Lancaster Physician Winter 2014

PROTECTING PHYSICIAN APOLOGIES Legislation Signed by Governor

The Affordable Care Act:

Exploring New Coverage Options

ALLSPIRE HEALTH PARTNERS ALLIANCE Aims to Improve Health Care

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(from (from left: left: Andrew Andrew Tinsley, Tinsley, M.D., M.D., Walter Walter Koltun, Koltun, M.D., M.D., Emmanuelle Emmanuelle Williams, Williams, M.D., M.D., Marc Marc Schaefer, Schaefer, M.D.) M.D.)

(from left: Andrew Tinsley, M.D., Walter Koltun, M.D., Emmanuelle Williams, M.D., Marc Schaefer, M.D.)

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Contents

2014 BOARD OF DIRECTORS OFFICERS

WINTER 2014

Paul N. Casale, MD President The Heart Group of Lancaster General Health

Christopher L. Hager, MD Immediate Past President Lincoln Family Medicine

James M. Kelly, MD President-Elect Lincoln Family Medicine

The Affordable Care Act A guide to help you in pointing your patients in the right direction as they explore their coverage options.(p.23)

David J. Simons, DO Vice President Community Anesthesia Associates

C. David Noll, DO Secretary Ephrata Community Hospital

Part 2

Stephen T. Olin, MD

Long Term Care

Treasurer Lancaster General Hospital

Featuring Willow Valley Retirement Communities. Part two of a series focused on the long term care options in Lancaster County. (p.11)

DIRECTORS John A. King, MD Elected Director Three Years General Internal Medicine of Lancaster

Laura H. Fisher, MD Elected Director Two Years Lancaster Family Allergy

Robert K. Aichele, DO Elected Director One Year Aichele & Frey Family Practice Associates

Stacey Denlinger, DO Elected Resident Two Years Heart of Lancaster Regional Medical Center Residency Program

Shawn F. Phillips, MD

Protecting Physician Apologies Gov. Tom Corbett signed into law legislation preventing most physician apologies from being used against them in a medical liability lawsuit. (p.26)

Elected Resident One Year Lancaster General Hospital Family & Community Medical Residency Program

Venkatchalam Mangeshkumar, MD International Medical Graduate Representative Neurology & Stroke Associates

Charles A. Castle, MD Lancaster County Business Group on Health Representative Lancaster General Health

Karen A. Rizzo, MD, FACS PAMED Officer Liason Lancaster Ear, Nose & Throat

Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS).

The Lancaster City & County Medical Society’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.

Best Practices

In Every Issue

6 Athletic Concussions 11 Caring for the Long Term 14 Ephrata Hospital Renovations 16 Cancer Screenings 19 Professional Appearance

20 23 26 32 34 37 38

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Reading PA I HoffmannPublishing.com 610.685.0914 I kay@hoffpubs.com

Healthy Communities Patient Advocacy Legislative Updates Restaurant Review News & Announcements Member Spotlight LMS Foundation Updates

Editor-in-chief: Kelly Lyons, Executive Director, LCCMS Editors: Laura Fisher, MD, Lancaster Family Allergy James Kelly, MD, Lincoln Family Medicine

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

Executive Director’s Message

2013: A Year in Review 2013 WAS A GOOD YEAR FOR PENNSYLVANIA PHYSICIANS

“Thank physicia you to the manage ns, practice rs, who ext and readers e congratu nded their lati job well ons on a done.”

2

013 was a good year for Pennsylvania physicians. Through the advocacy efforts of both the Pennsylvania Medical Society and the Lancaster City & County Medical Society, several laws affecting all Pennsylvania physicians were passed or moved toward Governor Corbett’s desk. Successes include:

• Apology Bill – Thanks in large part to PAMED and LCCMS members, the so-called “Apology Bill”, now Act 79 of 2013, was signed into law by Gov. Corbett in October.

(Read more on page 9.)

• Physician Assistant Bill – On November 27, 2013, Gov. Corbett signed two bills into law that will permit the Physician Assistant counter-signature requirement to be relaxed under appropriate circumstances. PAMED and the Pennsylvania Society of Physician Assistants support this legislation as it ultimately increases access to care through physician-led, team-based care.

• Controlled Substance Database – A bill that would create a controlled substance database (to give physicians better knowledge of prescriptions written for and filled by patients) is one step closer to becoming law. The success is a result of two years of efforts by PAMED and its county societies’ members who recognize the value such a database would have on reducing doctor-shopping and controlled substance abuse. The Medical Society’s “Pills for Ills, Not Thrills” campaign played a major role in public support for this legislation. PAMED is working to reconcile differences between House Bill 1694 and Senate Bill 1180 to make this important tool a reality for Pennsylvania physicians.

As we start 2014, the Medical Society will be advocating for physicians on several issues, including:

As always I want to engage you in the conversation, and we welcome you to suggest topics that will serve the interests of the Lancaster medical community and your patients. Please contact me at: klyons@lancastermedicalsociety.org or 717.393.9588.

• Team-Based Care – With millions more Pennsylvanians gaining health insurance as the Affordable Care Act (ACA) goes into effect, physicians want to be sure that patient care is team-based and physician-led.

• Healthy Pennsylvania – Gov. Corbett’s package of initiatives that supports pro-physician, pro-patient measures.

• Voluntary Reporting of Psychiatric Bed Capacity – Working with partners in psychiatry and emergency medicine, PAMED supports a program for hospitals to voluntarily report their psychiatric bed capacity.

• Loan Forgiveness and Residency Slot Expansion – The proposal will endorse increased medical student debt forgiveness, which has been a long-time goal of the Medical Society. In addition, a proposal to provide additional funding to increase the number of in-state primary care residency slots is being pursued.

To learn more about the successes and goals of both the Pennsylvania Medical Society and the Lancaster City & County Medical Society, visit our websites: www.pamedsoc.org or www.lancastermedicalsociety.org.

lancastermedicalsociety.org

The Lancaster City & County Medical Society sincerely thanks our member physicians for their support of these efforts — current and future. If you’re not yet a member, join us. You’ll gain access to educational resources, practice management support, and networking opportunities with colleagues. This is your medical society — add your voice, make a statement, and shape the practice of medicine in Pennsylvania. Best wishes for a happy, healthy, and successful New Year!

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Healthy Communities

Life-changing diagnosis.

Game-changing treatment.

A breast cancer diagnosis can put your entire life on hold.

At the Ann B. Barshinger Cancer Institute, we personalize each care plan by using your own biology and genetics.

This ensures each patient has the most appropriate treatment for the best possible outcome. And, through membership in the Penn Cancer Network, we offer access to cancer research and more surgical options for breast reconstruction. It’s the smart choice for breast cancer care, so you can get back in the game.

Visit LGHealth.org/breastcancer to learn more about breast health and breast cancer prevention and treatment.

Choose well. Be well.

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MEMBER

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best

pr ctices Athletic Concussions Caring for the Long Term Ephrata Hospital Renovations Cancer Screenings Professional Appearance

Concussions in Lancaster County Athletes FOCUS ON PREVENTION, EARLY DETECTION, AND FULL RECOVERY ARE KEY TO BETTER OUTCOMES CHRISTOPHER KAGER, MD, FACS

C

oncussions are defined as disturbances in brain function caused by trauma. They are generally thought of as “minor traumatic brain injuries,” as they do not require a direct blow to the head to occur, but they can have significant negative short-term and long-term effects. Concussions involve an alteration in consciousness, generally due to complex pathophysiologic processes,

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Winter 2014

Best Practices including direct injury to neurons and changes in cell permeability, as well as cerebral blood flow. Electrolyte and metabolic changes also occur leading to varying levels of damage and varied recovery phases.

As neurosurgeons and psychiatrists in Lancaster County, the physicians at Lancaster NeuroScience and Spine Associates are both the frontline and the last resort for athletes with concussions. Nationwide, there are an estimated 2 million sports-related “minor traumatic brain injuries,” or concussions, each year. Approximately 3000 of those cases occur in Lancaster County. Many of them are never recognized or reported. When these patients are evaluated, the vast majority of cases seen are in youth sports participants under the age of 19. Males account for the vast majority of cases. But when you factor in the number of male athletes compared to female athletes, females may have a higher rate of sports related concussions, particularly in sports such as basketball and soccer. Females are also generally more susceptible to prolonged recovery, and it is not clear why this is the case. Physical or hormonal factors may be responsible. Younger age of patients is associated with higher incidence of concussion and a more prolonged recovery, possibly due to physical and developmental factors. Of all sports, football has the highest rate of concussions; however, soccer, basketball, and lacrosse are also very common sports in which athletes sustain concussions.

