Chester County Medicine by Hoffmann Publishing Group

Fall 2014

THE ART of Chester County Works of

Mary Smith

PROTECTING PATIentS

f e at u r e d o n pa g e 1 8

IN CHESTER COUNTY FROM Metabolic Syndrome:

ONE-SIZE-FITS-ALL HEALTHCARE Ailment of the SODIUM RESTRICTION: Video Generation

A TIME-HONORED DOGMA OR AN EVIDENCE-BASED PURSUIT? End-of-Life Discussions

CROZER-KEYSTONE HEALTH SYSTEM WELCOMES NEW SPECIALISTS Crozer-Keystone is proud to announce the addition of these well-trained and experienced new specialists to its outstanding staff. All physicians are accepting new patients.

Allison Aggon, D.O.

Kimberly Arkebauer, D.O.

Sunny Fink, M.D.

Charles M. Geller, M.D.

Breast Surgery

OB/GYN

Kidney Transplant and Hepatobiliary Surgery

Chief, Department of Cardiothoracic Surgery

Alan Graham, M.D.

Michelle Mergenthal, M.D.

Omer Nasir, M.D.

Meaghan Nelsen, D.O.

OB/GYN

General Surgery

OB/GYN

Meredith Osterman, M.D.

Hayley Solomon Quant, M.D.

Hemchand Ramberan, M.D.

Lloydia Reynolds, M.D.

Hand Surgery

Maternal Fetal Medicine

Director of Advanced Endoscopy

OB/GYN

Jason Schafer, M.D.

Tameka Sisco, D.O.

Aley Tohamey, M.D.

Sergey Zhitnikov, M.D.

Endocrinology

OB/GYN

Bariatric Surgery

General Surgery

Chief, Department of Surgery

WITH MULTIPLE AREA LOCATIONS TO SERVE YOU

FOR MORE INFORMATION ABOUT CROZER-KEYSTONE HEALTH SYSTEM,

VISIT WWW.CROZERKEYSTONE.ORG

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ENDOCRINOLOGY

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INTERNAL MEDICINE

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in Chester and now Delaware County, has been serving our community since 1996. Gateway strives to provide the highest quality primary and specialty care with a focus on our patients’ wellbeing and health.

Our 43 physicians and nurse practitioners provide quality care Gateway Medical Associates, Chester County’s largest independent physician practice, has beenGATEWAYDOCTORS.COM serving our community since 1996. Gateway strives to provide the highest quality primary and specialty care with a focus from any of and our 10 convenient on our patients’ wellbeing health. Our 35 physicians and nurse practitioners provide quality care from any of our 8 convenient locations throughlocations throughout the Counties. out the County.

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Geriatric Medicine

Internal Medicine

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If you have any medical questions for a physician member of the Chester County Medical Society, please submit an inquiry to

admin@chestercms.org with “Ask a Physician” 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.

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Contents FALL 2014

2013-2016 CCMS OFFICERS

of Delegates 16 House Addresses Issues

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 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 Society’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 karen@hoffpubs.com

18 20 THE ART of Chester County Features

Metabolic Syndrome

10 Answers to Mcare 31 Cancer Incidence in Chester County Settlement Questions 32 CCMS Membership ® 12 Foundation’s LifeGuard Program Offers Professional CPR 16 House of Delegates 6 President’s Message Addresses Maintenance of Certification, Ebola, and 8 PAMED Legislative Update E-Cigarettes 18 The Art of Chester County 17 Could It Be Ebola? 30 Hospital Profile 20 Metabolic Syndrome: 34 Membership News & Announcements Ailment of the Video Generation 22 End-of-Life Discussions Correction We express our apologies for the error that appeared 24 CCMS Hosts Annual Clam with the article titled, Case Study: Woman with Bake Cardiac Arrest and Prolonged Coma Secondary to 26 DocbookMD Member Hypoxic Encephalopathy Caused by Viral Myocarditis, authored by M. Kouresch Jan and Mian A. Jan, Benefit Provides Secure MD., in our Summer 2014 issue. The first sentence Mobile Communication should have read, ”A 43-year-old Caucasian female Platform for Efficient Workflow was brought to the emergency room following a 28 Dr. Jan Honored for cardiopulmonary arrest witnessed by her husband who then began cardiopulmonary resuscitation and Contributions to Chester called emergency medical services.” County

In Every Issue

Chester County Medicine is published by Hoffmann Publishing Group, Inc. Reading, PA I HoffmannPublishing.com I 610.685.0914 I for advertising information: karen@hoffpubs.com

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Presidentâ&#x20AC;&#x2122;s Message

Presidentâ&#x20AC;&#x2122;s Message E

arlier this year, I began making a running list of things that positively and negatively affected day-to-day practice and altered our ability to care for those in the community. On the positive side, our community provides an incredibly dedicated and rich medical specialty, hospital, ER, and urgent care resource and support structure. Dedicated physicians, nurse practitioners, physician assistants, nurses, pharmacists, medical assistants, lab technicians, therapists, home health providers, office staffers, and other health professionals are interacted with locally on a daily basis. At the hyper-local level, where we have direct relationships and mutual respect for our local care teams, the system seems to work quite well. The converse is encountered when we interact with other groups that are largely operating at a regional or national level. Unintended consequences abound under the rules and regulations spawned by large institutions (remember my run-on sentence paragraph from two issues ago) that seem disconnected from the process of delivering care at the individual level. They create the ever-increasing number of pebbles in our shoes, which make the march of continuing in our profession less and less sustainable. Physicians in practice easily diagnose these mounting thirdparty pebbles, and complain about their mounting discomfort. We problem solve and collaborate with our local network of care providers, with a phone call or email, but we fail to devise

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Murdoch

a cohesive solution to the overreaching challenges. An individual or small group will not have much influence in dealing with institutional players. Don’t get me wrong, an empowered individual with good communication skills and collaborative insight and ideas is what drives most change. We need these voices of reason to effect change. Without a substantial collective of support, however, inspired individuals are largely ineffective at articulating or solving systemic problems. Organized medicine—institutions such as the American Medical Association as well as state and county medical societies—have had a general decline in member engagement over the last two decades. Those that consistently remain active in volunteer leadership positions have been slowly dwindling in numbers. Age attrition, a growing sense of futility, and increased employee status of physicians (especially younger physicians, who believe that their employer will advocate for their profession) are significant factors in this decline. How then do we ignite positive change? One immediate catalyst will be front and center in the upcoming year. The Pennsylvania Medical Society (PAMED) just had a substantial one-time financial gain.

Through hard work and good fortune, KEPRO, a standalone, wholly owned subsidiary of PAMED (not founded or funded by membership dues) has been sold to a private equity firm. The sale frees up more than $40 million that can now be appropriated to change. This change is to be directed by you, to support innovation toward a more sustainable practice environment and other projects that advocate for healthier communities. Things are changing rapidly, and we need you to get involved by lending a voice, volunteering for a special project, and adding to the collective that is needed to ignite change, not just more rhetoric. Please contact me or PAMED to connect to the collaborative and find a niche where your voice, leadership, expertise, and passion will become the change.

