Lehigh County Health & Medicine Spring 2022

SPRING 2022

Official Publication of The Lehigh County Medical Society

L T A H E Y H aging SOCIAL CONNECTIONS KEY TO AGE-FRIENDLY LEHIGH VALLEY

PLUS SUMMER FUN AND STRADDLE INJURIES THE UPHILL BATTLE OF TELEHEALTH ASSIMILATION

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contents

L C M E D S O C .O R G

SPRING 2022

LEHIGH COUNTY MEDICAL SOCIETY P.O. Box 8, East Texas, PA 18046

610-437-2288 | lcmedsoc.org

2022 LCMS BOARD OF DIRECTORS Rajender S. Totlani, MD President Oscar A. Morffi, MD Treasurer Charles J. Scagliotti, MD, FACS Secretary

6

William Tuffiash Immediate Past President *effective February 1, 2022

CENSORS Howard E. Hudson, Jr., MD Edward F. Guarino, MD

TRUSTEES Wayne E. Dubov, MD Kenneth J. Toff, DO

EDITOR

David Griffiths Executive Officer

The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Lehigh County Medical Society.

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

4 IN THIS ISSUE/LCMS NEWS ON THE COVER 6 HEALTHY AGING

By Laura McHugh

FEATURES 8 "WHITE BAGGING" & "BROWN BAGGING"

How Does it Impact Your Patients?

13 SWIPE LEFT ON SYPHILIS IN PA!

By Yvonne Kingon, Sheri Hilt and Tom Brodhead

15 SUMMER FUN AND STRADDLE INJURIES

By Patricia Maran, MD, FACOG

17 THE UPHILL BATTLE OF TELEHEALTH ASSIMILATION

By Mark Wendling, MD

By Donna Rovito

11 S URVIVAL STRATEGIES

For People Who Use Drugs When They Are Alone

By Tony Newman

20 2021 HUMANENESS IN MEDICINE AWARD 21 LEGISLATIVE UPDATE

Lehigh County Health & Medicine is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA | HoffmannPublishing.com | (610) 685.0914

SEE PAST ISSUES AT LH.HoffmannPublishing.com FOR ADVERTISING INFO CONTACT:

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Tracy Hoffmann, Tracy@hoffmannpublishing.com, 610.685.0914 x201 SPRING 2022 | Lehigh County Health & Medicine 3

IN THIS ISSUE

LCMS NEWS NEW MEMBERS

WELCOME TO THE SPRING EDITION OF LEHIGH COUNTY HEALTH & MEDICINE. A few important housekeeping items up front. First, apologies for missing the winter edition, but as we learned from the pandemic, change happens. Second, in our fall edition, we didn’t include an acknowledgement for an article titled “Rofeh.” This was an article sent into us by Dr. Gene Ginsberg. We are grateful for the submission.

In this edition you will find articles to get you ready for physical activity as we head into spring. As you will see from “Summer Fun and Straddle Injuries” there are some particularly good pointers on how to keep your children a little safer as they go outside.

The pandemic has exacerbated the overdose crisis across the country. Using drugs alone is a leading cause for overdose. If this sounds like someone you know, please see the pieces on this topic inside, including “Survival Strategies While Using Drugs Alone from People Who Use Drugs.”

Syphilis cases are on the rise in Pennsylvania and the country. Learn more about the disease, its symptoms and more in the piece “Swipe Left on Syphilis in Pennsylvania!”

The article “White Bagging” & “Brown Bagging” is probably not what you might think. These terms are referring to medication ordered by physicians and the unusual ways some health insurance companies and their integrated Pharmacy Benefit Managers are trying to change the way oncology patients receive some of their medications. We think you’ll find it interesting.

Other articles you must read are “The Uphill Battle of Telehealth Assimilation” and the sidebar piece. Telehealth helped people get needed access to health care during the pandemic, but it may not always be here. Check it out for some valuable information.

If you’re interested in how legislative activities regarding healthcare are moving in Harrisburg, we’ve added a legislative update as well.

We hope you enjoy our health and medicine magazine. If you want to see more issues, you can find them at https://lcmedsoc.org/our-publication. Thank you for reading.

Paul Bergh, MD (REI) Xing Shun Chin, MD – Resident Bibi Swalehah Khoyratty, MD (HEM) Abby Susan Letcher, MD (FM) Anna Marie Mesina, MD (OBG) Laura McElrone Mory, MD (EM) Marjorie A Pierre, MD (AN) Anthony Mark Rainey, MD – Resident Matthew Peter Romagano, DO (OBG) Megan Alexandra Satyadi – Medical Student Andrew Dean Shoemaker, MD (OBG) Mausumi Natalie Syamal, MD (OTO) Christopher Wang – Medical Student Jacob Wilson, DO – Resident

RE-INSTATED MEMBERS

Courtney Ann Boyle, DO (OBG) Matthew E. Brown, MD (DR) Danielle Elise Durie, MD (MFM) Kristen Lee Halm, MD (CRS) Joanne N. Quinones, MD (MFM) James M. Sacco, DO (ORS)

PROGRAM

Safe and effective Management of Acute and Chronic Pain in the Context of the Opioids Crisis This 2.0-hour CME is designed to fulfill the required two hours of continuing education in pain management, identification of addiction, or the practices of prescribing of opioids.

SPEAKER: Gillian Beauchamp, MD

4 Lehigh County Health & Medicine | SPRING 2022

FEATURE

Healthy Aging SOCIAL CONNECTIONS KEY TO AGE-FRIENDLY LEHIGH VALLEY

BY LAURA MCHUGH, UNITED WAY OF THE GREATER LEHIGH VALLEY

6 Lehigh County Health & Medicine | SPRING 2022

L C M E D S O C .O R G

O

n a Sunday afternoon in May, 71-year-old Carol Gonzalez heard a knock on her door.

It was Mother’s Day, more than a year into the pandemic, and when she opened it, Carol found 8-year-old Nika waiting outside with a bouquet of flowers.

“Oh, you are so thoughtful!” Carol cried as she wrapped Nika in a big hug.

Though Carol lives alone, she’s created a sense of community through working fulltime, remaining active in civic engagement and volunteering with organizations like Girl Scouts of Eastern Pennsylvania, where she met Nika.

BEING AN OLDER ADULT IN THE LEHIGH VALLEY DOESN’T HAVE TO BE BORING AND LONELY. IT CAN BE FUN AND REWARDING IF YOU REACH OUTSIDE OF YOURSELF AND GET INVOLVED. “Girl Scouts has enriched my life, because it allows me to transfer skills, knowledge, morals and values to the younger generation.

I have been able to watch them mature into go-getters, innovators, risk takers and

leaders. Most of all, I show them love and respect which I get back tenfold,” said Carol.

AT THE HEIGHT OF THE PANDEMIC, THE UNITED WAY HEALTHY AGING TEAM: • Contacted approximately 2,000 seniors at risk of loneliness or isolation due to senior center closures.

• Trained community members in the Savvy Caregiver Program designed to help caregivers better manage their role.

• Equipped and trained law enforcement agencies through the Project Lifesaver program to track individuals with dementia or autism.

• Held webinars and virtual town halls to educate older adults about fraud and scams.

• Funded programs to help seniors age in place including transportation, meal delivery and grocery shopping, case management, senior centers, adult day care centers, fall prevention and diabetes prevention and management.

“They also keep me young,” she added.

“Being an older adult in the Lehigh Valley doesn’t have to be boring and lonely. It can be fun and rewarding if you reach outside of yourself and get involved.”

That’s why Carol’s involved with AgeFriendly Lehigh Valley, a coalition led by United Way dedicated to building a community where everyone has the opportunity to age successfully.

