Delaware County Medicine & Health Spring 2016

Medicine&Health DELAWARE COUNTY

SPRING 2016

The History of the Delaware County Medical Society

Dream

CARE Dan Maxwell’s Legacy: A Mental Health Story

WELCOME

From the Executive Director Greetings to all DCMS members, prospective members and members of our Delaware County community. It’s a pleasure to offer this update on the current activities of the Delaware County Medical Society. Our county medical society has a longstanding history of serving our physician members and helping to address the healthcare of our community. We hope you will appreciate our work and encourage you to participate in our activities.

T

he DCMS is blessed with a strong leadership, it’s a great mix of experienced physicians and young, enthusiastic board members and practice managers. Our board is made up of physicians from both private and hospital affiliated medical practices from throughout Delaware County. We also have an outstanding network of practice managers who are a tremendous help in identifying emerging practice management issues and communicating with very busy physicians.

I’m afraid that too many physicians are unaware of the fantastic resources which are available to them through their membership in the DCMS and the Pennsylvania Medical Society (PAMED). Our state medical society provides effective advocacy on behalf of physicians of all specialties and practice modalities.

We encourage all members to subscribe to the PAMED “Daily Dose” and to read the updates and summaries on a very wide range of important medical issues. Use the PAMED site as a resource www.pamedsoc.org.

Our DCMS website is also source of great information, including our Guide to Community Resources. All members are encouraged to let us provide a link to your practice’s website on our web page’s Member Practice Directory. Check this out at www.delcomedsoc. org. We want to offer the finest level of customer service when our members need assistance on a practice management or personal issue or concern and will be pleased to make an appointment to visit and learn more about these issues. We’re also hard at work behind the scenes helping patients to connect

with a physician or medical practice; tracking down medical records and planning programs to share important developments in our community.

Speaking of delivering quality care, our efforts to promote a better understanding of health literacy and the challenges which many patients face have been remarkable. A little over two years ago, the DCMS formed and organized the Delco Health Literacy Coalition (HLC), to help promote an awareness of the importance of effective two-way communications and to promote the use of tools to assist in the process.

The HLC coalition has grown to nearly forty community stakeholders and will be conducting a formal strategic planning session later this month. Stay tuned for more details.

Our other active community involvement includes participation in local efforts to address: suicide prevention & awareness; overdoses of prescription & street drugs; emergency planning and infant mortality. Please let us know if you are interested in participating in any of these local and regional coalitions and task forces!

Is there something keeping you up at night? Please let us know how we should best be representing you and your patients. Call the DCMS office (610) 8927750 or email delcomedsoc@comcast.net to talk or set up an appointment for a confidential conversation.

Please support the organizations that supports you!

-David A. McKeighan

TABLE OF CONTENTS

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OFFICERS 2016 Ronald B. Anderson, M.D., President Joyann Kroser, M.D., President Elect George K. Avetian, D.O., Vice President Fredric N. Hellman, M.D., Treasurer Salvatore A. Lofaro, M.D., Secretary Richard V. Buonocore, M.D., Past President DIRECTORS Stephen N. Clay, M.D. Margaret T. Hessen, M.D. John A. Kotyo, M.D. Joseph W. Laskas, D.O. Virginia McGeorge, CCS-P, CMM Michael A. Negrey, M.D. Chike N. Okechukwu, M.D. Stephanie Tanner, M.D. Jill Venskytis, CMM, HITCM-PP DCMS STAFF David A. McKeighan, Executive Director Rosemary McNeal, Administrative Assistant

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2 Contents

CONTACT INFORMATION Publisher, Tracy Hoffmann Hoffmann Publishing Group, Inc. Design, Kim Lewis 2921 Windmill Road Reading, PA 19608 HoffmannPublishing.com 610.685.0914 ADVERTISING Karen Zach 484-924-9911 Karen@HoffPubs.com

SPRING 2016

Medicine&Health NTY

DELAWARE COU

SPRIN G 2016

The History of the y Delaware Count MeDiCal SoCiety

Any opinions expressed in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.

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

Delaware County Medicine & Health is published quarterly {Spring, Summer, Fall, Winter}.

Dream

CARE

acy: Dan Maxwell’s Leg y A Mental Health Stor

ON THE COVER

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www.delcomedsoc.org

2 Dan Maxwell’s Legacy 6 “Girls in Medicine” Program 8 Medical Marijuana

in Pennsylvania 11 Fighting Opioid Abuse

in Pennsylvania 12 The History of the Delaware

County Medical Society 18 Community Volunteers in Medicine 24 2016 Tools for Success 26 Dream Care 29 Jill’s Timeless Tidbits

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FEATURE

Dan Maxwell’s Legacy: Creating DMAX Clubs on College Campuses

By Laurie Burstein-Maxwell

D

an Maxwell would have been 21 years old today. On July 23, 2013, however, at the age of 18, Dan took his life. He had known for about 18 months that something was wrong. Midway through his junior year, Dan approached my husband and me wondering if he had ADHD. This very bright National Honor Society student, three-sport athlete and beloved friend of so many kids was in the gifted program at school ever since second grade. How could he have ADHD? But we had him tested, and there was a possibility that he might have ADHD as well as some depression. Dan started seeing a therapist and taking medication. We all assumed he would get better.

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But he never did.

Treatment was ineffective. In fact Dan got worse - much worse - and he started having difficulty with academics. He would spend his nights scouring the Internet for a solution.

We tried everything we knew about and so did Dan. He tried herbs, exercise, various diets and various medicines and therapy, hoping each attempt was the answer. But the emotional pain became excruciating, unending, and unbearable. Dan began to talk of suicide, and in July 2013 he was hospitalized for 12 days. Even then, the devastating pain of mental illness would not release its hold on Dan, and he couldn’t bear it any longer. Eleven days after being discharged from the hospital, he gave up and took his life.

I was told by a friend that, as parents, we can only be as happy as our saddest child.

When Dan was alive…when he was sick… his pain was my pain. I felt it every minute…every day. And yet I kept silent. The pain of silence, of pretending things were okay, was terrible as well.

How do you tell your friends and family that our talented, smart, funny, athletic and beautiful son had problems? It seemed impossible to do. The stigma was just too strong.

Dan was beginning to feel as if no one else in the world was experiencing what he was going through. How could he tell anyone outside his family? How could he believe that anyone would understand? So Dan isolated himself from the friends that previously were part of his very active social life. The isolation was shocking and concerning to us because instead of being out with friends, he stayed home with us day after day, night after night. Dan would not go to his senior prom, to his graduation ceremonies or even to his graduation.

Emotional pain in young people is not an isolated instance.

According to the American College Health Association’s 2013 National College Health Assessment, over the previous 12 months, college students reported that: • 60.5 percent felt very sad • 51 percent experienced overwhelming anxiety • 32 percent had felt so depressed that it was difficult to function • Over 20 percent felt • Hopeless • Lonely • Overwhelmed

When Dan took his life, he left behind never-ending unimaginable pain for his family and friends. Not a day goes by that we aren’t stricken by the deep sadness that his suicide brings to us. Not a day goes by that we don’t question the adequacy of our performance as parents, and question the legitimacy of us surviving while he died.

So why did we start DMAX Foundation?

And why does it focus on DMAX Clubs on college campuses?