Winslow W. Murdoch, MD, practices family medicine in West Chester. He is president of the Chester County Medical Society. Contact Dr. Murdoch at winslowmurdoch@gmail.com.

At Advanced Hearing Care, we take a patient-focused and clinical approach to audiology and hearing loss. Did you know that: • There is a direct correlation between hearing loss & diabetes • Researchers have found a link between age-related hearing loss and cognitive decline • Relationships, self-image, and social life greatly improve with hearing loss treatment • 90 percent of hearing losses can be effectively treated with hearing aids Joan D’Alessandro, Au.D. Annette Peppard, Au.D. Kelly Flaherty, Au.D. Paoli • 30 S Valley Rd, Ste 206

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PAMED Legislative Update

Pennsylvania Medical Society Quarterly Legislative Update

ctober 20, the last scheduled voting day for the 2013-2014 legislative session, brought good news for medicine as a result of the groundwork laid by physician advocates and the Pennsylvania Medical Society (PAMED) during the two-year session. As the legislative year closed, the legislature sent House Bill (HB) 1655 to the governor. The bill will create a patient-centered medical home advisory council to ensure that members of the health care team work together in a coordinated, efficient approach to ensure that patients receive the highest quality of health care, at the lowest cost, and resulting in the most optimal outcomes. In addition, the governor received HB 803 which allows schools to maintain a supply of EpiPens in a safe, secure location, and for students who are having an allergic reaction to self-administer the injection or have it done by a trained employee. Governor Corbett subsequently signed both bills into law.

This last hurrah followed several weeks of legislative victories. CHESTER COUNTY

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Good Samaritan Law On September 30, Governor Corbett signed SB 1164, providing Good Samaritan immunity to individuals who seek to obtain aid for someone experiencing a drug overdose. This matters because individuals in the company of someone experiencing an overdose may have been using or selling drugs at the time and thus be reluctant to seek help for fear of facing legal trouble. The law removes this obstacle. The law also allows naloxone, a lifesaving opioid antagonist, to be prescribed to first responders and to friends and family members of persons identified as being at risk of experiencing a drug overdose.

Actions on Controlled Substances After a three-year effort, PAMED succeeded in obtaining an essential tool for physicians to identify doctor shoppers and combat opioid abuse. Senate Bill (SB) 1180 creates a controlled substance database in Pennsylvania, giving physicians better knowledge of prescriptions written for and filled by patients. Governor Corbett signed the bill into law on October 27. The database will be housed at the Department of Health, where it will be run by a board consisting of the Secretaries of Health, Human Services, Drug and Alcohol Programs, State, Aging, the Insurance Commissioner, the State Police Commissioner, the Attorney General, and the Physician General (if the Secretary of Health is not a physician). The board will aid prescribers in identifying atrisk individuals and referring them to drug addiction treatment programs, and will also refer information to the appropriate licensing board when the system produces an alert of a pattern of irregular prescribing or dispensing data. It will also create a written notice that prescribers and dispensers will use to let patients know that information regarding their prescriptions for controlled substances is being collected by the program. Prescribers will not be required to submit prescribing information to the program, but dispensers must electronically submit information to the program regarding each controlled substance dispensed, no later than 72 hours after dispensing a controlled substance. However, prescribers at a licensed health care facility who dispense controlled substances limited to an amount adequate to treat a patient for a maximum of five days, with no refills, are exempted from the requirement to submit that information to the program.

continued on page 11

For more information on the database, visit www.pamedsoc.org/database.

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PAMED Legislative Update

Answers to Mcare Settlement Questions On Oct. 16, the Pennsylvania Medical Society, in coordination with the Hospital and HealthSystem Association of Pennsylvania and the Pennsylvania Podiatric Medical Association, announced the settlement of our litigation regarding the Mcare Fund. This historic agreement means that $200 million will be returned to physicians, hospitals, and other health care providers who paid assessments into the fund. Of the $200 million: • $139 million will be returned in refunds for prior assessment overpayments. • $61 million will be returned via a reduction to the 2015 Mcare assessment. This litigation included our appeals of the 2009-2014 assessments and the challenge to the transfer of $100 million to the general fund from Mcare in 2009. The commonwealth has agreed to operate the fund on a pay-as-you-go basis going forward. This means that health care providers will not be required to put money into the fund until it is needed and the fund will not be able to build up substantial reserves such as those diverted in 2009. Here are answers to the most frequently asked questions so far: • Who is eligible for the refunds? Physicians will be eligible for a refund if they paid an Mcare assessment (or an assessment was paid for them) for any time during 2009, 2010, 2011, 2012, or 2014 (excluding 2013).

• When will I get my refund? The refunds likely will not be made until 2016 due to the extensive calculations required to determine the amount payable to each eligible health care provider. However, the 2015 assessment will be reduced by about one-third. • What address will my refund be sent to? When the refunds are ready to be sent to providers, physicians will receive a letter from Mcare, followed by a lump sum payment from the Treasury. The refunds for physicians will go to the physician’s license address, so physicians should make sure that this address is up-to-date. • Will I be required to remit my refund to an employer who wrote the check for my assessments? This will vary depending upon your circumstances. For example, even though an employer wrote the check, you may have ultimately borne the cost due to an overhead reduction from your compensation pool. The settlement does not impact any contractual or other obligation that a health care provider may have to remit a refund.

Get the latest information as more details become available at www.pamedsoc.org/mcare. CHESTER COUNTY

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continued from page 9

Disposal of Controlled Substances In addition, there now are more options for disposing of unwanted controlled substances. Under the Drug Enforcement Agency (DEA) final rule on the disposal of controlled substances, patients and other “ultimate users” will be able to dispose of their unwanted controlled substances through an expanded option of disposal programs provided by authorized collectors: take-back events, mail-back programs, and collection receptacles. The DEA defines an “ultimate user” as a “person who has lawfully obtained, and who possesses, a controlled substance for his own use or for the use of a member of his household or for an animal owned by him or by a member of his household.” In addition to ultimate users, the rule only authorizes two other groups to deliver controlled substances to authorized collectors for disposal: (1) a person lawfully entitled to dispose of a decedent’s property, if a person dies while in lawful possession of a controlled substance, and (2) long-term care facilities, on behalf of ultimate users who reside or have resided in the facility.

Letters to the Editor: If you would like to respond to an item you read in Chester County Medicine, or suggest additional content, please submit a message to

admin@chestercms.org with “Letter to the Editor” as the subject. Your message will be read and considered by the editor, and may appear in a future issue of the magazine.