One major concern we face when treating Lancaster County athletes is safety and the ability of being able to return to play. Jeff presented to our practice following a lacrosse-related concussion while playing for the Manheim Township varsity team. He was evaluated and was neurologically normal. He did, however, have symptoms, particularly

SAFETY

In Youth Sports Act Patrick Moreno, MD, CAQSM Team Physician, Lancaster Barnstormers Medical Consultant, USA Field Hockey East Petersburg Family Medicine

headache, with physical exertion. He was taken out of practice and games, but was slowly progressed as his symptoms improved. Within two weeks, he was able to return to play. He has not suffered another concussion and is now playing college lacrosse. Proper recognition of his concussion and early evaluation and treatment were the keys to allowing him to safely return to school and sports. Most Lancaster County athletic directors and head coaches are well-versed on the problem of concussion in sports, and there are many online resources for players, parents, coaches, and physicians involved in the care of these athletes. Baseline neuropsychologic testing (IMPACT) and neuropsychology services are available in Lancaster County and can make a tremendous difference in the evaluation and progression of athletes with concussion.

The early symptoms of concussion are numerous and vary widely from case to case. They can include typical symptoms of headache, nausea, visual changes, and signs of confusion, amnesia, and disorientation. Long term symptoms can include these and other Continued on page 8

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In the school-aged population, the primary goals in treating sports-related concussion (SRC) are to prevent permanent brain damage and to limit the impact on academic performance. To this end, it takes coordination of care between athletic trainers, coaches, teachers, parents and the clinician.

Many schools in Lancaster County have developed a policy for handling concussed athletes thanks in part to the recently passed Safety in Youth Sports Act. This piece of state legislation stipulates that athletes may return to play only after being cleared by a licensed physician (or their designee) trained in evaluation and management of concussion.

While most SRC’s will resolve in the athletes will have symptoms that last days to months longer. The management of these cases may require balance therapy, speech therapy, neuropsychological assessment, or even pharmacologic intervention.

Many local school districts use a form of computerized neuropsych testing (most commonly ImPACT) to assist in the management of concussed athletes. While this type of testing may serve as a helpful tool, it should never be used by itself to diagnose concussion or clear an athlete to return to sports. Every concussion is practitioner must synthesize available information and tailor the treatment of the concussed athlete.

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complaints such as irritability, depression, anxiety, emotional liability, and restlessness. Post-concussive syndrome refers to the ongoing presence of symptoms for weeks, months, or years after the initial injury. The medical literature suggests that 60% of patients have persistent symptoms at one month post-injury and 15% of patients still have ongoing symptoms at one year. It also has been shown that athletes suffering one concussion are six times more likely to suffer a second concussion. Additionally, pro football players with multiple concussions are three times more likely to suffer from depression, and 19 times more likely to develop Alzheimer’s disease or other memory-related diseases.

The treatment of concussion is generally rest, which allows the brain to heal. It appears that appropriate mental and physical rest can contribute to improved rates and odds of full recovery. No patient should return to play or vigorous activity while signs or symptoms of a concussion are present.

It is recommended that athletes not return to play on the same day as the injury. Treatment and activity recommendations must be tailored to the individual patient based on whether post-concussive symptoms persist with exertion. Neuropsychologic testing both at baseline and post-injury can also help guide the return to play recommendations. Second impact syndrome can occur when an individual, generally under 18 years old, has not completely recovered from a prior brain injury. A second concussion during this period of increased vulnerability can cause a loss of autoregulation of cerebral blood flow, with consequent vascular engorgement, increased intracranial pressure, and herniation of the brain. Second impact syndrome carries with it a grim prognosis, namely significant brain damage and a mortality rate nearing 50%.

Athletic Concussions

The prevention of concussions in sports is somewhat controversial. Proper protective gear is recommended, and appropriate headgear has been shown to decrease the rate of concussions in athletes. Mouth guards may also offer some protection against concussion in contact sports. Proper athletic technique, such as proper tackling in football, is also important, and should be taught as early as possible in all sports.

In summary, sports-related concussions remain a significant problem in athletes, and a potential source of long-term morbidity. Proper early recognition and treatment are required for optimum recovery and function. No athlete should return to play until properly evaluated and medically cleared, including a progression of activity. Baseline and post-injury testing may also be helpful in guiding return to play recommendations.

January Lancaster Physician

Learn more at

lancasterneuroscience.com SOURCES: http://iom.edu/Reports/2013/Sports-Related-Concussions-in-Youth-Improving-the-Science-Changing-theCulture/Report-Brief103013.aspx http://www.cdc.gov/concussion/sports http://www.clearedtoplay.org/concussion-information/concussions-by-the-numbers http://www.lancastergeneralhealth.org/LGH/Our-Services/Outpatient-Services/Brain-and-Nervous-System/Concussion-Management/About-the-Program/Testing – Treatment.aspx http://www.jlgh.org/Past-Issues/Volume-3 – Issue-3/Concussion-Not-so-Minor-an-Injury.aspx http://lancasteronline.com/article/local/705433_Heading-off-concussions.html

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Winter 2014

Leasing

Management

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Construction

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Perfect office location makes practice.

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Winter 2014

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ian Lancaster Physic ongoing series...

CARING FOR THE LONG TEstRerM County

Part 2

In Lanca

It’s one of those things people never want to think about until they, or a loved one, need long term care. It is also one of those things that is much easier to talk about and research before you, or a loved one, actually need it. This series features long term care options in Lancaster County.

It is aimed at providing insight for your patients so you can be better equipped to guide them through this major change in their families’ lives.

Willow Valley Communities is comprised of two campuses, Lakes and Manor. Each boasts miles of walking paths, sparkling ponds, and stunning views. Lush landscaping provides an ever-changing tapestry of color and texture.

Willow Valley Retirement Communities DANA D. MYERS

I

t’s one of those things people never want to think about until they—or a loved one—need it. But long-term care is something much easier to talk about and research before you’re faced with making a life-changing decision.

This ongoing series in Lancaster Physician magazine features long-term care options in Lancaster County.

Through it, we aim to provide insight to physicians and the patient community so people can be better equipped to navigate this major change in their families’ lives.

Lancaster County has the largest number of senior living communities of any county in America. Right or wrong, people have perceptions of each community. That’s why we’re talking

with the administrations of different Lancaster County facilities to set the record straight about retirement living in general and to share what individual facilities offer to those seeking longterm care.

Life Lived Forward “People don’t come here to die, they come here to live,” said David HaverContinued on page 12

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Caring for the long term

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That means that residents’ costs are dependent upon the initial size of their first apartment. That monthly fee does not ever change. The one phrase we hear so often is, ‘I never thought I could afford to live at Willow Valley.’

My recommendation for families is to compare many different options. People are often surprised at how favorably we compare from a cost standpoint.

Never discount a community based on your perception because, as we so often see, people’s perceptions can be inaccurate.”

stick, COO, Willow Valley Retirement Management, Inc. “That’s why we just went through a rebranding and came up with our new tagline, Life Lived Forward. ‘Retirement’ means withdrawal…pulling back…that’s not what we’re about.”

The mission of Willow Valley is to enrich the life of each resident. The staff considers the unique needs of each person. From the 70-year-old husband and wife who don’t want to be tied down with home responsibilities to the 90-year-old widow in skilled care, the staff gets to know the residents and their past experiences. Individuals discover what is important to them and what types of activities make them the happiest. To ensure each life is enriched by living there, Willow Valley makes specialized attention a priority.

Willow Valley is one of the largest single site communities in America. With 1,500 independent living residences and 505 supportive living ‘life care’ residences (including skilled, personal care, and memory support), Willow Valley is home to 2,400 residents.

Willow Valley’s expansiveness does not, however, get in the way of personalized attention. According to Haverstick, “We use our large size to provide the broadest range of services and amenities to our residents.”