Each child lost to suicide is one too many. And yet the numbers are startling. According to the Centers for Disease Control, every day in the United States, at least 12 children between the ages of 10-24 take their own lives. That is 4,600 every year. Most of them (81 percent) are boys. Every year, there are 575,000 attempted teen suicides, most of them girls.

In fact, this study also found that more than six percent of students had inflicted self-harm while eight percent had seriously contemplated suicide. Suicide is the second leading cause of death among college and university students.

Stigma plays a role in these concerning factors. The National Association of Mental Health (NAMI) reports that “While 1 in 5 Americans live with a mental disorder, estimates indicate that nearly two-thirds of all people with a diagnosable mental illness do not seek treatment.

Lack of knowledge, fear of disclosure, rejection of friends and discrimination are a few of the reasons why people with mental illness don’t seek treatment.”

www.delcomedsoc.org

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FEATURE

In addition, insufficient mental health resources are cited as another reason that students don’t seek or get the help they need. Thirty-nine percent of the students reported that they had to wait five days or more for services. With Counseling Centers overwhelmed by an increasing prevalence of mental illness on campus, students in the NAMI study cited the need for an increase in mental health services at their schools.

In fact, 42 percent of the students named peer support as a critical element in the needed mental health support services. DMAX Clubs fall into this category and aim to provide students with a nonjudgmental way to talk to each other, to help each other, and to reduce the stigma of mental illness.

After Dan died, we established the DMAX Foundation to create communities of caring around mental and emotional issues in our youth so students don’t have to hide who they really are and how they are really doing, from each other. Conversations That Matter help eliminate stigma and help students navigate the ups and downs of their college years.

DMAX Clubs on college campuses create

environments for students to get together and talk about how they are doing, how their friends are doing, and how they can help each other. DMAX Clubs are for all students because we all fall along the mental health continuum at different places, at different times in our lives and because mental health is everyone’s concern.

Our first DMAX Club has just started at Elon University in North Carolina. Our objective is to work with the club to ensure its quality and sustainability, and then to add additional clubs going forward.

Stefanie Milov ic, one of the officers of a DMAX Club, at a wellness Fair

DMAX Clubs on college campuses create environments for students to get together and talk about how they are doing, how their friends are doing, and how they can help each other.

If you know of students or colleges that would like to start a DMAX Club, please contact us at dmaxclubs@dmaxfoundation.org. If you would like to volunteer in our effort, or support us through donation, please visit our website and let us know atwww.dmaxfoundation.org.

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FEATURE

Although the number of females graduating from medical school has grown by leaps and bounds, women still have a ways to go in holding leadership positions in healthcare and academic settings.

The Clinic Launches “GIRLS IN MEDICINE�

PROGRAM

S

ince The Clinic, located in Phoenixville, opened its doors in 2002, it has been providing comprehensive health care to the uninsured. We are committed to helping not only those who need healthcare but also those who seek to provide it. That is why we have created Girls in Medicine, the only program of its kind in Pennsylvania. Girls in Medicine connects high school girls interested in healthcare careers with hospitals, healthcare professionals, and mentors who can help them learn how to achieve their dreams.

The Program

Make a difference

Please confirm your interest in being a mentor or speaker by emailing: David A. McKeighan, Executive Director, Delaware County Medical Society, at delcomedsoc@comcast.net.

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DELAWARE COUNTY MEDICINE & HEALTH

Girls in Medicine is a rigorous one-year enrichment program for highly motivated and talented high school girls interested in pre-medicine and healthcare careers. Accepted applicants will learn from top medical leaders in the area, study at Paoli and Phoenixville Hospital facilities, gain medical research and presentation skills, achieve CPR/First Aid Certifications, receive volunteer and internship opportunities, and obtain leadership experience as a Health Ambassador. Our goal with Girls in Medicine is to help young women build their self-confidence to discover and realize their full potential for a career in medicine.

spring 2016

Mentors Needed

Each student will have a mentor to assist her in building selfconfidence, provide an experience that she may not otherwise be able to obtain, and encourage her to pursue her dreams.

If you are a physician or allied healthcare professional, you can be a Medical Practice Mentor, agreeing to have a student shadow you in the office. This provides the student with first-hand observation of medicine in action. There is a minimum requirement of one hour per month of your time for nine months.

If you are a heath care administrator, you can be a Supportive Mentor advising a student as she works on her Girls in Medicine Health Ambassador Project. You would answer questions and help a student analyze her project’s strengths and weaknesses. No research or writing on your part is necessary. It requires 30 minutes of your time by phone or 60 minutes at your place of employment per month.

This small commitment will be time well spent, helping a young girl reach her dream of a career in medicine, where she may help thousands of people throughout the course of her career. You will truly be paying it forward.

As a mentor, you need several legal clearances that many health care professionals already have including: Pennsylvania State Police, Pennsylvania Child Abuse, and Federal clearances.

Speakers/Presentations

We have a need for speakers who can provide information in your area of expertise so the students have an idea of the myriad of career opportunities available in medicine. .

Spread the Word

Because of the overwhelming response to the Girls in Medicine Program, a second week for new applicants has been added to fulfill the Summer Healthcare components of this year-long enrichment program.

If you know a girl who might be interested in applying to the program, she should email Marrea Walker Smith, Director of Girls in Medicine, The Clinic at msmith@theclinicpa.org.

www.delcomedsoc.org

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LEGISLATION

Medical Marijuana in Pennsylvania On April 17, 2016, Pennsylvania Governor Tom Wolf signed Senate Bill 3, which allows the legalization of medical marijuana. The implementation of the Pennsylvania Department of Health’s Medical Marijuana Program is expected to take approximately 18 months, and will offer medical marijuana to patients who are under a physician’s care for the treatment of certain serious medical conditions. The new law will allow physicians to prescribe medical marijuana to patients with qualifying conditions in liquid, oil, ointment, pill or liquid form that can be vaporized and inhaled. Smoking marijuana will not be allowed under the law.

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These conditions are: • Amyotrophic Lateral Sclerosis • Autism • Cancer • Crohn’s Disease • Damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity • Epilepsy • Glaucoma • Positive status for HIV or AIDS • Huntington’s Disease • Inflammatory Bowel Syndrome • Intractable Seizures • Multiple Sclerosis • Neuropathies • Parkinson’s Disease • Post-traumatic Stress Disorder • Severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain in which conventional therapeutic intervention and opiate therapy is contraindicated or ineffective • Sickle Cell Anemia

Patient-Centered Care, Focused on Recovery Kindred’s Transitional Care Hospitals specialize in patient-centered care.

Our patients are critically or chronically ill, requiring specialized and aggressive treatment. Care is provided through an interdisciplinary team approach which includes physicians, nurses, therapists and specialists, among many others.

Our goal is to produce the optimal clinical outcome, helping our patients recover as fully as possible.

