Lancaster Physician Spring 2015

Your Community Resource For What’s Happening In Health Care

Spring 2015

Official Publication of The Lancaster City & County Medical Society

Measles Making An Unwelcome Comeback: Declining Vaccination Rates Are To Blame

Physician-Assisted

SUICIDE What Could It Mean For Lancaster Physicians?

Mcare Settlement to Return $200 MILLION to Physicians and Other Providers —Includes Future Protections

WellDelivered.

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Now that Ephrata Community Hospital and its respected physicians have come together with WellSpan Health, we’re excited to announce the arrival of our new maternal-fetal medicine specialists. With this addition to our physician family, we can now offer advanced specialty care to expecting moms right here in our community – for everything from gestational diabetes and preeclampsia, to premature birth complications and the delivery of multiples. Your goal is to have a healthy baby and WellSpan can get you there.

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To learn more visit WellSpan.org/MFM.

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Contents

2015 BOARD OF DIRECTORS OFFICERS James M. Kelly, MD President

Lincoln Family Medicine

David J. Simons, DO President Elect

Community Anesthesia Associates

Robert K. Aichele, MD Vice President

Aichele & Frey Family Practice Associates

Paul N. Casale, MD Past President

The Heart Group of Lancaster General Health

C. David Noll, DO Secretary Ephrata Community Hospital

Stephen T. Olin, MD Treasurer

Lancaster General Hospital

DIRECTORS

SPRING 2015

Best Practices 6 WellSpan Health Expands

its ‘Patient-Centered’ Approach

to Lancaster County 8 Physician-Assisted Suicide 12 Lancaster Regional Medical

Center & Heart of Lancaster

Enhance Patient Experience 14 LGH’s Family Medicine

Residency Program

Celebrates 45 Years 16 What Physicians Should

Know About The 2015

OIG Work Plan

Charles A. Castle, MD Stacey Denlinger, DO Laura H. Fisher, MD Alyssa K. Jones, MD John A. King, MD Venkatchalam Mangeshkumar, MD Karen A. Rizzo, MD, FACS Jennifer Zatorski, MD

In Every Issue 4 President’s Message 18 Healthy Communities 27 Patient Advocacy

Interim Editor: Dawn Mentzer

Editors: Laura Fisher, MD Lancaster Family Allergy James Kelly, MD Lincoln Family Medicine

32 Medical Society Updates 40 Regulatory Updates 42 Restaurant Review 43 News & Announcements

COVER STORY

Physician-Assisted Suicide: What Could it mean for Lancaster Physicians? (p.8)

46 LCCMS Foundation Updates 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.

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 klyons@lancastermedicalsociety.org.

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

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

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President’s Message

PAMED Physicians

Fighting for SGR Reform

James Kelly, M.D. President

B

y the time this edition of Lancaster Physician is published, Congress will have made a decision regarding the Medicare Sustainable Growth Rate (SGR). The SGR was enacted as part of the Balanced Budget Act of 1997, back when Newt Gingrich was Speaker of the House and the Clintons had put forward an initial plan to overhaul our nation’s health care system. The goal of the SGR was to ensure increases in Medicare spending did not exceed annual GDP growth. The SGR is assessed on a yearly basis and is the primary method whereby payment rates are determined for health care services. This winter, PAMED physicians and staff have been hard at work lobbying for reform of this controversial process.

Since its inception, the SGR has been a flawed system. Since 1997, multiple short-term annual “patches” have been passed out of necessity. The patches are temporary adjustments to ensure care for seniors is not limited by a substantial drop in payments for health care services. The most recent 2014 SGR override is expected to expire March 31, 2015. If no further legislation is passed, Medicare payment rates to health care providers will fall 21.2%. A drop in reimbursement of this magnitude would in turn limit physicians’ ability to care for large numbers of Medicare patients while still covering overhead expenses. This will cause significant access issues for Medicare beneficiaries, jeopardizing their ability to receive necessary primary and specialty care for chronic health care conditions.

Thankfully, this winter a bipartisan bill was introduced in the US Senate and House that will permanently repeal the SGR and look at Medicare payment reform. This is a progressive step that will lead us out of the volume-rewarding fee-for-service landscape and into payment based on coordinated quality care. The new model will allow for a small increase in reimbursement for health care professionals over the next four years, while readying us to enter the new Merit-Based Incentive Payment System (MIPS). Current Medicare incentive measures such as the Physician Quality Reporting System (PQRS) and electronic health record meaningful use will be streamlined into one program, and payments for health care professionals will be adjusted based on performance and in comparison to peers. Bonuses will be awarded considering incurred risk and participation in alternate payment models (such as bundled payments). Reimbursements are also proposed for services such as chronic disease care management and medical home participation.

Visit lancastermedicalsociety.org

As I write this article, a final vote by Congress is expected in the next week, and PAMED physicians continue to be in contact with legislators to express our support for this bill. I would like to extend thanks to our local legislators, especially Congressman Joe Pitts, who is an advocate for reform and one of the major sponsors of the bipartisan bill. While expected to pass, it is possible that another “patch” will be enacted, freezing rates and unnecessarily tabling the discussion for another year. Passage of the bill will be a first good step to improve overall health care delivery to seniors, ensuring access while enhancing quality and value of care for all.

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pr ctices WellSpan Health Expands its ‘PatientCentered’ Approach to Lancaster County Physician-Assisted Suicide Lancaster Regional Medical Center & Heart of Lancaster Enhance Patient Experience LGH Family Medicine Residency Program Celebrates 45 Years What Physicians Should Know About The 2015 OIG Work Plan

WELLSPAN HEALTH Expands its ‘Patient-Centered’ Approach to Lancaster County

A

s Ephrata Community Hospital and its affiliated physicians continue their integration efforts with WellSpan Health, patients are beginning to see more changes than just a new name and logo.

The regional health system’s primary care practices in Lancaster County now bear the LANCASTER

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WellSpan brand identity and are moving to a new model of care—patient-centered medical homes.

Through these medical homes, physicians and caregivers work together to help patients achieve optimal health. To become a medical home, practices must adopt cutting-edge

SPRING 2015

WellSpan Health Expands its ‘Patient-Centered Approach’

techniques in pursuit of a primary care triple aim: better population health, better experience of care and lower cost.

“You not only try to help them understand their condition from a medical perspective, you find out what they personally consider important,” Jones said. “When patients are engaged, you get better outcomes.”

WellSpan has aggressively worked to expand the patient-centered medical home concept in its primary care practices throughout York, Adams and Lancaster counties. Karen Jones, MD, vice president and chief medical officer of WellSpan Medical Group, said medical homes represent a transformation in primary care.

Engaging patients as “partners” in health WellSpan has established “patient partners” at each of its medical home practices. Patient partners are patient volunteers who participate in monthly staff meetings and offer suggestions for improving the overall patient experience.

“This is a paradigm shift in health care,” Jones said. “It’s very different from the way we practiced medicine in the last century.

“Before, physicians concentrated on patients who came to the office seeking care, and there wasn’t much focus on patients who weren’t present,” she continued. “Now, WellSpan is transforming care delivery to optimize the health of individual patients and populations.”

“Our patient partners have been engaged and excited about what we’ve been doing,” Noll said. “They’ve been helpful in suggesting improvements in our communications and how we manage certain workflows so that we’re improving the overall patient experience.”

Building a “Team-Based” Culture Last year, 28 WellSpan primary care practices in York and Adams counties earned the Patient-Centered Medical Home recognition by the National Committee for Quality Assurance.

Now, WellSpan is bringing its Lancaster County practices into the “medical home” fold.

In the spring of 2014, the health system began the work of developing medical homes at six Lancaster County practices. By this summer, all WellSpan primary care practices will be actively involved in the patient-centered medical home model.

As part of WellSpan’s program, each practice designates a Quality Improvement Team to identify ways to improve care delivery and efficiencies. Once a month, the teams gather together as part of a collaborative to share information and best practices.

WellSpan physicians also encourage patients to take ownership of their health and actively participate in decision-making.

“We emphasize the idea of health care as a partnership,” Jones said.

“Traditionally, physicians have been perceived as the sage leaders who know precisely what’s needed to cure an ailment. While a physician’s understanding of medical science is clearly an integral part of care, we also realize that no one knows the patient better than the patient.”

In today’s age, technology can help patients better manage their own health, particularly through the use of secure patient portals.

“It’s really about developing a team-based culture,” said C. David Noll, DO, associate medical director of quality and innovation at WellSpan Medical Group. “Our providers are genuinely excited about the opportunity to provide a broader and higher level of care to our patients, with more resources and improved processes.”

WellSpan Health’s patient portal, MyWellSpan.org, allows patients to access their medical records, view their lab and imaging results, send secure messages to their health care providers and even request an appointment.

WellSpan’s medical home model includes “health coaches,” who are embedded in the primary care practices to help physicians coordinate the various services that patients require.

More than 100,000 patients—including more than 11,000 in Lancaster County—have enrolled in the MyWellSpan.org patient portal to date.

Much of the early work at the Lancaster County practices focuses on identifying gaps in care for high-risk patients, particularly those transitioning from a hospital setting back into a home-based environment, Noll said. The collaborative works to share the knowledge they’ve learned, so patients experience a consistently high level of care.

“We’ve gotten positive feedback from our patients about the MyWellSpan portal,” Noll said, adding that all of these initiatives have the same goal.

“These are all tools that allow us to engage with patients and partner with them in their health care,” he said. “That leads to improved care and better patient outcomes.”

Identifying at-risk patients is just the first step. Medical homes also strive to involve patients in their own care.

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Best Practices

Physician-Assisted

SUICIDE What Could It Mean For Lancaster Physicians?

DR. THOMAS GATES, MD

DR. THOMAS MILLER, MD

Faculty Family Practice Residency Program of LGH & Chairman of the Ethics Committee at LGH

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Hospice & Community Care of Lancaster County

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SPRING 2015

Physician-Assisted Suicide

T

he “Death with Dignity” movement has been gathering momentum since Oregon voters legalized physician-assisted suicide (PAS) in 1997. Also in 1997, the U.S. Supreme Court ruled that although there was not a constitutional right to PAS, individual states can properly decide for or against the issue.

Washington state and Vermont have followed Oregon’s lead, and now the legislatures of our neighbors in Maryland and New Jersey, as well as Montana and Connecticut, are considering bills to legalize the procedure. In Pennsylvania, it is a felony for a physician to assist a patient in committing suicide. However, PA State Senator Daylin Leach from Montgomery County expects to introduce a “Death with Dignity Act,” allowing the practice in our state.

Since 1997, Oregon has carefully tracked its experience with PAS, and in general these concerns have so far proven unfounded.

Between 1998 and 2007, 541 lethal prescriptions were written in Oregon, with 341 associated deaths. Sixty-three percent of people who received a prescription chose not to use it. The median age was 69 years old, and 81 percent of the patients had a cancer diagnosis. Most patients were white, well-educated, insured, and enrolled in a hospice. PAS currently accounts for fewer than 80 deaths per year in Oregon. 1

The movement to legalize PAS recently gained heightened exposure with the widely publicized case of Brittany Maynard, the 29-year-old California woman suffering from a brain tumor, who moved to Oregon and was assisted in taking her own life rather than experience an exhausting decline. Although it is not inevitable that we will be faced with legalized physician-assisted suicide in our state, the momentum cannot be denied, and most physicians will be confronted with questions, if not overt requests. In this article, we will attempt to give some framework for the discussion and some guidelines for responding to requests for our assistance with a patient’s suicide.