Other Legislative Actions In addition, Governor Corbett recently signed several other laws that affect the practice of medicine: • HB 2204 provides early intervention and tracking services to homeless infants and toddlers. • HB 1907 requires hospitals to provide oral and written notice to patients about their outpatient status after they have spent a full day in the hospital outside of the emergency department. • HB 1846, set to take effect Dec. 26, 2014, will cap the reimbursement rate for drugs and pharmaceutical services in the workers’ compensation system at 110 percent of the original manufacturer’s average wholesale price, calculated as of the date of dispensing. Updates compiled by CCMS staff from Pennsylvania Medical Society sources. For updates on legislative and regulatory matters, visit the PAMED web site, www.pamedsoc.org and read the Weekly Capital Update blog.

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Features

Foundation’s LifeGuard® Program Offers Professional CPR

llentown-based Surgeon George W. Hartzell Jr., MD, FACS, enjoyed the combination of teaching, learning, training, and patient care for 33 years, but at age 65, he found that his feet were hurting at the end of the day, and getting up at 3 a.m. was losing its charm. “I was still working a full schedule, but I noticed that it took me five minutes longer to perform a routine hernia repair. This change was noticed only by me and by my favorite scrub nurse, but it would only be a matter of time before others would take an interest in my performance. It was time to let my partners know that I would retire the following year,” he said in 2011 in Medical Economics.

But retirement didn’t take for Dr. Hartzell. He had already voluntarily given up his license and turned to LifeGuard® to help get it back so that he could continue to practice medicine in a different capacity. The Foundation of the Pennsylvania Medical Society’s Lifeguard program assists physicians who need a seamless pathway for re-entry into the workforce. The program provides remediation for those who may have fallen behind in clinical skills or continuing education, or about whom quality concerns have arisen through a peer review process. Other reasons for using the program are varied such as taking time off to raise a family or, like in Dr. Hartzell’s case, the desire to return to medicine in a different capacity.

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LifeGuard offers physicians guidance on how to re-enter the practice of medicine. The program provides the availability of a multicomponent evaluation and assessment process to hospital medical staffs, medical executives, the State Board of Medicine, and other potential sources of referral. Physicians are also encouraged to refer themselves when appropriate. LifeGuard utilizes the medical model as its basis and a case management approach to provide components of the program as needed. No single pathway is appropriate for all referrals; rather, individualized evaluation, clinical skill assessment, and remediation/refresher plans are considered, depending upon the needs of the individual physician. After participation in LifeGuard, Dr. Hartzell enjoys being back to work as a primary care physician. “The physician-patient relationship feels the same, and taking care of complex problems is challenging,” Dr. Hartzell said. “I still have a lot to learn, and, many times, I find myself relying on reference sources. My smartphone always is at the ready with the appropriate applications. When I refer to the device in the presence of a patient, I explain that, as a surgeon, I was familiar with about 14 drugs, and now, as a PCP, I am supposed to be familiar with 1,400. Patients actually seem to appreciate that I am looking up information, and I do not believe that I am losing face by relying on an external source of wisdom.” “Am I glad that I went through the arduous process that was necessary to become a practicing physician again? The answer is an enthusiastic yes. The studying made me feel like a medical student again and awakened many neurons that had been in a resting state for eight years. I am now 76 years old, but I feel much younger, and I hope that I will be able to work for another five or 10 years,” he said. Vice President for Medical Affairs at Philadelphia’s Riddle Hospital Helen Kuroki, MD, sees LifeGuard as an asset to hospital organizations as well as for individual physicians. “At times, we as physician leaders need to identify whether or not our colleague physicians can continue to provide the best care. Knowing that an external organization like the LifeGuard program can provide services such as independent medical exams and neurocognitive assessment is important,” she said. “Physicians love the work they do and they want to continue to serve their patients in their community for a lifetime. Occasionally they run up against problems that may limit that ability to practice and we need to be

CHESTER COUNTY

respectful of their years of service and find a way to enhance their practice. Physicians may find it difficult to sit in judgment of other physicians,” according to Kuroki. The LifeGuard® Program has three essential core characteristics: • Objectiveness: Evaluations are based on data such as evidence of compliance with performance standards. • Fairness: The evaluation process is open, is unbiased, and complies with labor regulations. • Responsiveness: Physicians enter into case management promptly and they are moved through the assessment and remediation phase in a timely manner to enable them to continue or return to the practice of medicine, when possible. The pathways to address licensure and assess clinical competency include the following.

Re-Entry LifeGuard provides licensing boards with a convenient process to help reinstate physicians who wish to re-enter the practice of medicine after an extended leave. A unique and common component of the re-entry case management process involves time in active practice settings through a customized preceptorship or shadowing arrangement. The duration of this component is based on each individual physician’s length of time away from active practice. LifeGuard develops individualized remediation plans based on the documented deficits by the physician and/or the licensing body, if applicable, as well as those identified through the assessment process. A variety of resources can be used to create such individualized plans, including services from specialized referral sources. The remediation experience affords the physician the opportunity to refresh knowledge and skills as well as use a real-time ongoing evaluation process conducted by a board-certified, fully credentialed preceptor. LifeGuard provides a comprehensive report to the referring licensing board outlining the physician’s performance related to all assessment tools utilized within the individualized program, as well as evaluation of the physician’s practical phase of the program.

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Features

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External Peer Review Assessment

LifeGuard® Program Objectives To protect the public welfare and ensure patient safety. • To increase the number of physicians in the Commonwealth of Pennsylvania, thereby increasing the workforce capacity to meet the health care needs of patients. • To provide a customized, unbiased process to address physician performance concerns. • To provide objective clinical assessment to identify and address concerns. • To provide physicians with appropriate educational remediation to meet their learning goals/objectives. • To help medical organizations, the State Board of Medicine, physicians, and the general public through a collaborative effort to improve the consistency of care, enhance patient safety, and assure access to needed medical care.

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This service is designed to assess actively practicing physicians when medical knowledge and/or clinical abilities in relation to medical responsibility are called into question. When a problem or deficit is identified and ongoing privileging is called into question, the LifeGuard program can assess variations identified through the external peer review process. LifeGuard utilizes an extensive panel of physician reviewers who are fully credentialed, board certified within their specialty, and are actively practicing in their field to provide external peer review assessments.

Aging Physician Assessment

For entities and organizations that need “ability to perform” assessments for senior physicians, the aging physician assessment measures abilities, competencies, and health status. A core component of the assessment includes an objective measurement of cognitive and physical abilities. Additional assessment options, including the National Board of Medical Examiners (NBME) practice-based exams and proctoring for technical skill evaluation, are available based on the need identified by the requesting entity.

Competency Testing Competency testing, a key component in the LifeGuard® program, is designed to assess a physician’s medical knowledge and decision-making skills. It is also used by physicians who want to assess their respective clinical and medical knowledge on a self-referral basis. Competency testing available through the LifeGuard program is offered in collaboration with the NBME and Federation of State Medical Boards (FSMB).

Physician Shortages According to new Association of American Medical Colleges work force projections, nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020. In a 2011 research study sponsored by the 2011 American College of Surgeons, Richard Cooper, MD, senior study author and professor at the Perleman School of Medicine at the University of Pennsylvania predicted a national physician shortage increase of 7-8 percent annually.