Willow Valley employs a multigenerational model to provide residents with activities not only for them, but also for their children and grandchildren.

“People also have the idea that if you are not already in an apartment at Willow Valley, you cannot be accepted into skilled care,” shared Kendall Hunsicker, Vice President of Healthcare. “People can enter Willow Valley at whatever time in their life they need us.“

“Lancaster County Has the Largest Number of Senior Living Communities of Any County In America”

Willow Valley also offers short-term respite care for a person needing extra help after a hospital stay, or if a family is going out of town for several days.

Respite care has the added benefit of giving prospects the chance to “try it before they buy it” by giving them a flavor of what life would be like at a retirement community.

Some of the most popular features of the community include the Cultural Center, Fitness Center (designed by an NFL trainer), and the state-of-the-art Aquatic Center. A Club House and the Arcade are also on the horizon to broaden Willow Valley’s appeal to diverse ages and tastes.

The community’s size and personalized attention doesn’t equate to high entrance costs and monthly fees. “One of the major misconceptions about Willow Valley is that it is only for the very wealthy. That is simply not the case.

Willow Valley is surprisingly affordable,” explained Haverstick. “Our financial model is ‘life care by the square foot.’

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According to Hunsicker, “There is another level of care at retirement communities between skilled and independent, and it is often ideal for patients who are discharged from the hospital. Personal care provides LPNs for individuals who are ambulatory but still need assistance. It also offers residents more freedom while better preparing them to move back to their own homes.”

Like some other local communities, Willow Valley embraces the concept of Resident Centered Care. That means they schedule daily events according to each resident’s preferences. If a resident must take medications each morning, the medications are given when the resident wants to wake up—not at a set time because it’s more convenient for

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Caring for the long term

the nurses.

“The key in selecting a retirement community is doing your homework,” suggested Hunsicker. “The Center for Medicare and Medicaid Services (CMS) has a five star rating for retirement communities. I know if I were looking for a community for a family member, I would only look at 4 or 5 star communities.” CMS ratings include information about health inspections, staffing, and quality measures.

“People often say, ‘I really waited too long to come…I thought it was something for old people…my life is so much better now’,” Hunsicker said.

“That’s because we remove the typical stresses that come with growing older.

When you are in a community that offers life care, you know you will be taken care of and you will not be a bur-

den. You know that even if your spouse passes away, you will still have a place to live and have friends who are nearby. People feel more relaxed, more secure, and they actually live longer than they might if they were burdened by those worries.”

Hunsicker said if she could offer one piece of advice for physicians to share with their patients, it’s to encourage them to begin thinking about their retirement years long before it’s time for retirement. People will benefit by doing their homework and comparing their options. When proactive about

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their long-term care, they have more of an opportunity to take advantage of — and enjoy—all their community has to offer.

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

Photos courtesy of Benchmark Construction

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Newly Renovated Ephrata Community Hospital Emergency Room OFFERS HIGH-TECH CARE & WELCOMING ENVIRONMENT DANA D. MYERS

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hile an unexpected trip to the emergency department is never a pleasant experience, Ephrata area patients may be surprised by the updated facilities in place to make their emergencies a bit less alarming. The first phase of the newly renovated Ephrata Community Hospital Emergency Department opened

to patients in April 2013, and the final phase was completed in October.

The primary goal of the renovations was to create a superior medical facility and to provide the hospital’s over 30,000 patients annually with the best possible care. Wireless patient monitoring was incorporated to allow staff to

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quickly move a patient from department to department or to diagnostic testing without losing any critical data for the patient medical record. That advancement provides for ongoing collaboration and treatment of the patient.

The facility also added stretchers with built-in scales, overhead bariatric lifts,

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for stroke care. Working in conjunction with specialists at Penn State Hershey Medical Center, neurologists remotely evaluate patients who have had acute strokes and make diagnoses and treatment recommendations. Physicians communicate using digital

“Our care for our patients has always been at the highest level and now we have the technology to match it.” video cameras, internet telecommunications, robotic telepresence, and other technologies. That allows patients to have prompt neurological evaluations and increases the possibility that they receive thrombolytics or other clot-retrieving procedures in time to reduce disability and death resulting from stroke.

Orie Chambers, RN, Emergency Department (ED) Unit Manager, said, “Our staff is very happy with the new department as well as the new equipment and technology that we have introduced to help them to better care for the patients. Our care for our patients has always been at the highest level and now we have the technology to match it.” end tidal CO2 measurement, and Skytron LED procedure lighting (which doesn’t produce uncomfortable heat on the physician during a complex suture and allows for different levels of light exposure). Special areas for crisis behavioral health patients enable staff to keep patients in a protected environment until they are safe.

Tele-medicine, the use of electronic communication methods (such as telephone, internet, and videoconferencing) to exchange medical information from one geographic site to another, is a growing trend among hospitals. With its renovation, Ephrata Community Hospital incorporated telestroke, which is the use of telemedicine specifically

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The hospital has gotten positive feedback from patients, staff, and physicians alike who are thrilled with the new ED. All have commented that it is warm, welcoming, and open.

“We feel proud to offer the Northern Lancaster Community a high-tech option for their emergency needs.” said Chambers.

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Colon Cancer Screening Saves Lives CARL G. COLTON, M.D. Regional Gastroenterology Associates of Lancaster (RGAL)

C

olorectal cancer (CRC) is common and often fatal. The lifetime incidence for patients at average risk is 5 percent, with 90 percent of cases occurring after age 50.

In the United States, CRC is the second leading cause of cancer death and accounts for approximately 9 percent of cancer deaths overall [1]. Worldwide, CRC is the second most commonly diagnosed cancer in women and third most common in men, accounting for over 600,000 deaths in 2008 [2].

Approximately one in three people who develop CRC die of this disease.

Most colorectal cancers (CRCs) arise from adenomas, many of which are polyps that progress from small to large (>1 cm) polyps, and then to dysplasia and cancer. Polyps and cancers are distributed almost evenly throughout the colon and rectum, but tend to be more proximal in women and with increasing age. For that reason, the ideal screening tool for detecting colon cancer inspects the entire length of the colon. Most colorectal polyps are either adenomatous or hyperplastic.

These cannot be distinguished reliably

by gross appearance; biopsy is required for diagnosis. Hyperplastic polyps usually do not progress to cancer.

Two-thirds of polyps are adenomas and thus contain malignant potential. Adenomas are found in about 25 percent of men and 15 percent of women, and the prevalence increases with age [3].

Data has suggested that approximately 30% of those aged 60 and 40% of those aged 70 harbor adenomatous polyps.

Therefore, any screening tool that detects adenomatous polyps and removes these polyps has the potential to save lives. Because polyps and colon cancer are so common, the impact of screening for CRC is tremendous.

Removal of polyps saves lives; it has been demonstrated that removal of adenomatous polyps prevents cancer. The National Polyp Study Work Group followed 1418 patients in whom colonoscopic examination led to the removal of one or more polyps [4]. During a mean follow-up of six years, the incidence of colon cancer was 88 to 90 percent lower than in patients reported in other studies who had polyps that were not removed and 76 percent lower than in the general population.

Unfortunately, screening rates for CRC, although rising in the United States over the past few years, are generally below national targets, despite evidence that screening reduces colon cancer mortality [5]. In 2012 in the United States, 65.1 percent of adults

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between ages 50 and 75 years were up to date with CRC screening, and 27.7 percent had never been screened [6].

Colonoscopy was the most commonly used screening test (nearly 62 percent).

Because approximately 35% of adults are not up to date with their CRC screening, tremendous potential exists to significantly impact mortality from CRC. Unlike other screening modalities such as fecal occult blood testing, barium enema, or CT colonography, colonoscopy possesses the unique ability to both inspect the colon and remove any polyps discovered during examination. If sigmoidoscopy alone is used as the screening mechanism, approximately one-half of all polyps would be completely missed. The American College of Gastroenterology now considers colonoscopy the preferred screening test when available.

In 2008, The United States Preventive Services Task Force issued updated guidelines for colorectal cancer screening. They recommend screening beginning at age 50 and continuing until at least age 75 [7]. Screening colonoscopy should be performed every 10 years unless adenomatous polyps are detected.

