Bucks Physician Winter 2015

Winter 2015

Celebrating 20 Years of Successful Health Improvement Initiatives in Bucks County BUCKS COUNTY Relief for Sufferers of Restless Leg Syndrome (RLS)

Assisting Patients and Families Using Advance Care Planning

For 60 years, our family has been taking care of your family. We are proud to let you know we were named part of the 2013 Top 15 Health Systems in the Nation!

01604.112514

When you have award�winning care in your backyard, why go anywhere else?

501 Bath Road | Bristol, PA 19007 | (215) 785-9200 | LowerBucksHosp.com 01604.LBH.AD.General_Ad_Physician_Magazine.112514.indd 1

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Contents CONTACT INFO EDITOR Nancy Croll Bucks County Medical Society 200 Apple Street Quakertown, PA 18951 (215) 536-8665 EXECUTIVE DIRECTOR John Detweiler CONTACT info@bcms-pa.org

• Presidents Message ................................. Page 4 • Meet Your Board....................................... Page 10

PA MED Updates

• Lawmakers Off to a Quick Start................... Page 5 • 2015 Medicare Fee Schedule...................... Page 6 • Ebola Preparedness.................................. Page 8 • All PA Physicians Must Comply With Changes in Child Abuse Laws..................... Page 8 • Dr. Rizzo Responds to CRNP Claims............ Page 9 • PA MED Year in Review.............................. P age 27

Feature Articles WEB bcms-pa.org

• BCHIP.................................................... P age 12 Celebrating 20 Years of Successful Health

BOARD PRESIDENT, 2014 Eric Gejer, DO BOARD PRESIDENT-ELECT Bindukumar C. Kansupada, MD

Improvement Initiatives in Bucks County

• Relief for Sufferers of

Restless Leg Syndrome (RLS)..................... P age 16

• Assisting Patients and Families Using Advance Care Planning..................... Page 20 • Collection Strategies Can Help Physician Patient Relationship: Protect Bottom Line...... Page 24

PUBLISHER Hoffmann Publishing Group, Inc. 2921 Windmill Road Reading, PA 19608 610.685.0914 x201 HoffPubs.com Advertising Contracts Mark Schelling 610.685.0914 x205 Mark@HoffPubs.com Karen Zach 610.685.0914 x213 Karen@HoffPubs.com

In Every Issue • Commentary: Medical Marijuana.................. Page 19 • Community: We Have A House.................... P age 23 • Noteworthy.............................................. P age 28 • Health Awareness Monthly Calendar............. Page 30 For Advertising Opportunities: Call Mark Schelling at 610.685.0914 Ext 205 The written and visual contents 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.

President’s Message As President of the Bucks County Medical Society, I am proud to introduce the Bucks County Physician, a Society periodical that will be published and distributed quarterly.

There have been so many changes in healthcare over the Eric R. Gejer, DO last several years. It remains President Bucks County imperative that physicians be Medical Society involved in organized medicine and be advocates for our patients and for our profession. As physicians treating patients in the 21st century, we must keep the patient as our focus as we face the challenges of practicing medicine. This magazine may be our voice and a vehicle in bringing information, issues and perspectives to the healthcare table.

This magazine has been created for our Society members and our greater community. For members, Bucks County Physician aims to provide timely articles pertaining to current issues facing the practice of medicine.

This could include health issues that impact our communities, continuing education, practice management, Society activities, physician and hospital profiles and community perspectives. For our general public readers, we hope you will gain more insight into the many ways that our Society members, your friends and neighbors, contribute to the welfare of our communities. We believe this new format, featuring relevant and timely topics combined with local perspectives, will lead to greater engagement and build stronger ties with our community.

In addition to mailing to our 600 members, this magazine will be mailed into the waiting rooms of over 1,600 doctors, dentists, allied health professionals, and beauty salons throughout the Bucks County area, and shared directly with 1,000 business and community leaders.

Each issue will also be posted on-line. Overall, Bucks County Physician will reach over 20,000 Bucks County residents.

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Should you have an interest in contributing editorial material or advertising in a future issue of the Bucks County Physician contact Nancy Croll, Society Administrator, at (215) 536-8665, or our publisher’s media executive, Mark Schelling, at 610-685-0914 x205, or email at Mark@hoffpubs.com.

The Board of Directors and I hope you will enjoy our quarterly publication, and find it a valuable resource that will not only enhance value for our membership, but help grow greater fellowship with our community.

Eric R. Gejer, DO President Bucks County Medical Society

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PA MED Updates

Lawmakers Off to a Quick Start BY: Scot Chadwick, Legislative Counsel, PAMED The 2015-2016 session of the General Assembly technically began on Monday, Dec. 1, 2014, though lawmakers won’t actually meet and be sworn in until Jan. 6, 2015. That will be the first day on which House and Senate members can formally introduce bills.

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

This gives PAMED’s government affairs staff an opportunity to spot legislation of interest before it is actually introduced, and the benefits are obvious. For example, we can ask prospective bill sponsors to share their language with us, in the hopes of offering suggested improvements before the bill is formally introduced. Getting a change made that way is clearly preferable to seeking an amendment at a committee meeting or on the floor of the House or Senate.

We can also identify future legislation that, shall we say, will cause PAMED some degree of heartburn. If we can’t dissuade prospective bill sponsors or convince them to make needed changes before the bills are introduced, we can at least get a jump-start on planning our efforts to oppose them.

Here are three examples of already filed co-sponsorship memos that got my attention: 1. Rep. Mark Rozzi (D-Berks County) intends to introduce a bill that would “allow people with terminal disease Winter 2015 Bucks County

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to, under certain conditions, request a prescription for medicine that would end their life in a humane and dignified manner.”

This is an issue that has been in the news recently due to the death of a terminally ill young woman in Oregon, who took advantage of that state’s law to end her life.

2. You may recall that the General Assembly recently enacted legislation authorizing schools to obtain and store epinephrine auto-injectors for use by trained school employees to aid students who are experiencing an anaphylactic reaction. Sen. Matt Smith (D-Allegheny County) is seeking co-sponsors for a bill that would allow restaurants to do the same thing.

3. And, Sen. Mike Folmer (R-Lebanon County) has expressed his intention to reintroduce last session’s legislation that would authorize the prescription and use of medical marijuana in Pennsylvania.

More co-sponsorship memos are circulated every day as House and Senate members seek to get a jump-start on the new legislative cycle, and PAMED’s government affairs team looks at every one of them. Check in with us often, and we’ll keep you up to date on all the latest developments.

See more at: http://www.pamedsoc.org/MainMenuCategories/Laws-Politics/Weekly-Capitol-Update-Blog/ Weekly-Capitol-Update/12192.html#sthash.s9rwWAd6. dpuf

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PA MED Updates

2015 Medicare Fee Schedule Creates Payment Opportunities for Chronic Care Management The final 2015 Medicare physician fee schedule was recently issued by the Centers for Medicare and Medicaid Services (CMS). But, who has time to read the final rule that is more than 1,000 pages long? The Pennsylvania Medical Society (PAMED) has you covered with what you need to know about changes that could affect your reimbursement.

