Fall 2016

growing need for

BEHAVIORAL HEALTH RESOURCES

understanding, preventing, and overcoming the downward spiral by Adam Biuckians, MD

Plus

LOW BACK PAIN

by Tony Ton-That, MD

SPORTS INJURY PREVENTION by Jennifer Payne, MD

DIABETIC RETINOPATHY UPDATE

by Michael Pavlica, MD

Advanced A higher level of heart care is now available at WellSpan Ephrata Community Hospital. At WellSpan Health, we want to help you reach your goals in life. So, if your heart’s health is standing in the way, take comfort in knowing that advanced new treatment procedures are now available at WellSpan Ephrata Community Hospital. • Get higher-level treatment from the specialists of WellSpan Cardiology (formerly Heart Specialists of Lancaster County). These physicians now perform angioplasty, stent therapy and other advanced procedures right here in Ephrata. • Receive complete heart care, including prevention, diagnostics, medical and interventional treatments and cardiac rehabilitation – in one location. • Learn how to keep your heart healthy with our special “HeartTalks” education series, scheduled right in your community. • Take comfort in knowing your heart is in good hands – with the region’s largest, most comprehensive system of care across Lancaster, Lebanon, Adams and York counties.

Let’s take this journey together. Get started at WellSpan.org/Lancaster, or call (855) 237-4222.

Contents 2016 BOARD OF DIRECTORS

FALL 2016

COVER STORY

Teen Depression

OFFICERS

(p. 16)

David J. Simons, DO, FAOCA President

Community Anesthesia Associates

Best Practices

Robert K. Aichele Jr., DO President Elect

PAL South Family Medicine

6 Combat Low Back Pain

Laura H. Fisher, MD Vice President

Lancaster Family Allergy

8 Behavioral Health Care

Stephen T. Olin, MD Treasurer

Retired/Consultant

10 Diabetic Retinopathy

Stacey Denlinger, DO Secretary

Baron Family Practice

James M. Kelly, MD Immediate Past President

LGHP - Lincoln Family Medicine

DIRECTORS Sarah E. Eiser, MD Robert A. Garvin, DO Robin Hicks, DO | Resident John A. King, MD Venkatachalam Mangeshkumar, MD

In Every Issue

Emily Miller, MD | Resident Lora S. Regan, MD Karen A. Rizzo, MD, FACS Rebecca M. Shepherd, MD Caitlin White, MD | Resident Kristy L. Whitman, MD

Editors: Dawn Mentzer Beth E. Gerber Lancaster City & County Medical Society

4 Presidentâ€™s Message

36 Medical Society Updates

12 Healthy Communities

38 Restaurant Review

24 Passion Outside of Practice

41 News & Announcements

26 Patient Advocacy 33 Legislative & Regulatory Updates

James Kelly, MD LGHP - Lincoln Family Medicine Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Societyâ€™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.

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

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

President’s Message

am honored to accept the position of president from Dr. James Kelly and lead the Lancaster City & County Medical Society (LCCMS). I want to first and foremost thank all the past and current LCCMS officers and directors for their contribution and leadership. The rich history of the society representing our physicians and advocating for the citizens of Lancaster County should be celebrated! My goal for the next two years is to continue LCCMS’s momentum as a relevant organization representing our members and delivering value to them.

David Simons, DO, F.A.O.C.A President, LCCMS

The specific objectives I would like to address include:  1. Growth of membership – As the saying goes “no margin, no mission.” Recruitment and retention of society membership is the key to our financial bottom line and integral to our ability to remain a strong voice for local physicians. Many PA county medical societies struggle to survive, however, we thrive because of our strong membership numbers. Communicating with and understanding the needs of our physicians and their practice administrators will be the foundation to continued stability and growth.  2. Political advocacy – The PA Medical Society’s pending legislative activity list is extensive and reviewed at our board meetings. LCCMS roundtable legislative breakfasts have provided opportunities for our local representatives and senators to hear face to face from our members and better understand the implications of their votes for or against proposed healthcare legislation. Recent legislative discussions included CRNP independent practice and timely physician credentialing with insurance companies. We must not underestimate the impact that LCCMS has had and will continue to have on helping to shape meaningful changes to our health care environment.  3. Physician collaboration – The quality of the local health care delivered to our patients depends not on a few large health care systems, but on the hundreds of relationships and thousands of decisions made each day by both employed and independent physicians in our community. Improved communication equates to better patient care, and opportunities that encourage the development and nurturing of relationships will ultimately improve the quality of our personal and professional lives. LCCMS events include the annual meeting, young physicians social, and the holiday scholarship fundraiser celebration. (The holiday event this year is December 10th at the Lancaster Country Club – Mark your calendars!)

At our recent annual board re-organization meeting on August 22nd, several new board members were introduced. Rest assured that the society is in good hands with youthful and energized physicians who are well prepared to step up and tackle the challenges that we face as we move forward together. Our new executive director, Beth Gerber, has already begun to provide us with the support and structure necessary to position us for continued growth and success. Visit lancastermedicalsociety.org

As a life-long resident of the state of Pennsylvania, I am motivated and determined to ensure LCCMS continues to focus on issues that impact our physicians and patients. Please enjoy this edition of the Lancaster Physician magazine, and feel free to contact us with any feedback or questions.

LANCASTER

PHYSICIAN

Expertise in chest and esophageal surgery Our practice is dedicated to the prevention, diagnosis and treatment of diseases of the chest. Drs. Gaughan and Worth offer complex surgical care using minimally invasive techniques. Colleen Gaughan, MD Medical School: Temple University School of Medicine Residency: Temple University Health System Fellowship: University of Southern California Fellowship: University of Miami-Jackson Memorial Hospital Board Certified: Thoracic Surgery Jennifer Worth, MD Medical School: Drexel University School of Medicine Residency: University of Nebraska Medical Center Fellowship: Ohio State University Hospital Board Certified: Thoracic Surgery

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• Tumors

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To refer a patient for consultation, please call 717-544-9400.

LG Health Physicians Thoracic Surgery Ann B. Barshinger Cancer Institute 2102 Harrisburg Pike | Lancaster, PA

LGHealthPhysicians.org

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

best

pr ctices Combat Low Back Pain Behavioral Health Care Diabetic Retinopathy

LG HEALTH USES TRIPLE AIM APPROACH TO

Combat Low

Back Pain TONY TON-THAT, MD

LG Health Medical Director of Spine and Low Back Pain

LOW BACK PAIN IS THE NO. 1 REASON PEOPLE SEE A PRIMARYCARE PHYSICIAN. LANCASTER

PHYSICIAN

he often debilitating condition is also the leading cause of disability in the United States, accounting for nearly 15 million medical visits and $25 billion in health care spending annually. One major consequence—prescription opioid abuse—carries enormous societal burden. Lancaster General Health has taken an innovative, Triple Aim-focused approach to treating low back pain. The three-year project develops a systemwide standard of

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Combat Low Back Pain

care designed to reduce opioid prescriptions, unnecessary invasive treatments and imaging services, as well as related costs. Lancaster General Health Physicians practices and the Lancaster General Hospital Emergency Department treat more than 4,000 low-back pain patients each quarter. Variation in treatment, skyrocketing costs and the need for rapid access to effective, evidence-based alternatives led LG Health to prioritize transformation of care for these patients. LG Health Administrative Director of Neuroscience Joan M. Vance said the new low-back pain protocol creates a standardized, cost-effective approach to care that provides safe and effective pain relief for patients. “Our goal is to avoid getting patients on opioids,” she said. “So far, we’ve reduced opioid use by 20 percent in the Emergency Department and 10 percent in the family practices. We don’t have to get patients off of opioids when we never get them on.” Patient focus groups helped guide the project team’s approach. Frustrated patients who attended the groups told similar stories of experiencing long delays in finding effective care and pain relief. “They were seeing provider after provider for treatments that didn’t work,” Vance said.

We’re trying to successfully treat acute back pain before it becomes chronic. “They weren’t necessarily seeking narcotics or surgery. They were just seeking relief.” Previously many patients with low back pain received opioids or other addictive medications right away, even though there is no evidence that this approach is better in the long run, she said. The new protocol calls for physical therapy within 24 to 48 hours, as well as anti-inflammatory medication and patient education. Tony Ton-That, MD, LG Health Medical Director of Spine and Low Back Pain, said research shows that early intervention and access to physical therapy and a home exercise program can successfully treat pain without the need for opioids or costly imaging tests, which have questionable value for most patients. “We want to do what’s best for the patient,” Dr. Ton-That said. “Patient safety is our No. 1 goal.”

LANCASTER GENERAL HEALTH’S NEW SYSTEMWIDE APPROACH TO TREATING LOW BACK PAIN HAS WON THE HOSPITAL & HEALTHSYSTEM ASSOCIATION OF PENNSYLVANIA’S OPTIMAL OPERATIONS AWARD.

The award is part of the 2016 HAP Achievement Awards: Delivering a Healthy Pennsylvania. It recognizes LG Health’s “Transforming Care for Low Back Pain: A New Population Health Model” for innovation that affects patients and communities

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Provider education, including in-person meetings, a CME event, treatment guidelines for ED providers and a real-time Epic dashboard to measure outcomes, is another key to the project’s success. An Epic smart form now prompts providers to ask specific questions and recommend a standard course of treatment. The smart form also alerts providers when a patient has “red flags” that warrant imaging or a surgical consult. (A serious condition, such as cancer, is only rarely the cause of low back pain.) Patients with pain that persists after four to five PT visits return to their PCP or a specialist for additional treatment, which may include localized injections, non-addictive medications that target nerve pain, cognitive behavioral therapy or acupuncture. “We’re trying to successfully treat acute back pain before it becomes chronic,” Dr. Ton-That said. “Research shows that if you catch patients in the first three months, you win.”

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Best Practices

A typical day in

BEHAVIORAL HEALTH CARE WELLSPAN HEALTH’S PHILHAVEN OFFICE IN LANCASTER BRINGS HOPE AND HEALING THROUGH DIVERSE SERVICES

wo waiting rooms are starting to fill up on a Wednesday morning in the small brick building on Prince Street in Lancaster, next to the Lancaster Barnstormers Clipper Magazine Stadium. In one waiting room is a man ready for his 8 a.m. therapy appointment, where he will work on conquering anxiety before heading off to work for the day. In another waiting room is a boy with his frazzled-looking mom, who is at the end of her rope and hoping for guidance after her son has steadily refused to attend school all week.

