The Berks County Medical Society Medical Record Spring 2014

SPRING 2014

The Berks County Medical Society

Medical Record

Improving Patient-Physician Communication

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Managing Professional Risk ......................................................8 Drowning in Documentation? ..................................................12

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MEDICAL RECORD

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A Quarterly Publication

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

The Berks County Medical Record

Lucy J. Cairns, MD, Editor Editorial Board

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Berks County Medical Society Officers

Kristen Sandel, MD, President Lucy J. Cairns, MD, President-Elect

D. Michael Baxter, MD, Chair, Executive Council Michael Haas, MD, Treasurer Andrew Waxler, MD, Secretary Pamela Q. Taffera, DO, Immediate Past President Bruce R. Weidman, Executive Director

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.

All manuscripts and letters should be typed double-spaced on standard 8 1/2"x11" stationery.

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The Berks County Medical Record (ISSN #0736-7333) is published four times a year in March, June, September, and December 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.

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Go to our website at www.berkscms.org

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President’s Message A message from Kristen Sandel, MD

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Improving Patient-Physician Communication Patti J. Brown, M.D.

Drowning in Documentation?

By Kristi Brant

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Installation Update New officers installed and 50 Year Members honored in January 2013

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Medical History

Dr. Mesmer, Music and Ben Franklin

By Dick Bell, M.D.

Departments: Editor’s Comments ............................................................................................................................................................... 4 Managing Professional Risk................................................................................................................................................... 8 Legislative and Regulatory Updates..................................................................................................................................... 18 Alliance Update.................................................................................................................................................................. 22 Foundation Update............................................................................................................................................................. 24 Calendar of Events.............................................................................................................................................................. 28 MEDICAL RECORD

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EDITOR’S COMMENTS

Lucy J. Cairns, MD, Editor

I love my new job!

T

he hours are flexible, my coworkers are old friends, and most of the work is done by others. I haven’t quit my old job, mind you, because I still enjoy that one as well and it is the one that pays the bills, but being ‘in charge’ of Collegiality activities for the Berks County Medical Society, as the President-Elect for 2014, is pretty sweet.

Collegiality, or promoting friendships among members, is one of the four points of the BCMS compass – a graphic illustration of the priorities of our organization. Getting to know a wide circle of Berks County physicians enlarges both your professional and personal networks. You may discover a common interest in jazz, a hometown sports team, astronomy, or other pursuit while simultaneously adding a specialist to your speed-dial list in case you need to make a referral or ask for a curbside consult. And we all occasionally need to share the stresses and rewards – especially the stresses – of medical practice with someone who understands exactly what we are talking about.

Any involvement in the BCMS is by definition a collegial activity, but each year we sponsor several events whose main purpose is social interaction. Our annual Golf Outing, scheduled for Wednesday, September 24 this year, always attracts a crowd to enjoy a day of friendly competition capped off by a relaxing dinner together. Those who have never swung a golf club are invited to take their first lesson! The financial proceeds from this event support our weekly call-in radio show on WEEU (Health Talk) and other educational activities.

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On a pleasant evening last August, physicians new to our area were invited to meet BCMS members (and each other) at that iconic Berks County landmark, the Pagoda.

The PAMED Young Physicians Section co-sponsored this event, and our then President-Elect Dr. Kristen Sandel spoke briefly to the gathering about the importance of physicians acting together to advocate for our patients and protect the practice of medicine. Most of the evening, however, was spent chatting with new acquaintances while enjoying refreshments and taking in the extraordinary view from the Pagoda’s terrace.

In recent years, a separate social event has been organized exclusively for the resident physicians in the training programs at our local hospitals. This year will be a little different. Our physicians-in-training will be invited to the same gathering as physicians who have been in practice here for five years or less. We are selecting a venue designed to facilitate conversation and we trust that those who attend will discover new connections with colleagues who are also just beginning their careers.

Our annual Residents’ Day and Memorial Lecture supports both the Education and the Collegiality arms of our compass. On this day, residents present research projects to be judged by volunteers from the BCMS, with several cash prizes awarded. All who attend benefit from the chance to peruse the posters and discuss the projects

with the authors. Lunch will be provided, followed by a lecture dedicated to the memory of Berks County physicians who passed away during the prior year. Our lecturer this year is James F. Arens, MD, an anesthesiologist from Texas who has had a long and highly distinguished career in both academics and in service to organized medicine on the state and national levesl. His talk is titled “Medical Professionalism: Opportunities in a Time of Rapid and Enormous Change.” This event will be held on Friday, April 4, from 10 am to 2 pm, in the auditorium of the Berks Visiting Nurse Association. (For further details, please see the announcement elsewhere in this issue.)

I have saved the best for last, namely the Family Outing we have planned for 2014. I know I shouldn’t play favorites, but an autumn afternoon at Hawk Mountain Sanctuary during the peak of the fall migration is one of the most exciting and memorable experiences our area has to offer. Hawk Mountain was the first raptor sanctuary to be established anywhere in the world. Binocular-owners from all over the U.S. and abroad come to walk the rocky path to the North Lookout, in the footsteps of Rosalie Edge (founder of the Sanctuary), Roger Tory Peterson, Rachel Carson, and a

host of other eminent naturalists.