“Carol’s such a great example of how an age-friendly community builds intergenerational connections that make all residents feel safe, included and supported. They keep individuals socially connected and engaged in community life and they enhance opportunities to be healthy and active,” said Carmen Bell, Director of Healthy Aging for United Way. Bell adds that the recent pandemic exacerbated a growing issue among the region’s older adults. A new survey of Lehigh Valley seniors reveals that one in four respondents report that they lack companionship and one in six report feeling isolated from others. Older adults who are chronically lonely live shorter lives and are more likely to have problems with memory and mental and physical health. “That’s why we’re prioritizing social inclusion and participation in our Age-Friendly Lehigh Valley action plan,” said Bell.

With your support, we can continue to provide vital programs to ensure older adults like Carol are safe, healthy and connected. Give today to help your neighbors and caregivers.

SPRING 2022 | Lehigh County Health & Medicine 7

FEATURE

BA

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IN

“W

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& “BRO W N

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A B E

” G N I GG

HOW DOES IT IMPACT YOUR PATIENTS?

BY DONNA BAVER ROVITO n the September 2020 issue of Strategies Oncology Mag- bagging, to be supplied by the affiliated specialty pharmacy.” azine, Community Oncology Alliance’s CFO and chief Newton explained the practice further: “‘White bagging’” operating officer Ricky Newton explained the concept of occurs where a physician writes an order for particular medica“white bagging” and “brown bagging” in an article entitled tion for an in-office procedure, and rather than being sourced Help for “White Bagging” and “Brown Bagging” Issues at from the physician’s medication inventory, a separate specialty Your Practice. pharmacy fills a prescription for the patient, and delivers the Newton noted: “A growing — and extremely concerning drug directly to the prescriber or clinic who retains the medi— trend that has emerged is the concept of mandatory ‘white cation until the patient arrives at their office for administration. bagging’ of oncology medications that are administered in-office Likewise, ‘brown bagging,’ which is less common, involves a by community oncology practices. In seeming unison, several similar concept, except that instead of causing the prescription health insurance companies (who have integrated Pharmacy to be delivered directly to the community oncology practice, Benefit Managers and specialty pharmacies) have begun to the specialty pharmacy dispenses the medication to the patient mandate that certain IV drugs that were previously purchased him or herself, who then brings their own medications into their by community oncology practices and administered in-office physicians’ offices for administration in those settings. Each of to patients, are now requiring that they be filled by the PBM- these scenarios present immense concerns for patients, payers owned specialty pharmacy. These are drugs that historically and providers alike.” have been administered in-office by community oncology COA expands on its position about these disturbing practices and billed to patients’ medical benefit (as opposed practices in a position statement posted on their website and to their pharmacy benefit). In essence, these payers (which distributed to their members; following are excerpts from include Anthem Blue Cross of California, Blue Cross Blue Shield of Tennessee and Cigna) have mandated that cancer that position statement: patients receive their chemotherapy through white or brown

This article was originally published in the October 2021 issue of Strategies Oncology Magazine, focused on the safe handling of pharmaceuticals.

8 Lehigh County Health & Medicine | SPRING 2022

L C M E D S O C .O R G

COA WHITE & BROWN BAGGING POSITION STATEMENT (EXCERPTS) WHITE AND BROWN BAGGING ARE AN INCREASING TREND IN ONCOLOGY

quickly recognized by an in-person evaluation of the patient may be missed or downplayed in a telephone conversation with the patient, and the opportunity to report the adverse event to a national incident reporting database may be lost. Under the current paradigm, practice pharmacies can improve patient safety because the staff has a deep knowledge and understanding of specialty products and the conditions they treat.

About one-fourth of drug volume for in-practice use in 2014 was purchased by specialty pharmacies and supplied to practices via white and brown bagging, and more than three in 10 oncology practice managers forecasted an increase in white bagging in 2015 compared with 2014. Similar to previous study periods, Chemotherapeutic drugs are highly toxic 65.6 percent of cancer drugs are sent from agents, often calibrated to very specific criteria, specialty pharmacies directly to patients’ homes such as patient weight and current comorbidities, for self-administration or home administration, and require very specific storage and handling. followed by 21.8 percent of drugs delivered The insertion of patients and/or their family directly to oncology practices for treatment members and caregivers, all well-meaning of patients (white bagging) and 6.7 percent but untrained participants, into the drug delivered to patients’ homes for brown bagging. distribution chain disrupts the control of the A 2015 pharmacy trend report, which includes drugs and inserts unknown variables that may data from 59 health plans, representing 129.7 affect their efficacy. Product integrity becomes million covered individuals, found that 28 a safety issue for products that require special percent of medical benefit drug volume was handling, especially for products that are distributed to physician offices by specialty not designed for self-administration. Lack of pharmacies through white or brown bagging. temperature control during shipping is one example of how a product’s integrity may be WHITE AND BROWN BAGGING CREATE PATIENT compromised by a mail-order model.

QUALITY OF CARE ISSUES

White and brown bagging create quality of care issues by placing drug management on the patient. At a time when patients with cancer are in active treatment and at their most vulnerable, they are charged with the responsibility of accepting and transporting their own drugs. Community oncologists want this administrative responsibility; are prepared and capable of handling this administration as part of the treatment of patients with cancer; are strongly opposed to shifting the burden of care management to patients; and are gravely concerned that the loss of control in case management is detrimental to patient prognosis. Specialty pharmacies may not have full access to other medical information (e.g., complete medication list, concurrent disease states, comorbidities) needed to perform comprehensive medication reconciliation to assess for interactions and adverse events.

A part of dispensing cancer drugs is managing patient status. Community oncologists are best suited to provide this support based on their ongoing relationship with the patient.

Adverse events or side effects that could be

WHITE AND BROWN BAGGING CREATE LIABILITY AND RESPONSIBILITY CONCERNS FOR PROVIDERS

The responsibility for, but inability to fully and properly control, white and brown bagging drugs may cause liability issues for hospitals and physicians. When a drug order is filled through white or brown bagging, the medication leaves the pharmacy and physicians and hospitals have no control over the handling or storage conditions and are unaware of these factors prior to administration. The safety and integrity of the medication is not assured. This raises concerns amongst physicians and hospitals about their liability if an improperly handled medication leads to injury based on factors outside their control.

SUMMARY:

COA opposes white and brown bagging because it interferes with the proper treatment and management of patients with cancer. Both processes can disrupt the chain of control of expensive cancer drugs risking improper storage and can cause delays in the onset of treatment, create waste in such common occurrences as dosage change or the management of adverse events, and places an administrative burden on both patients with cancer and their oncologists.

During the course of treatment, adjustments White and brown bagging impact treatment and to dosage is common. Often a change is made patient prognosis. The presumed cost savings based on patients’ general status, comorbidi- often do not materialize. Patient continuity of ties, and the ability to tolerate the treatment. care is ensured by allowing practices to manage Treatment with drugs dispensed by the practice all aspects of drug therapy—from initial proallows for better patient management through curement through dispensing to completion of on-the-spot dose changes not possible with therapy. This flexibility means patients receive white or brown bagging. Patients who require care that is high-quality, high-value, convenient, an unexpected dosage change may have to wait and personalized. COA strongly opposes white to receive treatment until a new order is placed and brown bagging as they are disruptive to and delivered. the continuity of care and the best possible patient outcomes.

WHITE AND BROWN BAGGING CREATE DRUG WASTE

It is common for the quantity of drugs dispensed by community oncology practices at the beginning of a chemotherapy course of treatment to be limited in anticipation of dosage changes or adverse events. This adjustment is not typically made when drugs are dispensed through white and brown bagging. Any drugs not used because of such a change are wasted.