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The LifeGuard Program helps to solve the Pennsylvania physician shortage by putting physicians back to work in a manner that responsibly assesses their needs, provides a program of remediation, and tests to ensure that knowledge or skill has been increased and competency criteria has been achieved. Upon completion of the program, a report is issued to satisfy credentialing/licensure expectations of the state and/or health system. This report provides critical information that helps to ensure that the physician has reached a level of competency that assures a high level of patient safety. The program graduates return to the workforce as safe and certain physicians. The Foundation’s Board of Trustees provides program oversight and LifeGuard’s staff has worked closely with Bureau of Professional and Occupational Affair’s administrative staff to structure appropriate assessment and/or remediation services that are customized to meet the unique circumstances of each case. “It is so important for us as physicians to continue to serve our patients throughout our lifetime. However, we are just human beings with the frailties that come with

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that and we are subject to various illnesses or accidents that limit our ability to practice,” said Dr. Kuroki. “Sometimes we can come to that conclusion on our own and leave our practices or ask for help in proctoring to improve our skill set but sometimes we need the help or advice of others to get there. LifeGuard provides that very unique and specific service to evaluate our physicians and make sure they can provide the highest level of care to our patients,” she said.

CONTACT

Foundation of the Pennsylvania Medical Society 777 East Park Drive, PO Box 8820 Harrisburg, PA 17105-8820 www.foundationpamedsoc.org www.lifeguardprogram.com Phone: (717) 909-2590

MEDICINE

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Features

House of Delegates Addresses Maintenance of Certification, Ebola, and E-Cigarettes

hester County’s delegates to the Pennsylvania Medical Society’s 2014 House of Delegates, CCMS President Winslow W. Murdoch, MD, and Mahomoud K. Effat, MD, engaged in vigorous debate about current issues of concern to physicians. The result: the addition of several important issues to PAMED’s already robust agenda for the coming year: • Maintenance of Certification (MOC) — Ask the American Medical Association (AMA) to: o Work with the American Board of Medical Specialties (ABMS) to eliminate practice performance assessment modules as currently written from the requirements of MOC. o Develop and disseminate a public statement, with simultaneous direct notification to the American Board of Internal Medicine (ABIM) and other ABMS sponsoring boards that their current MOC program appears to be focused too heavily on enhancing ABIM revenues and fails to provide a meaningful, evidence based, and accurate assessment of clinical skills. o Investigate and/or establish alternative pathways for MOC.

o Report back to the House of Delegates at the Annual AMA Meeting in June 2015. The PAMED Board was asked to study a recommendation to then ask the AMA to revoke its support for MOC if no action is taken by the ABMS in working with the AMA to make MOC requirements less onerous. PAMED will continue to support efforts to create a reasonable and economical assessment process that provides physicians with the information necessary to improve the quality and efficiency of their practices. • E-Cigarette advertising/endorsement—Ask the AMA to work through an appropriate federal process to prohibit e-cigarette companies from paying for product placement in films and hiring celebrity spokespersons, and to prohibit e-cigarette advertising on television. • Ebola preparedness— Continue to provide Pennsylvania physicians with important information, such as local and state guidelines, how to put on and remove personal protective equipment, identification of containment facilities, and access to sensitive and specific surveillance tools. PAMED will continue to work with the Pennsylvania Department of Health and other state preparedness partners to ensure that health care facilities are prepared to handle a positive Ebola diagnosis. • Medicare coverage of vaccines—Aggressively petition the Centers for Medicare and Medicaid Services (CMS) to include tetanus and Tdap at both the “Welcome to Medicare” and Annual Medicare Wellness visits, and other clinically appropriate encounters, that allows for coverage and payment of these vaccines to Medicare recipients who have not been vaccinated within the past 10 years. • Barriers to getting health care—Work with insurers to provide payments to physicians and physiciansupervised designees for medications, vaccines, and their administration, without the burden of prior-authorization or any other administrative barriers. • Telemedicine—Work with stakeholders to evaluate the different applications and uses of electronic technology to adopt standard definitions of what constitutes telemedicine, identify standards for coverage and payment for the use of telemedicine, and work to establish policy in Pennsylvania for the licensure of providers and payment for services. • Urgent care clinics—Work to educate urgent and retail clinics on the importance of transmission of point of service patient medical records to primary care physicians and specialists, and investigate any complaints of non-disclosure of medical records by a facility due to alleged financial and network associations.

CCMS Delegates Mahmoud K. Effat, MD, at left, and Winslow W. Murdoch, MD, participate in a caucus.

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MEDICINE

Health Care Workers

Could it be

EBOLA? Think Ebola IF

Evaluate the patient ¾ Do they have • Fever (subjective or ≥100.4°F or ≥38°C) •

Other symptoms, including: – Severe headache

Consult with public health ¾ Do you have a question about a possible case of Ebola? • For a list of state and local health department numbers, visit: http://go.usa.gov/f74V

– Muscle pain • Liberia • Guinea • Sierra Leone

– Weakness – Diarrhea – Vomiting – Abdominal (stomach) pain – Unexplained hemorrhage (bleeding or bruising)

The patient has a ¾ Travel history ¾ History of exposure to person with Ebola.

¾ Do I need to test?

¾ Take a detailed travel and exposure history. In the past 21 days, has the patient been: •

To an area with Ebola

•

Exposed to a person with Ebola

• You, the health department, and CDC will work together to determine if testing is necessary

¾ If YES, Isolate the patient IMMEDIATELY.

Patient care checklist for patients under investigation for Ebola virus disease £ Isolate the patient in a separate room with a private bathroom. £ Activate the hospital preparedness plan for Ebola. £ Ensure standardized protocols are in place for PPE use and disposal. £ Wear appropriate PPE when in physical contact with the patient. £ Attend to the patient’s medical needs. £ Consider and evaluate patient for alternative diagnoses. £ Obtain detailed information about symptoms, contacts, and travel history. £ Perform only necessary tests and procedures. £ Ensure patient has the ability to communicate with family. £ Allow visitors only if they are wearing appropriate PPE.

For more information on how to care for a person under investigation for Ebola, please visit: http://www.cdc.gov/ebola CS252443

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The Art of Chester County

Autumn is “our season” The Art of Chester County BY BRUCE A. COLLEY, DO

(Above) The painting called “The Woods Are Lovely, Dark, and Deep” was inspired by the autumn trees in a wooded stretch on Northbrook Road near Mary Smith’s home. For the artist, the scene recalled Robert Frost’s sentiments in the classic poem, “Stopping by the Woods on a Snowy Evening.” She saw the autumn forest here as even more compelling than a winter one.

pple orchards loaded with fruit, pumpkins in the field, vineyards in harvest, and fox hunters with their hounds on brisk early morning rides. The days drift toward November and a riot of color erupts as the leaves of autumn turn. Every country road is a masterpiece of orange, red, and yellow. Walk along our streams and see the brilliant foliage reflected off the water. Look up in the woods and see Mother Nature’s stained glass “windows.” Mary Smith captures the softness of the season in these pastel and oil paintings. She finds inspiration in the beauty of the natural world. She emphasizes the energy of each scene while integrating the warm lights, rich colors, and strong shadows in them. Mary was born in Erie, Pennsylvania and has been a long-time resident of Pocopson Township. She received her B.A. in art from Mercyhurst College. Mary has studied and painted with many Brandywine Valley artists, including Donna Cusano and Jon Redmond. She paints each summer with the Howard Pyle Studio artists and a Brandywine Valley plein air group. Mary’s paintings have been shown at innumerable local venues.

