Central PA Medicine Spring 2016

g 2016 Sprin l

Your Community Resource For What’s Happening In Health Care

ura Inaugue Iss

Central PA

Official Publication of the Dauphin County Medical Society

COLON CANCER SCREENING

Can Save Your Life

VITAMIN

SUPPLEMENTS: Are They Useful?

PA S S I O N

OUTSIDE OF PRACTICE Artwork by David Yoder, MD

Central PA

{ Contents }

Spring 2016

Features 8

Vitamin Supplements: Are They Useful?

(717) 558-7849 • dauphincms.org

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5 Things New Patients Think Which Surprise Me

2016-2017

12

The New Member of the Surgical Team: The Patient

Dauphin County Medical Society 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105

DCMS BOARD OF DIRECTORS Mukul L. Parikh, MD President Robert A. Ettlinger, MD Immediate Past President Jaan E. Sidorov, MD President-Elect Heath B. Mackley, MD Vice President

Community, Health & Wellness 14

Colon Cancer Screening Can Save Your Life

16

Teen Dating Violence… and What You Need to Know

18

Joining Organized Medicine— A Medical Student’s Perspective

Shyam Sabat, MD Secretary-Treasurer

MEMBERS-AT-LARGE Lawrence L. Altaker, MD Bryan E. Anderson, MD Joseph F. Answine, MD Michael D. Bosak, MD Leonardo A. Geraci, DO

Practice Management 22

The Scope of the ‘Scope of Practice’ Issue

24

The Electronic Health Record: The EHR

27

Family Medicine Residents Embrace Population Health

Everett C. Hills, MD Andrew J. Richards, MD Andrew R. Walker, MD

EDITORIAL BOARD Heath B. Mackley, MD, Editor-in-chief Connie Benson, Editor Susan Neville, Executive Director Joseph F. Answine, MD Robert A. Ettlinger, MD Namath Hussain, MD Mukul L. Parikh, MD Serdar Ural, MD

The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals.

The placement of editorial opinions and paid advertising does not imply endorsement by the Dauphin County Medical Society.

All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.

In Every Issue From the Editor . . . . . . . . . . . . . . . . . . . . 4

Restaurant Review . . . . . . . . . . . . . . . . . 26

President’s Message . . . . . . . . . . . . . . . . 6

Legislative Updates. . . . . . . . . . . . . . . . 28

Passion Outside of Practice . . . . . . . . 20

DCMS News. . . . . . . . . . . . . . . . . . . . . . . 32

Central PA Medicine is published by Hoffmann Publishing Group, Inc., Reading, PA HoffmannPublishing.com | (610) 685.0914 FOR ADVERTISING INFO CONTACT: Kay Shuey, Kay@hoffpubs.com, (717) 454.9179 GRAPHIC DESIGNER: Brittany Fry

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From the Editor

Welcome to

Central PA Medicine!

T Heath Mackley, MD, FACRO

he members of the Dauphin County Medical Society (DCMS) are proud and excited to present to our community a resource for what’s happening in health care. The goal of our publication is to connect all of the physicians and patients of our area by providing engaging, educational content. This flows from our mission, which includes promoting and disseminating medical information to the members of the public and promoting collegial relations among our members. This is not new either. In 1866, when DCMS was founded, the mission included fostering partnerships between physicians and the communities they serve. Central PA Medicine is the latest chapter in this story that is celebrating its 150th anniversary!

Central PA Medicine Editor-in-chief

Building community starts at the core. Our center spread artwork for this issue is provided courtesy of one of our members, Dr. David Yoder. We hope to feature physicians sharing their passions outside of medicine in every issue. So all of you DCMS members out there, feel free to share what you enjoy doing in your free time! We’re also looking for timely articles that patients and physicians will find informative. This can include issues affecting public health, information about individual diseases or health promoting activities, “how-to” articles for our patients and colleagues to help navigate the health care maze, laws and regulations our state legislators are considering (or should consider), issues students and residents face, human-interest stories about the interesting activities or charitable work that our members are up to, or even healthy recipes you’d like to share.

Anything in the “universe of medicine” is fair game! Within our authorship, we’re hoping to be as diverse as possible, from retirees to first year medical students and everyone in between. That includes you!

If you’re one of our patients that picked up our magazine in a public place, welcome!

We want to give you information about health issues that you can use, but we also want you to know what health events and workshops are happening in your community. And by seeing what your physicians are involved in, it provides you with another dimension of their lives. We hope you enjoy it! facebook.com/dauphincms

Dauphin@pamedsoc.org

Dauphin County Medical Society 777 East Park Drive, PO Box 8820 Harrisburg, PA 17105

If you’re a member of DCMS but aren’t very involved yet, then this magazine is exactly what you need! We want you to see where your membership dues go, and how you can be a part of it. You can be involved in community outreach events, like Doc Talk, social activities like the President’s Dinner, or charitable activities through the DCMS Alliance or PA Medical Society Foundation. There’s something for everyone! And if you’re a physician or physician in training with some connection to Dauphin County and not currently a member, then this magazine is definitely what you need to see. Join us, you’ll be glad you did!

And please, give us feedback. Like us on Facebook www.facebook.com/dauphincms, email us Dauphin@pamedsoc.org, or pull out pen and paper and write us a letter. Our success will be measured by whether or not you find value in what we’re doing, so in areas where we need to improve, let us know. We want to make Central PA Medicine the best it can be!

4 Spring 2016 Central PA Medicine

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President’s Message

t is indeed a pleasure and privilege to write my very first President’s message in the inaugural issue of Central PA Medicine. Coincidentally, this also happens to be the 150th Anniversary of the Dauphin County Medical Society (DCMS) which was formed on February 20, 1866.

Organized medicine in Dauphin County has come a long way in the last 150 years.

To commemorate this milestone, we will insert some historical facts in other sections of our magazine titled “Did You Know” throughout the year.

Mukul Parikh, MD, DABA President, DCMS

Membership, as well as involvement in organized medicine, has waxed and waned over the course of our history and I sincerely hope that we are in the upswing at the county, state and national levels. The Pennsylvania Medical Society (PAMED) has been reinventing and reinvigorating its activities recently with fresh faces and new strategies for helping the physicians in the state. DCMS is working to be in lockstep with PAMED’s initiatives.

As the fourth largest county in terms of membership, we are proud to have contributed to the state and national societies in terms of leadership and many other facets. Please join/renew your membership for 2016 and help us become a strong representative of your interest in providing good quality patient care.

In our upcoming President’s Inaugural Dinner meeting to celebrate the history of DCMS, I would like to dedicate the theme to recognizing all the living past presidents and the history of DCMS which will include a brief presentation and display of some interesting documents from our past.

The event is set to occur on April 29, 2016.

Please plan on attending with your spouses and significant others. Wouldn’t an attendance of (at least) 150 be a wonderful gesture?

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Quick Q&A with Dr. Parikh 1.

2.

3.

4.

5.

What are your 2016 plans for the Dauphin County Medical Society as the new president?

I’m looking forward to celebrating the 150th anniversary of DCMS at the President’s Inaugural event where we will recognize all of the Past Presidents. Beyond that, I want to promote the unique history of DCMS through exhibits at various events. Also, as in prior years I would like to promote an increase in DCMS membership.

In your opinion, what are the two or three most pressing issues facing physicians in 2016?

The top three that come to mind are keeping up with the changing payment models and reporting of various performance measures; choosing between employment with a large health care entity or with an independent private practice; and negotiating with consolidating health care payers.

Why did you begin practicing medicine, and what do you like about your specific area of practice?

I began practicing medicine to help fellow human beings with compassionate care. As an anesthesiologist, I wanted to make the surgical experience as pleasant and painless as possible.

In your words, how can Dauphin County physicians become more involved in their communities?

DCMS physicians are already involved in their communities by providing health care education through public events like Doc Talk and Ask a Doc. In addition, we partner with other clinics like Hamilton Health in provision of free health screenings on designated weekends.

Any other thoughts you would like to include?

Physicians already contribute a lot to society through their medical practice by providing unpaid / underpaid medical care and involvement in community events. It’s commendable, but I think we are all capable of doing even more for our communities and globally.

Central PA Medicine Spring 2016 7

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Features

VITAMIN

SUPPLEMENTS: Are They Useful?

Robert Ettlinger, MD

t’s estimated that over half of Americans take some type of vitamin supplement.

Their reasons vary widely, based on personal longstanding beliefs, supportive scientific studies, and advice to do so from friends, family members and doctors. Does current scientific evidence support this multi-billion dollar industry? At the risk of getting a truckload of criticism, it’s starting to look like the answer is, no...I think.

Why exactly do so many people take vitamins?

Certainly, part of the answer stems from the many scientific studies pointing to their benefits, arguably starting with the revolutionary research of Linus Pauling. Pauling was an American chemist, biochemist, peace activist, author, and educator. He published more than 1,200 papers and books, of which about 850 dealt with scientific topics. He was rated the 16th most important scientist in history. In his later years he promoted orthomolecular medicine, megavitamin therapy, dietary supplements, and taking large doses of vitamin C. There have also been prevalent beliefs that if minimum daily requirements are important, then higher doses must be superior. While 8 Spring 2016 Central PA Medicine

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many people are aware that extra vitamins are rapidly lost through our elimination systems (we have the most expensive urine in the world), we tend to have faith that “flooding” the bloodstream with vitamins is better than getting small amounts.

you’d more likely conclude that the odds of flipping for heads is closer to 50%.

DCMS was founded on February 20, 1866.

So, just what do newer studies show about vitamins?

An important source of expert opinion is the United States Preventive Services Task Finally, many people are concerned about Force (USPSTF), a government-funded So, who should legitimately the nutritional adequacy of their diets, and scientific group dedicated to objectively be taking vitamins? view vitamins as a dietary insurance of sorts. advising issues related to health maintenance.

A few examples of scientifically supported After reviewing many studies, they recently recommendations include: Scientific Studies concluded that there was insufficient eviIn deciding what exactly to believe, let’s dence to claim that multivitamins prevented first look at how scientific studies are done, cardiovascular events or cancer, which are by 1 Vitamin B12 can be beneficial and how conclusive they are. One type of far the two largest categories of death causes above the age of 50, as that support for vitamins comes in the form of in our nation. Similar inconclusiveness was group does not separate dietary B12 from their food proteins testimonials such as, “I felt so much better found regarding single vitamin or paired as efficiently. since I started taking Acme brand vitamins.” vitamin supplements. Additionally, the This is the least convincing argument, as it is USPSTF specifically recommended against very subject to bias, chance, and suggestion. Vitamin E or Beta-carotene supplements 2 Vitamin D can be useful, to prefor the prevention of cardiovascular disease vent osteoporosis in older adults Related to this type of evidence are an- or cancer. and in those with low sunlight exposure. Of note, ecdotal studies, which rely on observations this benefit is lessened in made by multiple case studies. An example In the Iowa Women’s Health Study (pubthose without osteoporosis would be, “When over 1,000 patients took lished in the Archives of Internal Medicine in and at low risk of developing it.