It’s the start of a busy day at Philhaven’s Prince Street office, a unique place where as many as 100 people come every weekday for help with both mental health and physical health issues. Here, psychologists, therapists and physicians work with clients to promote hope and healing in therapy sessions and day programs, psychiatry visits, and medication checks. “The Prince Street facility is phenomenal,” says Scooter Haase, executive director of Mental Health America of Lancaster County. “Having a facility like Philhaven—which does the outpatient therapy and the partial day programs, and which you can just walk into—is great.”

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The Prince Street office offers:

OUTPATIENT PROGRAMS

About 10 therapists see children and adult patients for one-hour appointments throughout the day. An “Open Access” program also assesses children and adult walk-in clients who are seeking help for mental health issues but do not have a regular therapist. This program provides same-day appointments to these clients.

TRIAGE SERVICES Triage is designed for children and adults

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Behavioral Health Care

who have a more urgent mental health need. These clients, who are often referred by a physician, therapist, or even a family member, see both a therapist and a psychiatrist in an initial appointment. They regularly need medications, which often can be started on the day of the evaluation.

ADULT DAY PROGRAMS

Two programs are offered, one that meets five days a week and the other that meets three days a week. Both programs include individual and group therapy sessions, as well as medication management.

 THE CENTER FOR

INTEGRATED HEALTHCARE

The Center, run in cooperation with SouthEast Lancaster Health Services, offers both behavioral health care as well as routine medical care for SouthEast Lancaster and Philhaven patients. Many of the 30 or so staff members at Prince Street wear several hats in the course of their work day. Most offer therapy to individual clients but also may work to assess a new client or oversee a group session. By 9 a.m., Michael Herr, Prince Street’s triage coordinator, is overseeing a “Goals and Coping Skills” group session in the adult day program. Herr leads the group members, who sit in chairs arranged in a small room, in deep breathing exercises. Later, the group will talk about their experiences with depression, with older clients offering techniques that worked for them, as newer clients listen. Also in the morning, psychologist Christopher Grant leads another group, this one for adults who are receiving Dialectical Behavior Therapy, the gold standard for those with borderline personality disorder who are struggling with suicidal behavior, trauma recovery, and mood instability, among other issues. After lunch, Adam Miller, triage director, sees a man seeking help with a worsening depression. The man worries he is headed for a hospital stay, noting it’s the first time he’s been able to get out of bed

in more than a week. Miller assesses the man and then takes him to see psychiatrist Dr. Umar Khayyam, who makes sure the man has updated prescriptions for his anti-depressant medications and is able to make appropriate adjustments. Late afternoon rolls around, but the day isn’t over yet. Stacey Bailey, director of outpatient services at Prince Street, leads a group of teens in an after-school session that teaches coping skills for depression, anxiety, and other issues. As the sun begins to dip below the horizon, other clients filter in the doors for evening therapy sessions. Philhaven opened the Prince Street facility in April 2013, seeing the need for the increased and diverse services in the city. “Our goal is to improve the mental wellness of our community by providing services when, where and how people need

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them,” said Phil Hess, president of Philhaven and a senior vice president for WellSpan Health. “The walk-in and triage services ensure patients get care when they need it. Treatment is available in individual and group settings. We want to work with the provider community to continually find new and better ways to serve people.” Haase adds the center serves clients who may not know how to find or even get to a treatment facility. “The more access people have to care, the quicker they’re going to get healthy,” he said. “I wouldn’t want to imagine the community without Prince Street. I think if you talk to most people in the mental health field in Lancaster County, they are going to say it’s a huge resource, a huge asset.” For more information about Philhaven’s services, visit www.philhaven.org.

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Best Practices

UPDATE ON

Diabetic Retinopathy MICHAEL R. PAVLICA, MD

omplications of diabetes have become a major health crisis in the new millennium. Diabetic retinopathy (DR) affects approximately 30 million Americans and is a leading cause of blindness in working age patients 1,2,3. It is estimated that one third of affected patients are unaware that they carry the diagnosis3. Another 86 million patients are thought to have pre-diabetes, and the overall incidence of diabetes is increasing 4. It cannot be overemphasized that control of the systemic risk factors for diabetes and its complications, such as glycemic control and lowering of HbA1c, blood pressure, lipid levels, and possibly sleep apnea, are important for lowering the incidence and progression of DR. Communication between all members of a patientâ€™s health care team is crucial to conserve vision. Diabetes can affect many parts of the eye including the cornea, iris, lens, and retina.

Family Eye Group

Diabetic retinopathy is one of the most important complications of diabetes to detect, treat, and prevent. It is present in almost a third of diabetics and causes significant morbidity and blindness if left untreated. The hallmark of the process is damage to the retinal vasculature, which alters the blood-retinal barrier that separates the eye from the rest of the body, resulting in leakage, ischemia, and subsequent retinal neovascularization. Regular ophthalmic monitoring is important to identify the effects of diabetes on the eye. Education is crucial so that patients understand the importance of compliance with follow up and treatment to improve outcomes, particularly in view of the fact that DR is often asymptomatic until later in the disease. Current recommendations by the American Academy of Ophthalmology include ophthalmic screening at the time of diagnosis for patients with Type II diabetes and yearly evaluations until retinopathy develops. More frequent evaluations are required thereafter depending on

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disease severity. In Type I diabetics, evaluation may begin at 5 years after the diagnosis if the exact onset can be pinpointed, then yearly with more frequent evaluations, depending on the patientâ€™s metabolic status and the presence and advancing severity of retinopathy. Diabetic retinopathy is characterized as non-proliferative or proliferative, based on the presence or absence of abnormal neovascularization. Each type may be further graded as mild, moderate, or severe depending on its severity. Multiple pathways have been linked to diabetic retinopathy, and they all share the common effect of increasing oxidative stress, inflammation, and retinal vascular dysfunction. After extended periods of hyperglycemia, the funduscopic exam begins to show vascular changes including microaneursyms, dot and blot hemorrhages, venous beading, cotton wool spots, hard exudates, edema, and intraretinal microvascular abnormalities.

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Update on Diabetic Retinopathy

Eventual closure of the retinal microvasculature due to the damage leads to retinal ischemia that causes elaboration of vascular endothelial growth factor (VEGF). This growth factor leads to breakdown of the blood-retinal barrier, with resultant retinal leakage with edema and exudates that eventually interfere with vision. Such fluid involving the center of the macula, the central point of greatest visual acuity, is called clinically significant macular edema (CSME) and is a cause of significant visual loss. Elaboration of the growth factor from distressed tissue eventually leads to proliferation of abnormal neovascular blood vessels that grow out of the retinal surface into the vitreous cavity. These vessels proliferate and eventually bleed and scar, causing traction on the retina with subsequent retinal detachment, as well as vitreous hemorrhage and loss of vision. For decades, focal laser was the standard of care for treating retinal fluid near the center of the vision. This is performed by treating individual leaking blood vessels with laser spots or using a grid-like pattern surrounding the fovea, the center of the vision. Such treatment reduced the incidence of severe visual loss by approximately half 5. It is still the standard of care for eccentric CSME. The Diabetic Retinopathy Clinical Research Network (DRCR) is comprised of researchers working in concert with the National Eye Institute who collaborate on multicenter clinical trials. Recent studies by the network have shown intravitreal injections of antiVEGF antagonists that bind and temporarily inactivate VEGF to be the treatment of choice, supplanting focal laser for center-involved clinically significant macular edema. The injections are given into the vitreous cavity posteriorly in the eye, under eyedrop anesthesia, and have approximately a 1% risk of complications. They are continued for an extended period of time, usually monthly or bimonthly to begin and then less frequently as maintenance once the disease is stabilized. The DRCR Protocol I showed that visual outcomes for patients with center-involved edema treated with frequent injections of anti-VEGF had superior outcomes compared to those treated with laser alone 6.

I have had the pleasure of being an investigator in a large number of DRCR studies. Recently, I cared for patients in the pivotal Protocol T, which compared the three common types of intravitreal injections in use: Bevacizumab (Avastin®), Aflibercept (Eylea®), and Ranibizumab (Lucentis®). This study showed similar efficacy for all three medicines in patients with better vision. However, in patients with worse vision, Aflibercept had better efficacy. It is notable that Bevacizumab is significantly less expensive than the other formulations, but is not FDA approved for this indication. With differences in cost, FDA approval, and dosing schedule, important cost and efficacy analyses are ongoing, comparing outcomes associated with each of these treatments to determine optimal treatment regimens. Panretinal photocoagulation has been the standard of care for treating the neovascularization of proliferative diabetic retinopathy for several decades. This places numerous laser spots in the retinal periphery that decrease the amount VEGF producing cells present. This has shown a benefit of reducing the rate of visual loss significantly relative to observation in large controlled studies 7. It has side effects of decreased side and night vision, and may worsen center-involved edema. I am currently treating patients enrolled in the DRCR Protocol S comparing the peripheral laser for proliferative diabetic retinopathy to injections of anti-VEGF. The two-year results have shown that monthly injections of Ranibizumab were non-inferior (slightly superior) with respect to visual acuity compared to laser, and superior in terms of preservation of peripheral vision8. The injections had to be continued monthly for a year or more in some patients, depending on their progress. This study has created a new treatment paradigm for proliferative diabetic retinopathy. I am currently a member of the writing committee that is examining variables from the study in an effort to identify specific subgroups of patients that may have better outcomes with laser or injections. For patients with persistent hemorrhage in the vitreous cavity secondary to proliferative diabetic retinopathy, pars plana vitrectomy

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surgery is often used to clear the inside of the vitreous cavity. I participated in recruiting and treating patients in the DRCR protocol N, which compared the novel approach of monthly anti-VEGF injections with intravitreal saline injections in terms of obviating or delaying the need for vitrectomy surgery. The eyes treated with anti-VEGF cleared enough to allow complete laser more often than with saline, but ultimately vitrectomy rates were similar between the two groups 9. Diabetic retinopathy is extremely important from the public health perspective. With proper surveillance and treatment, many of the patients with this malady can preserve excellent vision and functionality. Dr. Michael Pavlica is a board certified ophthalmologist and a fellowship trained retina specialist who has been practicing in Lancaster for 20 years. At Family Eye Group, he specializes in diseases and surgery of the retina and vitreous, and he serves as director of the practice’s retina services. He recently published a chapter on subretinal neovascularization surgery in a leading ophthalmology textbook, Master Techniques in Ophthalmic Surgery. Dr. Pavlica is a past president of the Lancaster City & County Medical Society.

