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Contents

SPRING 2016

F E AT U R E S Bucks County Medical Society Letter From the Editor....................................................................... 4

6 PAMED Updates

Essential Ingredients, Uncommon Ideas—Key to Value in Health Care

Zika Virus—PAMED Holds Call-in to Provide a Pennsylvania Update...................................................... 9 Physician General Outlines Steps Physicians Can Take to Solve Opioid Crisis.............................. 20 Out-of-Network Surprise Billing:

Issue Is Much Broader than Balance Bill............................................... 22

Bill Aims to Streamline Physician Credentialing in Pennsylvania....................................................... 23

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Physician Advocacy Pays Off: DHS Announces

Medicaid Will Recognize & Pay for Observation Status......................... 23

Continuing Care Retirement Communities: A Senior’s Solution to Every Dimension of Wellness

Health & Wellness On the Leading Edge—St. Luke’s University Health Network

Offers the Latest in Valve Repair, Arrhythmia Management..................... 14

Teen Dating Violence…And What You Need to Know............ 16 Tips for Managing Arthritis........................................................................ 18

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Taking Charge of Your Diet for National Nutrition Month........... 24 Health Awareness Calendar.................................................................... 26

Spinal Cord Stimulation—Freeing Patients From Chronic Back Pain

St. Mary Offers a New Option to Reduce Risk of Stroke........................................................................... 28


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Letter From the Editor Bucks County Medical Society 200 Apple Street, Quakertown, PA 18951 (215) 536-8665

info@bcms-pa.org E D I TO R S J. Todd Alderfer, MD Eric R. Gejer, DO Nancy Croll E X E C U T I V E D I R E C TO R John S. Detweiler PRESIDENT J. Todd Alderfer, MD PA S T- P R E S I D E N T Bindukumar C. Kansupada, MD P R E S I D E N T- E L E C T Sean Butler, DO VICE-PRESIDENT Karl W. Helmold, MD S E C R E TA R Y Robert S. Mirsky, MD TREASURER Irwin J. Hollander, MD

PUBLISHER Hoffmann Publishing Group Inc. 2921 Windmill Road, Reading, PA 19608 (610) 685-0914 x201 • HoffPubs.com A D V E R T I S I N G C O N TA C T Sherry Mathias (610) 685-0914 x203 SherryM@Hoffpubs.com

P R O D U C T I O N A S S O C I AT E Sara Radaoui GRAPHIC DESIGNER Brittany Fry

When Life Matters Most

M

edicine continues to advance in both the treatment and prevention of disease. This is ever present in cardiology where we spend just as much time trying to prevent heart disease, in the form of modifying risk factors like blood pressure and cholesterol, for example, as we do in treating it. We have even looked in the human genome to start to identify and classify patients before their disease states even become clinically known. In appreciating our accomplishments in early identification, risk stratification and prevention of disease, we should not neglect another significant part of our profession that seems to get much less attention. This is the issue of “end of life.” Many patients and physicians do not want to talk about the “D” word. Yes, “death.” However, this part, near the end of a patient’s life, may very well be when the role of a physician is greatest. It really is our job as physicians to educate our patients and their families about end of life decisions. Every patient should be encouraged to obtain a living will and power of attorney. Why? In our cost conscious mindset of 21st century medicine, one may say that costs are highest at the last year of life, often because patients have not expressed what their wishes are. But cost is not the most important issue here. The most important issue is quality of life. With lack of understanding as to the effectiveness and utility of certain tests and procedures near the end of life, families are often left struggling to feel that they need to do anything and everything they can. But what does this mean? Often patients and families do not understand that certain treatments at this stage do nothing to truly prolong life, and do even less at contributing to its quality. Is this the patient’s fault or the physician’s? The key may really be better communication and education. We need to provide both to patients and families so that they can make informed decisions about treatment plans. When we fail to inform and educate our patients, we may actually watch them suffer. This is the last thing any physician wants to see. When our patients need us, we want to be there at their bedside. This is when precerts, reimbursement, regulations, and paperwork float out the window. This is where we want to be and should be. What happens at the end of someone’s life should always involve discussions between the physician and patient. End of life decisions should not come from government mandates or with only cost savings in mind. They should come out of discussion between physicians and patients about what treatments are in line with what the patient’s expectations are in terms of quality and comfort. As we move toward a focus on quality and not quantity of service, we should heed that lesson when speaking with our patients. This should not come from an urge to save money but from the dedication physicians have toward beneficence and in treating someone with respect for both their sovereignty and dignity.

The written and visual content of this magazine are protected by copyright. Reproduction of print or digital articles without written permission from Hoffmann Publishing Group, Inc., and/or the Bucks County Medical Society is forbidden. The placement of paid advertisement does not imply endorsements by Bucks County Medical Society.


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FEATURE

Essential Ingredients,

UNCOMMON IDEAS—

Key to Value in Health Care

Ron Watson, Director of Communications & Government Affairs, Doylestown Health

ntegration, collaboration and communication among healthcare providers are essential for the delivery of quality care to patients. The same ingredients are also keys in the emerging value-based reimbursement environment in which healthcare providers are paid based on quality, efficiency and efficacy, not on the number of patient visits or procedures they perform. Yet as basic as the ingredients are, healthcare delivery can be complicated for both the patient and provider. Take, for instance, a patient with multiple conditions and physicians who is prescribed 10 or more medications. Perhaps the patient also takes supplements such as fish oil and vitamins, or an herbal recommended by a friend. The patient may also use overthe-counter medications for pain or the common cold. There are hundreds of new medications approved by the FDA every year adding 6

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to the thousands of prescription drugs available, in addition to the hundreds of changes to labeling or the discontinuance of some medications. In many ways, medications sometime fit into the “too-much-of-a-good thing” category. Doylestown Healthcare Partnership (DHP) recently completed a pilot initiative to improve the reconciliation of medications taken by patients with the aim of preventing drug interactions, duplication and adverse effects, and improving a patient’s adherence to medication regimens. DHP is a clinically—and financially—integrated health network created by Doylestown Health and more than 400 physicians on the Doylestown Hospital Medical Staff. A six-week pilot program in late 2015 placed PharmD students in their sixth year of study in three primary care practices. The students from Temple University and University of the Sciences were overseen


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Essential Ingredients, Uncommon Ideas

by a hospital-based pharmacist; it was up to the primary care physician to accept, alter or override the students’ recommendations.

Parameters of the Initiative

The Practice Imbedded Pharmacy Program was tested to assess the impact of focused review of patient medications in primary care practices. The trial concentrated on a defined population:

 Patients discharged from Doylestown Hospital or others in the region, and patients discharged from nursing homes or following a visit to an emergency department  Patients taking 10 or more medications  High-risk patients identified by the primary care physician through a proprietary risk assessment dashboard (more on that later).

The PharmD candidates were given a defined role in the primary care practices:  Students completed medication reconciliation for the identified patients, including medical and medication history  They identified, triaged and resolved medication issues  They provided medication, smoking cessation and/or device counseling  They documented their interventions and recommendations to physicians about potential changes in the patient’s drug regimen.

