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IN CHESTER COUNTY FROM ONE-SIZE-FITS-ALL HEALTHCARE
SLEEP APNEA SODIUM RESTRICTION: much ignored malady AATIME-HONORED DOGMA OR AN EVIDENCE-BASED PURSUIT?
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Reach 3,500+ Physicians, Dentists and Practice Managers, and 25,000+ Engaged Consumers Throughout Chester County Advertise in CCMS Physician, the Official Magazine of the Chester County Medical Society For Advertising Opportunities Contact: Karen Zach 484.924.9911 Karen@Hoffmannpublishing.com
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Contents FALL 2015
2013-2016 CCMS OFFICERS President Winslow W. Murdoch, MD
President-Elect Mian A. Jan, MD, FACC
Vice President Bruce A. Colley, DO
Secretary David E. Bobman, MD
Treasurer Liza P. Jodry, MD
Board Members Mahmoud K. Effat, MD Heidar K. Jahromi, MD John P. Maher, MD
Evolves to 20 PHP Address Modern
Sleep Apnea A much ignored malady
Charles P. McClure, MD Susan B. Ward, MD
Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Societyâ€™s mission has evolved to represent and serve all physicians of Chester County and their patients in order to preserve the doctor-patient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and health care within the community, Chester County and Pennsylvania. The opinions expressed in these pages are those of the individual authors and not necessarily those of the Chester County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Chester County Medical Society. Chester County Medicine is published by Hoffmann Publishing Group, Inc., Reading PA 19608 HoffmannPublishing.com For advertising information, contact Karen Zach 610.685.0914 firstname.lastname@example.org
22 Review of Pennsylvania Opioid Prescribing Guidelines and Legislation
Features 24 26 28
State Senator Andy Dinniman Our Friend In Harrisburg CCMS Hosts Annual Clam Bake CCMS Membership: Resources You Need
In Every Issue 6 12 18 30
Presidentâ€™s Message PAMED Legislative Update The Art of Chester County Membership News & Announcements
Chester County Medicine is published by Hoffmann Publishing Group, Inc. Reading, PA I HoffmannPublishing.com I 610.685.0914 I for advertising information: email@example.com
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s Alternative Payment Models (APMs) are experimented with by hospital systems, government, and commercial insurers, ownership for quarterbacking patient care, especially for the medically complex, elderly, poly chronic, or emotionally/cognitively challenged patient population, presents THE real challenge. How well a network resources, manages, and supports this captain of the ship role in this vulnerable patient population will emerge as key in reducing waste and controlling costs. Reduced utilization of hospital, emergency room, specialist, and redundant or unhelpful testing are trends consistently seen in pilot programs focused on this premise. Having all clinicians throughout the clinical spectrum identifying those at risk, and facilitating their inclusion in a focused team, lead by a “primary care quarterback (PCQ)”, will become paramount for reducing unnecessary care, improving outcomes, and bettering patient and professional satisfaction. I use the term PCQ loosely, as in many circumstances, this role may be best handled by a pulmonologist, oncologist, nephrologist, neurologist, palliative care specialist, gastroenterologist, or cardiologist who has forged a strong patient-physician bond, and accepts the PCQ role in late stage disease. Primary care’s role in hospital care has been marginalized, perhaps unintentionally by specialists, but perhaps strategically by the payers and hospitals. The specialist culture is closely linked to the inpatient hospital culture, where familiarity breeds collaborative partnerships.
Currently, these at risk patients are often put on the subspecialist merry-go-round of referrals. A separate problem or abnormality is identified by one specialist in the hospital, or in the emergency room, and the patient is referred to another specialist in that field, who finds something else, and refers on, etc. The patient is told at every step: if you think this is an emergency, call 911. A patient seen within this context tends to receive a bundle of services common to that specialty, often without knowledge of a patient’s goals, or what has been previously done in other venues. Assuming the role of PCQ requires a paradigm shift in the patient-physician relationship. Both parties have to create a role of shared responsibility. The PCQ must make a commitment, taking ownership of a given patient and his or her care. The patient likewise will recognize and value what the PCQ brings to their care through access and information, care coordination both inpatient and outpatient, and PCQ team resources. This is very different than population management, and is often referred to as Intensive Primary Care. Ownership requires time. Taking time requires resources. Currently, resources are heavily weighted to doing procedures, maximizing Evaluation & Management (E&M) codes, which have very little to do with the actual work that we do, or getting a patient to come back frequently to handle one brief problem per visit, face to face. Ownership requires communicating regularly with specialist consultants, incorporating any and all diagnostic or consultative data
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into a shared medical decision-making data set. It also requires regularly communicating effectively with family and caregivers. Traditional fee for service, face to face encounters, do not allow payment for the time it takes to do these important tasks. Time based models will be created that allow measurement and remuneration for the value of this work. Standards should not be over prescriptive (i.e., requiring participation in PCMH, MU, PQRS, MIPs, and most importantly, a move away from the very dysfunctional E&M coding process), as this work pivots on less easily measured metrics of personalized care and relationship building. This will create space for creative innovation in the PCQ space, and allow for best practices, which as they develop, can be shared collaboratively within a given Clinically Integrated Network (CIN). CINs will also include a population approach paradigm shift. Resources must be created to assist in managing lifestyle, and chronic disease management, collaboratively, but beyond the sole responsibility of the PCQ. Efficient inclusion of patients in health coaching teams; exercise, nutrition, substance issues, stress management, diabetic education, and CHF/COPD/obesity disease managers, need to be seamlessly integrated with a network of PCQs who have developed a strong patient bond. Once this bond has developed, review of labs, radiology, and consultation reports, reminders, and goal setting, etc., are all more efficiently managed by phone, or virtual appointments with the PCQ or their designee. This is a very exciting time to be on the ground floor of this disruptive innovation. As with any paradigm shift, there will be speedbumps, dead ends, and missed opportunities. We, the community physicians, must come together and provide the leadership to steward this collaborative process. We must insist that this not get bogged down in regulation, third party or administrative self-interest. Clinician experience and feedback is critical in these early stages. There is great opportunity for betterment in the health of our community, as well as the health of our profession. I am very concerned, however, that if we as a profession passively sit back, and allow the same academic, political, and administrative “experts” who are extolling the virtues of the CIN to construct it, we will never achieve anything resembling clinical integration. I welcome you to get involved. Be the change. Get organized NOW, and share your voice.
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SLEEP APNEA A much ignored malady BY ZARSHAWN AND MIAN JAN
leep apnea is one of the most common health issues in the United States with estimates of 20 to 25 million people who suffer from sleep apnea syndrome, many of whom are undiagnosed. One in three patients with hypertension suffers from sleep apnea, and two in three obese patients suffer from sleep apnea, similar to patients with diabetes mellitus. Since we spend approximately 25 years of our lives sleeping, it’s a very important part of our life cycle. Sleep apnea can even reduce our life span by five to 10 years.