In order for patients to purchase medical To learn more, visit www.kindredhospitals.com marijuana, their physician will have to or call 1.866.KINDRED. be registered with the PA Department of Health and they must provide Kindred Hospital Kindred Hospital Kindred Hospital signed certification stating that the Philadelphia Philadelphia – Havertown South Philadelphia patient has one of the aforementioned 6129 Palmetto Street 2000 Old West Chester Pike 1930 South Broad Street Philadelphia, PA 19111 Havertown, PA 19083 medical conditions. The patient then Philadelphia, PA 19145 has to apply to the Department of Health for an identification card, after which he or she can purchase medical marijuana at one of up to Any qualifying patient can designate up to two caregivers fifty authorized dispensaries (each dispensary can have who can obtain medical marijuana on their behalf; they up to three locations). If the patient is under the age of must also apply for a medical marijuana identification eighteen, they must have a caregiver who is approved by card. A caregiver can assist up to five patients. the department in order to obtain medical marijuana.

While the Medical Marijuana Program is still in the process of implementation, a parent or guardian of a minor under the age of 18 can obtain medical marijuana from another state, territory of the United States or any other country to be administered to a minor.

This condition will be put into effect 30 days after the bill has been signed, and is effective for 730 days.

www.delcomedsoc.org

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LEGISLATION Physicians are not required to participate in the Medical Marijuana Program. Those who wish to participate must apply to the Department of Health to become a registered medical marijuana practitioner. These physicians must provide documentation of their credentials, training, or experience to show that they are able to treat patients with the listed medical conditions.

Additionally, physicians interested in applying will be required to undergo a 4-hour training program approved by the Department of Health, which will cover the latest scientific research on medical marijuana along with the drug’s known risks and benefits. Interested physicians must also have an unexpired, unsuspended and unrevoked license to practice medicine within Pennsylvania. If any of these qualifications are no longer met, the physician will no longer be registered with the Department of Health as one who can certify patients for medical marijuana use. Physicians certified as medical marijuana providers will have their names, business addresses and medical credentials publicly available.

A physician participating in the program must, in their professional opinion, determine that the patient will likely receive a therapeutic benefit from the use of medical marijuana. A physician can place a time limit on the patient’s certification. The physician must immediately notify the Department of Health, in writing, if they know whether the patient no longer has a serious medical condition, whether medical marijuana would no longer be palliative for the patient, or if the patient has died.

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The physician is required to review the Prescription Drug Monitoring Program to determine the controlled substance history of the patient before issuing a certification and in order to recommend the proper amount or form of medical marijuana. The patient or a caregiver is allowed to receive a copy of the controlled substance history.

If the physician determines that medical marijuana is suitable for a patient, the physician must provide certification to the patient, provide a copy to the Department of Health, and file a copy in the patient’s health care record.

A physician should not accept or offer any payment to certify a patient, other than accepting a fee for the examination of the patient to determine if they should be issued a certification for the use of medical marijuana.

Physicians cannot hold an economic interest in a medical marijuana organization. They cannot advertise their services as a practitioner who can certify a patient to receive medical marijuana, nor can they issue a certification for their own use or for a family or household member.

References/Further Reading www.governor.pa.gov www.legis.state.pa.us www.pamedsoc.org

OPIOID ABUSE

FIGHTING OPIOID ABUSE IN PENNSYLVANIA

Introducing PAMED’s Innovative Educational Series and Other Resources Health Care Teams Can Use To Address The Opioid Crisis The Problem: Opioid abuse, misuse, and overdoses are increasing, both in Pennsylvania and nationally. While some requests for pain medication are legitimate, others are likely to be from pill scammers who have become addicted to opioids.

The solution: A multi-pronged approach that includes physicians, patients, and health care organizations like the Pennsylvania Medical Society (PAMED) working collaboratively to address this growing epidemic.

PAMED, in collaboration with the Pennsylvania Department of Health and 11 other health care associations, is creating a comprehensive online educational resource to help prescribers combat this problem.

“Addressing Pennsylvania’s Opioid Crisis: What Healthcare Teams Need to Know,” is a multi-part course that examines all the tools prescribers can use to identify patients with addiction issues and get them help.

The first session of the course addresses how prescribers can use the statewide voluntary opioid prescribing guidelines, and the second session takes a closer look at the state’s naloxone law. Both are available at www.pamedsoc.org/opioidscme.

Additional sessions are forthcoming.

This educational series features: Videos and interviews with physicians, other prescribers, and state officials working on the front lines of the crisis

Details on how to use opioid prescribing guidelines for physicians, emergency departments, and other providers Scenario-based learning to help implement the lessons into daily practice This crisis spans nearly every state in the U.S., but has hit Pennsylvania particularly hard. Nearly 2,500 deaths were reported in Pennsylvania as a result of drug overdoses in 2014, and more people die from drug overdoses than in car accidents.

No one disputes the magnitude of the prescription drug abuse crisis in Pennsylvania and the nation at large. The question is, how do we combat the problem?

“We need to get past the idea that these are somehow just drug abusers that are miscreants and throwaway members of our society,” says Dr. Levine. “This crisis hits everyone—our mothers, fathers, brothers, sisters, sons, daughters, rural, urban, suburban,” she said. “We have to get past the idea that this is someone else’s problem.

We have to get people into treatment and recovery. Addiction is a disease; we have to erase the stigma.”

www.delcomedsoc.org

3 Ways

To Increase Your Confidence In Managing Opioid Therapy

“I think that we have to understand this is a public health crisis and we all have a role to play in terms of solving this,” said PAMED member and Pennsylvania Physician General Rachel Levine, MD.

The latest statistics and data

PAMED’s education seeks to address the many layers and complexities of this crisis. Learn more and get CME credit by visiting www.pamedsoc. org/opioidscme. Access additional resources such as prescribing guidelines in PAMED’s Opioid Abuse Resource Center at www.pamedsoc.org/ opioidresources. “Opioid CME is not currently mandated by the state, but one way to ensure it stays that way is for Pennsylvania physicians to use the voluntary opioid guidelines and take this voluntary CME,” said Dr. Levine.

1. Familiarize yourself with these stateendorsed, voluntary guidelines for opioid prescribers in Pennsylvania:

• • • • •

Chronic Non-Cancer Pain Emergency Department Pain Geriatric Pain Obstetrics and Gynecology Pain Pain in Dental Offices

2. Get involved with grassroots advocacy and initiatives by having a discussion with the physicians in your county or region. Call PAMED’s Speakers Bureau at (800) 228-7823, ext. 2620.

3. Have a conversation with your chronic

pain patients using PAMED’s Opioid Prescription Checklist to help facilitate the pain-management discussion.

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ON THE COVER

The History of the Delaware County Medical Society

By Ronald B. Anderson MD, current DCMS President

The first half of the 19th century witnessed the expansion of our nation from 16 states at the turn of the century to 31 states by 1850. Coincident with this was the expansion of state medical societies, the first being the New Jersey Medical Society which was organized in 1766, and after the addition of 15 more state societies over the next several decades they were brought under the umbrella of the American Medical Association which was formed in 1847. The Medical Society of the State of Pennsylvania (later renamed the Pennsylvania Medical Society, or PAMED) was the 16th state to join in, founded the following year in 1848, which strove “to foster the advancement of medical knowledge, relieve suffering, and promote the health of the community.�

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A

t that time, Pennsylvania already had several regional medical organizations, the first having been the Philadelphia College of Physicians in 1787, followed by the first true county medical society, the Philadelphia County Medical Society, in 1796.