Our group will be chauffeured by tour bus on the 45-minute drive to the Sanctuary, leaving at noon on Saturday, September 27. We will have a little more than 2 hours to spend on the mountain, during which time an educational program featuring live raptors (from a nearby wildlife rehabilitation center) and a program to help beginning hawk-watchers identify the birds on the wing from one of the lookouts will be available (binoculars can be rented at the visitor’s center). Further details are contained in the announcement which appears in this issue.

Our Collegiality activities are limited only by the imagination and enthusiasm of our members. Do you have an interest or avocation you would like to share with other BCMS members? Would you like to start a book club, for example, or a sports club, or organize a group to take cooking lessons? If you would like to float an idea, just call the BCMS office at 610-375-6555 or email Betsy Ostermiller at info@berkscms.org. We are here for you. n

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president’s message

Kristen Sandel, MD

It’s the fans that need spring training.

You gotta wake ’em up, get ’em interested and let ’em know that their season is coming, the good times are gonna roll.

-Harry Caray

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ell, by now we are saying goodbye to winter, the cold and the snow, and are in the midst of spring. Being an avid baseball fan, spring has always been my favorite time of year. With the familiar smell of grass, peanuts, hot dogs, and the promise of a new beginning, teams (and their fans) start with a clean slate.

The trials and tribulations of the year before are behind them and everyone begins the season with the hope of the playoffs and a championship. There is a renewed sense that this year could be the year that things transform for your team.

I love the quote above by the late Cubs play-by-play announcer, Harry Caray. Just like baseball has to remind fans that the season is coming and good times are going to roll for their club, we also have to remind physicians that they need the Medical Society. Things are new, different, and in many cases, there is a need to wake physicians up and get them interested in order to let the good times roll.

Over the past few months, we have seen many historic changes and even more challenges are in store for us. The SGR issue in Congress is still unresolved and physicians are still facing decreased payments from Medicare if there is not a move toward permanent repeal. Physicians, both independent and employed, are still trying to ready 6 | MEDICAL RECORD

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themselves for the dramatic effects that ICD-10 changes in October will have on their practices. We continue to be challenged by the ever-present issues concerning scope of practice from medical personnel with lesser experience and training. Medical marijuana legalization is a topic that has also come to the forefront over the past few months in the Commonwealth and members of the Berks County Medical Society have been meeting with legislators to lend their expertise. The Medical Society is advocating for physicians when facing all of these challenges at the county, state, and federal levels. It is so difficult for physicians to balance a practice and also monitor and affect the multitude of issues that we face on a daily basis without the assistance of the Pennsylvania and Berks County Medical Societies.

We must recognize that our season is coming, and in many cases is already here. We need to wake physicians up now, so that we are not sleeping and do not miss important opportunities to make physician-led changes to the paramount issues at hand. If you are ready for the season, please join the team, and bring a friend to the game. It is never too late to have your voice heard as part of the roaring crowd. Let’s hope that this season is one that gets us to our World Series. n

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Managing Professional Risk (February 2014)

Responding to Negative Online Comments B y J o s h H yat t

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s such websites increase in popularity, so does the significance of such ratings. Many patients are using the sites to report negative comments about physicians, and physicians often feel unable to defend themselves due to HIPAA and other privacy regulations.

Negative reviews can come from angry patients, disgruntled employees, and sometimes even members of the public just trying to create unsubstantiated problems.

When these attacks occur, sometimes the physician wants to go into a defensive mode to preserve both integrity and reputation. But impulsive responses may do more harm than good.

Recommendations With the advent of social media and online marketing outlets, physicians, healthcare practitioners and facilities are experiencing, in a new medium, a not-so-new phenomenon – bad publicity. There are many online sites that allow patients to rate their physicians on various scales, and oftentimes they can leave narratives about their experiences.

Dozens of websites that permit people to rate, review, spin or flame their doctors have sprung up in the last year, operating in much the same way as online services that help people find the best hotels or avoid plumbers who overcharge.

1

Reported the Los Angeles Times in 2008.

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Because negative online reviews can affect a physician and his or her practice, the issue warrants a two-fold plan of action that is both proactive and reactive in nature.

Proactive Steps

• Set up your own practice web page where you can control the content and message you want to share with the community. Work with your group administrator or medical director as necessary.

• Develop a social media plan for your practice. This could include Facebook or Twitter accounts where postings can be controlled.

• Periodically check websites for yourself or your practice to identify any specific issue or trends. You may want to explore setting up online alerts that advise when comments have been posted about you as a physician.

• Ask patients to go online and rate your services.

Positive ratings will help to counter balance negative comments.

• Provide a patient complaint process so disgruntled patients can receive timely resolution.

Reactive Steps

• Don’t panic.

• Do not respond immediately or impulsively. Take time to consider the comment, to reflect on why the individual felt compelled to post, and to decide if it warrants a response. Not all negative comments are worthy of your time to respond. A response may start a chain reaction of negative slurs and comments, potentially leading to litigation.

• If you feel the information is “clearly false, inappropriate and solely inflammatory, contact the (Internet) site administrator.” 2 Legitimate sites have content guidelines and will probably remove information that violates them.

• If you are considering suing a reviewer, there are many potential issues you need to be aware of to avoid pitfalls and countersuits. Consult with your attorney as soon as possible before taking any steps in that direction.