Mechanism of sleep apnea
What is sleep apnea?
When breathing is interrupted, carbon dioxide builds up in the blood stream. To reduce the carbon dioxide, chemoreceptors in blood respond by signaling the brain to wake up and breathe deeply and restore oxygen. This allows one to go back to sleep. Maintenance of this balance is the hallmark of treatment of sleep apnea.
Symptoms of Sleep Apnea
Sleep apnea malady is characterized by pauses in breathing, or breathing that becomes extremely shallow. Pauses typically last 10 to 20 seconds and can occur hundreds of time during the night. As a result, you spend more time in light sleep and less time in deep restorative sleep that one needs to be energetic, mentally efficient and productive when awake. Chronic sleep deprivation results in daytime drowsiness, slow reflexes, limited concentration, and increased risk of accidents and other health issues described later.
• Morning Headaches • Memory issues • Learning deficits • Irritability • Depression and mood swings
• • • •
Personality changes Frequency of micturition Dry mouth Sore throat
Jan & Jan
Signs of sleep apnea
2. Central Sleep Apnea [CSA] CSA makes up only .4 percent of sleep apnea. CSA occurs when the brain fails to properly signal the muscles that control breathing. These patients seldom snore. 3. Complex or Mixed Sleep Apnea Makes up 15 percent of cases and is a combination of obstructive sleep apnea and central sleep apnea.
Sleep apnea is tough to identify since most signs are observed when a person is asleep. A bed partner is the best person to help with the diagnosis. Gasping and choking following pauses in sleep provides major evidence of sleep apnea. Fighting sleep during the daytime, work activities, and driving is also common. If you don’t have a sleep partner, you can video record yourself and keep a sleep diary.
Types of Sleep Apnea 1. Obstructive Sleep Apnea [OSA]
Oral Cavity Normal and in SA
Risk Factors for Sleep Apnea • Overweight—especially if obese (body mass index above 30) • Male • Over the age of 65 • Family history of sleep apnea • Certain minorities, especially African American, Hispanic or Pacific islanders • People who smoke have three times the risk. • Large neck size [over 17 inches] • Enlarged tonsils or tongue • Small jaw bone • Sinus issues and gastroesophageal reflux • Deviated nasal septum • Usage of alcohol, sedatives, and tranquilizers • Central sleep apnea can occur with brain tumors or stroke Consequences of Sleep Apnea • Untreated sleep apnea patients die five to 10 years early • Stroke • Increased incidence of hypertension / worsening of existing hypertension • Diabetes mellitus • Cardiac arrhythmias, both atrial and ventricular, including lethal arrhythmias like ventricular tachycardia and sudden death • Heart failure is more common in patients with sleep apnea and difficult to manage. • Depression and increase in ADHD symptoms • Myocardial infarctions • Fatty liver disease and cirrhosis are more common with sleep apnea.
The most common sleep apnea is called Obstructive Sleep Apnea (OSA). According to the National Institutes of Health (NIH), 12 million Americans suffer from OSA and make up 84 percent of sleep apnea types. With OSA, breathing is interrupted by a physical block to airflow by soft tissues in the throat including the uvula and tonsils.
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Diagnosis is made based on a combination of clinical symptoms [see sleep apnea questionnaire] and a formal study called polysomnography, or reduced-channel, homebased tests.
Non-surgical treatments • Positive airway pressure o Continues pressure o Auto titrating PAP automatically adjusts pressure as needed, and is becoming more common. o Bi-level PAP reduces pressure on exhale, less competing flow, and is the more expensive option, typically reserved for when patient cannot tolerate other PAP options. • Oral appliances, custom made, are a viable option in mild to moderate cases and can also be used with PAP during times like travel when it’s difficult to carry cumbersome equipment. They can also be used if a patient is intolerant of PAP. • Medications acetazolamide, zolpidem, and triazolam have been used in central sleep apnea with varying effectiveness and side effects • Behavior modifications o Weight management o Active lifestyle
Polysomnography Polysomnography establishes an objective diagnosis linked to quantity of apneic events per hour of sleep [Apnea Hypopnea Index (AHI)], and respiratory disturbance index above which a person has sleep apnea. Sleep apnea can thus be quantified: • Mild OSA ranges from five to 14.9 events per hour of sleep. • Moderate OSA ranges from 15 to 29.9 events per hour of sleep. • Severe sleep apnea over 30 events per hour of sleep. Home-based test includes sensors to assess: • • • • •
Oximetry and heart rate Respiratory effort Apnea and hypopnea index Assessment of oxygen saturation Acoustic analysis of snoring
Surgical Treatments • Upper airway relief • Uvulopalatopharyngoplasty • Surgery for deviated septum • Tonsillectomy • Genioglossal procedure • Maxillomandibular advancement • Respiratory drive stimulation, implant to stimulate respiratory drive • Tracheostomy to bypass upper airway a more drastic measure • Bariatric surgery for weight loss. Data has revealed a loss of even 20 pounds can improve sleep apnea. In summary, sleep apnea is a much underdiagnosed malady which affects millions of Americans and often results in significant and sometimes lethal consequences. If properly diagnosed and treated, it would save millions of dollars in costs and save thousands of lives and promote healthy living.
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Jan & Jan
This article was a collaboration between Mian A. Jan, an interventional cardiologist practicing in Chester County, who has a special interest in sleep apnea syndrome and its treatment, and Zarshawn Jan a second year medical student at Drexel University College of Medicine.
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PAMED Legislative Update
Pennsylvania Medical Society Quarterly Legislative Update BY J. SCOT CHADWICK , LEGISLATIVE COUNSEL
s of this writing, Pennsylvania’s state budget for the 2015-2016 fiscal year is nearly four months overdue, with little indication that Gov. Wolf and legislative leaders are getting any closer to reaching an agreement on taxes and spending. Of course, the situation could change quickly, and hopefully by the time you read this there will be some sort of breakthrough. In the meantime, school districts and social service agencies are beginning to feel the pain that comes with the lack of their annual state funding. However, the state budget stalemate has not prevented legislative and regulatory action on other issues, many of which are health care related. The following is an update on some of those actions that have occurred over the summer.
Expunging Minor Violations from a Practitioner’s Disciplinary Record SB 538, legislation that would expand the obligation of professional licensees to notify their licensing board when they run afoul of the criminal law or another state’s licensing body, is just one step away from the governor’s desk, needing only Senate approval of amendments added by the House, which could occur in the near future. One of the House amendments could benefit physicians and other licensees who have a minor transgression on their disciplinary record. Should the bill become law, certain violations could be expunged (erased) from a licensee’s record, provided that certain conditions have been met.