If polyps are found, then repeat colonoscopy should be performed generally every 3 to 5 years, dependent upon the number and size of polyps removed. In patients with a first-degree relative with colon cancer or adenomatous polyps, screening should begin at age 40 or 10 years earlier than the age of diagnosis in the first-degree relative, whichever comes first.

Since it is estimated that 35% of patients are not current with their screening for colorectal cancer, it has become an important preventive maintenance item that primary care physicians are tracking as a quality measure. Developing a system to identify patients needing CRC screening is important and saves lives. Screening colonoscopy

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generally is covered in total by insurance companies.

Gastroenterologists at Regional Gastroenterology Associates of Lancaster (RGAL) are very involved in the CRC screening process. Our adenomatous polyp detection rate meets or exceeds national standards. Through the use of propofol for sedation and CO2 for insufflation of the colon, the procedure itself has become much more tolerable for the patient as compared to just a few years ago. Patients are asleep, and the use of CO2 instead of air to insufflate the colon results in less bloating and gassiness post-procedure.

Currently, RGAL is the only practice in Lancaster County using CO2 in its office-based endoscopy facilities.

Additionally, RGAL is using preparations for the procedure that require less volume and are more palatable than preps historically used.

In conclusion, it is clear that screening for colon cancer significantly impacts both the incidence of colon cancer and resultant mortality. This impact will be greater if a process exists to identify those needing screening. The coordination of care between the family physician and the gastroenterologist with respect to colon cancer screening and other digestive health issues can improve the quality of life for patients, including saving a life.

REFERENCES 1. Siegel et al. Cancer statistics 2013. CA Cancer J Clin. 2013 Jan; 63(1):11-30. Epub 2013 Jan 17.

2. Jemal et al. Global cancer statistics. CA Cancer J Clin.

2011; 61(2):69.

3.

306(12):1352.

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4.

ABOUT THE AUTHOR Carl G. Colton, M.D., is a board -

5.

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6.

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7.

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HEALTHCARE IS CHANGING. READING HEALTH IS READY.

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Winter 2014

Best Practices

DRESS CODES AND RELATED EMPLOYEE APPEARANCE ISSUES: Clear and Well-Communicated Policies are the Best Policy ROBERT D. ORZECHOWSKI, MBA, SPHR CHIEF OPERATING OFFICER, LANCASTER CANCER CENTER

Greater exceptions may exist within public sector entities or when employees are covered by a collective bargaining agreement.

O

ne of the most challenging issues for Human Resources is how best to align the company’s policies regarding appearance, grooming, and hygiene with business necessity, safety, legal compliance and reasonable accommodation.

The purpose of this article is to identify the substantive aspects of HR dress and appearance policies that should be considered when employers communicate what their firms consider appropriate.

Policies covering these issues are generally accepted to be the sole province of the employer, with attention to state and federal laws and regulations.

Any policy should be written clearly and include its purpose, a summary, scope (who is covered by it, specific departments, eligibility, etc.), relevant definitions, and the actual policy narrative. This last part should include the basic course of action or general approach designed to achieve the results desired. Finally, these policies should direct employees to seek management’s guidance or approval if the appropriateness of any specific course of action or employee decision may be in question. In many cases, management should reserve the right to send an employee home to correct a policy violation before returning to work if a compromise cannot readily be found.

Business necessity should be the driving force when developing such policies.

This standard can range from safety (no open-toed shoes) to comfort (shorts for delivery personnel in hot weather) to company branding, i.e., uniforms or formal business attire and a clean, professional image. In many workplaces, attire that is too provocative must be addressed immediately by the employer to minimize issues of harassment. Dress code policies reinforce company culture and values, and each job description should include clear and valid requirements for a particular dress and grooming standard.

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Directly related issues include responding to employee requests for accommodation for health or religious reasons, or for reasons related to other factors that place the employee in a protected class. This can include headwear, jewelry, hair placement or length, and allergic reactions to certain materials.

Policies must also strive for fair treatment of both genders, all races, and any employee in a protected class; policies cannot be unnecessarily burdensome for one sex or group. A more contemporary dimension includes the topics of sexual orientation and transgender employees. As with any accommodation, employers should make good faith efforts to identify and implement them. The exception, of course, is if the accommodation creates an undue hardship for the employer.

Personal grooming and hygiene are topics usually addressed in related policies. Topics will include standards of cleanliness, naturally occurring hair colors, hair length, absence of unpleasant body odor, use (or prohibition) of personal fragrances and other grooming products, visible body piercings and body art. HR must have the communication skills necessary to address real or potential violations with employees in a professional manner.

Many of today’s workforces are widely diverse, and companies would be wise to reexamine their appearance and grooming policies to accommodate this diversity. Employers should strive for a culture of respect, open communication, fair and reasonable treatment, and a genuine concern for employee safety and productivity. This is simply good business and sound human resource management. Finally, all HR policies should receive legal review on a regular basis.

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

Healthy Communities

AllSpire Health Partners Alliance AIMING TO IMPROVE HEALTH CARE QUALITY, AFFORDABILITY AND ACCESSIBILITY

are ranked within the top 10 in their state, and more than 20 specialties within those hospitals are ranked by U.S. News and World Report as among the top 50 in the nation.

Karen J. Kessler, chairperson of the Board of Trustees of AllSpire Health Partners said the partnership is expected to transform how health care is delivered. “This is the first step in a new chapter that will propel us to transform health care delivery,” Kessler said.

“This consortium will produce seven cutting-edge health systems working in tandem, giving patients greater access to best-in-class health care services. This is the future of health care.”

Member institutions have already begun planning and working together to meet that goal. Lancaster General’s College of Nursing is offering classes in the Lehigh Valley for registered nurses who wish to pursue a bachelor’s in nursing degree. Other joint initiatives, including looking at group purchasing and lab services to see how costs can be decreased, are also underway.

BY SUSAN SHELLY

T

he way health care is provided is poised to change dramatically, and health care providers are being called upon to be proactive in order to meet the expectations placed upon them.

Lancaster General Health is one of seven health care systems that joined together recently in an effort to improve the quality and affordability of health care, and to assure that care is accessible to as many people as possible. The Reading Health System and Lehigh Valley Health Network also are

members of the health care alliance known as AllSpire Health Partners.

The goal of the alliance, according to an AllSpire press release, is to “improve the quality, affordability and access to health care by sharing clinical, intellectual and economic capabilities.”

AllSpire Health Partners is the largest health care consortium in the country, with a service area of more than six million people and combined revenues of $10.5 billion. AllSpire encompasses 25 hospitals within the seven hospital systems. Among these hospitals, many

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While recognizing the task ahead of them is colossal, health care leaders are enthusiastic about the opportunities they envision the alliance will afford.

Thomas E. Beeman, President and CEO of Lancaster General Health, sees the possibilities presented by the AllSpire alliance as inspiring and exciting. “As health care progresses from a fee-for-service approach to a fee-for-value approach, health care providers are going to have to adapt and be creative in managing costs while improving services,” Beeman said.

AllSpire will give member institutions the ability to share best practices, knowledge, and learning resources; to use their combined purchasing power to decrease the cost of goods and services; and to better manage population health. “We all share a common desire to serve our communities and the common good,

Winter 2014

Healthy Communities

because health care systems realize they need to work together to meet the challenges before them. He believes the systems that can work collaboratively to lower costs while enhancing patient outcomes will benefit greatly.

While the alliance’s health care providers can combine their buying power, share best practices and engage in other means of offering affordable, high quality care, each institution remains independent. “One of the benefits of the AllSpire Health partnership is that we’re able to collaborate to achieve

Lancaster General Health

and we’re excited about these opportunities,” explained Beeman.

Dr. Robert W. Swinfard, President and CEO of Lehigh Valley Health Network, agreed with Beeman that there is great opportunity ahead for health care providers. “The AllSpire partnership,” Swinfard said, “will help providers to move into the future by strengthening their abilities and helping them achieve the goals of the Institute for Healthcare Improvement’s (IHI) Triple Aim.”

Lehigh Valley Health Network

Affordable Care Act is to get patients more engaged in their own care.