• Periodically follow up with positive information about your practice on the sites. NEVER post fake consumer reviews, as this may result in significant fines and penalties.

• If you choose to respond in writing, limit the response to general information, NEVER use patient identifiers or reveal any protected health information, and do not directly or personally attack the individual posting the comment.

1. Roan, Shari. The Rating Room. Los Angeles Times.

May 19, 2008.

2. California Medical Association. CMA On-Call, Document 0822: Online Consumer Review and Rating Sites, www.cmanet.org.

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Improving Patient-Physician Communication: Fix the Cracks Before They Become Potholes B y Pat t i J . B r o w n , M . D .

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t starts as a crack. Many of us have noticed small cracks in the sidewalks and streets starting in December. By January, after several ice and snow storms, these cracks had developed into small potholes. In February, among the bitter extremes of temperature, we noticed large potholes develop, with big chunks of asphalt missing. And now, in March, we see PennDot starting to repair these many significant potholes.

I will use this as an analogy of the patient-physician relationship. It may start as a brief misunderstanding or a misinterpretation of something the physician or patient said. It may be just a small rift in the relationship. By recognizing and addressing the rift quickly and immediately, often the relationship can be easily repaired and large misunderstandings (or potholes) can be avoided. If the misunderstanding is allowed to fester, large problems can develop and the larger rift takes more time and effort to smooth over.

For the past 9 years I have been the Chairman of the Grievance committee of the Berks County Medical Society.

The Grievance process is offered as a benefit of membership in the Society. According to our bylaws, the purpose of the committee is “to prevent or resolve misunderstandings, to clarify and adjust differences between physicians and patients, and to assist in maintaining high levels of professional deportment.”

We have a specific procedure which is used to handle a grievance. Most importantly, the Medical Society does not get involved if there is legal representation, nor is it able to act as a court of law to impose sentences or to order a person to make restitution. The grievance must be in writing and a release of information form must be signed. No records are kept and the process is considered “non-discoverable.” The committee’s purpose is to mediate disputes or misunderstandings that arise between patients and physicians. Often, patients want to make sure their concern is communicated, and that they are being “heard.”

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I see communication as the most important role of the Grievance committee.

Patient and physician communication is an integral part of the healthcare relationship. I will present some ideas which may be useful in maintaining a healthy patientphysician relationship. By no means do I purport to be an expert in communication or patient-physician relationships.

But I have been able to glean some helpful advice from books, surveys and personal observations. Most of this is common sense and ideals for which we all strive. However, in the world of the electronic medical record and harried work schedules, it seems like a good opportunity for a brief review.

Sincerity is one of the first qualities a patient perceives in a physician. Convey a genuine interest and respect for the individual. According to Dr. Michael S. Woods, in his book Healing Words: The Power of Apology in Medicine, this is best done through a physician’s attempts to authentically see, listen, speak, understand and connect with a patient.

Visual communication includes making eye contact.

Greet patients with a smile. These nonverbal behaviors demonstrate respect for patients. Introduce yourself and shake hands. Sit down if possible. Do not cross your arms.

Give the patient your full attention.

Good verbal communication conveys the message that a patient’s or family member’s comments are valued. Use the patient’s preferred name and title. Explain your role.

Adjust clinical explanations to individuals’ specific level of understanding. For example, if they have a scientific background, use data. Use technology if they are tech savvy.

Allow adequate time for exchange of information. Try not to interrupt.

Listen with intensity. Hear the emotions, fears, and underlying concerns behind the words. If dealing with difficult personalities, don’t allow things to become personal.

Focus on goals. The patient’s welfare should be your priority.

Establish common ground. Stop to think why a person might be difficult at that moment.

For every medical intervention there is an expected outcome. However, we all know that complications occur and patients can suffer unexpected outcomes. As physicians, what can we do to improve our communication in good times and in bad times?

Dr. Woods offers the 4 Rs of an authentic apology: Recognition. Feeling regret or remorse is a good indication that an apology is in order.

Regret. An expression of regret is an empathetic response. You can express regret for an outcome. “I am so sorry. I know this outcome is not what you expected. It is not what I expected either.”

Responsibility. This is the statement of transparency. It answers the questions: What happened? Why did it happen? How it will effect long and short term health status? What steps are being taken to ensure it will not happen to others in the future?

Remedy. What is being done to correct the problem or situation.

Some of the grievances I have addressed over the years involve patients’ perceptions of poor service. Wendy Leebov’s Essentials for Great Patient Experiences addresses the “gift of customer complaints.” She argues that patients and other customers who go away mad tend to go away, to another provider if they have that option. Complaints give you a second chance to make things right. In the business world this is known as service recovery. Service recovery involves making things right for an unhappy customer.

It includes doing all you can to correct a wrong.

Maintain a positive, welcoming attitude toward complaints. Adopt the attitude that problems exist when patients say they do. Institute methods for inviting feedback. You can’t address issues if you don’t know about them.

Speaking of feedback, I enjoy being an active member of the Berks County Medical Society and encourage everyone to become active by attending events, possibly becoming a member of a committee, or just letting us know what the Medical Society can do for you. It is my pleasure to be available to handle grievances as necessary. Hopefully, I have been able to provide some pointers to help physician members continue to provide excellent patient centered care. Remember, it is easier to fix the cracks than to wait for the potholes.