The students saw a total of 270 patients. There were a number of findings, none unexpected (see sidebar), but the analysis of the results of the pilot will help structure an expansion and deployment of the program to Doylestown Healthcare Partnership primary care practices in 2016. Continued on page 8 SPRING 2016

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Essential Ingredients, Uncommon Ideas

Transitions of Care

There are many other opportunities to add value to health care, among them, better coordination of care after a patient leaves a hospital or nursing home. A number of tools and methods are available to forecast a patient’s health risk based on chronic conditions, risk factors and medical complexity. There are few, if any, readily available risk assessment dashboards that individual primary care physicians can use to manage the care of a patient transitioning from institution to home.

What the PharmD Students Found: (in order of most to least)

Potential adverse effects Regimen not followed Patient experiencing adverse effects Questions/concerns about the medications Uncontrolled symptoms

Beginning with the widely available LACE score (Length of stay, Acute admission, Comorbidities and number of Emergency Department visits), Doylestown Healthcare Partnership created a proprietary risk assessment dashboard with a dozen other variables to arrive at a risk score for individual patients. In addition to the LACE score, the tool collects a patient’s age, number of medications, number of ED visits in the last year, previous and next primary care visit, and if the patient has heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes, dementia and an injury from a fall in the previous year. The tool collects data from the hospital EMR and community EMRs, HealthShare

Insurance issues Unnecessary drug therapy Drug interactions Health maintenance Alternative therapy available Patient taking discontinued medication Duplicate therapy

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Exchange of Southeastern PA, and work is underway to collect data from urgent care centers and skilled nursing facilities.

The risk assessment is supplemented by an aggressive effort to notify primary care physicians of a patient’s discharge from Doylestown Hospital, and the physician practice is responsible for scheduling a follow-up visit within 14 days of discharge. “There are few areas of health care with greater impact on patient outcomes and efficacy than in helping to manage the transitions of care for patients moving among hospitals, skilled nursing facilities and the patient’s home,” said Scott Levy, MD, chairman of Doylestown Healthcare Partnership.

Coordination is Key

Doylestown Healthcare Partnership created the Fragility Fracture Initiative, based on the “Own the Bone” program of the American Orthopaedic Association, to address osteoporosis treatment throughout the community. Primary care physicians, the Doylestown Hospital Emergency Department and orthopedists share information about their patients who suffer fractures or are treated for osteoporosis in order to coordinate care and prevent future fractures. This initiative is purely driven by changes in the marketplace that are placing greater emphasis on value and prevention over fee-for-service. The savings in preventive care versus illness care can be shared by providers and insurers, while better health is enjoyed by patients. “Doylestown Healthcare Partnership creates a tipping point for better care coordination with all partners—specialists, primary care providers, the health system and insurers— focused on common goals for the benefit of the patient,” said Sheri Putnam, executive director of DHP. “A few short years ago this kind of arrangement could only be envisioned. Today it is a reality.”


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PAMED Updates

Zika Virus PAMED Holds Call-in to Provide a Pennsylvania Update

T

he World Health Organization anticipates that the Zika virus will spread to all but two countries in South, Central, and North America. Aedes albopictus mosquitoes, which are found throughout the U.S. and are known for transmitting dengue fever and chikungunya, may also transmit the virus. What is Pennsylvania doing about this virus? How concerned should Pennsylvanians be?

The Pennsylvania Medical Society (PAMED) held a media call-in in late January, to help answer these questions. The panelists for the call-in included several state and health care leaders: Loren Robinson, MD, deputy secretary for health promotion and disease prevention at the Pennsylvania Department of Health (DOH); Stephen Colodny, MD, and Ray Pontzer, MD, both infectious disease specialists; and Kurt Barnhart, MD, chair of the Pennsylvania Section of the American Congress of Obstetricians and Gynecologists and a practicing OB/GYN in Philadelphia.

with appropriate risk factors (primarily travel to the above-mentioned areas) be properly evaluated and screened, if necessary, for the Zika virus. Dr. Robinson confirmed that the state will look to monitor mosquito activity as the weather warms up. Drs. Colodny and Pontzer talked about the virus and how it spreads. The virus is not transmitted through casual contact. Dr. Colodny said that symptoms include fever, rash, and body aches, but also noted that most people who get infected with Zika virus have no symptoms. Dr. Pontzer added that the symptoms of the virus, when present, are mild.

PAMED President Scott Shapiro, MD, and Michael Fraser, PAMED’s executive vice president, also participated in the call.

As there’s an increased risk for pregnant women, Dr. Barnhart talked about what is known and unknown about the chance of transmitting the virus from mother to baby. If a pregnant woman is infected with the virus, ultrasound is recommended to assess the fetus.

Dr. Robinson talked about alerts DOH has recently issued, including a Jan. 28 alert that has information on the process for diagnostic testing in the state. She also discussed Pennsylvania’s status and DOH’s preparations.

“It’s reassuring to me to know that we have experts and state officials aware of the possibility of Zika arriving in Pennsylvania, and that we’re all working towards a common goal to be ready just in case,” said Dr. Shapiro.

She said that DOH is closely following the surveillance and advisory information coming out of the Centers for Disease Control and Prevention (CDC), as well as guidance issued from national physician organizations, to ensure that we keep Pennsylvanians and their families healthy. She said that, at this time, DOH fully supports the travel advisories issued, especially with regard to pregnant women and travel to affected countries.

“And, for the Pennsylvania Medical Society, our role is primarily educational—keeping our members up-to-date through our communication channels but also working with our media partners to keep the public informed. We are in regular touch with the Pennsylvania Department of Health and the Centers for Disease Control and Prevention. And we will continue to do so as part of the team working to keep Pennsylvania healthy and safe.”

She also said that DOH will work with health care providers and facilities to ensure that patients

Stay up to date with the latest news, advisories, and guidance on PAMED’s Zika web page at www.pamedsoc.org/zika. SPRING 2016

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FEATURE

Continuing Care

RETIREMENT COMMUNITIES:

A Senior’s Solution to Every Dimension of Wellness Jennifer Doone, Pennswood Village, Director of Marketing

hat if I told you there is a onesize-fits-all solution to many of the health care needs for your senior patients? Would you believe me? I’m happy to say that such a solution exists, and it’s called a continuing care retirement community, or a CCRC for short. 10

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You may have heard of a CCRC before; essentially, it’s a retirement community that provides many different levels of health care for seniors, including, but not limited to, personal care, skilled nursing, memory care, and rehabilitation. CCRCs also provide seniors with a strong community support

system, access to wellness programs and amenities, educational and cultural opportunities, and the option to participate in community organizations. “The CCRC model revolutionized how seniors live,” says Dr. Firas Saidi, the