A study that looked at the reasons people in Oregon chose PAS revealed that: 91 percent feared loss of autonomy, 88 percent feared loss of function and ability to participate in activities, 65 percent feared loss of dignity, 53 percent feared loss of bodily functions, 36 percent feared becoming a burden on family and friends, and 23 percent either had intractable physical pain or, more commonly, were afraid of future pain. Only 2.5 percent feared the financial consequences of their illness.2

In an effort to address intractable suffering, loss of control, and loss of “dignity” associated with a terminal illness, proponents of PAS believe that physicians should have the legal ability to prescribe a lethal dose of a medication (usually a barbiturate) to a patient, who then self-administers the medication with the intent of causing death. Laws legalizing PAS typically contain mandatory safeguards and guidelines. The patient must be terminally ill (defined as a prognosis of 6 months or less) and not clinically depressed. There must be two separate requests from the patient, orally and in writing, separated by at least two weeks, and witnessed by two people. The patient must be told of other options (such as hospice and palliative care) that are able to address concerns and be certified to have met all requirements by two physicians.

It appears that the vast majority of suicides were committed not because of physical suffering, but out of psychosocial suffering, or anticipated suffering.

In Oregon, one in six dying patients will talk with their families about PAS, one in fifty will ask their physicians about the possibility, but only about one in 1000 patients actually avail themselves of PAS.1 In the US, 57 percent of physicians report they have received a request for assistance in dying. However, it is critical to recognize that such requests are usually not a straightforward request for death, but much more often a sign of patient crisis, a cry for help, a symptom of some failure of palliative care.

Opponents of PAS have expressed concerns that legalization would lead to a “slippery slope,” a cascade of unwanted consequences brought on by the practice. Will insurance companies see PAS as an opportunity to cut costs, and then pressure patients to end their lives prematurely? Will the poor and marginalized be disproportionally affected? Will the “right to die” gradually come to be seen as a “duty to die?” And will acceptance of PAS gradually be extended beyond the terminally ill, to include all who suffer, even if not terminally ill?

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What should our response be to a request to help a patient end his/her life? We should avoid the mistake of saying YES. And we should avoid the mistake of saying NO. Either of those answers would cut off an opportunity for an important discussion of our Continued on page 10

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Best Practices patient’s suffering and concerns, an opportunity to address the root cause of his or her suffering. The Education in Palliative End of Life Care (EPEC) curriculum advises a 6-step protocol to respond to requests: STEP 1: Clarify the Request Our response needs to be immediate and compassionate, asking open-ended questions, asking about suicidal thoughts

Physician-Assisted Suicide and plans, and being aware of how our own biases may influence our response.

STEP 2: Determine the Underlying Causes Understand the patient’s suffering. Is it fear of loss, of being a burden, of physical symptoms? Is there spiritual suffering or a lack of sense of worth? Is there depression that can be treated?

STEP 3: Affirm Your Commitment Listen and acknowledge fears, allow for the expression of emotion, explain your role and commit to find solutions, and stand by the patient.

Lead the Way for your

HEALTH CARE TEAM Looking to advance your career? Want to hone your team-building skills?

PAMED, in collaboration with the American Association for Physician Leadership(AAPL), has training options for individuals and groups.

www.pamedsoc.org/ leadershipacademy

Questions?

Contact Leslie Howell at (800) 228-7823, ext. 2624 or lhowell@pamedsoc.org.

STEP 4: Address Root Causes

and insured. The reasons given are likely to be the same concerns we would have at the end of our own lives. The issue of PAS raises profound questions about our culture’s ability to deal with suffering. Suffering would seem to be an inevitable part of life, and the notion that it is best dealt with by a pill seems very impoverished.

Ivan Illich, in his 1976 book Medical Nemesis, describes how “culture makes pain tolerable by interpreting its necessity; only pain perceived as curable is intolerable.”  In our 21st century world, we have come to expect that all pain is curable, even the pain of death. The fact that what is inevitable has become so intolerable that we look beyond our traditional sources of strength in family, community, and faith to instead medically “manage” death with a pill, raises the question: What kind of people have we become?

Commit to aggressive comfort measures and withholding or withdrawing unwanted life-prolonging procedures, address suffering and fears, and connect the patient with our local palliative care programs and hospices. Help the patient select a personal advocate who will follow his/ her wishes if he/she is not able. Help him/her to develop advance directives and plan for death. Explore what “dignity” means to the patient and offer resources to maintain dignity and reassure the patient you will do all in your means to maintain dignity as defined by the patient.

STEP 5: Educate About Legal Alternatives Inform patients about refusal of treatment, withdrawal of treatment, declining oral intake, and palliative sedation.

STEP 6: Consult with Colleagues Seek support from trusted colleagues. Get to know your palliative care colleagues in the community.

We find the demographic of those who chose PAS in Oregon disturbing, for it is our own demographic: white, well-educated,

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REFERENCES: 1. Hedberg K, Hopkins D, Kohn M. Five years of legal physician-assisted suicide in Oregon. N Engl J Med 2003; 348: 961-964.

2. Loggers ET, Starks H, Shannon-Dudley M et al. Implementing a death with dignity program at a comprehensive cancer center. N Engl J Med 2013; 368: 1417-1424.

3. Illich, Ivan. Medical Nemesis: The expropriation of health. p.134 (Random House, New York, 1976).

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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

Best Practices

Lancaster Regional Medical Center & Heart of Lancaster

Enhance Patient Experience With Cloud-Based Technology To Match Patients With Resources

DANIELLE GILMORE

Director of Marketing, Lancaster Regional Medical Center & Heart of Lancaster Regional Medical Center

A

s medical facilities shift to an outcome and quality based model, it’s more crucial than ever to optimize resources to provide the best and most efficient care to our patients. As part of a broader initiative to enhance the patient experience, Lancaster Regional Medical Center (LRMC) and Heart of Lancaster Regional Medical Center (HLRMC) have streamlined patient transitions in care by using par8o’s Healthcare Operating System—a cloud-based platform technology that connects providers, payers, and patients.

Simply put, par8o helps match the right patient to the right resource at the right

time, providing a seamless, personalized patient experience.

The platform works independently of an EMR (electronic medical record) and provides a comprehensive view of how patients move through the hospitals and affiliated providers. It puts all necessary patient information at a provider’s fingertips electronically (e.g., test results, discharge plans, appointment scheduling and confirmation, etc). This results in more efficient and timely patient care, whether that care involves a visit to a specialist after an appointment with a PCP (primary care provider) or a follow-up with a PCP after

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a late-night visit to the emergency room.

LRMC and HLRMC are part of a growing and diverse list of organizations that have adopted the par8o platform. Others that use it include the largest employer in the State of Nevada, MGM Resorts, and several pre-eminent academic medical centers, such as Harvard Medical School affiliated hospitals in Boston and facilities that are part of the Mount Sinai Health System in New York.

“This is the future of health care, and we are excited to be at the forefront,” said Russell Baxley, CEO, Lancaster Regional

SPRING 2015

Enhancing Patient Experience

Where Experience Meets Excellence

Medical Center. “We can share patient information faster with providers. And the enhanced coordination of care has helped to improve patient service quality, reduce hospital and patient costs and ultimately reduce readmissions.”

There are several key steps that LRMC and HLRMC have taken to connect patients utilizing par8o:

➊ Physician Network Mapping

Par8o provides a directory of providers and recognizes which providers are available at any time within the network.

➋ Identification of the Right Resources for Each Patient

Par8o applies intelligence at the point of referral, allowing hospitals to navigate the patient in a direction that aligns with both clinical goals and the availability of resources.

➌ Empowered Allocation

Improving communications between providers about pre-referral needs, such as pre-visit testing, helps reduce unnecessary care and ensure that a patient’s clinical pathway is appropriate. Providers are able to shift away from the typical first-come, first-serve patient appointment scheduling. Schedulers can triage appointments based on referral urgency and reason for referral.

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➍ Engagement with Patients from the Beginning

LRMC and HLRMC use par8o to proactively schedule patients with an appropriate provider in the network to ensure appointments are scheduled in a timely manner. This takes the burden of that process away from the patient. Feedback from the patient about that provider can then also be recorded.

➎ Effective Tracking

LRMC and HLRMC can track the flow of patients between providers and also the time it takes for providers to contact patients—in real time. We can then easily report that data to all who need it.

The Results

Since launching par8o in June 2014, LRMC and HLRMC have managed over 25,000 patient transitions. In a short period of time, both hospitals have seen improvements in how patients are engaged throughout the platform.

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Best Practices

LANCASTER GENERAL HOSPITAL’S FAMILY MEDICINE RESIDENCY PROGRAM

Celebrates 45 Years

OF CARING FOR THE COMMUNITY

At that time, Penn Medicine was not in the forefront in these negotiations. Dr. Gurin told Dr. Zervanos to get in touch with Dr. Joel Alpert at Harvard. Dr. Alpert was a pioneer in pediatric primary care training and Director of the Family Health Care Program, which was preparing physicians of internal medicine, pediatrics and general practice for academic careers in the proposed new specialty of family medicine.

Dr. Zervanos also contacted Dr. James Z. Apple, a general practitioner in Lancaster County and president of the American Medical Association, who provided strong encouragement. Following additional training in internal medicine at the Philadelphia VA and Penn, Dr. Zervanos completed his fellowship at Harvard and came to LGH in July 1969 to establish Lancaster General Hospital’s Family Medicine Residency Program.

At its core curriculum was—and still is—a commitment to community service, administering to the underserved in both the urban and rural settings, and providing comprehensive care to women through all aspects of pregnancy—all concepts unheard of at that time.

Dr. Nikitas J. Zervanos, left, founder and Director Emeritus of Lancaster General Hospital’s Family Medicine Residency Program, and Dr. Stephen D. Ratcliffe, current Program Director, recently celebrated the program’s national ranking with more than 200 current residents and graduates.

I

n the early 1960s, Lancaster County and communities across the nation were experiencing a shortage of general medicine doctors. Physicians were retiring and, in an age of specialization, not enough family physicians were graduating from medical schools to replace them.

An American Medical Association commission looked into the family medicine practice situation, described as “moribund,” and reported, indeed, there was a shortage of medical school graduates. To remedy that, the commission recommended an

increase in the physician manpower pool and the creation of a new specialty to attract students into family medicine.

Forty-five years later, as founding director and one of the first physicians in the country to tackle development of a three-year specialization program in family medicine, Dr. Zervanos has guided Lancaster General Health’s Family Medicine Residency Program to national prominence.

In September 2014, the program was ranked fourth in the nation in the Family Practice category by Physician network Doximity and U.S. News & World Report; and in January 2015 it was ranked number one in the northeastern United States.

In the midst of this growing family practice movement was an interested Dr. Nikitas “The proof of our success is the quality of J. Zervanos, who interned at Lancaster our family physicians in Lancaster County General Hospital from 1962-1963 and who and around the country,” said Dr. Zervanos, was serving in Greece as a U.S. Medical who continues to serve as Director Emeritus.