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The types of violations that would be eligible for erasure fall into one of two categories: 1. Failure to complete continuing education requirements or practicing for six months or less on a lapsed license, registration, certificate or permit. At least four years must have elapsed since the final disposition of the disciplinary record at the time of application for expungement; and 2. Any violation, except those which resulted in license suspension or revocation, in which at least 10 years have elapsed since the final disposition of the disciplinary record at the time of application for expungement. Thus, only minor violations would be eligible for expungement, and some time needs to have gone by since the problem was resolved. Anything serious enough to have warranted a license suspension or revocation would stay on a licenseeâ€™s disciplinary record permanently. Other conditions would also have to be met in order for a licensee to apply to have a disciplinary black mark removed.
Specifically: 1. the licensee must make written application for expungement not earlier than four years from the final disposition of the disciplinary record; 2. the disciplinary record must be the only disciplinary record that the licensee has with either the commissioner or a licensing board or commission under the commissionerâ€™s jurisdiction; 3. the licensee must not be the subject of an active investigation related to professional or occupational conduct; 4. the licensee must not be in a current disciplinary status, and any fees or fines assessed must be paid in full; and 5. the licensee must not have had a disciplinary record previously expunged by the commissioner. You only get one bite at this apple. Continued on page 14
Pennsylvania Medical Society Quarterly Legislative Update As indicated, the bill may be enacted soon, and if so, PAMED will provide all the information physicians need to initiate the process of requesting expungement of old, minor violations from their disciplinary record.
Gov. Wolf ’s 2015 Regulatory Agenda On July 25, the Governor’s Office released its Regulatory Agenda for calendar year 2015. The purpose of the Governor’s Regulatory Agenda is to provide advance notice of upcoming regulatory activity. The publication represents the Administration’s intentions regarding future regulations. The following is a brief summary of the regulations proposed for action: Achieving Better Care by Monitoring All Prescriptions Programs: The Department of Health plans to release proposed regulations to support the implementation of the forthcoming prescription drug monitoring program—Achieving Better Care by Monitoring All Prescriptions Programs (ABC-MAP)—in
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Spring 2016. The Department anticipates that these regulations will (1) improve the quality of patient care in Pennsylvania by providing prescribers and dispensers access to information about all controlled substances dispensed to a patient, and (2) aid regulatory and law enforcement in the detection and prevention of fraud, drug abuse, and criminal diversion of controlled drugs. Anesthesia Regulations: The State Board of Dentistry plans to issue proposed regulations updating the standards for administration of general anesthesia, deep sedation, moderate sedation, minimal sedation, and nitrous oxide/oxygen analgesia in dental offices to conform to and adopt the current standards used by the dental profession. Child Abuse Reporting Requirements: This winter, the State Board of Medicine and the Osteopathic Board of Medicine plan to issue regulations to update the Board’s existing rules regarding the mandatory reporting of suspected child abuse pursuant to the recent amendments to the Child Protective Services Law (CPSL). Compounding Regulations: This fall, the State Board of Pharmacy will issue, as proposed, updated regulations to improve the profession’s safe, sterile practices and procedures for the compounding of pharmaceutical products for patients. Health Care Worker Identification Badge Regulations: Specific provisions of the 2011 Photo Identification Tag Regulations law went into effect on June 1, 2015. Even though the law related to the use of titles (e.g., Doctor, Nurse, etc.) and their precise placement on the badge did not go into effect until June 2015, many of those affected by the law (particularly physicians) have been in compliance with all components of the law since it was passed in 2011. This fall, the Department of Health plans to release proposed regulations for this law. Injectable Medications, Biologicals, and Immunizations: The Board of Pharmacy plans to issue proposed regulations to implement the 2015 amendments to the Pharmacy Act this winter. These amendments allow a pharmacist to administer influenza vaccine to patients beginning at age nine and allow pharmacy interns to administer injectable medications, biologicals, and immunizations. Laser Regulations: This fall, the State Board of Medicine will issue proposed regulations to clarify the requirements for the use and delegation of the use of medical lasers. The proposed rule will bring the Board’s regulations in line with the majority of other states with regulations related to these devices. Osteopathic Prescribing Regulations: This fall, the State
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Board of Osteopathic Medicine anticipates its release of regulations to outline the minimum acceptable standards of practice that an osteopathic physician or physician assistant licensed by the Board must follow when prescribing, administering, or dispensing controlled substances or one specific additional drug which shares serious potential for addiction and abuse (butalbital). According to the Board, butalbital is a barbiturate that is known to have addictive and abuse potential and is prone to overuse by the consumer.
Medical Marijuana Legislation to legalize medical marijuana has cleared the state Senate by a vote of 40-7, and now awaits House action. Senate Bill 3, introduced by Sen. Mike Folmer (R-Lebanon County), was the subject of House and Senate public hearings earlier this year. PAMED testified at the hearings, repeating our position that the FDA should relax marijuana’s status as a Schedule I drug to facilitate testing of a substance that seems to have some promise in treating children with epileptic seizure disorders, nausea in cancer patients, and other conditions. PAMED also believes the state should fund pilot studies that the Department of Health laid the groundwork for last year. However, until solid research results are in hand, the Society believes legalization would be premature. The bill’s scope is broad, and goes beyond the legalization of cannabidiol, the non-psychoactive component of marijuana that seems to help some children with seizure disorders. SB 3 would also legalize THC, the psychoactive component of marijuana, to treat cancer, epilepsy and seizures, ALS, cachexia/wasting syndrome, Parkinson’s disease, traumatic brain injury and post-concussion syndrome, multiple sclerosis, Spinocerebellara Ataxia (SCA), post-traumatic stress disorder, severe fibromyalgia, HIV/AIDS, glaucoma, and other conditions authorized by the Department of State pursuant to review initiated by a patient petition. The bill originally would have permitted the medical use of marijuana edibles, raising concern over the risk of diversion and unintended harm. However, the Senate State
Government Committee deleted edibles from the bill on April1/22/15 21, 11:02 AM while adding nebulizing (smoking and vaping would be prohibited). The bill would authorize up to 65 growers and another 65 processors, raising questions about product consistency. The bill as introduced would have permitted physicians, CRNPs, nurse midwives and physician assistants to all “recommend” medical marijuana to patients. However, the committee-approved amendment restricts that authority to physicians. The bill provides that the Commonwealth cannot be held liable for any deleterious outcomes resulting from the medical use of cannabis by a registered patient. However, no similar protection is given to health care practitioners who would actually “recommend” non-FDA approved marijuana medications to their patients. PAMED was recently joined by the following physician specialty societies in sending House members a joint letter expressing opposition to premature legalization of medical marijuana: Pennsylvania Society of Anesthesiologists American College of Physicians Pennsylvania Allergy and Asthma Association Pennsylvania Neurosurgical Society Robert H. Ivy Society of Plastic Surgeons
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Pennsylvania Medical Society Quarterly Legislative Update Pennsylvania Society for Pulmonary Disease Pennsylvania Rheumatology Society Pennsylvania Chapter of the American College of Cardiology Pennsylvania Occupational and Environmental Medical Society Pennsylvania Academy of Otolaryngology Pennsylvania Chapter of the American Academy of Pediatrics Pennsylvania Psychiatric Society Pennsylvania Chapter American College of Emergency Physicians Nevertheless, there appears to be considerable rank and file support for medical marijuana among House members, though House leaders have taken a cautious, go-slow approach, and have spent much of the summer working to address concerns with the Senate legislation. Watch for a more modest House proposal to emerge early this fall.