Vitamin X at the start of colds or bronchitis, 2011), over 39,000 postmenopausal women over 80% of them got better within three were followed for as long as 22 years. The 3 Folic acid is strongly recomdays.” These types of studies are also of research showed that multiple regimens mended for women intending limited benefit, as they too inherently can (including multivitamins, Vitamin B6, to become pregnant. A Journal involve bias and subjective conclusions. folate, iron, magnesium, zinc and copper) of the American Medical Associhad slightly higher death rates than those ation study showed that women Better studies are termed “double-blind, who did not take vitamins. Only calcium who took 400 mcg of folate at placebo controlled.” These experiments supplements showed benefits. least a month before conception, compare a treatment to a placebo, so it can until at least eight weeks after be determined if the treatment triggers an A 10-year study of 14,000 men older than conception, delivered babies action statistically different than the placebo. 50 who took 400 IU of vitamin E and 500 with a lower incidence of brain and spinal birth defects, and Additionally, neither the testers nor the mg of Vitamin C daily (both higher than with a 40% lower rate of autism. test subjects know who is getting which the minimal daily requirements, but less treatment, so all patients are dealt with the than the upper limit advised by the institute same, which cuts down on potential bias. of Medicine of the National Academies) It’s hard not to have a healthy dose of In these studies, higher numbers of subjects showed no reduction in risk for major lead to more conclusive data. cardiovascular events, but an increased risk skepticism about all of this. Most of us have been ingrained throughout much of our of hemorrhagic stroke. lives to “take your vitamins.” Even if data Finally, a very conclusive (usually, but not always) way to evaluate treatments is Lastly, two other studies are noteworthy. about benefits is lacking overall, vitamins through a meta-analysis. In this type of In one study, reported by the Journal of are cheap, readily available, and the scientific test, multiple studies are compared to each the American Medical Association in 2012, data seems to change often enough to make other, to see if a majority of them seem to fish oil capsules did not lower risk of heart your head spin. Vitamins are also reasonably reach a similar conclusion. If you did two attacks, strokes or death. Regarding Vitamin harmless, when taken in lower doses. studies of a thousand coin flips to see how C, while a few studies have shown benefits You make the call. Personally, I’m going often heads came up, you might get rates of shortening the length of colds, the vast of 54% and 57%. However, if you did a majority of Vitamin C studies did not show to get my nutrients from food, until better evidence proves otherwise. few dozen such studies, and averaged them, this benefit.

Central PA Medicine Spring 2016 9

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Features

Things New Patients Think

Which Surprise Me David Lee Scher, MD

P

atients often enter a physician’s office with preconceived notions and all the parties involved are cognizant of one thing—time is limited. The patient is hoping his or her issue is addressed and the physician is hoping that the right information is provided. These desires are commonly not met by either side which poses the questions:

Should there be ‘sides’ to health care?

How did this inherently adversarial relationship develop before the parties have even met?

In a separate article posted on my blog (http://davidleescher.com/), I discuss the importance about navigating the health care system. I would like to outline here some observations I have made both in practice and as a caregiver for my mother on her initial office visit. They address my sensitivity to issues which are viewed by others who are resigned to a new status quo and accept them as part of health care. Perhaps digital health technologies facilitating communication among patients and providers will help in these regards.

10 Spring 2016 Central PA Medicine

1.

Patients view physicians answering their questions as a value-added service.

I am always amazed when a patient asks, “Is it okay if I ask a question?” To their amazement, my answer is, “This is what I am here for.” Every encounter is concluded by me asking, “Do you have any (or other) questions?” The look of satisfaction after that is the only thing I need to propel me to my next patient with a sense of satisfaction and purpose.

2.

Patients think they need to provide a diagnosis instead of seeking one.

I have heard countless patients seeking my help (either via referral by another physician or self-referred) say that they are sorry they don’t have a diagnosis for the complaints which have prompted their visit. My philosophy on this is that a patient is only responsible for describing symptoms. Most physicians are familiar with Sir William Osler, a great pioneer in medicine, who said, “Most times it is the patient who will furnish the diagnosis.” What he meant was that the patient’s narrative, NOT them stating a specific diagnosis,

would provide adequate information to make the said diagnosis. While it is not as easy today, given significant therapeutic implications not present in Osler’s time, the patient’s story remains critical to focusing future investigation and questioning. As the physician, I allow the patient to furnish the whole story without interruption. In cases where there is no specific diagnosis found for a non-serious condition, I emphasize that it is just as important in knowing what it ISN’T as what it is, and that it is not a denial of their symptoms. I encounter this often facing patients with palpitations.

3.

Patients smile when I tell them that I dispense medications and suggest tests on a minimal basis.

Most patients, contrary to many providers’ impression, do not seek or desire a pill, tests or procedures. Certainly they cannot be avoided in all circumstances. Initially, they want to know if the condition is (or is potentially) serious, and why each therapy, test, or procedure is prescribed. Explanations go a long way. Often communication with other providers (especially regarding side effects of medications prescribed by others) is critical. I tell patients that my goal is to decrease medication use, not increase it.

When I encounter relatively healthy 90-yearolds who are on minimal medications, I tell

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them that it is, in part for this reason, that they are doing relatively well. Ordering tests for defensive medicine purposes is largely unnecessary and many do not fall into accepted practice guidelines. Good patient relationships are fundamental to decreasing liability concerns. Minimizing interventions are both important in this regard and appreciated by patients as a sign that I am practicing patient advocacy.

4.

Patients are relieved when I acknowledge the importance and intent of caregivers.

Many patients are embarrassed when significant others or other caregivers accompany them to appointments to either ask questions, take notes or corroborate the narrative. I take time to dispel any doubt about the importance of that person. I first ask for the relationship of the person and if it is okay to share all of my thoughts with that person. The extent of caregiver support might very well affect the type of treatment plan I recommend or the need to contact that person to discuss the shared decision plan.

5.

Patients are surprised when I tell them that old age is not a diagnosis.

While many diseases are diseases of old age, a patient’s age itself is not a disease. Someone presenting with fatigue due to anemia should certainly not be written off as having ‘anemia of old age.’ I am not advocating exhaustive workup of elderly patients, I am merely stating that a discussion regarding shared treatment decisions needs to take place.

Discussions surrounding advanced directives should also include how far one would like to go in testing and therapeutic procedures.

This might not preclude an otherwise healthy elderly patient from undergoing a workup for a problem impairing quality of life.

David Lee Scher, MD, is Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in helping digital health technology companies, their partners and clients. As a cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he understood early on the challenges that the culture and landscape of healthcare present to the development and adoption of digital technologies. He is a well-respected thought leader in mobile and other digital health technologies. Scher lectures worldwide on relevant industry topics including the role of tech in Pharma, patient advocacy, standards for development and adoption, and impact on patients and healthcare systems from clinical, risk management, operational and marketing standpoints.

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Features

The New Member of the Surgical

THE PATIENT

Joseph F. Answine, MD

hen a patient is scheduled for a surgery, there is what is called a perioperative period. This is the time period that commonly includes admission, anesthesia, surgery, and recovery. Perioperative generally refers to the three phases of surgery: preoperative, intraoperative, and postoperative. The goal of perioperative care is to provide better conditions for patients before and after the operation.

Historically, patients were passive contributors to the perioperative process. They stopped eating and drinking, took their usual medications as instructed, and came to the hospital as ordered by the surgeon, anesthesiologist or hospital representative, then tried to understand the risks and hope for success.

As part of a protocol for enhanced recovery after surgery, which many hospitals are instituting, patients will become active participants in their own care.

12 Spring 2016 Central PA Medicine

Preoperative

In the first step, the entire journey through the perioperative period is described in detail in order to alleviate fear and anxiety for the patient and family. This includes an outline of what is expected of them when it comes to preparation and postoperative care. Additional requirements include: reading through materials about their upcoming hospitalization, watching videos, and communicating by phone or in person with an enhanced recovery specialist.

Any specialized postoperative care, such as stoma care after GI surgery, is part of the preoperative education as well. Patients are expected to maximize their health by getting better control of their hypertension and diabetes; smoking cessation; and controlling excessive alcohol consumption. They are encouraged to improve their nutrition status and exercise tolerance with a regimen constructed by a dietician and rehabilitation specialist. This is termed “prehabilitation.�

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“Perks” to these additional pre-surgical medications include no bowel preps and less drains, catheters and vein punctures.

Postoperative

After surgery, early hydration and nutrition by mouth, as well as early ambulation, replace the old days of no eating and liquid intake and extended bed rest. IV poles are set aside to allow for easier maneuverability.

Pain is now controlled utilizing a multimodal approach of regional blocks and non-narcotic- based medications given through an IV or by mouth. Narcotics are only used for breakthrough pain.

This is dramatically different than the current status quo, where a patient requests a narcotic every four hours or so while recovering in the hospital and at home, and experiencing the dreaded, but expected, side effects of disorientation, drowsiness, constipation, urinary retention and endless nausea.

In addition, rehabilitation specialists are involved as early as a few hours after surgery to implement an exercise program tailored for each individual patient and the surgical procedure that was performed.

Team: Prior to the procedure, the patient will also undergo preoperative testing. Moving away from “routine” studies, tests are ordered based on history, symptoms and the intended procedure by his or her primary care physician to identify any health issues, such as cardiac or pulmonary disease, that could and should be addressed prior to undergoing the stresses of surgery.

Preoperative fasting is liberalized to encourage the ingestion of clear liquids up to a few hours before surgery, especially carbohydrate-rich drinks, in order to avoid dehydration and nutritional imbalances. This obviously requires the patient to understand the nil per os (NPO) guidelines—which are more complex than just stopping all eating and drinking at midnight the night before.

Potentially, patients are given a regimen of additional medications to take prior to surgery, whether by mouth or injection, for pre-emptive analgesia and to reduce the risk of deep vein thrombosis.

Why the separation from a long history of patient passivity and “blind trust”?