The 2015 final rule released by CMS: • Reimburses physicians for providing chronic care management services starting in 2015, including developing and revising a patient’s plan of care, communication with other treating health care providers, and medication management. This new code could be

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billed once a month per patient. CMS has also added greater flexibility in the supervised clinical staff providing these services. CMS had proposed standards for EHRs, specifically, a 2014-certified EHR. Due to public comments indicating that very few practices have adopted 2014-certified EHR, the final rule says that CMS will require the version of the certified EHR that is in use on Dec. 31 of the prior calendar year for the EHR Incentive Programs to bill for these services. Rather than creating a new G-code, the final rule also says that CPT code 99490 will be used for this purpose.

• Sets Medicare payment rates for physician services in 2015, including a 21.2 percent cut in physician reimbursement due to the flawed Sustainable Growth Rate (SGR) Medicare payment formula. The current temporary patch expires on March 31, 2015. Urge Congress to work in a bipartisan manner to permanently repeal SGR. • Adjusts malpractice RVUs as part of a required fiveyear review. For 2015, CME conducted the third comprehensive review and update of the malpractice RVUs

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PA MED Updates and proposed new malpractice RVUs for all services.

CMS also is adopting new resource-based RVUs based on updated professional liability insurance premiums.

responded to public comments. The final rule says that CMS will transition in 2016, with full implementation in 2017

• Continues implementation of the value-based payment modifier by:

• Makes changes to Open Payments, including:

• Applying the 2017 VBPM, based on 2015 performance, to all physicians, regardless of group size • Confirms the maximum penalty for groups with 10 or more eligible professionals of 4 percent.

• Outlines criteria for avoiding 2017 PQRS penalties, which will be based on 2015 performance. To avoid this two percent penalty, eligible professionals will general have to report nine measures next year.

• Expands the Physician Compare website to include information about quality performance for both groups and individuals • Expands the list of approved Medicare telehealth services to include annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services • Outlines CMS’ misvalued code decisions for 2015 related to hip and knee replacements, radiation therapy and gastroenterology, radiation therapy, epidural pain injections, and film to digital substitutions • Revises the definition of “colorectal cancer screening tests” to include anesthesia that is separately furnished in conjunction with screening colonoscopies effective Jan.1, 2015. In order to encourage beneficiaries to seek colorectal cancer screening services, the coinsurance and deductibles will be waived for anesthesia or sedation services furnished in conjunction with screening colonoscopies.

• Deleting the definition of “covered device” • CMS expanded the CME exemption by stating that they would not consider any CME-related payments to be reportable as long as the commercial supporter “does not require, instruct, direct, or otherwise cause the continuing education event provider to provide the payment ...to a covered recipient.”

• Requiring the reporting of the marketed name and therapeutic area or product category of the related covered drugs, devices, biologicals, or medical supplies, unless the payment or other transfer or value is not related to a particular covered or non-covered drug, device, biological, or medical supply.

• Requiring applicable manufacturers to report stocks, stock options, or any other ownership interest as distinct categories.

Based on public comments and manufacturers’ need to update their systems accordingly, the changes will be implemented for data collection 2016.

See more at: http://www.pamedsoc.org/ Right-Side-Nav/Tools/2015-Medicarefees.html#sthash.lmfo9ynU.dpuf

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• Finalizes CMS’ proposal to eliminate the use of 10 and 90-day global surgical codes starting in 2017 • Creates a process for added transparency in developing payment rates to ensure that changes to rates for certain services are only effective after CMS has Winter 2015 Bucks County

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PA MED Updates

CDC Recommends ThreeTiered Strategy for States’ Ebola Preparedness

All Pennsylvania Physicians Must Comply With Changes in Child Abuse Laws

On Dec. 2, 2014, the Centers for Disease Control and Prevention (CDC) issue interim guidance for state and local health departments, acute care hospitals, and other emergency care settings, suggesting a “tiered-approach” in preparing to treat patients with possible Ebola.

The interim guidance recommends that states designate acute care facilities to serve as 1) frontline health care facilities, 2) Ebola assessment hospitals, and 3) Ebola treatment centers.

The CDC also provided separate guidance for preparing these facilities: • Interim Guidance for Preparing Frontline Healthcare Facilities for Patients with Possible Ebola Virus Disease • Interim Guidance for Preparing Ebola Assessment Hospitals

The first and perhaps most important thing to know about the changes to the state’s Child Protective Services Law (CPSL) is that all Pennsylvania physicians, regardless of your specialty, are impacted by the changes in the law.

Physicians need to be prepared to comply with changes in their responsibilities that go into effect on Dec. 31, 2014. The law was amended to address concerns with the adequacy of protections for abused children in Pennsylvania.

The Pennsylvania Medical Society (PAMED) will be holding a panel discussion and Q&A on Thursday, Dec. 18 at 7 PM. Join us and find out what you need to know about the state’s new child abuse laws by calling (877) 312-9906.

PAMED held a webinar on Dec. 4 to help physicians understand the changes to the law. An archive of the webinar is available.

• Interim Guidance for Preparing Ebola Treatment Centers The CDC also designated 35 U.S. hospitals as Ebola treatment centers, including the Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania.

Separate guidance exists for primary care offices and other non-emergent ambulatory care settings.

Stay up to date with the latest information through the Pennsylvania Medical Society’s (PAMED’s) all-member daily email (the Daily Dose) and on our website at www. pamedsoc.org/ebola.

See more at: http://www.pamedsoc.org/MainMenuCategories/Patient-Care-Quality/Health-Issues/Ebola-2/StatesEbola-preparedness.html#sthash.thWzJAgW.dpuf

PAMED also has developed a suite of materials to help physicians understand the child abuse law changes and is making all materials available to all Pennsylvania physicians.

Watch for additional information in PAMED’s all-member daily email, the Daily Dose, as well as other PAMED’s other communications channels.

See more at: http://www.pamedsoc.org/Right-Side-Nav/ Latest-News/Child-abuse-laws.html#sthash.pjiNZhKO. dpuf

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PA MED Updates

Dr. Rizzo Responds to CRNP Claims: It’s about Training, Not Injustice In response to an op-ed in which the American Medical Association was accused of “social injustice” in opposing independent practice for nurse practitioners, based on the fact that most nurse practitioners are women, Karen Rizzo, MD, president of the Pennsylvania Medical Society (PAMED), spoke out.

“As president of the Pennsylvania Medical Society, and a woman, I can state emphatically that our opposition to independent practice for nurse practitioners has nothing to do with the repression of women, a notion I find both abhorrent and ludicrous,” she said in her response, which was published on Penn Live on Dec. 3.

“Our position on the issue was determined by sound clinical reasoning, based on education, training, and expertise,” she said. “In other words, patient safety.”

She went on to cite the education and training differences between physicians and nurse practitioners — physicians receiving four years of education in medical school, followed by three to seven years of residency and 12,000-16,000 hours of patient care training, and nurse practitioners only two to four years of education (some of which can be completed online) and 500-720 hours of patient care training.

PAMED supports physician-led team based care, in which the physician is the leader of the team, but all health care practitioners work collaboratively to provide the best possible patient care.

“We fail to see how eliminating physicians, with their 12,000-16,000 hours of training, from the team will improve care,” said Dr. Rizzo.

“Nurse practitioners are valuable members of that health care team. However, CRNP independent practice, which Winter 2015 Bucks County

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would sever the collaborative tie between physicians and CRNPs, would lead to fragmented care and is antiethical to the team-based approach,” she said.

PAMED encourages nurse practitioners to work with physicians to improve patient care, and supports legislative initiatives that promote physician-led team based care.