Drugs received for a specific patient cannot be re-dispensed to another patient. For example, if patient A has a drug discontinued, it cannot be provided to patient B and must be wasted.

Newton offered this additional assistance for oncology practices in the September 2020 article in Strategies: “In collaboration with the Frier Levitt law firm, we have developed a template letter that can be used as part of our grassroots efforts to combat this trend. The template letter can be used to respond to these instances where insurance companies and/or PBMs are requiring your practice to accept white bagged medications. You can adopt the letter to fit your locality and circumstances.”

SPRING 2022 | Lehigh County Health & Medicine 9

Struggling with addiction?

FEATURE

Help is available Find treatment 1-800-662-HELP (4357)

Find drug and alcohol treatment, support services, and help with funding.

Get Naloxone ddap.pa.gov/naloxone Naloxone is a life-saving medication that can reverse an opioid overdose. Naloxone is safe and easy to use.

Print the naloxone standing order and take it to a pharmacy or have naloxone mailed to your home.

EDUCATION and resources justfive.org/pa-workforce

L C M E D S O C .O R G

Survival Strategies for People Who Use Drugs When They Are Alone

BY TONY NEWMAN, VITAL STRATEGIES

November 12, Philadelphia -

The overdose crisis has touched millions of people in the United States, with nearly 500,000 lives lost over the last decade alone. COVID-19 has exacerbated the overdose crisis with 93,000 lives lost due to overdose in 2020 alone, the highest number ever recorded in one year.

Using drugs alone is a leading risk for overdose death, as there is no one around who can administer naloxone, the life-saving opioid overdose reversal drug, or call 911 for help. Harm reduction and public health experts encourage people who use drugs never to use drugs alone, but shame, stigma and the threat of punishment drive many people to use drugs alone. Evidence-driven harm reduction recognizes that offering information to meet people where they are at with their drug use – such as encouraging people to take incremental steps for greater safety if they use alone – can save lives.

Project SAFE, a Philadelphia-based mutual aid harm reduction organization for women, queer, and transgender people who use drugs and do sex work, in partnership with public health organization Vital Strategies, has created two new resources to address this complex problem of solo drug use: one offering guidance for people who use drugs on how to be safer if they use alone, and a second for organizations who serve people who use drugs.

“The adulteration with fentanyl and other psychoactive contaminants in the unregulated drug supply has heightened the need to think pragmatically and proactively about safety skills when using drugs alone,” said Jen Bowles, Board Member of Project Safe. “It is shortsighted to think that people who use drugs always have a ‘safe’ person present to

use drugs with. And so, we turned to our community for guidance on this difficult subject, and, as further evidenced by these documents, their expertise is unparalleled.”

The “Do You Ever Use Drugs Alone?” guide for people who use drugs by people who use drugs shares how to use drugs as safely as possible, and what strategies to use to prevent overdose, when using drugs alone. Information and suggestions in the pamphlet include “learn about the day’s drug supply,” “plan before using,” and “lessons from sex workers who use drugs on navigating client and provider use.”

"I hear people talking about the guide. I hear people using the statements that are in the guide, even the men are bringing it and taking in information,” said O, a Project Safe participant. “It’s very helpful and it’s keeping people more alert and more aware. We are addicts but we don’t have to be dead addicts. The guide was the best thing I have seen in a long time and I’m glad to put it out there and make people more aware. Not only addicts, but people who aren’t addicts too.”

The second guide, “Survival Strategies While Using Drugs Alone from People Who Use Drugs,” focuses on groups that provide services to people who use drugs with suggestions for improvements to harm reduction and public health messaging to never use drugs alone. Also sourced through knowledge and experiences gathered directly from people who use drugs, the guide addresses why solo drug- use commonly occurs, and shares safety strategies for survivorship.

Continued on page 12 SPRING 2022 | Lehigh County Health & Medicine 11

2022 PENNSYLVANIA

PAIN AND ADDICTION SUMMIT

FEATURE “To save lives, harm reductions organizations and service providers need to tap into and respect the knowledge and experience of people who use drugs,” said Tracy Pugh, Senior Technical Advisor for Vital Strategies. “These new resources – built through listening and learning – share risk reduction methods that those who have used drugs while alone are taking to protect themselves and their peers, and may empower people to take steps that lessen the chance of a fatal overdose if they use alone.”

About Project SAFE Project Safe is a volunteer-run mutual aid-based collective providing harm reduction supplies and related efforts for women and queer people involved in the street economies of Philadelphia. We have existed for more than 15 years, led and informed by the expertise of community members who use drugs and do sex work.

FRIDAY APRIL 22, 2022 8 A.M.–5 P.M. MOHEGAN SUN POCONO Join us for this full-day conference featuring professionals on the frontline of the addiction crisis as they discuss substance abuse, treatment, prevention and patient care.

Up to six hours of continuing education credit available.

Register online: wilkes.edu/addiction or call 570-408-5615 Cost: $150 (early-bird price of $130 if registered by March 25, 2022) $75 for either morning or afternoon sessions

To find out more, please visit social platforms (Twitter, Instagram, Facebook) @safephila and at www.projectsafephilly.org. We can be contacted at safephila@gmail.com.

About Vital Strategies Vital Strategies is a global health organization that believes every person should be protected by a strong public health system. We work with governments and civil society in 73 countries to design and implement evidence-based strategies that tackle their most pressing public health problems. Our goal is to see governments adopt promising interventions at scale as rapidly as possible.

About Vital Strategies Overdose Prevention Program In November 2021, Bloomberg Philanthropies announced a fiveyear, $120 million investment to help combat the overdose crisis in the hard-hit states of Kentucky, New Jersey, New Mexico, North Carolina and Wisconsin. The initiative builds on work of the past three years in Michigan and Pennsylvania, launched in 2018 with $50 million and expands the work to promote improved federal policies. The partnership between Vital Strategies, Pew Charitable Trusts, Johns Hopkins University, CDC Foundation, and Global Health Advocacy Incubator is helping to strengthen and scale up evidence-based, data-driven policies and interventions to reduce overdose risks and save lives.

To find out more, please visit www.vitalstrategies.org or Twitter @ VitalStrat.

12 Lehigh County Health & Medicine | SPRING 2022

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Swipe Left on Syphilis In Pa!

BY YVONNE KINGON, SHERI HILT AND TOM BRODHEAD DISEASE INTERVENTION SPECIALISTS OF THE ALLENTOWN HEALTH BUREAU

I

f syphilis filled out a dating app profile, its relationship status would have to be: “It’s complicated.” But that hasn’t stopped it from getting around.

During calendar year 2020, Pennsylvania (exclusive of Philadelphia) reported the highest number of primary and secondary (P&S) syphilis cases in almost 30 years.

This mimics national trends: according to the CDC, the number of reported P&S cases in 2019 represented a 63% increase from 2015 and the highest reported number of cases since 1991. The numbers have been trending upward since 2010, but while the increase in cases from 2010 to 2017 was primarily driven by men who have sex with men, since 2017 the rise was driven

by increases among women and men who have sex with women. The surge in cases among women has led to a particularly tragic consequence: nationally, from 2013 to 2019, congenital syphilis, which can cause stillbirth and infant death, increased by an astonishing 417%. On the dating app, syphilis definitely has a preference for everyone.

Further complicating the matter, depending on a wide range of factors including symptoms (or lack thereof), prior history of syphilis, and the date and results of prior tests, syphilis can be classified as primary, secondary, early latent, late latent, and tertiary. And if that weren’t enough, neurosyphilis, ocular, and otic syphilis can occur at any stage at all, even if there are no other symptoms.