Recent studies demonstrate that surgical care based on outdated studies or “habits” should be replaced by a data-driven, cooperative process—one that begins at the earliest identification of a surgical candidate and continues through to when a patient returns to normal daily activities. This protocol is based on extensive data and involves a diverse team of specialists working with the patient in a cohesive manner. Furthermore, educated patients who undergo a preoperative optimization program experiences less mental and metabolic stress-induced morbidity, experiences less overall complications, better pain control, shorter hospital stays, lower re-admission rates, and more satisfaction with their care.

So, to all our future patients, welcome to the team!

Joseph F. Answine, MD

• Partner, Riverside Anesthesia Associates, Harrisburg , PA • Staff Anesthesiologist, Pinnacle Health Hospitals, Harrisburg , PA • Clinical Associate Professor, Department of Anesthesiology, Pennsylvania State University Hospital, Hershey, PA

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Community, Health & Wellness

Karen K. Kormis, M.D., FACP, FACG

C

olorectal cancer is the third leading cause of cancer death in men and women in the U.S., with more than 140,000 adults diagnosed with colorectal cancer each year. Screening for colorectal cancer can help detect the disease at an early stage, when treatment is most likely to be successful. It’s estimated that 70% of all colon cancer cases could be prevented with early detection.

80% By 2018—Raising Awareness To Save Lives “80% by 2018” is a National Colorectal Cancer Roundtable initiative in which hundreds of organizations have committed to eliminating colorectal cancer and are working toward the goal of having 80% of adults aged 50 and older screened for colorectal cancer by 2018.

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“Screening by colonoscopy is the number one way to help prevent colon cancer,” explained Dr. Karen Kormis.

Who Should Be Screened?

“Colorectal cancer is a major public health problem, but many people aren’t getting tested because they don’t believe they are at risk. Sometimes their primary doctor hasn’t recommended it or they don’t understand what their testing options are,” said Dr. Carmen Guerra, President of the American Cancer Society East Central over the age of 50. The Division Board of Directors. “Those 50 and American Cancer Society, the older should talk with their doctor about National Cancer Institute and the Amerigetting screened for colon cancer and the can College of Gastroenterology endorse test that’s best for them.” screening for colorectal cancer beginning at age 50. There is strong evidence that Colon cancer, in particular, is a cancer appropriate screening significantly reduces found predominantly in men and women the risk of colon and rectal cancer.

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“Some patients may need to get screened earlier than age 50, if they have increased risk factors,” said Dr. Kormis. “Higher-risk patients include those who have a family history of colon cancer or polyps or if they have a personal history of colon polyps or inflammatory bowel disease.

“There are a number of screening tests that can be done,” Dr. Kormis explained. “A colonoscopy, done by a gastroenterologist, is considered the ‘gold standard’ for colon cancer screening for a number of reasons. It not only allows us to closely evaluate the colon, but we can also remove any polyps that are detected at the same time as the screening. This prevents those polyps from developing into colon cancer, which in turn dramatically decreases the patient’s risk of developing colon cancer.”

According to the

we will be mailing colon cancer screening information to them during March,” said Dr. Kormis. “We hope that doctors throughout Central PA will partner with us in our efforts to increase the number of people who get screened for colon cancer.”

Another barrier to screening was the cost.

Thanks to changes in insurance coverage with the passage of the Affordable Care Act, screening colonoscopies are now fully covered by Medicare and many insurance plans for people who are over 50. There are also more people who are now able to get insurance, offering them access to medical tests that they may not have had previously.

Learn More Today Take a moment during National Colon Cancer Awareness Month to learn more about colon cancer symptoms, the preventive colonoscopy screening procedure and how you can get screened. Look for detailed colonoscopy information sheets at www.

PAGIconsultants.com or visit the American Cancer Society’s website, www.cancer.org.

ABOUT THE AUTHOR Dr. Karen K. Kormis, M.D., FACP, FACG, is board certified in Gastroenterology & Internal Medicine and works for PA GI Consultants.

Dr. Kormis is a graduate of Hahnemann School of Medicine in Philadelphia, PA. She completed her residency at the University of Connecticut Hospital and its affiliates. She completed her Gastroenterology Fellowship at the University of Connecticut Medical School.

Dr. Kormis treats all types of digestive disorders and has a special interest in patients with irritable bowel syndrome and inflammatory bowel diseases. Much of her work centers on helping patients manage chronic conditions to improve their overall health and quality of life.

She has been caring for PA GI patients since 1996.

National Colorectal Cancer Roundtable, about 1 in 3 adults between 50 and 75 years old — ABOUT 23 MILLION PEOPLE —are not getting tested as recommended.

Removing Barriers To Screening One of the findings of the National Colorectal Cancer Roundtable was that patients weren’t getting screened because their primary care doctor was not suggesting it.

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Community, Health & Wellness

TEEN DATING VIOLENCE...

and What You Need to Know Brandi Gift

A

mong the many concerns that parents have for their teens, 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.

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.

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 16 Spring 2016 Central PA Medicine

“If your teen discloses that they have experienced dating abuse, assure them that you believe them and that the abuse is not their fault,” says Kwee.

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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.

So what can you do to safely help your child? Meara Dietrick Kwee, Prevention Education Specialist at YWCA of Greater Harrisburg, believes that parents play an important role in responding to teen dating violence by talking with their children about

healthy relationships. Here are a few key steps that she recommended parents take when helping a child 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. Encourage 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.

Call the YWCA Greater Harrisburg’s 24/7 hotline at 1-800-654-1211 to learn about options and services.

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Community, Health & Wellness

Joining Organized Medicine—

{A Medical Student’s Perspective } Michael Skolka MSII, Penn State Hershey

s president of Penn State Hershey’s student chapter of the American Medical Association (AMA), I am often asked by my fellow medical students why they should join. My answer is largely based on my personal experience in discovering what I appreciate about organized medicine.

This article is about that story and ultimately my answer to that question.

Association” sounds impressive, but in reality, I didn’t know what the organization actually did. Fortunately, they were hosting a lunch lecture the following week, so I signed up to learn more about it. Plus, the guest speaker was providing boxed lunches from Panera Bread! After surviving on a student’s diet of mainly hot pockets and noodles, a nice lunch made the meeting worth it.

I began my medical education at Hershey in July 2014, and like most first-year students, even though I fully believed I was prepared for medical school, I was clueless.

Learning how to manage the firehose of information was intense. Physicians, once friendly faces who saw me as their patient, were now my instructors and quite honestly, a little intimidating. Those first few months required some adjustment.

The speaker was a medical student from Johns Hopkins, and she was very enthusiastic.

What stood out to me the most, however, was that this young adult was heavily involved in an organization I previously assumed was run by old white coats. Hearing all of the opportunities available for student input, advocacy, and involvement in hot-topic health care issues sparked an interest inside of me. I wanted to join and that evening I signed up to be part of the AMA.

Luckily, I was not alone as 149 other first-year students were having the same experience. I am grateful for Penn State because they provided an orientation schedule to ease us through the transition. For example, about a week or two into medical school, all the clubs and organizations held an activity fair for incoming students. I remember attending, eager to see what social activities were available that would pull me out of my biochemistry books. This fair is where I first encountered the AMA. Of course, I recognized the AMA mostly by their name. The “American Medical 18 Spring 2016 Central PA Medicine

Over the following months, I became increasingly involved in our school’s chapter.

Specifically, I heard that the Dauphin County Medical Society’s (DCMS) board was looking for a medical student representative. My chapter selected me for this local position, and when I walked into the room of my first meeting, I was greeted by all of the physicians—some of whom I recognized from medical school classes at Hershey. We had dinner, discussed the health care topics on the agenda, and made plans for future

meetings. To the individuals at the meeting, my opinion sincerely mattered, and while this story may sound simple, I felt a deep sense of connection and camaraderie. At that moment, I understood that I personally like organized medicine for the sense of community it can provide.

Moving beyond the four walls of my medical school into a larger community was a worthwhile experience. By hearing from retired physicians, attending physicians, and residents, I viewed hot-button issues like medical marijuana and student debt in a new light. Plus for me, the break from the didactic atmosphere of medical school was refreshing.

Although I discovered my niche based on this experience, every medical student is different.

There are other medical students at Penn State who find that organized medicine connects them with other students across the nation, which is what they value. I know of some students who value these organizations because they are passionate about voicing their opinions on health care topics that will shape future medical practice. Whatever the passion or “thing” that drives you may be, there is typically a place or avenue to get involved.

This, along with my story, is the answer I give when my colleagues ask me why they should join organized medicine.

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Passion Outside of Practice It’s our pleasure to highlight a Dauphin County Medical Society member’s “passion outside of practice” in each issue of Central PA Medicine. Beyond their commitment to health care, DCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature the artwork of David Yoder, MD.

POUTSIDE A S OF S PRACTICE ION Artwork of David Yoder, MD How did you develop an interest in your passion outside of practice?

I have always enjoyed drawing from an early age, mostly doodling as a child. It wasn’t until my senior year in college, however, that I took a formal class in drawing. I initially took the course in the hopes of an escape from my more structured biology major as

a way to vent my creative side. Far from the escape I was looking for, I found the class very challenging (even more so than some of my science courses) but ultimately very rewarding.

My assignments forced me to concentrate on seeing the world in a different way than I had ever before, enveloping me for hours at a time with only my pencil and eraser.

Girl with the Red Umbrella

Girl on Windy Day

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After my class was over, I wanted to explore other mediums of art. After experimenting briefly with acrylics (which dried too fast for my taste) I decided to take an oil painting workshop. I fell in love with how much there was to learn about the subject…composition, color theory, even the chemistry of the paints and supports themselves. I remember

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spending most of my free time in the last semester of my senior year often at my easel, experimenting with the medium.

Most of my initial projects didn’t turn out anywhere close to what I had initially imagined, sometimes falling apart altogether, but occasionally I would improve upon the last piece, learning something new every time. Unfortunately, my frenzied experiment came to an abrupt end once the demands of medical school became too much for me to seriously explore my new-found hobby.

My early paintings hung on my apartment wall as I essentially took a six-year hiatus, not picking up a paintbrush again until my last year of internal medicine residency in the spring of 2014. Perhaps to avoid the loneliness of hours apart from my then fiancée, I wiped the dust off my easel and got back to work. It was as if I had awakened a part of my brain that had laid dormant for those six years. I again became immersed in the magic of the creative process. I have been painting since that time, mostly learning through free YouTube videos online which allows me the flexibility I need to pursue my hobby. I currently am a Hospitalist for Penn State Hershey Medical Center, working 7 days on/7 days off schedule which allows me the luxury of being able to pursue my hobby with my weeks off.

How long have you been doing it?