One such initiative, a bill that was recently passed by the state legislature, creates a Patient-Centered Medical Home Advisory Council to advise the Pennsylvania Department of Human Services (formerly the Department of Public Welfare) on how the state’s Medicaid program can increase the quality of care while containing costs through a variety of patient-centered medical home approaches.

- See more at: http://www.pamedsoc.org/MainMenuCategories/Patient-Care-Quality/Team-Based-Care/ Rizzo-response.html#sthash.5dchssoP.dpuf

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BCMS Board Profile

We hope to introduce our BCMS Board members in each issue who serve as your representatives for the Medical Society, starting with the executive committee.

Eric Gejer, DO

BCMS President, 2014 Central Bucks Specialists Ltd Favorite part of practicing medicine: Making that personal connection with a patient is one of my favorite parts of practicing. Communication is as important a part of the interaction with the patient as is treating their disease. I like feeling like I am treating a person and not just their diagnosis. Those positive personal interactions with patients are very fulfilling.

Where do you practice and why did you settle there?

I practice in Doylestown, PA. When I was a resident, I was moonlighting at several hospitals across the Delaware Valley. I was struck by the sincerity and pleasant nature of the Doylestown Hospital community. It was

consistent with whomever I met. I was also impressed with the cardiac program at Doylestown hospital. They were providing state of the art care in a community setting and that was a draw for me.

Are you or any family members actively involved in community, non-profit or professional organizations?

I am actively involved in Pennsylvania Medical Society and American College of Cardiology.

Hobbies: Spending time with my wife and 4 kids.

Hobbies include travel, wine, sportscars, Penn State football, reading about history especially American history.

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James Todd Alderfer, M.D. BCMS President-Elect, 2015 Alderfer & Travis Cardiology

Where do you practice and why did you settle there?

I grew up in the Grand View community and returned in 1997 to start Alderfer & Travis Cardiology and help serve the medical and cardiovascular needs of the local community where I grew up. My father was an Obstetrician/Gynecologist at Grand View Hospital for over 20 years. I began working at Grand View Hospital in High School and through College as an orderly before attending medical school.

Are you or any family members actively involved in community, non-profit or professional organizations?

I reside in Hilltown Township with my wife Donna and our three children, Kayla, Tyler and Kaci. We areactive mem-

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bers at Blooming Glen Mennonite Church, Penn View Christian School, the Healthy Hearts Foundation and in many other local community activities.

Hobbies: Athletics are an ever-present distraction for me, coaching and playing soccer and baseball and many other things. My passion has become marathon running, completing over 25 marathons including the Boston Marathon from 2001-2008 and ongoing, Lord Willing. However, my biggest joy is spending time with my family, from eating dinner, to music lessons, sports, homework, mowing the lawn, fishing in the backyard, planting the garden or trees, singing, church and traveling.

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BCMS Board Profile Bindukumar C. Kansupada, MD FACC MBA

BCMS President, 2015 HeartCare Associates Bucks County Favorite part of practicing medicine: Providing free healthcare. I love to participate in free healthcare clinic. As a Cardiologist my best moments were unclogging clogged arteries.

Where do you to practice: Bucks County. My family has resided in Bucks County for greater than 40 years. Best county to raise family. It is safe and known for excellent school district and excellent healthcare facilities.

My grandmother influeneced me to join my uncle”s practice for family bondage and to assist in sponcoring my extended family from India. My uncle Dr Raj Shah is reknowned Cardiologt in Bucks County since 1975.

Are you or any family members actively involved in community, non-profit or professional organizations?

I am elected PAMED Board member for past 2 years.

My wife Neeta and I am actively involved with local BAPS Chapter for health care initiatives. We organize free annual health care camp for for past 8 years. Objective is

Sean Butler, D.O.

BCMS Vice President, 2015 Interventional Spine, Electrodiagnosis, Sports Medicine Bucks County Orthopedic Specialists Bucks County Orthodedic Specialists Favorite part of practicing medicine: My favorite aspect of practicing medicine is the satisfaction of returning quality of life to my patients. Many times, my patients have given up activities that they enjoy because of their ailments. Being able to help them return to these activities is very rewarding.

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to educate participants for preventive care and disease management. Cultural diversity is major issue for Indian population. We organize this event in collaboration with local hospitals, Insurance companies , healthcare providers & volunteer team . Interactive lectures are arranged in Gujarati for active participation and better understanding for nonenglish speaking participants. More than 250 participants join us every year. Neeta and I participate in voluntary health care services in India. I have participated with other medical societies namely, AAPI, American college of Cardiology, American Society of Nuclear Cardiology, American Society Of Echocardiography and Vraj in central PA. I am proud participant of organized medicine for over 30 years.

Hobbies: Love to visit historical places. I love to visit different countries with friends and family.

Vision: We must learn to combine science of integrative healthcare with science of allopathy for improving patient outcome data, compliance and patient satisfaction.

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Where do you practice and why did you settle there?

I practice in Warrington and Doylestown. I live in the area and was immediately drawn to the area by the people I had met who had grown up in the area and decided to stay to raise their families here. I think that speaks volumes about a community.

Hobbies: When not seeing patients I enjoy playing guitar and gardening, as well as spending time with my wife and two young daughters.

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Feature

Celebrating 20 Years of Successful Health Improvement Initiatives in Bucks County BUCKS COUNTY

Bucks County Health Improvement Partnership (BCHIP) began with a far-reaching vision: to bring together the County’s major medical institutions with the goal of improving the health of the County’s most vulnerable residents. It began when Bucks County’s then seven community hospitals, the local county Health Department, and Bucks County Medical Society collaborated on a study of Bucks County’s health needs. The resulting report, issued in November 1994, led to the incorporation of this unique non-profit organization to address unmet community health needs.

Leadership of BCHIP began with the CEO’s of the acute care hospitals of Bucks County, the Director of the local Health Department and a Board member of the Medical Society. The current BCHIP Board of Directors includes healthcare executives from these same organizations along with five community leaders. BCHIP defines its mission as “providing a leadership role in Bucks County,

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through a collaborative approach, to address gaps in health services and to improve the health status of the community.”

Over the years, BCHIP has developed numerous task forces and programs to address unmet community health issues. It developed the Children’s Dental Program to provide basic dental care to low-income, dentally uninsured children and started the Domestic Violence Task Force to bring awareness of the issue of family violence.

It provides countywide tobacco cessation better known as “quit smoking classes.” These five week sessions are offered for free at community locations including our local hospitals. The participants are offered free nicotine patches and gum to assist them in their efforts to stop smoking.

The underlying problem of insufficient access to basic health services – medical and dental – remains BCHIP’s

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days and 3 evening each week. In order to address the unmet needs of chronically ill adults in Upper Bucks, BCHIP partnered with community physicians and the hospitals in Upper Bucks in 2008 to open a part-time free clinic for low-income, uninsured residents of that region. primary focus. With the assistance of a three-year federal grant in 2002, BCHIP opened a free health clinic for low-income, uninsured adults in Lower Bucks County, expanded a dental network for uninsured children, developed a health promotion program to reduce cardiovascular risks, helped increase enrollment program for Pennsylvania’s Children’s Health Insurance Program and supported a mental health counseling center for teens. Some projects have been handed over to community organizations for ongoing operation, such as the Teen Center at Oxford Valley Mall, which is managed by Family Service Association of Bucks County as a drop-in center for youth.

