressive and overreaching National Labor Relations Board (NLRB), Department of Labor (DOL), and Equal Employment Opportunity Commission (EEOC). However, based on the shift in power, employers may breathe a little easier. Now that Republicans in both houses can set the congressional agenda and will have subpoena powers, it means much more aggressive oversight of agency actions at the U.S. Equal Employment Opportunity Commission (EEOC), the U.S. Department of Labor (DOL), and the National Labor Relations Board (NLRB). It also could trigger possible appropriations riders to prohibit or restrict funding to enforce certain regulations, such as the imminent NLRB “ambush election rules” and the Labor Department’s regulatory overhaul of the Fair Labor Standards Act’s Part 541 overtime exemptions for bona fide executive, administrative, professional, outside sales, and computer employees.

The newly-formed Congress could also pursue ways to limit the actions of the EEOC and DOL, which have initiated investigations and filed lawsuits against employers at a record-setting pace, despite being rebuffed by a number of federal courts for their aggressive tactics and sometimes legally unsupported contentions. Although President Obama maintains the power to veto legislation, Congress holds the purse strings. Limiting financial support to these agencies would severely curtail their recent conduct and may dull implementation of any new “employer unfriendly” initiatives. Republicans proved that primary elections are important in selecting qualified candidates. Now, having been elected, Republicans have two years to prove they can govern before facing a much more challenging 2016 election. n Source: Tonya Nevling, PHR, Managing Director Power Kunkle HR Solutions, LLC 999 Berkshire Blvd. Suite 16, Wyomissing, PA 19610 22 | www.berkscms.org


“Code Black” Documentary A Successful Goggleworks BCMS Partnership T

By: Michael Baxter, M.D.

he acclaimed documentary “Code Black” about life, death and the multiple stressors facing patients and physicians in the LA County Hospital’s Emergency Department was shown at the Goggleworks theatre for a week in October. In cooperation with the Goggleworks staff, The Berks County Medical Society was able to sponsor this film and bring its message to a broad Berks County audience: The U.S. healthcare system is overwhelmed especially caring for the most indigent in our society, overburdened with an onslaught of regulations and challenged to maintain the ideals especially of young physicians who find themselves in a system which drains one’s physical and emotional energy. In addition to the general population, there was a large attendance by area physicians and especially residents. Pennsylvania Medical Society Executive Vice President Mike Fraser and Chuck Moran, Director of Media Relations and Public Affairs, joined us and gave the film positive reviews. Two viewings were followed by audience discussion led by BCMS members. It was a successful event and represented a great partnership with a very accommodating Goggleworks staff. n

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Alliance Update

Seasons Greetings

from The Berks County Medical Society Alliance!

I

t has been a busy and exciting couple of months for the Alliance. In September, we hosted our (now bi-annual!) New Member Coffee to introduce potential members to the Alliance’s tremendous educational and philanthropic contributions in the community. A warm welcome to newest members: Jeane Serrian, Michelle Trayer, Tracy Rossi, and Simi Rai! We also raised public awareness about our organization’s mission by hosting a table at the ground-breaking 2014 Guts & Glory Event, organized by member Aparna Mele, M.D. Held at Reading’s First Energy Stadium, Guts & Glory was a free event with vendors and exhibitors selected to help raise community awareness of health and wellness through preventative health care and holistic well-being.

October marked our Annual Fall luncheon, hosted by member Amy Impellizzeri. We invited a representative of The Children’s Home to speak to our members about their life-changing work in the lives of adolescent boys, ages 12–18, who have been abused or neglected, or face significant mental health challenges. In addition to raising awareness for The Children’s Home and starting a dialogue with the organization about on-going collaborative efforts, we also collected a car-load of gift cards, supplies, and other donations for The Children’s Home that day. In November, immediate Past President Kathy Rogers hosted a special presentation of “Say It Out Loud” — a discussion with member and local best-selling author Amy Impellizzeri, about her journey from corporate attorney to published author of the critically acclaimed novel Lemongrass Hope. As a result of Amy’s challenge to “Say It Out Loud,” our group’s members have been inspired to explore those wishes, dreams, and goals that we have not previously given ourselves permission to explore — committing to new professional goals, volunteer work, writing projects,

24 | www.berkscms.org


registering for races, and even raising honeybees! Our members are looking forward to a very exciting and inspirational 2015 and beyond!