Several more county societies were added, including the Chester County Medical Society in 1828. It was only a matter of time, then, until Delaware County (which had until 1789 been a part of Chester County) would follow the lead of its neighbors. This was spearheaded by Dr. Elwood Harvey and Dr. George Martin who met at the law office of John M. Broomall at 3rd and Market Streets in Chester (which was then the county seat) on May 2, 1850. A constitution for the Delaware County Medical Society (DCMS) was drawn up and adopted at the Penn Building in Chester on May 30, 1850, with Dr. Jessee Young of Snead’s Corner (now Brookhaven) as president, Dr. Joshua Owen as vice president, Dr. Robert Smith as secretary, and Dr. Elwood Harvey as treasurer.

The DCMS was slow to get going but picked up momentum over time. In 1851 there were 14 members. They published a quarterly journal starting in the summer of 1853, but this was discontinued after 3 years at which point, according to DCMS minutes, the society “languished and languishing did live.” For lack of interest and support, the DCMS was formally disbanded on February 24, 1857, and subsequent efforts to resurrect it failed. Finally in April of 1861, through the auspices of Dr. Joseph Parrish, then Superintendent of the Pennsylvania School for Feeble-Minded Children (now Elwyn Institute), reorganization was effected and the constitution re-adopted. The membership roll at that time numbered 13.

The following resolution outlined the initial concept of the DCMS: Whereas, Experience has fully shown that the progress of any Art or Science is promoted by the frequent reunion and full interchange of the personal observations of those whose profession is connected with it; and Whereas, The organization of County Medical Societies throughout the State is calculated to produce such results; and Whereas, It is of the highest importance to introduce throughout every county of the State an elevated Code of Ethics for the government of our profession by which its members will be under recognized censorial head, which may tend to increase its respectability on the one hand and unite it against the encroachments of Charlatanism on the other; therefore we, the physicians of Delaware County here assembled do hereby Resolve, That it is expedient to form ourselves into a medical association, which shall bear the name of the Delaware County Medical Society; Resolved that the society shall be considered as a branch of the Medical Society of the State of Pennsylvania.

When the war was over, reorganization was undertaken in 1865, but the Society again languished for a few years until, again under the auspices of Dr. John Parrish, at a meeting in Media (which by then had become the county seat) at his Sanatorium on March 16, 1869, the DCMS was finally revived and thereafter continued to flourish. Membership in 1873 numbered 23, but by 1900 it had grown to 50, in 1922 it was 100, in 1938 it was 215, and in 1950 it was 325. Today the membership of DCMS is around 600. Since the 1970s, full membership has been open to osteopaths (D.O. degree) as well as allopaths (M.D.), as symbolized in the DCMS logo which was adopted in 1988. Since the 1990s medical practice administrators have been accepted as associate members as well as non-voting Board members—one of the first county medical societies to do so.

Then came the Civil War which disrupted everything.

As Dr. Stiteler recounts, “The War of Rebellion demanded the services of so many of the physicians that those doctors who remained home were so busy that they seldom attended meetings, which were held occasionally, but no records of the proceedings were kept.” www.delcomedsoc.org

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Pulmonary Associates of Drexel Hill Specializing In: Critical Care Pulmonary Medicine Sleep Medicine scientific endeavors as well, such as the creation in 1851 of a comprehensive geologic survey of Delaware County which proved to be a standard reference for many years.

Thomas F. Prestel MD FCCP James W. Ortmeyer MD FCCP Michael S. Weinstein MD FCCP Geoffrey L. Koff MD

610.394.9860 | 610.394.9922 fax https://secure.mydrsoffice.org 2100 Keystone Ave Suite 309 | Drexel Hill, PA 19026 You will note the reference to Charlatanism and “respectability” in the original resolution which created the Society. During the mid-19th century physicians were striving to separate themselves from the snake oil hawkers. This was also the era of the pill, with the 19th century seeing the development of sugar coated tablets, gelatin capsules, and the invention of the compressed tablet, which became vehicles for scores of “patent medicines” designed to cure any ailment. Unfortunately, although the concept of taking a pill was garnering considerable popular appeal, supportive pharmaceutical science was rudimentary at best, and governmental oversight nonexistent (the FDA was not established until 1906).

The original DCMS constitution stipulated that a member should “not prescribe any remedy the compounds of which he was unacquainted with, or who was interested in any way in patent medicines or in collusion with any apothecary to procure patronage or profit.” “Members were interdicted from rendering service gratuitously to any clergyman or physician whose name was attached to any certificate in favor of patent medicines, or who permitted reference to such nostrums to be made to him;” and in proceedings from a later meeting it was recorded that “the true physician should be prompt to relieve [suffering], and at the same time he must show no complicity with quacks and pretenders.” There were resolutions to discourage physicians from selling patent medications (1873) and from advertising (1888).

In addition to fostering ethics and respectability, the early DCMS initiatives strived to emphasize not only the science of medicine, but also sought to improve the image of the medical professional through supporting other

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The DCMS took an early interest in dealing with the then-controversial subject of female physicians, and meeting minutes from 1869 onwards expressed disappointment that the State Society was slow to take an official stand on welcoming women to its professional ranks. In August 1871 the DCMS passed a resolution that its “delegates to the State Medical Society are hereby instructed to recognize no distinction in sex in our profession, if any question in relation to that subject should arise.” The first woman elected to DCMS membership was Dr. Rebecca Fussell of Media in July 1873, though it was not until 1910 that Dr. Frances Baker served as the first woman president. (The first female PAMED president wasn’t elected until 2001.)

Issues relating to medical practice administration and advocacy have been a concern of the DCMS from early on.

In 1904, the Society adopted recommendations for physician fees, pegging office visits at $1.00, obstetrical work at $10.00, and consultations at $5.00, with doubling of these amounts for evening and night hours. In 1920-21 the DCMS came out in strong opposition to statewide efforts to impose compulsory health insurance or establish a socialized medical plan such as was getting started in England. In 1938 the concept of Group Hospitalization insurance plans was endorsed though the DCMS was opposed to including medical services in these plans.

As further statewide and national efforts to develop medical service insurance plans (especially for low income patients) picked up steam in the late 1930s, the DCMS (and the Philadelphia County Medical Society) remained in staunch opposition, resolving in 1939 that “the Delaware County Medical Society is opposed to Voluntary Insured Medical Service and recommends that physicians should continue to take care of the low income group as they have done in the past,” which is to say through flexible fee-for-service and payment-in-kind arrangements The political debate escalated over the next decades as organized medicine, from the county level up to the AMA, remained steadfastly opposed to the concept of insurance to cover physician fees, particularly the government-sponsored programs which were being proposed as an outgrowth of the Social Security Act of 1935, and the DCMS remained engaged in this dialogue and in sympathy with state and national medical societies. As we know, in spite of this opposition organized medicine lost this

battle as medical insurance plans—both public (Medicare came about in 1965) and private—have burgeoned over the ensuing years. In more recent years, the issue of tort reform has been a major concern of the DCMS (and PAMED), and a centerpiece of our engagement hinges on political advocacy. Currently we are also addressing issues relating to payment reform, changing health care delivery models, and information technology. Practice management support has been a core principle as exemplified in the well-received “Tools for Success” conferences the DCMS has been organizing annually for the past several years.