The IHI Triple Aim, a framework designed to optimize the performance of health systems, calls on health systems to simultaneously pursue the following:

Swinfard believes health care providers will need to work toward that initiative in a creative and proactive manner, and that they can benefit from sharing ideas about what works and what doesn’t.

Improve the patient experience of care (including quality and satisfaction). Improve the health of populations. Reduce the per capita cost of health care.

“Won’t there be better brainpower when people from seven institutions are sitting down to discuss these kinds of issues?” asked Swinfard. “We all have smart people, but our strengths vary from area to area. We need to share and then implement our best practices.”

The IHI Triple Aim goals overlap significantly with the goals of the Patient Protection Affordable Care Act, also known as “Obamacare.” A major initiative of both Triple Aim and the

D. Clinton Matthews, President and CEO of Reading Health System, said the AllSpire alliance was created

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economy of scale while maintaining our independence and autonomy to function within our respected markets,” Matthews said.

Swinfard affirmed nearly everyone agrees that changes to the U.S. health care system are necessary and long overdue. While health care providers work to get patients more involved in their own care through education and engagement, they will also become increasingly accountable for the health outcomes of those patients. The process will be extremely challenging, but also very rewarding.

“This is a major change,” Swinfard said. “This health care paradigm shifts Continued on page 22

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

Healthy Communities

Improving the Health Care System

Reading Health System

responsibility toward educating patients, which will not be easy. But, it’s a journey that we’ll be on with the other partners in AllSpire. That should make it smoother for all of us.”

Lancaster General Health’s Beeman agreed. While daunting,

the impending changes in the way that health care is delivered, received and reimbursed have great promise. “I have been in health care for more than 35 years, and this is the most exciting time I’ve ever seen,” shared Beeman.

This level of care means early detection could reduce our patients colorectal cancer risk by 90%.

With more precise screening methods, the odds are in our patients favor.

Talk with LGI today.

Beat the Odds.

AllSpire Health Partners is an alliance of seven health care systems. Together, the systems’ 25 hospitals serve patients, families, and communities in Pennsylvania, New Jersey, New York, and Maryland.

Highest polyp detection rates in the nation.

Participants include: • • • • • •

Lancaster General Health (Lancaster, PA) Lehigh Valley Health Network (Allentown, PA) Reading Health System (Reading, PA) WellSpan Health (York, PA) Atlantic Health System (Morristown, NJ) Hackensack University Health Network (Hackensack, NJ) • Meridian Health (Neptune, NJ)

the Practice of Health Caring

717-983-4916 LANCASTER

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Winter 2014

Patient Advocacy

The Affordable Care Act: A Guide to Guiding Patients

“So What Do You Know About This New Health Insurance?”

Hopefully, this relatively short list of facts can guide you in pointing your patients in the right direction as they explore their coverage options.

1. The Health Insurance Marketplace is a new way for consumers to shop for health coverage that meets their budget and needs. It’s a one-stop, online resource that lets consumers get information about their health coverage options. On the website, they can easily make side-by-side comparisons of private insurance plans’ benefits, quality, and price. They can also find out if they’re eligible for assistance to help cover the cost of health coverage.

2. The same application allows consumers to find out if they and their family members might qualify for free or low-cost coverage available through Medicaid or the Children’s Health Insurance Program (CHIP).

3. Each state has a Marketplace run either by the state, or through a state-federal partnership, or by the federal government. Each Marketplace will give consumers the same access to all Marketplace coverage options.

Pennsylvania’s Marketplace is run by the federal government.

BY KELLY LYONS

P

atients have been asking their physicians this question since the implementation of the Affordable Care Act, also known as Obamacare. The myriad of answers can be confusing and the unknowns are frustrating. Since the Marketplace opened in October, there has been one setback after another, and information seems to change on a weekly basis. So what’s a physician to do when patients expectantly await an answer from their most trusted source of health care information?

4. Health plans offered in the Marketplace will generally offer comprehensive coverage, including 10 “essential health benefits” with, at a minimum, these items and services: • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment (which includes counseling and psychotherapy) • Prescription drugs

The Affordable Care Act is intended to provide a streamlined approach to acquiring health insurance, but it has proved itself to be less than straightforward for both busy physicians and concerned patients. With so many moving pieces, it may be difficult to sort out the most critical, helpful information for your patients.

Continued on page 24

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Patient Advocacy • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care 5. Health insurance companies selling plans through the Marketplace cannot deny coverage or charge more due to pre-existing health conditions, and they cannot charge women and men different premiums based on gender.

6. Depending on household income and family size, many individuals may qualify for tax credits to help lower their share of monthly premiums or for help that reduces deductibles, co-payment, or other cost-sharing amounts.

7. Individuals will be able to choose a Marketplace plan by health plan category (bronze, silver, gold, or platinum). The differences among the categories will be based on the

Improving the Health Care System

average percentage of the costs the plan will cover. This system makes it easier to compare similar plans based on price and coverage.

Catastrophic plans and stand-alone dental plans may also be available.

8. Individuals can buy insurance through a Marketplace if they live in the United States, are U.S. citizens or U.S. nationals (or are lawfully present), and are not currently incarcerated.

9. If health insurance is offered through you or your spouse’s employer, you are not eligible to get health insurance through the Marketplace.

10. You may have to pay a penalty if you don’t have health insurance coverage in 2014.

Trained Navigators are available in the community to help consumers understand their choices and apply for coverage online, by phone or mail, or in-person. In Lancaster County, patients should contact:

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Project Access Lancaster County (PALCO) 717.392.1595 SouthEast Lancaster Health Services 717.299.6371 Welsh Mountain Medical & Dental Centers 717.354.4711

Other resources are available at: • Marketplace.cms.gov: Where organizations and individuals looking to assist others can get the latest resources and learn more about the Marketplace.

• HealthCare.gov: Where individuals can learn about the Marketplace and the benefits, as well as apply for insurance.

• Health Insurance Marketplace Call Center: Where individuals can ask questions about any aspect of the Affordable Care Act. Call 1-800-318-2596 24 hours a day, 7 days a week. TTY users should call 1-855-889-4325.

winter 2014

Patient Advocacy

While a physician’s office isn’t the primary place for consumers to get assistance with applying for health insurance, it’s helpful to have some additional information on hand or in the back of your mind if patients ask questions.

Improving the Health Care System

In general, when choosing your health plan keep this in mind: The lower the premium, the higher the out-of-pocket costs. The higher the premium, the lower the out-of-pocket costs.

Plans Are Put Into 4 Categories When you compare plans on the Marketplace, they’re put into four categories based on the portion of cost you can expect to pay and how much the plan will pay.

Bronze Silver 3. Gold 4. Platinum The category you choose affects how much your premium costs each month and what portion of the bill you’ll pay for things like hospital visits or prescriptions. It also affects the affects your total out-of-pocket costs (the total amount you’ll spend for the year if you need lots of care). The categories don’t reflect the quality or amount of care the plans provide.

Balancing Monthly Premiums With Out-Of-Pocket Costs As with all health plans, you’ll have to pay a monthly premium. But it’s also important to know how much you’ll have to pay out-of-pocket for services when you get care.

• Premiums are usually higher for plans that pay more of your out-ofpocket medical costs when you get care. For example, if have a Gold plan, you’ll likely pay a higher premium, but may have lower costs when you go to the doctor or use another medical service.

• With a Bronze plan, you’ll likely pay a lower premium, but pay a higher share of the costs when you get care.

• Platinum plans will likely have the highest monthly premium and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care.

You may be able to get lower costs on your health coverage After you fill out a Marketplace application you’ll learn if you’re eligible for lower costs on your monthly premiums. An individual earning less than $54,960 per year or a family of four earning less than $94,200 per year may be eligible for a subsidy.

The Following Private Insurers Are Offering Plans In Lancaster County: Do You Expect A Lot Of Doctor Visits Or Need Regular Prescriptions?

If you do, you may want a Gold or Platinum plan. They likely have higher premiums, but you could pay lower out-of-pocket costs for each visit, prescription, or other medical service.

If you don’t, you may prefer a Bronze or Silver plan. Your monthly premiums will be lower, but you’ll likely pay more of the costs when you see a doctor.

