Lancaster Physician Summer 2016 by Hoffmann Publishing Group

Summer 2016

COVER ting

Comba

E S U B A D I O A I I N P A V L O IN PENNSY TREATMENTS AND RESOURCES TO ADDRESS

OBESITY

Plus

RESTAURANT REVIEW:

THE WATERFRONT

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Contents 2016 BOARD OF DIRECTORS

SUMMER 2016

COVER STORY

OFFICERS

Combating Opioid Abuse in Pennsylvania

David J. Simons, DO, President

(p. 22)

Community Anesthesia Associates

James M. Kelly, MD Immediate Past President

Best Practices

LGHP Lincoln Family Medicine

Robert K. Aichele Jr., DO, President Elect Aichele & Frey Family Practice

6 Acupuncture

Laura H. Fisher, MD, Vice President

Aichele & Frey Family Practice Associates

8 Stroke Studies Offer Hope For Favorable Patient Outcomes

Stacey S. Denlinger, DO, Secretary

Baron Family Practice

Stephen T. Olin, MD

9 Innovative Health Care: Concierge Primary Care Practice Model Offers Patients Less Complexity And More Convenience

Treasurer

Retired Physician/Consultant

DIRECTORS Sarah E. Eiser, MD, Robert A. Garvin, DO, John A. King, MD, Rebecca M. Shepherd, MD, Kristy Whitman, MD,

Editors: Dawn Mentzer Beth E. Gerber Lancaster City & County Medical Society James Kelly, MD Lincoln Family Medicine

Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Societyâ&#x20AC;&#x2122;s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment.

In Every Issue 4 Presidentâ&#x20AC;&#x2122;s Message

30 Medical Society Updates

12 Healthy Communities

32 Restaurant Review

20 Passion Outside of Practice

35 News & Announcements

22 Patient Advocacy 28 Legislative & Regulatory Updates

Content Submission The Lancaster Physician magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Lancaster City & County Medical Society. For more information or submission suggestions, please email bgerber@lancastermedicalsociety.org. Lancaster Physician is published by Hoffmann Publishing Group, Inc. Reading PA HoffmannPublishing.com 610.685.0914

For Advertising Info Contact: Kay Shuey, Kay@hoffpubs.com, 717.454.9179

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President’s Message

s I pass the gavel to Dr. Dave Simons, I wanted my final column to reflect on the past two years and relay thoughts as our county medical society moves forward. As medicine shifts to a higher percentage of employed physicians, we have continued to look at the evolving role of our local medical society. Maintaining relevance by giving physicians a platform to voice concerns is the ultimate goal, and each physician has a varied idea of what the society can and should do. Taking this into account, I wanted to review a few of our recent accomplishments and goals:

James Kelly, MD President

 1. Significant efforts over the past calendar year went into a search for a new Lancaster County Medical Society Executive Director. I am pleased to say we have found a hard working, dedicated professional in Beth Gerber Miller (see page 35 for a full interview). Beth has taken off running and has already grown significantly in her new role after just six months. I anticipate she will become the face of our local society, and am excited to see where her leadership will take us over the next few years.  2. We have successfully implemented a new roundtable discussion format for our legislative breakfasts. Discussing medically relevant issues with our local politicians has become the focal point of our society’s grassroots advocacy efforts. The most rewarding moments of my board tenure have involved opportunities to educate and hopefully influence decision making with local politicians. Our goal moving forward is to meet regularly with our local representatives and senators, and I’d like to continue to involve interested members in these discussions.  3. Advocacy builds the foundation and is always at the forefront of the society’s mission. PAMED has had several major wins over the past few years, such as Mcare refund and controlled substance legislation, and continues the fight on several hot topic items, like credentialing and CRNP collaborative agreements. At the local level, we assure Lancaster County’s physician voice is heard through full representation at PAMED’s annual House of Delegates.  4. Facilitating involvement and building awareness amongst the membership regarding our local society’s capabilities and active programs is an ongoing process. With three major health systems in the area, the medical society provides a neutral ground for countywide programs to thrive. PALCO, Doctors on Call, our medical student scholarship fund, and the community transformation grant (looking at blood pressure control across the county) are programs that have fallen under our umbrella. I would like to see similar programs continue as a way for the local medical society to facilitate collaboration between health systems.

Visit lancastermedicalsociety.org

 5 . Through social events and physician involvement, the society continues to enhance development of our medical neighborhood. Maintaining camaraderie amongst established physicians while continuing to recruit early career physicians helps with job satisfaction and retention in this challenging environment. We have provided networking venues and opportunities for participation through our holiday scholarship fundraiser, young physicians social, and annual meeting.

Our goal at LCCMS as always is to listen to our membership and develop guiding principles for our activities at both the state and local level. As our strategy continues to evolve, I am confident our incoming leadership will lead the county society in the right direction.

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best

prâ&#x20AC;&#x160; ctices Acupuncture Stroke Studies

Medical Acupuncture

Direct Primary Care JOSEPH DEGENHARD, MD

WellSpan Family Medicine â&#x20AC;&#x201C; Trout Run

lagued by migraine headaches since adolescence, I would often get three headaches per week. Finding minimal relief from OTC or prescription pain medications, I sought a way to reduce the frequency of headaches with my first acupuncture treatment 10 years ago. I found acupuncture to be very relaxing, and post treatment, the prophylactic effect on my headaches lasted several weeks. Throughout my career, I have found that mainstream medical treatments do not sufficiently alleviate certain health conditions. Some clusters of symptoms do not fit neatly into a standard diagnosis. Chronic pain syndromes especially lack adequate solutions that do not carry

significant side effects. These limitations, in combination with the burgeoning opioid crisis our society is facing, led me to seek additional therapies. I expanded my knowledge in complimentary medicine through CME, and became board certified by the American Board of Integrative and Holistic Medicine. As a natural next step, I decided to pursue medical acupuncture as an additional treatment modality to help patients with musculoskeletal and neurological pain. As I went through the Helms Medical Institute acupuncture training, I was pleased to see that it can help with many other conditions. According to the World Health Organization, acupuncture has been shown (through controlled trials) to effectively treat

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SUMMER 2016

Medical Acupuncture

the following list of symptoms, diseases, and conditions: low back pain, neck pain, sciatica, tennis elbow, knee pain, arthritis of the shoulder, sprains, and rheumatoid arthritis. It has been shown to help relieve facial pain (including TMJ syndrome), headaches, dental pain, and peripheral neuropathy. Acupuncture also can help with nausea (in pregnancy, postoperatively, and associated with chemotherapy). This is by no means a complete list of conditions acupuncture can heal.

Dr. Joseph Degenhard holding acupuncture needles, which are about as thin as a cat’s whisker

My acupuncture training included recognizing different “biopsychotypes” in patients. The acupuncture questionnaire I give includes questions about seemingly unrelated symptoms like personality traits, preferences in taste and season, predominant emotions, sleep habits, and mental state. Clusters of physical, emotional, or psychological traits can illuminate patterns of illness affecting a patient. This data is integrated with more mainstream queries in a Western-trained method for history taking. In combining these two methods, I employ both allopathic medicine and acupuncture to help the patient. Depending on the patient situation presented, I may use acupuncture as a primary or adjunctive treatment. Its outright advantages have proven beneficial in treating some of mainstream medicine’s harder-to-solve problems. Acute injuries, such as sprains, can be remedied with 1 or 2 acupuncture treatments. I

PHOTO CREDIT: STEPHEN MOYER/STEPHEN MOYER PHOTOGRAPHY

I have often been asked how it works. Traditional Chinese health theory holds that meridians of energy (chi) run in regular patterns throughout the body and over its surface. Needles are used to alter and rebalance disturbances in the flow of chi that manifest in disease, pain, or emotional problems. Modern medical models to explain the effects of acupuncture have implicated the actions of cytokines, autonomic and somatic nervous systems, alterations in the immune function, or biomechanical effects. The needles have been shown to trigger endorphin release at spinal and supraspinal levels. Another theory is that microelectrical currents of nerves, as well as anatomical pathways along fascia, bones, tendons, and all connective tissue, are therapeutically modified by the insertion of needles.

recommend a series of treatments (typically 5) on a weekly basis for chronic conditions. Follow-up treatments then become less frequent. I recently treated a woman with diabetic neuropathy with scalp acupuncture. She gradually weaned herself from gabapentin and remains minimally bothered by her symptoms now that she’s off the medication. Patients with hand and wrist tendonitis or arthritis from repetitive motion have gotten effective relief from local treatments. While each person experiences acupuncture differently, most people feel only a minimal amount of discomfort as the needles are inserted. Some people reportedly feel a sensation of excitement or euphoria, while others feel relaxed. Once the needles are in place, they can be stimulated manually, with heat, or by

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electrical stimulation. Side effects are rare. Properly administered, acupuncture does no harm. Minor soreness or bruising may occur post procedure. There is a rare possibility of infection, hematoma, or puncture of an internal organ. Acupuncture has been a great addition to my therapeutic toolbox. My employer, WellSpan Health, embraces mind/body centered healthcare throughout its regional system, and has fully supported my efforts. Like all physicians, I derive great satisfaction from a patient’s improvement and recovery. As I have integrated acupuncture into my medical practice, I have been delighted to help patients with both straightforward and challenging problems.

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Best Practices

Stroke Studies

OFFER HOPE FOR FAVORABLE PATIENT OUTCOMES

JAMES PACELLI, MD

troke care continues to evolve. All aspects from acute interventions to the best secondary stroke prevention strategies remain active areas of investigation. I have chosen to review the results of the most recent studies, which may have the highest impact value in day-to-day practice for both specialists and primary care providers. As always, our main focus continues to be finding ways to educate the patient population to immediately seek medical attention when they have symptoms. Unfortunately, even with all the advances only a small number of patients make it to the hospital within the therapeutic window. This makes it imperative that all physicians make an effort to educate their at-risk patients as to the signs and symptoms of stroke, and to go to the ER without delay. Research in acute stroke treatment has advanced over the last decade and our ability to restore cerebral blood flow continues to improve, leading to better functional outcomes for affected patients. The most recent data has focused on how to augment the available treatments by providing additional interventions to remove the symptomatic blood clot. A variety of device studies have been done in that respect. The HERMES study showed that patients treated with interventional thrombectomy in addition to intravenous tissue plasminogen activator (rt-PA) fared far better than patients treated with intravenous rt-PA alone. This is a concise

Regional Neurology and Pain Management Associates

indication of the benefits of interventional relief in the acute stroke setting that allows for a longer therapeutic window. Over the next few years, efforts will be concentrated on being able to provide this therapy at more locations across the country. The treatment of patients with symptomatic carotid artery disease has been well established, however, whether or not to intervene on patients with asymptomatic disease remains an open discussion. Data from the ACT I study explored asymptomatic patients with a high degree of carotid artery stenosis. The study concluded there were no differences in the outcomes of patients treated with either endartectomy or endovascular stent placement, and that vascular event rates were very rare in both groups, helping to clarify the role of endovascular treatment in this patient population. Another major issue impacting stroke patients can be determining the cause for their infarction. Despite all the major technological advances on neurological and cardiac imaging, up to a quarter of patients have their stroke mechanism classified as cryptogenic. In a recent study, patients with cryptogenic stroke were randomized into two groups; those in the active group underwent prolonged holter monitoring for atrial fibrillation. The study results showed that atrial fibrillation was detected in 14% of patients undergoing extended holter monitoring, while extended

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ECG monitoring detected only 5% of cases. This data has clinical applicability beyond patients with an unclear cause for their stroke. Patients with multiple vascular risk factors who suffer from large or small vessel ischemic lesions are at higher risk for atrial fibrillation, which may cause consideration for monitoring high-risk patients within this population. With detection rates of atrial fibrillation on the rise, more and more patients will be candidates for oral anticoagulation. Over the last five years the advent of non-vitamin K antagonists for anticoagulation has freed patients from the necessity of frequent trips for INR monitoring. However, many patients remain on warfarin and when they have cerebral bleeding, fast reversal of the underlying coagulopathy is warranted. The INCH study looked at INR reversal rates for patients on warfarin with intracerebral hemorrhages. Individuals who were given prothrombin complex concentrate (PCC) achieved full reversal 77% of the time, whereas only 9% patients treated with fresh frozen plasma (FFP) achieved a similar result. Rapid coagulopathy reversal can reduce hematoma expansion and lead to better functional outcomes. As such, PCC is favored over FFP in the management of warfarin related intracerebral hemorrhage. Additional advantages of PCC are that it is a one-time weight based infusion and is also less of a volume challenge to the patient than repeated FFP administration.