During the first half of the 20th century the DCMS increasingly took a leading role in county health care advocacy. There were numerous initiatives promoting efforts to combat epidemics of small pox, diphtheria, and tuberculosis which were moving through Delaware County around 1900. Thanks to the efforts of the Society, the city of Chester began employing a bacteriologist in 1908. There was advocacy for vigorous vaccination programs (though the DCMS felt this should primarily be pursued through individual physician offices). The problem of tuberculosis received particular attention. In 1906 the Society urged that a dedicated facility be created “for incurable pauper consumptives.”

The DCMS helped to establish a Delaware County Tuberculosis Association in 1919, which sought to provide public education on the disease as well as promulgate mass public chest X-ray screenings in the county which continued for the next 30 years. In 1925-26, the DCMS helped to spearhead an initiative to have a dedicated TB hospital built in Delaware County, and even though state and local funding was allocated, a site selected, architectural plans were prepared, and a public electoral referendum in 1921 had supported the project, it was ultimately voted down by the County Commissioners in 1926. More recently the DCMS has been engaged in initiatives concerning suicide prevention, opioid abuse, and health care literacy, among others.

Today, the members and Board of the Delaware County Medical Society continue in the tradition of our forebears, to advocate for physicians and office managers in the practice of medicine, to provide public and professional education, and to organize and support programs to improve the health of our county and beyond.

---------------------------------------------------------------------------

DCMS President Ronald B. Anderson, MD

Acknowledgement: Much of the information for this article is derived from a booklet entitled “A History of the Delaware County Medical Society” published in 1950 to commemorate the 100th anniversary of the Society, authored by C. Irwin Stiteler, MD, who was designated at the time as Historian to the Board)

www.delcomedsoc.org

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DCMS Presidents 1851 – present Jessee Young, M.D. J. Owen, M.D. L. A. Barton, M.D. Robert K. Smith, M.D. Manly Emanuel, M.D. Hilborn Darlington, M.D. Manly Emanuel, M.D. J. L. Forwood, M.D. Joseph Parrish, M.D. Edwin Fussell, M.D. M. Fisher Longstreth, M.D. William B. Ulrich, M.D. S. P. Bartleson, M.D. Isaac N. Kerlin, M.D. D. W. Jefferis, M.D. Ellwood Harvey, M.D. Samuel Trimble, M.D. William B. Ulrich, M.D. R. H. Milner, M.D. F. R. Graham, M.D. L. M. Bullock, M.D. Frank H. Seidell, M.D. Samuel Trimble, M.D. S. P. Bartleson, M.D. William B. Ulrich, M.D. J. Harvey Fronfield, M.D. S. P. Bartleson, M.D. Harry D. Stoever, M.D. W. K. Evans, M.D. D. F. Laine, M.D. W. T. W. Dickeson, M.D. D. M. McMaster, M.D. Robert S. Maison, M.D. D. M. McMaster, M.D. George D. Cross Harry Gallager, M.D.

1850-51 1852 1853 1854 1855-56 1857 1861-69 1870 1871-73 1874-75 1876 1877 1878 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899-1900 1901 1902

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F. Farwell Long, M.D. Thomas C. Stellwagen, M.D. S. Ross Crothers, M.D. Morton P. Dickeson, M.D. J. L. Forwood, M.D. Franklin J. Evans, M.D. Maurice A. Neufeld, M.D. Frances W. Baker, M.D. D. Forest Harbridge, M.D. William F. Lehman, M.D. Fred H. Evans, M.D. J. William Wood, M.D. Alexander R. Morton, M.D. Ethan A. Campbell, M.D. Harry M. Armitage, M.D. G. Victor Janvier, M.D. C. Irvin Stiteler, M.D. Daniel Monihan, M.D. George H. Cross, M.D. John B. Roxby, M.D. J. Clinton Starbuck, M.D. Stoddard P. Gray, M.D. Adrian V. B. Orr, M.D. George B. Sickel, M.D. Raymond B. Loughead, M.D. Frank R. Nothnagle, M.D. Richard Owen, M.D. George L. Armitage, M.D. Walter E. Egbert, M.D. William B. Evans, M.D. Harry C. Donahoo, M.D. E. Arthur Whitney, M.D. John S. Eynon, M.D. John J. Sweeney, M.D. Albin R. Rozploch, M.D. Ralph E. Bell, M.D.

1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938

DCMS Presidents 1851 – present Frank H. Murray, M.D. Augustas H. Clagett, M.D. Franklin E. Chamberlain, M.D. Drury Hinton, M.D. Carl A. Staub, M.D. Walter V. Emery, M.D. Denis T. Sullivan, M.D. Paul C. Crowther, M.D. Thomas J. Ryan, M.D. Ferdinand W. Nyemetz, M.D. Walter E. Wentz, Jr., M.D. Joseph F. Dougherty, M.D. Richard W. Garlichs, M.D. W. Gifford Crothers, M.D. Edward G. Torrance, M.D. Merrill B. Hayes, M.D. W. Benson Harer, M.D. Rocco deProphetis, M.D. Patrick J. Devers, M.D. E. Wayne Egbert, M.D. C. T. McCutcheon, M.D. William H. Erb, M.D. Harry B. Fuller, M.D. J. Albright Jones, M.D. Harry V. Armitage, M.D. Lewis C. Hitchner, M.D. James W. Dunn, M.D. William Y. Rial, M.D. Ralph H. DeOrsay, M.D. Arthur H. Silvers, M.D. J. Vernon Ellson, M.D. Conrad A. Etzel, M.D. John H. Wigton, M.D. Otto F. Muller, M.D. David L. Mudrick, M.D. John L. Kelly, M.D. Furman T. Kepler, M.D. F. Peter Kohler, M.D. Hunter S. Neal, M.D. W. William Nagle, M.D. David J. McAleer, M.D. John W. Lawrence, M.D. Joel B. Jurnovoy, M.D. Wallace O. Lecher, M.D.

1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 * 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 ** 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 * 1981 1982

J. Walter Valenteen, M.D. Howard A. Richter, M.D. Samuel D. Allen, M.D. Charles K. Gorby, M.D. Alvin E. Gaary, M.D. Richard R. Ratner, M.D. James A. Morris, Jr., M.D. Mandell J. Much, D.O. H. Thomas Dodds, M.D. Mark W. Shulkin, M.D. Marc I. Surkin, M.D. Bruce G. Silver, M.D. C. Richard Schott, M.D. Robin B. Scheiner, M.D. Mark S. Friedlander, M.D. Stephen N. Clay, M.D. Mark F. Kelly, M.D. Martin J. Bergman, M.D. Francis C. Lazorik, M.D. William J. Lewis, M.D. Charles D. Hummer, III, M.D. Salvatore A. Lofaro, M.D. Maria C. DeMario, D.O. Christopher F. Hannum, M.D. Fredric N. Hellman, M.D. Richard V. Buonocore, M.D. Ronald B. Anderson, M.D.

1983 1984 * 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 * 1996 1997 1998-99 2000 2001-02 2003-04 2004-05 2006 2007-08 2009 2010-11 2012 2013-14 2015-16

*subsequently served also as Pennsylvania Medical Society president **subsequently served also as American Medical Association president

DCMS Executive Directors John Kotik Joseph Fleming John L. Kelly, M.D. David McKeighan

www.delcomedsoc.org

1962-80 1981-84 1984-86 1986-present

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IN THE COMMUNITY

Community Volunteers in Medicine A Medical and Dental Home for the Uninsured How You Can Help?