Keystone Health Highmark Health Services HealthAmerica Highmark Health Insurance Co. Geisinger Health Plans Capital Blue Cross

Important Health Insurance Marketplace dates: You can generally buy health insurance only during the annual open enrollment period. Upcoming dates to know: March 31, 2014: Open enrollment ends. If you haven’t enrolled by this date, you may have to pay a penalty.

November 15, 2014: January 15, 2015: To buy health insurance after open enrollment, you must qualify for a special enrollment period due to a qualifying life event such as marriage, divorce, birth or adoption of a child, or loss of a job.

Please refer to the Pennsylvania Medical Society’s website, www.pamedsoc.org, for additional assistance and information,

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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 Updates

COVER STORY

January Lancaster Physician

A 2013 Win for the Pennsylvania Medical Society

Legislation Protecting Physician Apologies Signed by Governor

T

hanks in large part to physician advocacy, on October 25, 2013, Gov. Tom Corbett signed into law legislation preventing most physician apologies from being used against them in a medical liability lawsuit.

PAMED thanks the supporters who sent more than 1,300 messages to the state legislature in support of this legislation over the course of a twoyear campaign.

This legislation (Act 79 of 2013) will protect most physician apologies except for admissions of negligence, which would remain admissible. It removes a barrier to open communication between physicians and

patients after a poor outcome, which is essential to maintaining the physician-patient relationship.

It does not take away any legal right from injured patients or impair their ability to file a personal injury action against a health care provider should they choose to do so. It also does not limit the amount that a patient can recover in such an action.

At the time of the bill’s signing, C. Richard Schott, MD, then-president of PAMED said, “As physicians, it is part of our job—part of our moral and ethical responsibility—to respond to patients and families when there are less than favorable outcomes.”

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Legislators and attorneys understood that medicine is not an exact science, and outcomes may be unpredictable.

Benevolent gestures are always appropriate, and physicians should not have to fear giving them. With the signing of this bill into law, Dr. Schott said doctors will feel more comfortable doing so, knowing that an apology is inadmissible unless their expression admits fault.

The bill became effective on December 24, 2013. The Pennsylvania Medical Society has put together a short webinar that goes over the nuances of the law. It can be accessed on the Society’s website.

Winter 2014

Lancaster NeuroScience & Spine Associates

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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 Updates

House of Delegates, more than 200 physicians voted to address the issue by calling upon the state legislature to pass electronic cigarette laws that have safeguards equivalent to existing tobacco laws, including taxation and banning sales to minors.

Furthermore, doctors want Pennsylvania schools to include the potential dangers of electronic cigarettes in their tobacco education efforts.

“Electronic cigarettes mimic smoking tobacco cigarettes and deliver nicotine to the body,” says Bruce A. MacLeod, MD, president of the Pennsylvania Medical Society. “For some it may be used to beat their nicotine addiction.

On the other hand, electronic cigarettes are addicting. And many of the marketing materials appear to be geared toward younger individuals.”

Electronic Cigarettes Should be Treated like Tobacco, Say Pennsylvania Doctors

T

he potential dangers of electronic cigarettes, or e-cigarettes, have members of the Pennsylvania Medical Society concerned, and until more is known about the

products, the state’s physicians believe they should be treated no differently than tobacco products.

Meeting at the PAMED’s 2013 Annual

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According to Dr. MacLeod, there are a lot of unknowns about electronic cigarettes, and until more facts are known, they should not be treated any differently from traditional cigarettes.

“They may be odorless and give the appearance of being less harmful, but beyond that, we just don’t know the impact that the vapors have on the user and others,” Dr. MacLeod says. “It may be best for now to err on the side of caution while researchers investigate.”

Regardless of the vapors issue, MacLeod also stresses that nicotine has been linked to health problems, and should be avoided.

Winter 2014

Legislative Updates

Biosimilars Are Coming CO2 During Colonoscopies Reduces Pain

P

A physicians urge lawmakers to set requirements for biosimilar substitution. Many physicians are concerned about the potentially serious patient safety implications when they write a script and a pharmacist substitutes a biosimilar for the prescribed medication.

Biosimilars—the biological equivalents of generic drugs—are similar, but not identical, to the brand name medication.

Though biosimilars are not yet commercially available in the United States, their approval and availability are expected in the near future.

Law currently does not restrict pharmacist substitution of biologic medications with biosimilars. Two bills in the legislature, supported by the Pennsylvania Medical Society (PAMED), would establish requirements for pharmacist substitution of biosimilar products.

The use of CO 2 has been proven to reduce pain and bloating, decrease recovery time and improve patient satisfaction.

The bills, House Bill 746, sponsored by Rep. Bryan Cutler (R-Lancaster) and Senate Bill 405, sponsored by Sen. Pat Vance (R-Cumberland), would allow a pharmacist to substitute only if:

RGAL is the only gastroenterology practice in Lancaster that uses CO2 (instead of room air) during colonoscopies. CO2 is used at the Oregon Pike and Harrisburg Pike centers.

The biosimilar product has been determined by the FDA to be interchangeable with the prescribed product for the indicated use.

No additional cost and less pain.

Wouldn’t your patients prefer CO2?

The prescriber does not designate, either verbally or in writing on the prescription, that substitution is prohibited.

The patient presenting the prescription provides written consent for such substitution.

The pharmacist notifies the prescriber in writing as soon as practicable but no later than 72 hours after dispensing.

The pharmacy and the prescriber retain a written record substitution for a period of no less than five years.

The PAMED board voted to support the legislation, with a proposed amendment to the bill changing the pharmacist substitution notification to the prescribing physician from 72 hours post-dispense to 24 hours pre-dispense. Support for the bills and proposed amendment was based on the strong desire to assure patient safety as these new biosimilars become available. PAMED and the Pennsylvania Academy of Dermatology and Dermatologic Surgery are working together to ensure that biosimilars are dispensed in a safe manner without impeding patient access to such medications.

Four Convenient Locations Lancaster Health Campus Oregon Pike-Brownstown Women’s Digestive Health Center

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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 Update

Pennsylvania Medical Society Quarterly Legislative Update December, 2013

T

he state House and Senate have both recessed until mid-January, closing the books on legislative activity for 2013. The fourth quarter was a busy one, with action on several measures of importance to physicians and patients. The following is a summary of a few of the highlights.

Controlled Substance Database A bill that would create a controlled substances database, giving physicians better knowledge of prescriptions written for and filled by a patient, is one step closer to becoming law.

The House of Representatives passed House Bill 1694 on Oct. 21, 2013, by a vote of 191-7. The success was the result of two years of effort by the Pennsylvania Medical Society and its members, who recognize the value such a database would have in reducing doctor-shopping and controlled substance abuse. Our “Pills for Ills, Not Thrills” campaign has played a major role in generating public support for the legislation.

On November 18, Senator Pat Vance (R-Cumberland) introduced her own version of the legislation, Senate Bill 1180. The bill differs in several respects from the House-passed bill, HB 1694. The Pennsylvania Medical Society is now working to reconcile those differences and get a final product to Governor Corbett’s desk to make this important tool a reality for Pennsylvania physicians.

Physician Assistant Bills Signed Into Law Do you have a physician assistant (PA) with whom you have worked for some time, and who has impressed you with his or her competence? Has your confidence in that PA’s work

reached the point where countersigning every one of his or her patient records has become an administrative burden rather than a necessity for patient safety? Could you be more productive, and do you believe patient safety would not be compromised if you were to countersign fewer of your PA’s patient records going forward?

If you can answer yes to all of those questions, help is on the way.

On November 27, 2013, Gov. Corbett signed two bills into law that will permit the PA countersignature requirement to be relaxed under appropriate circumstances. The measures, House Bills 1348 and 1351, had the support of the Pennsylvania Medical Society and the Pennsylvania Society of Physician Assistants, and will become effective on Jan. 26, 2014.

Under the new laws physician will continue to be required to countersign 100 percent of PA patient records during the first 12 months of a PA’s practice post-graduation and licensing; during the first 12 months of a PA’s practice in a new specialty; and during the first six months of a PA’s practice in the same specialty under the supervision of a new physician.

After that, the PA’s approved physician could choose to review on a reg-

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ular basis a lesser number of patient records completed by the PA. The physician will select patient records for review on the basis of written criteria established by the physician and the PA. The number of patient records reviewed must still be sufficient to assure adequate review of the PA’s scope of practice.

