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Summer 2013

OfďŹ cial Publication of The Lancaster City & County Medical Society

er Summ

Premiee!r Issu

The Debate over Scope of Practice Escalates!

2013

Medical Social Media Marketing... Connecting to patients is more important than ever.

ICD-10

Failing to prepare is preparing to fail...

Patient Advocacy


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Executive Director’s Message

Welcome to the First Issue of Lancaster Physician!

“A pla physicia tform for all one voic ns to speak wit e and h on Lanca lead the way s health c ter County are issue s.”

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hile the Internet and social media are primary sources of connection and information sharing, the tactile experience of holding information in your hands and taking time to slow down and focus on one thing without ulti-tasking is still relevant—and perhaps a welcome relief. m Sharing of knowledge becomes even more important as the dynamics associated with providing medical care change, and as physicians face a health care delivery system that focuses more on quality outcomes and value for the patient. The Lancaster City & County Medical Society understands this reality and wants to be a conduit for the sharing of knowledge within the medical community of Lancaster County. Lancaster Physician is a quarterly magazine mailed to all active members—physicians, practice administrators, and hospital executive staff. It is a resource that provides practical information, peels away the layers of complex legislative and regulatory issues, and highlights our members’ successes. It is a resource that will also provide the patient community with greater insight, awareness and understanding of local health care issues and initiatives. Regular features include local health care news, LCCMS board updates, physician profiles, and practical advice for the business of medicine. On the lighter side, Lancaster Physician will review the many opportunities in the county for entertainment, learning, and relaxation from a physician’s perspective. As the entire paradigm of the health care delivery system changes, LCCMS wants to ensure that physicians lead the health care team for the benefit of their patients. Communication among members and sharing of best practices is vital. While our medical society can never be more than a small segment of our members’ lives, we will strive to make that slice of time as valuable, enriching, and constructive as possible. We want to engage you in the conversation, and we welcome you to suggest topics that will serve the interests of the Lancaster medical community and your patients. Please contact me at kschober@lancastermedicalsociety.org or 717.393.9588.

lancastermedicalsociety.org

And thank you for your membership.

LANCASTER 4 PHYSICIAN


Contents

2013-2014 BOARD OF DIRECTORS OFFICERS Paul N. Casale, MD

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

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

JULY 2013

Patient Advocacy...

۩ Jeremy Hess Photographers

President The Heart Group of Lancaster General Health

A Physician’s Perspective (p. 24)

David J. Simons, DO Vice President Community Anesthesia Associates

C. David Noll, DO Secretary Northern Lancaster County Medical Group

Stephen T. Olin, MD Treasurer Lancaster General Hospital

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

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

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

On the Cover

*

For the Love of Sports

Breakthroughs in medical practice social marketing are becoming critical in building strong patient relationships (p.10)

Orthopedic Associates of Lancaster brings worldclass injury prevention and treatment to Spooky Nook Sports (p.18)

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

Shawn F. Phillips, MD Elected Resident One Year Lancaster General Hospital Family & Community Medicine Residency Program

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

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

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

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

Best Practices

In Every Issue

6 ICD-10...failing to prepare is preparing to fail 10 Medical Practice Social Media 16 Scope of Practice 13 Community Transformation Grant 17 Project Access Lancaster County (PALCO)

18 20 22 24 26 28 32 38

COVER PHOTO: Lancaster Physicians for Women Front (l-r); Dr. Jessica Krebs, Dr. Sharon S. Conslato. Middle (l-r); Dr. Jessika M. Kissling, Dr. Sarah E. Eiser. Back (l-r); Cindy Stoner, Ruth Hessen, Kali Karomfily, Amy Stoner (with daughter Charlotte). Not pictured; Dr. Kara F. Jones.

Healthy Communities PAMED Foundation Updates LMS Foundation Updates Patient Advocacy Restaurant Review News & Announcements Memeber Spotlight Legislative Updates Lancaster Physician is published by Hoffmann Publishing Group, Inc. Reading PA I HoffmannPublishing.com 610.685.0914 I tracy@hoffpubs.com


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pr ctices Failing to prepare for ICD-10 is preparing to fail

ICD-10 Medical Practice Social Media Scope of Practice Community Transformation Grant PALCO The Coming ICD-10 Cash Flow Crisis and How to Avoid It By Terry C. Kile

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CD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a diagnosis classification system whose initial version takes us back to the time of the Black Plague in Europe. At that time, local governments and medical professionals were trying to compare causes of death with

those of other nearby countries in order to understand and combat reoccurring disease. They created the beginnings of this system to track those diagnoses. Today the World Health Organization maintains this comparative information, and since the United States is the only country that is still using ICD-9, the move to


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ICD-10 will enable more accurate comparisons of health care data with other countries. But the most important part of this change for your practice is that coming Federal regulations will require more and better data tracking to measure the quality and safety of care. This tracking will be enabled by ICD-10. There are a few benefits to this transition, according to Charles D. Krespan, M.D. of the Drs. May Grant Associates practice. “ICD-10 gives us more data about our patients’ medical condition and about the hospitals’ inpatient procedure. Better data leads to better decisions, which leads to better patient care,” Krespan said. While many Pennsylvania hospitals and practices are beginning to prepare, and most will make the transition with significant effort and cost, cash flow will still be affected. Frank Musso, of Francis C. Musso, CPA, MPA, P.C., believes the shift to ICD-10 will be substantial. “Not only does the new code set include five times as many codes as the ICD-9 code set,” Musso said, “the different arrangement of codes will require