Continued on page 14 SPRING 2022 | Lehigh County Health & Medicine 13

FEATURE

How does syphilis announce itself? Primary syphilis, which is typically one to three weeks after inoculation, is characterized by the development of a painless ulcerated sore, called a chancre, at the location of exposure, which includes but is not limited to the genitals, rectum, mouth, and throat. Being painless and located in anatomic areas not frequently observed by the patient, this chancre will often go undetected. This means many patients who contract syphilis will never be aware they have it in this early, highly infectious stage, making primary syphilis a significant missed opportunity for prevention.

few resources and even some patients with insurance find the treatment is not covered or carries a high copayment. This gap in services leads to infected persons not being able to be tested and continuing to spread the disease. In addition to offering partner services, guidance and support, your local health department can provide treatment for those who are un- and underinsured.

Communication is going to be key as health professionals strive to gain control of this surge. Improved screening will help drive of patients will progress to the tertiary stage, down cases. The PA DOH now recommends which can manifest two to 50 years after the that all pregnant females be offered a test for The chancre will resolve on its own, causing original infection. Among the complications of syphilis at the first prenatal visit, the third the patient much relief (if they ever noticed it this stage are cardiovascular syphilis which can trimester of pregnancy, the delivery of a child, at all) and leading to the assumption that all cause ascending aortic aneurysm, aortic valve or at the delivery of a stillborn child. Annual is well. But this is far from the case. Four to insufficiency, and coronary artery disease; and screening is recommended for men who have ten weeks after initial infection, the symptoms late neurosyphilis, which can result in a range of sex with men, with more frequent screening of secondary syphilis appear. There are a few symptoms including dementia. (Neurosyphilis, (every 3 to 6 months) for MSM who have an hallmark symptoms of secondary syphilis, but including ocular and otic syphilis, can occur ongoing increased risk for acquiring syphilis they are notoriously unreliable – syphilis’s wide during any stage of infection.) (e.g., multiple partners, anonymous partners, variability in presentation has earned itself the and concurrent partners). Routine syphilis moniker “the great imitator” for good reason.

The good news is that syphilis is treatable at screening is not recommended for men who Unlike the chancre, these symptoms are more any stage of infection, primarily with penicillin have sex with women, nonpregnant women likely to get the patient’s attention. They include given via intramuscular injection. The treatment who have sex with men, and nonpregnant a body rash that generally is not itchy, and regimen varies depending on the stage, which is women who have sex with women, but for these which often involves the palms and soles. Other why some detective work may be necessary. For groups, syphilis screening may be indicated if symptoms include sore throat and swollen example, knowing if a currently asymptomatic the individual has increased risk for acquiring lymph nodes, fatigue, muscle ache, and fever, patient tested negative for syphilis within the syphilis. Taking a thorough, nonjudgment all of which occur in many common infections. past twelve months can help determine the stage sexual history, talking honestly with patients Some patients may notice oral lesions, wart-like of latency, which in turn determines treatment. about risk, and screening and treating approclusters in skin folds, or patchy hair loss, but If you aren’t sure what stage your patient is priately will be key to lowering the rates – and these are present in a minority of patients. These in or how to treat them, contact your local consequences – of this dangerous disease. symptoms often resolve spontaneously, and if health department for assistance with staging, the earlier hallmark chancre went unnoticed, lab interpretation, and treatment guidance. It ALLENTOWN HEALTH BUREAU syphilis may not appear on the differential is never too late to treat syphilis and prevent 610-437-7760 should these patients seek care. potential medical catastrophe down the road.

BETHLEHEM HEALTH BUREAU Unfortunately, once again, the waning of Why is syphilis suddenly so prevalent? Lack 610-865-7083 symptoms does not mean the infection has of testing is the first hurdle. Public funding resolved. Syphilis is the toxic partner you can’t of STD clinics has not kept up with the need STATE DEPARTMENT OF HEALTH break up with. Untreated, it can lie dormant for for decades. The COVID pandemic further www.health.pa.gov years, only to re-emerge with an array of some- reduced services by fostering the elimination times devastating and irreversible manifestations. of both walk-in and by-appointment STD The asymptomatic phase, called latent syphilis, testing clinics. Other contributing factors can be early latent (an infection of less than one include a general increase in the number of year of duration) or late latent (an infection of lifetime sex partners; lack of comprehensive greater than one year). Latent syphilis is not sex education; and the rise of dating apps. infectious, but if untreated, approximately 30% Insurance also plays a role; the uninsured have

14 Lehigh County Health & Medicine | SPRING 2022

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Summer Fun

AND STRADDLE INJURIES PATRICIA MARAN, MD, FACOG

A

s the snow drops begin to open, and the crocus tips peek through the soil, I start to hear children playing outside. I am lucky to live in a neighborhood where kids still venture outside.

As a former teacher and sports coach turned gynecologist, I am slightly more apprehensive watching kids begin to play this year. Two years of Covid restrictions have deconditioned us all.

Let me explain. A common reason for me to get called to the ER during spring and summer months is to fix straddle injuries: think little children slamming down on their privates. Jungle gyms, backyard balance beams, rope swings, water parks, and bicycles all keep me busy on warm sunny evenings. Just as academic and social skills have been altered for our children so too have fundamental movement skills. Our children are two years taller and heavier, unaccustomed to these bodies, and potentially delayed in learning kinesthetic skills such as skipping, climbing, jumping, peddling, and swimming.

STRADDLE INJURIES Typical injuries resulting when a child slips or missteps and falls, splitting the legs and causing damage to the genital region. Often these injuries can be categorized as laceration, abrasion, bruise, or trauma. Below I will discuss categories of injuries and preventative suggestions.

Balance changes as children grow; their center of gravity moves during growth spurts. Learning basic activities becomes more difficult the further we are from the ground, making balance beams and jungle gyms my nemesis. Lack of estrogen in prepubescent girls prevents the labia from having any cushion or padding so when they fall, the proximity of bone to skin makes pelvic injuries bleed like facial injuries. I have had a challenging

time putting “lady parts” back together after these falls because unlike obstetric injuries of adult women, there is no “extra” skin or folds or fat to help with the repair. Ultimately, while children heal quickly with no marked cosmetic or structural defects, it is exceptionally difficult to keep an elementary child from “playing” for a week during postoperative recovery.

Rule 1: Wear shorts that cover the entire underwear and inner thigh.

Don’t play in sundresses and bathing suits without board or bike shorts.

Rule 2: Avoid biking with flip flops; the feet easily slip off the pedals, and bike cross bars have the potential to make mincemeat of the genitalia. Bikes have been difficult to buy for supply chain deficits, so children are often using older siblings’/neighbors’ bikes increasing susceptibility to injury.

Helmets, footwear, and proper shorts are likely the most important safety features for little ones.

If your child has injured themselves and you find blood in their groin or on underwear and garments, regardless of how long ago this might have happened, please get this assessed. It’s infinitely easier to fix these genital cuts sooner rather than later. Remember oftentimes children will show doctors and nurses before they might show parents, so encourage them to be honest with health care providers.

GENITAL HEMATOMAS A purple bruise, possibly expanding, found in the genital region likely after a fall, kick, sports injury or “rough-housing.”

Continued on page 16 SPRING 2022 | Lehigh County Health & Medicine 15

FEATURE

If skin is protected and there are no visible cuts, please make sure the child has no labial or scrotal swelling forming. It’s easy to diagnose: the child will start walking as if they just got off a horse, complaining about underwear pulling or sitting at the dinner table crookedly. Boys may remain curled up in a fetal position if there has been a hematoma that may compromise or constrict the scrotal sac. Older children may be hesitant for anyone to “look down there.” To identify an issue, have them walk over you as you are lying on the floor. Even older children tend to be willing to do this. If anything looks bruised and swollen or you are not able to distinguish distinct anatomy, it’s time to seek help. Have the child sit on a cool pack or damp, cool towels, or have your older child self-administer a wrapped ice pack between the legs. If old enough, have the child use a marker to identify the affected area.