Controlled Substances Database Progress Update It now appears certain that the long-awaited statewide controlled substances database will not be operational until sometime in 2016. That word comes from the Department of Health, which is charged with housing the program. The law creating the database, Act 191 of 2014, set June 30, 2015, as the date it was supposed to be operational, but that didn’t happen, for a number of reasons. First, creating a robust, interactive system that will be used daily by thousands of health care practitioners is no small task. And while it’s disappointing that Pennsylvania is the only state besides Missouri that doesn’t have an operational database, we do benefit from the opportunity to look at what other states have done and identify best practices. The Department is doing that now, and it takes some time. The second problem is money. The $2.1 million earmarked to build and operate the system for the next year is tied up in the ongoing state budget stalemate. How long it will take to resolve that impasse is anyone’s guess. Fortunately, the state recently received a $900,000 grant that can be used to get the ball rolling financially. The board that is to run the database, made up primarily of Gov. Wolf cabinet members, held a public meeting on Sept. 15,
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and revealed that the process of selecting a vendor to build the system is now under way. That process should be complete before the end of the year, but then comes the task of actually creating the database. Hence, the likelihood that the program won’t be operational until 2016.
Allowing Traveling Team Physicians to Treat Players without a Pennsylvania License Most sports fans are aware that college and professional teams often bring their team physicians with them when they travel to another state to compete. This makes sense, because the team physician would be most familiar with the players, along with any injuries or other medical conditions they may be dealing with. This seemingly straightforward situation becomes complicated if the out-of-state team physician actually treats a player while they are competing in Pennsylvania, because our state law requires physicians to be licensed in Pennsylvania in order to practice here. Thus, under the letter of the law a duly licensed out-of-state team physician who has an established physician/patient relationship with the team’s players, and who may be treating them for anything from asthma to postconcussion follow-up to a sore knee, technically must stand aside and allow a Pennsylvania-licensed physician, who likely doesn’t know the players at all, to treat them when the team is playing in Pennsylvania. In order to address this situation, 21 states currently allow for visiting team physicians to practice in their state without meeting home state licensing requirements. As indicated above, Pennsylvania is not among them. However, Sen. Jake Corman (R-Centre County), whose district includes Penn State’s main campus in State College, has introduced legislation that would ease our physician licensing requirements in those circumstances. SB 685 and 686 (one for MDs and one for DOs) provide that any visiting team physician who is licensed in his or her home state and has an agreement with a sports team to provide care for the team while traveling, may treat the team’s players while they compete in the Commonwealth without a Pennsylvania license.
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Specifically, under the bills a physician who is licensed in good standing to practice in another state is exempt from the licensure requirements of Pennsylvania’s Medical Practice Act and Osteopathic Medical Practice Act while practicing in the Commonwealth if either of the following apply: (1) The physician has a written or oral agreement with a sports team to provide care to the team members and coaching staff traveling with the team for a specific sporting event to take place in the Commonwealth, or (2) The physician has been invited by a national sport governing body to provide services to team members and coaching staff at a national sport training center in this Commonwealth or to provide services at an event or competition in this Commonwealth which is sanctioned by the national sport governing body (think Little League World Series) so long as: (i) The physician’s practice is limited to that required by the national sport governing body, and (ii) The services provided by the physician must be within the area of the physician’s competence.
A physician who is exempt from Pennsylvania licensure under the bills would not be permitted to provide care or consultation to any Commonwealth resident other than those specifically allowed by the legislation, or practice at a health care clinic or health care facility, including an acute care facility. The Senate Consumer Protection and Professional Licensure Committee approved the bills without objection on Sept. 17, and the measures could receive consideration by the full Senate in the near future. J. Scot Chadwick is legislative counsel for the Pennsylvania Medical Society.
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The Art of Chester County
The Art of
Chester County BY BRUCE A. COLLEY, DO
On Cover: “Yellow Roof” oil on canvas “When I returned to southeast Pennsylvania from living in Northern California for 41 years, I was horrified to see the disappearance of the farms in Northern Chester County. It occurred to me that my greatest sadness was the removal of our heritage bank barns. It was kind of coincidental that I started painting their portraits. The barns themselves inspire me.”
f note, the “Art of Chester County” past featured artists have nearly all, somewhere in their works, featured a barn. But Sherry McVickar has made barn portraits her personal oeuvre. Before 100 years ago each farm’s barn was a storehouse of all they needed to survive. It held the hay and feed for the animals. The grain, potatoes, onions, apples and other stores for the winter, as well as all the tools and machinery needed to farm. All rural areas have barns on the farmstead. But Chester County possesses, like no other county in the United States, the widest variety and most evolved expression of barn structures. Not that they are complex, they are not. The Southeastern Pennsylvania bank barn is a genius of simplicity, but lends itself to an infinite expression of form. Stone and wood and combinations of stone and wood. Examine the stone, and you will know of just what geology is beneath the farm stead. Perhaps granite, limestone or serpentine, among a dozen other stones, as Chester County has the most complex geology of any county in the United States. The timbers reveal the species of the virgin forest that stood on the farm. Giant beams of oak, chestnut or poplar. Even the 200-year-old cement holding the stone together will reveal the source of the most local limestone quarry. McVickar was born and raised on the Philadelphia Main Line, then studied art at Earlham College and Sarah Lawrence College. Subsequently, she has studied landscape and portrait painting in the United States, Italy and France. Inspired by the conversion of farms to developments and the loss of Chester County barns, McVickar, for the past ten years, has focused on recording, with her art, the Pennsylvania bank barn. And through her art, is active in efforts to help preserve these gracious and timeless structures. McVickar’s art is found in private collections worldwide, and in art shows nationwide. Enjoy her renderings, and perhaps you will recognize one from your own neighborhood. Bruce A. Colley, DO, is vice president of the Chester County Medical Society.
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Rock Raymond Road Downingtown oil on board “Heart-warming Pennsylvania bank barn.” Haskell’s Barn oil on board “A family barn near Chadds Ford.”
Wyeth 1—McVickar 2 oil on board “Painted from inside the same vantage point as Andrew did his; but he had only ONE bucket to depict.”