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Continuing Care

Medical Director of Pennswood Village, “and Pennswood is an exceptional example of that.” Dr. Saidi works both at Pennswood Village, a well-known Bucks County CCRC, and as a geriatrician for Mainline Health Systems. He’s worked at several other CCRCs in the past, and has significant experience working with seniors both living at home and in retirement communities. He’s won awards such as Top Physician in Geriatrics from Mainline Times Magazine, and even teaches as a clinical assistant professor at Thomas Jefferson University. On top of all that, Dr. Saidi is a husband and father of three. He has seen the myriad of obstacles seniors face when it comes to their health, and the number of ways they choose to handle it. From ongoing health conditions and the medications they take, to issues like isolation and depression, each of the dimensions of health (physical, emotional, social, intellectual, physical, professional, and spiritual) can be in a constant game of balance. Some seniors choose to focus on one dimension over another, while others may choose to ignore them all together. However, at a CCRC, each dimension of health is easily addressed, making total wellness an obtainable goal. “When I see someone who is sick at the office, and I have to send them home, I worry about them,” says Dr. Saidi. “But, at Pennswood, they have all these resources available to them. They are able to integrate everything from a nutritious diet with dining services to an exercise program in the fitness center, to an active social life.” Pennswood Village is fully staffed with professionals available around the clock including, but not limited to, nurses, social workers, and maintenance and security staff who all have countless hours of training, schooling and risk management experience. While family members can be wonderful caregivers, nothing beats a full time staff of trained professionals.

When I see someone who is sick at the office, and I have to send them home, I worry about them. But, at Pennswood, they have all these resources available to them. They are able to integrate everything from a nutritious diet with dining services to an exercise program in the fitness center, to an active social life.

is that a CCRC can be a smart financial move, too. Upon move-in, residents trade the equity in their house as a down payment on any and all future healthcare needs. It’s a cost they’ve already paid elsewhere, and they are guaranteeing future services. This fee is considered a health care cost, which can have substantial tax benefits. Residents also pay a monthly fee that covers the use of amenities and other monthly services that is often less than the combined monthly bills in an individual’s house. The entrance fee and monthly service fees allow residents to receive the type of health care they need, when they need it, without ever having to move. When an independent living resident decides the time is right to receive a little more help on a regular basis, he or she can move into personal care, and then onto skilled nursing, and so on. Residents can live in the same place with spouses or partners who receive a different level of service, and can avoid the stress that comes along with only being allowed to see each other during visiting hours. But, above all the services, amenities, and health care offered to residents by the community, is what residents can offer to one another. A community lifestyle allows residents to work with their peers to create a community that works for them. Like any community, they seek out weak spots and work together to improve them. They voice their passions and unite to peruse them. From creating a committee that focuses on the environment and teaching classes about Shakespeare, to donating bikes to charity and volunteering hours of time to those less fortunate, residents often choose to give to their community rather than take, leaving everyone better in the end. Above all, this is undeniably the greatest way to maintain an active, fulfilling retirement.

Each dimension of wellness is integrated into the community lifestyle. Residents have access to physicians and trainers to help them with their physical wellness; clubs and organizations to improve occupational wellness; therapists and friends nearby for emotional wellness; a saturated event calendar for social wellness; housekeeping and maintenance staff for environmental “Pennswood is not a place where people wellness; and the list goes on. Any resource come to be taken care of,” says Dr. Saidi. imaginable is available and in one location. “They come to contribute to life here at Pennswood. But, they always have in the I know what you’re thinking: “How can back of their minds, that should they ever someone afford all that?” But, the truth need help, it’s going to be there for them.” S P R I N G 2 0 1 6 11


FEATURE

Spinal Cord Stimulation—

FREEING Patients From Chronic Back Pain

Fred Goldberg, MD Board-Certified Anesthesiologist & Pain Specialist for Aria Health

I

magine this: you’re a 35-year-old mother of two. Your lower back pain is so debilitating that you can’t work, you’re completely dependent on pain medication, and participating in simple activities with your children makes you writhe in agony. Or, you’re an elderly grandmother diagnosed with spinal stenosis and the radiating lower back pain that this condition causes has you wheelchair-bound and prevents you from easily leaving your house or playing with your grandchildren. These patient stories are not uncommon. In fact, according to the American Academy of Pain Medicine, back pain is the single leading cause of disability in Americans under 45 years of age, and more than 26 million Americans between the ages of 20-64 experience frequent back pain. This serious and disabling condition has serious effects, both physical and mental, and the impact often reaches far beyond the sufferer. Families feel the strain of a reduced income because the pain is so severe their loved one is unable to work. Or they live with someone who is depressed because their quality of life is so negatively impacted by the pain. Even worse, they see a family member slipping into addiction, as their reliance on pain medicine increases in a desperate attempt to find relief.

Out With The Old, In With The New… and a Higher Quality of Life Over the years, treatments to help those who suffer from this chronic pain have ranged from over-the-counter medication to physical therapy to spinal cord


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Spinal Cord Stimulation

stimulation. Traditional spinal cord stimulation treatments have led to decreasing some of the pain, but can cause a tingling, prickling and pins-and-needles sensation. Many patients find this sensation unpleasant and it may cause restrictions such as operating a motor vehicle. Many people who suffer from back pain do not respond positively to traditional spinal cord stimulation. Recently, the FDA approved a brand new therapy that is limiting the side effects of traditional spinal cord stimulation and giving a wider range of patients their lives back. At Aria Health, we became early adopters of this innovation in pain management to give our patients the high quality care and treatments they deserve. The new spinal cord stimulation therapy, called the Senza® spinal cord stimulator, is helping our patients experience at least 50 percent reduction of pain. Not to mention, with this technique, fewer patients are claiming dependency on pain medication for lower back and leg pain, and this is the only spinal cord stimulation therapy that does not restrict the patient’s ability to drive. You might be wondering how this new therapy differs from traditional spinal cord stimulation. This treatment uses much higher frequency electrical pulses, which are delivered to the spine to significantly reduce pain perception. The treatment soothes the pathway to the brain—all without that irritating tingling sensation and no damage to the spinal cord. In fact, the patients don’t typically feel any sensation other than pain relief. From the physician’s standpoint, if patients report a 50 percent reduction in pain, we consider the device to be a success. This new treatment method has been so successful that, in a two-year national study conducted by Nevro, in association with the FDA, 88 percent of patients reported significant reduction in pain and underwent permanent implantation following a trial period.1 The success of this two-year study has led to the FDA giving the Senza system a superior rating, and this is the only spinal cord stimulator with this rating. As an anesthesiologist and pain specialist, I have been treating patients suffering from chronic pain with traditional spinal cord stimulation since 1992. In July of 2015, Aria Health implanted the first patient in the Philadelphia region with the Senza® treatment, and we implanted 18

patients in the first six months. Aria Health is in the top 10 percent nationally in implanting this device. Since July, patients have consistently reported improvements in quality of life as a result of Senza® spinal cord stimulation. Remember the 35-year-old mother whose pain was so severe, she couldn’t work? She suffers from an incurable degenerative disc disease, which causes her pain. I have been treating her for many years and she wasn’t a candidate for traditional spinal cord stimulation. However, after just four months with this new therapy, she is now back to work, part-time, and has significantly reduced her reliance on pain medication. She has said that the Senza® spinal cord stimulation changed her life. Overall, the treatment has been extremely successful, bringing the average starting pain score of 7.9 down to an average pain score of 1.7 at the end of a week-long trial. As a result of the rapid rate of pain reduction, 90 percent of my patients have elected to move forward with permanent implantation following their trial. Of those patients, all are more than satisfied with their pain reduction. The Senza® spinal cord stimulation treatment is just one example of how Aria Health is constantly innovating and investing in new treatments. As the largest healthcare provider in Northeast Philadelphia and Lower Bucks County, we are proud to offer high quality care and pioneering treatments to the patients in the community who we care so deeply for. 1 Sustained Effectiveness of 10 Hz High-Frequency Spinal Cord Stimulation for Patients with Chronic, Low Back Pain: 24-Month Results of a Prospective Multicenter Study, The Journal of the American Society of Anesthesiology, 2014