ICD-10

severe crimp in your practice cash flow but can be avoided if your team takes the correct steps to implement ICD-10 across the practice.

more documentation, revised forms, retraining of staff and physicians, and changes to software and other information technology. I would also expect changes in reimbursement patterns resulting from the increased specificity of the new code set.” “We are very concerned about the ICD-10 transition,” Mona Engle, RN, CEO/Practice Administrator of Drs. May Grant Associates said. “Our practice is fairly progressive in that we have had electronic medical records in place for four years, which will ease our transition. Our physicians also stay current with trends in health care, which is so critical. I feel confident about the plan we have in place. That said, I know that ICD-10 will be very costly in terms of training our staff, implementing the codes, and retraining our physicians. It is extremely important that we do it right, because if we don’t it will impact our patients— and that’s something we never want to happen.” The next sixteen months or so are all the time we have to make this change as the US will adopt ICD-10 on October 14, 2014. This means that any HIPPA-covered entity must make the change to the new system and will not be reimbursed by any payer—be they commercial, Medicare or MA—if the correct ICD-10 codes and documentation are not used. This can put a

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An important note to remember: If you are making diagnoses prior to October, 2014 that will be completed (surgical, testing, medication) or will be billed after October 14, 2014, YOUR deadline for ICD-10 transition is the first time you make that diagnosis. If not, you run the risk of losing the reimbursement or doing all of the medical coding and charting twice for those patient encounters. So, how do you avoid being one of those practices for which cash flow will be a challenge in the last part of 2014? It will take planning, training and support from your employees, partners and vendors. This will certainly not be solved simply by your EHR vendor making a software change, especially since you do not yet know when or even whether they will be ready to test with ICD-10 documentation and codes prior to the deadline. To get started, find the person in your practice that can be the “czar” of this process—it may be your practice manager or one of your partners. Their qualifications should include a good understanding of the complexity and financial significance of the ICD-10 transition, someone who can delegate effectively and motivate others to accomplish their assignments, and who will hold others accountable if they do not. Your “internal champion” may take the form of a committee, as long as one person is the responsible party for the entire transition. When you look into the tasks involved you Continued on page 8


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may say, “we just don’t have an extra person waiting for a major assignment.” That’s okay too. While you still need an in-house point person, the champion may very well be an outside consultant. Just don’t wait too long to book them for the engagement. Training is the next step in the process. Besides the obvious training for medical coders, physicians need to be brought up to date on the clinical documentation changes for ICD-10 as soon as possible. The earlier you start training, the more times your team can train on the material and the earlier you can begin dual coding. Dual coding, which is the process of coding patient encounters in ICD-9 and ICD-10 concurrently, will provide you with a great overview of what needs to be fixed prior to the deadline. Look for online training alternatives that staff can complete from anywhere. An

ICD-10

inexpensive set of courses is provided by BridgeFront, another by industry certifier AAPC. Both are modular and number 14-20 courses that can be taken one at a time, as time permits.

“This is a permanent change, not a learning curve change and translates into an increase in physician time spent on documentation for ICD-10-CM with no expected increase in reimbursement.” Both have testing and individual tracking as part of their design. Musso commented that the increase in docu-

OAL

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mentation time is not something that is going to go away any time soon. “The move to the ICD-10-CM will also increase documentation activities for medical support staff and physicians,” Musso said. “This is a permanent change, not a learning curve change and translates into an increase in physician time spent on documentation for ICD-10-CM with no expected increase in reimbursement.” Planning the transition process takes time and your “czar” may not have enough time to work out the schedules, milestones and assignments that will be required to encourage accountability. Several project management software programs and whitepapers are available to simplify and speed up the planning process, among them the ICD-10 Checklist from AHIMA, the national organization to which most health care information professionals belong.


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Read their white paper on this subject at: ahima.org/downloads/ pdfs/resources/checklist.pdf.

An inexpensive alternative to creating the planning documents yourself is the ICD-10 Toolkit from Complete Practice Resources (CPR). From their consultations with many large practices across the US, CPR created a program that effectively helps your team manage the entire ICD-10 transition process from beginning to end. It may be a good solution to keep the project moving, at a very low cost. A free demonstration of the software is available at http://www.cpticdpros. com/promantra. Mona Engle is also concerned about coding outcomes. “If something is not coded correctly, the insurance company will not pay—so we HAVE to do it right. Our goal is to always offer the best possible, personalized care to our patients. We’ll continue to achieve that goal, but I will say that the ICD-10 transition will make this a difficult and costly endeavor.” By nine months from your deadline, your team—medical coders, billers, and physicians—should be documenting, coding and billing in both ICD-9 and ICD-10. For most of us, that timing falls around the end of 2013 and there are many details to identify and resolve before then.