SUMMER 2016

INNOVATIVE

HEALTH CARE: CONCIERGE PRIMARY CARE PRACTICE MODEL OFFERS PATIENTS LESS COMPLEXITY AND MORE CONVENIENCE

CHRISTOPHER HAGER, MD

Founding Physician, Novara

hen my partners and I went through Practicing Excellence: A Physician’s Manual to Exceptional Health Care by Dr. Stephen Beeson about five years ago, one of the questions we asked each other was: “Why did you choose to go into medicine?” Nearly all of us vividly remember the “calling” we answered many years earlier, all centered around a desire to take care of every patient as an individual with unique needs. It is what got us to study as undergraduate students when it would have been easier to party. It pulled us through MCATs, anatomy lab, the USMLE, long nights as medical students, and endless shifts as residents.

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STAYING PATIENT-FOCUSED I have tried for many years to think of ways to increase my efficiency in order to maximize the time I am able to spend with my patients. I have huddled, started earlier, stayed later, batched results, organized administrative tasks, sat less, raised counter heights, implemented patient agendas, and counted footsteps. While we have invented new technology, added innovative solutions, and implemented robust electronic health records, we have had difficulty finding ways to deepen our relationship with our patients—to find the time to really listen to their stories, understand their wellness goals, and develop ways to help them achieve optimal levels of health. Continued on page 10

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Best Practices

Insurance companies have been working to reward patients and doctors for value, but the overwhelming majority of our time, attention, and compensation is based on volume and the fee-for-service model. This treatment model makes it challenging to be able to spend as much time with each patient as doctors would like, and it makes it even more difficult to give attention or advice to a patient outside of the examination room. Unfortunately, insurance companies continually reinforce this model, and it has advanced much more slowly than the technological tools available for patients and doctors today. Enter a new approach: Direct Primary Care.

CONCIERGE MEDICINE VS. DIRECT PRIMARY CARE Concierge Medicine has been around since the mid-1990s. This practice of medicine charges additional fees for increased access, time, and attention to a physician. It most often continues to collect revenue from insurance companies for the services rendered beyond the membership fee. It is, in a nutshell, a retainer fee physicians charge patients for special care. Direct Primary Care (DPC) is a newer, less familiar practice model. While very similar to concierge medicine, it typically

has a lower membership fee and includes more services as part of the membership. Preventive visits, phone calls, e-visits, and sick visits are normally included in the price of membership, in addition to guaranteed increased access and time with a physician. Many DPC practices do not participate with insurance at all and liken the model to the auto insurance system of care. Auto insurance covers unexpected, costly (often catastrophic) encounters, not day-to-day needs such as oil changes, tire wear, filling the gas tank, or getting a 15 point preventive inspection. Primary care can cover the day-to-day needs of people’s health, and many patients can afford this without depending on their insurance. The model is coined “Direct” Primary Care because it allows patients to contract “directly” with a physician and remove the barriers inherent in today’s insurance-based payments. Additionally, by removing the middleman (insurance companies), most DPC practices are able to scale down the number of patients they have to see from the traditional panel of around 2,500 to 500-800 patients per doctor. This provides greater access to care, more time per patient, and the ability to see patients on time.

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COMBINING THE BEST OF BOTH WORLDS This August, in partnership with Lancaster General Health/Penn Medicine, I have the privilege of opening a new practice, Novara, that combines the benefits of the concierge and direct primary care models, ignores the rules established by fee-for-service medicine, and focuses on one thing— the patient. Patients will have individually tailored services for a flat monthly fee, rather than utilizing insurance, thereby making primary care costs predictable. Our goal for “Novara” (paying homage to Latin roots which refer to newness, a star which suddenly becomes brighter, and a passionate pursuit) is simple: to provide personalized, innovative, relationship-based primary care that fits into people’s lives, while simplifying their health care experiences. By eliminating barriers between doctors and patients, the focus will be on personalized treatment goals and care that is both convenient and proactive. Office visits won’t always be necessary as patients can receive a physician’s input by telephone, Skype, or by using the MyLGHealth portal for an electronic visit.

SUMMER 2016

Innovative Health Care

TRANSPARENCY

By sharing the cost of medical services upfront, patients won’t receive any unwelcome surprises. The vast majority of primary care services will be included in the membership price. Flu shots will be free. While there will be a minimal materials charge for things like stitches and cortisone shots, the services will be included with membership. As is the hallmark of the DPC and concierge practice models, the doctor and nurse will know each patient, anticipate his or her needs, and provide guidance in achieving the highest state of wellness possible. From a tangible perspective, the office experience has been created to be soothing, not intimidating. There will be front and rear reception areas, two beverage stations, a fireplace, and plenty of natural lighting. Examinations and interviews will be conducted in the doctor’s office, and they will range in length from 30-60

minutes—every visit. We intend for the experience to feel more like a spa than traditional health care, complete with warm robes for patients to slide into for their annual wellness examinations. They will appreciate partnership as they take the time and attention to strategize their health care goals with their personal physician. I couldn’t be more excited to offer personalized care as a trusted advisor. I believe this practice and model of care will create excitement about a doctor visit as both patient and physician work together to achieve wellness goals. Additionally, by offering virtual visits, evisits, and telehealth, it is quite likely I will only be seeing my patients when they are well and want to be in the office.

MEETING THE MANY NEEDS OF OUR COMMUNITY

Traditional models of care will—and need to—continue. Population-based care, increased accountability for outcomes, and

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affordable health plans require us to all work together for the health and well-being of our communities. Without the continued dedication of organizations like Lancaster General Health to give back to the community, provide care for those who can’t afford it, and grant access to anyone who needs to see a provider, our community would suffer tremendously. We have already proven that we can provide this level of care, do it exceptionally well, and continue to improve. With that said, I believe now is the time to provide a unique service that doesn’t depend upon the reimbursement of insurance companies to decide how or when care can be delivered. Instead, we will work to enhance the relationship between a doctor and a patient one interaction at a time. This is the reason I, like many of you, chose to heed the call to medicine, and it is a calling I will work tirelessly to guard.

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Healthy Communities

Foundation Updates

30 STORIES FOR

30 YEARS LANCASTER

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Foundation Updates

he Foundation of the Pennsylvania Medical Society celebrates the 30th anniversary of the Physicians’ Health Program (PHP) by sharing 30 stories of how the program changed people’s lives. Here are some excerpts from a few of them:

When my husband’s alcoholism came to light, he went into a rehab center and I went into a crisis. It felt like a hand-grenade had gone off in my living room, and the pieces of my life were flying around me like shrapnel and debris. I honestly didn’t know what to hold onto, and what to let blow away. The counselor at the rehab center recommended that I get in touch with the PHP to learn about the voluntary monitoring program for physicians. Although I was reluctant to share our family secrets and to ask for the help that we needed, I found the phone number on the Internet and called the PHP while my husband was still in inpatient treatment. The reception I got from the PHP was warm and welcoming. I realized that I didn’t have to find my own way, because others had gone before me on this path.

When I told the PHP counselor that my plan for my husband after his rehab discharge was to administer a breathalyzer test before he went to work, when he came home, before he drove with the kids, etc., I was quite wisely told that I couldn’t be a spouse and the sobriety police. What would I do if my husband kept drinking? How could I enforce these rules? What would happen with empty threats and ultimatums that might not work? I listened to the information about their program and started to have hope that I wouldn’t be alone to shoulder the burden of living with an alcoholic. Fast forward two years, and our family is doing well. I attend Al-anon meetings, and have found a whole group of people who understand this disease. I have learned that I am not responsible for anyone else’s drinking or sobriety. My husband has a strong AA program and attends 5-6 meetings per week. He has maintained his sobriety by using all the tools available, one of which is the PHP monitoring program. He has random blood and urine tests, and follows the program requirements of meetings and counseling. We don’t look at these program requirements as an intrusion or a punishment. Instead, they are a welcome means of accountability. It is a way to reestablish trust and prove that he can “walk the walk” as well as “talk the talk.” Alcoholism can’t be cured, but it’s a disease that can be managed with the right strategy. I am grateful to the PHP for helping us live with alcoholism.

Tina Fell

Continued on page 14

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Healthy Communities

my home in search of Oct. 12, 1988: DEA agents invaded rolled substances. More cont of tion evidence regarding distribu to me and not accounted for. than 70,000 doses were registered admitted (to the agents) that That day was the first time I ever er ideas.” This was the end I was a drug addict. They had “oth of life as I knew it. and DEA registration were My Pennsylvania medical license ital privileges. Felony suspended/revoked, as were my hosp later. I had to stop using charges were issued three years ible. poss narcotics, and that was not ing that my supply was On Oct. 14, two days later, know for suicide. I prepared two frighteningly low, I did prepare one filled with Pavulon, syringes, one with Midazolam and That same day, an old and placed them in my top drawer. ly been in much trouble ious prev had acquaintance of mine who e number and said, “You do accepted my call. He gave me a phon Life can be beyond your not have to feel this way anymore. wildest dreams.” I spoke somewhat honestly The phone number was for the PHP. n. They sent a gentleman to for the first time about my addictio , a rehabilitation facility. I my home to escort me to Marworth as a participant, monitor, and have been involved with the PHP lus years, with continuous 27-p committee member for the past ided the framework for my sobriety since Day One. PHP prov of support whenever needed. I recovery, monitoring, and letters owe them my life. in 1989 and have been I resumed practicing anesthesia time. This is a direct that e sinc ul professionally successf y is a miracle. My path result of PHP intervention. My stor out the support and guidance would not have been feasible with of PHP.

The Physicians’ Health Program (PHP), a program of The Foundation of the Pennsylvania Medical Society, the charitable arm of PAMED, provides support and advocacy to physicians struggling with addiction or physical or mental challenges. The program also offers information and support to the families of impaired physicians and encourages their involvement in the recovery process.

Dean Steinberg, MD

SAVING LIVES AND CAREERS

THE FOUNDATION OF THE PENNSYLVANIA MEDICAL SOCIETY

For 30 years, the PHP has helped more than 3,000 physicians enjoy life without drugs or alcohol and continue to be successful physicians.