Bruce A. Colley, DO, is vice president of the Chester County Medical Society. CHESTER COUNTY

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“Still Waters” was painted along Octorora Creek on a warm fall day. The artist was dazzled by the shallow waters making their way through the orange and yellow countryside.

in Chester County “Welcome October,” painted near the Pocopson Home along Unionville Lenape Road, depicts the richly colored grasses that dominate October meadows. This small oil painting was completed on site.

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Features

Metabolic Syndrome:

Ailment of the Video Generation BY ZARSHAWN JAN

etabolic syndrome is diagnosed when a constellation of risk factors for cardiovascular disease are present. While one factor presents a risk, the combination of factors increases the risk of cardiovascular event two- to three-fold. Metabolic syndrome dates to the 1950s but the term became more popular in the 1970s and 1980s. Various names have been given to metabolic syndrome from the rather diabolic name of Syndrome X to insulin-resistance syndrome to Reavens syndrome. In 1947 French physician Jean Vague made the connection between upper body adiposity and populations predisposed to diabetes mellitus and atherosclerosis. In 1977 Haller used the term metabolic syndrome when describing additive effects of risk factors and atherosclerosis. In 1988 Gerald Reaven proposed insulin-resistance as the underlying cause.

DEFINITION The American Heart Association definition is met if three of the following five risk factors are present: 1. For men a waist size of greater than 40 inches (102 cm) and for women greater than 35 inches (88 cm) 2. Elevated triglycerides, equal to or greater than 150 mg/dl 3. Reduced HDL cholesterol of <40 mg/dl for men and < 50 mg/dl for women 4. Elevated blood pressure equal to or greater than 130/85 mm/Hg or taking medication for hypertension 5. Elevated fasting glucose equal to or greater than 100 mg/dl or using medications for diabetes

CLINICAL FEATURES Other than visceral or apple shaped adiposity, there are no visible signs. Symptoms are also rare although increased thirst and frequency of urination may be seen with high sugar and occasional headaches from high blood pressure.

CHESTER COUNTY

In most people the syndrome presents silently other than the presence of obesity.

PATHOPHYSIOLOGY Fat cells or adipocytes of visceral fat increase plasma level of tumor necrosis factor-alpha (TNFa) and alters levels of other substances like adiponectin, resistin, and PAI-1. TNFa increases production of inflammatory cytokines, but also alters trigger cell signaling and leads to insulinresistance. Central nervous system and especially cannabinoid system that modulates peripheral carbohydrates and lipid metabolism plays a central role. Some studies have revealed a role for hyperleptinaemia.

CAUSES There are several known causes of metabolic syndrome, including the following: 1. Genetic predisposition. Certain families have a genetic predisposition to obesity and metabolic syndrome 2. Aging. As we age, predisposition increases to metabolic syndrome. Over the age of 50, there is a 44% incidence of metabolic syndrome as compared to 34% in the general population. 3. Diet. Both increased calories and increased intake of carbohydrates and fats increases the incidence of metabolic syndrome. 4. Sedentary lifestyle. Unmatched physical activity with increased intake of calories results in development of obesity and metabolic syndrome. 5. Stress. Recent research indicates prolonged chronic stress can lead to metabolic syndrome by disrupting hormonal balance of hypothalamic pituitary adrenal axis (HPA-axis). The dysfunctional HPA-axis causes high cortisol levels which results in raising glucose and insulin levels and affects adipose tissues. 6. Schizophrenia and other psychiatric ailments, including bipolar disorders, have predisposition to

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the metabolic syndrome exacerbated by sedentary lifestyle. 7. Rheumatic and other immunological disorders also result in a more sedentary lifestyle and data indicate an increase in the incidence of metabolic syndrome in these disorders. Psoriasis and seborrheic arthritis have also been found to be associated with metabolic syndrome.

COMPLICATIONS 1. Diabetes Mellitus. Metabolic syndrome by definition is insulin-resistance and the minor elevation of glucose that defines metabolic syndrome if unchecked will ultimately result in type 2 diabetes mellitus. Patients with metabolic syndrome have much higher incidence of diabetes mellitus as compared to the general population. A large study from Medical University of South Carolina, published in Circulation on November 7, 2005, followed 3,323 middle-aged adults with no baseline cardiovascular disease or diabetes. The risk estimate associated with metabolic syndrome for cardiovascular disease, coronary heart disease, and type 2 diabetes mellitus were 34%, 29%, and 62% in men and 16%, 8%, and 47% in women, significantly higher than the general population. 2. Cardiovascular Disease. Patients with metabolic syndrome as we described earlier have two- to three-fold increase in development of cardiovascular disease. A study by E. Bonoraâ&#x20AC;&#x2122;s group in Italy indicated that patients that have type 2 diabetes and metabolic syndrome have a five-fold increased risk of cardiovascular disease. 3. Musculoskeletal Complications. With the increased weight comes the burden on the joints, bones and spinal column that results in increased incidence of degenerative joint disease and also loss of work days. 4. Complications related to kidneys. A study from Finland showed that when patients with type 2 diabetes mellitus were compared to patients with the combination of type 2 diabetes with additional metabolic syndrome, there was high prevalence of not only cardiovascular disease but also microalbuminuria and macroalbuminuria (23% vs. 7%). 5. Peripheral Neuropathy. The same study from Finland showed that there was a high incidence of distal neuropathy (16% vs. 6%) in patients who had metabolic syndrome as compared to diabetics without metabolic syndrome. 6. Sleep apnea. Patients with metabolic syndrome have a higher incidence of sleep apnea as compared to the general population.