Works Cited

1.Aiello, LM. Perspectives on diabetic retinopathy. Am J Ophthalmology. 2003;136:122-35 2. Ryan, S. Retina. 2013;45: 907 3. K lein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol 2007;14:179-83 3. Centers for Disease Control and Prevention 4. Early Treatment Diabetic Retinopathy Study Research Group. 5. P hotocoagulation For Diabetic Macular Edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Opthalmol 1985;103:1796-806 6.Diabetic Retinopathy Clinical Research Network. Expanded 2 year Follow up of Ranibizumab Plus Prompt or Deferred Laser or Triamcinolone plus Prompt Laser. Ophthalmology. 2011 April; 118(4):609-14 7. D iabetic Retinopathy Study Research Group Photocoagulation treatment of proliferative diabetic retinopathy: the second report of Diabetic Retinopathy Study findings. Ophthalmology 1978;85:82-106 8. D iabetic Retinopathy Clinical Research Network. Panretinal Photocoagulation vs Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Trial. JAMA.2015; 314(20):2137-2146. 9.Diabetic Retinopathy Clinical Research Network. Randomized Clinical Trial Evaluating Intravitreal Ranibizumab or Saline for Vitreous Hemorrhage from Proliferative Diabetic Retinopathy. JAMA Opthalmol. 2013 Mar1;131(3):283-93.

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Healthy Communities

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Growing Need for Behavioral Health Resources

Lancaster County Health Networks Expand Efforts to Meet

GROWING NEED FOR

BEHAVIORAL HEALTH RESOURCES BY SUSAN SHELLY

t is no secret that people suffering from mental health problems often do not receive the care they need.

The number of psychiatric beds nationwide has decreased by about 13 percent since 2010, according to Treatment Advocacy Center, a nonprofit that works to remove barriers to treatment for mental health issues. In Pennsylvania, the number of beds went from 1,850 in 2010 to 1,334 this year—a 10.4 percent decrease. The country also faces a critical shortage of psychiatrists, according to the Academy of Psychosomatic Medicine. This occurs just at the time that demand for psychiatric services has increased due to expanded access to care through the Affordable Care Act, Medicaid expansion and the Mental Health Parity Act. According to the U.S. Department of Health and Human Services, more than half of the counties in the country have no practicing psychiatrist, psychologist, or social worker. Lack of care or lack of access to mental health treatment has resulted in hundreds of

thousands of mentally ill people housed in prisons or homeless shelters, and estimates place one-third of all homeless people in America in the category of mentally ill. In addition, the life expectancy of those with mental illness is set at between 10 and 24 years less than that of the general population, according to reports. The problem is huge, multi-faceted, and complex, and experts often disagree on how to solve the problem of inadequate care for people who experience mental illness. Lancaster County mental health providers acknowledge that the county is not immune to the types of problems occurring nationwide. The 2016 Health Needs Assessment revealed that mental health ranked as one of the most critical health needs for Lancaster County. “We know that behavioral health consistently ranks among the top health care needs in our region,” Dr. Kevin Mosser, president and CEO of WellSpan Health, noted in a press release issued last December.

While acknowledging the need for increased access to mental health care for residents of Lancaster and surrounding counties, Lancaster County medical facilities are working hard to address and meet that need. WellSpan Health in January became affiliated with the Mount Gretna-based Philhaven, the 14th largest mental and behavioral health provider in the United States, while Lancaster General Health has plans to build a 126-bed behavioral health hospital in Lancaster. The facility is expected to open in 2018. Both effortssare aimed at increasing access to behavioral health care across the region. The new hospital, which Lancaster General Health will operate in conjunction with Universal Health Services, a hospital management company, will include an inpatient adolescent unit and dedicated women’s trauma unit, as well as intensive outpatient programs. The facility is in response to a growing need for services, said Jan Bergen, president and CEO of Lancaster General Health.

Continued on page 14

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Healthy Communities

Everyone should be making an effort to break that stigma. “The significant demand for behavioral health services in our community is outpacing the ability of current providers to meet that demand,” Bergen said in a press release. The joining of WellSpan Health and Philhaven, which has 21 locations serving Lancaster, Lebanon, York, Harrisburg, and surrounding areas, will enable residents to access care more easily and quickly, said Philip D. Hess, senior vice president of WellSpan Health and president of WellSpan Philhaven. “Our affiliation with WellSpan will enable us to provide greater access and more effective mental health care within our communities,” shared Hess. “We need to make access to care easier and we need to provide care when, where and how someone needs it.” Philhaven has a long track record of working with other mental health providers, organizations, and community partners to assure rapid response and access to help for those in need of services, Hess noted. Another move toward helping patients access care quickly is placing behavioral health professionals in primary care physician offices, assuring that patients can get help on site without the need to schedule and get to a separate appointment.

Andrew Newcomer, community education manager for Lancaster Regional and Heart of Lancaster Regional Medical Centers’ behavioral health programs, said those hospitals are working to establish behavioral health care within the offices of primary care physicians. “It will be advantageous to have someone on site so that patients who need it could get care right away,” Newcomer said. WellSpan has added behavioral health providers to 10 of its primary care physician offices. In addition, at its Prince Street Center in Lancaster, WellSpan Philhaven, in conjunction with SouthEast Lancaster Health Services, operates the Center for Integrated Healthcare. There, space is given to family physicians who treat the physical needs of behavioral health patients before or after their regular appointments. “It links the whole system of care,” explained Hess. Lancaster General Health also is beginning to incorporate integrated behavioral health staff into primary care offices, according to Tracey Lavallias, executive director of behavioral health services at Lancaster General Hospital. “These counselors and coaches work closely with the primary care team and with counselors

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and psychologists in our community to start to more effectively identify and treat patients early in the process of mental health concerns,” Lavallias said. While access to mental health and behavioral health services has lagged behind access to other forms of medical treatment, professionals in the field are optimistic that things are changing. The Affordable Care Act (ACA), which stresses patient-centered and preventative care, not only has made it possible for more people to access care, but has caused health care providers to change the way they view patient care, Hess said. Because the ACA shifts the reimbursement system from one based on volume of services to one based on the value of care, health care providers have increased incentives to keep people well. “It changed the paradigm for payment of care when someone is sick to payment for population health and wellness,” said Hess. Under that model, and with the integration of mental and physical health care, patients will be able to get care sooner, which may help to prevent crisis situations that result in visits to the emergency department.

Behavioral Health Resources

“It always makes more sense to treat someone before they reach the tipping point,” Newcomer noted. “Having care available before that happens is good for everyone.” And, while there still is stigma attached to mental health issues and treatment, health care professionals are hopeful that, with conversation about mental health on the national stage and efforts being made within communities to better understand mental health, that stigma will continue to lessen. “Everyone should be making an effort to break that stigma,” Newcomer said. Lavallias noted that with significant changes already underway, the future of behavioral health care is likely to look very different. “There is so much going on nationally to remove stigma and bring mental health to the forefront as an issue that is as important as physical health,” Lavallias said. “That is so exciting, and frankly, overdue. We anticipate that there will be significant changes occurring within mental health care delivery over the next decade.”

joint forces We’re proud to welcome joint replacement and reconstruction specialist Gregory A. Tocks, DO to our practice.

joint forces

A graduate from Philadelphia College of Osteopathic Medicine and Penn State University, Dr. Tocks received his joint replacement & adult reconstruction fellowship training at Virginia Commonwealth University. With an extensive residency at Pinnacle Health System and Penn State Hershey Medical Center, We’re proud to welcome joint replacement and reconstruction he brings a wealth of experience to the OAL Team.

specialist Gregory A. Tocks, DO to our practice. To schedule an appointment with Dr. Tocks, please call 717-299-4871. A graduate from Philadelphia College of Osteopathic Medicine and Penn State University, Dr. Or visit us online at fixbones.com. Tocks received his joint replacement & adult reconstruction fellowship training at Virginia Commonwealth University. With an extensive residency at Pinnacle Health System and Penn State Hershey Medical Center, he brings a wealth of experience to the OAL Team.

To schedule an appointment with Dr. Tocks, please call 717-299-4871. Or visit us online at fixbones.com.

fixbones.com

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Dr. Gregory A. Tocks, D.O.

Healthy Communities

Teen Depression UNDERSTANDING, PREVENTING, AND OVERCOMING THE DOWNWARD SPIRAL

ADAM BIUCKIANS, MD

Community Services Group, Inc.

LANCASTER

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Teen Depression



Signs & Symptoms

epression is a very common mental health condition in teenagers. According to the National Institute of Mental Health, in 2014 there was an estimated 2.8 million adolescents aged 12-17 in the US who had at least one major depressive episode that year. That number represents 11.4 percent of the US population aged 12-17. Many studies estimate higher rates, as high as 20 percent.

Exercise also helps protect against depression. Encourage regular physical activity. (One hour/day is a generally accepted recommendation, but any amount helps.)

While there is no sure way to prevent depression, there are things you can do to help protect your teenager against depression.

Limiting screen time can also be helpful. Some studies suggest a link between screen time and depression. It’s possible the screen time could interfere with sleep or take time away from physical activity. It also may expose teenagers to issues like cyberbullying. Exposure to negative or violent content may worsen feelings of depression, as well.