Beginning the process of dual coding should consist of A Chart review by an ICD-10 trained medical coder to help you identify documentation needs for ICD-10 Increased training for the entire team

ICD-10

Any changes to processes and forms that were created around your present coding and billing procedures At first, your coders may spend many hours “crosswalking” codes. That is, doing a side-by-side comparison of an ICD-9 code to its closest match in ICD-10. This is a challenge when the ICD-9 code for Extrinsic Asthma-unspecified (493.00) has 16 different code choices in ICD-10. To make the correct choice requires additional documentation detailing the severity of the diseases and other factors. “Crosswalking” requires using coding books that take a lot of time, so as you might guess several software options are now available to speed this process and make it more efficient. Check out Simple Solutions, again from Complete Practice Resources, or have your coders use ICD-10 Code Search, found online at icd10codesearch.com. Another key to success is communication with all system vendors and business partners that use diagnostic related group codes to receive and send data to your systems. This can include pharmacies, labs, your EHR, etc. This is imperative to complete as you approach the deadline because a vendor’s plan for conversion to ICD-10 will directly affect your bottom line. Some practices and hospitals are planning to test for internal ICD-10 compliance a full six months before the deadline, probably well in advance of when most of their external partners are ready to convert. If your vendors are not ahead of the game, you will need to develop conversion strategies or lose cash. Is the ICD-10 transition challenging? Absolutely. Is it impossible? Absolutely not. But, it is certainly not over when October 2014 comes around or whenever your self-imposed timetable concludes. Your ongoing job is to make sure that cash flow over the first three

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months of the new processes is affected as little as possible. Be ready to do immediate chart, coding and billing “triage” during the last two quarters of 2014 and to immediately change the systems, habits and processes responsible for the problem. If not, you will have ongoing problems that will cost real money because revenue is not coming in. Feel free to reach out to industry organizations, professionals and your vendors to help make this transition a success. We are all trying to work as fast as we can to insure that your practice comes through this process with as little loss as possible. Terry C. Kile is a local health care revenue cycle and ICD-10 consultant and Senior Sales Executive of BridgeFront, a nationally-known provider of e-learning for health care professionals.

READ MORE ABOUT ICD-10 decisionhealth.com/ ICD-10/Homehealth/index

pamedsoc.org/MainMenu Categories/Practice-Manage ment/ Management/Coding/ ICD10

cms.gov/Medicare/Coding/ ICD10/index PAMED endorsed vendors and online resources at: http://www. pamedsoc.org/MainMenuCategories/Practice-Management/ Endorsed-Vendors.


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Best Practices

COVER STORY

SOCIAL MEDIA Presents Opportunities & Unique Challenges for Health Care Providers Dawn Mentzer

SOCIAL MEDIA HAS BECOME A STAPLE IN NETWORKING, MARKETING, AND CUSTOMER RELATIONS ACROSS ALL INDUSTRIES – AND ITS GROWING PROMINENCE IN THE HEALTH CARE SECTOR IS NO EXCEPTION

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ccording to a 2011 study by QuantiaMD, physicians are becoming increasingly active on online networks and social media. In fact, nearly 90 percent of physicians use at least one social networking site personally, and 67 percent use social media for professional purposes. According to the QuantiaMD study, 28 percent of those using online networks professionaly are active on two or more online networks. Platforms like LinkedIn, Facebook, Pinterest, YouTube, Twitter, Google+, and sites specifically for physicians like Sermo and Practice Fusion provide a readily accessible and instantaneous communications platform. They give colleagues, patients, community partners and the public a way to stay connected, ask questions and give feedback. While that presents a wonderful opportunity to engage and build awareness, health care practitioners and organizations face some

undeniable challenges as well when incorporating social media into their professional development, marketing, and patient relations activities.

Social Media Challenges Facing Health Care Providers According to Lancaster County-based social media strategist Rachel Strella of Strella Social Media, among the hurdles that stand in the way of medical practitioners and practices launching and effectively managing a social media presence are those common to all individuals and businesses – and those unique to the health care industry. Universal challenges

• Not familiar with using online social tools • No time to keep social media posts up to date

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• Uncertainty about what to share on social media • Uncertainty about which social media platform(s) will be most effective and offer the best return on investment Health care field-specific challenges

• Fear of violating HIPPA laws and endangering patient protection • Fear of posting information that could be misinterpreted as “medical advice” • Vague rules surrounding what can or cannot be posted on social media in a regulated industry To help practitioners navigate the health care-specific challenges, in May 2012, the FSMB (Federation of State Medical Boards) issued guidelines to help state medical boards offer social media training to their licensees. The


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“Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice” directs physicians on using social media professionally and responsibly so patients’ privacy and confidentiality is protected. In addition, it discusses maintaining proper boundaries-within the context of online interactionswithin the physician-patient relationship. “To ensure a proper physician-patient relationship, there should be parity of ethical and professional standards applied to all aspects of a physician’s practice, including online interactions through social media and social networking sites,” advises the FSMB guide. PAMED (Pennsylvania Medical Society) also shares some guidelines for using social media in its 2012 Managing Risk newsletter “Risks Associated with Curbside Consultation.” • “Do not assume that what you or others post online is anonymous, cannot be accessed by attorneys, or is in compliance with HIPAA or state privacy rules.” • “View the advice gathered from a social networking site as a resource, not a consultation. Even when a site is touted as “physician only,” you have to consider the credentials of the person with whom you are exchanging information.” • “Take advantage of the website’s tools to receive information only from trusted colleagues. Anytime you make treatment decisions using information gained through social networking, the weight given to the information should be comparable to information you could have obtained from other sources, such as journal articles.” So, how can health care providers use social media networks without fear of

Medical practice social media

breaching HIPPA or in some other way violating industry regulations?