Physicians’ Health Program Endowment Campaign

To learn how you can make a difference by contributing to the PHP Endowment, contact Marjorie Lamberson, CFRE, at mlamberson@pamedsoc.org or (717) 558-7846. Or, mail your gift to:

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777 East Park Drive P.O. Box 8820 Harrisburg, PA 17105-8820

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Foundation Updates

As a medical student, my experience in the PHP has been quite interesting. Initially, I was hesitant, mainly because I had never imagined myself in a program like this. However, after almost a year in the PHP, I can honestly say that this program is the best thing that has ever happened to me. My family and closest friends constantly remind me how much better I am since joining the PHP. The staff is very kind, and it is clear that they care about you and your well-being. My most memorable patient experience that reminded me how great the program has been for me was on my psychiatric rotation. I was talking to one of my patients, and another patient happened to be sitting at the table with us. I had never met her before and I felt a very unique connection and understanding with her. She mentioned that she no longer drinks because no one likes being around her when she drinks. This patient went on describing her story, and I was able to relate on a very personal level. I understood her intimately, as my family and friends have been telling me how great I am to be around since Iâ&#x20AC;&#x2122;ve stopped drinking.

Through the PHP, I feel like I am finally in a place where I have always wanted to be. I feel happier than I ever have before. Mainly, I am grateful to PHP for making me a better person, and I know I will be a better doctor.

Anonymous

Visit www.foundationpamedsoc.org throughout the year to read new stories every month and donate online.

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Healthy Communities

TREATMENTS AND RESOURCES TO ADDRESS

OBESITY

Josie Schreder-Guhl, 28, of Harrisburg, started on a popular diet when she was 15 years old. After losing a significant amount of weight, she was no longer able to adhere to the restrictive eating plan, and the pounds sheâ&#x20AC;&#x2122;d lost gradually returned.

With increasing frustration, she repeated that cycle for 11 more years.

By Susan Shelly

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Treatment and Resources to Address Obesity

inally, she decided things needed to change. She needed to find a way to lose weight and keep it off.

“It was May 2014 when I decided to really get serious about weight loss,” said Schreder-Guhl, who is employed as a pediatric nurse practitioner at Lancaster General Health’s Roseville Pediatrics. She consulted with Lancaster General’s Healthy Weight Management Center and considered all the options the center offered. Eventually, even though she had begun losing weight again through diet and exercise, she decided that bariatric surgery was right for her. “My problem had always been that I could get it started and lose a significant amount of weight, but then I’d fall off the wagon and the weight would come back on,” Schreder-Guhl explained. “After a lot of thought, I decided that weight loss surgery was the right step for me.” In March 2015, Schreder-Guhl underwent sleeve gastrectomy surgery, a procedure that staples the stomach into a tube about the size of a banana. She has lost 135 pounds, 60 of which was before surgery.

It requires significant effort to stay on track, Schreder-Guhl said, but the results are worth it. “My high cholesterol is no longer an issue, and my blood pressure is good,” she said. “I feel a lot better and my self-confidence has skyrocketed. I’m a lot happier than I was.” Schreder-Guhl is one of hundreds of people who elect to have bariatric surgery in Lancaster County each year. In addition to Lancaster General Health, physicians at WellSpan Ephrata Community Hospital and Heart of Lancaster Regional Medical Center also perform the surgeries. The three most popular types of bariatric surgery are: gastric bypass, adjustable banding, and sleeve gastrectomy. All of these surgeries can be done laparoscopically. »Gastric bypass – Performed since the 1960s, gastric bypass limits food intake and absorption of calories by decreasing the size of the stomach and allowing food to bypass part of the small intestine, where most of the calories are absorbed. »Adjustable banding – In this surgery, the stomach is divided by a gastric band, which

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reduces the size of the stomach and limits the amount of food that can be consumed at one time. The band can be adjusted, as needed. »Sleeve gastrectomy – The stomach is stapled into a tube or sleeve, limiting the ability to consume large quantities of food. The procedure also removes a part of the stomach that produces a hormone responsible for hunger, meaning that patients feel full for longer periods of time. In addition to these procedures, Lancaster General is looking to offer duodenal switch surgery, a complex procedure sometimes recommended for severely obese patients. Duodenal switch surgery has been proven to be even more effective than gastric bypass in weight loss and reversal of Type 2 diabetes. It comes with greater risks, however, said Dr. James Ku, a bariatric surgeon at Lancaster General. It is important that each patient is carefully evaluated prior to surgery to assess medical history, behavioral history, weight and diet history, and other factors, Ku explained. Also, patients should be informed about how particular surgeries work and what they entail. Continued on page 18

Healthy Communities

“A patient needs to fully understand and feel good about the type of surgery,” Ku said. “It’s very important to take that into account.” At the Bariatric and Metabolic Institute (BMI) of Lancaster, the weight management and bariatric surgery center operated by Heart of Lancaster/Lancaster Regional Medical Center, surgeons are starting to employ endoscopic suturing, a procedure aimed at patients who have undergone bariatric surgery but did not experience the expected results or have regained weight. “We’re starting to use that, and it looks like it’s going to be very useful,” said Dr. Justin Rosenberger, a bariatric surgeon with BMI. “The type of surgery we do depends on the choice of the patient and on morbidities which may lead to a particular procedure.” While it used to be that bariatric surgery was pretty much a stand-alone procedure, it now is part of a bundle of services offered by multi-disciplined teams of health care providers at area hospitals and medical centers. “We’ve been doing these surgeries for a long time, but there have been a lot of advances made,” Ku said. “Fifty years ago there weren’t really programs built around the surgeries. Now we realize that surgery is only one component of the big picture.” Typically, patients are encouraged to attend an informational session and undergo counseling before surgery. They may work with nutritionists, bariatric dieticians, clinical psychologists, exercise physiologists, registered nurses, and other health care providers before undergoing surgery. Extensive follow-up care also is recommended to assure the best chance for success, explained Dr. Jason Marone, a bariatric surgeon with WellSpan Health. “We know that patients who follow up and are accountable do much better,” Marone said. He strongly encourages his patients to schedule follow-up visits at two weeks after surgery, and again at six weeks, three months,

six months, 12 months, and 18 months. Yearly follow-up visits are then scheduled. It is Marone’s opinion that as bariatric surgery becomes increasingly accepted and common, it should not be considered only as a last resort. Surgery also can reverse Type 2 diabetes and has been determined to be the best treatment for morbid obesity, a very severe degree of the disorder. The surgery, however, is not on its own a cure-all. “There’s a lot of work involved on the part of the patient,” Marone said. “They need to really think about how they’re going to change the way they think about food and exercise.” Ku agreed, saying that while surgery is a powerful tool for weight loss, it needs to be supported by patient effort. “If you don’t do the work, the surgery can fail,” Ku said. While bariatric surgery may no longer be considered a last resort for weight loss, it is not for everyone. Dr. Minnie Taw is the medical director of WellSpan’s Medical Weight Management Center, with offices in Ephrata, York, and Gettysburg. In addition, WellSpan has a bariatric surgery office in Stevens. The center employs an evidence-based approach for treating overweight and obesity, which includes goal setting, meal planning, physical activity and behavioral modification strategies. Health care providers work with each patient individually to chart a course for medically supervised weight loss. “For medical weight loss there is no one-sizefits-all plan because every person is different,” Taw explained. “I don’t think I’ve ever had two patients who were just the same.”

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Taw works with adults and pediatric patients, addressing obesity as a long-term, chronic disease that must be managed to the best degree possible. Even a 5 to 7 percent weight loss can improve health and reduce morbidities. “If it’s not a realistic goal to get to an ideal BMI (body mass index), then we’ll work on getting to a best weight for that particular patient,” Taw said. Lancaster General Health also offers a medical weight management program that focuses on minimizing obesity-related health risks. Depending on need and physician recommendation, patients can choose one-on-one, ongoing consultation with a board-certified bariatric doctor, or opt to begin on an intensive, medically supervised low calorie or very low calorie diet. At BMI of Lancaster, a multidisciplinary team works with patients to establish programs that may include dietary counseling, exercise prescriptions, and meal replacement plans. For Schreder-Guhl, weight loss is an ongoing process, greatly aided by surgery, but up to her to maintain through healthy habits. It’s not easy, she said, but has been well worth the effort. “It’s (surgery) not right for everybody, but it’s the right step for some people, and it’s been a good tool for me,” she said. “I feel grateful to have gotten the care I did and have ongoing support. It’s a journey I’ll be on for the rest of my life.”

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Passion Outside of Practice

It’s our pleasure to highlight a Lancaster City & County Medical Society member’s “passion outside of practice” in each issue of Lancaster Physician. Beyond their commitment to health care, LCCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature Zachary Geidel, MD, and his passion outside of practice.

Zachary Geidel, MD

2. H ow did you develop an interest in your passion outside of practice?

I really enjoy trying different styles of craft beer. With the craft beer scene becoming more popular and different takes on traditional styles, I thought I could possibly try creating some on my own. My wife and I were about to have our first child, and she asked me what she could get me for my first Father’s Day. Jokingly, I said, “How about a home brew kit for beer?” Well, she ended up getting me that home brew kit, and I have been using it ever since.

3. H ow long have you been participating in this activity? 6 years.

Dr. Zachary Geidel works on the initial home brewing process, called the “mash.” He is steeping the grains and adding the hops to make what is called the “wort.” This is beer before the fermentation process.

4. Why is this pursuit special to you?

It is very rewarding to go through the whole creative process of brewing and have the end product come out to be something you have put a lot of thought and hard work into—and not to mention, it’s delicious and enjoyable. I have interacted with a lot of interesting people in the community that share this same passion, and it is fun to get new ideas and try different styles of beer.

Passion Outside of Practice: Home Brewing Craft Beer

1. W ould you briefly describe your passion outside of practice for those who might be unfamiliar with it?

One of my hobbies that I really enjoy taking part in is home brewing beer. I really enjoy the creativity, “science,” and intellect it takes to come up with a recipe and bring it to life. I typically try

to take traditional styles and put my own creative spin on them to come up with something not so conventional. Examples of this would be my chicory coffee stout, honey cream ale, rye saison infused with habanero peppers and Belgian wit with muscat grape juice.

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5. W hat else would you like readers to know about this?

So far I don’t think I have had a “bad batch.” Most of my friends would attest to that. They don’t have a problem taste testing for me. I have entered into some local competitions and took home a silver medal twice for my coffee stout from the Lancaster Iron Brewer contest, hosted by Iron Hill restaurant. I would encourage others who enjoy the craft beer scene and want to try their hand at creating their own to visit their local home brew store and start today.

As fellow clinicians—

what inspires you, inspires us. penn State Health’s MD Network serves as a resource to referring providers at any stage of the referral relationship.

For the families you serve Now, one call is all you need to get into the Milton S. Hershey Medical Center system via MD Network:

for more information, please visit the MD Network web page at PennStateHershey.org/mdnetwork.

1-800-233-4082

MD Network is reserved for clinicians and office support staff only.

(WaNt to CoNNeCt to pediatriC providerS? SiMply preSS ‘4’ for kidS to be CoNNeCted to peNN State CHildreN’S HoSpital.)

SRG-10481-16 062716

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Patient Advocacy

g n i t a Comb

E S U B A D I O A I I N P A V O IN PENNSYL PA M E D L AU N C H E S

“Opioids for Pain: Be Smart. Be Safe. Be Sure.” Initiative

THE PROBLEM:

T H E S O LU T I O N :

Opioid abuse, misuse, and overdoses are increasing, both in Pennsylvania and nationally. Opioid overdoses accounted for nearly 2,500 deaths in Pennsylvania in 2014—that’s nearly 7 people a day— and indications are that those numbers are climbing.

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.