I have been drawing since I was a child, but not formally until senior year of college.

I picked up oil painting at that same time, but for six years in medical school and residency did not have much time. I have been painting now more consistently for the past two years and plan to make it a life pursuit.

What makes it special to you?

I really enjoy the idea that oil painting is a very traditional craft that has been practiced and developed upon over several centuries.

Whenever I pick up a paintbrush, I feel I am participating in this craft much like an apprentice of the old masters, albeit in the

very beginning stages of learning the art. I’m constantly looking to painters like Titian, Rembrandt, Sargent, and Bouguereau for inspiration. Painting has given me a better appreciation for these and other artists, and has made visits to an art museum that much more exciting. Learning how to paint is possibly one of the hardest pursuits I’ve taken in my life, and I love the challenge of emulating these old masters. I think most of all I enjoy the sense of accomplishment in having finished a painting and the ability to hang it on the wall to share with others. I also enjoy looking back at my older pieces and seeing how far I’ve come already, anticipating that if I keep at it, I will only continue to improve in the future.

About the Artist:

David Yoder grew up and has always considered York, PA his home. He obtained a dual degree in both biology and history from the University of Pittsburgh before going to Penn State Hershey for medical school. He trained at the University of Maryland Medical Center as an internal medicine resident before returning to the Hershey Medical Center for his current position as a hospitalist. His passions include oil painting, history (with a particular interest in early modern European history), and traveling abroad during his time off.

He stays active playing golf during the summer and skiing in the winter months. He had at one time lived in London working as an intern at King’s College Hospital, volunteered at a medical mission in Haiti, and donated his bone marrow as a part of ‘Be the Match’ program. He also has an elementary understanding of Mandarin Chinese. During medical school he met his beautiful wife Nancy Khov who is currently a gastroenterology fellow at Hershey Medical Center and says, “She is the most kind-hearted and courageous person I know.”

Treason

Ice Skating at Natural History Museum, London

Apples Central PA Medicine Spring 2016 21

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Practice Management

Heath Mackley, MD, FACRO

n Oct. 22, the Pennsylvania House Professional Licensure Committee received testimony on HB 765, a bill that would grant certified registered nurse practitioners (CRNPs) an unrestricted license to practice medicine in the commonwealth. The Pennsylvania Medical Society (PAMED) was well represented, not only by then-President Karen Rizzo’s expert testimony, but also by dozens of physicians from near and far who showed up in their white coats. There were so many that everyone attending couldn’t be accommodated in the room!

The message of PAMED was articulate and compelling, and can be found in their “Keep the Team” campaign materials.

2.

The education and training of CRNPs falls significantly short of the education and training of a physician.

3.

Current licensing standards serve an especially important function in supporting critical safety and quality objectives. For these reasons and more, the majority of states still require a physician’s collaboration or supervision in order to practice.

The chief arguments of those in favor of the bill were also taken on with hard facts:

1.

The collaborative requirement between CRNPs and physician supervisors enhances, rather than impedes, the ability of CRNPs to deliver quality patient care.

2.

Granting unrestricted licenses does not significantly improve access in rural and underserved areas.

They include:

1.

The best and most effective care occurs when a team of health care professionals with complementary, not interchangeable, skills work together.

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3.

Ultimately, underserved areas need more physicians, and increasing the responsibility of CRNPs does not help that.

This debate over who should be allowed to practice medicine has been going on in America since medical licensing laws were instituted in the American colonies. During the 1800s, most of the laws were abolished, leading to the legal equality between “allopathic physicians” and “non-traditional physicians” of that time, such as homeopaths and eclectics. This also led to a proliferation of medical schools, many private and forprofit, of various quality and enrollment standards. The AMA, with its state-level partners such as PAMED, lobbied for the reintroduction of medical licensing laws with standardized testing for individual physician candidates and national accreditation of medical schools. Although there is clearly a public interest behind these measures for public health and safety, and in support of

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a consumers’ right-to-know, it would be easy for a cynic to view this as a monopolistic tactic with self-interest at heart. But history tells us a different story. Doctors of Osteopathic Medicine (DOs) became viewed as equal to Medical Doctors (MDs) when both sides could agree on the criteria for accreditation of medical schools, residencies, and medical licensure. Other philosophies of medicine, such as homeopathy, are not illegal.

Patients can receive counseling and advice from those practitioners. So what does this history say to CRNPs, or naturopaths, or anyone else? If you create schools, tests, and post-graduate programs that are similar to what MDs and DOs currently have, we can work with you. If not, you do not have our support to practice medicine independently.

That being said, the debate, then and now, will always be influenced by economics.

Large health systems have trouble filling the primary care “provider” (their word, not mine) positions they have, and hiring CRNPs for those positions might be easier if out-of-state CRNPs are attracted by an unrestricted license, but it will certainly improve their bottom line for multiple reasons. CRNPs command a lower salary than physicians, and there is an added administrative cost to documenting the collaborative agreements. However, CRNPs also order more tests and make more specialist referrals than primary care physicians, which increases corporate revenue, at the expense of global health costs. Mike Young, CEO of Pinnacle Health, while speaking in favor of the CRNP bill, bemoaned his institution’s inability to hire primary care physicians.

This is a real problem, one that can’t be fixed with a sound bite. But if he believes that giving CRNP’s an unrestricted license is going to improve his institution’s ability to provide primary care, why not allow Pinnacle to also hire MDs from unaccredited foreign schools that can’t pass the United States Medical Licensing Exam (USMLE)? Wouldn’t that be a good idea too? If CRNPs aren’t expected to pass

the USMLE or train in a residency, why should anyone be required to do so?

Medicine will always be delivered by a team, with the majority of the care being delivered to one individual patient at a time. PAMED feels that a physician, the most highly trained professional, should be the leader of the team. There are other alternatives. Mr. Young, near the beginning of his testimony, said, “I’ve heard a great deal of discussion today about who should lead the health care team. With all due respect, according to the Joint Commission and the Department of Health, <sic> the doctors and the nurse practitioners in this room, I, as CEO of Pinnacle Health, I lead the team.”

No one would argue that corporations do not need effective managers, or that firms that engage in health care are not businesses with

Dr. George Laverty was appointed as historian for DCMS in 1954.

bottom lines. But that isn’t what practicing medicine is. Practicing medicine is seeing a patient, diagnosing an illness, and prescribing a treatment based on scientific principles.

Managers don’t do that. Physicians do.

PAMED will continue to advocate to keep it that way.

Dr. Mackley is a Radiation Oncologist at the Penn State Hershey Cancer Institute and 5th District Trustee, representing physicians of this county.

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Practice Management

The Electronic Health Record: The E H R Patrick F. McSharry, MD, MBA, CHC-QM, Member AMIA

Some Frequently Asked Questions (FAQs) 1. What is an Electronic Health Record (EHR)?

An EHR is a systematic collection of health information about an individual patient or population. (Gunter Tracy D, 2005) The EHR differs from an Electronic Medical Record (EMR) in that the former is specifically designed to be shared across different health care settings.

2. Are EHRs catching on?

Yes! In fact in 2013, a large majority (78%) of Office Based Physicians (OBPs) in the United States used some form of an EHR/EMR. In 2001 that number was only 18%. (National Center for Health Statistics (NCHS), 2014)

3. What are the reasons for the high uptake of the EHR in the USA? There are many reasons for the high uptake. However, a very significant 24 Spring 2016 Central PA Medicine

incentive is the Health Information and Technology for Economic and 4. How important is HITECH? Clinical Health (HITECH) Act of 2009.

HITECH is part of the very extensive The NCHS study of January 2014 piece of legislation called the American studied this question in some detail.

Recovery and Reinvestment Act of Their main question was, ‘what kind of 2009 which was passed in the wake of increase in usage could be attributed the 2008 economic fiscal crisis. Within to the “Certified EHR” required by the HITECH there are various incentives administration rules and regulations (and penalties) for health care providers that were formulated to ensure comto integrate a “certified EHR” into their pliance with the HITECH legislation office-based practice. passed in 2009?’

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They found that 11% of OBP’s practices in 2006 were using an EHR which would have been worthy of certification, whereas by 2013 that number had risen to 48%. (NCHS, 2014)

scheduling and other practice man- The hope of the organization that agement tools to quality management is sponsoring the development of metrics and programs such as NCQA these PPRNs is that there “will be a and HEDIS Measures, PQRS and “Mean- paradigm shift that powerfully expands ingful Use” incentives offered by health the current limited role of the patient care insurers and government agencies. and their caregiver in clinical research, participation and decision making.”

This organization, Informartics Branch 5. Who decides what’s PCORnet, is also concerned and in8. If the EHR can be shared volved with the development of CDRDs. “certified” and what’s not? over multiple platforms PCORnet is in turn a part of Patient across multiple instituThe Office of the National CoordinaCentered Outcome Research Institute tions (as opposed to the tor for Health Information Technology, (PCORI). (PCORnet PPRM consortium limited sharing of the or as it is more often called the ONC. et al, 2014) EMR), is this actually being done and where?

The ONC has required that physicians and other health care providers who A good example is the Great Plains wish to participate in an EHR incentive program, such as the one offered by Collaborative (GPC). The GNC brings 10. Who is PCORI? the Centers for Medicare and Medic- together 10 million covered lives and PCORI is a national organization that aid (CMS), should use an EHR system encompasses over 20 hospitals, 700 has established PCORnet which is a and modules that are on the Certified clinical locations and 800 providers. major initiative to support an effective Health IT Product List (CCHPL) which is This type of large network is called a sustainable national research infraa list maintained on the ONC website.

In January of 2011, the ONC issued a Clinical Data Research Network or CDRN. structure that will advance the use of the EHR in Comparative Effectiveness final rule to establish the Permanent These networks are based on the Research (CER).

Certification Program (PCP) for health EHR and other electronic sources information technology. covering large populations who are The support of the PCORI has enreceiving healthcare with integrated sured already that $93.5 million has and networked health care delivery been awarded to support 29 Health systems. (Florence, 2014) Research Neworms (11 CDRNs and 18 6. Were there other agencies involved in formulating the PPRNs) like the GLC described earlier. standards for certification (Waltman, 2014) of an EHR? 9. What is being done and Yes. In collaboration with the ONC, what is the purpose of this the National Institute of Standards sharing of data?

If there are requests for further and Technology (NIST) developed the analysis and discussion of any issues functional and conformance testing In the case of the GPC and other raised by this article , I would be requirements, the test cases and test CDRNs, the primary purpose of sharing tools to support the Health IT Certifi- this vast amount of data is to increase glad to discuss further any inquiries cation Program. the speed, efficiency and relevance of or comments sent to the editor, clinical research in the United States. cbenson@pamedsoc.org.