Some suggestions for engaging with an audience without putting yourself at risk include: • Announcing new certifications, credentials and affiliations • Highlighting new services or areas of expertise • Introducing new staff members • Posting changes to your office hours • Promoting wellness events and new programs • Raising awareness of fundraisers • Linking to information about new technology Another challenge facing health care providers is choosing the “right” social media network. Strella advises that physicians and organizations examine what they want to accomplish and consider how their target audience uses social media. “For example, if you’re a physical therapist with a primary goal of communicating valuable tips to your existing patients, I might recommend considering Facebook and an e-newsletter or blog,” explains Strella. “A doctor or specialist may have a goal to connect with like-minded professionals who can help expand his or her knowledge base. In that case, perhaps a medical group on LinkedIn would be effective.” She also shares that physicians and practices should remember that succeeding on social media requires consistency. It demands ongoing effort to develop and curate content and to perform the tasks of posting, monitoring for responses, and replying to comments and messages. That means setting time aside each week to execute social media responsibilities or outsource the work to someone who can help manage them. Continued on page 12

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Tips for Effective Use of Social Media in Health Care 1 Discover which channels your colleagues and patients are most active on, and create, and maintain an active presence

2 Embrace tools that play to your strengths. For example, if you’re an accomplished speaker, YouTube videos could showcase your knowledge and personality. Likewise, ifyou’re a strong writer, a blog might be your best outlet

3 Create content that provides value to your audience. To them, it should be relevant, interesting and build trust

4 Check and monitor your online reputation by setting up social mentions, Google alerts, and similar tracking tools

Tips to physicians on separating their personal and work lives on electronic media (from “Online Medical Professionalism: Patient & Public Relationships”)

1 Do not “friend” patients through social media 2 Maintain strict privacy settings on personal social media accounts 3 Always remain aware that anything posted online can be shared with a larger audience than originally intended-and could be taken out of context by readers 4 Do not provide medical advice via email unless a patient-physician relationship has already been established


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While that might sound daunting, Strella says physicians shouldn’t be dissuaded from participating in social media. They have the knowledge and expertise to offer value-added information to their followers – they just have to find their rhythm for communicating that expertise via the social channels available to them.

The Opportunities that Social Media Present to the Health Care Professional Though physicians need to be more careful and calculating when using social media than do professionals in most other industries, they can derive substantial benefits from maintaining an active online presence. According to data gathered by Geonetric, a company that provides online solutions to health care organizations, out of the 80 percent of internet users who look online for health information, 44 percent go online to look for doctors. Practitioners and practices with a strong, active online presence naturally stand a better chance of being found by those searching for services and specialties online. A study conducted by Social Media Examiner in 2011 reports that 45 percent of professionals who had invested 12 months or less in social media said they gained new partnerships as a direct result of their online activities. We might also assume that the experience of those engaged in social media marketing in health care correlates with that of professionals in other industries where 88 percent increased awareness of their businesses by using social media. Strella notes that social media networks present an especially promising opportunity to practitioners who work with a younger, tech-savvy demographic. Don’t discount their effectiveness in reaching a more seasoned audience

Medical practice social media

though; adults from the ages of 35 to 54 are one of the fastest growing groups using the major social media channels.

Local Social Media Success Stories Lancaster County-based physicians, practices and hospitals are seeing benefits from their involvement in social media. Bill Weik, CEO of Orthopedic Associates of Lancaster (OAL), shares that he and his marketing manager launched a Facebook page approximately five months ago to stay top of mind with the patients they serve in the local sports population. “Facebook is how that group communicates,” explains Weik. “It’s where they go for information.” According to Weik, OAL updates its page at least once weekly to maintain a consistent presence and hold followers’ interest. He has been pleasantly surprised by the amount of interaction they’ve gotten through the page in the way of testimonials and inquiries about services. OAL is also registered on Foursquare which adds an element of fun for those visiting physical therapy locations as they interact and compete for the most “check-ins.” In addition to OAL’s social media, Weik uses LinkedIn for his own personal professional purposes. He has found value in participating in professional LinkedIn groups where group members share information on topics relevant to his industry. Linkedin has also provided him a way to stay connected and communicate with colleagues who he doesn’t regularly have an opportunity to talk with or see face to face. According to Director of Community Relations Joanne Eshelman, Ephrata Community Hospital began using social media in 2010 with a Twitter feed, and added a Facebook page in 2011.

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“Today, we’ve made a conscious effort to use both Twitter and Facebook as a daily part of all marketing and community relations initiatives. It is just one more way to reach our customers where they are, and increasingly they are online whether at home, at work and on the go.” she explains. Eshelman shares that whenever they make a Facebook post or Tweet about their photo gallery, they get a lot of interest from their “fans.” Social media has proven to be an effective tool in fundraising, too. “We also received great support for a recent fundraising event that was heavily promoted through social media.” ECH has also seen increased interest from local media as a result of its social media activity. Within just the week prior to our interview with Eshelman, she was contacted by two reporters who learned about new Ephrata Community Hospital services through the hospital’s Twitter feed. So for administrators, physicians, and health care organizations, social media provides many opportunities and much potential. The key is to engage within the unique rules and regulations of the industry while taking advantage of these relatively new and always-evolving communications channels.