References Woods, M.D., Michael S. Healing Words: The Power of Apology in Medicine. Oak Park, IL: Doctors in Touch, 2004.

Leebov, Ed.D., Wendy. Essentials for Great Patient Experiences: No-Nonsense Solutions with Gratifying Results.

Chicago: Health Forum, Inc., 2008.

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Drowning in Documentation?

How to Make Home Health Documentation Work for You and Your Patients

By Kristi Brant, M a r k e t i n g & D e v e l o pm e n t D i r e c t o r , H o m e H e a lt h C a r e M a n a g e m e n t, I n c .

D

oes it seem like every home health referral that you make results in a never-ending stream of Plans of Treatment (POTs), orders, and the dreaded Face-to-Face requirement? There’s no question that the documentation burden for physicians ordering home health care has increased in the last few years, due to increased CMS requirements imposed on home health agencies across the nation. There’s no question, as well, that patients who receive care at home have reduced rates of re-hospitalization and improved outcomes compared to patients who do not receive the skilled nursing or therapy care that they need. So, how can physicians and home health providers work together to lessen the documentation burden and improve not only their patients’ health outcomes, but also their own revenue streams? Try these four steps.

1 Set up a system with the home health agencies you use. Make sure that you and your

office staff have communicated with liaisons from the home health agencies you use about how you wish to receive documentation for review and signature.

While some offices prefer to work exclusively via fax, others prefer a scheduled drop-off and pick-up time for documentation. “We can avoid a lot of duplicate documentation if we are able to set up a system that works for each office,” said Tricia Oswald, Customer Support Manager for Home Health Care Management and its subsidiaries Berks VNA and Pottstown VNA. “What works for one office, though, doesn’t work for another.

We rely on physicians and office managers to tell us what works for them.”

2 Sign documents as quickly as you can. Once you have a system in place, the key to avoiding duplicate document requests is to complete the documentation as

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soon as possible. Lucille Gough, President and CEO of Home Health Care Management, explained that home health agencies are responsible for the costs for all the care, services and supplies needed for their clients for the entire episode of care. “Agencies incur a significant outlay of costs upfront for each client, and timely billing is essential for reimbursement of these expenses,” Gough explained. “Agencies, however, are not permitted to present a final bill for their services until all orders, POTs and Face-to-Face documents are signed by the physician.

“We know that the documentation burdens on physicians are extreme,” Gough continued.

“Unfortunately, if patient documentation is not returned to home health agencies within a couple of weeks, we need to generate a duplicate document for signature.

The Commonwealth of Pennsylvania will cite any home health agency that has unsigned documentation more than 30 days old. Not only does an agency risk not getting paid, unsigned documentation can actually cause an agency to lose its licensure.”

3 Stay familiar with Face-to-Face. Since it took effect in 2012, the Face-to-Face certification requirement for home health services – and now for durable medical equipment – has only grown more cumbersome.

According to Oswald, “The key to a complete Face-to-Face is the physician’s narrative. In the physician’s own words, the narrative has to include information about how a diagnosis (or diagnoses) is affecting this specific patient, causing him or her to be homebound and to need skilled care.” The best way to make sure a Face-to-Face is complete, Oswald added, is to include office visit notes that support the diagnosis and home health referral. “Visit notes are extremely helpful for our staff, and for the CMS reviewers who determine whether the Face-to-Face encounter meets criteria.”

For information and specific examples about Face-to-Face Encounter requirements, please visit www.hhcminc.org/resources/f2f.

4 Get Paid for Your Time. The system is in place,

the documentation is signed, and the Face-to-Face encounters have all occurred. No doubt, this has cost you and your staff time and money. Billing for Care Plan Oversight, Transitional Care Management, and – coming in 2015– Chronic Care Management is the last step in the process. It’s optional to bill for these services – but it’s also profitable.

CMS has developed four codes that are commonly used for Care Plan Oversight.

G0180 Certification – This code is used for the work a physician must do to certify that a patient is eligible for Medicare home health services, including: ordering the

plan of care; signing the 485; and Face-to-Face encounter documentation. It is to be used for patients who have not had Medicare home health services in the past 60 days.

G0179 Re-Certification – This code is used for recertifying patients who have received home health care in the last 60 days.

G0181 Care Plan Supervision – This code is used for care plan supervision for Medicare home health patients. It is defined by CMS as “physician supervision of a patient receiving Medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of laboratory and other studies, communication (including telephone calls) with other health care professionals involved in the patient’s care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month, 30 minutes or more.”

G0182 Care Plan Supervision – This code is used for care plan supervision for Medicare hospice patients and follows the same definition as G0181.

For more information on Care Plan Oversight, ask your home health agency liaisons.

Transitional Care Management

Transitional Care Management services may be billed to CMS when a health care professional takes responsibility for a patient’s care and services required during the patient’s transition to community settings.

Services are billed for the 30-day period beginning on the date a patient is discharged to a community setting from any of the following: inpatient acute care hospital; inpatient psychiatric hospital; long-term care facility;

skilled nursing facility; inpatient rehabilitation facility; hospital outpatient observation or partial hospitalization; or partial hospitalization at a Community Mental Health Center.