Our annual Holiday Card fundraiser was an enormous success, raising over $13,000. Thank you to all who supported this effort which raises funds that are directed right back into the community through philanthropy and scholarship grants.

In December, Past President Emily Bundy opened her home for the Holiday Brunch, a festive morning of community and celebration in which we collected wrapping paper, bows, and tape for Toys For Tots! We are gearing up for a busy and productive spring season. Save the date (April 9, 2015) for the BCMSA’s annual Health Project, to be held at Glad Tidings in Wyomissing, PA. The 2015 Health Project – “Eating For Well-Being” is open to nurses, educators, and the community at large, and is shaping up to be an amazing day of presentations from local and nationally recognized experts in nutrition, exercise physiology, and more! n

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Legislative Update By: Scot Chadwick, Legislative Counsel, State Legislative Affairs, Pennsylvania Medical Society

Congressional Session Ending without SGR Repeal

T

he 113th congressional session is coming to an end, and without permanent repeal of the flawed Sustainable Growth Rate (SGR) Medicare physician payment formula. There will be limited time after the new Congress convenes next year — with the House only scheduled to be in session for 37 days — before the current patch is set to expire on March 31, 2015. Without congressional action, the SGR formula calls for a 21 percent cut to physician payments when the current short-term patch expires. This is on top of the 2 percent sequestration cut that began in 2013, as well as the various penalties physicians may face for nonparticipation in various Medicare programs. Earlier this year, Congress came close to passing bipartisan legislation — the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 (H.R. 4015/S. 2000) — that would have permanently fixed the SGR crisis. But, despite strong advocacy for permanent repeal from many in the medical community, including PAMED, Congress passed their seventeenth temporary patch to avert the 24.1 percent cut that physicians were facing on March 31, 2014, as a result of the broken SGR formula. But, once again, Congress failed to take action on the cuts physicians face next year due to the SGR. 26 | www.berkscms.org

“Hopefully, legislators will build on the progress made this year so that medicine can focus on addressing other important health care policy issues,” said the American Medical Association in an email alert.

Congress needs to avert these cuts and eliminate the formula that leads to this annual crisis. Physician payment reform would prevent a loss of $470 million for the care of the elderly and disabled patients in Pennsylvania alone. Cuts of this magnitude will worsen access problems and make it extremely difficult for physicians to pay for office space and other expenses and avoid staff layoffs. Just in Pennsylvania, the jobs of 161,232 medical practice employees, as well as access to care for 2,350,558 Medicare patients and 168,228 Tricare patients, are at risk due to these cuts.

Check back often, and we’ll let you know how it’s going. As always, you can reach me with questions or comments at (717) 558-7814 or schadwick@pamedsoc.org. n

Lawmakers Off to a Quick Start

A

s I mentioned in last week’s post, the 2015-2016 session of the General Assembly technically began on Monday, Dec. 1, 2014, though lawmakers won’t actually meet and be sworn in until Jan. 6, 2015. That will be the first day on which House and Senate members can formally introduce bills.


However, many legislators are using the interlude to draft legislation and circulate it among their colleagues in search of co-sponsors. Back in the mid-1980s, when I was first elected to the House of Representatives, members would walk around the floor of the House asking fellow members to sign onto their bills as co-sponsors, but with the advent of personal computers and email the process is mostly done electronically now. Co-sponsorship memos are posted on the General Assembly website where anyone, including you and me, can read them.