A strong and positive relationship between a teenager and her parents can help prevent depression. To help foster and maintain a positive relationship, consider dedicating time on a daily basis to talk with each other, encouraging expression of feelings, regularly providing nurturing and positive feedback, and responding calmly to your teenager’s expressed frustration and anger. Healthy peer relationships also protect against depression. Encourage your teenager to spend time with supportive friends. Encourage participation in sports, clubs, or other organized activities. This can help improve self-esteem and strengthen their social support network.

Sleep hygiene is important! A good night’s sleep helps teenagers feel and perform their best. Teenagers often require more sleep than adults; 9-10 hours per day is not unusual. Having a consistent bedtime routine helps tremendously.

A question often raised by parents is: ”What difficulties are part of normal adolescence and what are cause for concern?” This can be difficult to discern at times, as it is normal for teenagers to show moodiness, struggle with a sense of identity, have occasional poor self-esteem, argue with parents over independence, prefer to spend time with peers over family, test limits and rules, and even exhibit childish behavior when stressed. Having these issues occasionally may not be abnormal, but if they occur Continued on page 18

OF DEPRESSION IN TEENAGERS INCLUDE THE FOLLOWING: Frequent sadness or crying  Less interest in or desire for fun and enjoyable activities, or constant “boredom”  Increased irritability, anger, and hostility Increased social isolation  Worsening school performance  Extreme sensitivity to rejection or failure  Worsening ability to concentrate Talk of, or efforts to, run away  Major change in eating or sleeping patterns Low self-esteem  Feelings of guilt and hopelessness  Thoughts or expressions of suicide or self-injurious behavior

LANCASTER

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Healthy Communities Anne M. Lusk REALTOR®

Teen Depression

frequently or consistently for a longer period of time, it may warrant further attention.

Where Experience

Meets Excellence

Depression can look different in teenagers than in adults. They may not necessarily seem sad, so those in their life may not realize that concerning or problematic behaviors may really be a sign of depression. Problems with irritability and anger may be more common than sadness. Depressed teenagers may abuse alcohol or drugs to try to feel better, or numb their feelings. They may also engage in other risk taking behaviors to try to make themselves feel better.

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If you suspect your teenager may be depressed, seeking professional help is essential. Depression is a real illness that requires treatment and shouldn’t be ignored or delayed, as it can worsen over time. Depressed teenagers are at increased risk of suicide, and the earlier problems are addressed, the earlier these teens will start to feel better. Addressing depression early can prevent a poor or tragic outcome.

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$1,095,000

Treatment of depression often includes both individual and family therapies. During therapy, a mental health provider may help you and your teenager understand what depression is, develop stress management skills, improve communication with each other, and discover healthy ways to improve mood. Cognitive behavioral therapy and interpersonal therapy are forms of therapy that have been proven effective in treating depression in teenagers, though other forms of therapy may be just as effective, depending on the needs of your teenager and family.

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Conestoga, PA

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Sometimes treatment of depression requires medication, especially if symptoms are severe and/or persistent. However, it is very important to note that medication should almost never be used alone and constitutes only one part of an overall treatment plan. When medication is prescribed, teenagers and parents should be well informed of the indications and potential risks and side effects. Expectations of how long the medication may take to help, and what specific symptoms may or may not improve, should be understood prior to the start of medication.

Bent Creek, Lititz

$719,000

For help, parents can talk to their primary care provider, school guidance counselor, or even their insurance company to discuss their concerns and ask for a referral to a qualified mental health professional. Another great resource is through dialing “211,” which is run by United Way of Lancaster County. The information line is available 24 hours a day and helps to refer people to the most appropriate services. If a teenager is in crisis, contact Crisis Intervention at 717-394-2631.

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AnneLusk.com o 717.291.9101 | f 717.393.2336 | c 717.271.9339 100 Foxshire Drive | Lancaster, PA 17601 Sotheby’s International Realty and the Sotheby’s International Realty logo are registered (or unregistered) service marks used with permission. Sotheby’s International Realty Affiliates LLC fully supports the principles of the Fair Housing Act and the Equal Opportunity Act. Each Office is Independently Owned and Operated.

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FA L L 2 0 1 6

sports injury

prevention TALKING WITH THE ATHLETE AND PARENT JENNIFER PAYNE, MD

s physicians, we are taught much about the pathology of disease, diagnoses and differential diagnoses, and treatment pathways. However, we are often not schooled on how to talk to patients—part of this is the ever elusive and much vaunted “bedside manner.” Is it natural? Is it something that we can improve upon? As a sports medicine physician, I have the pleasure of working with athletes, as well as parents, something to which I’m sure most pediatricians can relate. There are many factors to consider when talking with the student athlete, and perhaps discussion of these will assist the physician in the structuring of a successful patient encounter. Patients and parents are not coming to you in a vacuum, although it may feel that way. Just as in a good story, you may wish to paint the picture of their backgrounds: Where do they go to school? What grade? What do they like to do for fun? Who is at home? What are their long-term plans? Do they have jobs? A middle school student who is swimming to meet friends and get in shape may require a different approach than a senior captain who is planning to swim in college. That doesn’t mean single-handedly restricting an athlete from play since they aren’t “important” to the team, rather, it means taking each case into account individually. Continued on page 22

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Healthy Communities

Sports Injury Prevention

After obtaining the patient’s background and the context of the injury (Is it during playoffs? Preseason?), the astute physician can move on to assess other factors. What are the expectations of the child and parent with respect to return to play? Do they intersect with the likely medical reality? Finding a way to connect the patient’s expectations with reality is key in the physician-athlete-parent relationship.

Oftentimes, part of the expectations piece of this can be elicited by discussion with the athlete with the parent out of the room. This can be done at the same time each visit (“Time for the physical exam, let’s have the parent step out.”), or can be gently discussed with the parent and patient ahead of time, perhaps on the phone. Usually, if the patient is afraid of disappointing a parent or is not particularly interested in a sport, the patient’s true feelings can be elicited in that time. Just as mentioned above, the patient does not exist in a vacuum. Writing down who are the involved parties can be very helpful in assisting communication between physician, patient, school, athletic team, and work. The patient often leaves my office with two or three very specific notes and an easy way for the interested parties to contact the office after we have discussed whether it is OK for me to communicate with these parties. Obviously, the interested parties don’t necessarily need to know all the details of the diagnosis, but they do need to be able

to have reasonable expectations of what the patient can do. With an ankle sprain, they can still do upper body and core work. They can watch practice but not participate. With a concussion, they will need specific limitations on not only physical education, but class time, testing, homework, and rest breaks. The ACE Care Plan online can be a good tool to be very specific for an athlete’s return to learn plan. Understanding that our student-athletes’ lives are complex, multifaceted, and ever changing is an important part of being a good sports medicine physician. Dr. Jennifer Payne is a member of LG Health Physicians Sports Medicine, a medical practice dedicated to care of non-surgical sports injuries. She and her partner, Dr. Patrick Moreno, are both fellowship-trained and board certified in Sports Medicine. More information about the practice can be found at LGHealthPhysicians.org/Sports.

Treating your family,

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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 Gerald Rothacker, Jr, MD, and his passion outside of practice.

Gerald W. Rothacker, Jr, M.D.

When I moved back to Lancaster in 1981 and started practicing medicine with Orthopedic Associates of Lancaster, we joined Highland Presbyterian Church, and I soon had the opportunity to play the trombone on special occasions at church. In 1984, I and several other brass musicians who were docs formed an ensemble, calling ourselves the “Auscultation Brass.” Since we started the group, we have performed in public hundreds of times in many venues, and we continue to practice on Sunday nights. I am the emcee and in that capacity have developed a wonderful library of musical information and stories about compositions and composers. Over the years, our members have included: myself and Scott Paist on trombone; Dick Weber, Jerry Albright, Ron Weaver, Bill Roberts, Dan Diehl, and Bob Belser (Jr. and Sr.) on trumpet; Joe Hess and Tom Anderson on tuba; Bob Falk and Bill Lovett on French horn; Dave Frederick on baritone; Joe Breslin on euphonium; and we await the return from fellowship of Andy Lutzkanin. We have donated thousands of dollars to scholarships and charities. Personally, I have continued to do church music whenever I can, and I am also a member of the Moonlighters’ Big Band in Lititz.

Passion Outside of Practice: Music

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

One of my passions outside of medical practice is music. I enjoy listening to almost any genre (rap excepted), but I really enjoy playing trombone and occasionally tuba or euphonium.

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

This passion was a natural. My father was a talented euphonium/baritone player, and as a youngster the whole family went to the Third Brigade Band of Pottsville, PA concerts. I started baritone horn lessons in fourth grade and by fifth grade I was getting private instruction from Tony Tremitere, a former Vaudeville musician who had been my Dad’s band director in high school.

One of the advantages of growing up in the small town of Minersville, PA was that by sixth grade, when the high school band needed more musicians, I got to sit in. By junior high, the school band needed trombone players so I made the switch to predominantly playing the trombone. My family moved to Glen Burnie, MD after my sophomore year, and I played trombone with the high school band there, as well. College at Muhlenberg as a Natural Science major still allowed me to play in the bands and ensembles. Once in medical school at Hahnemann, there was no longer the time or opportunity to play or practice unless it was duets with my Dad on visits home. With a wife and two kids by internship at LGH and a third son by the end of residency at Mayo, the horns did not come out of the case much in those years.

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3. Why is this pursuit special to you?

Music and especially the Auscultation Brass has allowed me a diversion with personal challenge but without the stress of life changing complications. It has given me a group of like-minded friends to share stories of medical adventures and misadventures that only another physician would understand. It has allowed my patients to see that there is more to their doctor than the concerned look and cold hands! As I move away from the clinical practice of medicine and the great satisfaction that it gives, I know I will have this avocation to enjoy.