Other projects continue to operate since the need for the services is great. BCHIP’s Lower Bucks Clinic has been open for 12 years. It is located in Bensalem in the heart of a very diverse and needy community. The clinic provides acute and chronic care to low income, uninsured adults 18 years of age and older. The clinic operates 5

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In 2013, BCHIP examined the community health needs assessments conducted by all the hospitals as part of the Affordable Care Act. New data reviewed an alarmingly low rate of mammography and a high rate of breast cancer. About 42 percent of women in Bucks County who are age 40 and older failed to get their annual mammogram, according to a recent survey by Philadelphia Health Management Corporation. This statistic was startling as Bucks has a highly educated and predominately insured population. However, only slightly more than half the women of Bucks County were getting mammograms on a regular basis. It showed that Bucks woman lag behind those in the other surrounding counties, including Montgomery and Philadelphia.

In October 2014, BCHIP launched a new educational initiative called, Timely Mammograms, to help address this issue. All six hospitals in Bucks County participated in the kick-off event which was incorporated into BCHIP’s 20 Year Anniversary luncheon. The partner hospitals

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“providing a leadership role in Bucks County, through a collaborative approach, to address gaps in health services and to improve the health status of the community.”

– Aria-Bucks, Doylestown, Grand View, Lower Bucks, St Luke’s Quakertown and St. Mary Medical Center have committed to making mammograms available to every woman who needs one, regardless of her insurance status and ability to pay.

BCHIP will work to keep this issue in the public eye through outreach and educational efforts over the next few years.

Our goal is to have at least 65 percent of Bucks County women age 40 and over get an annual mammogram.

children’s dental visits and 231 attendees to smoking cessation programs. In total, there were 10,500 visits to BCHIP clinics and programs during the past year.

After 20 years, BCHIP remains strongly committed to its founding purpose -improving health and enhancing lives.

For more information about BCHIP, please contact Sally Fabian, RN, MSN, Executive Director at sfabian@bchip.org or 215-710-2201.

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As a small non-profit, BCHIP provides an array of services to predominately needy residents of Bucks County.

In the past year, there were 7,813 visits to the Lower Bucks Clinic, 748 visits to the Upper Bucks Clinic, 415

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10th Annual Cardiac Update for the Practitioner

“Relaxis”

Relief from Restless Legs Syndrome!

Saturday, February 21, 2015 8 am - 1:30 pm (lunch included) DeSales University, Center Valley, PA CO-SPONSORED BY St. Luke’s Heart & Vascular Center and St. Luke’s Hospital - Allentown Campus Topics will Include: • Advances in Treatment of Arrhythmia • Hypertrophic Cardiomyopathy • Women’s Heart Disease • Advances in Treatment of Aortic Disease Approval of 5.0 hours AMA and AOA Category 1-A credit is anticipated. 5.0 CE for nurses.

Register early space is limited!

Advanced Medical Homecare Supplies is now accepting orders for Relaxis - the only FDA approved device for improving sleep in patients with primary RLS (aka Willis-Ekbom Disease).

Contact us for: Relaxis (RLS Device) CPAP Equipment and Supplies Oxygen

Lift Chairs Bathroom Safety Compression Therapy …and more

See our online catalog at www.advancedmedicalpa.com Or, come visit our new showroom.

Scan QR Code to Register

Serving the local Philadelphia tri-state area since 2005.

To Place an Order Call 610-524-1510 1025 Andrew Drive, Suite 150, West Chester, PA 19380

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87 branches in NJ & PA to serve you.

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Feature

Relief for Sufferers of Restless Leg Syndrome (RLS) “[Patients] are no more able to sleep, than if they were in a place of the greatest torture.”1 Those were the words of Dr T. Willis as published in The London Practice of Physick in 1685 as he described the implications of the Watching evil, or modern day RLS. Dr. KA Ekbom followed up over two and a half centuries later in his Restless Leg clinical study that: “The symptoms are exclusively subjective and consist of peculiar … indefinable “crawling” sensation, developing only when the legs are still, mostly shortly after the patient retires for the night… The paresthesia is highly unpleasant, but real pain rarely occurs… The sensations are felt deep inside, never superficially in the skin…To relieve the sensations, the patients move their legs continually or get up and walk about”2.

RLS is indeed characterized as an urge to move the legs that is usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. These sensations tend to begin or worsen during periods of rest or inactivity and can be partially or totally relieved by movement, such as walking or stretching, at least as long as the movement continues. It also known as Willis-Ekbom Disease (WED) and is a neurological disorder that affects up to 5% of the adult U.S. and European populations. Twice as many women as men are affected

by RLS. Some patients experience an early onset before the age of 45, usually in families with a history of RLS, and their symptoms progress gradually. Other patients experience the onset of RLS later in life, characterized by rapid development of severe symptoms.

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RLS can affect both your quality of sleep at night and well-being during the day. Many patients with moderate to severe primary RLS experience interrupted sleep that can cause poor sleep quality. This can lead to disrupted work and family life, moodiness, and feelings of tiredness or drowsiness during the day. Treatment options are designed to relieve your RLS symptoms so that you can wind down and get the rest you need.

According to the Agency for Healthcare Research and Quality (AHRQ), drugs recommended for RLS treatment include: Pramipexole, Ropinirole, Opiods and Gabapentin enacarbil, among others.3 While these drugs have shown an effectiveness for improving sleep in RLS patients, they also come with potential side effects. Some of the long-term side effects listed on their package inserts include:

1) excessive drowsiness without warning

2) impaired blood pressure regulation

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3) rebound, or worsening of RLS symptoms in the morning 4) augmentation, or earlier onset of symptoms in the evening 5) compulsive gambling and sex urges 6) and more Dr. Mark Buchfuhrer MD., medical adviser to the Southern California WED/RLS Support Group, sleep and RLS specialist and two-time member of the WED/RLS Foundation Medical Advisory Board, discusses non-drug RLS therapies as follows: “Currently, there are only a few non-drug treatments that may be helpful for treating RLS symptoms. The major focus of non-pharmacological therapy is to avoid drugs (antihistamines, antidepressants, anti-nausea drugs) and substances (alcohol, tobacco and caffeine) that tend to worsen RLS. Regular mild to moderate exercise and maintenance of bedtime habits and sleep patterns may be beneficial. Treatments

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such as biofeedback, acupuncture, chiropractic manipulation, neuromuscular stimulation (TENS device) and external counter pulsation devices may also be helpful but have not been proven as beneficial.�

In October 2014, a new device called Relaxis by Sensory Neurostimulation, Inc. was released to market. Relaxis is the only non-medication treatment cleared by the FDA for treating primary RLS-related problems. It is not intended for people who have secondary RLS caused by iron deficiency anemia, back pain, kidney failure, diabetes, peripheral neuropathy (numbness or tingling in hands or feet), or pregnancy. This vibration pad device requires a prescription and is designed to provide similar counter-stimulation relief to leg muscles as is achieved by walking around, exercising, massaging and/or moving your legs. It does so, however, without you having to leave your bed or create exertion that will keep you awake. The pad is simply placed beneath the leg(s) that are experiencing the attack and turned on. Based on a previously set intensity level, it will go through a 35 min-

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Doylestown Hospital ute cycle of counter-stimulation that ends with 5 minutes of gradual shutdown so as to not awaken you. Dr. Buchfuhrer concludes: “Relaxis presents a new option that does not involve medication to treat RLS symptoms…

The Relaxis device has been medically evaluated in scientific studies, which have demonstrated the device to be both effective and safe for improving sleep in patients with primary RLS.”