Pack the pelvis with covered ice packs and get to the doctor – especially for boys with scrotal injuries and girls with labial hematomas. With no natural place for the body to stop internal bleeding under the skin, a great deal of blood can be lost very quickly in this region.

Rule 3: Wear bug spray or use a morsel to press and combine with oil/vaseline an herb combination of rosemary and cedar, catnip, lavender, or mint to protect the skin. Most of the time, if you are walking on wilderness trails, these sources of bug repellent are all around you.

Rule 4: Wear clothes that cover the legs and arms especially at sunup, sundown, or near murky stagnant water sources. Near the ocean, protect yourself during low tide. Remember, children have a higher metabolism, emit more levels of carbon dioxide, and tend to attract biting insects more readily than adults.

than it had been. The sheer pressure that occurs as one is pulled through the water to stand on the ski, can cause penetrating water. Typically, women will report a popping sensation or a sense of acute, sudden onset vaginal pain with unexplained bleeding.

Rule 9: Please don’t rope swing.While incredibly fun, swinging on a thick rope, jumping into running river rapids, when your hands are wet, can lead to big trouble. First, it is hard to catch a grip of the rope, especially if you are heavier than you used to be with either less upper body strength or more weight in the hips. Second, when you slip or fail to time a release, you will GENITAL TRAUMA likely slip down the rope and can tear the skin Fun activities can bring unforeseen conse- around the clitoris and labia minora. Third, most quences and injuries even unexpectedly from rope swings I have used are not the cleanest of water fountains, water parks, water skiing, and devices. Even simple small cuts from a rope can rope swings. leave rope splinters, abrasions, lacerations, and hematomas or a combination of all of these.

Rule 5: Wear appropriate clothes.

Locations for these activities are in scenic, hard to reach places requiring some form of hiking in Rule 6: Whether you have teenagers who wish or out. Swimming towards land as this happens to sunbathe or little children who can’t help but can be difficult; walking after one of these ropesqueal with delight when they feel water poured, burn injuries can exacerbate risks for infection, GENITAL ABRASIONS splashed, and blown on them, please play safely. and often there is a delay in care, making these Cuts, scrapes, falls and bug bites naturally occur Don’t assume anyone has checked for insecure injuries challenging to fix and exceptionally as part of summer. Summer campfires or beach and unsafe settings. Be cognizant of your own painful to withstand. bonfires are frequented by mosquitoes, especially strength, balance, endurance, and surroundings in the Mid-Atlantic waterways. A simple cut if you are teaching a young one.

Rule 10: What you burn today, won’t feel good from scratching compromises the skin barrier. tomorrow. Seriously, skin cancer including On a child’s leg it is easy to use Neosporin or Rule 7: Don’t let little girls who might be potty melanoma of the glutes and inner groin are anti-itch cream but when close to the genitals, training and going commando stand or squat developing more frequently than one might cracked skin can become an infection requiring directly over water jets found at most water parks expect. First, these areas burned during our antibiotics or further evaluation. Our skin natu- and town pools. youth are not often examined and evaluated as rally has bacterial organisms, the most common adults. Second, late diagnosis of skin cancer in of which are staph and strep bacteria. While Fountain play and genital tears: Especially if the urologists’ and gynecologists’ domain are generally harmless, if the skin is compromised, other children are standing on up-spouts, the common. Third, these areas are very vascular, these bacteria can penetrate the surface, wall off, pressure from the fountain can blow into the vag- close to the inguinal blood vessel and lymphatic and become abscesses, especially in children inal opening of young children, and subsequently supply and have an easy pathway to metastasize. who are still toilet training. E. coli from our cause tears and trauma to the upper vagina. Not We may not be able to prevent it for ourselves or stool very easily can be transmitted to the site of only are these hard to diagnose, but these tears our older teens since the sun exposure has already skin abrasions. Certain local isolated infections to the vagina can also track upward and water occurred, but for our little ones, SPF clothing and can be managed at home, but somehow genital can cause a shear effect thus penetrating through fuller sun coverage protects from all the above abrasions always seem to blossom into unwanted to the abdominal cavity. While these are rare summer injuries mentioned. persistent infections. Soak the area in warm injuries, they are troublesome and potentially water and use a drawing salve or a touch of salt dangerous when they occur.

May our kids play every day, and may we have in the bathwater. If the area is getting warmer, fun chasing them. larger, redder, and more painful, please get to Water skiing for older teens or adult women a practitioner to see if antibiotics are indicated. can result in a similar traumatic injury. If a Be well, be safe, and have a great spring female has had a hysterectomy or has entered and summer. menopause, the tissue of the vagina is less sturdy 16 Lehigh County Health & Medicine | SPRING 2022

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hank goodness for telemedicine. It was a lifesaver during the early stages of the pandemic, when patients needed to see their physicians but were locked down at home.

As cautionary measures change, it still offers safety and convenience, especially for those who live distantly from their health care providers. However, its fate is up in the air depending on the life span of the health emergency status telehealth has been given due to COVID-19.

As of March 2022, the public health emergency status is still in place. But those in the industry caution that if that statute is lifted, for many, telehealth coverage will just end. People living in rural areas wouldn’t be able to use computers in their homes but would have to go to an authorized center for access. While we can’t predict the direction the industry will take, we can review the issues, understand the complexities of extending coverage, and explore some actions already in progress.

THE CURRENT STATUS WITH INSURERS AND REIMBURSEMENT So far, there has been a hunt-and-peck approach to extend and broaden reimbursement for telehealth, which would ensure providers can continue to offer the service to patients. CMS’s Calendar Year 2022 Physician Fee Schedule final rule, approved in early November, will promote greater use of telehealth for behavioral health care services, diabetes prevention, and vaccine administration. The final rule also

advances programs to improve the quality of care for people with Medicare by incentivizing clinicians to deliver improved outcomes.(1) However, there are caveats to coverage under Medicare as well as Medicaid. This is an excerpt from the Pennsylvania Department of Human Services Sept. 30 Medical Assistance Bulletin:

In response to CMS’s policy changes during the COVID-19 PHE, the Medical Assistance (MA) Program has allowed for audio-only services in situations where the beneficiary does not possess or have access to video technology and when clinically appropriate. The Department will continue to allow providers to utilize audio-only telecommunication when the beneficiary does not have access to video capability or for an urgent medical situation, provided that the use of audio-only telecommunication technology is consistent with state and federal requirements, including guidance by CMS with respect to Medicaid payment and OCR with respect to compliance with Health Insurance Portability and Accountability Act (HIPAA).

For the most part commercial payers are following in the footsteps of CMS, although some have added waivers, are allowing additional services, and disallowing others. For example, some payers do not pay for remote patient monitoring (RPM), while Medicare does.

Many of the commercial insurers allow virtual check-ins as long as the Public Health Emergency (PHE) is in effect. The current PHE was recently extended to April 16, 2022, and organizations such as Continued on page 18 SPRING 2022 | Lehigh County Health & Medicine 17

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the Federation of American Hospitals is urging the date be extended further.