Transitional Care Management may not be billed for the same period during which Care Plan Oversight (G0181 or G0182) is billed. In addition, only one physician may bill for Transitional Care Management for a beneficiary. For more information about billing for Transitional Care Management, reference: http:// www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNProducts/Downloads/ Transitional-Care-Management-Services-Fact-SheetICN908628.pdf.

Chronic Care Management Beginning in 2015, physicians will be able to bill for chronic care management services for time spent managing patients with multiple chronic conditions. CMS intends to issue its final standards for this payment code in the 2015 Physician Fee Schedule rule.

The Bottom Line: Don’t Let Documentation Get between Your Patients and Their Success at Home

“Home is where people want to be in times of illness or injury,” noted Gough, “and home health care agencies, including Berks VNA, strive to work with physicians to keep patients healthy, safe and living independently.

By working together to streamline our administrative functions, physicians and home health agencies can ensure the best possible outcomes for our patients and our communities.” n MEDICAL RECORD

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MEDICAL HISTORY

Dr. Mesmer, Music and Ben Franklin B y D IC K B ELL , M D

T

he association of Dr. Mesmer, music and Ben Franklin produced an interesting interaction in medical history.

Dr. Frantz Mesmer was an Austrian physician whose doctoral dissertation concerned his belief that the gravitational pull of the planets influenced an invisible fluid, which flowed through all organisms and affected human health. He felt that this fluid was magnetic and could be adjusted by a magnet in the hands of a trained practitioner.

The magnet would promote an improved flow of these fluids around blocks that caused various conditions. At times, he could produce a trance-like state that occasionally led to “crises” (convulsions, fainting, and deliriums) which would purge the body and mind of many maladies. In one instance, he had his patient swallow an iron preparation and attached magnets to her body to treat her symptoms. Reportedly, the subject felt streams of fluid flowing through her body and had symptomatic improvement for several hours.

Soon, Mesmer abandoned the use of magnets and developed other procedures for individuals and groups.

For individuals, he would sit close to them, knees touching, making eye contact and moving his hands along their arms and torso. He would apply pressure to various areas, which were felt to be poles of magnetism that could be massaged to break up the blockage. Sensations were elicited which reportedly induced cures.

With groups, he positioned them around a vessel containing “magnetized” water and iron filings. The vessel had protruding rods and a rope which the subjects touched to their various body parts. They also held each others’ thumbs, creating a mesmeric chain. The individuals having a “crisis” would usually induce a group mass response.

Mesmer effected treatments by moving around the room, approaching the individuals and manipulating the body fluids by motions of his hands and eyes without touching the patient. He was charismatic and usually able to develop a close professional relationship with his patients. During these treatments he used dim lighting, mirrors, and soft music as well as occasional incantations. For the soft music, Mesmer used a glass harmonica, called an armonica, which produced an eerie, ethereal, sweet sound.

The principle of the glass harmonica is the same as rubbing a wet finger on the rim of a series of goblets producing various tones depending on the volume of liquid in the goblet. When Ben Franklin was representing the colonies, he attended a concert in London where there was a performance using water filled goblets. He subsequently invented a more convenient instrument that involved a spindle with glass bowls. A treadmill that was powered by a pedal turned the spindle. The musician produced the tones with a wet finger on the rotating bowls.

Continued on page 16

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Mozart composed several works for this instrument having been introduced to the glass harmonica by Mesmer.

Other composers using this instrument were Handel, Beethoven, Richard Strauss, and Donizetti. Before electric amplification, the obvious limitation of this instrument was that it could not be heard in large concert halls.

Mesmer was accused of fraud while he was practicing in Vienna and moved to Paris. He soon became a celebrity and a prominent society physician. Even Marie Antoinette became a follower of Mesmer. Again the medical community, which offered little in effective treatments, criticized his theories. King Louis XVI became skeptical and commissioned the French Academy of Science to investigate Dr. Mesmer.

They appointed a commission that included Antoine Lavoisier, the acclaimed chemist, Dr. Guillotin, noted for his “humane” execution invention, and Ben Franklin, who was in France representing the newly independent America and was considered the contemporary authority on electricity.

Franklin was one of the subjects in the intense testing of Mesmer’s theories. As expected, Franklin’s gout and other maladies were not cured despite several sessions.

The commission concluded that the theory had no scientific basis and the “cures” were a result of a normal resolution of the disease state or a placebo effect. Some of the subjects’

improvements were attributed to Mesmer’s patients having stopped going to their physicians and discontinuing medications, which were possibly doing more harm than good. As a result of the report Mesmer’s popularity waned.

It is ironic that while Franklin’s invention contributed to the fame of Mesmer, he was a factor in Mesmer’s downfall.

Today, one of Franklin’s glass harmonicas is on prominent display in the Franklin Institute. A glass harmonica has been used in songs by Pink Floyd, Aerosmith, and Linda Ronstadt as well as in several Star Trek films with Spock’s theme song.

Occasionally, we hear of alternative medicine advocates using magnetic bracelets to help various ailments. Today, we have the terms “animal magnetism” (the power to attract others in a physical or sensual way) and “being mesmerized” (awed or spellbound by a wonderful event). Modern hypnosis can be traced to technical refinements of Mesmer’s autosuggestion trances. n Editor’s Note: Dr. Mesmer lived from 1734-1815, and Benjamin Franklin from 1706-1790. Franklin invented the glass armonica (or harmonica) in 1761 and became very skilled in playing it, as did Dr. Mesmer. Franklin participated in the debunking of Dr. Mesmer’s methods in 1784.