Corp officer. He wrote to his dean, Dr. Sam “So many of our graduates—so many—are Gurin, at the Hospital of the University of stars in their respective communities.”

Pennsylvania, to explore what his school was doing regarding the development of Dr. Stephen D. Ratcliffe, who succeeded this new specialty.

Dr. Zervanos as Program Director in 2002,

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SPRING 2015

45 Years of Caring for the Community

said the residency program’s 500 graduates include leaders in health systems, academics, and physician practices, and they are making an impact both locally and globally.

“One-third of Family Medicine Residency graduates remain in Lancaster County, and about two thirds of the 2015 class will remain in Lancaster County to practice family medicine,” he said. “If you do the math, we’ve been serving close to 1 million people because of the Lancaster General Family Medicine Residency program.”

Dr. Ratcliffe credits LG Health’s support of family medicine based clinical services and an infrastructure that gives residents the opportunity to develop critical and analytical skills to help them in their future practice.

“Lancaster General Health’s Research Institute and Comprehensive Care Medicine, which treats patients with HIV, are two examples of how we provide our residents with in-depth and wide-range knowledge in the medical field.”

Where are some of LGH’s Family Medicine Residency graduates today? Here’s a partial listing of those serving in Lancaster County: Dr. Jeffrey R. Martin: Lead Physician for LG Health’s Care Connections, which helps high risk, high-utilizing patients at LG Health Physicians’ practices and Southeast Lancaster Health Services better manage their care. (As a resident, Dr. Martin volunteered with Vantage House, a program of Gaudenzia/Lancaster residential drug and alcohol treatment center for women with children, and he continues volunteering as medical director.)

Dr. Pam Vnenchak: Deputy Director of LGH Family Medicine Residency.

Dr. Donna Cohen: Assistant Deputy Director of LGH Family Medicine Residency.

Dr. Matthew Beelen: Director of LGH Geriatrics Fellowship.

Dr. Christine Stabler: Vice President of LG Health Academic Affairs.

Dr. John Wood: Chair of LGH Department of Family Medicine and Medical Director of Care Connections.

Drs. Harrison McGrath & Andrea Stern: Established a new family practice in Mount Joy in 2013.

Dr. Christian Hermansen: Medical Director of Downtown Family Medicine and six other LG Health Physicians practices.

Dr. Steve Diamantoni: Managing Physician of Diamantoni & Associates and Lancaster County Coroner.

Drs. Chris Hager & Brian Young: Members of Managing Council for LG Health Physicians.

Dr. Kirsten Johnsen Martin: Medical Director of Southeast Lancaster Health Services.

Dr. Kristin Nebel: Lead Physician of Geriatrics & Associates.

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Best Practices

What Physicians Should Know About

The 2015 OIG Work Plan Information provided by PAMED

E

ach year, the Office of the Inspector The OIG will use 13 measures to indicate General (OIG) releases its work plan, possible questionable billing practices. which identifies the areas of health care on which the agency will focus its The OIG’s annual work plan also fight against fraud and abuse in Medicare includes projects that have been and Medicaid. The work plan serves as a carried over or extended from roadmap that can make the challenge of previous work plans, including: navigating the world according to Medicare a bit less daunting.

• New Inpatient Admission Criteria: A review will be done to determine the This year’s work plan includes impact of new inpatient admission criteria three new project areas: on hospital billing, Medicare payments, and beneficiary copayments. The review 1. Hospital Wage Data Used to Calculate will also report billing variations among Medicare Payments: The OIG will hospitals. determine whether there are appropriate controls in place for the collection and • Medicare Oversight of Provider-Based reporting of wage data, to ensure that Status: Provider-based status allows facilonly eligible services and compensation ities owned and operated by hospitals to are included in the wage data reported. bill as hospital outpatient departments.

This can result in higher payments for 2. Adverse Events in Post-Acute Care: the facilities, and increased beneficiary The OIG will examine adverse events coinsurance liabilities. The OIG wants and temporary harm events to identify to determine whether provider-based contributing factors, the extent to which facilities meet the Centers for Medicare the events were preventable, and the and Medicaid Services’ criteria. associated costs to Medicare.

• Comparison of Provider-Based and 3. Independent Clinical Laboratory BillFree-Standing Clinics: Medicare paying Requirements: Medicare is the single ments for physician office visits in largest payer of lab service, and the fact provider-based clinics and free-standing that lab spending has increased by almost clinics will be compared to determine the 30 percent in a five-year period from 2005 difference in payments. and 2010 has got the attention of the OIG.

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• Oversight of Hospital Privileging: The OIG will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials and review of the National Practitioner Databank. Medicare requires participating hospitals have a medical staff that operates under bylaws approved by the governing body.

• Part B Services During Nursing Home Stays: Congress directed OIG to monitor Part B billing for abuse during non-Part A stays to ensure that no excessive services are provided. Several broad categories of services, such as foot care, will be examined.

• Ophthalmologists inappropriate and questionable billing: Claims data will be reviewed to identify “potentially inappropriate and questionable billing” for ophthalmology services during 2012.

This is driven by the fact that, in 2010, Medicare allowed more than $6.8 billion for services provided by ophthalmologists.

• Imaging Services, payments for practice expenses: A review of Medicare Part B payments for imaging services to determine whether they reflect the expenses incurred and whether the utilization rates reflect industry practices. The focus will be on the practice expense components, including the equipment utilization rate.

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Healthy Communities

The School Access To

EMERGENCY EPINEPHRINE AC T A Step to Save Student Lives In Event of Life-Threatening Allergic Reactions ROSE BOETTINGER

E

pinephrine auto-injectors can help save lives when administered properly.

Now, thanks to the School Access to Emergency Epinephrine Act, schools around Pennsylvania are able to take measures to further ensure student safety.

Signed into law by former Pennsylvania Governor Tom Corbett on October 31, 2014, the School Access to Emergency Epinephrine Act permits schools to store epinephrine auto-injectors for administering to a student in the event that he or she is suffering anaphylaxis, a potentially life-threatening allergic reaction. It also requires designated faculty and staff members of participating school districts to complete a training program through which they learn the proper storing and administering techniques of epinephrine auto-injectors. The program also helps these individuals recognize symptoms of anaphylaxis (e.g., itching and swelling of the lips, watery eyes, swelling eyelids, nausea) in order to treat students as soon as possible.

Districts around the state are eager to begin the training process. Lead Nurse Sue Myers elaborates on Solanco school district’s plans for its training program: “We are coordinating the Lancaster County school nurses with our certified NASN trainer Lisa Albert to present the ‘Saving Lives’ in partnership with Lancaster General Health’s nursing director Claire Mooney and the Future Nurses Club. Then this fall, we are going to target as many staff and faculty members as we possibly can.”

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Although students with known allergies have been permitted to carry and self-administer their own epinephrine auto-injector prescriptions for some time, Myers explains that before the School Access to Emergency Epinephrine Act was put into place, students who have undiagnosed allergies and even students without prescribed epinephrine auto-injectors were not protected. Now, however, if a student is suffering an allergic reaction, a trained faculty or staff member’s liability is covered when administering an epinephrine auto-injector to the student.

It also benefits students with known allergies who happen to forget their prescribed epinephrine auto-injectors or who may be carrying expired epinephrine auto-injectors.

In addition, Myers endorses the presence of epinephrine auto-injectors in schools by stating, “Epinephrine auto-injectors are easy to use, quick to administer, and low-cost to maintain adequate supplies through various programs.”

But who is providing the schools with epinephrine auto-injectors?

According to allergy specialist Dr. Clark Kaufman, participating schools can contact Mylan to receive two two-packs of EpiPen® Auto-Injectors at no cost as long as those schools produce written prescriptions.

The EpiPen4Schools® program was designed by Mylan Specialty to provide qualifying schools with either the EpiPen® or EpiPen Jr®, depending on the needs of individual schools. It is also possible for

SPRING 2015

Emergency Epinephrine Act

schools to obtain one two-pack of each.

half an hour,” Kaufman explains, “and some children may have secondary reactions. Taking the child to the hospital is standard procedure to ensure that the recovery for the treatment is complete.”

Myers adds that Mylan will also replace used EpiPen® Auto-Injectors.

He also explains that parents have nothing to fear from use of an epinephrine auto-injector: “The medication in the EpiPen® is a natural chemical the body already makes itself.” Therefore, there is no harm in administering an epinephrine auto-injector to a person when he or she is mistaken for experiencing an allergic reaction.

“A large percentage of accidental ingestion cases occur in schools...and it is essential to treat an allergic reaction early on,” Kaufman says. He explains that medicine like Benadryl can take nearly half an hour to begin treating symptoms, whereas relief provided by the EpiPen® occurs shortly after injected and is much more effective in treating anaphylaxis.

This act is not an excuse for children with known allergies to avoid keeping their own epinephrine auto-injectors handy, however. Myers stresses that these children need to be champions for themselves by carrying their prescribed personal medications with them as part of their daily attire.

Making the choice whether to keep epinephrine auto-injectors on hand in schools can prove to be a life or death decision, as Kaufman estimates that approximately one in four cases of allergic reactions can be fatal and that more deaths occur from food allergy reactions than from allergic reactions to bee stings and insect bites.

By allowing the storage and administering of epinephrine auto-injectors by trained faculty and staff members in public and private schools, the School Access to Emergency Epinephrine Act may just be the next revolutionary step in ensuring the survival of students not just in Lancaster County but throughout the state of Pennsylvania as well.

Treating a student with an epinephrine auto-injector does not, however, eliminate the need for the student to receive immediate professional medical attention. “Epinephrine will work for about

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Healthy Communities

MEASLES MAKING AN UNWELCOME COMEBACK: Declining Vaccination Rates Are To Blame

CURTIS L. HERSHEY, MD

Lancaster General Health, Lincoln Family Medicine

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the spike in cases is declining vaccination rates. The vast majority of cases occurring in the U.S. today are among those that are unimmunized against the virus.

So, why has measles made a comeback?

This resurgence is not due to a new strain of the measles virus, it’s not due to global warming, and not even health care reform can be blamed. The primary reason for

The first measles vaccine was licensed in the U.S. in 1963. Prior to use of the measles vaccine, nearly 550,000 measles cases were reported annually in the U.S., and of those cases, each year an average of 48,000 people were hospitalized, 1,000 people developed chronic disability due to encephalitis, and 500 died. Those are staggering statistics.

Thanks to widespread use of the vaccine, the prevalence of measles in our country experienced a sharp decline in the 1960s and remained very low at the turn of the millennium. There were fewer than 100

easles has made a comeback. Having been considered eliminated from the United States as of 2000, there have been more cases of measles in 2014 and early 2015 than we have seen in decades. The latest outbreak originated from an amusement park in California and had caused 176 cases involving 17 states as of March 13, 2015. After experiencing a fifteen-year high number of cases (644) in 2014, it is very likely that the U.S. will see even more cases of measles this year than last.

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cases per year from 2000-2013. Measles has not been completely eradicated from the U.S. partly because it is still common worldwide, with an average of 20 million cases and 146,000 deaths annually.