References How Health Consumers Engage Online. (2012, November 1). Retrieved from Geonetric: http://geovoices.geonetric.com/2012/11/ infographic-how-health-consumers-engage-online Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking. (2012, May). Retrieved April 2013, from Federation of State Medical Boards: http://www.fsmb.org Pennsylvania Medical Society Newsletter. (2012). Managing Risk: Risks Associated with Curbside Consultation, 3 No. 4, 8. Modahl , M., Moorhead, T., & Tompsett, L. (2011, September). Doctors, Patients & Social Media. Retrieved April 2013, from QuantiaMD: http://www.quantiamd.com Stelzner, M. A. (2011, April). 2011 Social Media Marketing Industry Report: How Marketers Are Using Social Media to Grow Their Businesses. Retrieved April 2013, from Social Media Examiner: http://www.socialmediaexaminer.com/SocialMediaMarketingReport2011.pdf


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Local practices join forces to control hypertension EBONI BRYANT, MS, MBA PROGRAM MANAGER, LIVEWELL LANCASTER COUNTY

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n September 2011, Lancaster County received a Community Transformation Grant from the CDC to build capacity for sustainable intervention efforts to reduce heart disease, cancer, and stroke using best practice models and programs. To address the control of high blood pressure and cholesterol and improve access to quality clinical preventive services in the county, LiveWELL Lancaster County (the program that oversees grant efforts in the county) partnered with the Lancaster City and County Medical Society (LCCMS). Over the past year, LCCMS has convened primary care physicians, cardiologists, hypertension specialists, and pharmacists to identify blood

pressure treatment and control efforts in Lancaster County. This team, the Community Care Collaborative (CCC), was tasked with obtaining baseline hypertension data, developing a treatment and control protocol, and developing hypertension control goals and initiatives that would help improve efforts countywide to reduce chronic disease. Cardiovascular diseases, including heart

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livewelllancaster.org

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disease and stroke, account for more than one-third of all U.S. deaths and a leading cause of disability. Recent PA Department of Health studies have found that 11% of Lancaster County adult residents have experienced a heart attack, coronary heart disease, or a stroke. There are many modifiable risk factors for heart disease and stroke including tobacco smoking, obesity, sedentary lifestyle, and poor diet. Controlling high blood pressure and cholesterol are also important prevention strategies. According to the Centers for Disease Control and Prevention (CDC), a 12-13 point reduction in systolic blood pressure can reduce heart disease risk by 21%, stroke risk by 37%, and risk for death from heart disease or stroke by 25%. One of three American adults (or 67 million people) has been diagnosed with hypertension. Nationally, more than half of people with high blood pressure do not have their condition under control. Residents of Lancaster County also struggle with hypertension and its effects. Recently, the CCC obtained hypertension data from the largest primary care practice entities, federally qualified health centers, and safety net providers in the county. As a group, these practices saw approximately 70% of the county’s adult population between August 2011 and July 2012. The data revealed that 45,136 (or 17% of all patients seen) had uncontrolled blood pressures. While patients with uncontrolled blood pressure represent less than 10% of the county population (at almost 520,000), this uncontrolled rate is significant because high blood pressure costs approximately $1375 per Continued on page 14


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Community Transformation Grant

system. As the protocol has also taken age, race/ethnicity, and co-morbidities into consideration, once implemented, it will become a Clinical Decision Support (CDS) tool available to providers.

“One of three American adults (or 67 million people) has been diagnosed with hypertension.”

Over the next year, the CCC and LCCMS will work to encourage all primary care providers in the county to use this protocol to improve hypertension treatment and control in Lancaster County and meet the quality goal set by the CCC. As these goals are being met, the CCC will begin efforts to develop a similar cholesterol treatment and control protocol.

Recent studies For more information on incorporating have shown the Hypertension Treatment & that CDS Control Protocol into your practice, not only please email: contact@LiveWellLancan be used to address clinical needs, caster.org. This initiative is one of many but can also potentially lower costs, county-wide policies, systems, and improve efficiency, reduce potentially environmental change efforts designed duplicative testing, and reduce patient to reduce chronic disease among inconvenience. The U.S. Preventive residents. Other initiatives include Services Task Force recommends the improving walkability through use of team-based care, clinical decision Complete Streets efforts and promoting tobacco-free workplaces, and public support systems, and patient assistance parks and playgrounds throughout in reducing patient out-of-pocket costs for hypertension services and treatment. the county. This protocol has incorporated each of those recommendations and added additional information and resources to not only improve patient health, but improve the clinical effectiveness. The hypertension control goal established by the CCC is ANNE M. LUSK the 90th perRealtor centile (76.2%) www.AnneLusk.com NCQA HEDIS measure for commercial HMOs, 100 Foxshire Drive the highest qualiLancaster, PA 17601 ty level a provider (717) 291-9101 can attain. Currently, Lan©2013 BRER Affiliates LLC. An independently owned and operated broker member of BRER Affiliates LLC. Prudential, the Prudential logo and the Rock symbol are registered service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide. Used under license with no other affiliation with Prudential. caster County Equal Housing Opportunity is at 72%.