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overnor Corbett’s annual budget address is now in the books, and the House and Senate have completed their respective Appropriations Committee budget hearings. At these hearings cabinet secretaries pleaded their case and were cross-examined regarding the funding requested by the governor for their departments. The entire process (hopefully) will culminate with the enactment of a new state budget before the end of the fiscal year on June 30. The past few months have been busy, with action on several measures of importance to physicians and patients. Following is a summary of some of the highlights.

Controlled substance database

Progress continues to be made on the Pennsylvania Medical Society’s (PAMED) drive to enact legislation establishing a statewide controlled substance database.

As reported earlier, the House of Representatives passed House Bill 1694 back on Oct. 21, 2013, by a vote of 1917. The success was the result of two years of effort by PAMED and its members, who recognize the value such a database would have in reducing doctor-shopping and controlled substance abuse. Our “Pills for Ills, Not Thrills” campaign has played a major role in generating public support for the legislation.

Subsequently, Senator Pat Vance (R-Cumberland) introduced her own version of the legislation, Senate Bill 1180. The bill differs in several respects from the Housepassed bill, and PAMED has been working to reconcile those differences and get a final product to Governor Corbett’s desk to make this important tool a reality for Pennsylvania physicians.

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On March 19, 2014, the Senate Public Health and Welfare Committee approved Senator Vance’s bill unanimously, and as of this writing the bill awaits a vote by the full Senate. While PAMED supported the Senate committee action, we still have a number of concerns about the Senate version, particularly in the area of patient privacy and law enforcement access to the database.

At this point it is unclear whether the House bill or the Senate bill will ultimately be the one that reaches the governor’s desk, but in either case PAMED will continue to press for enactment of the best possible final product.

Medical marijuana

There has been a surge of interest in legislation that would legalize medical marijuana in Pennsylvania, culminating in a Senate public hearing on January 28, 2014. Senate Bill 1182 is based on the premise that there is some evidence that marijuana may provide relief from nausea to cancer patients, and that it may aid in the treatment of glaucoma and post-traumatic stress disorder. There are also recent stories that oil derived from cannabidiol has aided some suffers of Dravet syndrome, a rare form of epilepsy.

PAMED testified at the hearing, where we expressed concern that much of the evidence is anecdotal, and that one individual’s experience cannot be applied to others with any degree of confidence. In the absence of reliable scientific studies, we worried that there is no sure way to know whether the observed changes resulted from the administration of marijuana or from some other source or combination of sources. And might it be possible that two cases in which an individual benefited from marijuana were offset by three other cases where patients suffered harm?

PAMED also testified that serious questions remain even if one assumes that medical marijuana may benefit a certain class of patients. Was it the tetrahydrocannabinol (THC) that produced the result, or was it the cannabidiol (CBD), or a particular combination of the two? Or perhaps it was one of the dozens of other compounds in the particular strain that was used. What dosage or potency produces maximal efficacy, and how often should it be administered? And importantly, is there a dosage or frequency of administration that causes harm, and what are the long term effects? Until these questions have been answered, PAMED testified that we cannot support the legalization of marijuana for medical use.

Efforts under way to ban electronic cigarette sales to minors However, PAMED believes a compelling case exists for a serious scientific examination of the potential medical use of marijuana, and four years ago joined the AMA in urging that marijuana’s status as a federal Schedule I controlled substance be reviewed, with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods. PAMED has also called for further adequate, well-controlled studies of marijuana and related cannabinoids in patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy, and the application of such results to the understanding and treatment of disease. The bill’s fate is uncertain at this time.

Naloxone bills being considered

House Bill 2090 and Senate Bill 1299 would significantly expand access to naloxone, a drug used to counteract the effects of an opioid drug overdose. The bills provide for educational materials and training for law enforcement personnel, firefighters, and persons at risk and their friends and family members on how to identify a person experiencing an overdose, administer naloxone, and seek medical help.

The scope of practice of EMS providers would be expanded to permit them to administer naloxone once they have received the necessary training. And importantly, prescribers would be authorized to prescribe and dispense naloxone to law enforcement personnel, firefighters, and persons at risk, along with their friends, family members and others in a position to help them.

Prescribers who prescribe and dispense naloxone in good faith would be immune from civil, criminal, and professional disciplinary liability for doing so, and persons seeking medical help for someone experiencing an opioid overdose would also be immune from criminal liability.

While it is clear that naloxone saves lives, lawmakers are wrestling with the question of whether wide availability also encourages opioid abuse by reassuring potential abusers that an antidote is at hand.

The Pennsylvania Medical Society has expressed its strong support for Senate Bill 1055, which would ban the sales of electronic cigarettes to minors. The bill was approved by the Senate Judiciary Committee on December 3, 2013, and is poised for a vote by the full Senate.

PAMED believes that while electronic cigarettes may ultimately prove to be “safer” than tobacco cigarettes, a claim as yet unsubstantiated, they are far from harmless.

Electronic cigarettes deliver nicotine, a highly addictive substance, into the body, and according to the American Medical Association’s Council on Science and Public Health they also contain other toxins and carcinogens.