MANAGEMENT OF METABOLIC SYNDROME Prevention is better than treatment. Since metabolic syndrome is a constellation of risk factors, our management of metabolic syndrome is geared toward each of these risk factors that are ultimately precursors of type 2 diabetes mellitus and cardiovascular disease. 1. Diet. Cutting back on calories, especially from carbohydrates and fats, reduces the visceral fat as well as obesity, thus reducing the risk of complications of metabolic syndrome. Intake of foods like vegetables, lentils, beans, fish, and lean meats and chicken need to be encouraged. 2. Sedentary lifestyle. A major part of management of metabolic syndrome is a dedicated exercise program that results in at least matching the intake of calories so that weight gain is prevented and weight loss encouraged. Forty-five minutes to an hour of at least moderate activity on most days of the week is recommended. But even more modest exercise should help. 3. Gastric stapling procedure. There is some data to indicate that if diet and lifestyle modification is not working, a gastric stapling or gastric bypass procedure should be considered although these procedures do have potential risks and potential complications and should be resorted to only if the patient is unable to modify his or her lifestyle. 4. Pharmacological therapy. Obviously the elements of metabolic syndrome like hypertension and glucose intolerance need to be pharmacologically treated. Low HDL can improve with a modest intake of alcohol. Phentermine is the most widely prescribed weight loss supplement in the USA, but the drug can be habit-forming and can cause insomnia, constipation, and dry mouth. Xenical is a lipase-inhibitor but also has significant side effects. The FDA approved qsymia in 2012. It is a combination of phentermine and topiramate and is approved only for patients with body mass index over 30. Belviq is a newly approved medication and works by activating serotonin receptors that regulate hunger and is again available to patients with a BMI over 30. Other over-the-counter drugs include orlistat, garcinia, cambogia, and ephedra. All of these medications have complex side effects. In summary, metabolic syndrome is one of the most common ailments that can result in significant morbidity and mortality and can be managed with simple lifestyle modifications.

Zarshawn Jan is a first-year medical student at Drexel Medical School, who wrote this article under the guidance of Mian A. Jan, MD, an interventional cardiologist practicing in Chester County. CHESTER COUNTY

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Features

End-of-Life Discussions BY CHARLES P. CATANIA, MD

hen I decided on a career in family medicine, I set my main goal as taking care of the patient as a whole. I wanted to be a good communicator and liaison for my patients, a theme I learned while training in the United Kingdom. Most primary care doctors in the United Kingdom are more like coordinators of care and friends of families rather than someone whom the patient sees for a general or sick appointment. My special relationships with patients in the UK led me to learn more about palliative/ hospice approaches to medicine.

As our society grows in this technological age and medical advances continue to help our patients live longer, we find ourselves dealing with a much more complex and older patient base. Therefore primary care providers must learn how to start the discussion about palliative and hospice care. One of the most difficult decisions I have encountered in my short career is when to have a discussion about palliative/hospice care. Our main goal has always been to heal and care for our patients through the good and the bad times, and if you are anything like me, you never want to make the patient feel like you are giving up on their chronic health condition. It wasnâ&#x20AC;&#x2122;t until I opened up my mind to the thought that palliative care and hospice are just other means of helping my patients, did I understand the benefits these approaches to medicine could offer to them and their families.

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What some doctors and patients may find confusing is that both hospice and palliative care protocols call for patients to receive a combined approach where medications, day-to-day care, equipment, bereavement counseling, and symptom treatment are administered through a single program. This program has a goal to assist the patients and families without lengthy hospital stays and an overwhelming number of complex medical appointments. It also cuts back on hospital admissions and saves health care dollars while giving our patients what they desire: To have quality of life through their most important battles.

Barriers to Broaching the Subject Physicians face several barriers in approaching this subject with patients, including finding the right time to discuss options with them and their families, finding enough time in our schedules to have that lengthy discussion about palliative/hospice care options, and having knowledge of palliative care or hospice services that are available in our communities for our patients. The biggest barrier might be how to broach the subject of palliation. If a physician hasn’t learned strategies for talking about hospice or palliative care, the patient might feel that the physician is giving up on treating him or her. As physicians we should be able to elicit a patient’s concerns, goals, and values by using open-ended questions and following up on the patient’s response before discussing specific clinical decisions. Physicians can acknowledge patients’ emotions, explore the meaning of these emotions, and encourage patients to discuss difficult topics. Physicians should also be able to screen for unaddressed spiritual and existential concerns, regardless of one’s beliefs, because it’s important to our patients and their families.

hospice care to the patients and their families. The goal is to affirm life but regard dying as a normal process, and to provide relief from pain and other distressing symptoms. We should try integrating psychological and spiritual aspects into mainstream patient care, and providing support to enable patients to live as actively as possible until death. Lastly we should be able to offer support to the family during the patient’s illness and in their bereavement. Through these important conversations, we separate ourselves from specialized care. We are the comforting voice, the gentle hand, and trusting organizers of our patient’s care. We must ensure that the relationships we build with our patients over the years don’t fail when they are most needed. Charles P. Catania, MD, is board certified in family medicine and practices at Gateway Medical Associates in West Chester. He is also the medical director of Willow Tree Hospice in Chester County.

Communication Strategies Palliative/hospice care is important to consider throughout the course of serious chronic illness. Employing interviewing techniques about end-of-life issues, building on and exploring patient responses, and addressing the associated emotions, can help initiate difficult discussions about palliative care. In addition to addressing physical suffering, physicians can extend their caring by acknowledging and exploring psychosocial, existential, and spiritual suffering. As patients struggle to find closure in their lives, active listening and empathy have therapeutic value in and of themselves. We should be able to express the goals of palliative/ CHESTER COUNTY

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Features

CCMS Hosts Annual Clam Bake

egislators and physicians mingled and shared their viewpoints on various issues at the annual Chester County Medical Society (CCMS) Clam Bake on Friday, September 19, 2014, at the Radley Run Country Club. Special guests for the evening included Congressman Joe Pitts; Congressman Pat Meehanâ&#x20AC;&#x2122;s District Representative Maureen Quinn; Senator Andy Dinniman; Representatives Becky Corbin, Warren Kampf, John Lawrence, Duane Milne, and Dan Truitt; and Commissioners Ryan Costello and Terence Farrell. Following a sumptuous dinner, the eveningâ&#x20AC;&#x2122;s agenda included a legislative dialogue and presentation of the CCMS Darlington Scholarship, named in honor of Dr. William Darlington, the first president of the Chester County Medical Society from 1828 to 1852. CCMS President Winslow W. Murdoch, MD, presented the 2014 scholarship to Kristina Borham, a cell and molecular biology major at West Chester University who plans to attend medical school after she completes her undergraduate degree in 2016.

Congressman Joe Pitts addresses the audience.

CCMS President Winslow W. Murdoch, MD, presents the Darlington Scholarship to Kristina Borham as her parents look on.

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Representative Warren Kampf addresses the audience.

Commissioner Terence Farrell engages in discussion with the audience. Attendees enjoy their dinner.

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Features

DocbookMD

Member Benefit Provides Secure Mobile Communication Platform for Efficient Workflow BY TRACEY HAAS, DO, MPH

obile communication is an integral and growing part of every aspect of modern life, including health care. Fast and secure communication between care team members can measurably improve clinical efficiency as well as patient outcomes. In addition, federal and state requirements for electronic health recordkeeping are pushing many medical professionals to aggressively begin updating and integrating their electronic health records and communications. However, many physicians and health care organizations still rely on multiple technologies and information systems for their communications. Time taken to monitor multiple communication portals can eat away at time spent with patients and allow important messages to slip through.