Pediatric Services

at Doylestown Hospital When you choose Pediatric Services at Doylestown Hospital, you can expect family-centered care in a compassionate and supportive environment.

Pediatric services include: • • • • • •

Pediatric Inpatient Unit Emergency Services Medical & Surgical Options Maternity & Neonatal Care Pediatric Diagnostics & Imaging Orthopedic Care & More!

Learn more about Pediatric Services at Doylestown Hospital, call 215.345.2121 or visit dh.org/pediatrics LA_Bucks Co Phy_Layout 1 12/10/14 11:49 AM Page 1

DH_PedServQtrAd.indd 1

What are your wishes for your end-of-life journey?

For additional information on RLS, contact the Willis-Ekbom Disease Foundation at: http://www.rls.org/.

Note sure if you have RLS? Take a 13-question survey at: https://www.willis-ekbom.org/wed-rls-diagnostictool. Information about Relaxis can be obtained at: www.myrelaxis.com.

12/11/14 7:43 AM

Let’s talk about it now.

We give you peace of mind by walking you through the important conversation about your future healthcare choices.

Michael Hanlon is Owner / President of Advanced Medical Homecare Supplies (AMHS) in West Chester, PA.

Footnotes: 1. 1685 Willis, T. The London practice of Physick. Instructions for curing the Watching evil. Published in London, by Bassett and Crooke; pp 402-407.

2. 1945 Ekbom KA. Restless legs a clinical study. Acta Med Scand.

158, (Supplement)1-222.

3. Aurora, R. N.; Kristo, D. A.; Bista, S. R.; Rowley, J. A.; Zak, R. S.; Casey, K. R.; Lamm, C. I.; Tracy, S. L., and Rosenberg, R. S. The treatment of restless legs syndrome and periodic limb movement disorder in adults--an update for 2012 practice parameters with an evidence-based systematic review and meta-analyses an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep. 2012 Aug; 35(8)1039-62.

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Lookin gAh e ad AC P.o rg • 267. 5 4 4 .95 8 0

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Commentary

Medical Marijuana

By Jon Shapiro, MD

A recent trip to the Federation of State Physician Health Programs Annual Conference, in Denver, highlighted some of the controversy surrounding the legalization of marijuana. It has raised several complex issues.

of the 1970s so adults are showing up in emergency rooms with anxiety and other symptoms of overdose.

There is also concern that candy and pastries laced with THC could be eaten accidentally by children.

I endorse the American Society of Addiction Medicine policy on medical marijuana. Marijuana is not a standardized product. It has not been adequately studied as a treatment for the many indications for which it is recommended. Also smoking is an unhealthy delivery system. In states with medical marijuana, physicians do not prescribe it in a specific fashion but rather give the patients a certificate that allows them to use any dose they choose.

Research with airline pilots has demonstrated that marijuana can reduce performance. Importantly test pilots were unaware of their own temporary impairment. Until safe levels of marijuana usage are determined, its use must be prohibited in people in critical positions. A zero tolerance policy should be advocated for transportation workers and health care workers.

There is some consensus in the medical field that marijuana is not good for growing brains. Studies have suggested stunted intellect and emotional growth in young people who use large amounts of marijuana on a regular basis. The use of cannabis, similar to the use of alcohol, should be restricted to adults.

The safe operation of motor vehicles is extremely important. Mothers Against Drunk Driving has been an exceptionally influential and informative group, no doubt saving countless lives on our highways. The correlation between blood THC level (the active chemical fraction of marijuana) and performance is quite complex. It is difficult to set a safe level of THC for driving or other critical functions.

In the addiction field we frequently refer to the common final chemical nature pathway of a variety of substances in the brain. People in recovery are advised to steer clear of all mood-altering substances, including marijuana, to avoid triggering urges and relapse.

Never forget the law of unintended consequences.

Colorado is reporting an increase in THC poisoning. The new marijuana is much stronger than the classic weed

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What is at issue for us here is not the public policy of legalization of marijuana but rather maintenance of public safety. Marijuana use should be disallowed for young people, for recovering addicts, and for those in whom we entrust our lives.

This article is the opinion of Jon Shapiro, MD, who serves as Physicians’ Health Programs medical director.

He can be reached at php-foundation@pamedsoc.org.

The PHP is a program of the Foundation of the Pennsylvania Medical Society that has restored careers, families, and confidence by helping more than 3,000 physicians seek and receive the recovery care that enables them to remain a vibrant part of the physician workforce.

Phone: Monday - Thursday, 7:30 a.m. to 5 p.m., 866-747-2255 (In PA only) or 717-558-7819 Friday–Emergencies Only– 7:30 a.m. to 5 p.m.: (717) 558-7817 Email: PHP-Foundation@PAMEDSOC.ORG

Address: Physicians’ Health Programs 777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820

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Feature

Assisting Patients and Families Using Advance Care Planning

by Veronica Coyne, MD Looking Ahead Advance Care Planning

When my 90-year-old grandmother suffered a stroke in 1956, our family doctor explained that she would not survive and gave us the option of sending her to the hospital or keeping her at home. My parents chose the latter course, and with the help of family and good neighbors we cared for her until she died six weeks later, surrounded by those she loved, no blood tests, x-rays or feeding tube.

In 2006, a 92-year-old blind and frail relative was found unresponsive by her daughter, who called 911. EMTs resuscitated her and took her to the emergency room.

When family arrived they found her intubated, attached to a ventilator and cardiac monitor, intravenous lines in both arms. After blood tests, x-rays and a CAT scan, the ER doctor explained that the patient had suffered a stroke, her kidneys were failing and her heart rate was too slow. The doctor presented all options for treatment, then asked the family how they wished to proceed. With no previous discussion or guidance from their mother

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and no primary care physician to provide advice, the five children disagreed about next steps. Their mother died a year later in a nursing home after multiple interventions, confused and unable to speak.

Neither of these women had a living will to guide medical professionals or the family. In the 50 years between these two incidents – both common occurrences for their time periods – we’ve had dramatic advances in medical treatment and technology and a subsequent rise in life expectancy. But it’s clear that those advances have not made the end-of-life passage easier for our patients and their families.

Doctor-patient shift The remarkable advances in medicine have been accompanied by increased complexity of medicine and fragmentation of medical care, the growth of consumerism, the rise in malpractice litigation and the federal Patient Self-Determination Act of 1990 – all of which

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have played a role in changing how doctors and patients relate to one another.

Where once physicians made most of the healthcare decisions, today the burden rests heavily on the patient and the family; often, even the primary care doctor is not involved when critical decisions are weighed.

Where are we now? As a primary care internist for 35 years with an interest in geriatrics, palliative care and hospice, I have experienced the intense dilemmas that clinicians face every day when making critical healthcare decisions. We wish to inform patients and families of treatment options and expected outcomes so they can make decisions, but how much medical knowledge can frightened, ill patients or grieving family members assimilate in a couple of bedside conversations? And leaving family discussions until a point of crisis means out-of-control emotions can interfere with careful consideration of the medical factors and the patient’s goals for treatment.

“The committee believes that a patient-centered, familyoriented approach to care near the end of life should be a national priority and that compassionate, affordable effective care is achievable.”

Advance directives, or living wills, are designed to address the challenges of choosing what medical technology to employ, and thereby easing the decision-making process. These legal documents are prepared and shared with family and medical professionals in advance of an illness or medical trauma, before fear, grief and pain compound the patient’s and family’s concerns.