“Regarding Medicare, there are numerous bills pending, such as Bill S.1512 and H.R.2903 (CONNECT for Health Act of 2021), which would allow CMS to waive certain restrictions, such as the types of technology that can be used; permanently remove geographic restrictions; allow the home to serve as an originating site; permanently allow FQHCs and RHCs to serve as a distant site; and allow CMS to generally waive coverage restrictions during any PHE,” says Joseph Tracy, MS, BA, Vice President – Connected Care and Innovation at Lehigh Valley Health Network. “These bills were introduced in April 2021, but we don’t know when the Senate or House will vote on them.

“It’s always been an uphill battle,” continues Tracy. “When Medicare became law in 1965, nobody dreamed doctors would be seeing patients virtually. The laws essentially have to be rewritten. You could say that telehealth is just part of health care now, and we’ll pay for it like any other service. But where does the money come from?”

in other states to obtain an expedited temporary license to provide services to Pennsylvanians via the use of telemedicine. That waiver is set to expire on March 31, 2022. Eighteen other states also issued waivers modifying telehealth requirements in response to COVID-19.

Interstate compacts (agreements between two or more states) have been proposed that make it easier for health care providers to practice in multiple states — expediting the licensing process or allowing members to practice under a single multistate license.

Some of the larger compacts are backed by well-established regulatory boards. Many also meet the federal licensing requirements of the Centers for Medicare & Medicaid Services.

Those sitting on state licensing boards claim their regulations are put into effect to protect patients, referring to the trust and confidence in knowing the qualifications underlying one state’s license are on par with those of other states.

Critics question that perspective and link it to the fees that licensing boards collect. As this controversy slogs on, medical practitioners are held uncomfortably in the middle, obligated to comply with diverse regulations should they want to care for patients in a state other than where they live and primarily practice. The outcome is not yet clear.

STATE LICENSING ADDS A LAYER OF COMPLICATION The pandemic altered the previously standing law that forbid physicians and other health care practitioners to provide care to patients out DOES TELEMEDICINE of state without obtaining a medical license CUT COSTS AND IS THE in that state. There have been attempts at TECHNOLOGY AFFORDABLE? keeping the momentum going. For example, “It can cost less,” says Tracy. “For example, a bipartisan group of lawmakers reintroduced rather than moving a patient to a hospital where the Temporary Reciprocity to Ensure Access to there is a particular specialist, if that patient can Treatment (TREAT) Act (S.168, H.R. 708) on be seen and treated safely via video, you can Feb. 2, 2021, which would provide temporary drastically cut transport costs.” He also refers licensing reciprocity for health care professionals to cost reduction during the pandemic, when for any type of services provided to a patient virtual Covid screenings kept patients from located in another state during the COVID-19 going to the higher-cost emergency department pandemic. However, the act remains in limbo or urgent care route. “The principle is much at this writing. like that in the ICU,” he says. “When we can treat patients and move them to a lower-cost That has left it up to individual states to environment rather than an ICU, we are tackle the problem, since providers want to reducing costs.” be able to treat their patients and have access to their medical records wherever they may The cost of telehealth could be more for small, be traveling. Pennsylvania’s Governor Wolf independent practices who either need to set up granted a waiver to allow licensed practitioners a telehealth network of their own or contract

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with a vendor to provide those services. During the height of the pandemic, practitioners were able to use platforms such as Facetime® and Microsoft Teams®, which may have saved on expenses but are not necessarily secure. While Tracy notes that some practices are still doing it, “the majority of telehealth users accessed virtual care services through their regular physician or health plan, as opposed to direct-to-consumer telehealth platforms,” according to new data from Morning Consult. “Of the nearly 2,200 survey respondents, 72% reported that they attended appointments through their physician or health insurance, while 17 percent said they used on-demand telehealth services.”

Some practitioners and health systems have had some help from the government to further education and application of telehealth. In August 2021, the Biden-Harris administration appropriated investments to strengthen telehealth services in rural and underserved communities and expand telehealth innovation and quality nationwide. These investments — totaling over $19 million — were distributed to 36 award recipients through the Health Resources and Services Administration at the U.S. Department of Health and Human Services.

Tracy says that while this support will certainly help, there are numerous points that need to be addressed to ensure telemedicine can deliver its full potential. “How do we decide how many cell towers to put up? Where do we put them? And what if the patient doesn’t have the technology to connect? These are all important questions,” he says.

USAGE OF TELEMEDICINE STILL STRONG While one source puts usage at 38% higher now than before the pandemic, it notes that as cautions related to the virus ease, more people are returning to see their doctors in person.

According to a survey recently conducted

by The Harris Poll, roughly 65% of people plan to continue to use telehealth after the pandemic ends. If given the option between a telehealth visit or an in-person visit, relatively few respondents (15%) said they would opt for telehealth services alone. Most people (44%) still preferred in-person visits, but nearly as many

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(42%) would choose a combination of in-person and virtual care.(2) You have to look at the age groups to get a clear picture of acceptance and use of telehealth going forward. More than 70% of younger generations (Gen Z, millennials, and Gen X) said they prefer telehealth because of convenience. Gen Z and millennials are resisting a return to in-person care, with 44% saying they may switch providers if telehealth visits aren’t offered going forward. Meanwhile, only a quarter of baby boomer patients prefer telehealth to in-person care.(3) “It’s natural for some people to pull back and want to see their providers in person, if they live close by,” says Tracy. “But for those who live a distance away, telehealth levels the playing field in terms of access to necessary health care services, which sometimes makes the difference between receiving or not receiving care.”

PROVIDERS WAITING FOR AN OUTCOME TO MOVE FORWARD Some providers are voicing opinions about medicine moving toward a hybrid of both remote care — in the types of cases where that suffices — and in-person care. However, the more states hesitate on legislation and insurers remain undecided about coverage, providers are leery about how much their practices should invest in new or enhanced capabilities to offer telehealth appointments.

“There’s so much uncertainty about what’s going to be made permanent and what’s going back to the way things were,” says one physician. “Now, a lot of providers and even hospitals are asking, ‘Should we continue to invest in the infrastructure for this? Is our state going to continue to allow this or not?’”(4) The bottom line: Telehealth is a technology and service that can help mitigate stress on the health care system, patients like it, and it broadens access for those who live distantly. Are these benefits alone — without a pandemic to push the issue — enough to motivate insurers to continue coverage and technology providers to step up expansion? The next few months will absolutely be critical in learning which way the wind will ultimately blow in the world of telemedicine and electronic access to care.

SOURCES (1) https://www.cms.gov/newsroom/press-releases/ cms-physician-payment-rule-promotes-greater-access-telehealth-servicesdiabetes-prevention-programs (2) https://medcitynews.com/2021/01/ poll-most-americans-plan-to-use-telehealth-after-the-pandemic/ (3) https://www.aha.org/aha-center-health-innovation-market-scan/202106-29-there-may-be-generation-gap-telehealths-future (4) https://www.npr.org/sections/health-shots/2021/11/23/1056612250/ voice-only-telehealth-might-go-away-with-pandemic-rules-set-to-expire

ADDENDUM As the Public Health Emergency changes, so will the accuracy of the information in this article. The following is an update as of March 15, 2022: On March 15, President Biden signed the Consolidated Appropriations Act, 2022, an omnibus funding bill that includes government appropriations for fiscal year 2022 through September 30, 2022; $13.6 billion in aid for Ukraine; and an array of health policy provisions including Telehealth Flexibility Extensions under the Medicare Program. The bill temporarily extends the following, which enable Medicare beneficiaries to access a broad range of services via telehealth from any location, for 151 days beginning on the first day after the end of the public health emergency (PHE) period: • Any site in the United States, including a patient’s home, will be considered an eligible originating site for the delivery of telehealth services.

• Facility fees will not be paid to newly covered originating sites (e.g., a patient’s home).

• Eligible telehealth practitioners will continue to include qualified occupational therapists, physical therapists, speech-language therapists, and audiologists.