PAMED is especially concerned that electronic cigarettes are attractive to minors, as evidenced by their availability in flavors like bubble gum, chocolate, and even gummi bears. This is deeply troubling in light of a recent study of 76,000 Korean teenagers, which found that electronic cigarette use made them less likely to have succeeded in kicking the smoking habit and actually made them heavier smokers. The study, conducted by researchers from the University of California at San Francisco, concluded that:

“use of e-cigarettes is associated with heavier use of conventional cigarettes, which raises the likelihood that actual use of e-cigarettes may increase harm by creating a new pathway for youth to become addicted to nicotine and by reducing the odds that an adolescent will stop smoking conventional cigarettes.”

Attorneys General from 40 states have jointly submitted a letter urging the FDA to regulate electronic cigarettes in the same way that it regulates tobacco products, and since 2009 the FDA has banned e-cigarette imports on the grounds that they were unregulated medical devices. Yet under current law these devices can be freely obtained by children. PAMED is working aggressively to secure Senate passage of this important public health measure. n MEDICAL RECORD

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The Berks County Medical Society invites you and your family to join the fun at our Family Outing at Hawk Mountain Sanctuary.

Hawk Mountain Sanctuary September 27, 2014

Departing at 12 noon by chartered bus from the parking lot of BVNA. Return time: 4PM Cost: $5 for age 6-21 $10 for over 21 Children under age 6 are free.

PEAK TIME FOR FALL MIGRATION LIVE RAPTOR PROGRAM NATIVE PLANT GARDEN BINOCULARS AVAILABLE FOR RENT SPONSORED BY PMSLIC-NORCAL GROUP TO RESERVE YOUR SPACE: Call Betsy at 610-375-6555 or email info@berkscms.org

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Happy Holidays Thank you to Lisa Geyer for hosting one of our favorite events, our Holiday Brunch. What a wonderful time members had visiting with each other! The brunch was a nice way to relax for a few hours in the middle of the busy Holiday Season. Long-standing members as well as those new to the Alliance were present. Donations were collected for the Junior League Young Women’s Summit.

ALLIANCE UPDATE kathy rogers bcmsa president

Winter New Member Coffee How Can Home Ownership Affect a Family in a Positive Way? Our Fall General meeting was hosted by Kelly O’Shea.

The speaker was Mr. Tim Daley, the Executive Director of Berks County’s Habitat for Humanity. Mr. Daley shared not only information about the extensive process by which a family is chosen to receive a Habitat house, but also the many ways that homeownership can affect these individuals. Just a few of the very long list of ways that owning a home can positively change someone’s life are: increased chance of graduating from high school, increased likelihood to participate in higher education, improved compliance with medical appointments and an overall improved sense of well-being. Habitat for Humanity assists in helping make the dream of owning a home a reality. The recipients of houses provided by Habitat for Humanity have to earn the key by undergoing extensive credit checks and investing 400 hours of their time essentially “learning how to be a homeowner.” While Habitat for Humanity is the largest provider of houses in the world, it greatly depends on volunteers in the community to give their time and talents. Volunteers are needed not only for assisting in the physical building of the house, but also in helping in the family selection process, mentoring families on how to manage a mortgage, and assisting at the organization’s nonprofit home improvement store called “Restore.” After hearing Mr. Daley’s talk, many Alliance members agreed that a volunteer day with Habitat for Humanity would be a fun and fulfilling way to help the community. We are going to look into this opportunity for next year. Donations of food and personal hygiene items were collected for the Greater Berks Food Bank.

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Despite the snowy weather this winter, we were able to meet with several physician spouses who are new either to the area or to our organization. We are pleased to welcome the following ladies to our membership – Kim Gent, wife of Dr. Michael Gent; Beth Myers, wife of Dr. Stephen Myers; Lysette Ramos, wife of Dr. Christopher Ibrahim; and Allison Wilson, wife of Gregory Wilson. We look forward to seeing you at upcoming events!

Thank you to Gretchen Platt who hosted a childfriendly morning of conversation and play. It is wonderful that we have so many members with young children and that the children are able to join in the Alliance events when schedules demand it. We are planning to have a babysitter at future meetings to accommodate members’ needs, as we hope to help those mothers with young children feel welcome to come to our events. Our ability to be flexible as our membership grows and changes is one of the things that sets our county’s Alliance apart from others, and keeps our membership growing.

Upcoming Spring Events

It is exciting that Spring is right around the corner, not only because of this long, snowy winter, but also because we have some exciting events planned for the next few months!

Our Spring Meeting was held on March 20, 2014 at the home of Lisa Banco. We are honored to have one of our members and the President-Elect of the Berks County Medical Society, Dr. Lucy Cairns, speak to us about Hawk Mountain Sanctuary. Dr. Cairns is in the process of organizing a joint BCMS and BCMSA outing at Hawk Mountain Sanctuary in September. She will speak to us about the history of the Sanctuary and will share information about determined conservationist Rosalie Edge, founder of Hawk Mountain Sanctuary. We will surely be inspired after her talk!

Health Project On Thursday, April 10, the BCMSA will present Cyber Bullying and Social Media: Implications in School and Your Community. This program will be held at Glad Tidings Church from 8:30 am-12:30 pm and will be an informative and eye-opening look at the far-reaching consequences of today’s social media. Speakers include Robert Heiden and Heather Calabria, Detectives with the Berks County District Attorney’s Office, and Josh Ditsky, M.Ed., Director of College Counseling at Berks Catholic High School. For more information please go to HealthProject@berkscmsa.org.