However, few Americans have an advance directive in place, and too often those who do have not apprised the appropriate people of their existence.

Opening a door to communication A recent comprehensive report from the Institute of Medicine, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life1,” brings to light a crying need for open communication among healthcare professionals, patients and their families, especially regarding treatment in the final stages of life.

Clinicians as well as government agencies, insurers and social organizations are called to address how to utilize our technology and resources for the benefit of chronically ill and debilitated patients without causing increased pain and suffering. It also poses the question of how

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to assist family members who are trying desperately to provide care for a critically ill loved one in the face of job loss or bankruptcy.

Each one of us has the right to determine what medical treatment we wish to receive or reject. The time is right to revisit the subject of advance directives and help make them meaningful and useful tools for families and physicians to navigate the rough waters of critical healthcare decision-making.

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Fifteen years ago, Gundersen Health System in LaCrosse, Wisconsin, developed a process for advance care planning that initiates the conversation about an individual’s beliefs, goals and wishes for health care so that these can be shared with medical professionals and family members.

Looking Ahead ACP Gundersen’s highly regarded Respecting Choices® advance care planning program has spread beyond LaCrosse and is now promoted by medical societies in Wisconsin, Michigan and Minnesota as well as Canada, Australia and the European Union.

Here in Bucks County, a community service nonprofit organization modeled on the Respecting Choices program was established earlier this year. Looking Ahead Advance Care Planning uses one-on-one personal conversations led by trained counselors to guide individuals to an understanding of their healthcare options, reflect upon their own wishes for care, document decisions, discuss choices with family members and choose a durable healthcare power of attorney. The goal is to produce a legal document – the advance directive – that is flexible, usable and truly reflects the individual’s preferences and becomes part of their medical record.

The advance directive itself, however, is ineffective without open communication among family members and with healthcare providers. Looking Ahead’s facilitation process, which is an ancillary step in assuring that an individual’s wishes are documented, discussed and followed, does not replace the conversation that needs to occur between doctor and patient.

The challenge The Institute of Medicine report gives five strong recommendations directed toward government, insurers, educational institutions, professional societies and civic organizations. One of those recommendations is to promote advance healthcare planning: “The committee believes that a patient-centered, family-oriented ap-

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proach to care near the end of life should be a national priority and that compassionate, affordable effective care is achievable.”

As medical professionals, we have a challenge to meet.

Veronica M. Coyne, MD, a retired internist, served as medical director of Doylestown Hospital Hospice for 12 years. She is currently program director for Looking Ahead, a community service nonprofit advance care planning program that provides one-on-one conversations that result in clear communication of an individual’s wishes and objectives for health care near end of life.

LookingAheadACP.org 1

“Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life,” Institute of Medicine

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Community

We have a house!

The Village Improvement Assocation of Doylestown (VIA) is proud to announce it has chosen Villa d’Braccia, Chalfont, as the house for its 40th Bucks County Designer House & Gardens event. This 7,800 sf Mediterraneanstyled villa is set on four acres. Superior craftsmanship and top-quality materials are found throughout the home and will form the backdrop for extraordinary work by top area designers and landscapers. The heart-shaped driveway roundabout emphasizes the loving care with which this home was built.

About VIA-Doylestown

The VIA was the first Women’s Club established in Bucks County. The stated mission of the VIA is to enhance the quality of life in the community through service and education. Throughout the year, VIA committees work to fulfill the organization’s responsibilities to meet its mission, administer operations, maintain the James-Lorah Memorial Home and to explore mutual interests.

The VIA has grown in size and scope to its present membership of more than 350 women, many of whom are a Mark your calendars now to enjoy the fun and festivities vital presence at Doylestown Hospital. The VIA also overthat bring great benefit to residents of Doylestown and sees Pine Run Retirement Community. Today, the organithe Doylestown Hospital! zation’s efforts go beyond health services supporting the • Bucks County Designer House Empty House Party, local community. Additionally, it offers one-time grants to Sun, March 1, 2015, 2pm – 5pm community efforts and educational scholarships.

• Bucks County Designer House & Gardens The VIA is proud to call the James-Lorah Memorial Home Preview Gala, Fri, April 24, 2015, 6pm – 9pm at 132 North Main Street in Doylestown its headquarters.

The 17-room residence, its contents and a trust fund for • House & Gardens Tours, April 26 – May 30, 2015 maintenance were bequeathed to the organization in 1954 Sponsored by the VIA, the Designer House is a fundrais- by Sarah M. James, a charter member of the VIA.Today, the Federal-style building is listed on the National Register er for Doylestown Hospital and the mission of the VIA. of Historic Places.

To learn more about the VIA, visit the website at VIA-Doylestown.org.

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Practice Management

Collection Strategies Can Help Physician-Patient Relationship: Protect Bottom Line

By Carol Bishop, Associate Director of Practice Economics and Payer Relations, Pennsylvania Medical Society Collecting money from patients is one of those necessary things that few physicians or their staffs are comfortable doing. But, practices must have a good process in place to collect deductibles, co-payments, and co-insurances if they want to continue to offer quality health care.

When communicated clearly and respectfully to patients, these processes may also help avoid negative impacts on the physician-patient relationship and damage to the practice and/or physician’s reputation. Practices should take a step back and examine their current procedures — from how patients check in, to patient billing and collections.

Clearly Communicating Policies and Procedures With Patients The first steps in creating this process should include finding a reliable system for checking eligibility, accurately estimating the patient’s financial obligation, and reviewing the estimate with the patient prior to their appointment or when they check in. When a patient knows upfront what their financial obligation may be, they are more likely to pay all or some of what they owe at the time of service.

To ensure accuracy, it is absolutely vital that staff collects and enter demographic and insurance information correctly at time of check in. The best practice is to verify coverage and the applicable cost

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share amounts (i.e., co-payment, deductible, and co-insurance).

should include the insurance companies the practice participates with, policies for collecting co-payments, deductibles, co- insurances, as well as payments for non-covered services. Information should also include the practice’s process for filing claims, credit cards that are accepted, the process and timing for sending out patient statements, when payment is due, and the policy for turning balances over to a collection agency.

The Practice’s Bottom Line: Collection Strategies The bottom line: health care costs money. With payments from patient services poised to make up a larger and far more critical percentage of providers’ total revenue, bad debt can no longer be viewed as simply the cost of doing business. It now has the potential to damage your practice. Practices need to ensure that the policies and procedures are effectively used to prevent balances from becoming delinquent such as:

• Review financial policies annually, especially due to the ever-changing rules of private and public health insurance carriers.

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• Collecting payment

(e.g., co-payment, co- insurance, deductible) prior to services being provided

• Train the front office staff to double-check for

past due balances on the patient account and consider reminding the patients of such balance.

• Increasing the pace of collections to include reducing the number of days between when a bill is sent and when payment is due There is no better time to collect than when the patient is at the office. This will help to avoid wasting more time and money for billing patients later. Even if a patient is not able to pay in full, the opportunity for patients to pay a portion of their bill or set up a payment arrangement with automatic withdrawals is one that is becoming more prevalent.

Practices should also: • Implement a solid financial and billing policy that details expectations for charging, billing, and collection of accounts receivable.