• Federally qualified health centers and rural health clinics may serve as originating or distant sites for the delivery of telehealth services.

• Providers will not be required to meet in-person visit requirements in order to deliver mental health services via video or audio-only visits. This applies to all sites of care, including Federally Qualified Health Centers and Rural Health Clinics (except in the case of hospice patients).

• Coverage of telehealth services delivered via audio-only format will continue for specific service codes identified by Medicare as being eligible for delivery via audio only.

• Practitioners will be able to use telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care.

For more information, refer to the bill directly.

Telehealth Flexibility Extensions are found in Division P, Title III, Subtitle A, pages 1901-1911. https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-117HR2471SA-RCP-117-35.pdf

SPRING 2022 | Lehigh County Health & Medicine 19

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ehigh Valley Health System Medical Resident Lorena Rosero, MD, to Receive Lehigh County Medical Society’s 2021 Humaneness in Medicine Award

Every year, the Lehigh County Medical Society (LCMS) presents its Humaneness in Medicine Award to one or more Lehigh County medical residents or fellows who have best displayed the ideals of outstanding compassion in the delivery of care, respect for patients, their families, and health care colleagues, as well as demonstrated clinical excellence. In 2022, LCMS is proud to announce that Lorena Rosero, MD, has been selected as the 2021 Humaneness Award recipient.

Dr. Rosero is a resident in Obstetrics and Gynecology at the Lehigh Valley Health Network. She is described as a person who represents the definition of caring. An example of her dedication to and compassion for her patients is a story of one patient in the ICU. The patient was known to Dr. Rosero due to her involvement with the patient’s initial admission. And although Dr. Rosero’s clinical responsibilities changed to another rotation, she continued to visit the patient, speaking with and checking in on her often. Dr. Rosero at times assisted with translation services as the patient didn’t speak English and helped keep the patient’s family informed. When the patient took a turn for the worse, Dr. Rosero helped make sure that the family, who lived outside the U.S., was able to apply for visas so they could come see the patient. Even while on vacation, Dr. Rosero still visited this patient every day, talking with her even when she was no longer certain the patient could hear her.

Dr. Rosero is an integral part of the OB/GYN department’s wellness committee, actively supporting her colleagues’ well-being. In nominating Dr. Rosero, a colleague wrote: “She is not only an amazing resident physician, but a loving and compassionate individual.”

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LCMS is proud to have Dr. Rosero as the recipient of this important award.

Located in Allentown, PA, LCMS represents physicians of all specialties on local issues. In coordination with the Pennsylvania Medical Society, LCMS also works to address health issues at the state capitol.

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2021 YEAR-END LEGISLATIVE UPDATE Midway Point 2021-2022 Regular Session of the Pennsylvania General Assembly

As we come to a close on the 2021 calendar year, we also reach the midway point of the 2021-2022 regular legislative session of the Pennsylvania General Assembly. 2021 saw a return to a bit of normalcy at the state Capitol amidst the COVID-19 pandemic, but a new normal has certainly arrived. While many legislators are present on session voting days, remote voting is an option that many legislators have decided is the safest way for them to represent their constituents. Many offices, which had previously been easily accessible, are now locked or require advance appointments.

Across the country we’re seeing tensions rise in state capitols, and in Washington, over election reforms, mask and vaccine mandates, over-crowded hospitals, and the overall impact COVID-19 has had on businesses and our economy. It has been challenging for all, especially those dedicated to patient care.

As we look to 2022, politics may very well trump policy as legislators and legislative candidates eye the May primaries and November General Elections.

2022 also marks the creation of new legislative district maps that could potentially change the composition of the General Assembly and leave some legislators to decide if they should bow out of office or face the harsh reality of running against a colleague. Further, the eyes of the nation have shifted to the Commonwealth as we near a primary election for an open U.S. Senate seat in addition to the election of a new Governor. At last count, there are currently ten announced candidates seeking the republican nomination for Governor while Attorney General Josh Shapiro stands as the only democratic candidate.

Despite the currently political environment, the Pennsylvania Medical Society (PAMED) continues to work tirelessly to defend the practice of medicine, protect the physician-patient relationship and ensure that we are always mindful of legislation and regulation that could potentially impact the practice of medicine. The pandemic continues to provide policy issues and challenges in addition to the existing priority issues that PAMED advocates on behalf of, which include scope of practice and prior authorization.

The first year of the current legislative session provided a few highlights for PAMED. Among these were the enactment of Senate Bill 425 as ACT 61 of 2021. ACT 61 was a PAMED-supported effort to provide a remedy to the Pennsylvania Supreme Court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians.

PAMED was able to support or provide neutrality on various agreements with Advanced Practice

Providers including the passage of Senate Bill 416 (CRNAs) and Senate Bills 397/398 (PAs).

House Bill 931 - (Toohill) House Companion legislation.

Another key issue that saw movement was Senate Bill 225, an extensive effort to reform the prior authorization process. While this effort has a long road ahead, it advanced out of the Senate Banking and Insurance Committee for the first time and there is some level of optimism that it may be taken up before the full Senate early next year.

Senate Bill 425 - (Gordner) - Informed Consent - PAMED supported this effort to provide a remedy to a court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED supported this effort which passed the Senate (50-0) and the House (201-0). Signed into law as Act 61 of 2021.

House Bill 681 seeks to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House.

House Bill 1420 - (Thomas) - Health Care Heroes Act - PAMED supports this effort to establish a public awareness campaign to provide information regarding the programs and services available for first responders, healthcare workers, and other workers suffering from mental health issues related to COVID-19. Having unanimously passed the House (202-0), this bill now awaits a vote in the Senate Health and Human Services Committee.

Lastly, Senate Bill 705 that seeks to provide legislative framework for the practice of telemedicine has advanced out of the Senate. We have seen this effort reach the Governor’s desk in the past only to see it vetoed. We are hopeful that this effort might reach a compromise in the second year of this session.

While these are only a few highlights of the current legislative session, detailed below is a list of other issues that we are actively monitoring along with a brief summary. PAMED continues to engage in a number of legislative issues as well as participating in a large coalition to prevent any changes to the current Pennsylvania Supreme Court Civil Procedure rules regarding venue in medical malpractice professional liability cases.

House Bill 245 – (Kaufer) – International Medical Graduates (IMGs). Seeks to modernize the process by which graduates of international medical schools become licensed. Passed the House (201-0) and has advanced out of the Senate Consumer Protection & Prof. Licensure Committee and now awaits action from Senate Appropriations. We anticipate this bill to get to the Governor’s desk in the near future.

Senate Bill 705 - (Vogel) - Telemedicine -This legislation was voted favorably out of the Senate (46-4) and has been referred to the House Insurance Committee. PAMED supports this effort and will work to move this bill through the legislative process once again.

Senate Bill 416 - (Gordner) - This legislation officially recognizes certified registered nurse anesthetists (CRNAs) in the Commonwealth of Pennsylvania as well as outlining requirements for certification of CRNAs. PAMED followed the anesthesiologists’ lead in supporting this effort.

This legislation has unanimously passed both the Senate (50-0) and the House (201-0). Signed into law as Act 60 of 2021.

House Bill 1082 - (DelRosso) - PAMED supports this legislation, which establishes an education program for providers on early diagnosis of Alzheimer’s disease and other dementias and incorporates information about the disease into existing public health outreach programs. This bill passed the House (201-1) and is now awaiting final consideration by the full Senate.

House Bill 1280 - (Jozwiak) - Patient Test Results - PAMED will be working with the cardiologists to advance this bill through the House after it recently was voted favorably out of the House Health Committee. This bill amends the Patient Test Result Information Act in addressing how patients receive notifications after certain tests, etc.