More co-sponsorship memos are circulated every day as House and Senate members seek to get a jump-start on the new legislative cycle, and PAMED’s government affairs team looks at every one of them. Check in with us often, and we’ll keep you up to date on all the latest developments. As always, you can contact me with questions or comments at (717) 558-7814 or schadwick@pamedsoc.org. n

This gives PAMED’s government affairs staff an opportunity to spot legislation of interest before it is actually introduced, and the benefits are obvious. For example, we can ask prospective bill sponsors to share their language with us, in the hopes of offering suggested improvements before the bill is formally introduced. Getting a change made that way is clearly preferable to seeking an amendment at a committee meeting or on the floor of the House or Senate. We can also identify future legislation that, shall we say, will cause PAMED some degree of heartburn. If we can’t dissuade prospective bill sponsors or convince them to make needed changes before the bills are introduced, we can at least get a jump-start on planning our efforts to oppose them. Here are three examples of already filed co-sponsorship memos that got my attention:

1. Rep. Mark Rozzi (D-Berks County) intends to introduce a bill that would “allow people with terminal disease to, under certain conditions, request a prescription for medicine that would end their life in a humane and dignified manner.” This is an issue that has been in the news recently due to the death of a terminally ill young woman in Oregon, who took advantage of that state’s law to end her life.

4240_WstRdg_Ave_ad_Layout 1 12/18/14 11:34 AM Page 1

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2. You may recall that the General Assembly recently enacted legislation authorizing schools to obtain and store epinephrine auto-injectors for use by trained school employees to aid students who are experiencing an anaphylactic reaction. Sen. Matt Smith (D-Allegheny County) is seeking co-sponsors for a bill that would allow restaurants to do the same thing. 3. And, Sen. Mike Folmer (R-Lebanon County) has expressed his intention to reintroduce last session’s legislation that would authorize the prescription and use of medical marijuana in Pennsylvania.

955 E. Wyomissing Blvd. Reading, PA 19611 berkscatholic.org WINTER 2015

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FALL GOLF OUTING

The Annual Berks County Medical Society Fall Golf Outing took place on Wednesday, September 24, 2014 at Golden Oaks Golf Club. The Berks County Medical Society uses proceeds from this event to help fund HEALTH TALK, our weekly talk radio program on WEEU. Due to the generosity of the sponsors listed, we were able to net $6500 for this cause. Our sincere thanks for your generosity!

Thank You!!!

28 | www.berkscms.org


The Berks County Medical Society gratefully acknowledges the following sponsors who supported our Fall Outing: Pro Package Sponsors Stratix Systems Weik Investment Services Hole Sponsorship Alan Ross and Company Berks Visiting Nurse Association JKR Partners LLC Medical Protective National Penn Bank Parente Beard LLP St. Joseph Medical Center Tompkins Vist Bank West Reading Radiology Associates The proceeds from this event help sponsor “Health Talk,� our weekly talk radio program on WEEU.

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Calendar of Events

WINTER Department of Family 2015 Medicine Lecture Series January 2 – Friday’s Child January 9 – Approach to Wound Care for the Family Physician – Stacey Raybuck, DO January 16 – Multiple Sclerosis Update: Pathophysiology, Diagnosis and Treatment Options – Clifford Reed, MD January 23 – Prescription Drugs and Alternative Medicine: Are they Truly Complementary – Kemeisha Taylor, PharmD, and Caitlin Lozorak, PharmD January 30 – The Approach to the Patient with Joint Pain – Nancy Walker, MD February 6 – Friday’s Child February 13 – Early Diagnosis and Treatment of the Patient with CKD – Brigid Hallinan, MD

February 20 – Recognizing and Responding to Children at Risk: Suspected Child Abuse and Neglect Program – Jane Weida, MD, and Renee Riddle, MD Special hours: 8:00 – 10:00 a.m. Registration is required through the Reading Health CME website: https://www.readinghealth.org/education-andresearch/academic-affairs/continuing-medicaleducation/ February 27 – Practical Advice for Improving Patient Nutrition – Ann Wellock, RD, LDN March 6 – Friday’s Child All presentations take place from 8:00 – 9:00 a.m. in the Reading Hospital 5th Avenue Conference Center except where otherwise noted.

Berks County Medical Society Sunday, January 18, 2015 Friday, April 10, 2015 Wednesday, September 16, 2015

30 | www.berkscms.org

Installation Brunch Residents’ Day & Memorial Lecture Fall Golf Outing


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Berks County Medical Society Medical Record Winter 2015  
Berks County Medical Society Medical Record Winter 2015  

The official publication of the Berks County Medical Society. www.berkscms.org