For those who think measles is a mild illness, think again. Measles starts with fever (as high as 105°F), malaise, and the three C’s—cough, coryza (runny nose), and conjunctivitis. These symptoms could be confused for the flu or a bad cold but are then followed by a rash that spreads from the head to the body and then to the legs.

Common complications of measles include ear infection, pneumonia, and diarrhea. A less common but more severe complication, occurring in one out of 1,000 cases, is acute

SPRING 2015

Measles

encephalitis (infection of the brain), which often results in permanent brain damage. One to two out of 1,000 children affected by measles die from respiratory or neurologic complications. Subacute sclerosing panencephalitis (SSPE) is a rare but fatal complication of measles characterized by seizures and progressive decline of neurologic function, which develops between seven to ten years after measles infection.

Those at highest risk of complications from measles include children less than 5 years of age, adults over 20 years of age, pregnant women, and those with compromised immune systems. Measles is one of the most contagious illnesses; after close contact with someone with measles, 90 percent of susceptible people (those who lack immunity) will develop the illness. Measles is spread by direct contact and by airborne exposure via coughing, sneezing, etc. The rash usually appears two weeks after exposure, but the incubation period can range from one to three weeks. Those with measles are contagious from four days prior to onset of the rash to four days after the rash disappears.

The diagnosis of measles should be confirmed by laboratory testing of either blood or nasal swab samples (or both). Treatment involves supportive care and alleviation of symptoms, as well as treatment for possible complications including antibiotics for secondary bacterial infections, such as ear infections and pneumonia. Due to the very high chance of spreading the illness to contacts, people with confirmed or suspected measles should be quarantined and excused from school or work until the contagiousness period passes.

The most recent measles outbreak has caused concern among many people who fear measles could spread throughout the U.S. and come to our area. While this has not yet happened, it is still a possibility. If nothing else, there has been raised awareness of this potentially dangerous but very preventable illness. I am also hopeful that this will also cause parents to think twice before making a decision to withhold immunizations from their children. Again, the vast majority of measles cases in the U.S. occur in those who are not vaccinated.

The measles vaccine is a safe and effective method to prevent measles. A single dose of the MMR (measles, mumps, rubella) vaccine is 93 percent effective at preventing measles. A two-dose administration of the vaccine (as is recommended in the immunization guidelines) is 97 percent effective. Herd immunity, in which nearly all individuals in a given community are immunized against a particular illness, increases the vaccine’s effectiveness, making it nearly impossible for a widespread outbreak of measles in a fully vaccinated community.

The MMR vaccine is recommended as part of the routine vaccination schedule for children, with the first dose given at age 12-15 months of age and the second dose given at 4-6 years of age. The MMR vaccine is also indicated for other groups of patients that don’t have evidence of immunity to measles. Evidence of immunity includes at least one of the following: written medical records documentation of two doses of measles-containing vaccines given at appropriate intervals; laboratory evidence of measles immunity and laboratory confirmation of measles infection; and birth before 1957 (it is presumed that everyone born prior to 1957 had measles). College students, health care workers, international travelers, and adults born during or after 1957 without any of the listed evidence of immunity should receive at least one dose of MMR. Infants at least 6 months of age who will be traveling internationally should receive at least once dose of MMR prior to travel.

Again, measles is a potentially serious illness, which is preventable by a very safe and effective vaccine. If you are not certain you are immune to measles and think you are at risk, talk to your primary care doctor. If you are a parent of a child who has not yet been immunized, protect your child from measles and have him or her vaccinated.

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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

Healthy Communities

Physician Burnout A Local Take On A National Epidemic

morale, reduced levels of effectiveness, drug or alcohol abuse, and depression. Physician burnout affects doctors throughout the national health care system—including those in Lancaster County.

“I think it touches every single physician,” said Dr. Lee M. Duke, II, chief physician executive and chief medical officer at Lancaster General Health. “The extent within any one physician is hard to know, but I believe everyone is touched by it.”

SUSAN SHELLY

According to Dr. Anthony Mastropietro, system chief medical officer at Lancaster Regional and Heart of Lancaster Regional Medical Centers, a primary cause of physician burnout is that demands on doctors continue to increase as resources shrink.

“Physicians are just being stressed to do more and more and more, for less and less and less,” he said.

Dr. Jon Shapiro, medical director at the Foundation of the Pennsylvania Medical Society’s Physician’s Health Program, shared that physician burnout was first identified several decades ago, but has accelerated due to a number of factors, including: • A shift among physicians from being self-employed to becoming employees • Increase in federal regulations • The transition to electronic health records • Ongoing pressures surrounding the threat of malpractice • Push for larger volume with decreased reimbursements

B

urnout among physicians is occurring at an alarming rate and is on the rise, with nearly half of all doctors surveyed reporting that they suffer from the condition. In this year’s Medscape Physician Lifestyle Report, 46 percent of all physicians reported burnout, which is commonly described as “loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment.” Physicians

in five specialties: critical care, emergency medicine, family medicine, internal medicine and general surgery reported burnout at a rate of 50 percent or higher.

Some believe that physician burnout is actually significantly higher than reported, as doctors may be reluctant to admit they are feeling overly stressed. Results of physician burnout vary, but can include anxiety, low

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• A shift from fee-for-service to pay-for-performance payment model

Shapiro said all of these factors, when added to an already stressful environment, can affect productivity and cause doctors to feel like they’re losing control of how Continued on page 24

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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

Physician Burnout

Healthy Communities

can have a bad night in the ER—maybe you lose a patient— but you’ve got to show up for work the next day,” he explained.

“There’s no taking time Duke points out that electronic record off because of somekeeping has many advantages and probably thing like that.” has improved patient care, but it’s time consuming for doctors and frustrating for All of these pitfalls many patients who feel they are not getting are causing many phythe attention they should be. Many doctors sicians to re-evaluate the longevity of their have to add hours to their day to keep up careers.

A 2013 survey of more than 20,000 with the electronic records, and according doctors, conducted by Deloitte, noted that to Duke, “Many patients have complained that the doctor seems to spend more time 62 percent of respondents felt “it is likely with the computer than the patient.” that many physicians will retire earlier than planned in the next one to three years.” they perform their work. “Physicians feel like they’re losing control over how they deliver care,” he explained. “They have ceded control to insurance companies and health care institutions and government.”

“Physicians are just being stressed to do more and more and more, for less and less and less.”

Government regulations, including the Affordable Care Act and policy and payment changes to Medicare and Medicaid, are another major source of stress for doctors.

For younger doctors with high amounts of student debt, decreased reimbursement for services is a particularly acute problem.

“You can’t expect people to come out of medical school with $200,000 worth of debt and not consider what they’re going to get paid to be important,” Duke shared.

“There’s a high level of deferred income until a doctor starts practicing, and there’s got to be some reward for that.”

“The old idea of the rich doctor is quickly becoming passé,” said Mastropietro.

Health care providers—particularly physicians—face grueling schedules, Duke noted, and they are expected to meet those time demands regardless of circumstances. “You

hopes Duke. But, doctors will still be called upon to shoulder the bulk of the work and be burdened with administrative tasks that have become the new norm.

Carl J. Manelius, director of physician affairs, shared that Lancaster General Health is looking closely at the issue of physician burnout and working to assure that its doctors are able to maintain a favorable work-life balance. The health system held a program on physician burnout and has resources in place for doctors who ask for help. “It’s certainly something that’s on our radar screen here,” said Manelius.

According to Heather Wilson, executive director of the Foundation of the Pennsylvania Medical Society, the importance of reigning in physician burnout rises to a new level of priority with a well-documented doctor shortage already looming and an aging population needing increasing amounts of medical care. “When a physician stops practicing medicine (due to burnout), it’s a tragedy for all the training and time Lancaster Regional and Heart of Lancaster put into that career,” Wilson said. “It’s a Regional Medical Centers also are paying very bad thing for the institution and for attention to the issue of physician burnout, patients who depend on quality care being and are working to keep conditions favorable available to them.” for doctors. “We work really hard to make sure our people are fairly paid, with benefits She shared the issue of physician burnout and consideration for their time,” remarked is complex, and, while the answer to the Mastropietro. He praised doctors throughout problem is not clear, it is taken seriously Lancaster County, saying they are commitand is being addressed. The state’s Physician ted to patient care and heroic in the face of Health Program provides help and resources increasing responsibilities and stress. “I just for doctors, family members, and medical thank God for all the dedicated physicians practices across Pennsylvania. And, the I work with and around the county who Foundation of the Pennsylvania Medical continue to work to serve patients.”

Society is planning a retreat for doctors to address this issue later this year.

Duke believes the solution to physician burnout is to get doctors back to doing what “I think the fact that we’re talking about they trained for—working with patients and burnout and bringing it to the forefront of practicing medicine without all the distracconversation is a good thing,” Wilson said. tions they currently face. “I’m not sure how “The key to solving this problem is to catch we can make that happen, but as doctors, it (burnout) early and address it.” we need to reconnect with why we put our scrubs on in the morning, and what makes Instituting a team approach to care, such us smile when we’re leaving in the afternoon,” as with a patient centered medical home said Duke. “We need to remember why we model, may relieve some stress for physicians, went into medicine in the first place.”

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Michelle K. Cantwell, DMD THE CENTER FOR DENTAL SLEEP MEDICINE 2207 Oregon Pike, Suite 101, Lancaster, PA 17601

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SPRING 2015

Patient Advocacy

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In addition, it gives information to health care providers and staff so they can more effectively answer questions from patients.

Project Access Lancaster County (PALCO) uses this resource with their clients and finds it to be very helpful in orienting clients to the health care system.

Many people who have never had health insurance before need to learn where they should go for care and the difference between when to call their doctor’s

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“Many of the newly insured have little or no experience with health insurance or available health care services. We use the From Coverage to Care materials to give our participants information about how to use their health coverage and how to navigate the health care system.” – Lisa Riffanacht, Executive Director, Project Access Lancaster County You can find more about C2C and access its tools by visiting the CMS website and typing search term “C2C” at https://marketplace.cms.gov.

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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

Lancaster County Medical Foundation’s PALCO Program Launches Countywide Medical Support Program An Initiative To Help Residents Afford & Understand Affordable Health Care LISA RIFFANACHT

Executive Director, PALCO (Project Access Lancaster County)

T

he Affordable Care Act (ACA) and the expansion of Medicaid in Pennsylvania have made immense strides in expanding access to affordable health coverage. However,

some lower- and moderate-income consumers still struggle to afford coverage and care, even with the help of federal financial assistance. The Lancaster County Medical Foundation is gathering information on what is working well and what gaps exist as this new world of health coverage develops. It seems clear there will be individuals who will find “affordable” care beyond their means.

The Lancaster County Medical Foundation proposes creating a countywide medical support program, targeted to assist primarily low-income families whose insurance has high copays and deductibles; we would also assist individuals without health insurance as a system of last resort.

PALCO ceased to provide donated medical services to low-income Lancaster County residents on April 1st of 2015.

PALCO will continue to assist individuals in applying to the ACA program and the Medicaid expansion program, Healthy PA.