That written agreement would then be submitted to the State Board of Medicine or State Board of Osteopathic Medicine for approval, the final step before the agreement would go into effect.

It is important to note that entering into an agreement with your PA to countersign fewer than 100 percent of his or her patient records is purely optional. If a physician wishes to continue to review and countersign all of a PA’s patient records, he or she is free to do so.

However, in appropriate circumstances, physicians now have a way to improve their efficiency and productivity without jeopardizing patient safety. The Pennsylvania Medical Society believes this legislation is a good example of how physician-led, team-based care can be streamlined, ultimately increasing access to care.

Child Protection Laws Strengthened On December 18, 2013, Gov. Corbett signed into law a 10-bill package strengthening the state’s child abuse laws. The Sandusky scandal at Penn State had revealed a number of weaknesses in Pennsylvania’s child protection laws, and caused the General

Winter 2014

Legislative Updates Assembly to establish a Child Protection Task Force to review the state’s existing statutes and recommend changes. The task force, headed by Bucks County District Attorney Dave Heckler, released a 427-page report in November 2012 recommending a wide range of reforms, which found their way into more than 30 House and Senate bills.

While the 10 bills signed into law probably contain the bulk of the changes, there are still a couple more that will likely reach the Governor’s desk early next year. At least one of those will almost certainly have significance for physicians in their role as mandated reporters.

Many of the changes enacted don’t go into effect until Dec. 31, 2014, in order to give mandated reporters and others assigned new responsibilities an opportunity to be trained. The Pennsylvania Medical Society is already at work planning the necessary educational materials for our members.

Among the coming changes, the new laws will broaden the range of persons who can be found guilty of child abuse, and significantly lower the threshold for the degree of injury, pain or impairment needed to trigger a report of suspected child abuse. These are important things for physicians, who are mandated reporters, to know.

Physician Leadership Day Held At Capitol With millions more Pennsylvanians potentially gaining health insurance as the Affordable Care Act goes into effect, their physicians want to be sure that care is team-based and physician-led. To spotlight physicians’ concerns, on Dec. 10, 2013, Pennsylvania Medical Society leaders and members gathered at the Capitol in Harrisburg for a media event with Governor Corbett and Representative Matt Baker (R-Tioga), as part of the Pennsylvania Medical Society’s Physician Leadership Day.

Two bills that would help build a stronger framework for our health care teams have been introduced by Senator Judy Schwank (D-Berks) and Representative Baker. The bills, Senate Bill 1083 and House Bill 1655, propose a Patient-Centered Medical Home Advisory Council at the Department of Public Welfare to help nurture the growth and development of patient-centered care in the Medicaid program.

Following the media event, the physicians and physicians-in-training visited with their legislators to push for support of measures to help keep Pennsylvania’s health care teams strong, physician-led, and patient-centered. Member physicians also urged their legislators to support bills to improve access to care for the uninsured, retain and recruit the physician workforce, especially through student debt forgiveness and expanded residency slots; prevent prescription drug abuse through a controlled substances database; and improve access to health care technology in Pennsylvania.

Healthy Pennsylvania On September 16, 2013, Governor Corbett announced his Healthy Pennsylvania package of initiatives, and while his take on Medicaid expansion has grabbed all the headlines, the plan contains a number of other pro-physician, pro-patient measures.

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Among those proposals, the governor endorsed increased medical student debt forgiveness, long a goal of the Pennsylvania Medical Society.

According to a 2012 report, the mean debt for graduates from the class of 2012 was nearly $167,000, not including premedical educational debt, driving many graduates away from primary care to higher paying specialties.

The governor also proposed additional funding to increase the number of in-state primary care residency slots, a move that could help the growth of the physician population in medically underserved areas.

Corbett also publicly announced his support for the establishment of a statewide controlled substance database and the proposed apology law.

Not long afterward, the House passed a controlled substance database bill and the legislature enacted the state’s new apology law.

Finally, the governor also announced his advocacy for health care technology and telemedicine. The Pennsylvania Medical Society strongly supports the development of a statewide health information exchange (HIE), and is pleased that the Corbett administration and legislature are moving forward with this initiative.

The Pennsylvania Medical Society will be working aggressively with the governor and legislature over the coming months to advance this positive package of health care measures.

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

Restaurant Review lccms member reviewed!

All of your bar favorites are there, including a Pennsylvania Dutch country special: PA pretzel logs served with Appalachian’s special mustard. If you’re going for it, don’t forget to add a side of cheddar ale soup—it is a brewery after all.

Of course, any review of a brewery would not be complete without mention of their crafted selection.

Sadly, when we sampled, nothing was brewing or made locally, but that didn’t stop us from imagining, as we dined right next to the crafting apparatus. We sampled the Hoppy Trails IPA, which had a crisp golden glow and fragrance of orange and spice. The Water Gap Wheat Ale was rich and full-bodied.

We’ll be back without the children to sample some of their more seasonal ales: in June, the Auchenback Keller Pils, and in July, the Hinterland Hefe Weizen. We also tried the homemade root and ginger beers which where rich and fulfilling, like the originals should be.

BY DAVID SOMERMAN, DO & CHANDRA SOMERMAN

J

ust moving to the area makes you look for something friendly and warm. That wasn’t hard to come by in Lancaster County, home of family traditions. We have tried many restaurants, diners and brew pubs since moving, but we settled on the Appalachian Brewing Company’s satellite brewpub in Lititz, Pennsylvania to write our review. There is something about the combination of small batch handcrafted mottled barley and oat combined with a gastropub menu of spiced up American favorites to make you feel at home. It didn’t hurt that despite being a microbrewery - they were very kid and family friendly. The

waitress even brought out a plate of cheese and oranges while waiting for the entries, which we and our two-yearold enjoyed.

The menu is a mix of crafted American classics like hamburgers, quesadillas and flatbread pizzas, with a gastropub twist. Root beer BBQ sauce, cool-as-acucumber salad and brown-sugar-caramelized apple smoked bacon are just some of the homegrown extras on their delicious half-pound, one-hundred percent Angus burgers. You can also substitute a turkey patty or — if you’re daring and longing for some spice — a black bean veggie burger, which had plenty of taste.

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The building is known as Lititz Junction, which was a former paper box factory turned into a rehearsal studio, and now a microbrewery. They say some of the biggest names in rock-and-roll have rehearsed there. The ambiance has a rustic ski lodge feel with bare wood and a highly vanished tree trunk traversing the center of the room. The bar is the major focal point which is covered in light wood, with plenty of seating and a

Winter 2014

Restaurant Review

smile on the bar master’s face. With so many taps, who wouldn’t find this place appealing?

All in all, we had a great experience at the Appalachian Brewing Company and plan to return soon. We even plan on joining the Mugger wait list to complete our transition and make Lancaster County home!

Appalachian Brewing Company of Lititz

CAMPUS EYE CENTER For All Your Eye Care Needs

OUR SERVICES INCLUDE: Primary Eye Care | Routine Vision Services Medical & Surgical Eye Care Kerry T. Givens, M.D., M.S.

Among the specialized surgeries we offer: Lee A. Klombers, M.D.

Two Convenient Locations: Health Campus:

Lisa J. Kott, O.D.

Pulmonary Medicine

Willow Lakes:

David S. Williams, M.D.

Lung masses Asthma Interstitial lung disease Pneumonia Cough and chest pain related to pulmonary disorders COPD Chronic Bronchitis Dyspnea

Olga A. Womer, O.D.

Critical Care Management Surgical complications Infections Serious cardiac disorders Accidents Severe breathing problems

Sleep Medicine Sleep apnea Hypersomnia, insomnia, parasomnias Nocturnal epilepsy and circadian rhythm disorder 717-735-0336 233 College Ave. Suite 201 LANCASTER

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We have a Board certified Asthma Educator on site every Tuesday.

Masood Ahmad, MD Kayalvizhi Sambandam, MD LancasterPulmonaryandSleepAssociates.com

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

To publi new LC sh photos of physicia CMS memb er ns, p digital lease submit klyons@ c o p ie s to lancast er

News & Announcements

medica lsociety .org

Welcome New Physicians...