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SUMMER 2016

Combating Opioid Abuse in Pennsylavania

PAMED recently launched its Opioids for Pain: Be Smart. Be Safe. Be Sure. initiative, which focuses on patient empowerment and physician education. This initiative consists of a five-step physician call to action and seven questions patients should ask when prescribed an opioid.

THE PHYSICIAN CALL TO ACTION

ALL PENNSYLVANIA PHYSICIANS SHOULD TAKE THESE FIVE STEPS:

NOW THE PRESCRIBING K GUIDELINES. They are available on PAMED’s website at www.pamedsoc.org/ OpioidResources. The first session in PAMED’s online CME series focuses on the guidelines. In this session, analyze your prescribing practices against statewide guidelines and identify when and why to prescribe opioid medications. Get the CME at www.pamedsoc.org/OpioidsCME. SE PENNSYLVANIA’S PRESCRIPTION U DRUG MONITORING PROGRAM (PDMP) ONCE IT’S UP AND RUNNING (it’s expected to be operational in August 2016). The fourth session in PAMED’s online CME series will address common physician questions regarding governance, user access, and provider and dispenser reporting requirements. Watch PAMED’s Daily Dose email for when this session is available.

EFER PATIENTS WHO HAVE R A SUBSTANCE USE DISORDER TO TREATMENT. Referral to treatment is covered in the third session in PAMED’s online CME series. This session addresses substance use disorders; explores screening and assessment tools; reviews intervention strategies; and assesses best practices in referrals to specialists, rehabilitation services, and community resources. Get the CME at www.pamedsoc.org/ OpioidsCME. DISCUSS ALTERNATIVES TO OPIOIDS WITH PATIENTS. SK PATIENTS TO KEEP THEIR PILLS A SAFE, AND PROPERLY DISPOSE OF A PRESCRIBED MEDICATION WHEN THEY NO LONGER NEED IT. A list of drug take-back locations is available at https://apps.ddap. pa.gov/GetHelpNow/PillDrop.aspx.

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Patient Empowerment PATIENTS SHOULD ASK THESE SEVEN QUESTIONS WHEN PRESCRIBED A PILL FOR PAIN: 1. Is this prescription an opioid? 2. At what level of pain should I take this prescription? 3. Do I have to take every pill in the prescription? 4. Where can I safely dispose of remaining pills? 5. What can I do to avoid addiction? 6. W hat are possible warning signs of dependence or addiction? 7. What can I do if I believe that I might have developed a dependence on this drug? Resources for physicians, patients, and lawmakers are available at www.pamedsoc.org/OpioidInfo.

continued on page 24

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Patient Advocacy

“We need to make sure that we – as physicians – are doing everything we can to stop this wave of abuse, and empowering our patients to do the same,” said PAMED Board Chair David Talenti, MD. “If physicians don’t suit up for the battle, who will?” he asks. “Education is a silver bullet.” In addition to the above-mentioned educational sessions, PAMED’s online CME series also has a session on naloxone. This session addresses the use of naloxone as an opioid antidote, reviews regulatory requirements for prescribing naloxone to third-party first responders, and assesses naloxone prescribing options. PAMED is collaborating with the Pennsylvania Department of Health and 11 other health care associations on this

educational series. “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. “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 medical illness. It is not a moral failing. We have to erase the stigma.” PAMED’s educational series seeks to address the many layers and complexities of this crisis. Learn more and get CME credit by visiting www.pamedsoc.org/OpioidsCME.

David J. Simons, DO, LCCMS Board President, addresses the media as part of a kick-off ceremony at the Capitol on May 17 to fight statewide opioid abuse.

Access additional resources such as prescribing guidelines in PAMED’s Opioid Abuse Resource Center at www.pamedsoc.org/ OpioidResources.

From stroke to spine care, the neurology services you need are right here. You don’t have to go far to find an experienced neurosurgeon. James Pacelli, M.D., is board-certified in neurology and completed a fellowship in Stroke and Neurological Critical Care at the Hospital of the University of Pennsylvania, Philadelphia. Dr. Pacelli has an extensive background in stroke and stroke telemedicine. He sees patients with a wide range of neurological issues, including dementia, stroke, migraine, epilepsy, Parkinson’s disease and traumatic brain injuries. Call 717-735-3918 to make a referral.

James Pacelli, M.D. Board-Certified in Neurology

Regional Neurology & Pain Management Associates Member of the Medical Staff of Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center. These hospitals are owned in part by physicians.

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WillowValleyCommunities.org | Lancaster, PA

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Patient Advocacy

MEDICATION ADHERENCE AND WHY WE NEED TO TAKE ACTION A Pharmacist’s Perspective ALEXIS STINSON PHARMD CANDIDATE, CLASS OF 2017

he lack of proper medication adherence is a major issue currently facing our health care system today. An estimated half of the 3.2 billion prescriptions that are dispensed annually in the U.S. are not taken as prescribed1. Chronic disease states are those that most often encounter nonadherence. The reasoning for this disconnect is somewhat simple. For acute conditions such as pain or infection, patients are able to see immediate benefit from their medications and are therefore typically more conscious of their medication regimen. For chronic diseases, such as hypertension or hypercholesterolemia, patients are not experiencing that same immediate symptomatic relief. Studies show that only 50-60% of medications for chronic conditions are taken as prescribed1, 2. Nonadherence greatly impacts health care dollars as well as long-term patient outcomes.3 When considering both direct and indirect costs, the estimated total for nonadherence ranges from $100 to $300 billion annually1. And an estimated 125,000 patients die every year because of nonadherence in the U.S.1 Obviously, overcoming this large burden is no easy feat, but as health care professionals, it is our responsibility to take steps to address this problem and to improve patient outcomes and control the mounting costs. The first step is to identify nonadherent patients and then identify areas for intervention. There are a variety of reasons why a patient may be not be complying with their medication regimen and also numerous ways to identify these patients and the challenges they face. Open-ended questions about a patient’s daily routine and how they are taking their medications are a good place to start: When do you take your medications during the day? Do you have any technique to remember to take your medications every day? Where do you keep your medications? How many times this week did you miss your medications? Gauging which patients are able to list and describe their daily medications versus those who are unsure of what they are taking can open an opportunity for education and intervention. Other considerations include a patient’s health

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SUMMER 2016

Memory Care Options in Lancaster County

literacy. There are numerous tools available to aid in health literacy assessments, including the Rapid Estimate of Adult Literacy in Medicine (REALM), the Test of Functional Health Literacy in Adults (TOHFLA), The Newest Vital Sign (NVA), and more. Also, we can leverage interprofessional relationships to help obtain a complete health care picture of the patient. Through collaboration and communication we can find out how often they are refilling their medications at their pharmacy, recognize literacy complications with paperwork or trouble following other instructions, and/or identify if the patient is limited financially in getting necessary treatment. The challenge is to include these types of assessments as a part of routine monitoring plans. For example, when seeing an anticoagulation patient, health care providers routinely ask how many times the patient missed their warfarin dose in order to truly read their INR and adjust therapy accordingly. And this type of assessment is

just as important in all other chronic disease states such as heart failure, diabetes, hypertension, and hypercholesterolemia in preventing serious events and hospitalizations. This problem of patient compliance with their prescribed regimens is multi-faceted and does not have an easy fix, but there are a number of strategies to consider in order to encourage adherence. Some of these methods include adjusting a patientâ&#x20AC;&#x2122;s regimen to lower medication costs or to switch the patients to less frequently dosed medications or combination pills to reduce their pill burden. Sometimes patients respond to counseling about the outcomes of the medication, importance of adherence, adherence strategies, and their disease states as a whole. This is truly an area where treatment is both a science and an art and where the health care team has to find the right balance to overcome the challenges leading to patient nonadherence.

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Medication nonadherence is a serious problem affecting patients, providers, and health care systems. In order to ultimately help patients, we must seek to incorporate medication adherence in routine patient assessments. By asking the right questions, using assessments tools, and tapping our interprofessional relationships to identify nonadherent patients, we can intervene to make changes that will benefit individual patients and the health care system as a whole. 1. Bosworth H, Granger B, Mendys P, et al. Medication adherence: A call for action. Am Heart J. 2011;162(3):412-424. 2. Brown M, and Bussell J. Medication adherence: WHO cares?. Mayo clin proc. 2011;86(4):304-314. 3. Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Dig Dis Sci. 2008; 53: 1020-1024.

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Legislative & Regulatory Updates

Pennsylvania Medical Society Quarterly Legislative Update

JUNE 2016

ollowing is an update on recent legislative activity that is of interest to the Society.

Opioid-related Legislation The number of bills that have been introduced this session to address the current epidemic of opioid abuse facing the state continues to grow. Recently, a number of those bills have received action. Senate Bill 1202, which passed the Senate unanimously on June 15, would require licensed prescribers and dispensers in Pennsylvania to complete two hours of continuing education in pain management or in the prescribing practices of opioids for licensure renewal. The education could be completed as a portion of the total continuing education required for biennial renewal, and it would not apply to physicians who do not possess a DEA registration number to prescribe controlled substances. House Bill 1805 is nearly identical to SB 1202, except that it requires the two hours of continuing education to be completed in pain management, identification of addiction, or in the prescribing practices of opioids. HB 1805 was approved by the House unanimously on June 23. The Pennsylvania Medical Society (PAMED) has expressed support for both bills. HB 1698 and HB 1699 were also approved by the House on June 23. HB 1698 would require health insurance plans to provide coverage for abuse-deterrent

opioids (ADOs) that are harder to crush, cut, dissolve or inject, and apply cost-sharing provisions for these products at the same level as cost-sharing applied to other brand and generic drugs covered under a plan’s formulary. PAMED supports this legislation. HB 1699 would impose limitations on the prescribing of opioids within emergency departments and urgent care centers in Pennsylvania. It would limit prescribing to a quantity sufficient to treat a patient for seven days and any practitioner who violates this provision will have committed unprofessional conduct and be subject to penalties. The Pennsylvania Chapter of the American College of Emergency Physicians (PAACEP) and PAMED originally opposed the bill. However, both PAACEP and PAMED took a neutral position after the bills was amended to allow for exceptions to the seven-day limit if, in the professional medical judgement of the health care professional, more than a seven-day supply of an opioid drug product is required to treat the patient’s condition and there is a notation in the patient’s medical record. Legislation will also be introduced in the near future that would require medical schools in Pennsylvania to implement mandatory Safe Opioid Prescribing Curriculum. State funding would be dependent on implementation of the curriculum, which would focus on four areas: pain management, multimodal treatments for chronic pain that minimize the use of opioids, identification of risk for addiction to opioids, and management of substance abuse disorders as a chronic disease. PAMED has not yet taken

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a position on the proposed legislation. On June 23, members of the House of Representatives held a press conference in the Capitol Rotunda to call on Gov. Tom Wolf to call a special session of the General Assembly to combat the opioid crisis. So far, there have been nearly three dozen bills introduced to address this issue. Gov. Wolf has also made it one of his own priorities to provide a $34 million appropriation to create 50 Centers for Excellence across the state to treat Medicaid recipients for opioid addiction. It is unclear whether the appropriation will be part of the final spending plan approved by the legislature in the coming weeks.