Community Volunteers In Medicine (CVIM) was founded in 1998 as a non-profit, free clinic staffed primarily by volunteers to address the need for increased access to high quality primary medical and dental care and free prescription medications for uninsured, vulnerable adults and children living in poverty the working poor who have no place to turn for care.

S

tudies at that time estimated that 6 to 9% of the county’s population was uninsured or underinsured. Aware of this strain on communities and healthcare systems, the Paoli Hospital Foundation and its Auxiliary set aside funds in 1996 to develop CVIM and our first patients were treated in 1998. Current census data estimates that 8% of the county’s more than 512,000 residents or 41,000 people are uninsured. Today, our clinic serves as the premier free medical and dental home for thousands of uninsured adults and children living in poverty and near poverty and whose gross income is at or below 300% of the federal poverty level and are not eligible for government programs.

In 2014, our 16th year of serving our community, we were able to purchase our building and once again expand our physical plant, thus assuring a strong future for our programs and enhancing our ability to continue our commitment as the only totally free, comprehensive medical home serving the uninsured.

18 DELAWARE COUNTY MEDICINE & HEALTH

Since our founding, we have continued to effectively address the gap in the access to healthcare for the uninsured through collaborative relationships with hospitals, healthcare providers, community volunteers, and philanthropists. Our clinic’s growth and the impact we have had on the health of our community are a direct result of our ability to identify areas of need and to collaborate with appropriate partners to jointly address the urgent health issues facing our shared community.

Together with our partners we have served as a catalyst for change in the provision of free healthcare for the underserved—how it is delivered, kept cost effective, yet comprehensive and how the model can be replicated in other communities.

Our Mission CVIM provides compassionate primary medical and dental care and health education to people who lack access to insurance and who live or work in Chester County in order to support their goals to lead productive, healthy, and hopeful lives.

Our Vision CVIM will continue to remain a nimble and relevant organization that will evolve with purpose to meet the primary healthcare needs of uninsured adults, children and seniors across the county and surrounding neighborhoods. We will continue to strengthen our successful programs and services that provide primary medical and dental care and free prescription medications, while developing additional ones in dental outreach, behavioral health,

health education and prevention services to serve the identified unmet needs of marginalized populations in our region. Compelled by our conviction that all deserve access to vital healthcare services and powered by our partnerships with volunteer clinicians, healthcare providers and like-minded philanthropists, CVIM will expand our outreach and therefore our positive impact on the health of Chester County.

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2015 Accomplishments • The CVIM team of 380 clinical and professional support volunteers treated 3,059 unduplicated patients during 31,819 patient visits during 50,866 hours of donated volunteer hours.

• The eligibility team screened 3,428 new and returning patients for eligibility.

• CVIM Dentists and Hygienists cared for 2,099 patients during 5,541 visits, including the oral health of close to 800 children living in poverty referred from local school districts and through community outreach programs.

• On average CVIM treated 50 unscheduled dental emergencies every month.

• Through our Transitional Care program 206 uninsured patients discharged from ERs, hospitals and other institutions received continuity of care at CVIM. • With more than 47% of CVIM medical patients suffering with a chronic disease, we treated 948 patients during 5,293 visits in our Chronic Disease Management program.

• CVIM provided 718 social service sessions, an 18% increase from FY2014.

• A total of 444 GYN patients were seen in CVIM’s Women’s Clinic with 377 receiving a Pap test and 27 a Colposcopy; 242 received a preventative or follow-up mammogram.

• CVIM patients received 1,339 referral visits to offsite clinical experts, community partners who provide services in their practices and/or medical facilities.

• During more than 8,700 dispensary visits, patients received life saving prescription medications valued at $2,280,857.

PATIENT VISITS 2009-2015

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Who We Serve and Where We are Located Chester County is the wealthiest county in the Commonwealth of Pennsylvania and the 24th wealthiest in our nation. Yet, there are pockets of poverty and nearpoverty throughout the county. CVIM is based in West Chester near the center of the county in order to serve the uninsured from all zip codes in the county and is strategically located near the two major not-for-profit acute care hospital systems (Main Line Health and Chester County Hospital/ Penn Medicine) where a disproportionate quantity of uninsured patients seek care in their emergency rooms.

Our neighbors that are eligible for care at CVIM include those working hard at one or more low-paying jobs and making less than 300% of the Federal Poverty Level. They struggle with the daily demands of keeping a roof over their heads, food on the table and gas in the car so that they may get to their jobs. The percentage of households living at or below the Federal Poverty Level in our County is 7% and has not decreased over the past four years. It is reasonable to assume that the need for CVIM’s services will not diminish.

We also serve those who have lost their jobs and healthcare benefits during economic downturns. Many have worked for years at better paying jobs, however, job loss and longer term unemployment coupled with subsequent health issues in their families have caused them to deplete their savings and they now turn to CVIM for healthcare services.

A portion of our patients have been able to take advantage of the plans offered by the Affordable Care Act; however, many continue to be caught in the spiral of poverty. And, as with most free clinics, we continue to be challenged to educate the community, that even with the implementation of the ACA; CVIM continues to be a vital safety net provider of quality and free healthcare in our County.

The majority of our patients fall through the “Coverage Gap” and remain uninsured. We have also experienced the return of patients who had been able to afford a Bronze Plan through an exchange and subsequently have incurred large debts due to unexpectedly high deductibles and copays. So as not to go further into debt many have opted to cancel their plans and return to CVIM for care. Albeit the Commonwealth of Pennsylvania expanded the state’s Medicaid program, that only covers people up to 138% of the Federal Poverty Level. Despite the expansion that has helped some families, there has been little impact on dental and mental health insurance coverage. CVIM remains focused on people lacking insurance, while helping those newly eligible for insurance to transition to a high quality, culturally competent provider to the extent possible.

www.delcomedsoc.org

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CVIM IN 2015: 31,822 PATIENT VISITS MEDICAL 38% DISPENSARY 28% DENTAL 17% ELIGIBILITY SCREENINGS 11% SOCIAL SERVICE 2% COMMUNITY BASED SPECIALISTS 4%

A Physician Testimonial Laura Offutt, MD, volunteer Internist, says it best. “I came to CVIM two years ago. When I tell people that I am a volunteer physician here, they often comment of how nice that is of me.

But truly, working at CVIM gives me many times over what contribution I make to CVIM. The quality of care is high, but equally important so is the compassion. The patients are people we meet over the course of our day-to-day lives: cooks, wait staff, school bus drivers, landscapers, house cleaners, home health aides, day care workers, mothers, and many, many other hard working people who through no fault of their own do not have health insurance. To be able to help these patients is an honor, and furthermore, practicing medicine at CVIM allows me to practice the way I dreamed I would when I was in medical school. I can take my time with patients. I am surrounded by a skilled team of clinical and social support staff which works seamlessly together to provide holistic care to our patients. My fellow volunteers are dedicated, experienced, professional and kind. Interacting with students and residents allows me to teach, but also to continue what is the endless process of learning medicine. I come to CVIM weekly, and I can honestly say, it is the highlight of my week.”

“To be able to help these patients is an honor, and furthermore, practicing medicine at CVIM allows me to practice the way I dreamed I would when I was in medical school.”

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How do we get the job done?

Care is provided by more than 380 volunteer licensed healthcare professionals and support volunteers coordinated by a core staff of 17 full-time and 13 part-time employees.