4. What else would you like readers to know about this?

The Auscultation Brass continues to look for medical musicians who want to open their horn case once a week when they can and enjoy an hour or two of camaraderie and music making. www.auscultationbrass.com www.moonlightersbigband.org

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Patient Advocacy

ANOTHER FLU SEASON:

ARE YOU PREPARED? LANCASTER

PHYSICIAN

FA L L 2 0 1 6

RACHEL LEVINE, MD

Physician General for the Commonwealth of Pennsylvania and Professor of Pediatrics and Psychiatry at the Penn State College of Medicine

all has arrived and with it comes flu season. Flu is caused by influenza viruses and can cause mild to serious illness. In the 20152016 season, at least 64 Pennsylvania adults died as a result of flu complications. Flu symptoms are characterized by fever, cough, sore throat, runny or stuffy nose, body aches, headaches and fatigue. Patients with flu symptoms, particularly those at high risk for developing flu-related complications, such as pregnant women or patients with chronic lung disease, should check with their doctor promptly. A physician may prescribe an antiviral drug to treat the illness. Continued on page 28

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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

Patient Advocacy

Another Flu Season

“

YOU CAN TAKE EVERYDAY PREVENTIVE ACTIONS LIKE STAYING AWAY FROM PEOPLE WHO ARE SICK AND WASHING YOUR HANDS TO REDUCE THE

”

SPREAD OF GERMS.

While flu activity is impossible to predict, flu viruses are most common during the fall and winter months. Last year, Pennsylvania had an unusually late start and flu activity remained low from October 2015 until late December 2015 and peaked in March 2016. Overall, the 2015-2016 season was less severe than the past years with 31,925 confirmed cases of influenza in the 2015-2016 season. Of the types of seasonal flu, Influenza A(H1N1) pdm09 viruses predominated overall, but influenza A(H3N2) viruses were more commonly identified from October to early December, and influenza B viruses were more commonly identified from mid-April through mid-May. The Centers for Disease Control and Prevention (CDC) recommend a yearly flu vaccine for everyone 6 months of age or

older as the first and most important step in protecting against this potentially serious disease. Vaccination is especially important for people at high risk for developing flu-related complications as well as their close contacts. Children 6 months through 8 years getting vaccinated for the first time, and those who have previously gotten only one dose of vaccine, should get two doses of vaccine this season. Your child’s doctor or other health care professional can tell you if your child needs two doses. New for the 2015-2016 season, the U.S. Food and Drug Administration (FDA) has licensed FLUAD, a new seasonal influenza vaccine containing adjuvant, for adults 65 years of age and older. An adjuvant is an ingredient added to a vaccine to create a stronger immune response to vaccination. FLUAD, containing an oil-in-water

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emulsion of squalene oil called the MF59 adjuvant, is the first adjuvanted seasonal flu vaccine marketed in the United States. Also new for the 2016-2017 flu season, CDC has recommended only injectable flu shots and not the attenuated intranasal influenza vaccine. In addition to getting a seasonal flu vaccine, you can take everyday preventive actions like staying away from people who are sick and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others. For more information about the Department of Health’s efforts to prevent the spread of flu visit FLUFREEPA.COM or by calling 1-877-PA-HEALTH.

As fellow clinicians—

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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

Patient Advocacy

INFLUENZA VACCINE AVAILABILITY at Lancaster County Health Networks LANCASTER GENERAL HEALTH PHYSICIANS Lancaster area residents may visit any LG Health family medicine practice Monday through Friday from 8 a.m. to 4 p.m. to get their flu shots. To find a location near you, visit LGHealthPhysicians.org. Flu shots will also be available until October 27 from 6 – 8 p.m. on Tuesdays and Thursdays at the following Lancaster County locations: AMILY MEDICINE DOWNTOWN F 540 N. Duke St., Lancaster AMILY MEDICINE NORLANCO F 424 Cloverleaf Rd., Elizabethtown Flu shots are covered by most health insurance plans. Walk-ins do not have to be practice patients. LANCASTER REGIONAL MEDICAL CENTER AND HEART OF LANCASTER REGIONAL MEDICAL CENTER The Lancaster community can receive the flu shot as a patient at any one of our ten family practices. They are all listed here: www.HeartandRegionalMed.com. WELLSPAN HEALTH IN LANCASTER COUNTY Area residents can receive the flu shot as a patient at any one of WellSpan Health’s family practices. Find WellSpan practices in Lancaster County here: www.wellspan.org/offices-locations/lancaster-county.

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Do you have patients who need cardiothoracic surgery? Count on Dr. Brown to see them quickly. A member of the American Board of Thoracic Surgery and the Lancaster Medical Society with 23 years of experience, Dr. Paul Brown knows how important it is to work closely with primary care doctors and other specialists in the timely and coordinated care and treatment of their patients. Count on him for quick initial consults and for a collaborative approach to patient care.

To make a referral, call 717-735-3920. Paul S. Brown Jr., M.D., FACS, FACC, FACCP Board-Certified by the American Board of Surgery, American Board of Thoracic Surgery, and ARDMS as a Registered Physician in Vascular Interpretation

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If your patient has a wound that hasnâ€™t healed in 30 days, we can help. The Wound Healing Center of Heart of Lancaster Regional Medical Center specializes in the comprehensive care of problem wounds. Our treatment methods include debridement, hyperbaric oxygen therapy, dressing selection, special shoes, and patient education. Our treatments are also designed to complement the care you have already prescribed for your patients. Since opening in 2011, the Wound Healing Center has a 93% heal rate, with an average of 28 days for a wound to heal. For more information or to make a referral, call us today.

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FA L L 2 0 1 6

Legislative & Regulatory Updates

Pennsylvania Medical Society Quarterly Legislative Update

FALL 2016 HANNAH L. WALSH

ith passage of the 20162017 state budget in early July, the General Assembly recessed for the remainder of summer, not to convene again for regular business until September. When they do return, it will be for a limited number of session days before the two-year legislative session concludes at the end of November. The House of Representatives has twelve scheduled session days remaining this year; the Senate has nine. The short schedule this fall is due to the fact that it’s an election year in Pennsylvania. When voters go to the polls to cast their vote for the next President of the United States in November, they’ll also have an opportunity to vote for their local Representative in the state House and possibly their state Senator. All 203 House seats and half of the Senate’s 50 seats are up for re-election in 2016. It’s in the weeks following the November election that legislators are considered to be least accountable to voters. Votes on legislation during this time are made by either legislators who have retired or been defeated for re-election, or who don’t have to face voters for another two to four years. Commonly referred to as a “lame-duck” session, the General Assembly stopped the practice of meeting to vote on bills after the election several years ago amidst sharp criticism and calls for reform. While the General Assembly’s schedule this fall limits the amount of legislation action that

can take place, there are a number of current issues that still have potential to move. Any bill that isn’t signed into law when the twoyear legislative session concludes at the end of November will have to be reintroduced in the 2016-2017 session to begin the legislative process all over again.

Opioid-related Legislation The state’s opioid abuse epidemic has continued to intensify, with significantly higher rates for drug-poisoning deaths in Pennsylvania than the U.S. average. A report released in July 2016 by the DEA indicates that 3,383 Pennsylvanians died of a drug-related overdose last year—up 23.4 percent from 2014. In an effort to stem the crisis, many states, including Pennsylvania, have enacted mandates on use of a PDMP (Prescription Drug Monitoring Program), mandates on prescriber and dispenser education, increased access for naloxone, and measures to expand treatment for substance use disorders. Some states—such as Massachusetts, Maine and New York—have taken a more radical policy approach by restricting the amount of opioids a clinician can prescribe to just a few days’ supply, with specific exceptions. The Pennsylvania legislature is equally eager to take further action to address the proliferation of misuse and abuse of opioid prescriptions in our state. Until measurable reductions are seen in the number of

opioid-related harms occurring across the Commonwealth, the number of legislative solutions proposed to this problem and the pressure to enact them will continue to grow. At the time of this writing, over 50 bills have been introduced to address what has become the leading cause of accidental death in Pennsylvania, killing more people each year than motor vehicle accidents. On September 16, Governor Wolf called for a Joint Session of the House and Senate to focus on the opioid epidemic. The Governor also identified several policy priorities that he is encouraging legislative leaders to accomplish during the remainder of the 2015-16 session. The proposals include requiring prescribers to check the PDMP every time they prescribe; increasing education about opioid and pain management for current and future medical professionals; limiting the quantities of opioids that can be prescribed in emergency departments; requiring health insurance plans to provide coverage for abuse-deterrent opioids; adding opioid misuse to existing public school curriculum on drug and alcohol abuse; and establishing a voluntary non-opioid directive form for patients who don’t wish to receive opioids in their medical care. At the time of this writing, PAMED is in the process of reviewing legislation introduced related to the opioid crisis, including the proposals mentioned above, and is seeking feedback from physicians so as to best represent their interests. Continued on page 34

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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

Legislative & Regulatory Updates

Prescription Drug Monitoring Program On August 25, Pennsylvania’s new statewide prescription drug monitoring program (PDMP) went live, enabling prescribers to view the prescribing history of their patients. Prescribers are required to query the program for each patient the first time a patient is prescribed a controlled substance by the prescriber for the purposes of establishing a baseline and a thorough medical record, and if they believe or has reason to believe, using sound clinical judgement, that a patient may be abusing or diverting drugs. In the weeks since the PDMP went live, PAMED has received numerous questions from physicians regarding various aspects of the law and what it specifically requires of them, as well as issues they have encountered with the PDMP system itself. PAMED has shared these questions and concerns with the Department of Health (DOH), charged with administering the program under the law, and has requested official clarification from the Department. Among the questions and comments received, physicians have asked whether the administration of a controlled substance, as opposed to the prescription, necessitates a physician to query the PDMP; whether it is permissible for prescribers and dispensers to talk to each other about a patient’s prescription history if the prescriber or dispenser suspects abuse or diversion of controlled substances by the patient; if changes in dosage orders for the same controlled substance is considered a first-time prescription requiring a new query; are prescribers allowed to prescribe if the PDMP is down or undergoing maintenance

and, if so, if there is anything they must do for record-keeping purposes; and more. In addition to questions, reports of technical issues and suggestions for system improvements have also been communicated to DOH. PAMED will share with physicians any responses it receives from DOH regarding these matters and others.