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PHP Evolves to Address Modern Physician Burnout BY JON SHAPIRO, MD, MEDICAL DIRECTOR
Physicians’ Health Programs (PHP), a program of The Foundation of the Pennsylvania Medical Society, provides support and advocacy to physicians struggling with addiction or physical or mental challenges. The program also offers information and support to families of impaired physicians and encourages their involvement in the physician recovery process. The PHP, embarking on its 30th anniversary, is funded by grants and contributions from physicians, hospitals, and others interested in physician health issues. PHP assists all physicians (MDs and DOs), physician assistants, medical students, dentists, dental hygienists, and expanded function dental assistants. CHESTER COUNTY
As we are approaching our 30th anniversary at the Pennsylvania PHP, it is natural for us to undergo reflection and self-examination. Our main mission has and will continue to be the “care and feeding” of the recovering doctor. We are expanding our focus as we view the condition of the modern physician. As medical director, I have been called upon to examine and lecture about some areas that affect the practice of medicine in the Commonwealth of Pennsylvania in the 21st century. Once I get over the initial terror of stage fright, lecturing can be an educational experience. I only hope my audiences learn as much from me as I do from them. For the last year or so, I have spoken at several hospitals about physician burnout and stress. The increased attention to physician burnout reflects the multiplicity of stressors faced by modern health care professionals. Burnout Burnout is defined by the presence of overwhelming physical and emotional exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment. Burnout seems to have increased in prevalence. For a complete discussion of physician burnout and resources including a blog and CME presentation produced by the Pennsylvania Medical Society, visit www.pamedsoc.org/lifeofmedicine. I would like to share what some Pennsylvania doctors are saying about burnout. In Erie, doctors told me they feel in conflict with a large health system. Large health care systems provide economies of scale and bargaining power, but small hospital staffs are characterized by a warmth and camaraderie 20
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FOR MY GROWING MEDICAL PRACTICE NEEDS
that may be lost in larger organizations. Local medical staff influence easily becomes diluted and ineffectual. One hospital in Philadelphia endured more than the usual pain of breaking in an electronic health record. When they found that they had purchased an inferior product they had to suffer the frustrations and lost productivity of learning a second EHR within a single year. Other common complaints are EHRs that don’t communicate with one another and that clinicians spend more time viewing screens than faces. A practitioner in central Pennsylvania sold his practice to his local hospital. When he began to work as an employed clinician, he found that his values and those of the health care were not in accord. While his priorities had always involved the health of his patients and long-term relationships, the hospital system seemed to prize aggressive coding and billing. My ex-partner in a primary care practice wants to know why pharmacies and urgent care centers are allowed to skim off the easy cases when they aren’t responsible for continuity of care. Anyone can treat a sore throat, but only the family doctor will be there when hand holding is needed as much as pills. Physicians are drowning in the alphabet of regulation. It is hard to swallow so many abbreviations — PQRS, M.U., EMR, PCMH, OMG. Okay, the last one isn’t real but the point is clear. Every minute we spend on charting, reporting and regulations is a minute less that we spend with our patients. The subjective experience of being sued in a malpractice case is an earth-shattering event. It penetrates to the core, eroding confidence and inducing depression. It contributes to the waste of medical resources through the defensive practice of medicine. Our response to stress and burnout may be simple if not easy. Live the life you suggest for your patients. Eat right. Exercise regularly. Sleep a wholesome full night. Try generally to balance your profession with time spent with family and hobbies and community. Concentrate on the wonderful core of medicine: the doctor-patient relationship that called you to this illustrious career. We are privileged to be able to serve our patients in a therapeutic, trusting relationship and study the fascinating sciences of life. For more information, visit www.foundationpamedsoc. org. C
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Review of Pennsylvania Opioid Prescribing Guidelines and Legislation BY KIMBERLY STONE MD, MPH
pioid use, abuse and overdose continue to make headlines in Chester County, Pennsylvania and the United States. In the first six months of 2015, Naloxone was administered by municipal police 21 times, with 19 overdose reversals documented. The Chester County Overdose Prevention Task Force hosted the county’s first overdose prevention symposium on October 13. The District Attorney’s Office, Probation, and Drug and Alcohol Services continue to work together to divert those in need to treatment, not incarceration. As health care providers, what can we do to combat opioid use, abuse and overdose? 1. Ask questions! If you are considering prescribing an opiate, benzodiazepine or any other addictive medication, ask the patient about past and current substance use and abuse. The National Institute on Drug Abuse (NIDA) has information on validated screening tools, such as a Drug Abuse Screening Test with a 10-item brief screening tool (DAST10) that can be administered by a clinician or selfadministered. Each question requires a yes or no response, and can be completed in less than eight minutes. This tool assesses drug use, not including alcohol or tobacco use, in the past 12 months. 2. Educate your patients about risks of drug dependence, how to take medication safely and how to safeguard medication for use by others, either intentionally or unintentionally. To assist physicians in discussing pain management with their patients, the
Pennsylvania Medical Society (PAMED) created the Opioid Prescription Checklist. Go to pamedsoc.org/store/checklist for more information on this tool. 3. Follow best practice for prescribing opioids. Some current best practices: • Prescribe low quantities and lowest effective dose. • Consider complementary, non-pharmacologic treatments. • Discuss with patients how to safely discontinue and dispose of opioids. • Counsel against combining opioids with other medications and drugs, especially alcohol, benzodiazepines and other sedatives. • Consider providing naloxone for patients at high risk of overdose. (This includes patients who are on multiple medications, elderly, known heroin or other illicit drug use.) • Follow patients closely for treatment response, adverse effects and addiction risk. For more information on best practices, PAMED and the Commonwealth of PA created the Pennsylvania Guidelines on the Use of Opioids to Treat Chronic Non-Cancer Pain and Pennsylvania Emergency Department (ED) Pain Treatment Guidelines. You can find these documents at pamedsoc.org. The Centers for Disease Control and Prevention (CDC) also summarized current guidelines in the Common Elements in Guidelines for Prescribing Opioids for Chronic Pain which can
Stone GATEWAY INTERNAL MEDICINE AT BRANDYWINE WELCOMES
be accessed at http://www.cdc.gov. 4. Familiarize yourself with legislation. In 2014, Pennsylvania legislators enacted some laws regarding opioid use and overdose. Two notable acts are: a. Act 191 — Allows physician access to the Controlled Substances Database. This would allow physicians to query the database by DEA number to look at patient medication history and the prescribing physician before initially prescribing or if there is concern of drug abuse or diversion. Currently there is no funding for this legislation, but this may change in 2016. b. Act 139 — This law is attempting to increase reporting and treatment of overdose by increasing Naloxone availability and includes a “Good Samaritan” clause. It allows administration of Naloxone by first responders and allows prescribing of Naloxone to friends or family members of those at high risk of overdose. It also provides immunity from prosecution for an individual who prescribes or administers Naloxone in good faith and immunity from prosecution for an individual who reports an overdose and stays with the victim until help arrives. 5. Know about available resources in Chester County. Chester County Drug and Alcohol Services provide a myriad of prevention and treatment services. For information and referrals call 1-866-286-3767 or visit www.chesco.org. Health care providers are at the front lines of the battle to decrease opioid use, abuse and overdose. They are a crucial part of the community based, multidisciplinary approach to combating addiction in Chester County. The Chester County Health Department and Drug and Alcohol Services are here as a resource to help you provide the best possible care for your patients, and impact the health of Chester County.