Our medical division is overseen by one paid physician who oversees 90 medical providers. Our dental department is served by three part-time dentists making up over 1 full time employee with one serving as oversight for the department.

For nearly two decades, CVIM has remained a beacon of hope and a premier provider of free and compassionate healthcare for people in Chester County lacking access to quality medical and dental services. Current census data estimates that 8% of the county’s more than 512,000 residents or 41,000 people are uninsured. The uninsured go without necessary healthcare, affecting their ability to work and to provide and care for themselves and their families. Children suffering from dental pain and neglect struggle in school and often regress socially. The uninsured seek care from already overburdened hospital emergency rooms for nonemergent problems as well as uncontrolled chronic diseases, thus exacerbating the financial and staffing issues facing our hospitals and creating unnecessarily higher health costs that must be absorbed by all of us. Frankly stated, helping the uninsured gain access to care is a path we should all consider because at any moment in our ever-changing, volatile economy we could be the person struggling to gain that access.

Sustainability CVIM’s entire budget is supported by philanthropy and through the generosity of a broad base of donors and prudent fiscal management, we have been able to continue to accept new patients and expand our programs.

We are in need of Physicians, Dentists, Physician Assistants, Nurse Practitioners, Pharmacists, Dieticians, Physical Therapists, Dental Hygienists and English/Spanish bilingual Medical Interpreters.

If you can volunteer at CVIM, please contact Marie Frey, Vice President of Operations, at mfrey@cvim.org or call 610.836.5990 ext. 106. www.cvim.org

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2016 CONFERENCE

2016

Tools for Success

t Conference

l Practice Managemen

nal Medica The 11th Annual Regio

T

he 2016 “Tools for Success” Conference was held Wednesday evening April 27th and

all day on Thursday April 28th at the Villanova University Conference Center in Radnor, PA. The conference was coordinated by staff of the Berks, Bucks, Chester, Delaware, Montgomery and Philadelphia

Thursday evening’s session with Stephen Foreman, PhD, JD, MPA

County Medical Societies along with PAMED staff and members of the

This year’s conference was “Don’t Be a Deer in the Headlights!” and the agenda included the return of several very popular guest speakers, a choice of afternoon breakout sessions and nearly two dozen corporate sponsors who displayed their resources at vendor tables throughout the conference center’s dining hall.

Delco Chapter of PAHCOM.

In his only return since the original “Tools for Success” conference a decade ago, Stephen Foreman, PhD, JD, MHA revisited many of the predictions he’d made previously about the healthcare market in SE Pennsylvania. Professor Foreman, who is now at Robert Morris University in Pittsburgh, provided many details about changes in physician manpower in our region; the region’s experience over this time in terms of medical malpractice cases and the growth and strength of hospitals/ health systems. This Wednesday evening program included a networking reception and buffet dinner prior to Dr. Foreman’s presentation and was well attended by physicians and practice administrators.

Breakout Session in the Montrose Mansion with Karen Davidson, Esq. 24 DELAWARE COUNTY MEDICINE & HEALTH

spring 2016

On Thursday morning human resource attorney George Hlavac, Esq. entertained the audience while explaining many new rules about managing a practice’s human resource needs. Mr. Hlavac is the Chair of the PA Labor & Employment Group for Norris, McLauglin & Marcus in Allentown, PA. He has been a presenter each year at “Tools for Success” and has provided expert legal assistance to many medical practices who have struggled with managing, hiring and discharging some of their employees.

PAMED staff Mary Ellen Corum and Jennifer Swinnich from the Practice Support Team provided the morning keynote address which included a legislative & regulatory update; miscellaneous payer updates; a focus on MACRA & PQRS; Meaningful Use; Volume Based Payment Models and ICD-10.

The program evaluations which were completed by attendees reflect the great value which medical practices throughout Pennsylvania are able to appreciate through the work of the Pennsylvania Medical Society’s Practice Support Team.

“Tools for Success” participants had their choice of three excellent breakout sessions in the afternoon: “What to Look For in a Payer Contract” with healthcare attorney Karen E. Davidson, Esq.; “You’re Not Alone in the Headlights” with Paul Brewer, Practice Manager of Dermatology Ltd. in Media and Chaddsford and “Cyber Security – A Look Around the Corner” with Scott Patterson and Charlie Berner, Esq. from the Knox Corps.

The afternoon keynote presentation was presented

by Mark S. Friedlander, MD, MBA Medical Director, Aetna. Dr. Friedlander, who is a Past President of the Delaware County Medical Society and currently serving the PAMED as an Alternate Delegate to the AMA, helped the audience to better understand how health insurance companies use the data that is collected and reported by practices. His presentation entitled “Same Payers, Different Rules” addressed how practices can survive in the new era of accountability and quality improvement initiatives.

The conference included an outstanding venue, excellent meals and snacks, prize giveaways from many of the corporate sponsors and an opportunity for physicians and practice managers to network with outstanding professional resources.

Conference attendees & vendors

The following businesses and organizations made up “vendor row” during the 2016 “Tools for Success Conference”

• BB&T Bank • Choice Medical Waste • Delaware County Suicide Prevention & Awareness Task Force • 1st Healthcare Compliance, LLC • Healthcare Facilities Solutions, Inc. • Hoffmann Publishing Group • Legal Triage – Karen E. Davidson, Esq. • M & T Bank • Main Line Health System – Home Care & Hospice • Main Line Telecommunications • MDAdvantage Insurance Company • Medicare Consulting Professionals • MedPro Group • The National MS Society • Nixon Uniform & Medical Wear • Nolen Associates, Inc. • Pennsylvania Medical Society & Foundation • STI Computer Services, Inc. • TransAct Credit Card Processing We appreciate their strong support and encourage our members to use their services!

www.delcomedsoc.org

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has a and into your heart. She lap r you o int s wl cra o wh ld esn’t Maria is the kind of chi wispy bangs. W hat she do th wi ed orn ad e fac nd rou a d States. bright, playful smile and onduras, not in the Unite H in rn bo s wa she se au d. She have is health insurance bec that she was malnourishe ts ren pa her d tol r cto do a , d has Before they left Honduras ther, she is never hungry an mo her to ing ord acc d an checkis small for her four years, home to get her an annual ir the m fro ur ho an g vin dri to be forced to eat. After lth center, her parents tgomery County public hea on M ing eak -sp ish an Sp they up at a y she’s not growing. W hen wh re plo ex to list cia spe a t worry. were advised to take her to pointment. Instead they jus ap an de ma er nev y the learned the fee was $150 ankle for a skin rash around her ord aff can y the ent atm office asked Anxiety is also the only tre to see a dermatologist, the ed tri y the hen W y. ntl the doctor that Maria scratches consta response, “none”, suddenly ir the t A d. ha y the nce what kind of health insura After ntal care is also on hold. was no longer available. De were told e Maria to a dentist, they scraping up enough to tak ings. uld cost $1,200 for the fill wo it d an s itie cav ee thr d she ha lay n they could even begin to That was $1,200 more tha d them rse, a friend incorrectly tol out. To make matters wo ities, epted in pre-school with cav that Maria couldn’t be acc like this enroll her. Misinformation so they didn’t even try to when communities, particularly is rampant in immigrant th. to counteract with the tru there is no health provider the most at Maria’s parents dread Of all their anxieties, wh n’t ergency care and they would em d nee y ma l gir le litt ir that the Maria to a hospital. A while ago her e tak to ord aff to le be ab y, her peaked at 4 am. In a frenz had a ver y high fever that counter recommended an over-theo wh ve ati rel a led cal r mothe ddle of ve all over town in the mi remedy, and her father dro that pharmacy. The memory of the night to find an open ething hat would they do if som night still haunts them. W rk? and the medicine didn’t wo like this happened again ny undocumented Maria is typical of so ma victimized by ignorance. children whose parents are

ny believe their emergency room visit, ma an of se pen ex the of ed Not only are they petrifi there is no one of a primary care doctor, nce ida gu the t ou ith W child could be deported. ir child’s needs. places that can address the to m the ect dir or s on pti to allay their misconce unnecessarily. stakes and children suffer mi ke ma s ilie fam , nce W ithout health insura me. *Maria is not her real na

are County.