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SPRING 2015

PALCO Launches Medical Support Program

Premium Assistance

While initial reports from the Health Benefit Exchange indicate that most people are maintaining their premium payments, recent information shows that some enrollees ended their enrollment either due to non-payment or voluntarily.

PALCO will pilot a premium assistance program, with $50,000 of foundation dollars. For people who live at or below 200 percent of the federal poverty level (FPL), PALCO will pay half of their premiums for one year. Individuals who earn below 138 percent of the FPL are eligible for Medicaid. Above that level, they must buy their insurance through the ACA exchange.

Nearly 10,300 people in Lancaster are newly enrolled in the Affordable Care Act. Many more had the chance to buy subsidized health insurance on the Marketplace (starting November 15, 2014) for a fraction of the sticker price.

A mid-range “silver plan” that costs $540 on the open market is just $127 a month once federal subsidies kick in for a 50-year-old Lancaster couple whose income is $30,000. This is about 5 percent of their wages. For a couple scraping by on $30,000, there is little discretionary income, and even 5 percent can be a hit they can’t afford. Needing to fix the car or repair the water heater could make the insurance unaffordable during that month. The new premium assistance program would help ensure that people who took a chance and signed up for coverage won’t have to drop out if the premiums become too expensive.

PALCO would limit the program because it could not assist a huge number of people. To be eligible for premium assistance, individuals would need to meet three basic requirements. 1) Be a resident of Lancaster County, 2) purchase a silver plan available among the insurance providers listed in the Health Insurance Marketplace, and 3) be under 200% of the federal poverty guidelines. In order to comply with the guidance issued by Centers for Medicare and Medicaid Services (CMS), PALCO would have to provide financial assistance for a full year. The silver level plans are the only plans that provide tax credits as well as cost sharing assistance to individuals, making the out of pocket costs more affordable.

Hospitals or their foundations have long paid premiums for some patients. But the issue of “third-party payments” has taken on new urgency because of a provision in the federal health law that could leave providers on the hook for unpaid bills. Under the law, insurers must give subsidy-eligible enrollees who fall behind on payments a 90-day “grace period” before cancelling their policies.

While insurers must cover bills for the first 30 days, they may hold off paying those bills for the next 60—and ultimately, deny payment if the patient doesn’t catch up on premiums. That means doctors and hospitals face the prospect of not getting paid for their services, or having to seek payment directly from their patients.

LANCASTER

Just as with PALCO, we would ask the local hospitals and insurance carriers for financial support to provide the premium assistance dollars. Highmark Blue Shield has voiced interest in funding such a program. This program aligns with hospitals’ charitable missions and helps a vulnerable population obtain much-needed health care coverage. Hospitals are required by law to give some charitable care for free to the community. Paying the premiums of low-income people may make those charity dollars go farther. It seems a more cost-effective option than waiting for uninsured people to show up in their emergency rooms, ultimately unable to pay their bills.

Mental Health

Poor mental health has been closely linked to physical health, particularly to the prevention of individuals taking part in healthy behaviors and recovery from chronic disease. Based on state and national data, more than one in six Lancaster County residents (nearly 98,000 individuals) have a diagnosable mental, behavioral, or emotional condition. Many more are likely undiagnosed and untreated, including those without health insurance or with high copays and deductibles. The current system of care is fragmented and in need of repair to form a strong link between medical care and mental health (MH) services. Our county lacks resources for patients to turn to for help and there is no quick, seamless provider referral and feedback system.

Continued on page 30

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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

PALCO Launches Medical Support Program

This new initiative, intended as a payment system of last resort, is targeted to assist individuals without health insurance and the primarily low-income families whose insurance has high copays and deductibles. Based on the 350 uninsured and underinsured individuals served in 2013 by local non-profit MH providers, an estimated 450 individuals will receive support in Year One with approximately eight visits per year.

Many of these Americans are now contending with unfamiliar insurance terms and are at risk of making uninformed choices that they may regret. This matters because those with low health literacy already tend to experience poorer health and to generate increased costs.

Our ACA Counselors have spent up to five hours helping just one patient apply for insurance through the Marketplace. We need Specialty Care to explain basics like premiums and deductibles, as well as how PALCO would continue to assist the uninsured. Primary care to compare insurance options. We have walked patients through is available to this group through Southeast Lancaster Health Ser- checking to make sure their current doctors will be covered under vices on a sliding scale fee. Copays and the full costs of specialist new plans. Notably, despite having proficient health literacy and charges are roadblocks to further care where it becomes necessary. training, the coordinators have sought assistance to confirm the We would negotiate lower fees with specialists willing to see the finer details. Clearly, these are not easy tasks. undocumented, perhaps at the Medicaid or Medicare rate. Specialists would not be asked to provide routine care, such as diabetic eye A required part of receiving assistance through these new initiachecks, only needed treatment or evaluation. Compensation for tives would be that the families participate in a health literacy class developed by PALCO, with tools from the Marketplace. providers would be paid by PALCO. Families will also be required to participate in financial education classes through Tabor Community Services. They may choose between: “Budgeting: Making a Money Plan That Works,” “Savings: Making Your Money Work for You,” “Banking Basics,” or “Good Credit and How to Get It.” Additionally, Preferred Health Care (PHC) offers an online wellness portal that we will make available to grantees. Counseling on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use can improve health and reduce costs by preventing illness.

Preventative Care

Before the health care law, too many Americans did not get the preventive care they needed to stay healthy, avoid or delay the onset of disease, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate. The Affordable Care Act makes preventive care affordable and accessible by requiring certain private health plans to cover certain recommended preventive services without charging a deductible, copayment, co-insurance, or other cost sharing. Under this new requirement, those services (including well-woman visits, support for breastfeeding equipment, domestic violence screening and counseling) became more broadly available without cost sharing.

Health Literacy

A recent study from the Urban Institute indicates that a majority of those most likely to use the Marketplace are not confident in how well they understand even rudimentary health insurance terms.

We will require that all individuals participating in these initiatives have an annual physical.

Health literacy involves the ability to obtain, process, and understand the health information necessary to make appropriate decisions. It’s clearly essential to selecting health insurance. More Americans are enrolling in federal- and state-based marketplaces, but being insured is only the beginning when it comes to reducing health disparities related to literacy.

LANCASTER

PALCO is a trusted service provider for the medical community and the uninsured. PALCO has strong expertise in coordination of donated services as well as culturally competent insurance enrollment and navigation. By developing a countywide medical support program, we will support the local medical community as we navigate the new health care system.

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SPRING 2015

Patient Advocacy

REASONS To Keep The Health Care Team Together

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any physicians across the state, as well as the Pennsylvania Medical Society (PAMED), support physician-led, team-based care, in which all health care team members work together collaboratively, but the physician is the leader of the team.

Legislation that has been already introduced in the House, House Bill 765, and is expected to be re-introduced in the Senate, proposes an unacceptable alternative—allowing certified registered nurse practitioners (CRNPs) to practice independently without a link to the team through their collaborative agreement with a physician.

Why keep the team together? Here are seven reasons:

❶ Increasing the responsibility of CRNPs is

❺ Collaborative requirements do not prevent

not the solution to shortage of physicians.

CRNPs from currently practicing in rural and underserved areas.

❷ The best and most effective care

❻ Current licensure standards are not

occurs when a team of health care professionals with complementary—not interchangeable—skills works together.

arbitrary; they serve an especially important function in supporting critical safety and quality objectives.

❸ The collaborative requirement between

❼ A majority of states require CRNPs to have

CRNPs and physicians enhances rather than impedes the ability of CRNPs to deliver quality patient care.

a physician’s collaboration or supervision in order to practice, with many states requiring even more stringent oversight than what currently exists in Pennsylvania.

❹ The education and training of a CRNP falls significantly short of the education and training of a physician.

Urge your state legislators to maintain physician-led, team-based care across Pennsylvania, and oppose HB 765 and any other legislation that would allow CRNPs to obtain independent licensure and eliminate collaborative agreements between CRNPs and physicians.

Learn more at www.pamedsoc.org/teambasedcare.

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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

Medical Society Updates

Mcare Settlement to Return $200 Million to Physicians and Other Providers —Includes Future Protections Reprinted with permission from Pennsylvania Physician Magazine ©2015

“By no means does this mean the battle is won.

Pennsylvania physicians’ medical liability rates are still too high. Too many frivolous suits are still filed. The Mcare Fund still has a $1.3 billion unfunded liability.

But a small bit of justice has been achieved. It just means that when we unite, we can stand up for our rights and win.”

— Karen Rizzo, MD PAMED President

O

n a brisk autumn day in 2009, an unseasonably cold wind swept through a gathering of physicians in Hershey. In one blast, it turned the doctors’ normally congenial, pleasant gathering on health issues like the H1N1 pandemic and changes in Medicare, into a sea of surprised and angry faces.

The meeting was the gathering of more than 250 member physicians and others for the annual PAMED House of Delegates in Hershey, Pa. The cold wind: News that the Pennsylvania General Assembly and then-Gov. Rendell had raided the Mcare Fund—taking funds that were not taxpayer dollars, but rather solely money from doctors and hospitals—in order to balance the 2009-2010 state budget.

“I recently had a considerable amount of money taken from me,” said James Goodyear, MD, PAMED president at the time.

“I had paid my medical liability insurance bills, confident they would use my money as intended to help injured patients. But a highly sophisticated organization suddenly took it all and said it needed it for something else. Who took it? Our state government.”

Despite the magnitude of the loss and the daunting uphill court battles they would face, the physicians did not turn away in resignation to this injustice heaped upon their giving profession. Instead, they immediately shouldered the burden, aligned with

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the Hospital & Healthsystem Association of Pennsylvania (HAP), and filed legal actions.

PAMED had already aligned with HAP and the Pennsylvania Podiatric Medical Association (PPMA) to appeal the 2009 assessment and challenge Mcare’s inappropriate build-up of reserves via assessment overcharges. PAMED and HAP filed similar appeals in each subsequent year for the 2010–2014 assessments.

The goals of the actions were to ensure that, in the future, the commonwealth never

45% Decline in Medical Liability Filings* The fact is that PAMED has made a lot of progress on tort reform, and our list of accomplishments is pretty long. For example, did you know that annual medical liability lawsuit filings are down 45 percent from what they were a little more than a decade ago?

That’s right—medical liability lawsuits against physicians and hospitals have been cut nearly in half thanks to our hard work. *Data demonstrates a 45% decline in the total number of medical liability filings between 2012 and the base years 2000–2002.

SPRING 2015

Mcare Settlement

FROM A PHYSICIAN’S PERSPECTIVE: An Interview with Daniel Glunk, MD Q: You were president of PAMED when this whole thing started. Take me back to that time.

How did you feel as a PA physician? As president of PAMED? A: We had heard that raiding these funds was being considered, but we were quite surprised by this action. We had worked very hard to try to dissuade them from doing that. The first was when they took the money from the retention account and that was followed by the $100 million they took from the Mcare Fund.

My view was that taking the money from the retention account could be considered business as usual, but raiding Mcare was personal and required action.

Q: What do you mean by that?