Workers’ Compensation Reform On September 13, the House Labor and Industry Committee held an informational hearing on House Bill 1141, legislation that would institute a number of important reforms to Pennsylvania’s workers’ compensation system. Representative Stan Saylor (R-York) introduced the bill this session. HB 1141 addresses several issues with information access and reimbursement that often plague physicians who treat injured workers. For starters, the bill would ensure that providers have access to information about the injured worker’s claim, including the claim number and the description of the specific work-related injury for which the insurer has accepted liability. Workers’ compensation employers, insurers and their agents would be required to accept bills electronically, enabling reimbursements to be processed faster and with more accuracy. HB 1141 would prohibit a practice commonly referred to as “silent discounting,” where a health insurer or its “affiliates” pays providers at a discounted rate—in other words, below the mandated workers’ compensation fee schedule—without their knowledge, approval, or contractual agreement. It would also

prohibit insurers from using coercive tactics to compel a provider to accept discounted reimbursements. Finally, the legislation would increase penalties on payors who fail to timely implement updated fee schedules each year; define “health care provider” to clarify that the term does not include an entity that does not have a National Provider Identifier; and define “case management” according to national standards to include a variety of case management, care coordination, evaluation, and management services. During the hearing, the Labor and Industry Committee heard testimony from a panel of individuals representing organizations which strongly support HB 1141—including the Pennsylvania Medical Society (PAMED) and the Pennsylvania Orthopaedic Society (POS)—followed by individuals testifying in opposition. Members of the insurance industry and the Department of Labor and Industry opposed legislation, stating that the bill would increase costs within the workers’ compensation system without necessarily improving care. As the meeting was informational, the Committee did not hold a vote on HB 1141.

CRNP Independent Licensure On the evening of July 12, the Senate passed Senate Bill 717—legislation that would allow CRNPs to practice independently and eliminate the requirement that they collaborate with physicians—by a vote of 41-9. The bill now goes to the House of Representatives for consideration, where it has been referred to the Professional Licensure Committee. Prior to Senate passage, SB 717 was amended to require CRNPs to have a minimum of three years and 3,600 hours of experience before they can practice independently. While well-intentioned, PAMED believes the logic of this amendment was flawed. Requiring a minimum number of years or hours of work experience in an unstructured setting with highly variable experiential learning does not replace the expertise and support that comes with physician oversight and is no match for a physician’s education and training.

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PAMED has continued to express strong opposition to the legislation, which is being supported by the Pennsylvania Coalition of Nurse Practitioners (PCNP), the Hospital and Healthsystem Association of Pennsylvania (HAP), and AARP Pennsylvania, among others. On September 16, PAMED sent a “Call to Action” to all physicians, asking that they call or email their state Representative and urge his or her opposition to SB 717. If SB 717 fails to become law by the time the 2015-16 session concludes in November, the legislation will have to be reintroduced next session, which begins in January. The prime sponsor of SB 717, Senator Pat Vance (R-Cumberland), is not seeking re-election this year. A registered nurse by training, Senator Vance has for years been a strong proponent of advancing the scope of practice and role of the nursing profession in Pennsylvania during her tenure. At this time, it is unclear who will take up the cause and reintroduce the bill next year in the Senate. Similar legislation was also introduced this session in the House of Representatives

by Rep. Jesse Topper (R-Bedford) as House Bill 765.

Hepatitis-C Screening HB 59, which was signed into law on July 20, 2016, requires all individuals born between 1945 and 1965 to be offered a Hepatitis-C screening test when receiving health services as an inpatient in a hospital or when receiving primary care services in an outpatient department of a hospital, health care facility, or physician’s office. The bill provides for some exceptions to this requirement, such as if an individual is being treated for an emergency, has previously been offered or been the subject of a screening test, or lacks capacity to consent to a screening test. If an individual accepts the offer of a Hepatitis-C screening test and the result is reactive, the law ensures that a health care provider offer or refer the individual for follow-up health care, which must include a Hepatitis-C diagnostic test.

There’s no doubt that HB 59—now Act 87 of 2016—is well-intentioned and that increased Hepatitis-C testing of this at-risk population would be beneficial. However, PAMED has consistently opposed legislation that mandates aspects of the physician-patient relationship. PAMED was successful in advocating that the final version of the HB 59 contained no penalties on health care providers. Since the law’s passage, PAMED has received a number of questions from physicians regarding its implementation. PAMED sent a letter to DOH on August 31 requesting clarification on the requirements of the Act, which is set to take effect September 18, 2016, but at the time of this writing has not yet received a response. A Quick Consult has also been made available to PAMED members to provide guidance on some of the most frequently asked questions. Hannah Walsh is the Pennsylvania Medical Society’s Associate Director of Legislative Affairs. Email her at hwalsh@ pamedsoc.org.

Lancaster NeuroScience & Spine Associates Summer has come to an end, the leaves have changed and the chill in the air is signaling that the fall season is upon us. With fall comes a plethora of outdoor chores such as raking, mowing and cleaning gutters; all of which can leave you with nagging neck or back pain if you don’t plan ahead! To learn more about preventing common fall related back pain issues check out the link below:

www.lancasterneuroscience.com/text-neck

For appointments or referrals call

717.569.5331

Don’t FALL in to Back Pain

Convenient locations in Lancaster, Lebanon & Parkesburg

WWW.LANCASTERNEUROSCIENCE.COM

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Medical Society Updates

PAY IT FORWARD:

The Joy of Mentoring HEATH B. MACKLEY MD, FACRO

ndergoing the process of academic promotion in a university hospital is no small task, and in my case it includes distilling the last five years of work into a one to three page “personal statement.” A silver lining is that this forced reflection allowed me to put into words what I find the most valuable about my experience. In this process, I found myself writing recently, On a personal level, I have found mentoring to be one of the most rewarding aspects

of my academic life at Penn State, and will continue to do that as much as I can. Mentoring is not something that is only found in the halls of academic medicine. All physicians are teachers. We teach our staff, we educate our patients individually, and we inform society about public health issues in community groups of all shapes and sizes and in the media. Organized medicine reflects this. One of the AMA’s founding principles was to set standards for medical education. The Pennsylvania

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Medical Society’s (PAMED) original and current mission statements include a commitment to advancing medical knowledge and promoting the public health. This is also found in my county’s (Dauphin) mission statement, and I suspect this is found elsewhere thoughout the other county medical societies of Central Pennsylvania. Mentoring is a natural extension of this commitment to teaching. PAMED, the only voice that represents all physicians in the Commonwealth of

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The Joy of Mentoring

Pennsylvania, has a program called Mentoring Matters. The website says, “This volunteer program is designed to match physician mentees and physician mentors within common regions, specialties, or practice settings, based on the mentee’s needs and interests and the mentor’s abilities and experiences.” Although on some level, this program is “new.” It’s really more of a reboot. When I told Dr. Parikh I thought it was a good idea that PAMED was doing this, he smiled and said, “I remember taking part in this in the 1980s.” I’m sure our members with even longer institutional memories can describe past mentoring programs before that as well. Mentoring comes in more forms. Mentoring programs are a great start for people looking for advice, but I dare say a majority of mentoring takes place in informal relationships. Much of the best advice I received along my path has been in those settings, and I continue to seek out guidance during my “mid-career” as challenges and opportunities come and go. In some situations, I’m able to do something tangible for my mentor, but in most cases, I cannot. But I can “pay it forward.” I’ve personally had the good fortune of mentoring local high school students, undergraduate students, medical students, residents, fellows, and early career attending physicians. All of those opportunities do not exist outside of university hospitals, but many of them do. But what’s in it for the mentor? We’re all patients. We all benefit from investing in the medical community. It’s rewarding to

encourage bright high school and undergraduate students to choose medicine, but it’s equally valuable for a learner to shadow in a clinic before applying for medical school, because there is the occasional student who realizes after seeing clinical medicine that their best life decision is to go into something else that is often related, but that they will find more fulfilling. Likewise, medical students not only need to figure out which branch of medicine is best for them, but they also need specialty specific mentoring to help maximize their chance of matching into competitive programs. Residents, fellows, and early career physicians have struggles related to work-life balance, establishing a successful practice in a region they want to live, and for some to establish a niche that they can leverage into an academic career. Mid-career and later career physicians can struggle with work-life balance, the emotional impact of malpractice cases or physical illness,

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

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and developing leadership skills as some move up into management positions. End of career physicians have the challenge of navigating transition planning for their successful medical practice and the adjustment to the life change that comes with retirement. All students and physicians can benefit from mentoring, which means that all physicians of all ages could help by being a mentor. This means you! So, I encourage everyone, but especially PAMED physician members, to consider: If I have benefitted from mentoring in my medical career, how can I pay it forward? You’ll be glad you did! 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 https://www.pamedsoc.org/learn-lead/topics work-life-balance/MentoringMatters

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Restaurant Review

Luca reviewed by SARAH EISER, MD Lancaster Physicians For Women, LTD

estled on the corner of a treelined street, Luca is definitely the coolest restaurant in Lancaster! It is loud, but buzzing with energy and a very urban vibe that you would expect to find at a café in the West Village in New York. To dine at Luca, you can make a reservation using Opentable. com, but you’ll need to book pretty far ahead because it’s a popular place to eat! We made our reservation for 7:30 on a

Friday night and booked about three weeks ahead of time. When we arrived, the on-site parking lot, which is very small, was full. My husband dropped me off at the door and he parked the car along a side street, about two blocks away. Our table was ready immediately, and to my surprise, there was availability on the outdoor terrace, which I had not requested. We had great weather that night! The whole front of the restaurant is a glass garage-type door that opens up the entire restaurant to the terrace for open air

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dining—definitely one of the nicest features of the restaurant. The décor is clean, simple, and refreshing. The ceiling is high and vaulted, making the otherwise fairly small dining space feel airy. The tables are very small—think bistro set for a table for two—and very close together. This is a great place for a first date or a group of friends, but not for a quiet, intimate date night. The dress code is casual. People were wearing anything from yoga pants and loose-fitting tops to blazers and slacks.