ABOUT THE AUTHOR: Dr. Fred Goldberg is a certified anesthesiologist and pain specialist with more than 20 years of medical experience. Dr. Goldberg treats a variety of conditions at the Aria Pain Management Center at locations in Torresdale and Lower Bucks County. The Aria Pain Management Center works closely with a patient’s primary care or referring physician to provide the latest treatment options and technology for pain management. If you have any questions, Dr. Goldberg can be reached at FGoldberg@ariahealth.org.

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Health & Wellness

e g d E g n i d Lea ON THE

St. Luke’s University Health Network Offers the Latest in Valve Repair, Arrhythmia Management

o say the new procedures offered by St. Luke’s University Health Network’s cardiac valve replacement program are on the cutting edge would be an understatement. Instead, since there is no “cutting” involved, they are on the leading edge of minimally invasive procedures with shorter procedure and recovery times, and present options for patients who are not candidates for traditional open-heart surgeries. St. Luke’s University Health Network’s (SLUHN) Transcatheter Aortic Valve Replacement (TAVR) and MitraClip valve-repair procedures offer patients who suffer from progressive diseases and may not be healthy enough for open heart surgeries a solution to life-threatening cardiac illness. Additionally, the highly specialized technology of the Evera MRI defibrillator allows patients to undergo MRIs, an option unavailable to patients with traditional defibrillators. “One of our commitments at St. Luke’s is that if we feel new technology is game-changing, we go out of our way to get access to the technology so that we can offer it to our patients as soon as possible,” says Darren Traub, DO, SLUHN’s Medical Director of Cardiac Electrophysiology. “These are 14

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game-changing technologies and they’re available right here in our region.”

That’s a mechanical problem that requires a fix.”

Adds Christopher Sarnoski, DO, Medical Director of SLUHN’s Structural Heart Disease Program: “These procedures and devices broaden the pools of patients who now have better solutions to their medical problem and enables them to receive better care in the future.”

In the TAVR procedure, the Sapien 3 valve—manufactured by Edwards Lifesciences and released last summer—is carried via catheter through the femoral artery using imaging to guide cardiologists as they position the valve.

Transcatheter Aortic Valve Replacement with Sapien 3 Valves The TAVR procedure is for patients who suffer from a condition known as severe aortic stenosis, a narrowing of the arteries surrounding the heart, which Dr. Sarnoski explains as being similar to a great deal of rust forming on a gate. “In this case,” he notes, “the wear and tear on the valve doesn’t allow it to open. Essentially, the heart is pumping blood through a pinhole.

A temporary pacemaker paces the patient’s heart at approximately 180 beats per minute for the 15 to 20 seconds the doctor needs to implant the valve. That rapid pace results in little movement of the heart when the doctor implants the Sapien 3. The doctor uses a wire to guide the balloon-expandable replacement valve, which is on a stent, into the heart and across the aortic valve. The balloon is inflated and, as it expands, it moves the old valve out of the way and the new valve into place. St. Luke’s cardiologists have done nearly


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On The Leading Edge

200 TAVR procedures to date, with outstanding results.

speaks to the outstanding work of our heart valve team and the quality of imaging we get.”

“We look at success, mortality both in-hospital and at 30 days, and if the patient had a stroke or major vascular injuries,” notes Raymond A. Durkin, MD, Chairman of Cardiovascular Medicine at SLUHN. “We are superior to the national averages in all of these areas.”

Evera MRI

The MitraClip repairs a leaky mitral valve in patients who are too high risk for surgery. To implant the MitraClip, the surgeon guides the device through the common femoral vein.

In the past, having a pacemaker or an implantable cardioverter defibrillator (ICD) meant patients could not undergo an Magnetic Resonance Imaging (MRI) exam, which uses a magnetic field and radio waves to take highly detailed images of organs and structures inside the body. Not any more, thanks to devices such as the Advisa MRI pacemaker and Evera MRI ICD manufactured by Medtronic.

“We go in the right atrium, do a septal puncture and enter into the left atrium above the valve,” explains Stephen Olenchock, DO, SLUHN’s Chief of Cardiovascular Surgery, who traveled with Dr. Sarnoski to Cedars-Sinai Medical Center last July for highly specialized MitraClip training.

“Around 2010, Medtronic released an entirely new pacemaker platform (Advisa MRI) with leads that disperse heat and filtering that would prevent the device from malfunctioning from the electrical field that’s created by the MRI magnet,” Dr. Traub explains.

MitraClip

Shortly after the device received approval from the U.S. Food and Drug Administration, SLUHN became the first hospital in the region to offer MRIs to patients who had this pacemaker implanted.

The surgeon then uses imaging to place the clip in the area where the damage is or in the area where the leak is occurring. The MitraClip is repositionable and attaches the mitral valve’s front and back leaflets together to help prevent blood leaking back into the heart. “The MitraClip procedure can take anywhere from 45 minutes to two hours depending on how many clips we need to place, how many times we need to reposition the clip and how easy it is to grab the leaflets with the clip,” Dr. Olenchock points out. “At other sites, the average time is about two hours. Ours is about 45 minutes. This

“In September of 2015, the first MRI-compatible ICD was released,” Dr. Traub says of the Evera MRI ICD. “Within 10 days of FDA approval, St. Luke’s implanted its first Evera MRI ICD. It’s our responsibility to offer our patients the best technology as quickly as possible. “There is no substitute for an MRI for imaging of the spine or soft tissue of the brain,” Dr. Traub says. The implant technique is exactly the same as the standard pacemaker and ICD. Eight weeks after the implant, patients can undergo MRIs. “We place MRI pacemakers and ICDs in all of our patients unless there is a compelling clinical or patient-related reason to use a different device technology.” St. Luke’s has placed hundreds of MRIcompatible pacemakers and ICDs and performed dozens of MRIs on patients to-date.