A: The retention account was being funded through cigarette tax. This money was supposed to be used to fund the Mcare abatements in effect from 2003 to 2007. However, the state underfunded the abatements and then took the money that had been earmarked for that purpose. It was very disappointing to learn that the physicians with partial abatements actually funded the abatement program. What was clear was that the money from the Mcare Fund was money that physicians and other health care providers had paid directly into that fund.

Q: This has been a several year battle. How did those feelings change over the years? How did you feel when you found out about the recent settlement?

A: We had a lot of discussions and serious thought at that time about whether or not we should pursue legal action and what the potential consequences would be. But in the end, it was the right thing to do. And then we started winning, and we kept winning, which really was quite encouraging. But, then again, every time we won, we thought they’d have to figure out a way to settle with us, and that didn’t happen. The years went on and it ended up in the Supreme Court. We kept fighting the fight but didn’t know what the conclusion would be. We must congratulate the then-Corbett administration for taking the right action.

Q: How vital was PAMED and its physician leadership to this outcome?

A: It was very important that PAMED’s leadership understood what was at stake and that each succession of leadership took on this challenge and kept moving it forward. It wouldn’t have been successful if everyone in succession hadn’t continued to state that this was an important thing and we needed to have protection against it happening again. It also wouldn’t have happened without PAMED, HAP, PPMA, and other groups working together to carry this through.

Q: What would you say to nonmembers who question the value of PAMED? A: Every Pennsylvania physician has benefited from this. Nonmembers who collect this windfall should consider putting part of their payout toward joining organized medicine. The money would more than pay for membership dues. The more members PAMED enlists, the stronger the physician voice is in the state when it comes to policy change. More work like this can be done on behalf of the physician workforce.

diverts assessment dollars paid by physicians, hospitals, and other health care providers to the state’s general fund again.

Finally, in late October 2014, after more than six years in the courts, PAMED, HAP, and PPMA settled their litigation with the

commonwealth regarding the Mcare Fund and appeals of prior assessments and the challenge to the transfer of $100 million to the general fund from Mcare in 2009.

The Mcare Fund, administered by the Pennsylvania Department of Insurance,

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provides $500,000 of medical professional liability coverage to physicians, hospitals, and certain other health care providers above their basic coverage. The covered health care providers must pay an annual assessment to fund the cost of the fund’s claim payments and other expenses.

The settlement agreement requires that $200 million be returned to physicians, hospitals, and other health care providers —$139 million in refunds for prior assessment overpayments and $61 million via a reduction to the 2015 Mcare assessment.

Perhaps more importantly for future Pennsylvania physicians, the settlement includes key protections against any future diversion.

Moving forward, the commonwealth agreed that Mcare funds will be held in trust and will not be considered the general revenue of the commonwealth.

The commonwealth also has agreed to operate the fund on a pay-as-you-go basis going forward. This means that health care providers will not be required to put money into the fund until it is needed and the fund will not be able to build up substantial reserves such as those diverted in 2009.

“Without the Pennsylvania Medical Society and our partners on their side, impacted physicians may not have found justice,” said PAMED President Karen Rizzo, MD. “This is a valuable benefit to membership,” she said, asking all nonmembers to consider joining and thanking members for their support.

“This is just one reason why the Pennsylvania Medical Society plays an important function on behalf of physicians,” said Dr. Rizzo. “Without a strong membership, physicians do not have a strong voice in Harrisburg.”

2015 Assessments Reduced

by Almost 50 Percent Last November, Pennsylvania physicians and hospitals heard more good news regarding their Mcare assessments. The Mcare Fund announced that the 2015 assessment will be 12 percent of the prevailing primary Continued on page 35

3 Reasons Why You Should Initiate

Medicaid Revalidation

NOW!

1

The March 26, 2016, revalidation deadline is closer than you think.

Plus, that date is NOT the submission deadline; it’s the deadline by which your enrollment application must be processed and approved and updates to the PROMISe™ system must be completed.

2

Pennsylvania’s Department of Human Services (DHS) expects longer wait times for approvals so it’s imperative to submit applications immediately.

3

You won’t receive a written notice from the DHS. It’s your responsibility to initiate the revalidation process.

You can avoid deactivation of your billing privileges and disruption to your reimbursement.

717-DOC-HELP (717-362-4357) • www.pamedsoc.org/revalidation

SPRING 2015

Medical Society Updates

Mcare Settlement

premium, or overall, 47.8 percent lower than the 2014 assessment of 23 percent.

percent of the prior year claim payments and expenses.

Part of the decrease stems from the $61 million that the Mcare settlement required to be used to reduce the 2015 assessment. The remainder stems from a substantial reduction in the claim payments in 2014. The starting point for the assessment calculation is 110

Claim payments declined 19.7 percent from $193.9 million in 2013 to $155.7 million in 2014. At this point in time, it is not known whether the reduction in claim payments will be sustained, as they have fluctuated significantly in recent years.

FAQs About the Mcare Settlement Physicians have many questions about the settlement and how it will process their refunds.

While it will take more than a year for the state to develop and implement the complicated formula for calculating refunds, in the meantime here are answers to some common questions.

Who is eligible for the refunds?

Physicians will be eligible for a refund if they paid an Mcare assessment (or an assessment was paid for them) for any time during 2009, 2010, 2011, 2012, or 2014 (excluding 2013). Some physicians have multiple primary policies and pay multiple assessments, so they are entitled to a refund for each policy in each year that is covered.

Why is 2013 excluded?

Making a Difference to Reduce Defensive Medicine Recent Pennsylvania Supreme Court data on medical liability lawsuit filings and verdicts show a decline in the number of filings in Pennsylvania, continuing a spiraling trend seen in eight of the last 10 years since systematic collection of the statistics began. While there is a great deal more to do, we have achieved many important remedies addressing major physician concerns, including: • APOLOGY: Makes physician apologies and other benevolent gestures (except admissions of fault or negligence) to a patient after a poor outcome inadmissible to prove liability in a medical liability action.

• EXPERT WITNESS QUALIFICATIONS: Establishes expert witness qualifications.

• VENUE: Requires that cases be filed only in the county where cause of action arose.

• JOINT AND SEVERAL LIABILITY: Modifies this rule so that defendants less than 60 percent liable are only responsible for their proportionate share of the award.

• CERTIFICATE OF MERIT: Requires attorneys to also file a professional liability action to file a certificate of merit, stating that he or she has a supporting report from a qualified expert.

• PUNITIVE DAMAGES: Allowed only if a provider engaged in willful or wanton conduct or in reckless disregard to rights of others and caps damages.

• AFFIDAVIT OF NON-INVOLVEMENT: Allows defendants to get quick dismissal by filing this, stating that they were not involved with the plaintiff’s care.

• COLLATERAL SOURCE RULE: Limits double recoveries for past “losses” covered by collateral sources.

• PERIODIC PAYMENT: Mandated for future medical damages with cut off at death.

• REDUCTION TO PRESENT WORTH: Mandates reduction to present worth of future work loss damages.

• STATUTE OF REPOSE: Seven-year absolute time limit on filing claims, with some exceptions.

• REMITTITUR: Requires the court to consider the adverse impact of a verdict on availability or access to health care in community when ruling on motion to reduce verdict.

Next Steps in the Medical Liability Battle

While we have accomplished a great deal, we have much more to do. Frivolous lawsuits are still being filed and liability insurance costs remain high for physicians. PAMED’s vigorous tort reform agenda includes the following initiatives:

• Strengthen the Certificate of Merit Supreme Court Rule.

Refunds are for overpayments. Looking at assessment calculations over the years, it was determined that there weren’t overpayments in 2013, which is why there are no refunds for assessments paid in 2013.

When will I get my refund?

The refunds may not be made until 2016 due to the extensive calculations required to determine the amount payable to each eligible health care provider and the large number of providers that will be eligible for a refund. However, the 2015 assessment will be reduced by about $61 million (about onethird from what it would have otherwise been).

Will I be required to remit my refund to an employer who wrote the check for my assessments?

This will vary depending upon your circumstances. For example, even though an employer wrote the check, you may have ultimately borne the cost due to an overhead reduction from your compensation pool. The settlement does not impact any contractual or other obligation that a health care provider may have to remit a refund.

How much will the refunds be?

This will vary depending upon the years in which you paid an assessment and the amount of the assessments that you paid. A percentage reduction will be calculated for each year and you will receive a refund for each year in direct proportion to the assessment that you paid.

I’m retired at end of 2014. As a retiree, will I be part of this?

If you were practicing at any time from 2009-2014, you will be eligible for a refund for those years, excluding 2013. Since you will not be practicing and paying an assessment in 2015, you will not share in the 2015 prospective assessment relief.

I was talking to my state Representative, and he doesn’t know where the money will come from.

• Tighten the expert witness requirements under Act 13.

• Require a finding of gross negligence to award non-economic damages.

• Require clear and convincing evidence of gross negligence to find liability in emergency care.

• Obtain limits on plaintiffs’ attorney fees.

• Provide immunity from medical liability lawsuits to physicians who volunteer at non-profit clinics.

Right now, the money is in the Mcare Fund. This is not money the state is repaying back to the Mcare Fund. It’s money that has accumulated in the fund as a result of over charges. The commonwealth has agreed that there is $200 million in the fund for this settlement.

Get the latest information and updates on the Mcare settlement at www.pamedsoc.org/mcare.

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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

Medical Society Updates

Website Explains Process For Obtaining Your Mcare Refund

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ast fall’s Mcare settlement requires that $200 million be returned to physicians, hospitals, and other health care providers. This includes $139 million in refunds for prior assessment overpayments for 2009, 2010, 2011, 2012, and 2014.

Who is eligible to receive refunds?

How are refunds calculated?

Are physicians required to remit their refund to another person or entity that paid the assessment, such as a medical practice or hospital?

These are some of the questions the Pennsylvania Medical Society (PAMED) attempted to answer in a new website, www.McareRefund.org, which debuted April 1.

What should physicians and medical practices do over the next few months to protect their interests?

The first round is refund checks, tentatively scheduled to be sent to physicians in the first quarter of 2016.

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But to ensure that they make informed decisions and receive payment of refunds that they are entitled to keep, physicians need to understand several possible scenarios and actions that could arise from those scenarios.

LANCASTER PHYSICIAN

For example, a person or entity that paid the assessment for the physician may make a claim on that refund. The claim period has started and runs through August 19. Physicians will be notified of a claim through the mail—tentatively scheduled for the fall of 2015—and will be directed to a website where they must choose whether a claimed refund should be paid to them or have Mcare pay the claimant.

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A person or entity that paid your refund also may ask you to fill out an assignment agreement if it did not make a claim on the refund. Medical practices and other assessment payors are permitted to begin asking for assignment agreements once they obtain the required forms from Mcare. The form to request these assignment agreement forms is now available on the Mcare website.

Mcare Settlement to Return $200 MILLION to Physicians and Other Providers

How to Treat Win Com ter Alle mon rgie & Ai lmen s ts

—Includes Future Protections

The www.McareRefund.org website that PAMED created was designed to give physicians and medical practices the proper information to help them understand these scenarios and make the best decision.

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PAMED also has a webinar on www.McareRefund.org that provides an overview of the Mcare refund process.

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P a m’s l e g p a i n w a s

more serious than she thought.

PAD raises the risk for heart attack and stroke.