Eboni E. Bryant, Manager, LiveWELL Lancaster County (at Lancaster General Health)

person per year in health care services, medications, and missed days of work. In Lancaster County, that equates to approximately $62,062,000 annually. LiveWELL Lancaster County recently commissioned a policy study on hypertension treatment to determine the policies and practices of healthcare providers in the county. This study found that 47% of physician group practices reported that all of their providers followed a protocol for hypertension treatment and control; 44% of practices reported that all of their providers tracked their practice’s hypertension rates; and 6% of practices reported that all of their providers wrote prescriptions for exercise and fresh fruits and vegetables. Given the results of these studies, the CCC determined that the development of a hypertension treatment and a control protocol would be useful to primary care practices countywide. This protocol not only addresses medication treatment for patients with high blood pressure, but also incorporates best practice strategies in the treatment of hypertension like lifestyle modification. Such strategies include physical activity and nutrition counseling, timing of specialist referral, assessment of the health literacy of patients, and referrals to community programs and pharmacies. Additionally, the CCC is promoting the incorporation of the protocol into the electronic medical records

“Representing Lancaster County’s Most Distinguished Homes”

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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

professional complementary services that these allied health professionals bring to the practice of medicine, and acknowledge that their services increase access to medical care, the health and safety of patients must remain the highest priority when considering the roles of care providers at all levels.”

Debate over Scope of Practice Escalates ...WITH ENACTMENT OF PATIENT PROTECTION AND AFFORDABLE CARE ACT / By Susan Shelly Learn more at

A

s initial effects of the Patient Protection and Affordable Care Act begin to emerge, the issue of scope of practice remains a topic of discussion and debate, both locally and across the state and nation. As many as 34 million Americans are expected to gain insurance once the new health care law is fully implemented. Meanwhile, the number of physicians – particularly primary care physicians – is declining in many states, raising questions about future availability of adequate access to health care. The matter is complicated by the fact that the number of emerging physicians is constricted due to a limited number of medical school slots open throughout the country. At the same time, we are experiencing a growing number of allied health professionals. This brings the roles of individual health care providers to the forefront of the conversation. Pennsylvania state lawmakers are considering legislation that addresses the issue of scope of practice, while medical societies across the state monitor ongoing proceedings.

pamedsoc.org

Physicians are understandably concerned about the issue of scope of practice and the implications of expanding the roles of allied health professionals, such as physician assistants and certified registered nurse practitioners. Scope of practice also applies to chiropractors, optometrists, naturopaths, psychologists, podiatrists and other professionals.

Karen A. Rizzo, MD, FACS, a board member and former president of the LCCMS and vice president of the Pennsylvania Medical Society (PAMED), recently discussed the topic of scope of practice as it applies to a variety of disciplines. She agreed that the issue of patient safety is of the utmost importance. In some instances, Rizzo maintained, expanding scope of practice can put patients at risk. It also has the potential to increase costs as lower level providers may order more tests and other procedures to compensate for lower levels of knowledge and experience. While there certainly are roles for all levels of health care providers, Rizzo said, only physicians possess the highest levels of education and training specific to their areas of expertise. “Physician training is very long and complex and intense,” Rizzo said. “And, that’s really why, in medicine, we feel that we are the best trained for patient care.” A physician typically invests between 10 to 15 years in education, Rizzo said, which ensures that a doctor receives not only education, but real-life training during his or her residency.

Karen A. Rizzo MD, FACS

Scot Chadwick VP, Governmental Affairs, PAMED

LCCMS recently released this statement:

“While the physicians of the Lancaster City and County Medical Society greatly respect the education and

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“It’s really your residency where you learn your trade,” Rizzo said. “We feel that if other health care providers want to have the same responsibilities as physicians do, they also should have the same education and training.” Questions and debate surrounding scope of practice have been tossed around for decades, said Scot Chadwick, vice president of governmental


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Best Practices

affairs for PAMED. “This has been an issue for the past 30 years,” Chadwick said. Chadwick cited the issue of scope of practice as it pertains to acupuncturists. Acupuncturists have lobbied for legislation that would permit them to see patients indefinitely, without the patient obtaining a medical diagnosis. Currently, an acupuncturist is required to refer a patient to a physician, dentist or podiatrist if the patient’s initial problem has not been resolved within 60 days of beginning treatment. Allowing a patient to remain in treatment with an acupuncturist indefinitely clearly could jeopardize the safety of the patient, Chadwick said. “After all, what if your back pain is being caused by a tumor? Wouldn’t you want to know that as soon as possible?” he said. Fortunately, PAMED reached compromise regarding this matter with acupuncturists, who agreed to keep the 60-day requirement in place. However, patients who are not suffering from any ailment, but receive acupuncture as part of a wellness program, do not need to be referred to a physician after 60 days. “For those folks who are truly symptom free and are simply making wellness visits, there is no reason to enforce the 60-day rule, and we’ve agreed that it can be eliminated,” Chadwick said. PAMED will continue to monitor and act on legislation relating to scope of practice as it occurs. Rizzo acknowledged the need for access to primary care and other problems within the health care system. And while it is imperative that all health care professionals work together to assure access to care and address other problems, redirecting responsibility from physicians to other levels of professionals is not the answer. “Scope of practice is a complex practice that impacts patient safety and care in numerous ways,” Rizzo said. “Maintaining a team approach with physician oversight continues to provide the best quality of care and optimizes patient safety. At the end of the day, you want the right thing done at the right time for the right reason.”