These new procedures, devices and technologies align with St. Luke’s unwavering commitment to excellence as it cares for the sick and injured. The success of the Cardiac Team is based on its true team approach to health care. “St. Luke’s University Health Network has 31 cardiologists at six different hospitals and 10 different offices,” Dr. Durkin says. “We are here to take care of the entire community and we have areas of sub-specialization that have enhanced our development over the past five years. “Our structural heart program in which cardiologists and heart surgeons work together to do less-invasive and highly specialized procedures is on the forefront of that. Every specialized cardiac procedure performed at any major university hospital in the country is available right here at St. Luke’s.” S P R I N G 2 0 1 6 15


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Health & Wellness

TEEN DATING

VIOLENCE ...and What You Need to Know

Brandi Gift

the many concerns that parents have for their teens, Among dating tends to be near the top of the list, and not just for fears of sexual relations. One in three teenagers experience some form of abuse in their dating relationships, warranting a parent’s concern, according to Break the Cycle, a leading national nonprofit organization providing dating abuse programs to young people and adult allies.

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As a parent, it’s safe to say you’ve had plenty of sleepless nights, accompanied by endless tossing and turning, worrying about your child. You’ve read every parent manual or magazine hoping they would prepare you for the many trials and tribulations ahead. However, in rearing your child or children, you’ve come to realize that it’s tough to anticipate every outcome. As your child is approaching the teen years or beginning to date, you’re faced with even more concerns. In addition to your worries about them engaging in sexual activity, you also face the possibility that they could fall victim to a physically abusive relationship and not know how to escape it.


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Teen Dating Violence

Healthwise Inc. explains that violence and abuse are not always visible. Abuse can come in the form of physical violence or threats, emotional or mental abuse, and sexual abuse. Teen females are more likely to experience physical abuse, while males typically are abused via technology. The dangers don’t just end with the immediate threats, though. Further repercussions of relationship violence include eating disorders, depression, and low self-esteem, all further harming the teen. No teen is fully immune or safe from dating violence. Dating violence can occur in any teen relationship, regardless of one’s appearance, religion, school performance, race, sexual orientation, or family background. It is important to monitor your child’s relationship so you can recognize any signs of abuse as soon as possible and guide your child to a healthier lifestyle. Not to state the obvious, but chances are that parents would play the most important and influential role when it comes to responding to teen dating violence. So what can you do to safely help your child? Here are a few key steps recommended that parents take when helping your loved one through dating violence.

1

EDUCATE your child about what a healthy relationship is so that they have some good comparisons when assessing their relationships.

2 ENCOUR

AGE them to realize that their partner should make them feel happy, confident, safe, and respected.

3 PROVIDE

a safe atmosphere for your child to make them feel comfortable coming to you if there is a problem.

Recognizing potential warning signs of dating violence can be difficult. Some signals of detection may be isolation or distraction, continuous and tedious receipt of texts or phone calls, expressions of anger or irritation when asked how they are doing, noticeable unexplained injuries, continuous excuses for their partner’s actions or behavior, and showering as soon as they arrive home. Although these are not definite indicators of abuse, they are all causes for warning. Regardless of whether your teen is suffering from dating violence, it’s still important for you and your child to understand what you can do if they ever find themselves in this situation. Talk with your child to take any precautionary education measures to help them with the abuse they are receiving.

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Health & Wellness

Tips for Managing

Information compiled from The Arthritis Foundation

o what exactly is arthritis? While arthritis is very common, it isn’t very understood. There are over 100 different types of arthritis and related/similar conditions. Arthritis is really just an informal way of referring to join pain or joint disease. Although it is most common amongst women and occurs more frequently as people get older, people of all ages, sexes and races can suffer from arthritis. With more than 50 million adults and 300,000 children having some type of arthritis, it is the leading cause of disability in America. Common arthritis joint symptoms include swelling, pain, stiffness and a decreased range of motion. Symptoms can be moderate, mild or severe, and they may come and go. Symptoms can all stay the same for years, or they can progress or get worse with time. Arthritis can cause permanent joint change, and severe arthritis can result in chronic pain, resulting in inability to perform daily activities. While some changes may be visible, it is more common that the damage is seen through x-rays. Some types of arthritis can affect the eyes, lungs, kidneys and the heart. Lifelong joint health is an important part of everyone’s wellness, productivity, 18

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quality of life, and independence. If you have arthritis, ideally you’d like to find out as soon as possible so that you can take the necessary steps to protect your joints from ongoing pain and permanent damage of uncontrolled inflammation. With early diagnosis, you are saving more than just your joints. Several types of arthritis can cause internal damage to the heart and other organs. It is important to recognize that prompt treatment can protect your overall health. The diagnosing of arthritis usually begins with a primary care physician who performs a physical and several blood tests or imaging scans in order to help determine the type of arthritis the patient is suffering from. If the arthritis is inflammatory or the diagnosis uncertain, it’s best to call upon a rheumatologist. Arthritis can be a “tricky diagnosis” and they say this because there are over 100 different types of arthritis and related conditions. Rheumatologists typically manage ongoing treatment for inflammatory arthritis and other complicated cases. When the arthritis starts affecting other body parts or systems, other specialists such as ophthalmologists and dermatologists then become a part of the health care team.

Making an arthritis diagnosis can sometimes be straightforward—but not always. The diagnostic process includes eliminating problems aside from arthritis. If the problem seems to be arthritis, then which arthritis is it? As previously stated, there are over 100 types of arthritis and related conditions. Osteoarthritis is usually the first consideration, and by far the most common type. Some types of arthritis don’t always reveal their full range of effects at one time. Sometimes, a key feature that would confirm the diagnosis doesn’t show up for years. However, it is common that one type of arthritis be mistaken for another, as people sometimes suffer from more than just one type. In some cases, preventing a prior incident can significantly reduce the risk of arthritis. For example, avoiding sports injuries through proper equipment and adequate training can prevent ACL tears that could lead to osteoarthritis later down the road. Determine what you may need to change (whether it’s activities, diet, exercise or stress level). Make a plan with your doctor, write it down and ask your support network to help you keep on track. Here are five important self-management habits that can help you successfully manage your disease:


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1. BE ORGANIZED: Take charge of your treatment plan by keeping track of symptoms, pain levels, medications, and possible side effects so together with your doctor, you can determine what works best for you. 2. MANAGE PAIN & FATIGUE: It’s important not to allow pain and fatigue to become overwhelming. You can combine your medication regimen with non-medical pain management techniques. Similarly, fatigue is a common problem that can be caused by the underlying disease process or the stress of living day to day with the pain and limitations of a chronic disease. Learning and using natural therapies to manage fatigue is key to living well with arthritis.

avoid caffeine or strenuous exercise in the evening, and wind down with a warm bath or practice relaxation techniques before bedtime.

Right now scientists don’t fully understand the causes or mechanisms behind these diseases; true prevention seems out of reach. However, the breakthroughs may be closer than they seem. Consider this: Many types of arthritis are thought to result from a combination of genetic predisposition and an environmental trigger, such as a virus or toxin. Discovery of the trigger for a type of arthritis may be the key to its prevention, even in someone with genetic

risk. As the rate of discoveries is accelerated by the Arthritis Foundation scientific program, the search for preventions—and cures, too—may soon become reality. If you invest in yourself and recognize your responsibility—and ability—to take good care of yourself, you can live well with arthritis. You’ll need to make adjustments, but make sure your goals are realistic, even if they involve only small steps right now. No one can take care of you better than you can. For more information on how to better manage living with arthritis, visit your local Arthritis Foundation’s website, or http://www.arthritis.org/.