Telemedicine With a growing number of services being provided via telemedicine technologies, there is an obvious need for a set of safeguards and standards to support the appropriate coverage of and payment for telemedicine services in Pennsylvania. PAMED believes that patient safety and quality of care must be the guiding principles behind any use of telemedicine. For several months, PAMED has been working with other stakeholders to draft legislation addressing the use of telemedicine in Pennsylvania. Senator Elder Vogel (R-Beaver) is expected to soon introduce a bill in the Senate, and Rep. Marguerite Quinn (R-Bucks) has agreed to introduce a companion bill in the House of Representatives. The legislation will define what

SUMMER 2016

PA Medical Society Quarterly Legislative Updates

telemedicine is, offer guidelines outlining who can provide telemedicine services, and provide clarity around insurance company reimbursement for these services. In addition, legislation that would authorize Pennsylvania to join the Interstate Medical Licensure Compact passed the House of Representatives unanimously on June 15. At the time of this writing, HB 1619 awaits consideration by the Senate Consumer Protection and Professional Licensure Committee. The overarching purpose of the Interstate Medical Licensure Compact is to streamline the licensure process for physicians interested in becoming licensed in multiple states. HB 1619 is thus being promoted as a way to increase access to healthcare for individuals in underserved or rural areas and allow patients to more easily consult medical experts through the use of telemedicine technologies. PAMED has not taken a formal position on the legislation and Pennsylvania’s participation in the Compact.

CRNP Independent Practice The Senate Consumer Protection and Professional Licensure Committee approved SB 717 on May 18. The bill was amended by the Committee to require nurse practitioners (NPs) to have a minimum amount of post-licensure experience under a collaborative agreement with a physician before they may practice independently. While well-intentioned, PAMED believes the logic of this amendment was flawed. The stipulation on independence requires just three years and 3,600 hours of practice experience, while completely lacking meaningful details. There is no required curriculum for the completion of those hours/years, no assurance of the quality of mentors and oversight, and—unlike the three to seven years of heavily supervised residency training that a physician must complete—no accreditation or inspection of the “training” sites of NPs. Requiring a minimum number of years or hours of work experience in an unstructured

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setting with highly variable experiential learning does not replace the expertise and support that comes with physician oversight. PAMED continues to strongly oppose the legislation and encourages physicians to reach out to their legislators and urge opposition to the bill. PAMED strongly supports a physician-led, team-based approach to patient care, which emphasizes increased collaboration and integration among health care providers, rather than provider autonomy. With the complexity of our health care system ever increasing, patients need both physicians and nurse practitioners, coordinating care and sharing information for the benefit of the patients. The collaborative agreement serves to ensure that patients have direct access to a physician when their care requires a more highly trained professional. Eliminating this network of support would not only be contrary to proven concepts of team based medicine, but has the potential to jeopardize patient care.

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Medical Society Updates

BA We LANC Ca E B n D ILLI o B NG: ett er

s is often the case, it takes a New York Times article for a health care issue to enter the public consciousness. On 9/2/14, an eye-catching headline of “After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know” told the unfortunate story of Peter Drier, a 37-year-old bank technology manager who needed a neck surgery1. He went to an orthopedic surgeon in his health insurance network and had an operation at a hospital that accepts his insurance. However, his surgeon needed the assistance of a neurosurgeon on the case, a physician Mr. Drier

HEATH B. MACKLEY MD, FACRO

had not met previously. This physician was not in his network, so the “full bill,” not a negotiated fee, was charged to him. This was 19 times the fee his orthopedic surgeon, the primary surgeon, received for his part of the procedure. Not surprisingly, this was given the pejorative “drive-by doctoring,” likening it to highway robbery. This is clearly not fair to the patient. But what do we do to stop this from happening? The article further describes some hospitals and physicians in a very negative light, suggesting that they are deliberately seeking

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out these opportunities to “stick it” to unsuspecting patients. Somewhat surprisingly, the article portrayed the insurance companies as the defenders of the patients’ interests, often paying the exorbitant fee on behalf of the patients even though they don’t have to. As would be expected, the author proposes a solution: a New York state law, which went into effect in 2015. It absolves patients of personal responsibility for unforeseen outof-network charges beyond what they would have paid in-network, and it directs insurers and providers to negotiate directly or enter mediation. This sounds reasonable, until the

SUMMER 2016

Balance Billing: We Can Do Better

unintended consequences are fully realized. How do insurance companies arrange for contracts with physicians and hospitals? It involves a balance of competing interests. The insurance companies want to drive down fees so they can charge smaller premiums than their competitors and still make a profit. The providers also want to collect fees that give them a reasonable profit for the services provided. Providers can decide that a fee schedule is too low to be profitable, and decline participation with an insurance company. This makes the insurance company’s product less desirable as fewer physicians participate. But it also means there is a population of insured patients that will not likely go to that provider, thereby hurting that practice’s market share. On a fair playing field, this balance of interests will encourage providers and insurers to innovate and become more efficient, keeping costs at a minimum for patients and providing a fair profit for all parties involved. What if, as the insurance companies would prefer, physicians are forced to accept the in-network reimbursement even if they are out-of-network? How will physicians be able to negotiate with insurance companies then? What if, as the hospitals would prefer, physicians must accept the insurance policies that the hospitals accept in order to be on their medical staffs? This would incentivize hospitals to negotiate contracts with insurance companies that are good for the hospitals at the expense of the physicians. Is that good for the system as a whole? Finally, physicians of all specialties, unlike insurance company

managers and hospital administrators, stand on the front lines, seeing patients at all hours of the night and on weekends and holidays. They do not always check a patient’s insurance status before they engage in the medical care that the patient needs. Don’t those physicians deserve some bargaining power, to be able to negotiate their own fee schedules and to choose which insurance policies to participate in? These are thorny issues, to be sure, but that is why we need PAMED, with an engaged membership, to be active in any state-level discussion about insurance legislation or regulation. Additionally, the elephant in the room here is the inadequacy of “narrow networks.” The fundamental reason for surprise billing is there aren’t enough in-network physicians to provide the care patients need. Patients want to pay lower insurance premiums, and insurance companies want to charge them lower premiums. But if this low-cost premium exists because only a few physicians will accept the low fee schedule the plan offers, then the patient will end up paying for a plan for which they can’t find an in-network physician. They are then essentially forced into seeing out-of-network physicians, and the insurance company either doesn’t have to pay for anything, or only has to pay for the balance beyond a very high deductible. How can that be called “health coverage” at all? A Robert Wood Johnson Foundation and University of Pennsylvania analysis suggests that 41% of health networks are narrow, only including 25% or less of the office-based physicians practicing in the area2.

Designing Long Term Care Insurance Plans for Individuals and Small Groups.

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The AMA has created a thoughtful national model policy addressing this issue, calling for state regulators to enforce network adequacy requirements3. Insurance plans should be required to report quarterly on network adequacy measures to ensure compliance is maintained. Patients need financial protections when seeking necessary out-of-network care. Finally, the public needs full disclosure on the criteria of how health plans choose which physicians participate in their networks. Recently on the state level, PAMED has been communicating with Insurance Commissioner Teresa Miller, expressing our concern about access to care and the out-ofpocket costs consumers face. This is one of countless ways that PAMED is important to physicians and patients alike. So stay involved! This issue isn’t going to be resolved fairly without our active involvement. Dr. Mackley, a Radiation Oncologist at the Penn State Cancer Institute, is the 5th District Trustee of the Pennsylvania Medical Society representing physicians of this county.

Works Cited 1 http://www.nytimes.com/2014/09/21/us/ drive-by-doctoring-surprise-medical-bills.html?_r=0 2. http://www.rwjf.org/content/dam/farm/ reports/issue_briefs/2015/rwjf421027 3. http://www.ama-assn.org/ama/pub/news/ news/2014/2014-11-10-ama-policy-protect-patient-choice-access-care.page

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Restaurant Review

The

reviewed by CHRISTOPHER WENGER, DO, FACC The Heart Group of Lancaster General Health

Waterfront

& CASSANDRA WENGER

ollowing a work-marathon of 19 consecutive days, my wife and I were primed to embrace a dinner date set at a relaxed, yet secluded, restaurant where we had never dined before. This is why we chose The Waterfront. The Waterfront restaurant is actually a transformed mill house that dates back a century, shuffling through many identities over the years such as Water’s Edge, The Paddock, The East of Eden, and most recently The Cove. The restaurant is located just outside historic Lancaster, PA and sits along the seemingly timeless Conestoga River. Year round, the restaurant offers indoor seating, complete with a fireplace, full bar, and wall-mounted TV area. The summer months permit outside patio seating and a smaller service bar.

Upon entering the establishment, it was quite apparent that the sunny, 72-degree weather on this Friday evening drew the locals to the outside patio seating. The interior was somber and practically empty, aside from an employee behind closed kitchen doors shouting, “I need more food runners, now!” Maneuvering through the relatively dim and lifeless indoor dining area felt awkward and unwelcoming, as if we arrived hours too early to a surprise birthday party for someone we hardly knew. Thankfully, our initial skepticism dissipated upon seeing the sunny skies that loomed above a Conestoga River backdrop whilst walking down a short corridor to the outside patio dining area. My wife and I were promptly greeted by a courteous waiter who escorted us past many centralized outdoor tables and seated us at one

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of the twelve available spots along the river. The view was exhilarating with the early evening sun casting an orange hue atop the myriad of trees that are nestled along the riverbanks. The chirping birds and ambient conversation respectfully bowed to the soothing sounds of the running river water while we reviewed the restaurant’s offerings. The menu highlights The Waterfront’s use of local ingredients as well as organic and locally sourced produce. The food is moderately priced and features relatively short appetizer and raw bar lists, which carry a familiar theme of seafood, including jumbo shrimp, clams, oysters, and calamari. The entrees are split between small plates and large plates, the latter of which include bread and a house salad. We began our dining experience with the Waterfront Crab

SUMMER 2016

Restaurant Review

Dip, which is composed of a spicy blend of cheeses and crabmeat baked in ciabatta bread. While the spice kept the dish flavorful, the presentation of the appetizer and the overall taste were quite uninspiring, making the dip the low-point of our dining experience. Thankfully, the mojito I ordered was mixed well and the sour-sweetness cleansed my palate for the entrée, Seared Scottish Salmon with wild rice and sautéed spaghetti squash. The salmon was delicious and well paired with the side dishes, delivering what I would expect from a $24 salmon entrée. My wife, while pregnant, did not partake in alcohol, but commented that the drink menu was rather robust and rivaled the selection of food options. She ordered the Seared Jumbo Scallops with fingerling potatoes and asparagus. She felt that the scallops were slightly undercooked, but enjoyable and paired well with the local vegetables. After consuming the well-presented and delicious entrees, we quickly forgot about the

appetizer and began considering dessert. We were both quite full by this point, but we felt that ordering dessert would be necessary—for the review, of course! We were glad we did as the advertisement of “world class desserts” lived up to its name and became the highlight of the meal. We shared two desserts. My wife had the Lemongrass Crème Brulee which she enjoyed but felt it to have a slightly undercooked shell with a fairly bland underlying custard. I was crowned the winner of the best dessert decision on this dinner date for my selection of the Blueberry Cheesecake. The cheesecake contained a decorative blueberry swirl, blanketed in a generous rim of golden-brown graham cracker crust that was crisp, but not overdone, and topped with a well-placed dollop of whipped cream and blueberries. After the first bite of the cheesecake, my wife and I forgot how full we were and finished the dessert without care given to our gluttony.

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Ultimately, The Waterfront is a restaurant where you come for the scenic ambiance first and the food second. The seasonal outdoor seating is a must, and it’s what separates this restaurant from many other moderately priced restaurants in the local area. I recommend a reservation with a special request (the restaurant will honor it) to be seated along the riverside for the best view—especially if you desire the feel of dining somewhere outside of Lancaster. The food seemed to escalate in quality, starting with a pub fare-like appetizer but finishing with gustatory greatness among the dessert selection.