Project Access Lancaster County (PALCO)

S

ix years ago the Lancaster City & County Medical Society worked along with physicians and allied health care providers to start Project Access Lancaster County (PALCO). PALCO began providing access to health services to low income, uninsured patients in our community who might otherwise have gone without care. Some would have ended up in the emergency room at considerable costs to them and the community, or some would have died. Since that first patient visit back in October of 2007, over 4,300 participants have been seen by 945 health care providers in Lancaster County who volunteer their services. That equals $37 million in donated services! Many of these physicians are members of the Lancaster City & County Medical Society who have continued supporting the mission they established in 2007. PALCO has truly become a wide-ranging, caring and efficient answer to a significant problem faced by Lancaster and many like communities.

Accomplishments

Total enrollments: 4,345 Average monthly enrollment: 1,100 Prescription assistance program started June 2011 Dental Access Lancaster County (DALCO) started August 2011: the growth has been notable Volunteer health care providers: 945 and counting Value of donated services in 2012: more than $7.4 million Value of total donated services from 2007: $37 million

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Return on community investment: for every $1 spent, $24.76 in health care services are provided, or a 2,000 percent return Reduction in expensive emergency room visits Our top specialty medical needs are gastroenterology and orthopedics.

BY THE NUMBERS

Gender

Female 58%

Male 42%

Ethnicity African American

9%

Asian

6%

Hispanic or Latino

White

46

39%

%

For more information Visit PALCO at palcolancaster.org 717.392.1595


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

For the

of

By Dana Myers

Orthopedic Associates of Lancaster is bringing world-class injury prevention and treatment to the largest indoor sports facility in North America.

H

igh School athletes are performing at a much higher level than they ever have before,” Sam Beiler, founder of Spooky Nook Sports, said. “I’m not sure whether to say there’s a pressure or opportunity to become one sport athletes. Whatever it is, many athletes focus solely on one sport. This focus requires discipline and a higher level of training. Unfortunately, with that intensity comes injuries.” Sam contacted Orthopedic Associates of Lancaster (OAL) to discuss opening an office at Spooky Nook Sports to not only treat, but also prevent injuries. “The physicians at OAL are phenomenal. I think very

providers of orthopedic trauma care for Lancaster General. They also lead the way in the ability to provide sports medicine in Lancaster.” Spooky Nook Sports, located at 2913 Spooky Nook Road in Manheim, is the largest facility of its kind in North America. Spooky Nook officiall opened in June, while OAL’s office will open at the end of August. “We all love sports,” Paul Carroll, M.D., from Orthopedic Associates of Lancaster (OAL), said. “If I wasn’t a doctor, I’d probably be coaching basketball somewhere.” So, when Sam approached OAL to set up an office at Spooky Nook Sports, OAL quickly agreed to the offer. “It’s a great

highly of all of them. They already give so much back to the community, in that they are the exclusive

Recently retired, veteran field hockey player and two-time Olympian, Keli Smith-Puzo will support the U.S. Women’s National Field Hockey Team at their new Spooky Nook headquarters.

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“We all love sports...If I wasn’t a doctor, I’d probably be coaching basketball somewhere,” says Paul Carroll, MD of OAL.


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Healthy Communities

team will be a natural progression for our physicians,” Bill Weik, Practice Administrator and CEO for OAL said. “They are so experienced in being team physicians; and have definitely displayed that they have both the competency and expertise to treat all types of athletes exceptionally.” In terms of OAL’s work at Spooky Nook, they will maintain a regular Orthopedic Office, with normal hours. In addition, they will have athletic trainers to cover the over 400 tournaments scheduled so far. The office will have an open door for evaluation for anyone in the facility; in addition to full physical therapy services and training rooms. OAL is still working out their schedule and the additional services they will offer in response to the needs and opportunities Spooky Nook presents.

OAL opened their Spooky Nook office to not only treat, but also prevent injuries. (R) Bill Weik, OAL Practice Administrator and CEO.

opportunity for us and for the community,” Dr. Carroll said. We were looking to open a new office – and this seems like the perfect location.” One of the most exciting perks of the opportunity came soon after OAL decided to open their office. Sam Beiler and his crew secured a contract with the U.S. Women’s National Field Hockey Team to move their headquarters to Spooky Nook. After several trips to Colorado Springs, (where the team was previously headquartered) OAL will soon be the Official Team Physician for the U.S. Women’s National Field Hockey Team. “The U.S. Women’s National Field Hockey Team has never had an on-site orthopedic staff,” Carroll said. “We’ll provide them with a level of service that they haven’t had before – in treating injuries – but, more importantly, preventing injuries.” Carroll explained the Field Hockey Team has a new coach who is extremely focused on strength and conditioning, and the OAL physicians will be working closely with him – keeping with that philoso-

phy. In addition, Dr. Carroll, Dr. Gish, and Dr. Rogers, who are all Fellowship Trained in sports medicine, will cover the Field Hockey games. Most of the team’s athletes are from the Northeast, where field hockey is more predominant than anywhere else in the country. In fact, there are more than 100 girls from the Lancaster-Lebanon League participating on the collegiate level in Divisions I, II and III. When looking at the York, Berks, and MidPenn area also, there are more than 250 collegiate players. OAL is not new to being “team physicians.” In fact, the group is the team physician for Hempfield, Lancaster Catholic, Conestoga Valley, Manheim Township, Thaddeus Stevens and the Lancaster Barnstormers, as well as the orthopedic consultants for F&M College.“Working with the Field Hockey