7. So how is an EHR going to help my patient?

There are many practical applications of an EHR that can help us manage our patients better. They range from

There is another type of network called Patient Powered Research Network or PPRN. PPRNs are networks operated and governed by patients and advocacy organizations and usually assisted by a clinical research partner.

They are a relatively new concept.

These measures and incentives are quite complex and cannot be covered adequately in this initial contribution to this publication.

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Restaurant Review

Three Physicians Share A Passion

For Cuban Cuisine Robert Ettlinger, MD

ot all that long ago, the culinary landscape of Central PA was pretty, shall we say, “All-American.” These days, we’re fortunate to have restaurants featuring dozens of food choices from around the world. This past year, another brushstroke has been added to the scene, with the addition of the area’s first Cuban dining establishment with the nearest of its kind located as far away as Philadelphia and Washington, D.C. Los Tres Cubanos at 540 Race Street in Harrisburg has arrived at the Shipoke site of the former Char’s Bella Mundo. This welcome addition is the passion of three local physicians, Jose Mises, Al Leal, and Jose Manjon, all of whom are having fun branching out from their medical careers. All three have Cuban roots, with Dr. Manjon being the managing partner, and his wife, Pat, serving as maître d’. Since their move to the area from New Jersey many years ago, the Manjons have had their hands in several dining endeavors, and have found their calling with this latest project.

The dining room is tastefully remodeled to make one feel as if they are spending a sultry evening in Havana. The beautiful wooden bar area was transferred from Pittsburgh, and the walls are adorned with dozens of photos and paintings that celebrate the rich culture of our neighbors to the south. Arranged in clusters, they depict Cuban hero Jose Marti, author Ernest Hemingway, Cuban architecture, cars, and photos of the owners

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and their families.

Expansion of the second floor to a banquet room is being planned, which might be necessary given the regular crowds that the restaurant has attracted.

The food and service were terrific, with pleasing tastes and presentation, reasonable prices, and ample portions. (My apologies to those who disagree, but I’m not happy about places that serve courses requiring a magnifying glass to find the food on the plate.) On two occasions there, Pat Manjon and our delightful server, Dina, were knowledgeable and helpful in describing the unique cuisine of Cuba.

Appetizers included vegetable empanadas on a bed of cabbage, ceviche (shrimp and bay scallops with plantain chips), and ensalata de aguacate (delicate greens with a perfect avocado, in a light red wine vinaigrette).

The entrees were appetizing, with sides of rice served as attractive pyramids. The overall seasoning fortunately lacks the biting heat of food from other Caribbean lands,

reminding me of the cuisine of Puerto Rico. Many of the dishes feature plantains, served either as tostones (earthy and salty) or as maduros (soft and sweet). Highlights of the dozen or so options on the menu include lechon asado (slow roasted pork shoulder marinated in mojo), ropa vilea (shredded brisket in a tangy base of olives, garlic and bell pepper), anes relleno (roasted red bell pepper stuffed with yellow rice, onion, peas and crimini mushrooms, served over a black bean puree), and croquettes (ham or chicken, served with fresh lime wedges).

Save room for dessert; you’ll be glad you did! Choices included pastelito (warm guava and cream cheese in a puff pastry), arroz con leche (rice pudding with cinnamon, vanilla and dark raisins), and tres leches (three milk cake topped with whipped cream). Pair any of them with a hot cup of BonBon (Café Cubano with sweetened condensed milk).

Already popular in its rookie year, only a flood can stop Los Tres Cubanos from continued success!

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Practice Management

Family Medicine Residents Embrace Population Health Jason R. Woloski, MD

esidency can be a challenging time, complicated by long hours, struggles with work/life balance, specialty board preparation, and attempts to adjust to a busy life as a physician.

However, despite these many hurdles, resident physicians at all times must be ready to face the needs of both their patients and the community they serve.

Population health is often defined as “the health outcomes of a group of individuals.” As one might therefore expect, the family physician, by providing comprehensive care to patients and families, is uniquely positioned to explore population health at a deeper level.

the group at the adult daycare, singing a song with the students in the early intervention classroom, or counseling patients at Alder Health about sexually transmitted infections, my own population health engagement visits have made me a more informed individual and an enriched community provider. Physicians can become leaders of change within Dauphin County, and I am excited to be a patient advocate within the community.

Jason R. Woloski, MD

• Chief Administrative Resident, Penn State Hershey Family Medicine Residency • Member, Pennsylvania Academy of Family Physicians Board of Directors

During the past few years, the Penn State Hershey Family Medicine residents have increased efforts toward population health initiatives.

Beginning in the intern year of residency, the family medicine resident completes a series of longitudinal population health experiences.

In addition to didactics, community site visits are completed to increase awareness of community resources. These site visits range from meeting with workers at the Hershey Chocolate Company to interactions at Alder Health Services, the Interfaith Shelter for Homeless Families, and Adult Day Care Centers. Following intern year, residents then embark on a personalized initiative and partnership with a community organization.

Personally, I have had the pleasure to begin working with the Alzheimer’s Association, serving as both an advocate and a guest speaker at support groups. It is well known that physicians at times find great difficulty in addressing end-of-life care and treatment of patients with incurable diseases. My interest in the Alzheimer’s Association stems from the loss of my grandmother to Alzheimer’s back in 2008. Alzheimer’s has been cited as the only one of the top 10 causes of death which cannot be slowed, cured, or prevented. It affects the entire family, not just the patient involved. Working with the family and individuals affected assist me with carrying out my duties as a true “family” physician. Through increased awareness and referral to services provided by the Alzheimer’s Association, I hope to make this unfortunate disease more manageable for my patients and their families.

Community engagement is one way every physician can help contribute to the elimination of health disparities. Whether it is meeting with families at the homeless shelter and learning about their struggles to secure employment, enjoying “coffee hour” with Central PA Medicine Spring 2016 27

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Legislative Updates

Pennsylvania Medical Society Quarterly Legislative Update December 2015

O

n December 29, 2015, Governor Wolf signed a partial $23.4 billion budget for 2015â&#x20AC;&#x201C;2016, selectively vetoing portions of the $30-plus billion spending plan that the General Assembly sent him a week prior. The partial budget released some much-needed funding to schools and social service agencies, and a number of programs of interest to physicians.

Included in the enacted budget was $4.671 million in funding for the Primary Care Practitioner Program, the umbrella program under the Department of Health which provides educational loan repayment for physicians and residency programs.

Funding was also released for the stateâ&#x20AC;&#x2122;s new prescription monitoring program, known as ABC-MAP (Achieving Better Care by Monitoring All Prescriptions), which is expected to be up and running later in 2016. The Pennsylvania Health Care Cost Containment Council, or PHC4, received a $2.71 million appropriation, equal to the previous year.

The legislature has yet to reach final agreement on the remaining budget items that the Governor reduced or vetoed. The 28 Spring 2016 Central PA Medicine

line-item veto included funding for several health care related items, such as regional cancer institutes, diabetes programs, regional poison control centers, and Medical Assistance critical access hospitals, hospital-based burn centers, and obstetrics and neonatal services, among others.

In the midst of the ongoing budget standoff, there have also been developments on a few measures of importance to physicians and patients over the last few months. Below are a few highlights on that legislative activity.

Public Hearing Held on CRNP Independent Licensure

Last October, the House Professional Licensure Committee held a public hearing on House Bill 765, sponsored by Rep. Jesse Topper (R-Bedford County). HB 765 would allow Certified Registered Nurse Practitioners (CRNPs) to practice independently and eliminate the current requirement that

CRNPs have a collaborative agreement with a physician in order to diagnose, treat and prescribe to patients in Pennsylvania. PAMED is strongly opposed to the legislation.

Former PAMED President Karen Rizzo, MD, testified at the public hearing on behalf of PAMED. Also testifying in opposition to HB 765 were physician leaders representing the Pennsylvania Academy of Family Physicians, the Pennsylvania Chapter of the American Academy of Pediatrics, and the Pennsylvania Osteopathic Medical Association, as well as a PAMED member who was a licensed CRNP before becoming a family physician. Additional testimony was provided by Ann Peton, MPH, Director of the National Center for the Analysis of Healthcare Data,

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Section ??

who spoke about workforce migration trends nationwide. The information Peton presented countered claims that nurse practitioners are more likely to practice in rural areas after gaining independent practice authority.

Nearly two dozen PAMED members attended the public hearing on HB 765, which was held at the State Capitol in Harrisburg. The House Professional Licensure Committee also heard testimony from a panel of individuals in support of HB 765 and the independent practice of nurse practitioners. Committee members then had an opportunity to ask questions of those who testified.

Of the 200-plus amendments filed to SB 3, one particular amendment reflects recommendations issued by a House workgroup this past summer. The workgroup, which was comprised of legislators with varying opinions on medical marijuana legalization, was charged by House Republican leadership to come up with a compromise proposal that would garner enough support to pass the lower chamber.

Streamlining the Physician Credentialing Process

Rep. Matt Baker (R-Tioga) introduced legislation late in 2015 that aims to improve the physician credentialing process in Pennsylvania, making it timelier and more uniform across insurers. The legislation is strongly supported by PAMED. HB 1663 specifically addresses the problem of unwarranted delays by health insurers in credentialing applicants for inclusion in their networks. Hospitals and physician practices routinely face the situation where a newly hired health care professional who is fully licensed and qualified to provide care is not reimbursed by insurers for months while the insurers work their way through an unnecessarily and cumbersome credentialing process. This costs hospitals and physicians money, drives up the cost of health care, and limits access to care by keeping fully licensed and qualified providers on the sidelines until they are credentialed by insurers.

At this time, HB 765 has not yet been scheduled for a vote by the House Professional Licensure Committee. We are also closely monitoring both HB 765 and the Senate version of the legislation–SB 717, sponsored

by Sen. Pat Vance (R-Cumberland County).

Medical Marijuana

SB 3, which would legalize marijuana for medicinal use in Pennsylvania, passed the Senate overwhelmingly in May of last year, but has not yet reached a final vote in the House. With over 200 amendments to the bill having been filed and the General Assembly still struggling to complete the 2015-16 state budget, it is unclear when the issue of medical marijuana will be taken up again. Governor Wolf has indicated, however, that passage of medical marijuana legislation is one of his top three priorities for 2016.

it is expected that the legislature will vote on the measure sometime in 2016.