The Waterfront 680 Millcross Road Lancaster, PA 17601 717-390-8777

www.thewaterfrontlancaster.com.

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SUMMER 2016

News & Announcements

Introducing New LCCMS Executive Director

Beth Gerber

was founded in 1844 (making it one of the oldest in the state) and we have a long history of physicians working together to support the profession, advocate for issues to assure that the physician and patient communities are protected, and advance information and resource sharing—leading to professional development and innovation.

What are the main challenges facing the organization?

n January 19, Lancaster City & County Medical Society welcomed Beth Gerber as our new Executive Director. With extensive experience in member relations, communications, and marketing, she brings valuable skills and expertise to help our organization better serve our members. In this Q&A, Beth shares her experience with LCCMS thus far and what she hopes to accomplish in the future.

What drew you to the opportunity to work at the Lancaster County & City Medical Society?

There were a few things. I’ve always been drawn to non-profit roles as a way to support the community in which I live and to help others. Specifically, I grew up with a father who worked in supportive roles in the health care field (both in mental health systems and continuing care retirement) and I saw firsthand what a significant difference health care professionals make, not only in individual lives, but collectively in the overall health of a community. I was familiar with LCCMS, but did not really have an appreciation for who they were or what they did. That said, I think another driver was the opportunity that exists to share the mission and increase the role and reach of the organization.

In what ways do you hope your professional skills and experience will serve the organization? How do you believe they’ve contributed thus far?

In my most recent experience, I was responsible for developing and implementing member recruitment and retention strategies, which afforded me the opportunity to get out and talk with members and prospects to learn about their businesses, understand their pain points, learn where they needed guidance or could use assistance, and discover who they wanted to partner or collaborate with for success. While that was businesses and this is physicians, I think much of my role is the same. I am interested in hearing from Lancaster County physicians, members, and prospective members to learn how we can best serve them. How can we position the organization to assist with navigating the challenges they are facing? How do we help identify opportunities for efficiencies and information sharing—whether that be the latest regulation or pending legislation? How can we help acclimate early career physicians to keep them in Lancaster County, practicing and serving our community? Physicians face a multitude of complex issues daily, and I’d like to ensure that we are supporting them in a way that promotes and protects the practice of medicine.

Based on your observations and experience in working at LCCMS for the past several months, what strengths do you see in the organization?

We are very fortunate to have an active and engaged medical community, as well as a very committed group of volunteers. The Lancaster City & County Medical Society

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Like most membership organizations, I think we are challenged to attract new members and get their attention long enough to share the valuable resources we have to improve the work of physicians throughout our community. People are stretched in so many directions these days, and I recognize that time and resources are limited. But I do feel that as we are able to raise the profile of the organization, physicians will have a better understanding of the role we play and how an investment in LCCMS will positively affect not only their daily operations, but also the profession overall.

What issues/initiatives will be your primary focus in your first year as Executive Director?

We certainly want to grow membership. The more support we have, the stronger we are and the better we are positioned to represent the broadest physician community. I want to focus on elevating the organization’s profile and increasing awareness throughout the county. With increased support and investment, we can be a louder voice in promoting policies and processes that make sense for area physicians and patients.

What do you find most fulfilling about working at Lancaster County & City Medical Society?

I appreciate the opportunity to work directly with and for the physicians. Much of what we do as an organization—advocating for health-related issues, sharing information and resources, and providing training opportunities—allows them more time to focus on their patients, their practice, and broader community health issues—the things that matter most.

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

Frontline Group Spotlight

WellSpan Family Medicine – Trout Run

PHOTO CREDIT: STEPHEN MOYER/STEPHEN MOYER PHOTOGRAPHY

Left to Right: Drs. Irwin, Fannin, Degenhard

ellSpan Family Medicine – Trout Run is a “onestop shop” for family care in Ephrata, working as a partner with its patients to help them get healthy and stay healthy. All three of its physicians—Joseph Irwin, M.D.; Joseph Degenhard, M.D.; and Mandy Fannin, M.D.—care for patients across life’s spectrum. The physicians provide prenatal care for mothers, deliver their babies at WellSpan Ephrata Community Hospital, and care for their newborns there. They care for children and adults of all ages. Also, Degenhard is one of two WellSpan physicians in Lancaster County to offer acupuncture, as a Diplomate of the American Board of Integrative and Holistic Medicine.

The practice is working toward becoming certified as a Patient Centered Medical Home, a model of care where providers and staff know their patients, expertly treat their health issues, and counsel them on wellness issues such as nutrition and exercise. The staff has formed strong relationships with its patients and is engaged as a partner in their care, coordinating all of their health-related needs and working together to set goals. Preventive and ongoing regular care that is provided through a Patient Centered Medical Home has been shown to improve health care and reduce costs by reducing visits to the emergency room and inpatient stays in the hospital. WellSpan Family Medicine – Trout Run also offers the services of a health coach. That licensed practical nurse works closely with patients who have health issues such

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PHYSICIAN

as diabetes and high blood pressure, educating them and making sure they are being properly monitored and seeing a physician at appropriate times. To further ensure patients have the best experience, Trout Run has a Patient Partner. This is a patient who attends meetings of the practice’s quality improvement team and works to improve the practice from a patient’s perspective. WellSpan – Trout Run has a staff of 10 at its office at 808 Pleasant View Drive, Ephrata. The busy practice is in the midst of recruiting a fourth physician, who also will provide primary care for newborns through adults, including prenatal care and obstetrics.

News & Announcements

Community Events

LANCASTER CITY & COUNTY MEDICAL SOCIETY 2016 ANNUAL DINNER & BUSINESS MEETING

PHOTO CREDIT: MORRIS MILLER

FROM LEFT TO RIGHT: 1. Congratulations to Charles ‘Tony’ Castle, MD, Distinguished Service Award winner. Pictured L to R, James Kelly, MD; Dr. Tony Castle; and David Simons, DO. 2. 2016/2018 LCCMS Board President David Simons, DO, addresses the Annual Dinner attendees. 3. Congratulations to Paul Casale, MD, Distinguished Service Award winner. Pictured L to R, James Kelly, MD; Dr. Alexandra Gibas (accepting on her husband’s behalf); and David Simons, DO.

early 100 members of the medical community gathered at Lancaster Country Club on June 14th for Lancaster City & County Medical Society’s 172nd Annual Dinner & Business Meeting. The evening served as an opportunity to celebrate the contributions of Lancaster-area physicians and those impacting the health of our community. The event also included the installation of new officers and directors for the local society and provided a sneak peak at the Pennsylvania Department of Health’s new, statewide Prescription Drug Monitoring Program.

marked by their graduation from medical school, in the practice of medicine.

Dr. James Kelly, a family practice physician from LGHP - Lincoln Family Medicine and outgoing LCCMS Board President, shared highlights of his two-year term and spoke about the strong future of the organization.

This year’s recipients were selected for their contributions to the Water Street Mission Makeover, coming together to address a significant need in our community—one that affects the health and well-being of so many.

Several awards and honors were presented as part of the evening’s festivities.

The Water Street Mission kitchen and dining hall has been serving three meals a day 365 days a year for over 27 years. Although small upgrades and improvements had occurred over the years, it was in need of some major help. The list of issues was long:

LCCMS members V. Ward Barr, MD, FACS, and James A. Wilson, MD, were acknowledged for their 50 years of service,

The Benjamin Rush Award was presented to Clark Food Service Equipment/Clark Associates, Warfel Construction, Haller Enterprises, Rodgers and Associates, Marlin & Doris Thomas/Willow Valley, and the E.E. Murry Family Foundation. Named for Dr. Benjamin Rush, a native of Pennsylvania and a prominent physician in the 1700s, the award is given each year to businesses, organizations, or individuals (non-physician) who have made outstanding contributions to the health and welfare of the people of Lancaster County.

aging equipment, functional inefficiencies, poor layout of work space, electrical and plumbing systems outdated, and much more; all leading to waste of time, and food, and creating a difficult environment to provide the safe and healthy meals their guests needed. The cost to renovate the kitchen alone would have been prohibitive for Water Street; the idea of enlarging the project to encompass a new community building dining hall experience was merely a dream. And the prospect of shutting down current operations for six weeks to do the work made the task seem truly impossible. The final Makeover encompassed a complete renovation and upgrade of the kitchen, dining hall, lobby and restrooms. In total, more than 5,700 square feet of floor space was torn down and rebuilt in less than seven days. This was truly a community wide effort, but the six partners being honored at the annual dinner each played a critical role in making the Makeover a success. The honorees of 2016 Distinguished Service Award, presented to a member or members of Lancaster City & County Medical Society continued on page 38

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

Community Events

2016/2017 LCCMS Board of Directors: Officers: PRESIDENT

David J. Simons, DO, Community Anesthesia Associates

IMMEDIATE PAST PRESIDENT James M. Kelly, MD LGHP Lincoln Family Medicine

PRESIDENT ELECT

Robert K. Aichele Jr., DO, Aichele & Frey Family Practice

VICE PRESIDENT

Laura H. Fisher, MD, Lancaster Family Allergy

SECRETARY

Stacey S. Denlinger, DO, Baron Family Practice PHOTO CREDIT: MORRIS MILLER

FROM LEFT TO RIGHT: 1. Dr. James Kelly, outgoing President, LCCMS Board, shares remarks about his leadership term, organization accomplishments and future goals of the Society. 2. Congratulations to Haller Enterprises, Benjamin Rush Award honoree. Pictured L to R, James Kelly, MD, Immediate Past President, LCCMS Board; Kevin Weaver, Vice President of Operations; and David Simons, DO, Board President, LCCMS. 3. Congratulations to Warfel Construction, Benjamin Rush Award honoree. Pictured L to R, James Kelly, MD; Don Banzhof, Vice President; and David Simons, DO. 4. Keynote Speaker Meghna H. Patel, MHA, director of the PDMP Office, PA Department of Health, provides a sneak peak of the soon to be released PMP AWARxE System.

for outstanding service to the community and to the medical profession, were Dr. Paul Casale and Dr. Charles (Tony) Castle. Dr. Casale graduated from Tufts University and received his medical degree at Weill Cornell Medical College. He completed his internal medicine residency at New York â&#x20AC;&#x201C; Presbyterian/Weill Cornell Medical Center (then New York Hospital-Cornell University Medical Center) and his fellowship in cardiology at Massachusetts General Hospital and Harvard Medical School. He completed a Master of Public Health at Harvard T.H. Chan School of Public Health. Dr. Casale is a clinical professor of medicine at Temple University School of Medicine and has authored or co-authored more than 100 published papers, articles and book chapters.

While Dr. Casale has recently left the Lancaster community to become the Executive Director of New York Quality Care, the Accountable Care Organization (ACO) of New York Presbyterian, Columbia and Weil Cornell Medicine, he most recently served as chief of the Division of Cardiology and medical director of quality at Lancaster General Health/ Penn Medicine and had served the Lancaster community since 1993. A member of LCCMS since 1993, Paul served as the Board President from 2012 - 2014 and contributed much time, energy, and leadership to the organization. He was involved in the Lancaster County community as a member of the board of Lancaster Heart & Stroke Foundation and a mission committee member for Lancaster Heart & Vascular institute.