• Educate patients, especially new patients, on their financial responsibilities and billing policies and procedures. This will encourage them to comply. Some examples are office brochures, welcome letters, and websites. The information Winter 2015 Bucks County

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Ensure that the office staff is fully knowledgeable of the policies and procedures, as well of any changes which may be made to the financial policy.

• Consider payment plans; patients may be more

inclined to make a payment or pay the balance if this option is available to them.

Hard to Collect Balances For those hard to collect balances, practices should stick to their protocols listed in their financial policy and procedure manual, such as phone calls, late payment notices, and the process for placing patients on payment plans. The practice’s physicians should also be fully aware of the financial policies and procedures because many times physicians want to know who may be sent to a collection agency.

Some practices find it very difficult to pursue patients who owe the practice money or who fail to pay their co-payments, deductibles, co-insurances, or past due balances at time of service. However, it is important to keep in mind that the physician has provided important services to the patient and deserves to be paid for such services. When the patient claims he

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or she cannot pay a balance, the practice should do their due diligence to work out a payment arrangement that is comfortable for both parties.

truly in difficult circumstances, the practice’s willingness to work with the patient will show patient loyalty and goodwill.

For those patients who simply refuse to pay their balance, this should be handled in accordance to the practice’s financial policy. All patients should understand that health care costs money. If the patient is

Find more tools, valuable information, and suggested strategies from the Pennsylvania Medical Society (PAMED) at www.pamedsoc.org/collections.

Is your heart in the right place?

Ashish M. Agarwal, MD Rim Al-Bezem, MD, FACC Kulpreet S. Barn, MD William E. Costanzo, MD, FACC, FACP Deirdre V. Donaghy, MD, FACC Ketan M. Gala, MD Steven M. Goldsmith, MD, FACC William S. Hirsch, DO, FACC Richard L. Hyman, MD, FACC, FASE Justin A. Karl, MD Alexander J. Koppel, MD Philip L. Lebovitz, MD, FACC Craig J. McMackin, MD, FACC Charles F Paraboschi, MD, FACC Jigar A. Patel, MD, FACC David N. Rosvold, MD, FACC Neil M. Rothstein, MD, PhD Steven A. Samuel, MD, FACC Paula S. Seth, MD, FACC Jerome M. Thomas, MD, FACC Keith R. Wolfson, MD, FACC

Interventional Cardiology

David W. Drucker, MD, FACC, FSCAI George P. Heyrich, MD, FACC, FSCAI, FSCCT Mark J. Soffer, MD, FACC Sunder Venkatesulu, MD, FACC Andreas Wolf, MD, FACC, FSCAI

Clinical Cardiac Electrophysiology Scott W. Burke, MD, FACC Rafael E. Pena, MD, FACC Michael J. Rozengarten, MD, FACC Eran S. Zacks, MD, FACC

Nurse Practitioners Linda Bartleson, NP Deborah Bob, NP Elaine Fidler, NP Marian Gelber, NP Louise Joyce, NP

Patient Liquidity at Time of Service Big New Problem for Providers, Insurers, Managed Care www.managedcaremag.com/archives/2014/3/patient-liquidity-time-service-big-new-problem-providers-insurers Higher Copayments and Deductibles Delay Medical Care, A Common Problem for Americans, Managed Care www.managedcaremag.com/ archives/1001/1001.downstream.html

Mercer Bucks Cardiology is dedicated to providing complete cardiovascular care to our patients in a community setting Clinical Cardiology

References: Collection Protocols for the Medical Practice, PAMED, www.pamedsoc.org/collectionprotocols

Hyun Jin Lee, NP Denise Max, NP Stacey Nieves, NP Nicole Szilvasi, NP Patricia Patrick, NP

Changing Your Thinking on Patient Collections, Medical Practice Insider www.medicalpracticeinsider.com/bestpractices/changing-your-thinking-patientcollections How to Clearly Communicate Patients’ Financial Obligations, Medical Practice Insider www.medicalpracticeinsider.com/bestpractices/how-clearly-communicate-patients-financial-obligations Paying a Visit to the Doctor: Current Financial Protections for Medicare Patients When Receiving Physician Services, Kaiser Family Foundation http://kff.org/medicare/issue-brief/payinga-visit-to-the-doctor-current-financialprotections-for-medicare-patients-whenreceiving-physician-services/

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Newtown, PA 215.860.3344 • Lawrenceville, NJ 609.895.1919 Robbinsville, NJ 609.890.6677 • The Arrhythmia Institute 215.741.5600 www.MercerBucksCardiology.com

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PA Med Year in Review

2014 Was a Very Good Year BY: Scot Chadwick As 2014 comes to a close, Pennsylvania Medical Society (PAMED) members can look back on a year of important advocacy successes, particularly in the area of public health. While initiatives related to opioids got most of the ink, there were several other significant legislative enactments that will benefit physicians and patients.

Let’s start with opioids, by now, you probably know that a statewide controlled substance database is on the way, courtesy of a bill signed into law in October. The system, which will help prescribers and dispensers identify scammers and doctor shoppers, is to be up and running by June 30, 2015.

And thanks to a collective effort by PAMED, the Department of Drug and Alcohol Programs, and a large group of interested stakeholders, we now have opioid prescribing guidelines, both for chronic, non-cancer pain and emergency room care. Dental prescribing guidelines have also been approved, and should be released soon.

Another key opioid measure went into effect on Nov. 29, allowing physicians to prescribe naloxone, an opioid antagonist that can reverse overdose symptoms, to first responders like police officers and firefighters, as well as to friends and family members of at-risk individuals. The new law also gives Good Samaritan immunity to those who aid individuals experiencing an overdose.

(partially edited)

regarding Lyme disease, along with an active tick collection, testing, surveillance and communication program.

PAMED scored a patient safety victory with the enactment of legislation that preserves the requirement that acupuncturists refer patients to a physician, dentist or podiatrist for a medical diagnosis after 60 days of treatment for any condition. The only exception will be for healthy individuals with no condition, who visit an acupuncturist as part of a wellness program.

Yet another public health success came with the enactment of legislation that will permit a public or private school to authorize trained school employees to provide an epinephrine auto-injector that meets the prescription on file for either an individual student or the school to a student who is authorized to self-administer an epinephrine auto-injector. The new law also allows trained school employees to administer an epinephrine auto-injector that meets the prescription on file for the school to a student that the employee in good faith believes to be having an anaphylactic reaction.

Physicians and CRNPs will be able to prescribe auto-injectors directly to the school for that purpose. You can imagine the value of this measure when a child is having an anaphylactic reaction and the school nurse is unavailable.

2014 also saw the enactment of several other valuable initiatives, including; Legislation creating the Patient-Centered 2014 was the year we achieved a ban on the use of Medical Home (PCMH) Advisory Council at the Department tanning salons by minors. The significant correlation of Human Services; A measure requiring hospitals to notify between melanoma and tanning salon use by minors patients of outpatient status after 24 hours;The repeal of an made this a high priority public health issue. outdated law requiring physicians to obtain informed consent from patients for treatment of breast disease; Legislation Another major public health issue in Pennsylvania is Lyme expanding newborn screening tests; and A law requiring disease. Several years of PAMED persistence paid divithe Department of Health to make available to health care dends this year with the enactment of legislation that will facilities printable publications that include information on the establish a task force at the Department of Health to make Centers for Disease Control and Prevention’s recommendarecommendations regarding a wide range of surveillance, tions that pregnant women, family members and caregivers prevention, information collecting, and education measures. of infants receive vaccination against pertussis.