Her family lives in Delaw

26 DELAWARE COUNTY MEDICINE & HEALTH

spring 2016

H

ave you cared for a child like Maria or tried to help a child without insurance secure critical follow up care without success? It’s a plight that unfortunately many of us have faced. There are an estimated 1,000 Delaware County children who are undocumented and uninsured and an estimated 24,000 children statewide. They do not qualify for CHIP or Medicaid (with limited exceptions for Emergency Medicaid) or ACA Marketplace coverage.

As a nurse, I worked in a federally qualified health center for nearly a decade, so I had the good fortune of being able to provide care to every child and adult who walked

through our doors regardless of their citizenship status.

But if a child who was undocumented and uninsured needed an x-ray, physical therapy or a dermatologist, I had no place to refer her for affordable care.

We can’t afford NOT to cover all children. At CHOP alone, they spend $4,600 per child in uncompensated care, yet CHIP coverage costs just half of that amount – about $2,500.

PA is losing its national standing for children. While we are the birthplace of CHIP, we are still not among the five states and District of Columbia that cover all kids. But we have the ability to change that.

www.delcomedsoc.org

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Because of an ACA requirement, starting last October, the federal government is paying 89% of the state’s CHIP costs – up from 66% previously. This provides an extra $591 per child per year or a total of $92 million more available for the 150,000 kids PA anticipates enrolling in CHIP this year. Federal funds cannot be used to pay for undocumented kids’ coverage, so the state could use a portion of the savings and expand CHIP to cover ALL kids. Based on other states’ experience, PCCY estimates that about 25% of the newly eligible children would enroll in year one at a cost of about $15.4 million for the first year – which is less than 1/20th of 1% of the state budget.

Public Citizens for Children and Youth (PCCY) interviewed 53 parents across southeastern PA, 8 of them Delaware County parents, to better understand the health and financial impact of having a child who is undocumented and uninsured. Here are our findings:

It’s important to remember that these families contribute to public coffers. In fact, undocumented immigrants pay sales, wage and other taxes, contributing to revenues that back public health care programs. A 2007 Congressional Budget Office study found that 75% of undocumented immigrants had taxes withheld from their paychecks, filed individual tax returns or both. In PA, undocumented immigrants paid an estimated $135 million in combined income, property and sales taxes in 2010 but are ineligible to receive most services.

Public support is building for efforts to help cover PA children who cannot receive the health care that they so badly need and deserve. PCCY created the “Dream Care” initiative with a 51 member strong “Dream Care Coalition” working towards expanding CHIP for all PA children. Visit www.pccy.org/ fulfillingthepromise for coalition members, to join the coalition, for our report and much more information.

28 DELAWARE COUNTY MEDICINE & HEALTH

Colleen McCauley, RN, BSN, MPH Health Policy Director Public Citizens for Children and Youth --------------------------------------------------------------------------Colleen McCauley is PCCY’s Health Policy Director. Her research leads the conversation in southeastern Pennsylvania and Harrisburg on children’s access to health care and health insurance issues. Her work on child health focuses on researching and advocating for improved access to health care, particularly among uninsured, undocumented families in Philadelphia and suburbs.

Colleen is a nurse, and prior to joining PCCY in 2001, she was the Assistant Director of the Abbottsford Community Health Center in Philadelphia, a federally qualified health center. Colleen holds a Master’s degree in Public Health from Temple University.

spring 2016

JILL’S TIMELESS TIDBITS

MEDICAL PRACTICE MANAGEMENT

Jill’s Timeless Tidbits

T

here are many creative ways to foster comaraderie and teambuilding with your office staff or family and friends. Use fun and wacky holidays, also referred to as Unofficial Holidays, to create small celabrations or big events. Use of these unofficial holidays are increasing in popularity in today’s culture. I have been in healthcare for 28 years and have always enjoyed incorporating these into my workplace to help boost morale, create a positive focus, and strenghten our team. I also enjoy doing this with my own family. These can be used as humorous distractions and excuses to share laughs with friends.

Jill Venskytis, CMM, HITCM-PP Practice Administrator Drexel Hill Pediatric Associates DCMS Board Member Vice President Delco PAHCOM Chapter

There are many websites offering official and unofficial holiday dates. Most of the dates referrenced in my article are from www. holidayinsights.com Here are some of my favorites coming up. Celebrate these dates too or some of the many others not listed here and let your imagination be your guide!

JUNE 15th is “Smile Power Day”. Feel the power and turn someone’s day right around! Smile’s are contageous.

It is easier to smile than frown, they use fewer muscles!

JULY 7th is “Chocolate Day”. Whether your budget can handle a big chocolate treat or a simple Hershey Kiss. Any reason is a good reason to eat chocolate!

JUNE 20th is “Ice Cream Soda Day”. My staff enjoyed it when I surprised them one day with Root Beer floats. With Ice Cream Soda Day there are so many more variables to throw in!

JULY 11th is “Cheer Up the Lonely Day”. Encourage your staff to cheer up co-workers, patients, bosses, family members, even strangers! Origin of this day (quoted from: www.holidayinsights.com): According to L.J. Pesek, Cheer Up the Lonely Day was created by her father, Francis Pesek from Detroit, Michigan. She told us that he “was a quiet, kind, wonderful man who had a heart of gold. He got the idea as a way of promoting kindness toward others who were lonely or forgotten as shut-ins or in nursing homes with no relatives for friends to look in on them.”

Francis Pesek chose this day, because it was his birthday.

JUNE 23rd is “National Pink Day”. Have fun with staff wearing pink this day and serve pink lemonade and sugar cookies with pink icing!

JULY 20th is “Lollipop Day”. Bring in fun lollipops for staff or patients. Eat lollipops this day, share lollipops, play games with lollipops! Have a tasty day!

www.delcomedsoc.org

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DELAWARE COUNTY’S

ARE WITH

CROZER-KEYSTONE HEALTH SYSTEM At Crozer-Keystone, our team of talented, respected and award-winning physicians are a big reason why we have been — and will continue to be — Delaware County’s leading healthcare provider. We thank our physicians for their dedication to their profession and, more importantly, for their commitment to the men, women and children they care for every day.

FIND AND LEARN MORE ABOUT CROZER-KEYSTONE PHYSICIANS AT

WWW.CROZERKEYSTONE.ORG/PROVIDERS