The Problem Several products are currently on the market to address the need for HIPAA-compliant mobile messaging among medical professionals. However, many of these solutions have serious flaws: they are social networks that make their money by selling physicians’ information to recruiters, or they are silo’d solutions that only help those who work inside a hospital system. Physicians need a mobile communication solution that is not only HIPAA-secure, but also shields their personal information and works regardless of practice type or location. CHESTER COUNTY

The Solution The ideal messaging application for health care providers should include the following: • Efficient and instantaneous physician-to-physician communication • A secure community to share patient information and collaborate with medical colleagues, in a HIPAA secure manner • Ability to send medical images securely between physicians • Built-in local physician and pharmacy directories • Ability to scale from small groups, to hospitals, all the way to large multi-enterprise organizations • Widespread adoption among medical professionals • Availability across platforms including smartphones, tablets, and the web • Data that resides on secure servers, not users’ devices • Ability to remotely disable the app on a device that has been lost or stolen • Long-term message archive compliant with HITECH recommendations • Ability to integrate with other health IT solutions When all the information is at a physician’s fingertips, faster and richer discussions on patient treatment and care can result. Also, with local physician and pharmacy 26

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Start Using DocBookMD: A Free Member Benefit DocbookMD is available as a free member benefit to members of the Allegheny, Chester, Delaware, Dauphin, Lancaster, Montgomery and Philadelphia county medical societies. Details about how to register are available on the Chester County Medical Society website at www.chestercms.org.

directories built into a secure messaging app, the time physicians spend finding colleagues or tracking down a local pharmacy is cut from hours to minutes.

treatment, if needed, much more quickly. • An emergency physician is able to rapidly receive and send messages, images, and test results to consultants and referring doctors during a busy shift. They are also able to coordinate transfer of care with outpatient primary care, or inpatient hospitalists, thereby streamlining transitional patient care and closing the loop on any ER visit.

DocbookMD: A Secure Gateway for Physicians DocbookMD, available as a free benefit for CCMS members, is a HIPAA-secure instant messaging application that meets all these requirements. Designed by physicians, for physicians, it creates a secure community to share patient information and collaborate with medical colleagues as well as third-party services like radiology, labs, answering services, and even health plans. Drs. Tim Gueramy and Tracey Haas began developing DocbookMD out of their own need for more efficient and instantaneous physicianto-physician and physician-to-care team communication. Since then, DocbookMD has experienced incredible growth, now serving more than 200 medical societies across 42 states. In addition, DocbookMD offers CareTeam, a feature that allows physicians to invite members of the patient’s direct care team—including nurses, PAs, administrators, care coordinators and other staff—to join them on DocbookMD to communicate in a secure, fast, and efficient way through their mobile devices. With DocbookMD, health care providers of all kinds can communicate with colleagues rapidly and securely, with the confidence that their privacy and data integrity will be maintained. Here are some exemplary use cases based on actual users’ testimonials: • A dermatologist can send the ENT surgeon an image of a complicated skin lesion to be removed. The surgeon is able to make a more efficient plan for surgery and reconstruction ahead of time. • A family doctor in a rural area can collaborate over X-rays with an orthopedic surgeon in the nearest city. The specialist is able to determine if an urgent surgery or just a cast is necessary, saving the patient time, extra office visits and travel. • A radiologist can communicate test results immediately to the ordering physician, who can in turn notify the patient and bring him or her in for

Selecting a Mobile Communication Platform Ultimately, when choosing a secure instant messaging application for medical communications, physicians and health care organizations must carefully consider their professional needs as well as the potential to improve patient care. What features are absolute must-haves? What app characteristics would eliminate an app from consideration? Is the solution scalable? Is it cost-effective? Can it be integrated into existing health IT solutions? Answers to these questions and others will help physicians to evaluate messaging apps and select the right fit for their organization. A HIPAA-secure mobile medical communication solution should put physicians firmly in control of whom they connect with and who can send them messages. Any other model opens physicians up to unwanted contacts and wasted time. Tracey Haas, DO, MPH, is cofounder and chief medical officer of DocbookMD.

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Outstanding Service • Knowledge & Experience • Proven Track Record

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Features

Dr. Jan

Honored for Contributions to Chester County

tate Senator Andy Dinniman and the Board of Trustees of the Chester County Historical Society honored Dr. Mian A. Jan at a large gala event on September 10, 2014. Dr. Jan is president-elect of the Chester County Medical Society and chairman of the Department of Medicine at Chester County Hospital. He also served as president of CCMS from 2010 to 2013. The gala celebrated the contributions of the Indo-Pak community in Chester County and reached out to this vibrant community, Senator Dinniman said. The evening featured the unveiling of the documentation artwork by Indian artist Krishna Swamy depicting the Declaration of Independence, the preamble of the U.S. Constitution, and the painting “Signers of the Declaration.” In praising Dr. Jan for his services to the citizens of Chester County, Senator Dinniman announced the historical society’s creation of the Dr. Mian A. Jan Fellowship. As a result, a college or graduate level student will help build a collection of historical resources focusing on the Indo-Pak community in Chester County, and the Chester County Historical Society will record it in its archives. Dr. Jan, who is originally from Pakistan, also serves on the Governor’s Advisory Commission on Asian-American Affairs. Others recognizing Dr. Jan at the gala for his 27 years of service were Governor Corbett’s office; Chester County Representative Dan Truitt’s office; the offices of Chester County Commissioners Costello, Cozzone, and Farrell; Chester County Sheriff Bunny Welsh; and West Chester Mayor Carolyn Comitta. In receiving the recognition, Dr. Jan spoke of his pride in America and the importance of individuals preserving their diverse heritage. “I look around this room and I see a rainbow of colors – every ethnicity you can think of is here. And I think, where but in this great country can we have such a gathering? I see many like me and the ones who came before seeking liberty, justice, freedom and a better life,” Dr. Jan said. “Our heritage is the foundation of this great society. It must be preserved for posterity and the Chester County Historical Society is very willing to help in this endeavor.” Attendees enjoyed a traditional Indo-Pak meal and music.

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Cardiologist Wasif Qureshi, MD, Dr. Mian A. Jan, Chester County Hospital COO Michael Barber, Kouresch Jan, Dr. Ambereen Jan, Gibran Jan, and State Representative Duane Milne.

Dr. Ambereen Jan addresses the audience.

Dr. Mian A. Jan, State Senator Andy Dinniman, and Krishna Swamy pose in front of Krishna Swamyâ&#x20AC;&#x2122;s artwork.