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Quite a year, wasn’t it?

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Noteworthy

County Treasures The massive stone walls and warden’s house that make up the core of the Michener Art Museum today began as the Bucks County prison in 1884. After a century of use, the abandoned buildings and land were leased to house a new Museum.

After extensive renovation, the Museum opened in September 1988 as an independent, non-profit cultural institution dedicated to preserving, interpreting and exhibiting the art and cultural heritage of the Bucks County region. The museum is named for Doylestown’s most famous son, the Pulitzer-Prize winning writer and supporter of the arts who had first dreamed of a regional art museum in the early 1960s.

The Michener’s permanent collection comprises more than 3,000 objects that reveal the rich artistic culture and heritage of Bucks County and beyond. The museum is home to one of the finest collections of Pennsylvania

Impressionists paintings in public hands and a growing collection of American paintings, sculpture, works on paper, furniture and decorative arts.

The Michener will host a major installation of work by Auguste Rodin, which will be on view from February 28 through June 14, along with a small survey of top American sculptors who have been influenced by his themes.

If you’re in the mood, you may wish to join our special Rodin event, Ladies Night Out: An Evening in France, Friday, March 6, 2015, 6:30-9:30 pm, at Michener Art Museum. Space is limited but you can order tickets in advance.

Continued on page 29

Technology Solutions to Help Your Healthcare Organization Deliver Better Care Bucks County Medical Society members trust Stratix Systems to take care of their technology pains.

IT Support & Network Services

Document Management

Managed & Cloud IT Services

Printing & Imaging Systems

Learn more. Call (610) 374-1936 or visit www.stratixsystems.com.

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No one knows technology solutions like Stratix.

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Noteworthy Continued from page 28

Women will create a plaster over wire figure sculpture inspired by Rodin: The Human Experience – Selections from the Iris & B. Gerald Cantor Collection. A few French treats will be added to our usual array of refreshments.

C’est magnifique!

Women of all ages are welcome to attend these unique open-ended process oriented workshops, appropriate for beginners as well as experienced artists. Selfexpression, experimentation and all out fun are the focus of these gallery and studio events for women.

Simply bring your love of art, your sense of adventure, a spirit of creative camaraderie and a few friends. As always, refreshments are served. Class size is limited; so, please register early. This special event is sponsored

by Penn Management Group at Morgan Stanley For more information on exhibitions, programs, membership and support, visit MichenerArtMuseum.org or call 215.340.9800.

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Buck’s County Doctor Recognized Donald E. Parlee, MD, is the 2014 recipient of the R. William Alexander MD Award for outstanding political advocacy presented by the Pennsylvania Medical Society Political Action Committee.

Dr. Parlee, Past President and long time Secretary of Bucks County Medical Society, received the award at the Annual PAMED House of Delegates, held in Hershey, PA, on October 18, 2014. Dr. Parlee, a retired Radiologist from Doylestown, PA, stated that he was greatly honored to receive the award because he considered “Bill” Alexander to be both a close friend and a mentor.

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Health Awareness Monthly Calendar

January

March

• Cervical Cancer Screening For more information visit the National Cervical Cancer Coalition at www.nccc-online.org

• Mental Retardation Awareness For more information visit the ARC of the United States www.thearc.org

• National Blood Donor For more information visit the American Association of Blood Banks at www.aabb.org

• Trisomy Awareness For more information visit http://www.trisomy.org

• Glaucoma Awareness For more information visit www.preventblindness.org • Birth Defects Prevention For more information visit the March of Dimes at www.marchofdimes.com • Thyroid Awareness For more information visit the American Thyroid Association at www.thyroid.org •

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National Folic Acid Awareness For more information visit www.folicacidinfo.org National Radon Action For more information visit the U.S. Environmental Protection Agency www.epa.gov/radon/nram

February • Heart Health For more information visit the American Heart Association www.americanheart.org • Low Vision Awareness For more information visit www.preventblindness.org

• National Chronic Fatigue Syndrome Awareness National Chronic Fatigue Syndrome and Fibromyalgia Association www.ncfsfa.org • National Colorectal Cancer Awareness For more information visit the Cancer Research and Prevention Foundation www.preventcancer.org • National Eye Donor For more information visit the Eye Bank Association of America www.restoresight.org • National Kidney For more information visit the National Kidney Foundation www.kidney.org • American Red Cross For more information visit the American Red Cross www.redcross.org • National Multiple Sclerosis Education and Awareness Month For more information visit the Multiple Sclerosis Foundation http://www.msfocus.org/ national-ms-awareness-month.aspx

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• International Prenatal Infection Prevention For more information visit www.groupbstrepinternational.org

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Grand View Health Time to Make More Room at Home

The holidays present a great opportunity to clear out the old to make room for the new. Of course, it’s also a great time to think about those less fortunate as well. That’s why you may wish to think about the donating some of your unwanted or unused items to Grand View Health’s Recovery Room Thrift Shop.

Woman Donating Unwanted Items To Charity Shop Sponsored by the Grand View Hospital Auxiliary, The Recovery Room Thrift Shop offers quality items at affordable prices. All proceeds go to the Auxiliary’s annual gift to the hospital.

Why Donate?

• It’s a ‘Green’ Choice: Recycle your no longer needed items and make them available to others.

• It’s Tax Deductible: All donations are tax deductible (receipts available upon request).

• It Supports Grand View Hospital: All proceeds go to the Auxiliary’s annual gift to Grand View Hospital.

Why Choose Between Best Quality and Best Value?

St. Mary Delivers Both.

Where is the Thrift Shop Located?

Stump Farmhouse Rt. 309 & Lawn Avenue Sellersville, PA 18960 (Next to GVH Outpatient Center at Sellersville)

3 Named a Top 100 U.S. Hospital* by a leading health care analytics firm. Top 100 hospitals have better quality care, lower costs, and fewer complications, and save more lives.

When Is the Thrift Shop Open for Customers?

The shop’s hours are: Monday through Friday: 10 am to 4 pm Thursday: 10 am to 7 pm Saturday: 10 am to 2 pm

3 Greater Satisfaction by patients — consistently ranking in the top 5% overall nationwide

Before you donate, please review the list of items we are accepting and not accepting. If you have any questions, please call The Recovery Room Thrift Shop at 215-257-3703.

For a physician referral call 215.710.5888 www.StMaryHealthcare.org

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3 Winner of Best of Bucks Best Hospital award with more than 26,000 votes by Bucks County Courier Times readers 3 Most Preferred by patients — 5 times more than any other hospital in the region

3 Voted Jobs Now Best Places to Work award for best hospital and best employer overall – PA

*2014 100 Top Hospitals® award winner by Truven Health Analytics™

Healthcare

Wynton Marsalis

Yolanda Adams

Incognito

James Hunter Six

April 10-19, 2015 Reading, PA

Dave Koz

Terell Stafford

Spend 10 jazz- and blues-filled days and nights in the Greater Reading area!

Over 120 scheduled events, plus great shopping and dining in one area, make the 25th annual Boscov’s Berks Jazz Fest your perfect spring getaway.

For tickets, call Ticketmaster toll free at 1-800-745-3000 or visit www.ticketmaster.com to order online.

Boney James

Brian Culbertson

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

berksjazzfest.com * LINEUP AS OF 11/26/14.

SUBJECT TO CHANGE

PROUD SPONSOR OF THE BOSCOV’S BERKS JAZZ FEST

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