DR. EUGENE FERGUSON
OUR FAMILY taking care of
YOUR FAMILY Eugene J. Ferguson, MD
Gateway Internal Medicine at Brandywine was pleased to welcome Dr. Eugene J. Ferguson to our practice in February of this year. Dr. Ferguson received his medical degree at Georgetown University School of Medicine and is board certified in Internal Medicine. Dr. Ferguson maintained an internal medicine practice for 11 years in Lewiston, Maine. He has been recognized by NCQA for heart, stroke and patient centered medical home recognition programs. He also has been recognized in coronary artery disease, cardiac, diabetes and hypertension care by Bridges to Excellence. Dr. Ferguson greatly enjoys primary care medicine and values developing strong physician-patient relationships.
OFFICE HOURS: Monday 7:30am – 4pm Tuesday 7:30am – 4pm Wednesday 7:30am – 4pm Thursday 7:30am – 4pm Friday 7:30am – 4pm
ADULT BEHAVIORAL HEALTH RISK FACTORS (2010-2012) (Includes: Chester County Only) Ever told they have diabetes:
Overweight (includes obese):
No health insurance (ages 18-64):
Visited a doctor in the past 2 years for a routine check-up:
Current smoker: Ever tested for HIV (ages 18-64):
Resources: 1. PA State Coroners’ Association Drug Report 2014 2. Heroin: Combating this Growing Epidemic in Pennsylvania, September 2014 3. www.cdc.gov/drugoverdose, accessed 9-30-2015.
Currently has asthma:
Kimberly Stone, MD, MPH, is the Public Health Physician of Chester County. She is a pediatrician and volunteers at Community Volunteers in Medicine in West Chester. You can contact her at 610-344-6230 or email@example.com.
VISIT US AT: Gateway Internal Medicine at Brandywine Vitasta Bamezai, MD Eugene J. Ferguson, MD 217 Reeceville Rd, Suite C Coatesville, PA 19320 Phone: 610-384-5110 Fax: 610-594-2625
8 (5-11) 10 (7-13) 38 (31-46)
Fair or poor general health:
Needed to see a doctor but could not due to cost in the past year:
Notes: Data are based on 2010-2012 annual sample surveys of Pennsylvania adults. CI= 95% Confidence Interval. 2010-2012 data does not include information collected from individuals contacted by cell phone. Additional state or county/regional data are available at www.health.state.pa.us/stats/. 23
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State Senator Andy Dinniman Our Friend In Harrisburg BY MIAN A. JAN, MD
s a doctor, a nurse or anyone in the medical field, you have a chance to meet and interact with a diverse group of people from all walks of life. In treating patients and working with colleagues, we have a unique opportunity to build invaluable relationships with members from throughout the entire community. That experience is one of the many rewards of our vocation and I know it has been an important part of my training and development as a medical professional. During the course of my 28 years of practice here in Chester County, I have been truly fortunate to call many of my patients, colleagues and neighbors friends. But today, I am going to focus on just one individual who continues to stand out in working to bring people together to make a difference in our community — state Senator Andy Dinniman. Because of my involvement with the medical society, I have had close contact with legislators and I have always said we, in Chester County, are blessed for we have decent, honest and hard working legislators, who regardless of their affiliations, work toward the betterment of the citizens of Chester County. Unlike some other areas of the rest of the country, we take great pride in the fact that we have worked together with our legislators to keep Chester County at the top of 67 counties in the commonwealth as far as health and patient care is concerned. I first came to know Andy through my work with the Chester County Medical Society and the more I got to know about him and his efforts, the more I liked him. First as a county commissioner and now as a state senator, Andy’s work exemplifies the values that have come to define us as citizens of Chester County and practitioners of medicine: compassion, cooperation, consistency and commitment. The first thing I learned about Andy is that he never hesitates to step up to help those in need. For more than two decades, Safe Harbor Homeless Shelter has provided vital housing, meal and career training services for residents who have fallen on hard times. But back in 1992, it was just an idea. Homeless individuals were left to fend for themselves on our streets and in our parks. Then county commissioner,
Sen. Andy Dinniman
Sen. Any Dinniman and Mian Jan, MD, at the Phoenixville Foundry
HL Perry Pepper, past president of Chester County Hospital, Wiggie Featherman Chester County Hospital board member, Sen. Andy Dinniman and Mian Jan, MD at presentation of check to Chester County Hospital CHESTER COUNTY
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Mian Jan, MD, Amber Jan, MD, Hon. Ronald Nagel & Sen. Andy Dinniman award ceremony at the Chester County Justice Center Andy assembled a task force to address homelessness that ultimately resulted in the formation of Safe Harbor. Believe it or not, the idea of a permanent homeless shelter was not popular with every business owner in downtown West Chester. However, Andy brought all parties to the table to come up with a solution that works. Around that same time, Andy helped establish the Chester County Gleaning Program (now Chester County Food Bank) to provide fresh locally grown food to the hungry. Today, the organization feeds tens of thousands of families, children and residents in need. Hunger and homelessness are solvable problems. But Andy also contributed towards other important public healthrelated issues. Last year, Andy succeeded in passing legislation to help ensure all Pennsylvania schools have Automated External Defibrillators (AEDs) on hand in case of sudden cardiac arrest. It took several years with debates over cost-effectiveness and implementation. Still, Andy worked with colleagues on both sides of the aisle and assembled a grassroots coalition, led by the Aidan’s Heart Foundation, to get the bill across the finish line. Andy has also crossed party lines to pass the important Sunshine Act. As president-elect of the medical society, I am neither a card-carrying Democrat nor a Republican. Instead, I consider myself and our society non-partisan; we support any just cause. One thing Andy will tell you is that more often than not, the biggest issues, the most serious challenges facing Pennsylvania and our nation are neither Republican nor Democrat. They are problems that affect everyone. The key is to break through politics and get to the common denominator which is also our goal at Chester County Medical Society. How does he do it? Andy follows a consistent and proven approach to solving problems by bringing people together and initiating an open and honest dialogue. He is immersed in the community, regularly attending events and functions in order to stay in touch with his constituents. He is always ready to listen and quick to act. Be it taking on the bureaucracy in Harrisburg, challenging the growing role of standardized testing in schools, or cutting through red tape to get new road, bridge and highway projects completed ahead of schedule, Andy continues to be an extremely productive and effective leader. In fact, this fall he plans to take on a number of initiatives involving health, such as addressing CHESTER COUNTY
Mian Jan, MD, Sen. Andy Dinniman and artist Krishna Swamy unveiling of the bronze metallic plaque engraved with the US Constitution and the Declaration of Independence to the Chester County Historical Society the impacts of Lyme disease in our region, working to implement the recommendations of the Pennsylvania State Plan for Alzheimer’s disease, and introducing legislation to support our free health clinics like Community Volunteers In Medicine, the Clinic in Phoenixville and Project Salud. Andy has also been involved in helping Chester County Hospital and was responsible for obtaining $100,000 in grant money a few years ago. On a personal level I know how hard Andy works to promote interfaith dialogue and to establish bridges across different faiths and integrate minorities into various programs and activities. I know I can always call on Andy for any issue that affects our medical community. When I was appointed to the Governor’s Advisory Commission on Asian American Affairs, I worked closely with Andy on many occasions. Andy is someone we can count on; he attends almost every one of our society’s annual clam bake dinners in order to stay in touch with issues involving the medical community and share ways he can help. Through his efforts, initiatives and work as a public official, Andy remains committed to protecting and promoting the ideals and values that continue to make Chester County such a great place to call home. As both medical professionals and citizens, we can all continue to learn a lot from him. And that is why I am proud to call Andy Dinniman both my friend and my state senator. Dr Jan is an interventional cardiologist practicing in Chester County and president-elect of the Chester County Medical Society
Sen. Andy Dinniman and Mian Jan, MD, at the CCMS Clam Bake 25
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CCMS Hosts Annual Clam Bake L
egislators and physicians mingled and exchanged points of view on various issues at the Chester County Medical Society (CCMS) Annual Meeting and Clam Bake on Friday, September 11, 2015 at the Radley Run Country Club. Following a sumptuous dinner, CCMS President Winslow W. Murdoch, MD, provided a brief update on the medical society and then recognized two Chester County physicians who have served the practice of medicine for 50 years as marked by their graduation from medical school.