3. STAY ACTIVE: Even though it might seem like the last thing you want to do when you’re in pain, exercise is beneficial for managing arthritis and your overall health. It can strengthen muscles that support your painful joints, preserve and increase joint range of motion, improve sleep quality, boost your mood and sense of well-being and help you lose excess pounds that add stress to painful joints. 4. EAT A HEALTHY & BALANCED DIET: A healthy diet, when combined with exercise, can help you achieve and maintain a healthy weight. Also, adding foods with anti-inflammatory properties and that are rich in antioxidants can help control inflammation. 5. IMPROVE SLEEP: Poor sleep habits can worsen arthritis pain and fatigue, but there are things you can do to help you fall asleep and stay asleep. Make your bedroom dark, cool and quiet,

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PAMED Updates

Physician General Outlines Steps Physicians Can Take to

Solve Opioid Crisis

ennsylvania Physician General Rachel Levine, MD, spoke about the continuing opioid abuse crisis at the Pennsylvania Medical Society’s (PAMED) Specialty Leadership Cabinet Meeting on Feb. 9, 2016. “The opioid crisis is THE biggest health crisis we are facing in Pennsylvania, and in the country,” said Dr. Levine. While the 2014 Pennsylvania Coroners Association’s report found that, on average, seven people a day die of overdoses in Pennsylvania, signs are that the numbers will be higher when the 2015 report is released sometime this spring, she said. 20

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“This crisis hits everyone—our mothers, fathers, brothers, sisters, sons, daughters, rural, urban, suburban,” she said. “We have to get past the idea that this is someone else’s problem. We have to get people into treatment and recovery. Addiction is a disease; we have to erase the stigma.” She talked about a multi-pronged approach to addressing this growing epidemic that involves physicians, health care organizations such as PAMED, and patients.

EDUC ATION

“We want to educate medical students, residents, new physicians, and current physicians,” said Dr. Levine.

Dr. Levine talked about PAMED’s new CME series—“Addressing Pennsylvania’s Opioid Crisis: What the Health Care Team Needs to Know”—that was developed in collaboration with other stakeholders, including the state and 11 other health care related organizations. The first two courses in the series on the state’s opioid prescribing guidelines and naloxone law are now available. Courses on the warm hand-off/ referral into treatment and the controlled substances database are coming soon. She encouraged all Pennsylvania physicians to take advantage of this CME, which is free for PAMED members.


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Steps to Solving Opioid Crisis

“Opioid CME is not currently mandated by the state, but one way to ensure it stays that way is for Pennsylvania physicians to use the voluntary opioid guidelines and take this voluntary CME,” she said. During the American Association of Medical Colleges meeting in Baltimore on Nov. 9, 2015, PAMED convened deans and leaders from every one of Pennsylvania’s 10 medical schools to meet with Dr. Levine, Secretary of the Department of Drug and Alcohol Programs Gary Tennis, and other state leaders to discuss opioid abuse and pain management curriculum development for physicians-in-training and other opioid related issues across the Commonwealth. Dr. Levine also talked about the specialty-specific voluntary prescribing guidelines that currently exist for health care providers: • For the treatment of chronic, non-cancer pain • For treatment of pain in the emergency department • For dental practice • Dispensing guidelines for pharmacists • For obstetrics and gynecology pain treatment • For geriatric pain

She said that new guidelines are coming on benzodiazepine, orthopedics and sports medicine, pediatrics and adolescent medicine.

TRE ATMENT

Dr. Levine said there is funding in the state budget for substance abuse disorder health homes, whose emphasis will be on improving access to medication-assisted treatment. How did we get here? According to Dr. Levine, it was the perfect storm.  The emphasis from many different agencies and in the field on pain. In the late ‘90s/early 2000s, pain became the fifth vital sign.  The emphasis on fully evaluating pain and treating pain, but at the same time, development of very powerful, long

acting, and very addictive, opioid medications.  The influx of tremendously cheap, plentiful, and very powerful heroin.  “Put together, this combusted into the epidemic we are seeing now,” said Dr. Levine. “We have to act. Physicians have to act, or it will be superseded by legislative actions.”

Get tools to help you combat the opioid abuse crisis in PAMED’s Opioid Abuse Resource Center at www.pamedsoc.org/OpioidResources

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PAMED Updates

Out-of-Network Surprise Billing: Issue Is Much Broader than Balance Bill

T

he Pennsylvania Department of Insurance’s proposed solution to the “surprise billing” problem was the primary topic of discussion for the Pennsylvania Medical Society’s (PAMED) Board of Trustees on Feb. 9, 2016. PAMED testified at a hearing on this issue last fall. A common sentiment among the PAMED Board was that this issue was much more complex than just out-of-network (OON) balance billing. That’s why it tasked PAMED’s new payer advocacy task force and representatives from affected specialties with examining these issues further. PAMED will be sending an initial comment letter to the Pennsylvania Department of Insurance in the coming weeks about intersecting issues such as network adequacy as well as how transparency of the process and patient education have effects on OON balance billing. PAMED’s task force will be discussing details concerning what solutions will work best for Pennsylvania physicians and their patients. “You can’t look at OON billing in isolation,” said Dennis Olmstead, PAMED’s senior advisor of health economics and policy. “There are a lot of other factors that intersect with this issue such as network adequacy, complex benefit 22

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“Balance or surprise billing issues are part of the aftermath of weaknesses in the current network adequacy, patient education, and insurance contracting processes in Pennsylvania. If you don’t address the underlying problems, you’re never going to enact meaningful change.”

design that many consumers don’t understand, narrow/tired networks, assignment of benefits, and transparency—transparency between the insurer and physician, physician and patient, and insurer and consumer. “Balance or surprise billing issues are part of the aftermath of weaknesses in the current network adequacy, patient education, and insurance contracting processes in Pennsylvania,” he said. “If you don’t address the underlying problems, you’re never going to enact meaningful change.” Network adequacy has been an issue for PAMED for quite some time. For example, several years ago, physicians were terminated from 2014 Medicare Advantage (MA) plan networks of UnitedHealthcare and other insurers in select markets. At that time, PAMED worked with UnitedHealthcare, other MA plans, and the Pennsylvania Department of Health, Bureau of Managed Care to address termination issues. The Centers for Medicare and Medicaid Services and others—in response to advocacy efforts by PAMED and other state and national organizations—are beginning to address network adequacy. PAMED will continue to advocate on behalf of Pennsylvania physicians and patients.


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PAMED Updates

Bill Aims to Streamline Physician Credentialing in Pennsylvania We know that the credentialing process for physicians can be a long and burdensome one, often resulting in a delay of several months before a physician is formally credentialed and can begin seeing patients. This bureaucratic and time-consuming process is not only frustrating for physicians, but also negatively impacts patients, who may face limited access or delays in care. House Bill 1663, recently introduced by Rep. Matt Baker (R-Tioga), would improve the physician credentialing process in Pennsylvania by making it timelier and more uniform across insurers. This legislation is awaiting consideration by the House Health Committee. We need YOU to take action! Send a message directly to your Representative and ask him/her to support HB 1663 when it comes up for a vote. Please be sure to share examples of frustrations you've personally experienced during the insurer credentialing process.