Pam was worried about the pain in her legs—they often felt heavy, fatigued and cramped after walking. Then, her doctor told her about the new Vascular Clinic at the Lancaster Heart & Vascular Institute. There, she met with a specialist and learned it was Peripheral Artery Disease (PAD), a serious condition that could increase her risk of heart attack and stroke. With proper diagnosis and treatment, Pam is on her way to better health.

The Vascular Clinic at the Lancaster Heart & Vascular institute offers multidisciplinary care and testing in one convenient location. To refer a patient for consultation, please call 717-544-6565 and we will select the most appropriate provider for your patient’s care.

Choose well. Be well.

®

We can help your patients breathe easier and get the healthy rest they’ve been missing.

For more than 20 years, Lancaster Pulmonary & Sleep Associates has been serving Lancaster County residents who have lung or sleep disorders. The physicians and staff of Lancaster Pulmonary and Sleep Associates are dedicated to improving the lives of patients affected by pulmonary disease, sleep-related disorders or life-threatening critical illness. Call 717-735-0336 to make a referral or visit LancasterPulmonaryandSleepAssociates.com for more information.

Lancaster Pulmonary and Sleep Associates • Asthma Education • Critical Care Management • Pulmonary Medicine • Sleep Medicine 233 College Ave., Suite 201 • Lancaster, PA 17603 LancasterPulmonaryandSleepAssociates.com

SPRING 2015

Medical Society Updates

Naturopathic Licensure Bill Scheduled for Committee Consideration

SCOT CHADWICK

he House Professional Licensure Committee held a meeting on April 1 to consider HB 516, which would provide for the licensure of “naturopathic doctors,” and grant them a formal scope of practice.

T

This concerns us for several reasons. The level of credibility that state licensure establishes could be misleading to the average Pennsylvanian by implying that naturopathy is equivalent to mainstream medicine.

The bill would permit licensed naturopaths to independently prevent, diagnose, and treat human health conditions, injuries, and diseases. They could order and perform physical and laboratory examinations, and order diagnostic imaging studies.

“Naturopathic medicine” is defined in HB 516 as “a system of primary health care.” Patients may see unproven and possibly unsafe treatments by “naturopathic doctors” as a substitute for conventional medical care.

They would be authorized to utilize invasive routes of administration for their tests and treatments that include “oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous and intramuscular.”

If there is doubt about whether the bill allows naturopaths to perform a particular test or treatment, the question would likely be resolved in their favor, as Section 102 (4) specifically calls for the act to be “liberally construed.”

And, there is no requirement in HB 516 that naturopaths collaborate or refer complicated medical cases to a physician.

Shouldn’t a naturopath who is concerned enough about a patient to order a CAT scan immediately refer that patient directly to a physician?

There are also concerns of oversight and logistics. HB 516 would require the State Board of Medicine to establish and maintain the necessary infrastructure for a mere handful of people. Our information is that fewer than 100 naturopaths would qualify for licensure under HB 516. The vast majority of Pennsylvania naturopaths would remain unlicensed after the bill is enacted, adding confusion and providing little, if any, protection to the general public.

Similar legislation was approved by the House during the 2013-14 session, but died in the Senate. As we did then, we’ll share our concerns with lawmakers. Stay tuned, and we’ll keep you up to date on any important developments.

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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

Regulatory Updates

MEANINGFUL USE ATTESTATION IS COMPLETE, Now Breathe a Sigh of Relief — Or Can You? CONTRIBUTED BY PENNSYLVANIA MEDICAL SOCIETY’S PRACTICE SUPPORT TEAM

N

60-210 days. In some instances, the local MAC needed to “recycle the provider file” to correct the problem. This in turn, by the press of a button, corrected the problem, allowing the practice to resubmit its attestation. In other instances, the Electronic Funds Transfer (EFT) information for the group needed to be updated for those providers not yet revalidated.

umerous eligible professionals have been working diligently to meet Meaningful Use (MU) measure objective thresholds, whether by using the Flexibility Rule or by attesting to the stringent requirements of Stage 2 in 2014.

The Pennsylvania Medical Society (PAMED) has received quite a bit of feedback from our membership regarding the MU program, and some potential problems and issues they are experiencing such as: • Attestation rejections related to information within the PECOS system not aligning with the information within the EHR Incentive Program Registration and Attestation System

➋

EHR payment adjustment being assessed

Imagine being a successful user of MU and receiving your 2015 Medicare reimbursements reduced by 1 percent with remittance code N700 (Payment adjustment based on Electronic Health Record). Your practice never received a letter from CMS advising that your provider was subject to a penalty, your attestations were successful, and you have documentation stating such. One of your providers was audited, but the result of that audit was favorable again with supporting documentation. So, how can your practice be assessed a penalty?

In order to get to the root of the problem, PAMED placed a call to the EHR Information Center (888-734-6433) and is awaiting further information on this issue. At this point, we do not have any clear-cut answers as to how and why this is happening. We do know that an informal review form should not be completed unless a penalty letter was received by the provider. This is an error on CMS’ end, which will need to be corrected. What is unfortunate is the administrative burden the practice’s billing staff will face in reapplying the 1 percent corrected payments.

• EHR payment adjustment being assessed although attestation was successful • Prepayment audit letter received only after two days of submitting Stage 2 attestation

Let’s take a moment to discuss each one of these topics individually.

➊

Attestation rejections due to

According to the Centers for Medicare and Medicaid Services (CMS), providers who received this rejection would need to contact their local Medicare Administrative Contractor (MAC) Enrollment department because information within the PECOS system does not match what is listed in the EHR registration and attestation system.

When researching this problem, PAMED found a direct correlation to the revalidation process. Numerous practices having revalidated one or more providers within their group still had remaining providers yet to be revalidated, a scenario that seemed to cause the attestation to be rejected.

Providers still in the revalidation process also would be rejected for a PECOS mismatch. In conversation with CMS representatives, revalidation processing may range from

PECOS mismatch with EHR Incentive Program Registration

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despite successful attestation

➌ Prepayment audit letter received only after two days of submitting Stage 2 attestation

40

We can only speculate that CMS has realized the difficulties physicians have had meeting the objective thresholds for Stage 2 due to the stringent requirements. Therefore, after

PHYSICIAN

SPRING 2015

Regulatory Updates

CAMPUS EYE CENTER

providers submit attestation, audit requests follow shortly thereafter. Some feedback PAMED has received from its members is that audit requests have been received within two days of attestation or even within hours after Stage 2 attestation.

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.

Providers need to be certain to have all of their documentation ready and in hand to send to Figliozzi and Company to support all the Core and Menu objectives. Any measures that were answered with a yes/no, screenshots, or reports from the EHR supporting that answer should be provided.

Lee A. Klombers, M.D.

Let’s take the example of Core Measure 11 (Generate patient list by specific conditions). When attesting, the system simply states, “generate at least one report listing patients of the eligible professional with a specific condition.” The provider must mark a yes or no. To support this measure in the case of an audit, the practice will need to show that a report was indeed run during the attestation period to support their answer.

Astigmatism (Toric Lens) Blepharitis Cataracts Diabetic eye problems Dry eyes

Eye infections Eye injuries Eyelid growths Foreign bodies Glaucoma Macular degeneration

Pediatric and NeuroOphthalmology Premium Intraocular Lenses (IOL s) Strabismus (lazy eye) Thyroid-related eye problems

Among the specialized surgeries we offer: State-of-the-art small incision no-stitch cataract surgery with topical anesthesia Modern laser vision correction techniques, such as LASIK In-office glaucoma and diabetic laser surgery Eye muscle surgery for eye misalignments and lazy eye Two Convenient Locations: Health Campus: 717.544.3900

2108 Harrisburg Pike | Suite 100 | Lancaster, PA 17601 David S. Williams, M.D.

Lisa J. Kott, O.D.

MU continues to be a controversial issue and struggle for many providers. Those providers who choose not to participate due to the burdensome requirements and associated costs, as well as those providers who choose to participate to avoid the associated payment adjustments to their Part B fee-for-service reimbursements, must deal with aggravating issues like those issues listed above.

Willow Lakes: 717.464.4333

222 Willow Valley Lakes Drive | Suite 1800 | Willow Street, PA 17584

Olga A. Womer, O.D.

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)LKHANOFF 3ILVERSTEIN Attorneys at Law Legal Representation for Clients in Central PA, Lancaster, & coming soon to East Petersburg.

PAMED has the resources to help practices meet MU requirements, earn incentives, and avoid penalties.

One of the most common causes for a failed audit is insufficient documentation of the Security Risk Analysis (SRA). PAMED has a toolkit available to assist practices in the completion of the SRA. This toolkit and other HIPAA-related resources can be found at www.pamedsoc.org/hipaa.

Providing Physicians and medical personnel with quality representation from our experienced legal team. Coming from a family of physicians, both of our attorneys bring you a fresh perspective and understanding of the challenges you face in negotiating your employment contract for Professional Services in the ever changing and dynamic healthcare field.

PAMED has educational webinars on MU, available at www. pamedsoc.org/webinars. MU incentives and penalties also will be a topic at our spring practices manager meetings across the state. Learn more and register at www.pamedsoc.org/managermeeting. Watch your email inbox for the Daily Dose, PAMED’s daily, all-member email, as it contains the latest news and resources to help you and your practice navigate the challenges you face, such as MU.

The Firm can also provide representation in domestic issues, relocation issues, real estate and business transactions.

717.563.0681 www.islawyers.com

PAMED members who have questions about MU can contact our Practice Support Team at (717) DOC-HELP, that’s (717) 362-4357.

2938 Columbia Ave., Ste. 802 Lancaster, PA 17603

When you need a Fighter in Your Corner

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Restaurant Review

M A( i )SON A N UR B A N COOK E R Y

JILL K. SATORIE, M.D.

OBGYN of Lancaster

M

y husband and I had been hoping to dine at Ma(i)son for quite some time. Many of our close friends have told us how delicious the food is, and we liked the owner’s vision of creating a menu based on farm to table dishes. When I was asked to write a restaurant review, I felt it was the perfect opportunity for my husband and I to take advantage of a night out together.

We went to Ma(i)son on a Wednesday night in February. When I called the restaurant to make a reservation, I was prompted by the answering machine to schedule my reservation online through the OpenTable link on their website. It was easy to do, and I was able to edit my reservation later that day without difficulty.

Ma(i)son is located in downtown Lancaster off of Prince Street. Parking is available on Prince Street and on the side streets. Upon entering the small, quaint restaurant, we were greeted by our waiter who was expecting us. We were seated at our table and then given a brief introduction to the style and set up of the restaurant since it was our first time dining there.

I would describe the ambiance as having a refined rustic feel. The main wall is made of reclaimed barn wood and is where the restaurant’s large chalkboard menu is displayed. Ma(i)son’s seating area is small and cozy and is overlooked by an open kitchen.

True to what the Ma(i)son website shares about the owners wanting to create an atmosphere that is intimate and inviting, dining there does make one feel like a guest

at a dinner party in their home. In fact, “maison” is “home” in French.

The only copy of the menu was posted on the chalkboard. Perhaps because of our age, we had to get up from our table to get a good view of the menu. The selection was limited, which we expected given the farm to table concept. Our waiter informed us that the menu changes weekly based on the production from the local farms and artisans they do business with. There were eight different appetizers and salads to choose from; they ranged in price from $13–$15. There were four entrée options available, ranging in price from $17–$28.