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TREASURER

Stephen T. Olin, MD, Retired Physician/Consultant

Directors:

Sarah E. Eiser, MD, Lancaster Physicians for Women Robert A. Garvin, DO, Anesthesia & Pain Associates of Northern Lancaster County John A. King, MD, General Internal Medicine of Lancaster Rebecca M. Shepherd, MD, LGHP Arthritis & Rheumatology Specialists Kristy Whitman, MD, LGHPFamily & Maternity Medicine

Resident Representative positions: Robin M. Hicks, DO; Emily Miller, MD; and Caitlin White, MD

International Medical Graduate Representative

Venkatchalam Mangeshkumar, MD, Neurology & Stroke Associates

Business Group on Health Representative

Lora S. Regan, MD, Lancaster General Occupational Medicine;

PAMED Liaison

Karen A. Rizzo, MD, FACS, Lancaster Ear Nose and Throat

SUMMER 2016

Dr. Castle graduated from Amherst College and received his medical degree at University of Virginia School of Medicine. He completed his OBGYN residency at Naval Regional Medical Center in Portsmouth, VA and is a retired Captain of the Medical Corps, US Navy Reserves. Dr. Castle currently serves as Assistant Secretary for District III for the American College of Obstetrics and Gynecologists and is a National Board of Medical Examiners Diplomate. Board certified in Obstetrics and Gynecology, Dr. Castle is on staff at Lancaster General Health/Penn Medicine in the department of OBGYN and also at Drs. May-Grant Associates. A member of LCCMS since 1980, Dr. Castle served the board as the liaison to the Business Group on Health, an affiliate of The Lancaster Chamber, from 2009-2015 and has been very active in LCCMS activities and initiatives, including Docs on Call, an annual public service event held in conjunction with WGAL. He is also very involved in the Lancaster County community, serving on the boards of the Heritage Center of Lancaster County and the Fulton Theatre, and as a vestry member and senior warden at St. Edward’s Episcopal Church.

The evening’s presentations also included an update on the legislative and advocacy related work of PAMED, shared by Dr. David Talenti, a Gastroenterologist practicing in Honesdale, Pennsylvania, and Chair of the Board of Trustees for the Pennsylvania Medical Society. The keynote address, offered by Meghna Patel, MHA and Director of the Prescription Drug Monitoring Program for the Pennsylvania Department of Health, provided an overview of the opioid crisis in Pennsylvania and illustrated the impact that the new database will have on physician practices, including integration with electronic health records (EHR), assignment of delegate responsibilities and query access, and, for patients who may be struggling from the disease of addiction, a connection with treatment services. Patel has been appointed as the first director of the Pennsylvania PDMP Office. In her role, she will ensure that the PDMP meets its goal of assisting health care professionals in identifying patients who would benefit from treatment. Patel will be responsible for developing and launching the PDMP online database that allows prescribers and dispensers of controlled substances to monitor their patients obtaining opioids—giving them access to information about where the prescriptions are being obtained from, and how often they are prescribed.

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Physicians’ HEALTH Program The Foundation of the Pennsylvania Medical Society

30 Years of Change – Transforming Lives

“ONE IN TEN

people suffer from addiction. At any time, there could be as many as 3,000 doctors in the state whom we could be helping.” Raymond Truex Jr., MD, FAANS, FACS

“Physicians, like the rest of the population, are vulnerable to chemical dependency, physical disability or breakdowns in mental health. Your support of the 30 Years of Change Campaign will make sure the Physicians’ Health Program will always be available to our fellow health care providers.” Raymond Truex Jr., MD, FAANS, FACS, Honorary Chair of 2016 PHP 30 Years of Change Campaign

•

WHY SHOULD I SUPPORT THE PHP?

For 30 years the PHP has provided confidential support, monitoring and advocacy to those who may be struggling with addiction or physical or mental challenge. • The PHP relies on contributions from physicians, hospitals and others so that the cost to the participant can be kept as low as possible during challenging times. • Your gift TODAY is an investment in an established endowment ensuring that the PHP will have funding support in perpetuity. • Your gift provides a transformational opportunity for your fellow health care providers who deserve a chance to live life in recovery and good health.

HOW CAN I HELP? PHP is a program of The Foundation of the Pennsylvania Medical Society – the charitable arm of PAMED. The program assists all physicians, physician assistants, medical students, dentists, dental hygienists, and expanded function dental assistants.

Please consider a gift to the PHP in honor of this anniversary to ensure that physicians will always have a place to go to when help is needed. Let’s make the most of it! In celebration of this milestone, the campaign has received a $30,000 challenge grant from an anonymous physician – by making your gift TODAY you will help us to take full advantage of this generous matching fund opportunity! Go to www.foundationpamedsoc.org to see true stories of transformation and recovery.

Contact the PHP at (717) 558-7819 or php-foundation@pamedsoc.org.

If you want to learn more about how to make a contribution to the PHP Endowment, visit www.foundationpamedsoc.org. You can also contact Director of Philanthropy Margie Lamberson, CFRE, at mlamberson@pamedsoc.org or 717-558-7846.

The official registration and financial information of the Foundation may be obtained from the Pennsylvania Department of State, Bureau of Charitable Organizations, by calling toll-free within Pennsylvania, (800) 732-0999. Registration does not imply endorsement.

777 East Park Drive • Harrisburg, PA 17105-8820

SUMMER 2016

FRONTLINE GROUPS | SUMMER 2016 The Lancaster City & County Medical Society thanks these groups for 100% membership in the Medical Society.

Allergy & Asthma Center

Lancaster Physicians For Women

Patient First - Lancaster

Cardiac Consultants PC

Lancaster Radiology Associates Ltd

Pediatrix @ Heart of Lancaster

Community Anesthesia Associates

LGHP – Lincoln Family Medicine

Red Rose Cardiology

Community Services Group Dermatology Associates of Lancaster Ltd

LGHP – Manheim Family Medicine

Southeast Lancaster Health Services Inc

LGHP – New Holland Family Medicine

Southeast Lancaster Health Services-Arch St

LGHP – Susquehanna Family Medicine

Southeast Lancaster Health Services-Hershey Ave

Eye Associates of Lancaster Ltd The Heart Group of Lancaster General Health Hypertension and Kidney Specialists Lancaster Cancer Center Ltd Lancaster Neuroscience and Spine Assoc

Manning & Rommel Associates

Surgical Specialists Of Lancaster

OBGYN of Lancaster

Wellspan Family Medicine Trout Run

Otolaryngology Physicians Of Lancaster

LCCMS Foundation Updates

SAVE THE DATE!

12.10.16 | HOLIDAY SOCIAL & FOUNDATION BENEFIT Lancaster Country Club, doors open at 6:30 p.m.

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News & Announcements

Welcome…New Members Marie Anderson, Administrator Otolaryngology Physicians of Lancaster Leigh Ann DeShong, MD Monroe Community Hospital Robert A. Garvin, DO Anesthesia & Pain Associates of Northern Lancaster County Mary Alex Kadysh, MD Strasburg Family Medicine

Kermit L. Summers, MD Dr. Kermit L. Summers, age 81 of Gap, PA, passed away at Willow Valley on Tuesday, June 14, 2016. He was born in Gap, son of the late George P. and Ruth Mast Summers. He was the husband of the late Jerilyn L. Armentrout Summers. Dr. Summers was a member of Bellevue Presbyterian Church of Gap, where he served as an Elder, an organist and in the choir. He was a graduate of Coatesville Area High School and attended Franklin and Marshall College for 4 years. He then went on to graduate from medical school at the University of Pennsylvania. He retired from the Lancaster General Hospital where he worked as a Emergency Room Physician. He enjoyed classical music, playing the organ and piano, playing on his computer, and spending time with family.

Clifford T. Lomboy, MD Regional Gastroenterology Associates of Lancaster Richard Allison Pollock, MD ENT Head & Neck Surgery of Lancaster Keith Radecic, Administrator Lancaster Radiology Associates Ltd

Richard S. Wagner, MD Richard S. Wagner, Jr., M.D., of Lancaster, PA and Naples, FL, age 88, died on Sunday, May 22, 2016 at Lancaster General Hospital. He joins his wife of nearly 60 years, Sarah Hooker Wagner, who died May 7, 2013. He met Sarah, the love of his life, as an intern at the Lancaster General, where he established his career.

Jonathan Thomas Kinley, DO Resident Heart of Lancaster Regional Medical Center

Dick was a graduate of Franklin & Marshall College. He earned his Doctor of Medicine degree at Temple University, School of Medicine and post graduate degree of Master of Science in Anesthesiology. He continued at Temple University Hospital for his internship, residency and fellowship in Anesthesiology. During his fellowship, he was privileged to study with Chevalier Jackson at the Chevalier Jackson Clinic in bronchoesophagology, where he completed post graduate courses. He was an instructor at Temple University Hospital, Department of Anesthesiology prior to serving in the United States Navy. While in the Navy, Dick was stationed at the United States Naval Hospital in the National Naval Medical Center, Bethesda, MD where he was on the medical teaching staff and Assistant Chief of the Department of Anesthesiology. He held the rank of Lieutenant Commander when he resigned.

Congratulations...Reinstated Members Philip M. Bayliss, MD LGHP-Family and Maternity Perinatology

James Patrick Pacelli, MD Regional Neurology & Pain Management Associates

Saba Faiz, MD Pennsylvania Institute of Endocrinology LLC

Emily M. Pressley, DO LGHP-Behavioral Health Specialists

Ketan G. Kulkarni, MD Regional Gastroenterology Associates of Lancaster Peter B. Murdock, Administrator Campus Eye Center Randall Alan Oyer, MD LGHP-Hematology and Medical Oncology

Matthew A. Sauder, MD LGHP-Diabetes & Endocrinology Specialists Chris G. Theodoran, DO Lancaster Urology

He established his private practice in anesthesiology in 1957 as a solo practitioner, which evolved into Anesthesia Associates of Lancaster, Ltd. He was chairman of the Department of Anesthesiology at the Lancaster General Hospital, and earlier in his practice, was a member of the courtesy staff of the St. Joseph's Hospital and a consultant at the Good Samaritan Hospital in Lebanon. He was on the honorary medical staff of the Lancaster General Hospital since he retired in 1992 from the active medical staff in the practice of anesthesiology.

Charles A. Wagner, DO Patient First

During his membership in the Medical Staff of the Lancaster General Hospital, he was chairman of the Department of Anesthesiology, a member of the Executive Committee of the medical staff, and Chairman of the Impaired Physicians Committee, which he was asked to establish. He was Chairman of the Intern and Resident Committee and in 1964 helped establish a Director of Medical Education and Department of Medical Education for the medical staff. He also served on the Bylaws Committee, Credentials Committee, Transfusion Committee, Operating Room Committee and others. He authored many articles and papers in his field, plus was a Diplomat of the American Board of Anesthesiology and a fellow of the American College of Anesthesiology.

In Remembrance...Deceased Members Thomas J. Stuart, MD Thomas J. Stuart, MD, 89, of Clearfield, passed away unexpectedly on Thursday, June 4, 2015 at his residence. Born December 26, 1925, in Newark, NJ, he was a son of William and Julia Stuart. He attended St. Benedict’s Prep, Newark, NJ and at age 16, graduated first in his class. He went on to Seton Hall University before he joined the U S Navy, where he attained the rank of Petty Officer Third Class. He was a veteran of World War II. After his service he completed his BA at St. Peter’s College, Jersey City, NJ and earned his masters degree and medical degree at Georgetown University. He completed a neurology residency at the VA Hospital in Richmond, Virginia and served two years at Walter Reed Medical Center, Washington, D.C.