Heidar K. Jahromi, MD – 50 Years of Service
Donald H. Cook, MD – 50 Years of Service Dr. Donald H. Cook received his Bachelor’s Degree, cum laude, from Albright College and then went on to study medicine at Hahnemann Medical College. After graduating, he did his internship at Santa Barbara General Hospitals before returning to Pennsylvania to do his residency in pathology at Lankenau Hospital. He was part of the medical staffs at Lankenau Hospital and Phoenixville Hospital for many years and also served as the Medical Director of the Blood Bank at Phoenixville Hospital.. Dr. Cook has served as a professor at Temple University School of Medicine, at The Pennsylvania State University and at Jefferson Medical College of Thomas Jefferson University. Dr. Cook served in the United States Navy Medical Corps Ready Reserve from 1965 – 1976, attaining the rank of Lieutenant Commander. He is certified by the American Board of Pathology in Anatomic and Clinical Pathology and belongs to a number of professional organizations. The Chester County Medical Society thanks Dr. Cook for his 50 years of service to medicine!
Dr. Heidar K. Jahromi graduated from Tehran University in September 1965 before coming to the United States in 1969. He spent two years doing his internship and medical residency in Detroit, Michigan, then began his neurology training at the University of Alabama in Birmingham. He then went to Georgetown University in Washington, DC and finished his fellowship at George Washington University. Dr. Jahromi moved to Pennsylvania in 1975, joining the Thomas Jefferson Medical College neurology program and was stationed in Coatesville teaching neurology residents. He entered private practice in Chester County in 1977. Dr. Jahromi has been a member of the Board of Directors of the Chester County Medical Society since 2013. Congratulations to Dr. Jahromi!
50 Years of Service - Heidar K. Jahromi Family with CCMS President Winslow Murdoch, MD
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Dr. Zimniski with 2015 Scholarship Winner Kamron Salvitabar
Chester County Medical Society Darlington Scholarship The Chester County Medical Society Darlington Scholarship was established as a tribute to, and in memory of, Dr. William Darlington, who was the president of the Chester County Medical Society from 1828 to 1852. The intent of this scholarship is to provide a $3,000 individual scholarship award each year to a West Chester University junior or senior undergraduate student who has conveyed an intent to attend a U.S. Medical school and who is a current resident who grew up in Chester County who possesses the aptitude, grades and character of an ideal medical school candidate and is in need of financial assistance to help cover the cost of completing undergraduate work at West Chester University. The 2015 scholarship winner is Kamron Salavitabar. Kamron has been attending West Chester University since the summer of 2013 and is majoring in physics. He currently works at West Chester researching the interactions of small boron clusters with oxygen molecules and the interactions of semi-conductors with nanoparticles as part of the undergraduate research program. Kamronâ€™s goal is to challenge himself to acquire the skills necessary to help others through the power of modern medical knowledge. CCMS President Winslow W. Murdoch welcomed Dr. Steve Zimniski of West Chester University to the podium to present him with a check for the West Chester University Foundation to be used for the benefit of Kamron Salavitabar before presenting Mr. Salavitabar with a certificate honoring his achievement. The Chester County Medical Society congratulates Kamron Salavitabar and wishes him great in his future endeavors. Among the other special guests for the evening were Senator Andy Dinniman; Representatives Becky Corbin, Warren Kampf, and Dan Truitt; Commissioners Michelle Kichline and Terence Farrell; and District Attorney Thomas Hogan. Each took the opportunity to make a few remarks to the audience. Karen Rizzo, MD, President of the Pennsylvania Medical Society, was also present and shared a few words.
Representative Kampf speaking with CCMS President Winslow Murdoch, MD and PAMED President Karen Rizzo, MD
Dr. Steve Zimniski and Dr. Winslow Murdoch present Scholarship Winner Kamron Savitabar with a certificate
President Winslow Murdoch, MD addresses the galthering
Representative Warren Kampf addresses the audience CHESTER COUNTY
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CCMS Membership: Resources You Need Building Better Practices and Stronger Communities One Member at a Time
PAMED and Chester County Medical Society (CCMS) membership supports you and your community in many ways. Membership in both Societies provides an indispensable resource for information, continuing education, distance learning, professional contact, and networking. PAMED offers practice management courses and refreshers on patient care. As leadership development is hard to find, PAMED presents webinars, online courses, conferences, and seminars for the benefit of its physician members. PAMED advocacy has an inside track on legislative and executive proposals on need-to-know issues so we can keep members like you fully informed. CCMS works collaboratively with PAMED, but its focus is on the local Chester County community. Some specific benefits of membership in CCMS include: • An opportunity to sign up for the PAMED “Find a Physician” program to promote your practice • Representation with local legislators • An annual meeting which provides you with the opportunity to impact your Society’s activities and goals • A legislative dinner, known as “The Clam Bake,” where you can meet with local legislators in an informal setting • An automatic subscription to Chester County Medicine magazine, the Society’s new twist on its longtime quarterly publication, and • Access to DocBookMD®, an exclusive HIPAA-secure messaging application for smart phone and tablet devices.