PAMED remains opposed to broadbased legalization of marijuana for medical use. PAMED’s 2015 House of Delegates reaffirmed this policy, noting marijuana’s ongoing status as a federal Schedule I controlled substance and the need for adequate and well-controlled studies of marijuana’s effects.

Given that public opinion is overwhelmingly supportive of marijuana legalization, however,

HB 1663 will establish a standardized process and timeline for insurer action on credentialing applications. The legislation introduced would require all insurers in Pennsylvania to accept the Council for Affordable Quality Healthcare (CAQH) credentialing application and provide for provisional credentialing of a provider when Continued on page 30 Central PA Medicine Spring 2016 29

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Legislative Updates Continued…

a determination is not made within 30 days of a submitted application. HB 1663 is currently awaiting consideration by the House Health Committee.

PAMED is also working closely with the Department of Human Services (DHS) to ensure timelier credentialing of physicians within the state’s Medicaid program.

After discussions led by PAMED, DHS announced that beginning in 2016, Physical Health Managed Care Organizations (PH-MCOs) will be required to begin the credentialing process upon receipt of a provider’s application and must complete the credentialing process within 60 days.

Improving Prior Authorization Processes

Rep. Marguerite Quinn (R-Bucks County) will soon be introducing legislation to streamline and standardize the prior authorization process in Pennsylvania. The legislation is strongly supported by PAMED. Many health plans require physicians to obtain prior authorization for certain procedures or treatments before they can be administered. While the process is intended to minimize overuse of health care services, it often becomes an extremely burdensome

DCMS 100 yearcentenary history was published by Dr. George Laverty in 1966.

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process for physicians and their patients.

Lack of transparency and standardization in prior authorization requirements not only makes the process difficult and time consuming, but can also result in delays in needed care for Pennsylvania residents.

Rep. Quinn’s legislation would increase transparency and consistency in prior authorization criteria; establish standards and reduce the overuse of prior authorization; lessen manual processes and enhance the electronic exchange of information; develop a standard prior authorization form; and improve response times for prior authorization determinations. These steps will go a long way toward addressing administrative waste in our health care delivery system, resulting in both cost savings and improved access to care.

Reauthorization of CHIP

Legislation reauthorizing Pennsylvania’s Children’s Health Insurance Program (CHIP), which was set to expire at the end of 2015, was signed into law a week before the new year. HB 857, sponsored by Rep. Tina Pickett (R-Bradford County), extended the life of CHIP until the end of 2017. Now Act 84 of 2015, the new law also moved administration of the CHIP program from

the Pennsylvania Insurance Department to the Department of Human Services.

CHIP provides health insurance to children in Pennsylvania under age 19 who don’t qualify for Medical Assistance. In August of last year, Gov. Wolf announced a number of changes to CHIP would take effect on Dec. 1, 2015, to ensure that the program meets minimum essential coverage requirements of the Affordable Care Act. The changes included the following: • All CHIP plans will cover certain preventive care services—such as oral hygiene education and dietary instruction—without cost sharing in the form of copayments, coinsurance, or deductibles.

• Annual and lifetime limits will be eliminated on the cost of some specific services and equipment like durable medical equipment, hearing aids, pediatric vision and dental service, including orthodontic services.

• Health plans must provide parity between mental health/substance abuse benefits and medical/ surgical benefits.

In April 2015, federal funding of CHIP was extended for two years under H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015.

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DCMS News

National Doctor’s Day March 30, 2016

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n the United States on March 30, National Doctors’ Day is a day on which the service of physicians to the nation is recognized annually.

Similar days have been declared in many other countries.

The first Doctors’ Day observance was March 30, 1933, in Winder, Georgia. The idea came from Eudora Brown Almond, wife of Dr. Charles B. Almond, and the date chosen was the anniversary of the first use of general anesthesia in surgery—March 30, 1842, in Jefferson, Ga., where a tumor was removed from a patient’s neck. On October 30, 1990 (creating Public Law 101-473), Doctors’ Day was officially designated as a national holiday to be celebrated every year.

Becoming a doctor involves years of extensive education and training.

Depending on whether you plan to work as a general physician or as another type of doctor, training can take between eleven and sixteen years. Most doctors complete at least four years of undergraduate school, followed by four years of medical school and then three to eight years of residency programs. Fellowships can last an additional one to three years.

Doctors of all specializations often work long hours and can have hectic schedules. Even when not working, they may be on call.

More than the application of science and technology, medicine is a special calling, and those who have chosen this profession in order to serve others understand the tremendous responsibility it entails.

On March 30, take a moment to reflect on all that your doctor provides for you and the community. If you happen to have an appointment that day, thank them for their service. After all, serving their patients and serving them well is what they most thrive on.

The following is a list of all Dauphin County Medical Society Member Physicians.

32 Spring 2016 Central PA Medicine

A

Robert C. Aber, MD Ayesha Abid, MD Falguni R. Acharya, MD Timothy S. Ackerman, DO Shiv S. Aggarwal, MD Adnan Ahmad, DO Shahla Ahmad, MD Rimsha Ahmed, MD Michael Omobolaji Akinyemi, MD Islam Abdelrahman Al-Howaidi, MD Lawrence L Altaker, MD, DLFAPA Domingo T. Alvear, MD, FACS Olubunmi I. Amakor, MD Margretta J. Ameigh, MD Bryan E. Anderson, MD Elizabeth J. Anderson, MD Robert Andrew Anderson, DO A. Thomas Andrews, MD Joseph F. Answine, MD William P. Apollo, MD Lawrence David Appel, MD Edwin A. Aquino, MD Christopher B. Arena, MD Joseph N. Awantang, MD Reza George Azizkhan, DO

B

Jennifer Wells Baccon, MD Rae Elena Bacharach, DO James Austin Baer, MD Robinder Bahniwal, MD Robert G. Baily, MD Ayodeji O. Bakare, MD Balint Balog, MD Elizabeth M. Balraj, MD Dennis R. Banducci, MD, FACS Carolyn A. Barbieri, MD Elizabeth Isobel Barchi, MD Glen S. Bartlett, MD John O. Barton, MD Frank J. Battista, MD Rommel B. Bebe, MD Simranjit Singh Bedi, DO Nicholas L. Behonin, MD Alisa Bell, DO Jacob Benrud, MD Michael S. Bentz, MD Bridget F. Berich, DO Ilan Berlinrut, MD William J. Beutler, MD, FACS Hardik Bharatkumar Bhatt, MD Eric J. Binder, MD Charrell M. Bird, MD

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Dauphin County Physicians continued…

Ajit Kumar Bisen, MD Andrew Bloschichak, MD Richard J. Boal, MD Henry Boateng, MD Arlene S. Bobonich, MD Mark S. Boland, DO,FACOS George B. Boline Jr., MD, FACS Amy J. Bonneau, MD Kathryn A. Bonnett, MD Megan J. Borror, MD Michael D. Bosak, MD Randall S. Bossler Jr., MD Jonathan W. Bourgeois, MD James H. Bower, MD Isabel Jeannette Brea, MD, MPH Robert W. Brennan, MD Geoffrey J. Brent, MD Paul P. Bricknell, MD Sara Michelle Brown, MD Robert C. Buckingham, MD Roger George Bucs, MD Wayne C. Burgess Jr., MD James R. Burke, MD

C

John G. Calaitges, MD Julia C. Caldwell, MD Aarti Campo, MD Emma G. Cargado-Leynes, DO Robert Carman Jr., DO Logan William Carr MD Christine L Cassel MD Jennifer A. Chambers, MD Tiffany Chan, MD Justin D. Chandler, MD Ying Tai Chang, MD Maciej T. Charczuk, MD Bilal Aslam Chaudhry, MD Jeffrey K. Chen, MD Jihua Cheng, MD Julie Chepovetsky, MD Bennett Chotiner, MD, FACS Erik A. Chotiner, MD, FACS Joseph A. Cincotta, MD Charles E. Cladel, MD Bruce S. Cohick, MD Renee L. Coleman, MD Kenneth B. Conner, MD Jane K. Conroy, DO Mary P. Consevage, MD, FAAP Michael W. Consevage, MD, PhD Jason Albert Conway, MD Lauren C. Cook, MD Carol E. Copeland, MD

Michael Cordas Jr., DO Paul J. Creary, MD, FACS Richard D. Crispino, MD Cary Cummings III, MD Paul D. Curtin, DO

D

Frank C. D’Amico, MD, FACS Donald R. D’Annunzio, MD Lekhaj Daggubati, MD Raymond E. Dahl, DO Robert R. Dahmus, MD John R. Dailey, MD Charles E. Darowish, DO Bradley K. Davidson, MD Matthew D. Davidson, DO Richard A. DeRamon, MD Esmeralda Maldia Del Rosario, MD Carrie L. Delone, MD J. Bret Delone, MD, FACS Brian S. DeLong, MD, FACS Steven Michael Deluca, DO William W. DeMuth, MD, FACS Cynthia T. Demuth, MD Prashant Desai, MD Ruchi Jayesh Desai, MD Denise Dhawan, MD Ivona P. Diamond, MD Jonathan R. Diamond, MD Katie Lindsey Dickinson, MD Peter W. Dillon, MD, FACS Christopher C. DiMaio, MD Luciano A. DiMarco, DO Thomas Charles Dispenza, MD Justin A. Doble, MD Renee Elizabeth Doll, MD Lisa M. Domaradzki, MD Devanand A. Dominique, MD, FAANS Vignesh Iyer Doraiswamy, MD Eleanor Fernandez Dunham, MD, FACEP Thomas M. Dunn, MD Donald C. Durbeck, MD

E

Greg R. Ehgartner, DO Matthew Adam Emerich, MD Brett B. Ernst, MD Rose N. Eskin, MD Daniel Esslinger, MD Stephanie J. Estes, MD Robert A. Ettlinger, MD Richard G. Evans III, DO M. Elaine Eyster, MD

F

Maureen E. Fairbrother, MD

Paul F. Fairbrother, MD Michael John Faretta III, MD Elena R. Farrell, DO Safa P. Farzin, MD Robert J. Feczko, MD David Michael Fehr, MD Todd Matthew Felix, MD Scott C. Felter, DO Jorge Feria, MD Michael Fernandez, MD Katelynn M. Ferranti, MD Irina S. Filatova, MD Todd R. Fisher, MD Margaret Mary Fitzsimons, MD Joshua Fleetman, MD Melanie R. Fleischmann, MD Donald J. Flemming, MD Anneli C. Fogelberg, MD Oluwamayowale Folaranmi, MD Theodore T. Foley, MD Thomas Foley, MD John P. Forney, MD Deanne L. Fosnocht, MD Lisa M. Foster, MD Michael W. Foster, MD James Francescangeli, MD Ekezie M. C. Francis, MD Carl A. Frankel, MD, FACS Sharon R. Frankel, MD John R. Frankeny II, MD, FACS Kathryn M. Frantz, MD John R. Freshman, MD Jeffrey S. Fugate, DO Craig W. Fultz, MD