Dick's professional memberships included the Lancaster City and County, Pennsylvania and American Medical Associations and the Pennsylvania and American Societies of Anesthesiologists, as well as the International Anesthesia Research Society, the Society of Cardiothoracic Anesthesiologists and the American Society of Regional Anesthesia.

Dr. Stuart began his neurology practice in Lancaster in September 1961 and was on the staff of Lancaster General Hospital and St. Joseph Hospital. He held leadership posts at Lancaster General that spanned more than 30 years. He was Chief of Neurology from 1968 to 1994, served as vice-president of the medical and dental staff from 1979 to 1981, and president from 1982 to 1984.

LANCASTER

A member of the Board of the Pennsylvania Society of Anesthesiologists, Dick also was chairman of the Committee on Insurance and Legislation, and served as a Delegate from Pennsylvania to the House of Delegates of the American Society of Anesthesiologists.

PHYSICIAN

Cancer expertise, right here in Lititz. There’s just something comforting about staying close to home that makes a difference when one of your patients is fighting cancer. So it’s good to know that treatment is available nearby in Lititz. Board-certified in internal medicine and oncology, Naeem Latif, M.D., brings 19 years of experience to the fight against cancer and blood disease. As an oncologist, Dr. Latif designs personalized treatment plans that integrate patient care plans prescribed by primary care and other physicians. Naeem Latif, M.D.

Specialized Training

Conveniently located across from the Heart of Lancaster Regional Medical Center.

Bone Marrow Transplantation Rotation Mayo Clinic, Jacksonville, Florida Fellowship Medical Oncology University of Florida, Jacksonville, Florida Research Fellowship Tumor Vaccine Program Albert Einstein College of Medicine, NY Clinical Observership Hematology/Oncology Montefiore Medical Center, Albert Einstein College of Medicine, NY

Board-Certified in Internal Medicine and Oncology

For a referral, call 717-625-5850.

1575 Highlands Drive, Suite 205, Lititz Member of the Medical Staff of Heart of Lancaster Regional Medical Center and Lancaster Regional Medical Center. These hospitals are owned in part by physicians.

Better breathing for patients with COPD and emphysema.

Chinenye Emuwa, M.D. Board-Certified in Pulmonary, Critical Care and Internal Medicine

If you have a patient suffering from a chronic lung condition such as COPD or emphysema, Chinenye Emuwa, M.D., is here to help. Dr. Emuwa is certified by the American Board of Internal Medicine and completed a fellowship in Pulmonary Critical Care at Rutgers New Jersey Medical School in Newark. Dr. Emuwa designs personalized treatment plans that integrate current patient care plans prescribed by primary care and other physicians. He works with patients who are acutely and chronically ill with breathing problems, including, but not limited to: • Chronic cough, shortness of breath, chest congestion, and wheezing • Asthma • Bronchitis • COPD • Emphysema • Lung cancer • Pneumonia • Interstitial lung disease • Pulmonary HTN Call 717-735-0336 to make a referral.

Lancaster Pulmonary and Sleep Associates

233 College Ave., Suite 201 • Lancaster, PA 17603 LancasterPulmonaryandSleepAssociates.com Member of the Medical Staff of Heart of Lancaster Regional Medical Center and Lancaster Regional Medical Center. These hospitals are owned in part by physicians.

92349_HLRM_LatifEnuwa_8_375x10_875c.indd 1

6/29/16 12:15 PM

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Come see what makes a

great place to work!

Our delegates to PAMED's 2016 House of Delegates will be... Robert K. Aichele, Jr., DO

With more than 800 physicians and 6,100 employees, PinnacleHealth proudly serves the health and well-being of our region. Our physicians, physician assistants and nurse practitioners use a team-based approach to patient care to improve patient satisfaction and ensure long-term positive outcomes.

Stacy S. Denlinger, DO

We have opportunities in the following positions: ■ Neurology ■ Family Medicine ■ Internal Medicine ■ Internal Medicine Faculty ■ Outpatient Pediatrics ■ OB/GYN ■ Hematology Oncology ■ Hospitalists

David J. Simons, DO (alternate)

Laura H. Fisher, MD James M. Kelly, MD Stephen T. Olin, MD Rebecca M. Shepherd, MD Kristy Whitman, MD Meeting annually each October in Hershey, The House of Delegates is the legislative and policy-making body of the Pennsylvania Medical Society (PAMED). It is comprised of delegates and alternate delegates, chosen and certified by the county medical societies, specialty societies, and the special sections. In addition to policy-making the House of Delegates is charged with filling elective offices, including electing representatives to the House of Delegates of the American Medical Association.

Join our Team! ■ ■ ■ ■ ■

High-quality work environment Continuous improvement High volume, high touch Teamwork and training Electronic medical records

PinnacleHealth is an Equal Opportunity Employer.

Apply today at pinnaclehealth.org/careers.

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SUMMER 2016

News & Announcements

Member Spotlight

Lora S. Regan, MD, MPH, FACOEM MEDICAL DIRECTOR, CORPORATE HEALTH

Q: Where do you practice and why did you settle in your present location or community?

Q: W hat are your hobbies and interests when you’re not working?

A: I came to Lancaster County in 2013 to join Penn Medicine/Lancaster General Health as Medical Director for Corporate Health and Occupational Medicine. I am very proud to be part of this organization, which has received national recognition for excellence in many areas of medicine. I am originally from Southern California, but have been living in Pennsylvania for the past 20 years.

Q: What do you like best about practicing medicine? A: In occupational medicine, I help patients with health concerns related to their jobs. Often these issues are musculoskeletal, but I also treat respiratory and dermatologic conditions. I have a passion for helping patients get back to normal function. I also help patients with disabilities by finding accommodations to improve their functional status at work. I help workers with chemical exposures ensure that they are adequately protected at the workplace, and that they aren’t taking their occupational exposures home to their families.

y husband and I have three grown children, but no grandkids M yet! So we love to travel to interesting places around the world. I love to cook ethnic food, especially Mexican and Indian food. I enjoy hiking and running for exercise. I like to read biographies and mystery novels.

Q: For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership? A: I value the role of the Medical Society in advocating for physicians legislatively. Many physicians are not aware of important legislation that affects our practices and our patients. The Medical Society (local and state) makes the process easy through regular updates, and I know they are working on our behalf. Also, the practice management resources available through PAMED are very helpful.

Q: Are you involved in any community, non-profit, or professional organizations? If so, please list the groups: A:

I n addition to joining the board of the LCCMS, I serve on the board of the Business Group on Health. This is a group of providers, insurers, and employers working together to promote wellness in the workplace and collaborating to ensure the best quality and cost-effective medical care here in Lancaster County. I am also serving on the Specialty Leadership Cabinet with PAMED, representing Occupational and Environmental Medicine.

LANCASTER

PHYSICIAN

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center Events:

WellSpan Ephrata Community Hospital Events:

Support Group for Stroke Patients and Caregivers

Surgery For Weight Loss

Learn more about the WellSpan bariatric surgery program by attending a free program that will feature an overview of the program, including pre-op education, surgical procedures, medical weight management and patient expectations. To register, call (717) 721-8795.

When: The first Wednesday of each month Where: Lancaster Regional Medical Center, 250 College Avenue in Lancaster, 3rd floor rehab unit sunroom.

When: Thursdays, on July 21, August 18 and September 15 Where: WellSpan Cocalico Health Center, 63 W. Church St., Stevens Time: 6 p.m.

Time: 11 a.m. – noon. (Times may vary depending on the needs of the community.)

RSVP: By calling (717) 358-7208.

Golf Tournament

Diabetes Support Group and Educational Series; Topic: “Panel discussion with health

The WellSpan Ephrata Community Health Foundation will hold its 30th annual golf tournament. A reception will be held immediately following play. For more information or to register, go to www.EventsAtECH.org.

professionals and fellow patients with diabetes answering your questions.” RSVP by calling 717-462-9532.

When: Monday, September 12 Where: Hershey Country Club, 1000 East Derry Road, Hershey Time: Lunch and registration start at 11 a.m. Shotgun starts, on the East

When: August 10 Where: Heart of Lancaster Regional Medical Center, 1500 Highlands Dr., Lititz, PA 17543

and West courses, will begin at 1 p.m.

Time: 6-7 p.m.

WellSpan HealthTalk - “Nutrition To Prevent Cancer: Lower Your Risk With Superfoods”

Free Joint Pain Seminars

by Tom Ring, M.D., of Orthopaedic Specialists of Central PA. RSVP by calling 844-784-3627.

Clinical dietitian Lisa Forcellini will talk about foods that help prevent cancer. To register for this free program, call (717) 738-3556. Press 1, then 2.

When: August 16 and October 18 Where: CPRS Physical Therapy, Willow Street Office: 3100 Willow Street Pike,

When: Tuesday, September 20 Where: Ephrata Public Library, 550 S. Reading Road, Ephrata Time: 6 p.m.

Willow Street, PA 17584. Time: 5:30-6:30 p.m.

BMI of Lancaster Bi-monthly Weight Loss Seminar

Fit Futures

This program focuses on a child’s physical inactivity and nutritional concerns. Families will have four individualized counseling and educational sessions that will address nutrition, activity, motivation, goal setting and ideas to promote healthier lifestyles for the entire family. For more information, call (717) 721-8790.

Get back to the active life you love with help from fellowship-trained orthopaedic surgeon Thomas Ring, MD, with Orthopaedic Specialists of Central Pennsylvania. Join him for a discussion on the many treatment options for joint pain, from physical therapy and injections to minimally invasive surgery and total joint replacement. Register today by calling 1-844-784-DOCS.

When: September 7 Where: Heart of Lancaster Regional Medical Center, 1500 Highlands Dr., Lititz, PA 17543

Time: 7 p.m. RSVP: By calling 717-627-0398.

Lancaster Regional and Heart of Lancaster Regional Medical Centers offer multiple events via the Senior Circle program.

Senior Circle is a membership program for individuals age 50 or better who are interested in pursuing an active lifestyle, learning about health and wellness, and meeting others. Events and activities are designed to help seniors stay healthy, vibrant, and active. See the complete listing of activities and events here: lancastermedicalcenters.com/seniorcircle.

LANCASTER

PHYSICIAN

Supportive Personal Care from an Experienced Team You Can Rely On

When a senior patient can no longer live alone or requires supportive care following an injury, illness or operation, refer them with confidence to Personal Care at St. John’s Herr Estate. Our residents are our top priority. Our dedicated care team – on site 24 hours a day – is focused on providing the highest quality of care that is customized to the specific needs of each resident.

A Dynamic Approach

Call Melissa L. Waltman,

Through regular health monitoring and continuing assessments, our care plans change as our residents’ needs change. We deliver physician-ordered medical treatments, provide medication monitoring and management, assist with activities of daily living, coordinate ancillary service appointments and more – all to ensure the optimal care, health and well-being of each resident.

CSA, PCHA, Marketing Manager – Supportive Living

A Referral You Can Both Be Confident In

717.604.3405

Quality care. A highly trained team. All the comforts of home. A referral to St. John’s Herr Estate ensures you and your patients’ expectations are met . . . and exceeded.

Personal Care services are also available at our sister community, Luther Acres in Lititz. Find Luthercare on:

200 Luther Lane • Columbia, PA 17512 • www.DiscoverPersonalCare.org

Free Ultrasound Screenings Wednesdays 1-3 pm. Call to Schedule Today!

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Please visit us at our new location:

DAVID WINAND, MD, FACS 896A Plaza Blvd., Lancaster, PA 17601

717-295-VEIN (8346) S934929