Physician Advocacy Pays Off:

DHS Announces Medicaid Will Recognize & Pay for Observation Status The state Department of Human Services (DHS) recently announced that Medicaid will start recognizing and reimbursing for observation status—which occurs when a patient is in the hospital but not actually admitted as an inpatient— sometime this summer. Guidance and specifics, such as codes and billing indications, are not known at this time. As soon as DHS releases more details, the Pennsylvania Medical Society (PAMED) will make sure its members have all the information they need to know. If you would like to receive an update, email us at stat@pamedsoc.org and say “Observation Status Reimbursement Update” in the subject line. PAMED’s advocacy efforts included leading discussions with DHS, PAMED’s Medical Directors Forum, and the American Medical Association.


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Health & Wellness

TAKING CHARGE

of Your Diet for National Nutrition Month Kathleen Levitt, Registered Dietitian & Manager of the Outpatient Nutrition Center at Aria Health

Follow a Healthy Eating Pattern

It’s important to remember that all food choices matter. Focus on variety, nutrient density and amount. For example, you can limit calories by eating nutrient-dense foods across food groups and by cutting back on added sugars, saturated fats and sodium intake. When you choose a healthy eating pattern at an appropriate calorie level, you are helping your body to achieve a healthy body weight, supporting nutrient adequacy and reducing your risk of chronic diseases.

Add More Fruits & Veggies to Your Plate

o you want to improve your diet and serve your family more fresh, healthy and nutritious meals? For most of us, the answer is almost always, “Yes!” We all know that eating a nutritious and balanced diet will go a long way for our health; however, it’s easy to be tempted by the convenience 24

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of fast food restaurants, unhealthy take-out meals, and sweets in your office kitchen. March is National Nutrition Month, making it a great time to revamp your family’s eating habits. Here are a few simple tips to help you adopt a healthier lifestyle without a complete diet transformation.

While this might seem obvious, increasing your fruit and vegetable intake is a great place to start, and for many of us, requires some planning and commitment. Instead of reaching for a second serving of carbs, fill your plate up with another serving of veggies. Lead by example and encourage your children to do the same.

Get Creative with What’s in Season

Have fun with food, and be creative with what’s in season by researching new recipes that incorporate seasonal ingredients. Some forgotten fruits and veggies that are in


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Taking Charge of Your Diet

season in the springtime include artichokes, honeydew, apricots, mango and peas, but the list goes on.

Grow Your Own

Gardening is a fun and interactive way to get the entire family, especially kids, involved in making healthy choices. According to the Journal of the American Dietetic Association, garden-based nutrition intervention programs can increase children’s willingness to taste new fruits and vegetables, and promotes increased fruit and vegetable intake among children and adolescents. Watch your garden grow as you plant new types of seeds. When it’s ready, pick your new herbs and vegetables and use them in your recipes!

Consider Healthy Substitutions

It’s easy to lose track of calories when cooking and baking, but there are plenty of substitutions you can use to make your recipes healthier without sacrificing flavor. For example, you can use egg whites when a recipe calls for eggs to make it heart healthy. And be sure to use heart healthy oils instead of butter when cooking.

Say No to Sugary Drinks; Say Yes to More Water

Remember that caloric beverages count, too. Think about all the calories you can remove from your diet by cutting out soda and sugary fruit drinks. Plus, when you stop drinking soda and juice, you’ll drink more water, which does wonders for your energy level, skin and digestion, not to mention also helps with weight loss!

Healthy eating can be challenging for many of us, especially with so many temptations in every aisle of the grocery store. But each step you take toward a healthier diet is a step in the right direction, and implementing just a few of these healthy eating tips will make a big difference for your health. For more tips on how to encourage your family to eat healthier foods, Aria Health is hosting Kids in the Kitchen in honor of National Nutrition Month on Monday, March 14, 2016 at 5 p.m. Kids and their parents will cook easy, healthy snack recipes and learn all about healthy eating. For more information, please call (215) 612-4863.

Kids in the Kitchen March 14, 2016 • 5 pm Kids and their parents will cook easy, healthy snack recipes and learn all about healthy eating. For more information, please call (215) 612-4863

ABOUT THE AUTHOR: Kathleen Levitt is a registered dietitian and the manager of the Outpatient Nutrition Center at Aria Health, the largest healthcare provider in Northeast Philadelphia and Lower Bucks County. In her role, Kathleen oversees nutrition services including individual nutritional counseling, healthy lifestyle programs, educational nutrition seminars and post-operative diet and nutrition guidance. If you have any questions, she can be reached at KLevitt@AriaHealth.org.

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Health & Wellness

Health Awareness

MARCH 2016  National Colorectal Cancer Awareness Month  National Endometriosis Awareness Month  National Kidney Month  Multiple Sclerosis Education Month (promoted by the Multiple

APRIL 2016  Alcohol Awareness Month

M AY 2 0 1 6  American Stroke Awareness Month (promoted by the National

 National Autism Awareness Month—Pennsylvania Autism Action Center

 Arthritis Awareness Month

 National Child Abuse Prevention Month

 National Asthma and Allergy Awareness Month

 National Donate Life Month

 Better Hearing & Speech Month

 National Facial Protection Month

 National Celiac Disease Awareness Month

Stroke Association)

Sclerosis Foundation and others)

 National Nutrition Month  Save Your Vision Month

 Irritable Bowel Syndrome (IBS) Month

 Healthy Vision Month

 Trisomy Awareness Month

 Occupational Therapy Month

 Lupus Awareness Month

—Pediatric Therapy Center Interview

 National Sarcoidosis Awareness Month  Sexual Assault Awareness & Prevention Month

(promoted by the Lupus Foundation of America)

 National Mediterranean Diet Month  Melanoma/Skin Cancer Detection & Prevention Month  Mental Health Month  National High Blood Pressure Education Month  National Osteoporosis Awareness & Prevention Month  Preecalmpsia Awareness Month  Ultraviolet Awareness Month  National Women’s Health Week (begins on Mother’s Day)

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BUCKS COUNTY MEDICAL SOCIETY Gives back to community by making donations to various community organizations including Family Service Association of Bucks County, Ann Silverman Community Health Clinic, Bucks County Health Improvement Partnership, Child, Home, and Community

FAMILY SERVICE ASSOCIATION OF BUCKS COUNTY Protect, maintain, strengthen, and enhance individuals, families, and children, and their social and psychological functioning. Offer a variety of programs and services focused on increasing opportunities for adults, protecting seniors, reducing substance abuse, improving lives of mentally ill, preparing children and adolescents for future, improving HIV/AIDS quality of life. Operate Bucks County Emergency Homeless Shelter

ANN SILVERMAN COMMUNITY HEALTH CLINIC Provides free medical and dental care for uninsured low-income adults and children in the central Bucks County community. Since 1994.