(10.01.13-12.02.13)

Justin Roberts, DO Isaac Annan, MD

Neurology & Stroke Associates

Gregory Cox, DO

Red Rose Cardiology

Kaveer Nandigam, MD

Neurology & Stroke Associates

The Heart Group of Lancaster General Health Christopher Wenger, DO

The Heart Group of Lancaster General Health

Daniel Tapia, MD

Resident Milton S. Hershey Medical Center

Deceased Members John Gastaldo, MD, FACS

William Caskey, MD

John Andrew Gastaldo, MD, 66, passed away on November 5, 2013. He was the devoted husband to Helen (Nimick Welsh) Gastaldo with whom he shared 9 years of marriage. He recently retired from active medical practice in neurosurgical care after more than 35 years of work that included private practice for 12 years, followed by the remaining years with Lancaster Neuroscience & Spine Associates. He is a graduate of Hofstra University and earned his medical degree from Hahnemann Medical College, where he also completed a medical internship.

He completed a general surgery residency at Hahnemann followed by a neurosurgery residency at Temple University Hospital. He was a member of multiple medical societies and organizations, including very active roles as president of the Lancaster County Medical Society (1989-1990); president of the Pennsylvania Neurosurgical Society (2000-2001); and as the board chairman of the Central Pennsylvania Physicians Risk Retention Group.

William B. Caskey, M.D., 74, passed away on May 21, 2013. Dr. Caskey was certified by the American Board of Internal Medicine in both internal medicine and in endocrinology and metabolism. He was a member of the American College of Physicians, the American Diabetes Association, the county and state medical societies, the American Medical Association, the Endocrine Society and the American Society of Clinical Endocrinologists, and was inducted as a fellow of the American College of Endocrinology in 1994. Dr. Caskey had been involved in the private practice of endocrinology, diabetes mellitus and internal medicine in Mercer County since 1969. He was currently associated with United Health Group. He was associated with St. Francis Medical Center and served as the chairman of Endocrinology from 1981 to 1983, director of the Department of Medicine and director of the Internal Residency Program from 1981 to 1984. He served as president and chief executive officer from 1983 to 1985 and vice president of clinical development from 1985 to 1990. He also served as president of IPA from 1986 to 1992 and was president of the Mercer County Medical Society in 2003 to 2004. Dr. Caskey was instrumental in bringing the first catheterization laboratory to Mercer County at St. Francis Medical Center.

Frontline Groups Allergy & Asthma Center Argires, Becker, Marotti & Westphal Breast Health Associates Campus Eye Center Cardiac Consultants PC Cardiothoracic & Vascular Surgeons of Lancaster Child & Adolescent Psychiatric Associates

Groups with 100% physician membership as of 12.09.13

Community Anesthesia Associates Community Services Group Conestoga Family Practice – Terre Hill Conestoga Pulmonary & Sleep Medicine Dermasurgery Center PC Dermatology Associates of Lancaster Ltd

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Electrodiagnostic Medicine Group Ltd ENT Head and Neck Surgery of Lancaster Ephrata Behavioral Health Services Eye Associates of Lancaster Ltd Eye Doctors Of Lancaster Eye Health Physicians Of Lancaster Eye Physicians of Lancaster PC

Winter 2014

News & Announcements

Family Eye Group Family Medicine of Ephrata General and Surgical Oncology Specialists of Central PA General & Vascular Surgery of Lancaster Georgetown Family Health Glah Medical Group Heritage Surgical Assoc Highlands Family Practice Hospice and Community Care Hyperbaric & Wound Care Hypertension and Kidney Specialists Internal Medicine Specialists of Lancaster County Jeffrey H Chaby DO & Associates Justin L Cappiello Md Pc Keyser & O’Connor Surgical Associates Ltd

Lancaster Arthritis & Rheumatology Care Lancaster Cancer Center Ltd Lancaster Cardiology Group LLC Lancaster County Center for Plastic Surgery Lancaster Ear, Nose and Throat Lancaster Family Allergy Lancaster General Health Physicians Lancaster HMA Physician Management Lancaster Physicians For Women Lancaster Plastic Surgery Lancaster Radiology Associates Ltd Lancaster Skin Center PC Lancaster Urology Lincoln Family Medicine Manheim Family Medicine Maternal-Fetal Medicine Specialists Nemours Children’s Clinic

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Neurology & Stroke Associates PC New Holland Family Medicine OBGYN of Lancaster Orthopedic Associates Of Lancaster Ltd Orthopaedic Specialists of Central Pa Otolaryngology Physicians Of Lancaster Pain Medicine & Rehab Specialists Pennsylvania Specialty Pathology Red Rose Cardiology Rothsville Family Practice Roy D Brod MD Surgical Specialists Of Lancaster The EMG Group@The Electrodiagnostic Center of Lancaster The Heart Group of Lancaster General Health Welsh Mountain Health Center

winter 2014

MEMBER Spotlight

LANCASTER COUNTY DERMATOLOGIST RECEIVES PAMPAC AWARD Our congratulations to Dr. Brod on this well deserved award!

The PAMPAC Alexander Awards may be given each year in recognition of the political and grassroots advocacy activities of an individual or PAMED affiliated organization. The award is named in memory of R. William Alexander, MD, who led PAMPAC, served on the AMPAC Board and was a PAMED President. He was a well know Berks County physician.

Dr. Brod has been a member of PAMED and LCCMS for 13 years; a fellow of the Pennsylvania Academy of Dermatology & Dermatologic Surgery for 17 years; and a member of PAMPAC for five years. He is a physician with Dermatology Associates of Lancaster, Ltd.

BRUCE BROD, MD

L

ancaster City & County Medical Society member Bruce Brod, MD, has been selected to receive the R. William Alexander Award for Political Involvement and Advocacy in 2013.

Examples of the physician advocacy efforts and leadership accomplishments that typify Dr. Brod are easy to point to: Dr. Brod espouses a positive view on the power of physicians to influence politicians for desired

outcomes. He “practices what he preaches” and encourages his colleagues to participate in the political process.

He established a solid link between PADDS and PAMED to work together to advance legislation benefitting the missions of both organizations. He is the legislative coordinator for AAD and serves on the PAMED Political Advocacy Council.

Dr. Brod was an outspoken proponent for HB 1259 - tanning salon regulation - having authored many letters to the editor of Lancaster Newspapers on the bill; having been inte viewed by local media as an expert on the issue and the legislation; and having been interviewed for the LCCMS magazine, Lancaster Physician, in which he encouraged all physicians to contact their senators in support of HB1259.

Membership: What’s In It For You? No time to get down into the weeds of health care policy, legislation, and regulations that will affect the way you practice medicine? Most likely not. That’s where the Pennsylvania Medical Society and the Lancaster City & County Medical Society come in. They inform and represent you on the issues so you can stay focused on diagnosing and healing your patients.

The Pennsylvania Medical Society and the Lancaster City & County Medical Society advocate on your behalf to address the issues that will impact your practice–and your patients. The Medical Society also provides resources for education, leadership training, practice management, and patient safety–all made possible by your membership dues.

Take this important step toward sustaining a thriving practice —renew your membership for 2014!

Respond to your October renewal letter Go to pamedsoc.org/membership Call 717.393.9588

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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

LMS Foundation Updates

“Representing Lancaster County’s Most Distinguished Homes”

LONG TERM CARE CONSULTANTS* The greatest financial risk you face today is the cost associated with Long Term Care Marcille Crossland, LUTCF, CLTC Designing Long Term Care insurance plans around today’s sensitive budgets 1560 Lititz Pike, Lancaster, PA 17601 717.394.4287 m.crossland@verizon.net * Division of Integrated Business Consultants, Inc

ANNE M. LUSK Realtor

www.AnneLusk.com

100 Foxshire Drive Lancaster, PA 17601 (717) 291-9101 ©2013 BRER Affiliates LLC. An independently owned and operated broker member of BRER Affiliates LLC. Prudential, the Prudential logo and the Rock symbol are registered service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. Used under license with no other affiliation with Prudential.

Equal Housing Opportunity

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THE ENDORSED MEDICAL LIABILITY INSURANCE CARRIER OF THE LANCASTER CITY AND COUNTY MEDICAL SOCIETY

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A N O R C A L G R O U P C O M PA N Y

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