Restaurant Review

The menu is small, reasonably priced, and changes with the seasons. The first time we ate there, our waiter, Joe, told us if we closed our eyes and pointed a blind finger at the menu, we would land on something delicious. He was right! We ordered a variety of food our first night, and again this time. We were lucky enough to have Joe as our waiter again, and he made the experience even better! He is funny and polite and knows the menu inside and out. The drink menu is somewhat limited, but if they don’t have what you ask for, they’ll direct you to something that will be a great alternative. We ordered three appetizers and two entrees. Of the three appetizers, I would wholeheartedly recommend the handmade burrata and the spiedini di maiale. I would have never ordered the spideini di maiale myself, as I had no idea what it is. The spiedini was a recommendation by Joe, and it was our favorite! It is a grilled pork skewer with braised greens and onion, and it was delicious. Our entrées were also delicious. We had a dish of crab spaghettini, which kind of reminded me of crab mac and cheese gone Italian. We also ordered the San Remo wood oven pizza. It is described as basil pesto, squash blossoms, mozzarella, ricotta, and parmigiano reggiano. It was very fresh and flavorful. There is no dessert menu, or at least not a printed menu. Joe rattled off a list of things that sounded delicious and then suggested two for us to share: a gelato sampler (pistachio, roasted sweet corn, and salted caramel) and fresh donut squares with raspberry and peach jam. They speak for themselves—so good! The roasted sweet corn gelato sounded a little strange to me, but it was actually very tasty, even more so when mixed with the other two flavors. My husband disagreed on that one. The donuts were soft, warm, and drizzled in the perfect amount of extra sweetness with the jams. The menu ranges from appetizers starting at $7 and entrees max at $17, so when our bill came we were pleasantly surprised at the total for the amount of food and drink that we enjoyed that night. Overall, Luca is a great addition to our city and I would definitely rank it in the top ten restaurants in Lancaster!

Luca

436 W. James St. Lancaster, PA 17603 717-553-5770 www.lucalancaster.com

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News & Announcements

42 Young Physicians Among The Best Earn Physician

40 UNDER 40 RECOGNITION

hen it comes to the practice of medicine and caring for patients, 42 physicians under the age of 40 won’t allow their youth to be a hurdle in what they can accomplish. In fact, the 42 physicians named to this year’s Physician 40 Under 40 by the Pennsylvania Medical Society have demonstrated a significant amount of success for someone so early into a medical career. Those selected were chosen by a committee of physicians after being nominated for outstanding contributions to the practice of medicine and the delivery of patient care, despite being early in their medical careers. According to Scott Shapiro, MD, president of the Pennsylvania Medical Society, this new award is one of several efforts by his organization to recognize the special place Pennsylvania has in training physicians and also to encourage physicians to stay and practice in Pennsylvania. Among other projects at the Pennsylvania Medical Society to encourage early career physicians to stay in the state are advocating for physician-led team-based care, meaningful tort reform, increased medical residency training positions, and medical school student loan forgiveness programs

for those willing to practice in rural and/or underserved areas of the Commonwealth. “These 42 physicians under 40 are trailblazers who are redefining the way we see health care,” says Dr. Shapiro, who likely is the youngest president in the history of PAMED at age 44. “In a state like Pennsylvania, the young talent we have throughout the health care spectrum is outstanding, but these individuals are going to be the ones to watch in upcoming years.” Three of the physicians recognized are members of the Lancaster City & County Medical Society: Daniel Schlegel, MD, Hershey – Dr. Schlegel is with the Department of Family and Community Medicine at the Penn State Hershey Medical Center. He serves as program director for the Penn State Hershey Family Medicine Residency Program, an accomplishment for a physician so early in his career. With his leadership, he also assisted in setting up the “Reach Out and Read” program that distributes age-appropriate children books to kids at well checkups.

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Adam Biuckians, MD, Lancaster – Dr. Biuckians is a child and adolescent psychiatrist with Lancaster General Health and Community Services Group, where he serves as medical director. He was instrumental in bringing the services of a board certified child and adolescent psychiatrist to Fulton County through telepsychiatry. He is also a consultant to Lincoln IU 12, providing evaluation and services to students in York and Adams counties. Kristina Newport, MD, Lancaster – Dr. Newport is a palliative medicine specialist with Lancaster General Hospital and Palliative Medicine Consultants. Currently, she is the task force chair for the Pennsylvania Department of Health Palliative Care Plan and for the Comprehensive Cancer Control Plan. Dr. Newport is described as a person who in every effort that she engages in “gives 100 percent to grow and execute any initiative she puts her force behind.”

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News & Announcements

MEDICAL SOCIETY FOUNDATION

ANNOUNCES SCHOLARSHIP WINNERS Three County Residents Awarded Funds for Medical School

he Lancaster Medical Society Foundation, a Foundation of the Lancaster City & County Medical Society, recently awarded its 2016 scholarships to Karla Verkouw of Lancaster, Christine Klingaman of Holtwood, and Gregory Troutman of Columbia. Verkouw received a $5,000 scholarship, while Klingaman and Troutman both received $2,500. They were selected from a talented pool of applicants from across Lancaster County. Verkouw is a first-year student at The Commonwealth Medical College in Scranton. She knew from experiences as a young adult that she wanted to pursue medicine as a career, but was unsure what direction that would take her. “In my youth, exchanging trust and compassion was a theme I experienced repeatedly between patient and caregiver,” she explained. “The mutual fulfillment of such relationships convinced me this was something I wanted to pursue, however, I was unsure which of the many ways to provide care to those in need would best utilize my strengths.” Before embarking on medical school, Verkouw worked as a nursing assistant and as a clinical research coordinator. Klingaman, a Lancaster native, is a third-year medical student at the Philadelphia College of Osteopathic Medicine. As an undergraduate, she completed an internship at Lancaster General, as part of the research team for the Heart & Vascular Institute—an experience that solidified her decision to go to medical school.

“Through my internship, I gained experience working with a unique group of patients and saw first-hand the progressive research and innovations that were being initiated right here in Lancaster County,” she said. “Being integrated into the hospital team gave me invaluable experience and insight into many realities of working in the medical field. While my studies have not taken me far from home, I would love to have the opportunity to return to practice in the area some day.” Troutman, a first-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University, officially announced his interest in a career in medicine during his kindergarten graduation. Inspired after learning a close friend would undergo surgery without feeling a thing, Troutman told the audience that he “wanted to grow up to be an anesthesiologist so I could help people not hurt.” “Although my knowledge and interest in medicine has matured since then, I still feel that childhood urge to heal.” Founded in 1991, the Lancaster Medical Society Foundation is a 501(c)3 nonprofit organization that was formed to grant scholarships to students from Lancaster County who are accepted at or continuing a medical degree at an accredited allopathic or osteopathic medical school.

MARK YOUR CALENDAR

Gregory Troutman

Christine Klingaman

Karla Verkouw

Scholarship recipients exemplify good character, motivation, academic achievement, and financial need. Since its inception, more than $214,000 in scholarships has been given to deserving local students. For more information about the scholarship, how to apply, or how to make a gift to the Foundation, please visit lancastermedicalsociety. org , then “Scholarship Foundation,” or contact the Society at 717.393.9588. Established in 1844, Lancaster City & County Medical Society (LCCMS) is a professional organization for physicians to network, share ideas and advocate locally. The organization is committed to supporting its mission to promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality patient-centered care in an increasingly complex environment. LCCMS works in conjunction with the Pennsylvania Medical Society (PAMED), the voice of Pennsylvania physicians, advancing quality patient care, the ethical practice of medicine, and advocating for the patients they serve. The organizations promote physician leadership, education, professional satisfaction, practice sustainability and the public’s health.

THE 2016 HOLIDAY SOCIAL AND SCHOLARSHIP BENEFIT

SATURDAY, DECEMBER 10

AT LANCASTER COUNTRY CLUB. DOORS OPEN AT 6:30 P.M. While there is no cost to attend, registration is requested. We hope you will join us for an evening of great food, entertainment, and networking—including a silent auction to raise funds for the Foundation. LANCASTER

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News & Announcements

Frontline Group Spotlight

MAPS Behavioral Health Services

APS Behavioral Health Services, a Community Services Group (CSG) outpatient program, provides psychiatric care for young children, adolescents, and adults. Services include initial psychiatric evaluations and ongoing medication monitoring visits. MAPS Behavioral Health Services also offers telepsychiatry (which allows a psychiatrist in a different location to

work with patients at the 790 New Holland Avenue office in Lancaster) and Spanish language services for children and adolescents. The practice employs over 25 clinicians, who offer initial assessments as well as individual, group, and family therapy. Its evidence-based practices include Parent-Child Interaction Therapy, Dialectical Behavioral Therapy (Adults and Adolescents), and

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Trauma-Focused Cognitive Behavioral Therapy. In addition, MAPS Behavioral Health Services provides therapy services on-site at 17 local schools, along with integrated Behavioral Health/Physical Health Interventions at SouthEast Lancaster Health Services. You can learn more at csgonline.com

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News & Announcements

FRONTLINE GROUPS | FALL 2016 Frontline Practice Groups (with three or more physicians) have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.

Allergy & Asthma Center

Lancaster Radiology Associates Ltd

Cardiac Consultants PC

LGHP – Manheim Family Medicine

Community Anesthesia Associates Community Services Group Dermatology Associates of Lancaster Ltd Eye Associates of Lancaster Ltd The Heart Group of Lancaster General Health Hypertension and Kidney Specialists

LGHP – New Holland Family Medicine LGHP – Susquehanna Family Medicine Manning & Rommel Associates

Southeast Lancaster Health Services Inc Southeast Lancaster Health Services-Arch St Southeast Lancaster Health Services-Hershey Ave Surgical Specialists Of Lancaster Wellspan Family Medicine Trout Run

OBGYN of Lancaster Otolaryngology Physicians Of Lancaster

Lancaster Cancer Center Ltd

Patient First - Lancaster

Lancaster Neuroscience and Spine Assoc

Pediatrix @ Heart of Lancaster Red Rose Cardiology

Lancaster Physicians For Women

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

In Remembrance...Deceased Members

Welcome…New Members Chelsea L. Cambria, DO Resident, Heart of Lancaster Regional Medical Center Danielle Cook Student, Thomas Jefferson University Hospital Jessica Duffy, Administrator Regional Neurology & Pain Management Associates Wendell E. Kellum, MD LGHP Care Connections Borko Kereshi, MD Resident, Lancaster General Hospital Victor Longo, DO Resident, Lancaster General Hospital

Shannon F. Scrudato, MD Resident, Lancaster General Hospital

Albert B. Wolbach, Jr., MD Albert B. “Bud” Wolbach Jr. MD, 83, a resident of Landis Homes in Lititz, PA, formerly a longtime resident of Ephrata, PA, passed away on Friday, July 1, 2016 after a lengthy illness.