Senate Bill 397 – (Pittman) – Physician Assistants (PAs); seeking to help physician assistants work and practice with increased efficiency. The bill allows for modernization for physician assistants to practice while maintaining their role under supervising physicians. This legislation has recently passed the Senate (50-0) and House (200-0); signed into law as Act 78 of 2021. (DO ACT) Senate Bill 398 – (Pittman) –This legislation has passed the Senate (50-0) and House (200-0) and has been signed into law as Act 79 of 2021. (MD ACT) Senate Bill 225 – (Phillips-Hill) - Prior authorization reform bills. There is a large coalition with multiple provider entities and patient advocacy groups seeking to make wholesale changes to the prior authorization process in the Commonwealth.

PAMED has played an integral role in developing this legislation and working to advance it. While this legislation will require ongoing efforts to continue to advance it through the legislative process, it was voted out of the Senate Banking and Insurance

Continued on page 22 SPRING 2022 | Lehigh County Health & Medicine 21

LEGISLATIVE UPDATES Committee. PAMED continues to work with a broad coalition to pass this important legislation.

House Bill 225 – (Mentzer) – House Companion legislation.

Senate Bill 25 - (Bartolotta) – PAMED opposes this legislative effort which seeks to grant CRNPs independent practice authority. PAMED has long opposed these efforts, but last session agreed to listen/negotiate a pilot program where CRNPs would be granted independent practice with specific guidelines and restricts. This bill was recently voted out of the Senate Consumer Protection and Prof. Licensure Committee, but it is not anticipated that this bill will advance beyond the Senate in its current form. Likely, any movement on this issue would come in the form of a bill/amendment that starts from the agreed upon pilot program.

(HCO2108) – (Hickernell) – Co-sponsorship memo recently introduced to advance the pilot program legislation.

House Bill 681 – (Ecker) – PAMED has worked closely with the sponsor of this bill, Rep. Ecker, to advance legislation dealing with restrictive covenants in health care practitioner employment contracts. This effort would seek to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House.

be covered (experimental long-term antibiotic for example). Although PAMED opposed this effort, this legislation has passed the House (136-66) and has been referred to the Senate Banking and Insurance Committee.

Senate Bill 621 - (Brooks) Publishing of vaccine availability by physicians - PAMED opposed this legislation which would require physicians that provide the COVID-19 vaccine to pay for the weekly publication of vaccine data, such as the number of vaccines they have available, in local newspapers. Further, it would require that physicians in private practice vaccinate any individual who shows up even when an established relationship does not exist. This bill failed at the Senate Health and Human Services Committee level and has been referred to the committee by a motion to reconsider.

Senate Bill 671 - (Hutchinson) Retaining Health Care Innovations Act - PAMED opposes this effort to extend the emergency administrative regulation changes granted to health care facilities, practitioners, and providers by Governor Wolf during the COVID-19 pandemic. This bill has advanced out of the Senate Health and Human Services Committee and has been referred to Senate Appropriations.

House Bill 1700 – (Sonney) – Disclosure of disingenuous physician complaints -This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical license if the case was closed without any formal action. PAMED supports this effort and will advocate to advance these bills. This legislation has been referred to the House Professional Licensure Committee. (DO ACT)

House Bill 958 – (Zimmerman) – PAMED opposed this effort that would prohibit pediatricians from deciding not to provide care to unvaccinated patients or patients whose House Bill 1701 - (Sonney) parent or legal guardians choose to (MD ACT) utilize a vaccination schedule that House Bill 192 - (Topper) - Intervaries from the vaccination schedule recommended by the CDC. While state Medical Licensure Compact Act this bill advanced out of the House - PAMED supports this effort which Health Committee, PAMED does would allow Pennsylvania to fully not believe this effort will advance join the Interstate Medical Licensure Compact Act (IMLC). The IMLC beyond there. provides a streamlined process that House Bill 1033 - (Rapp) - This allows physicians to become licensed bill requires health insurers to cover in multiple states with a mission of treatment plans of Lyme disease or reincreasing access to health care. This lated tick-borne illnesses as prescribed bill has passed the House (201-0) by a health care practitioner; issues and now awaits consideration in the over what type of treatments could 22 Lehigh County Health & Medicine | SPRING 2022

Senate Consumer Protection and Prof.

Licensure Committee.

House Bill 1774 – (Flood) – PAMED supports this effort to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. This bill was signed into law as Act 72 of 2021.

House Bill 1319 – (DelRosso) – This legislation is intended to curb the predatory practices of Pharmacy Benefit Managers (PBMs) by targeting the practices being used by them to interfere with the funding stream health centers and 340(b) plans use to fund the care they provide to low-income, uninsured residents. PAMED supports this effort and anticipates a committee vote in House Health during early 2022.

House Bill 1440 – (Millard) – PAMED supports this legislation that would establish a Medical Imaging and Radiation Therapy Board of Examiners which would license and establish qualifications for individuals in the Commonwealth of Pennsylvania who perform medical imaging or radiation therapy procedures. The House Professional Licensure Committee held an information hearing on the topic and the bill awaits action by this committee.

House Bill 1562 – (Pickett) – PAMED strongly worked to oppose this effort to expand access to the PDMP and as of this time, this legislation has yet to be brought up for a committee vote. It is currently sitting in House Insurance and at this time we do not anticipate movement on this bill that grants private health care insurers access to the PDMP, when they have no enforcement abilities and no compelling rationale as to why they should have access to this hypersensitive information.

House Bill 1005 – (Cox) – PAMED is opposing this effort that would require emergency physicians to provide information that is frequently not available during the time in which care to a patient is being delivered.

Specifically, this bill requires information to be added to the PDMP when Narcan/Naloxone is used to combat an overdose by emergency responders or medical professionals.

This bill advanced out of the House Health Committee and PAMED will continue to work to prevent this effort

from becoming law.

House Bill 1959 – (Pennycuick) – This legislation authorizes the clinical study of the efficacy and cost/benefit optimization of the psilocybin-assisted therapy in the treatment of PTSD, traumatic brain injury and various mental health conditions. PAMED has new policy to support clinical studies to determine the full efficacy of the use of psilocybin as appropriate.

This bill is currently awaiting a vote by the House Health Committee.

Senate Bill 196 – (Ward) – Co-pay accumulator legislation; requires insurers or pharmacy benefit managers to count any amounts paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to the plan’s deductible.

PAMED is still working through this effort to determine a position while the bill awaits action from the Senate Banking and Insurance Committee.

House Bill 1664 – (Gleim) – House companion legislation.

House Bill 605 – (Ecker) – This COVID liability legislation specifically requires certain cases alleging personal injury damages because of exposure to COVID-19 to be subject to expedited compulsory arbitration programs. Having passed the House (107-94) this bill now awaits action from the Senate Judiciary Committee.

Should this legislation advance to the Governor’s desk, it is likely it would be vetoed as similar legislative efforts have ended in the same result.

House Bill 1186 – (Quinn) – Legislation to amend the Acupuncture Licensing Act to provide for the title protection for licensed acupuncturists and practitioners. PAMED worked to provide language on amending this bill that resulted in a position of neutrality.

HB1186 advanced as amended out of the House Professional Licensure Committee and is to now before the full House.

L C M E D S O C .O R G

31 S T A N N U A L

April 1-10, 2022 Reading, PA JAZZ AT LINCOLN CENTER ORCHESTRA with WYNTON MARSALIS GREGORY PORTER

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SPECIAL EFX ALL-STARS JOHN NÉMETH BÉLA FLECK: MY BLUEGRASS HEART

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