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Hospital Profile

Chester County Hospital:

Among Most Wired

hester County Hospital has been named one of the Most Wired Hospitals in the nation, according to the 16th annual Health Care’s Most Wired Survey, conducted by Hospitals & Health Networks. This is the second consecutive year the hospital has made the list. As the nation’s health care system transitions to more integrated and patient-centered care, hospitals are utilizing information technology to better connect the wide realm of care providers, according to Hospitals & Health Networks. The West Chester-based hospital is one of 19 hospitals in Pennsylvania to receive the Most Wired designation, which was awarded, based on a survey of hospitals’ uses of technology in infrastructure, business and administrative management, clinical quality and patient safety, and clinical integration. It is one of only 375 hospitals in the nation to receive the designation. The University of Pennsylvania Health System, of which Chester County Hospital is affiliated,

also received Most Wired recognition. “Health care in the 21st century is so complex that advanced technology must be used to assure safe and optimal care,” says Ray Hess, vice president of information management at Chester County Hospital. “We recognized this reality more than a decade ago. It has been a long hard road, but we see the fruits of our labor every day through the quality care that is being delivered and the outcomes that are achieved.” The survey noted that Most Wired hospitals have made tremendous gains by using information technology (IT) to reduce the likelihood of medical errors. Among Most Wired hospitals, 81 percent use bar-code technology at the bedside to assure an accurate match between medications, patient, and nurse. This IT initiative, which the hospital has had in place for numerous years, confirms that the right patient is receiving the right drug, dose, administration route, time, and frequency before the nurse gives the medication each time. The publication noted that, as the CHESTER COUNTY

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nation’s health care system transitions to more integrated and patientcentered care, hospitals are utilizing IT to better connect disparate care providers, and that 67 percent of Most Wired hospitals share critical patient information electronically with specialists and other care providers. Chester County Hospital is actively connecting to physician offices so that it can electronically and securely pass key patient data directly into the office computer systems. The hospital has launched a Patient Portal (called Health e-Me), through which inpatients and outpatients can access their hospital records and detailed discharge instructions for future reference. Health Care’s Most Wired Survey, conducted between January 15 and March 15, 2014, asked hospitals and health systems nationwide to answer questions regarding their IT initiatives. Respondents completed 680 surveys, representing 1,900 hospitals, or more than 30 percent of all U.S. hospitals.

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Cancer Incidence in Chester County (2008-2010 Residents)

Invasive Cancer Incidence and Average Age-Adjusted Rates Per 100,000* for Major Sites by Sex

Male

Female

Total Rate Total Rate All Sites 4,000 547.2 4,032 472.7 Prostate 1,144

146.0

Female Breast -

1,168

136.5

63.1

463

54.5

Lung and Bronchus

437

Colon and Rectum

325 47.1 354 40.3

Urinary Bladder

303 44.5 82 9.4

Corpus and Uterus, NOS -

265

30.0

Non-Hodgkin Lymphoma 187

26.1

160

18.8

Kidney and Renal Pelvis 156

20.9

9.4

Melanoma of the Skin

254 35.3 199 23.4

* Per 100,000 2000 U.S. standard million population. Age-adjusted rates are only comparable if the same standard million population is used in the calculation.

Source: Pennsylvania and County Health Profiles 2013, Pennsylvania Department of Health Bureau of Health Statistics and Research CHESTER COUNTY

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Features

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 admin@chestercms.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.

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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

First

Middle

Home Address:________________________________________________________

_________________________

Office Address:________________________________________________________

_________________________

Email Address: ____________________________________________

_________________________

For mailing, please use:  Office Address  Home Address

Office Fax

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: ____________ Spouseʼs Name:

INSTITUTION

LOCATION

DEGREE

BEGIN DATE END DATE

Medical

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. ___________________________________________________________

 Yes

 No

___________________________________________________________ ___________________________________________________________ DATE RETURN TO: ATTENTION:

SIGNATURE Pennsylvania Medical Society Member Services

QUESTIONS? Call (800) 228-7823

FAX: MAIL:

717-558-7840 777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820

Features

Membership News & Announcements

Members in the News

continued from page 16

House of Delegates Addresses Maintenance of Certification, Ebola, and E-Cigarettes (continued from page 16)

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 and photos to share, please submit it to admin@chestercms.org.

CCMS President Winslow W. Murdoch, MD, poses with Berks County Delegate Jane A. Weida, MD, before a reference committee session.

Frontline Groups Frontline Groups with 100 percent membership in CCMS are the backbone of the society. We are thankful for their total commitment to CCMS. This list reflects the Frontline Groups as of October 20, 2014.

•

Academic Urology-West Chester Brandywine Gastroenterology Associates Ltd. Cardiology Consultants of Philadelphia-Main Line

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Cardiology Consultants of Philadelphia-Paoli Cardiology Consultants of Philadelphia-West Chester Chester County Eye Associates PC

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Chester County Otolaryngology & Allergy Associates Clinical Renal Associates-Exton Devon Family Practice LLP Gateway Family Practice Downingtown

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Gateway Medical Colonial Family Practice Great Valley Medical Associates PC Levin Luminais Chronister Eye Associates Main Line Dermatology

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Main Line Gastroenterology Associates Paoli Hematology Oncology Associates PC Plastic & Reconstructive Surgery of Chester County PC

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Village Family Medicine Wade Townend Pediatric Associates West Chester GI Associates PC

•

CHESTER COUNTY

Single national narcotic provider number—Ask the AMA to continue to work with the Drug Enforcement Administration (DEA) and Congress to move toward a system in which individual physician DEA registration numbers are person-specific rather than site-specific within a state. Unification of GME accreditation standards—Seek legislation to: 1) drop the licensure requirement for DOs to do at least one AOA approved year; and 2) make the number of required GME years the same, whether for DOs or MDs, to get a full, unrestricted license. Independent practice access to facilities and insurance program participation— Seek legislation to provide access to participation in insurance networks and hospital facilities for independent physicians that meet the accepted quality measures. Hospital privileges for private practice physicians— Pursue legislation concerning the enforcement of the Community Benefit Standard in Pennsylvania; research ways to provide legal support to aid PAMED member physicians who are impacted by hospitals’ exclusionary tactics; and work to maintain private physician health care network relationships. Contracts with insurers— Pursue fairer insurer contracts and consider support of legislation to provide for contracts between insurers and networks to assure access to care with a level of insurance coverage for patients. Universal Patient Transfer Form—Work with state government agencies and hospitals to develop a Universal Patient Transfer Form (UPTF) and an understanding of how it will work in Pennsylvania. Membership dues—The PAMED Board, working with the Membership Task Force, will be studying alternative dues models. At the annual meeting, members provided a lot of good feedback and ideas that will be incorporated into the task force’s discussion.

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Medical Building For Sale Chester County’s most desirable location

This 3,000 square foot, all brick building with a full concrete basement, is situated on over 1 and 1/3 beautiful landscaped acres. This free standing building contains two private offices, two powder rooms, kitchenette/ lunchroom, electronic security system, sprinkler system, and 23 private parking spaces.

Traffic count is over 70,000 vehicles per day. This building is located on Route 202 one mile south of West Chester in Westtown Township. This building is easily expandable to over 4,100 square feet. This is a rare opportunity to locate your medical office in one of Chester County’s fastest growing and high income areas. There are over 500 new residential units - either under construction or approved for construction - within a half-mile of this site.

For information please contac t Joseph McCawley 610-431-0925

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PMSLIC is committed to its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. For more information contact your agent, or call Laurie Bush at PMSLIC at 800-445-1212, ext. 5558 or email lbush@pmslic.com. Or visit www.pmslic.com/start for a premium estimate.

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