G

Kara Garcia, MD Guillermo Garcia-Cabrero, MD Miroslaw D. Gardyasz, MD Joseph A. Gascho, MD Sandra Gascon-Garcia, MD Scott M. Gayner, MD Jeffrey S. Genda, MD David Gendelberg, MD Gaspere C. Geraci, MD Leonardo Anthony Geraci, DO Charles D. Gerlach IV, MD Michael T. Gette, MD Mehrdad Ghahramani, MD Kelly Sansouci Gidusko, MD Navneet K. Gill, MD Robert C Gilroy MD Robert Cummings Gilroy Sr., MD Dennis L. Gingrich, MD

David Goldenberg, MD, FACS John D. Goldman, MD Jennifer P. Goldstein, MD Curtis A. Goltz, DO David C. Good, MD Robert A. Goodman, MD Vitaly Gordin, MD JoAnne G. Gordon, MD William S. Gordon, MD Sahithi Gosala, MD Monica A. Gran, MD Raymond C. Grandon, MD John Grandrimo, DO Kurt Alan Graupensperger, DO Robert B. Greer III, MD, FACS Zachary A. Gregg, MD Ajitpal Grewal, MD Margaret L. Grotzinger, MD Anthony J. Guarracino, DO, FACEP Roger B. Gustavson, MD Felix Gutierrez, MD Julian Gutierrez, MD

H

Brittney Hacken, MD Timothy F. Hahn, MD Virginia E. Hall, MD, FACOG, FACP Richard H. Hallock, MD Robert W. Hamilton, MD Richard K. Hammer, MD Gregory A. Hanks, MD Robert E. Harbaugh, MD, FACS Rhondey I. Harford, MD Lewis E. Harpster, MD, FACS Denise F. Harr, MD James R. Harty, MD Todd J. Harvey, MD Soroosh Hashemi, MD Randy M. Hauck, MD, MS, FACS Margaret M. Hawn, MD Minghua He, MD, FAAP Steven G. Heckenluber, DO Maria Paula Henao, MD Eileen F. Hennrikus, MD William Lawrence Hennrikus, MD Cathy Renee Henry, MD Baker Livingston Henson, DO Stephen J. Herceg, MD, FACS Deborah J. Herchelroath, DO Joseph Bryan Herchelroath, DO James M. Herman, MD Andrew J. Herman, MD Continued on page 34 Central PA Medicine Spring 2016 33

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DCMS News Dauphin County Physicians continuedâ&#x20AC;Ś Jeffrey W. Hermann, MD Steven Richard Heverley, MD Ashley Nicole Hill, MD A. Craig Hillemeier, MD Everett C. Hills, MD Roberto Pablo Hodara Friedmann, MD Arthur J. Hodge, MD Kaylee Marie Hollern, MD Valentyna Honchar, MD Jordan C. Humphrey, MD Raselette Agatha Hunt, MD Debra Marissa Hurwitz, MD Namath Syed Hussain, MD

I

Mark Robert Iantosca, MD Robyn Christyl Iglehart, MD John Robert Interrante, MD Marcel Alexandru Ionita, MD Huseyin Isildak, MD Emad G. Iskandar, DO Viswanathan S. Iyer, MD

J

F. Wilson Jackson III, MD Nikhil Pollo Jaik, MD Puneet Jairath, MD Nitin Jaluria, MD George E. Jefferies III, MD Elizabeth Rose Jennings, DO William Kurtis Jens, DO Steven R. Jones, MD Christine Marie Jones, MD Danette J. Joseph, MD Sarah Nadia Joseph, MD Nirmal Joshi, MD Judith A. Jozefiak, MD John P. Judson, MD, FACS Nicholas Julius, MD

K

Thomas A. Kachel, MD Timothy William Kaminsky, MD Robert R. Kaneda, DO Anne C. Kantner, MD Robert J. Kantor, MD Rena Beth Kass, MD Michael Katzman, MD Kevin J. Kelly, MD Fareeha Khalil, MD Amrit Khalsa, MD Needa Khan, MD Laurie B. Kile, MD Scott G. King, DO Emerson L. Knight Jr., MD, FACS Neil Kocher, MD

James J. Kogut, DO Pauline H. Kostelac, DO Raymond F. Kostin, MD, FACS Shannon Kotch, MD Mary Kovacik Eicher, MD Joshua D. Kraft, MD Michael P. Krall, DO Margaret Kreher, MD Parul Krishnamurthy, MD Ottar G. Kristinsson, MD Karen Krok, MD Barbara G. Kuhlengel, MD Sambhu N. Kundu, MD, FACS George W. Kunkel, MD Louis F. Kuskin, MD Eric M. Kutz, DO Stephanie Kyc, DO

L

Paul G. Lacey, MD Charlene Lam, MD Richard C. Lanning, MD, FACS Julianne Rae Lauring, MD Herman Lawson Jr., MD John Franklin Leopold Lazar, MD David C. Leber, MD, FACS Ashley Nichole Leberfinger, MD Deborah Mei-Yun Lee, MD Dean J. Leis, MD Roger J. Levin, MD, FACS Rachel L. Levine, MD Maurice J. Lewis, MD Varsha Shukla Lift, MD Heng-Feng Lim, MD Baba H. Limann, MD, FACP, FCCP, FAASM Michael Gary Link, MD Ronald W. Lippe, MD, FACS George R. Little, MD Yongjun Liu, MD David B. Loran, MD Michael F. Lupinacci, MD Kristen Marie Lutzkanin, MD

M

Donald R. Mackay, MD, FACS Heath B. Mackley, MD S. Sava Macut, MD Gerald F. Maenner, MD R Lynn Magargle, MD Richard M. Magill, MD Nicholas A. Mahoney, MD Naresh S. Maingi, MD Brijeshwar S. Maini, MD John Paul Malayil, MD Atizazul Hassan Mansoor, MD

34 Spring 2016 Central PA Medicine

John R. Mantione Jr., MD Ann M. Markiewicz, MD Jason Paul Marone, MD Wayne K. Marshall, MD Britt Alyssa Marshall, MD Arthur T. Martella III, MD, FACS Morgan S. Martin, MD Francis J. Martinez, DO Emily W. Matlin, DO Faith Jabers Matzoni, DO Robert J. Maurer, MD Kenneth J. May Jr., MD Thomas M. Mazza, MD, FACS Patrick Feargal McSharry, MD, MBA CHC Meada J. McAllister, MD Derek Brandon McCleaf, MD David M. McDermott, MD Susan J. McGarrity, MD Johnathan D. McGinn, MD Kevin J. McKenna, MD John P. McLaughlin, DO James W. McManaway III, MD Colleen A. McNulty, DO Kevin McVeigh, MD William J. Meisler, MD Anna Mesina, MD Berend Mets, MD Eileen M. Micaroni Smith, MD Maria Michalek, MD John J. Michel, DO Denis J. Milke, MD Lee C. Miller, MD Jessica A. Miller, MD Katelin A. Mirkin, MD Gautam Mishra, MD Anne K. Misiura, MD David S. Mize, MD Jaime Moellman, MD Bernadine B. Moglia, MD Matheen A. Mohabbat, MD Malik N. Momin, MD Denise F. Montisano, MD Jack H. Moody, MD Barry B. Moore, MD, FACS Philip William Moore, DO Sam Moradian, MD Steven E. Morganstein, DO Troy A. Moritz, DO Matthew T. Moyer, MD Mubashir A. Mumtaz, MD, FACS Azka Munawar, MD Shawn C. Murphy, DO Kylie Marie Murray, DO

William M. Murray, MD Anila Mustafa, MD Sunil Muthusami, MD Franklin J. Myers III, MD

N

Seth C. Narins, MD Hanford Ndlovu, MD Ifesinachi Brenden Ndukwu, MD Janet A. Neutze, MD Thach N. Nguyen, MD John H. Nipple, DO Alexander T. Nixon, MD Kevin James Nolt, MD Jess Nordin, DO Matthew S. Nudy, MD

O

Kenneth J. Oken, MD Jeffrey Olson, MD Morton C. Orman, MD Steven K. Orman, MD Nicole Marie Osevala, MD Henry E. Ostman, MD Barbara Ellen Ostrov, MD R. Scott Owens, MD Peter Jacob Owens, MD

P

Leslie A. Packer, MD Michael Pak, MD Mukul L. Parikh, MD Neelima M. Parikh, MD Khushboo N. Parikh, MD Young-Ok Park, MD Herbert M. Parnes, MD Chinmay P. Patel, MD Khyati Chinmay Patel, MD Shashikant B. Patel, MD Jigisha P. Patel, MD Vijay A. Patel, MD Leland F. Patterson, MD Lewis T. Patterson, MD, FACS David G. Pawlush, MD David B. Peisner, MD Robert F. Pendrak, MD Walter C. Peppelman Jr., DO Manuel Angel Peregrino, MD Kathryn Peroutka, MD Andrew Perrotti, MD Bradley Steinar Peterson, MD MaryEllen Estevez Pfeiffer, DO Thu T. Pham, MD Thomas R. Pheasant, MD, FACS Paul A. Piccini, MD Stuart B. Pink, MD

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Dauphin County Physicians continued…

James A. Piper, MD Christoper J. Pizzola, MD Nathallie Pokasuwan, MD William J. Polacheck Jr., MD Gwendolyn A. Poles, DO William A. Pomilla, MD Albert R. Porter, MD John D. Potochny, MD, FACS Joyson Poulose, MD John David Powell, MD Stephen K. Powers, MD, FACS, FAANS Jay G. Prensky, MD, FACS Susan Promes, MD, MBA, FACEP Jose N. Prudencio Jr., MD