BUCKS COUNTY HEALTH IMPROVEMENT PARTNERSHIP Join efforts of all Bucks County major healthcare providers, the medical society, and department of health towards a common goal. Developed programs to address the needs and opportunities identified through health assessment activities and continual community analysis. Attempt to improve general health of Bucks County and address gaps in service. Lower Bucks Clinic – free health care to uninsured; Children’s Dental Program; Tobacco Control Program – free smoking cessation program; Bucks County Wellness Partnership – collaborative health promotion and disease prevention activities; Domestic Violence Task Force – increase awareness and promotes universal screening and counseling of patients.

CHILD, HOME, AND COMMUNITY Empower and educate young parents so they can have healthy pregnancies, give birth to full term babies, learn parenting skills, complete high school, and plan for higher education or a career. Sponsors free childbirth classes, support groups, career counseling and other advocacy services for teens.

BIG BROTHERS, BIG SISTERS Provides children facing adversity with strong and enduring, professionally supported one-to-one relationships that change their lives. Enhance children’s ability to succeed and thrive by interacting with volunteer mentors.

AMERICAN RED CROSS Disaster Relief, Supporting America’s Military Families, Lifesaving Blood, Health and Safety Services, International Services

BCMS Health & Community Partnerships

Health & Wellness

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Health & Wellness

St. Mary Offers

a New Option To Reduce Risk of Stroke

Breakthrough technology allows some patients to stop using blood-thinner medications

or 69-year-old Terry Wesner of Ewing, N.J., managing his irregular heartbeat (non-valvular atrial fibrillation) has been a constant challenge since his first heart attack in 1986. He’s had five stents in his heart and two in his legs to keep blood flowing through his arteries, as well as numerous implantable defibrillators and pacemakers to maintain a healthy heart rhythm. But it is his atrial fibrillation that requires him to take a steady stream of blood-thinning medication to keep his blood from clotting and causing a stroke.

WATCHMAN Left Atrial Appendage Closure Implant photo credit: bostonscientific.com

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St. Mary Offers a New Option

And it was the long-term use of this medication that really worried him. Wesner developed anemia, a common side effect from consistent use of blood thinners. Even more troubling, Wesner was worried about other unintended consequences. “Every time I cut myself, it’s hard to stop the bleeding,” says Wesner. “What if I got into a serious accident? Suddenly, a minor wound isn’t so minor anymore. It felt like a constant threat.” That concern prompted him to seek an alternative to his medication regiment. His cardiologist at St. Mary, Dr. Steven Goldsmith, recommended an innovative new implant. The WATCHMAN Left Atrial Appendage Closure Implant could drastically reduce his need for blood-thinning medication, such as warfarin, as the new device is proven to cut the risk of stroke dramatically. “The WATCHMAN is ground-breaking new technology that truly benefits patients who are at risk for stroke because of atrial fibrillation,” says Dr. Richard Leshner, Chief of Cardiology at St. Mary. “We are excited to be the first in Bucks County to add this treatment option so that our cardiac patients do not have to travel far to receive the best and most advanced care.” On Wednesday, Dec. 16, 2015, Wesner became the first patient at St. Mary to receive the WATCHMAN implant, which recently received approval from the FDA. Two additional WATCHMAN procedures also were performed later that first day. St. Mary is the first hospital in Bucks County and the first hospital in the Trinity Health System, which operates 88 hospitals around the country, to begin implanting the device into eligible patients like Wesner.

“We are very excited from a regional perspective. We are the first center in the Mercer/Bucks County Region to provide this service.”

In a minimally invasive procedure that takes about an hour, the WATCHMAN is inserted into a vein in the upper thigh via a catheter and skillfully guided through the veins until it gets to the heart. Once at the left atrial appendage, the device is deployed to cover the structural opening. Once implanted, the body forms a tissue lining around the device to cover and close the left atrial appendage. Blood thinners are continued for about six weeks post-surgery during the healing process. Dr. Burke feels this new technology is a major step forward for patients in the Bucks County area. “We now have a completely Continued on page 30

“Dr. Burke and myself have performed the first half a dozen implants, and all of the procedures have been successful.”

Resembling a mini-jellyfish, the WATCHMAN implant works by blocking the left atrial appendage, a small structure in the left atrium of the heart, from filling with blood and forming harmful blood clots which can then enter the blood stream and potentially cause a stroke. “Patients like Mr. Wesner have a five-fold increased risk of stroke resulting from the pooling and clotting of blood in the left atrial appendage,” says Scott Burke, MD, Director of Cardiovascular Electrophysiology at St. Mary and one of Wesner’s physicians. “Ninety percent of strokes in patients with atrial fibrillation are believed to originate in the left atrial appendage.” S P R I N G 2 0 1 6 29


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St. Mary Offers a New Option

new category of treatment for patients with atrial fibrillation who are at a high risk of stroke and bleeding. The device affords patients protection from stroke without the challenges of long-term blood thinners. We are thrilled we now have this option available for appropriate patients here in our community and thankful to St. Mary Medical Center for investing in this technology.” Wesner’s procedure may sound simple and straightforward, but in reality, it involves a lot of sophisticated resources such as a hybrid operating suite, advanced imaging tools such as 3-dimensional echocardiology, and a structural heart team of highly skilled physicians. In addition to Dr. Burke, interventional cardiologist David Drucker, MD, Director of Peripheral Vascular Interventions; and Anand Haridas, MD, Director of Cardiovascular Imaging; were among the team of experts to perform the first WATCHMAN procedure at St. Mary. “St. Mary Medical Center has a longstanding commitment to leading-edge cardiovascular technologies in the realm of interventional cardiology,” says Dr. Drucker. “This new technique continues this tradition of bringing new technologies to the community in the experienced hands of leading physicians.”

“Three patients have already been seen back for their follow-up appointments and are making wonderful recoveries.”

“St. Mary Medical Center believes in delivering advanced cardiovascular care in our community,” adds Dr. Haridas. “They have consistently renewed this commitment with investments in the most up-to-date imaging technologies, including 3-dimensional echocardiography and advanced biplane fluoroscopic imaging used in our state-of-the-art operating suites.” As for Wesner, his wife Pat Wesner was pleasantly surprised to see how well he was doing shortly after the procedure. “He was sitting up in bed and he just looked great,” she said. “We’re both extremely grateful to his team of doctors and St. Mary for having this treatment option. It really does offer us peace of mind.” With a short recovery time, the WATCHMAN procedure requires only a 24-hour hospital stay for most patients. Mr. Wesner was happy to go home the next day. “I feel great,” he said before being discharged.

“Now that the government gave their blessing, everything is in place for these patients to receive the Watchman Procedure.”  First, FDA approval is needed (passed in March 13th, 2015)  Then it goes through the CMS, which develops criteria for which patients can be deemed candidates for this procedure

David Drucker, MD President of Mercer Bucks Cardiology

Scott Burke, MD

Director of Cardiovascular Electrophysiology at St. Mary

Quotes from Dr. Drucker phone interview—Friday, February 12, 2016.

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Bucks County Physician Spring 2016  
Bucks County Physician Spring 2016  

The Official Publication of the Bucks County Medical Society