For additional information about becoming a PAMED and CCMS member, visit http://www.pamedsoc.org/membership and click “Join PAMED,” email firstname.lastname@example.org, or call ( (717) 909-2684. To renew your current membership, visit http://www.pamedsoc.org/membership and click “Renew your membership.”
Membership is available only for physicians licensed to practice in Pennsylvania.
APPLICATION ___________________________________ County Medical Society (You may choose to be a member of the county in which you either live or work.) 777 East Park Drive, PO Box 8820, Harrisburg, PA 17105-8820 717-558-7750 (Phone) 717-558-7840 (Fax) Full Name (Print): ___________________________________________________________________________________ Last
Email Address: ____________________________________________
For mailing, please use: Office Address Home Address
Area Code & Phone Number
Area Code & Phone Number Area Code & Phone Number
Preferred Communication: Email Fax Mail
BIOGRAPHICAL DATA Gender: Male Female EDUCATION
Date of Birth: ____________ Spouse’s Name:
BEGIN DATE END DATE
FOR RESIDENCY & FELLOWSHIP, YOU MUST GIVE ACTUAL OR PROJECTED ENDING MONTH & YEAR BEGIN DATE END DATE Residency__________________________________________________________________ Fellowships_________________________________________________________________ License: PA No. Date Issued
__________ -_________ __________ -_________
PROFESSIONAL DATA Present Type of Practice (Check Appropriately): Owner of Physician Practice Group Name ___________________________________________________ Employed by Hospital/Health System Employed by Physician(s) Group Name ___________________________________________________ Employed by Industry or Government Independent Contractor Other (specify) _________________________________________________ Specialty: Within the last 5 years, have you been convicted of a felony crime or is your license to practice medicine actively suspended or revoked? If yes, please provide full information. ___________________________________________________________
___________________________________________________________ ___________________________________________________________ DATE RETURN TO: ATTENTION:
SIGNATURE Pennsylvania Medical Society Member Services
QUESTIONS? Call (800) 228-7823
717-558-7840 777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820
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To publi new CC sh photos of physicia MS membe r ns, p digital lease submit c op admin @chest ies to ercms.o rg
Membership News & Announcements
Members in the News
We would like your help in touting the accomplishments of Chester County physicians. If you receive an award or certification or have other good news to share, please submit it to email@example.com.
Frontline Groups with 100 percent membership in CCMS
Chester County Medical Society Board Meeting Date: Tuesday, January 5, 2016, 5:30 PM Location: Chester County Hospital
are the backbone of the society. We are thankful for their total commitment to CCMS. This list reflects the Frontline Groups as of October 7, 2015.
Chester County Medical Society Board Meeting Date: Tuesday, March 1, 2016, 5:30 PM Location: Chester County Hospital
Academic Urology-West Chester Brandywine Gastroenterology Assoc Ltd
Chester County Medical Society Board Meeting Date: Tuesday, May 3, 2016, 5:30 PM Location: Chester County Hospital
Cardiology Consultants of Phila-Main Line
Chester County Medical Society Board Meeting Date: Tuesday, September 6, 2016, 5:30 PM Location: Chester County Hospital
Chester County Eye Care Associates PC
Cardiology Consultants of Phila-Paoli Cardiology Consultants of Phila-West Chester
Chester County Otolaryngology & Allergy Associates Clinical Renal Associates-Exton
Chester County Medical Society Board Meeting Date: Tuesday, November 1, 2016, 5:30 PM Location: Chester County Hospital
Family Practice Associates of West Grove Gateway Endocrinology Associates Gateway Family Practice Downingtown Gateway Internal Medicine Of West Chester Gateway Medical Colonial Family Practice Gateway Myers Squire & Limpert Great Valley Medical Associates PC
Ask a Physician: If you have any medical
Levin Luminais Chronister Eye Assoc
questions for a physician member of the Chester County Medical Society, please submit an inquiry to firstname.lastname@example.org with â€œAsk a Physicianâ€? as the subject. Your question will be forwarded to a physician and may be featured with an answer in a future issue of the magazine.
Main Line Dermatology Medical Inpatient Care Associates Plastic & Reconstructive Surgery of Chester Co PC Village Family Medicine West Chester GI Associates PC
Temple cardiovascular surgeons now perform procedures at Brandywine Hospital. To provide patients with easier access to advanced heart and lung care, cardiovascular surgeons from the Temple Heart & Vascular Institute are now performing surgery at Brandywine Hospital under the leadership of Medical Director of Cardiovascular Surgery Ravishankar Raman. Dr. Raman completed his fellowship training at Mayo Clinic and Hahnemann University Hospital, and his residency in the United Kingdom. He has performed thousands of open heart surgeries, including minimally invasive techniques. Our program takes an integrated approach across medical disciplines and care settings to truly provide patient-centered care. And patients who require very complex procedures can easily access Temple University Hospital. The surgical team performs a wide range of surgeries at Brandywine Hospital, including: Myocardial revascularization • Beating heart surgery Total arterial revascularization • Surgery for valvular heart disease Surgical treatment for atrial fibrillation • Non-cardiac thoracic surgery, including VATS, lobectomy and lung surgery for thoracic oncology Why have we taken this important step? We believe hospitals should work together for patients. For questions, call the CV Coordinator at 610-383-8434.
201 Reeceville Road, Coatesville
Ravishankar Raman, M.B.B.S., F.R.C.S. Board Certified in Cardiac Surgery Medical Director of Cardiovascular Surgery, Brandywine Hospital Assistant Professor of Clinical Surgery, Lewis Katz School of Medicine at Temple University Independent Member of the Medical Staff at Brandywine Hospital
CROZER-KEYSTONE LISTENED. COMING IN EARLY 2016… CROZER-KEYSTONE AT BROOMALL
You wanted a convenient, patient-friendly facility with a wide range of healthcare specialties. You wanted well-trained caregivers and the latest technologies. You wanted access to things like free covered parking and concierge services — not to mention a total dedication to your satisfaction. You spoke. We listened. Introducing Crozer-Keystone at Broomall: a comprehensive outpatient services facility offering full-service cancer care, urgent care, imaging, an integrated women’s center, primary care, onsite laboratory, and a range of specialty services. Everything you need—in one state-of-the-art location.
FREE COVERED PARKING CONCIERGE SERVICES CONVENIENTLY LOCATED NEAR HAVERFORD SURGERY CENTER and PHILADELPHIA CYBERKNIFE 30 LAWRENCE ROAD CROZERKEYSTONE.ORG/BROOMALL
C R O Z E R - K E Y S T O N E at B R O O M A L L Delaware County’s New Standard in Care
Published on Nov 16, 2015
Published on Nov 16, 2015
Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Society’s mission has evol...