Q

Brian C. Quirk, MD Mehreen A. Qureshi, MD

R

Nancy L. Radtke, MD Richard M. Rayner, MD Richard A. Razzino, MD Scott M. Readence, MD Krista Rebo-Massara, DO Patricia A. Reddy, MD Carl T. Reese, MD, FACS Desmond J. Reilly, MD John T. Repke, MD Julianne Rich, MD Andrew J. Richards, MD, FACS, FASCRS Corey N. Rigberg, MD Jonathan Scott Rill, DO Joseph C. Riney, MD John Michael Roberts, MD Ann Marie Rogers, MD Max E. Rohrbaugh, MD Ramunas Rolius, MD William A. Rolle Jr., MD Justin D. Rosenberger, DO Stephen C. Ross, MD John P. Rossi, MD James Gerald Rossignol Jr., MD Alan D. Roumm, MD William A. Rowe, MD Ernest R. Rubbo, MD Morton L. Rubin, MD Ana Rubin-Panvini, MD Kimberly Allison Rush, MD Edward Russek, MD

S

Shyam Sabat, MD Ira Sackman, MD Rajinder K. Sahi, MD Kym A. Salness, MD, FACEP

Xavier Sanchez Flores, MD Raman K. Sandhu, MD Robert G. Sanford, MD Michael Arthur Santos, MD Amy N. Saracino, DO Joseph W. Sassani, MD, MHA Sandip M. Savaliya, MD William H. Saye, Jr. MD David L. Scher, MD John J. Schietroma, MD, FACS Robert S. Schoaps, MD Diane E. Schuller, MD Robert C. Schwartz, MD Joseph F. Scrobola, DO Stephen L. Segrave-Daly, MD Jarrett Sell, MD Patricia Seto, DO Sapna Shah, MD Shivani Upendra Shah-Becker, MD Abdolazim Shahsavar, MD Jon A. Shapiro, MD Stuart H. Shapiro, MD Pundalik G. Shenai, MD Christine M. Sheridan, DO Robert L. Shindler, MD Hiren Bhikhubhai Shingala, MD Andrew D. Shoemaker, MD Cori Shollenberger, MD Jaan E. Sidorov, MD Mary A. Simmonds, MD Rochelle Sims, MD Jatinder Singh, MD Robert A. Skotnicki, DO Jeffrey Martin Small, DO Michael F. Smith, MD Sadie E. Smith, MD Ashley H. Snyder, MD Adnan Solaiman, MD Larry L. Sollenberger, MD, FACS Cheyenne C. Sonntag, MD Angela M. Soto Hamlin, MD, FACS David I. Soybel, MD, FACS Diana N. Spell, MD Amanda S. Spencer, DO Philip Hunter Spotts, MD Samir J. Srouji, MD, FICS Mark Charles Stahl, MD Bradly Wade Starks, DO Ryan Michael Staszak, MD John K. Stene, MD Nancy I. Sterling, MD Jennifer Noelle Still, MD Paul Stoko, MD

Lindsay Marie Stratchko, DO Mustafa N. Sulemanji, MD Lindsey Taylor Surace, MD John T. Swick, MD

Dr. Laverty’s father and grandfather were both physicians in Dauphin county.

T

Claudia Daniele Taboada, DO Linda M. Taylor, MD Donna M. Testa, MD Krishnamoorthy Thamburaj, MD Karine Thevenin-Smaltz, DO Nini Chalakkal Thomas, MD Ashley D. Thompson, MD David T. Thoryk, MD Suzanne J. Tintle, MD Lisa S. Tkatch, MD Aaron W. Tober, DO Henry D. Train, MD Terry B. Tressler, DO Naman Manojkumar Trivedi, MD Alexander George Truesdell, MD Gary Tsai, MD Pon Lion Tsou, MD James Rory Judson Tucker, MD Peter J. Tucker, MD Cortni Jill Tyson, MD

U

Abdurrahman Unal, MD Serdar H. Ural, MD

V

Suneetha Vaddineni, MD Kavita Tarun Vakharia, MD Michael Paul Van Scoy, MD Michael A. Veliuona, MD J. Clark Venable, MD Eduardo S. Violago, MD

W

Kristina M. Wagner, MD Stephen M. Wagner, MD Ian N. Waldman, MD Andrew R. Walker, MD Eric Alfred Walker, MD John C. Wallendjack, MD Thomas E. Wallin, MD Timothy P. Walsh, MD Grace Zi-Yan Wang, MD Eric R. Washburn, MD Walter B. Watkin Jr., MD Travis Watson, MD Mary M. Waybill, MD Daniel I. Weber, MD, FACS, FACOG Jesse A. Weigel, MD, FACEP David Weksberg, MD, PhD David R. Wenner, DO

Robert F. Werkman, MD Kevin C. Westra, DO Eric J. Wevers, MD David Allan White, MD Matthew Paul Wicklund, MD Kristine Lee Widders, MD Naomi Wiens, DO Daniel P. Williams, DO Jessica Y. Williams, MD Paul D. Williams, DO Joella Elizabeth Wilson-Dagar, MD Nicole Lynn Witman, DO David Wolf, DO Robert E. Wolf, MD, FACS Brynn S. Wolff, MD Jason Woloski, MD Edward Gerald Woodward, MD Paul Wu, MD Malinda Wu, MD Amy L. Wyatt, DO

Y

Melissa Yacur, MD Harold C. Yang, MD, FACS Charles S. Yanofsky, MD James A. Yates, MD, FACS Ming Yin, MD David Yoder, MD Isaac Yoon, MD Thomas A. Young, MD

Z

Sufana Jawed Zafar, MD Dani Zander, MD Debra L. Zauner, MD M. LeRoy Zeigler Jr., MD John P. Zornosa, MD Robert M. Zuckerman, MD

Central PA Medicine Spring 2016 35

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DCMS News

FRONTLINE GROUPS

NEW MEMBERS

The Dauphin County Medical Society thanks the following groups for their 100 percent membership commitment:

W E L C O M E !

 Hershey Kidney Specialists Inc.

 Healthy Starts Pediatrics

 Tan & Garcia Pediatrics P.C.

 Nabeel Akhtar

 Pinnacle Health Internal Medicine Associates

 Hershey Pediatric Center

 Central PA Surgical Associates Ltd.

 Pinnacle Health Maternal Fetal Medicine  Saye Gette & Diamond Dermatology Assoc. P.C.

 Sollenberger Colon & Rectal Surgery Ltd.  Woodward & Associates P.C.  Patient First—Harrisburg

 Pinnacle Health Cardiovascular & Thoracic Surgery Associates

 Ivona P. Diamond, MD  Eleanor Fernandez Dunham, MD, FACEP  Baker Livingston Henson, DO  Charlene Lam, MD  Jarrett Sell, MD

 Urology of Central PA

 Pediatrix Medical Group

 Watkin, Nipple & Assoc.

 Pulmonary & Critical Care Medicine Associates P.C.

 Pinnacle Health Cardiovascular Institute Inc.

36 Spring 2016 Central PA Medicine

 Carol E.Copeland, MD

 The Arlington Group  Women First Obstetrics & Gynecology P.C.

 Cocoa Family Medicine

 Julia C. Caldwell, MD

 Michael Katzman, MD  James A. Piper, MD  Pon Lion Tsou, MD  David Wolf, DO

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DCMS News

Dauphin County Medical Society’s Upcoming

Events

DOC TALK S a t u r d a y April 9, 2016 Capital City Mall, Camp Hill

Doc Talk provides DCMS members with an opportunity to share their knowledge and expertise with those who might not have ready access to medical care for FREE! DCMS is looking for physicians to volunteer. Sponsorship opportunities are available. Due to space restrictions, we can only accept a limited number of participants. Reserve your space early.

If you are a DCMS member and are interested, call the office at 717-558-7849.

11 am – 2 pm

‘ASK A DOCTOR’ EVENT T u e s d a y April 29, 2016 Strawberry Square, Harrisburg

‘Ask a Doctor’ is a feel-good event and a great way to show what doctors are all about— the patient and the community!

For this event, DCMS is looking for 8–10 physicians who are willing to sit at our table to answer medical questions from the general public. Sound like fun? It is! And it’s one of many ways to give back to your community.

DCMS members, please RSVP to: DauphinCMS@pamedsoc.org or call us at (717) 558-7849 if you are interested in participating in ‘Ask A Doctor’.

10 am – 2 pm

Save the Date!

T u e s d a y April 29, 2016

PRESIDENT’S INAUGURAL DINNER Come celebrate 150 years with us!

The Dauphin County Medical Society (DCMS) was established on February 20, 1866, for the purpose of uniting with similar societies of other counties to form and maintain the Pennsylvania Medical Society and the American Medical Association. The primary purpose of DCMS at that time was to extend medical knowledge and advance medical science; elevate and maintain the standards of medical education; uphold the ethics and dignity of the medical profession; foster partnerships between physicians and the communities they serve; and promote public health and hygiene in the prevention and management of diseases.

To celebrate, join us at the President’s Inaugural Dinner April 29, 2016. Watch DCMS communications for further details!

Central PA Medicine Spring 2016 37

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DCMS News

Dauphin County Medical Society Alliance QUARTERLY N EWS DCMSA MISSION The DCMSA is organized exclusively for charitable and educational purposes.

To further these objectives, we are involved in: 1. Improving community health 2. Supporting medical education 3. Engaging in charitable activities and contributing to charitable organizations on behalf of the medical profession.

DCMSA Ongoing Volunteer Opportunities: • Hands are Not for Hitting: A non-violence curriculum presented to 1st grade children at a local Harrisburg School.

Welcome to the first issue of Central PA Medicine!

The Dauphin County Medical Society Alliance (DCMSA) is delighted to be included in this publication. This year DCMSA celebrates its 90th year. We are looking forward to our upcoming spring events listed below.

Dauphin County Medical Society Alliance Upcoming County Events

Capitol tour of Violet Oakley’s artwork with Dr. Donald Koones

February 26, 2016 1:00 pm, at the Capitol (Snow date Friday, March 4 at 11:30 AM)

Dauphin County Medical Society Alliance Fashion Show

West Shore Country Club April 19, 2016 Proceeds benefit DCMSA programs and community partnerships

Penn State Association of Family & Friends (AFF) Events

Blood Drive

Hershey Medical Center February 12, 2016

Fashion Show

Hotel Hershey April 13, 2016 10:30 AM-2:30 PM Supports programs at Milton Hershey Medical Center

• Community Check-Up Center: Volunteers read to children while family members are seen by medical professionals.

Holy Spirit Auxiliary Events Please Contact Holly Mackley at dcmsalliance@gmail.com if you would like more information regarding these events, volunteering or to join the DCMSA.

Spring Luncheon

March 17, 2016

Jewelry Sale

Find us on Facebook at www.facebook.com/ dauphincountymedicalsocityalliance/

Holy Spirit Hospital August 30-31, 2016

Spring Festival

Adams Ricci Park May 21, 2016

Membership Event

September 8, 2016

38 Spring 2016 Central PA Medicine