This year’s Health Project is one you don’t want to miss!

Judith Kraines, Allison Wilson and daughter

Lysette Ramos and son

Thank you to all of the above speakers and hosts and to Lindsay Romeo for organizing these events. If you are interested in joining our organization or attending a meeting, please check out our website at www.berkscmsa.org or contact our Vice President of Membership Gretchen Platt at gretchenplatt@mac.com. n

Back row (Left to Right): Kim Gent, Pam Charendoff, Dee Dee Burke, Amanda Abboud, Beth Meyers, Lisa Geyer, Emily Bundy, Tiffany Shaffer, Jacquie Fernandez, Jody Menon.

(Middle Row): Gretchen Platt, Kathy Rogers, Allison Wilson, Lysette Ramos, Judith Kraines. (Front): Sara Tuanquin

Lindsay Romeo, Tim Daley and Kathy Rogers

Sara Tuanquin and children

Pam Charendoff and Kim Gent MEDICAL RECORD

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FOUNDATION UPDATE

T

he Foundation of the Pennsylvania Medical Society Pennsylvania PHP staff is now offering intervention services to physicians and those who care about them. Sr. Case Manager Lou Verna is certified in intervention services.

Intervention. Once thought of as a confrontational tool in treating addiction has developed into a “carefrontational� approach that demonstrates care and concern not only for the impaired individual, but also the family, friends, employers, and coworkers impacted by addiction or behavioral issues.

Intervention is a way to address enabling behaviors and empowers those held hostage by addiction or behavioral problems and the challenges they present.

People learn to utilize community resources and develop strategies for taking their lives back and returning to a healthy, productive lifestyle on a daily basis.

Those impacted by addiction quite often sit by helplessly witnessing and even contributing to the dysfunction. The process of intervention will allow those impacted to take charge of the situation, freeing them from being held hostage.

The importance of recognizing, defining, developing, and implementing solutions is paramount. Early recognition cannot be stressed enough. Too often, the addictive patterns and behaviors are allowed to continue and go on unchallenged.

When determining whether an intervention is needed, some of the signs to look for are: absenteeism, excessive sick leave, tardiness, and Friday / Monday absences. In addition, absences prior to and after holidays can be telling. Accident rates, poor work performance, or poor relationships or disruptive behavior in the workplace also are significant factors.

The process of coaching a team for the intervention can be initiated by a phone call to the PHP. This can be the start of a well thought out process that will help alleviate conditions and behaviors that have a far reaching impact on the outcome.

An interview will be conducted over the phone which will address the needs of the organization, family, employer, or coworker. The intervention process will 24 | MEDICAL RECORD

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be discussed as team members will be determined or eliminated. Those who continue to demonstrate enabling behaviors will be eliminated from the intervention team.

A dialogue with concrete examples of the behaviors exhibited will be created and rehearsed. Finally a time and place will be determined for the intervention to take place and ultimately the recommendations for treatment to begin the process of resolution. Contact us for more information. n

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installation brunch recap

Mike Baxter, MD Chair, Executive Council of the Berks County Medical Society

Michael Fraser, PhD Executive Vice-President Pennsylvania Medical Society

Dr. Kristen Sandel taking the oath of office as 2014 President of the Berks County Medical Society

Lucy Cairns, MD, taking the oath of office as President Elect.

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Stacie June, DO, receiving her new member plaque from Gina Riordan, Pennsylvania Medical Society

Lucy Cairns, MD, Ray Truex, MD , Bruce Weidman and Michael Haas, MD sharing a moment at the Installation Brunch

50 Year Award recipient Hector J. Seda, MD

Barton Smith, MD 50 Year Award recipient

John Shuman, MD 50 Year Award recipient

Roger Longenecker, MD, receiving his award for 50 years of Service MEDICAL RECORD

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BERKS COUNTY MEDICAL SOCIETY 2014 Schedule of Events

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Wednesday, April 23 7:30AM Friday, April 25 7AM Friday, April 25 noon Saturday, April 26 7:30am-noon Thursday, May 1 6PM Friday, May 9 6:30AM-9AM Friday, May 30 7AM Thursday, June 5 6PM Monday, June 16 noon Friday, June 27 7AM Friday, July 25 7AM Friday, August 22 7AM Thursday, September 4 6PM Monday, September 8 noon Wednesday, September 24 Friday, September 26 7AM Saturday, September 27 noon-4PM Thursday, October 2 6PM Tuesday, October 14 8-noon Friday, October 31 7AM Thursday, November 6 6PM Friday, November 21 7AM Thursday, December 4 noon Thursday, December 4 6PM Friday, December 19 7AM

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BVNA Healthcare Champion Breakfast Administrative Committee Alliance Luncheon at Doctors’ Grove BCMS & BCBA End of Life Seminar Executive Council Legislative Breakfast Administrative Committee Executive Council Retired Physician Luncheon Administrative Committee Admimnistrative Committee Administrative Committee Executive Council Retired Physicians Luncheon Golf Outing Administrative Committee Hawk Mountain Family Outing Executive Council CPR Recertification Administrative Committee Executive Council Administrative Committee Retired Physicians Luncheon Executive Council Administrative Committee

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