Ann Sillaman, Administrator Doctors Eichenlaub & May Mark L. Simmons, MD LGHP-Internal Medicine Kim Sterner, Administrator Electrodiagnostic Medicine Group LTD Matthew J. Winfeld, MD Resident, Lancaster General Hospital Derek A. Woessner, MD Resident, Lehigh Valley Sports Medicine Lori Zerbe, Administrator Surgical Specialists of Lancaster

Patti J. Bearley, DO

Letha Klein, Administrator Eye Physicians of Lancaster PC Jeffrey R. Martin, MD LGHP Family & Maternity Medicine Emily Miller, MD Resident, Lancaster General Hospital

A very devoted student, Bud completed his undergraduate studies at the University of Pennsylvania in 1954 where he was a member of Phi Betta Kappa and went on to earn his M.D. from Jefferson Medical College in 1958 where he was in the Theta Kappa Psi Medical Fraternity. For over forty years, Bud operated his own family medical practice at his home in Ephrata. He held memberships in the American, Pennsylvania, and Lancaster Medical Societies and served as a Lancaster County Deputy Coroner.

Congratulations...Reinstated Members Gary S. Gehman, MD LGHP Abbeyville Family Medicine

Bud was born in Allentown, PA and his family later moved to Philadelphia where he graduated from John Bartram High School in 1950.

Michelle E. Naylor, MD Resident, Lancaster General Hospital Meera R. Ranganathan, MD Wellspan Pulmonary & Sleep Medicine Caitlin M. White, MD Resident, Lancaster General Hospital John C. Wood, MD LGHP Care Connections

Wondering how to keep up with important LCCMS and PAMED news and updates? Visit our website at www.lancastermedicalsociety.org

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News & Announcements

Member Spotlight

Robin Hicks, DO 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 am currently a third-year family practice resident physician at Heart of Lancaster Regional Medical Center (HLRMC) in Lititz. My fiancé, an internal medicine resident physician, and I both went to medical school at Lake Erie College of Osteopathic Medicine and we couples matched at HLRMC. We chose Lancaster because it is a wonderful area to live, a perfect mix for us between country and city, plus it is part way between my family in Massachusetts and his family in North Carolina.

I love being physically active by running, swimming, weight training, hiking, and skiing. Music is also a big part of my life, and I love singing with the Music for Everyone chorus, as well as with my sister and parents. I also play the flute and the trombone. Additionally, I love to bake, cook, and create interesting recipes. I also love traveling and spending time with my fiancé, family, and good friends.

Q: What do you like best about practicing medicine? 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 like many different aspects of practicing medicine. There is so much variety, and you literally never have the same day twice, especially in family medicine. More importantly though, I love practicing medicine because I am able to help improve my patients’ lives every day, using everything I have learned over my many years of training.

A: I initially became a member of the Lancaster City & County Medical Society because I was nominated by Dr. Stacey Denlinger to replace her as the HLRMC resident representative on the Board. I am so glad that I joined, because I have found that the medical society allows physicians from all over Lancaster County to communicate and work together, despite being employed by different institutions. I also value the fact that the Medical Society gives physicians of Lancaster County a collective voice to help induce change in the county as well as at the state level.

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

Y es, I am a member of the Music For Everyone Lancaster Community Chorus. We meet every Monday night and have numerous concerts throughout the year at churches, festivals, as well as retirement and nursing homes. I also am a member at the Universal Athletic Club.

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News & Announcements Lancaster General Health Events

WellSpan Health Lancaster County Events (con't)

Lancaster General Health October Community Blood Drives Please consider giving the gift of life by donating blood at any one of the following blood drives:

October Community blood drives dates/locations:

Tues., Oct. 11: Solanco High School, 585 Solanco Rd., Quarryville, 8 a.m. - 2 p.m. Wed.,Oct.12: LGH,555 N.Duke St.,3rd Floor Balcony James St.,Lancaster,11 a.m.- 5 p.m. Thurs., Oct. 13: Intercourse Fire Co., 10 N. Hollander Rd., Intercourse, 2-7 p.m. Tues., Oct. 18: Yoder’s Country Market, 14 S. Tower Rd., New Holland, 2-7p.m Wed., Oct. 19: Gordonville Fire Co., 3204 Vigilant St., Gordonville, 2-7 p.m. Thurs., Oct. 20: Lititz, 2-7p.m. Please call for details 717-544-0170 Tues., Oct.25: Bart Fire Co., 11 Furnace Rd., Quarryville, 2-7 p.m. Wed., Oct. 26: Kinzer Fire Co., 3521 E. Lincoln Hwy, Kinzers, 2-7 p.m. Thur., Oct. 27: Alliance Church, 425 Cloverleaf Rd., Elizabethtown, 2-7 p.m. Mon., Oct. 31: Hempfield High School, 200 Stanley Ave, Landisville, 8-2p.m. LG Health collects blood donations every First Thursday at LG Health Downtown Pavilion-Lab Testing, 540 N Duke St Lancaster by appointment. Call 717-5440170 to schedule an appointment. LG Health sponsors community blood drives each month throughout Lancaster County. Blood donors must be 16 years of age or older and weigh at least 110 pounds. Blood that is collected stays in Lancaster County to benefit members of our community. No appointments are needed. The LG Health Blood Donor Center hours are: Mondays from 10 a.m. to 7:30 p.m.; Tuesdays, 8 a.m. to 4 p.m.; Wednesdays, 8 a.m. to 6 p.m.; Thursdays, 8 a.m. to 4 p.m.; and Fridays, 8 a.m. to 6 p.m.

Stroke Awareness

Stacy Ettinger, disease management coordinator at WellSpan Ephrata Community Hospital, will be the speaker. To register call (855) 237-4222.

When: Tuesday, November 1 Where: In the chapel at Garden Spot Village, 433 S. Kinzer Ave., New Holland Time: 7 p.m.

Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center Events: Free Joint Pain Seminars

There may come a time when chronic hip and knee pain may reduce the quality of life. Everyday activities, such as walking, shopping, or housework can become difficult or unbearable. Taking part in favorite hobbies such as golf or bowling may be a thing of the past as conservative measures like diet, exercise, physical therapy and medications no longer provide relief or alleviate pain. Attend a free seminar to learn about joint pain and your treatment options.

When: Thursday, October 13, Thursday, November 10, Thursday, December 8 Where: Lancaster Regional Medical Center Auditorium, 250 College Avenue, Lancaster, PA 17603

Time: 6-7p.m. RSVP: Online or by phone 717-291-8498.

WellSpan Health Lancaster County Events

Neck and Back Pain Treatment Options Seminar

There may come a time when back or neck pain may reduce the quality of your life. Everyday activities, such as walking, shopping, or housework can become difficult or unbearable. Taking part in favorite hobbies such as golf or bowling may be a thing of the past as conservative measures like diet, exercise, physical therapy and medications no longer provide relief or alleviate your pain. If this is you, it may be time to consider spine surgery. You are invited to attend a free back and neck pain treatment option seminar.

Sleep Apnea: The Condition and Treatment Options Dr. Sheela Ahmed, of WellSpan Pulmonary and Sleep Medicine, will be the speaker. To register, call (855) 237-4222.

When: Tuesday, October 18 Where: Ephrata Public Library, 550 S. Reading Road, Ephrata Time: 6 p.m.

When: Wednesday October 26 Where: Lancaster Regional Medical Center Auditorium, 250 College Avenue,

Surgery for Weight Loss

The seminar will provide an overview of the WellSpan Bariatric Surgery program, including preoperative education, surgical procedures, medical weight management, patient expectations and outcomes. For more information, call (717) 721-8795.

Time: 6-7 p.m. RSVP: Online or by phone 717-291-8498.

When: Thursday, October 20 Where: WellSpan Cocalico Health Center, 63 W. Church St., Stevens Time: 6 p.m.

Lancaster Regional Medical Center: Orthopedic and Spine Program Open House

Lancaster, PA 17603

Are you or someone you know considering back, neck, knee, or hip surgery? Come see our new and improved designated recovery area for our spine and joint surgery patients.

3D Mammography

Dr. Heather Sholtis, obstetrician/gynecologist with WellSpan OB/GYN – Lancaster County, will be the speaker. To register, call (855) 237-4222.

Talk with dedicated staff about the many enhancements to the Orthopedic and Spine Program and experience the new Lincor “patient experience” system for yourself. It is a new system exclusive to Lancaster Regional Medical Center.

When: Tuesday, October 25 Where: Ephrata Public Library, 550 S. Reading Road, Ephrata Time: 6 p.m.

Find out why and how we are becoming the destination center for spine and joint surgery in Lancaster County.

Suicidal Behavior and Prevention

When: Tuesday, November 1 Where: 3rd Floor Orthopedic and Spine Program Area – Lancaster Regional

A free Mental Health Community Talk. For more information or to register, call (717) 738-6400 or (717) 738-6473.

Medical Center, 250 College Avenue, Lancaster, PA 17603

When: Tuesday, November 1 Where: Pine Conference Room, WellSpan Ephrata Community Hospital, 169

Time: 5:30-7:30 p.m. RSVP: Online or by phone 717-291-8498 before October 21, 2016.

Martin Ave., Ephrata

Time: 6 p.m.

This is a “drop by” event.

LANCASTER

PHYSICIAN

FREEDOM FROM VARICOSE VEINS Fall in love with your legs. At AVLC, we are committed to total vein care.

Tired, achy, painful legs? AVLC can help. Safely and effectively eliminate varicose veins without painful surgery. Treatments in the comfort of our facility. Walk in. Walk out.

Take the first step and call AVLC today! BEFORE

AFTER

Actual Patient Results

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

717-295-VEIN (8346) S934929

Hoffmann Publishing Group

Published on Oct 10, 2016

Lancaster Physician Fall 2016

Published on Oct 10, 2016

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