They told us nearly any dish could be prepared vegetarian, vegan, or gluten-free upon request.

Since the restaurant style is BYOB, my husband and I brought a bottle of wine to share as we enjoyed our dining experience.

Our waiter was helpful and knowledgeable when assisting us in selecting our menu options. We started with the Lyonnaise salad with a farm-fresh fried egg on top.

It was absolutely delicious and made to perfection. We also had the Mussels on Toast, which was flavorful and fun to try. The freshly baked bread served with homemade butter was a nice complement to the food.

For our entrée selections, we decided on the Pan-roasted Monkfish and the Beef Cheeks and Parsnips. We loved the monkfish dish, as the fish was cooked perfectly and the Brussels sprouts and pistachio pesto added a delicious flavor to the fish.

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While the monkfish was outstanding, the beef cheeks were just okay in comparison.

Perhaps it was because the sauce served with it was a bit overwhelming, and they also seemed a bit dry to us. Despite my disappointment in the beef, I did enjoy the crisp parsnips that were part of the dish. We both agreed that when we came back, it would probably be best to order two appetizers and then split an entrée.

That would provide the perfect amount of food for the two of us.

Although we were completely stuffed after our entrees, we wanted to have the full Ma(i)son experience so we indulged in two desserts and French press coffee. My husband chose the Chocolate Soufflé Cake and I had their Peanut Butter Chocolate Dessert. They were both a lovely finish to our meals.

Overall, our experience at Ma(i)son was excellent from start to finish. The waiter was friendly, the service was excellent, and our food was fabulous. I would give Ma(i)son 4 out of 5 stars. We enjoyed the ambiance and we believe in supporting the concept of farm to table. We will definitely be going back to Ma(i)son in the near future.

Ma(i)son 230 N Prince St., Lancaster, PA 17603 717.293.5060 www.maisonlancaster.com

SPRING 2015

News & Announcements

RGAL Recognized for Patient Safety and Quality of Care

Welcome…New Members January

February

Meghan Dermody, MD LGHP – Surgical Group

Candice Capstick Boyer, DO Lancaster County Osteopathic & Integrative Health

Zachary Andrew Geidel, MD Cocalico Family & Sports Medicine Rodney Moussa Jamil, MD LGHP – Hematology & Medical Oncology Kathryne J. Stabile, MD Orthopedic Associates of Lancaster Ltd.

RGAL is honored to be the only GI practice in Central Pennsylvania to receive two prestigious National and State recognitions for patient safety and quality of care.

David Doyle Administrator, Lancaster Cardiology Group, LLC Jack Wright, MD Hospice & Community Care

Joan Brumbaugh Thode, MD Resident

• National Quality and Safety Recognition from the American Society of Gastrointestinal Endoscopy (ASGE) for commitment to quality and safety of the RGAL endoscopy centers.

Kristy Whitman, MD LGHP – Family & Maternity Medicine

• Pennsylvania Patient Safety Authority Recognition as a leader in quality initiatives focused on patient safety.

Congratulations...Reinstated Members December

February

Mandy Renea Fannin, MD Trout Run Family Practice

Gerald W. Rothacker, Jr., MD Orthopedic Associates of Lancaster

Amy C. Hancock, MD LGHP – Geriatrics

Daniel J. Schlegel, MD Penn State Hershey Medical Group – Fishburn Road

Christopher J. Peterson, MD Anesthesia Associates of Lancaster Ltd January Scott T. Reibel, MD Heart Specialists of Lancaster County Maung Kyaw Win, MD General Internal Medicine of Lancaster

Four Convenient Locations

In Remembrance…DECEASED Member

• Lancaster Health Campus • Oregon Pike-Brownstown • Women’s Digestive Health Center • Elizabethtown

Theresa A. Walls, DO Theresa A. Walls, DO, 65, of Lancaster, formerly of Englewood, NJ, passed away on November 30, 2014. Dr. Walls was a practicing psychiatrist who studied Biology and Theology at St. Peter’s University in New Jersey. She was a graduate of the Philadelphia College of Osteopathic Medicine and received her residency training at Thomas Jefferson University in Philadelphia.

She completed her Master’s Degree in Bioethics at the University of Pennsylvania and was interested in the changing doctorpatient relationship.

www.RGAL.com • 717.544.3400

To learn more about the commitment to quality and patient safety by RGAL physicians and staff, visit www. RGAL.com.

Dr. Walls had been the Medical Director at Ephrata Community Hospital since 2005.

She had previously served there as the Clinical Director, staff psychiatrist, and chairperson of the Bioethics Committee. Previously, she served as the Medical Director for the former Community Hospital of Lancaster Mental Health Services, was a member of the Ethics Committee of Hospice Community Care, the Bioethics Tribunal for the Diocese of Harrisburg and the Board of the Samaritan Counseling Center.

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News & Announcements

Frontline Groups The Lancaster City & County Medical Society thanks these groups for 100% membership in the Medical Society for 2015.

Allergy & Asthma Center Brain Orthopedic Spine Specialists

Cardiac Consultants PC Community Anesthesia Associates Community Services Group Dermatology Associates of Lancaster Ltd Eastbrook Family Health Center Eye Associates of Lancaster Ltd Family Eye Group Hospice & Community Care

Keyser & O’Connor Surgical Associates Ltd Lancaster Cancer Center Ltd

Lancaster City & County Medical Society Young Physicians Social

Lancaster Neuroscience & Spine Associates

Bent Creek Country Club 6:30 pm

Lancaster Radiology Associates Ltd LGHP – Lincoln Family Medicine LGHP – Manheim Family Medicine OBGYN of Lancaster

Earn your Certificate in Population Health Tailored for front-line staff, Pennsylvania College of Health Sciences’ new Population Health Certificate provides an understanding of the principles of population health management and tactical skills to increase patient engagement.

The 15-week online course emphasizes collaboration through the use of a multidisciplinary cohort. Participants are eligible for 45-hours of ANCC continuing nursing education hours or general continuing education units.

• Understanding the change process • Building empowering relationships with patients

Discounts are available for employer cohorts. For more information, call (717) 544-2539 or visit www.PACollege.edu/OneGroup/pophealth.

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JUNE

Lancaster City & County Medical Society Annual Business Meeting & Dinner Lancaster Country Club 6:15 pm

Southeast Lancaster Health Services Inc

Internal Medicine Specialists of Lancaster County

SKILLS COVERED INCLUDE: • Assessing needs and barriers • Achieving success with motivational interviews

APRIL

Lancaster Physicians For Women

Hypertension and Kidney Specialists

MARK YOUR CALENDARS!

PHYSICIAN

SPRING 2015

News & Announcements

FRONTLINE GROUP SPOTLIGHT

Hypertension & Kidney Specialists 2110 Harrisburg Pike, Suite 310, Lancaster, PA 17604 • 717.544.3234 • www.kidneydrs.com

H

ypertension & Kidney Specialists (HKS) has been faithfully serving the patients of Lancaster County for 35 years.

HKS began as Nephrology Associates of Lancaster in 1980, founded by Dr. Laurence Carroll. The practice continues to flourish and now has nine board certified nephrologists and five CRNPs. HKS recently renovated their office at 2110 Harrisburg Pike, Suite 310 within Suburban Outpatient Pavilion, and they have a satellite office in Stevens.

HKS, as a group, is recognized for excellence, sought for teaching appointments, medical directorships and comprehensive medical evaluations. They remain committed to serving the patients of Lancaster with hypertension or kidney diseases, which is the founding mission for which HKS was founded.

HKS provides care for patients at all of the local hospitals. There are five outpatient dialysis units where HKS treats their patients.

The group is recognized nationally for its high percentage of patients who chose a home modality, such as peritoneal dialysis or home hemodialysis. To meet the needs of the county, a new hemodialysis unit will open in Leola this fall. The group is anticipating welcoming two new physicians in 2015. To keep patient care local, our patients requiring transplant care have the convenience of seeing the Pinnacle Transplant team in our office. We are optimistic that the University of Pennsylvania transplant team will be affording our patients the same opportunity.

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LCCMS Foundation Updates

Lancaster Medical Society Foundation: Supporting the Future of Health Care

S

ince 1991, the Lancaster City & County Medical Society, through its charitable foundation, has been supporting local students who are exploring—or working toward—a career in health.

In addition to the Lancaster Medical Society Scholarship Foundation Awards*, which are given to students who are beginning or continuing their education in medical school, the foundation also encourages those interested in science.

Sara J. Sigafoos Memorial Award

The Lancaster Medical Society Foundation is dedicated to supporting a strong health care team. Each year the foundation honors this commitment by recognizing four nursing student graduates from the Lancaster Campus of Harrisburg Area Community College (HACC).

The Sara J. Sigafoos Memorial Award is a financial award presented to nursing students who demonstrate outstanding clinical skills and passion for medical service.

The Lancaster Medical Society Foundation is pleased to partner with HACC on this award. As we continue to promote physician-led, patientcentered care, we recognize the importance of supporting students who will become valuable members of health care teams.

*About the Lancaster Medical Society Scholarship Foundation The Lancaster Medical Society Scholarship Foundation provides funding to Lancaster County residents attending medical school. Recipients must exemplify good character, motivation, and academic excellence, and demonstrate financial need.

Since its establishment in 1991, the Foundation has awarded over $200,000 in scholarship funds. Any Lancaster County resident fulfilling the criteria listed above and pursuing—or continuing—a medical degree at an accredited medical school may now apply for the Lancaster Medical Society Scholarship Foundation scholarship. Applications are due by July 1, 2015 for the 2015–2016 academic year.

Apply now by visiting our website: www.lancastermedicalsociety.org If you wish to contribute, please contact the foundation at 717-393-9588 or info@lancastermedicalsociety.org.

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What inspires these hands?

PennStateHershey.org/skill He watched his grandparent battle a chronic illness. She diagnosed her older cousin with breast cancer. He learned he could quickly change the course of a disease with his own hands.

Driven by inspiration, these hands treat some of the most complex cases around.

Meet the surgeons behind the hands at PennStateHershey.org/skill.

U.Ed. MED 6217-15 SRG

It’s your brain that hears.

Not your ears.

Hearing loss is associated with 5 times increased risk of dementia* When the sound signals from your ears are compromised, your brain has to work even harder to fill in the gaps.

This extra effort can take its toll. In fact, studies have shown that, over time, hearing loss can lead to isolation and depression. That’s why it makes sense to take care of your patients’ hearing health the same way you care about the rest of their health: There’s a lot more riding on it than just their hearing.

Hearing Care is Health Care.

(*Lin et al., JAMA, January 2013)

a&e audiology&

Hearing Aid Center Better Hearing...Better Life!

Hearing Aids  Tinnitus  Diagnostic Testing Adults, Children and Babies Five Doctors of Audiology

717-283-4661 HaveBetterHearing.com LANCASTER: 2160 Noll Drive, Suite 100 LITITZ: 235 Bloomfield Drive, Suite 111 WILLOW STREET: 226 Willow Valley Lakes Drive, Suite D