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What prompted Sam Beiler, former owner of Auntie Anne’s pretzels, to make a career twist into the sports arena? Sam’s vision for Spooky Nook Sports arose out of years of traveling to his daughter’s volleyball tournaments. He and his wife spent many tournaments trying to entertain their son during the weekend. As their son got older, the Beilers found themselves splitting their time—with one parent going to the tournament and the other staying home with their son. “We started going separate ways weekend after weekend. Spooky Nook has something for everyone—it is a place where hopefully, families will choose to stay together.” “It’s a fabulous facility and will be wonderful for Lancaster County,” Carroll continued.” It is truly state of the art... we are thrilled to be a part of it.”

Visit OAl at fixbones.com and Spooky Nook Sports at spookynooksports.com


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

PAMED Foundation Updates

Foundation’s LifeGuard Program Offers Help to Physicians ®

who may have fallen behind in clinical skills or continuing education, or about whom quality concerns have arisen through a peer review process. Through the program, the Foundation offers a multi-component evaluation and assessment process to hospital medical staffs, medical executives, the State Board of Medicine, and other potential sources of referral. Physicians are also encouraged to refer themselves when appropriate.

Reading-based neurosurgeon Dr. Raymond Truex Jr.

R

eading-based neurosurgeon Dr. Ray mond Truex Jr., serves as chair of the Board of Trustees of The Foundation of the Pennsylvania Medical Society. He chose to undertake this leadership role to support the foundation as it offers programs that speak to improving the human conditions of wellness, knowledge and competency for every physician regardless of the political and economic influences that impact the practice of medicine. “Ensuring high standards of professional conduct is the greatest responsibility of a professional and one that the public has a right to expect. It is the responsibility of the physician community to ensure that quality and safety of our colleagues’ performance is paramount to providing health care that is safe and certain for all Pennsylvania residents,” said Truex. The Foundation offers programs that support physician wellness. It administers the Lifeguard® program that assists physicians who need a seamless pathway for re-entry into the workforce. The program provides remediation for those

The LifeGuard® Program has three essential core characteristics Objectiveness.

Evaluations are based on data such as evidence of compliance with performance standards

Fairness. The evaluation process is open, unbiased, and it complies with labor regulations Responsiveness.

Physicians enter into case management promptly and they are moved through the assessment and remediation phase in a timely manner to enable them to continue or return to the practice of medicine, when possible.

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LifeGuard® utilizes the medical model as its basis and a case management approach to provide components of the program as needed. No single pathway is appropriate for all referrals; rather, individualized evaluation, clinical skill assessment, and remediation/refresher plans are considered, depending upon the needs of the individual physician.

The pathways to address licensure and asses clinical competency include: Re-entry LifeGuard® provides licensing boards with a convenient process to help reinstate physicians who wish to reenter the practice of medicine after an extended leave. A unique and common component of the re-entry case management process involves time in active practice settings through a customized precep-


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PAMED Foundation Updates

The objectives of the LifeGuard® Program • To protect the public welfare and ensure patient safety. • To increase the number of physicians in the Common- wealth of Pennsylvania, thereby increasing the workforce capacity to meet the health care needs of patients. • To provide a customized, unbiased process to address physician performance con- cerns. • To provide objective clinical assessment to identify and address concerns. • To provide physicians with appropriate educational remediation to meet their learning goals/objectives. • To help medical organizations, the State Board of Medicine, physicians, and the general public through a collaborative effort to improve the consistency of care, enhance patient safety, and assure access to needed medical care.

torship or shadowing arrangement. The duration of this component is based on each physician’s length of time away from active practice. LifeGuard® develops individualized remediation plans based on the documented deficits by the physician and/or the licensing body, if applicable, as well as those identified through the assessment process. A variety of resources can be used to create individualized plans, including services from specialized referral sources. The remediation experience affords the physician the opportunity to refresh knowledge and skills as well as use a real-time ongoing evaluation process conducted by a board-certified, fully credentialed preceptor. LifeGuard® provides a comprehensive report to the referring licensing board

outlining the physician’s performance related to all assessment tools utilized within the individualized program, as well as evaluation of the physician’s practical phase of the program.

External Peer Review Assessment This service is designed to assess actively practicing physicians when medical knowledge and/or clinical abilities in relation to medical responsibility are called into question. When a problem or deficit is identified and ongoing privileging is called into question, the LifeGuard® program can assess variations identified through the external peer review process. LifeGuard® utilizes an extensive panel of physician reviewers who are fully credentialed, board certified within their specialty, and are actively practicing in their field to provide external peer review assessments.

Aging Physician Assessment For entities and organizations that need “ability to perform” assessments for senior physicians, the aging physician assessment measures abilities, competencies, and health status. A core component of the assessment includes an objective measurement of cognitive and physical abilities. Additional assessment options, including the National Board of Medical Examiners (NBME) practice based exams and proctoring for technical skill evaluation, are available based on the need identified by the requesting entity.

Competency Testing Competency testing, a key component in the LifeGuard® program, is designed to assess a physician’s medical knowledge and decision-making skills. It is also used by physicians who want to assess their respective clinical and medical knowledge on a self-referral basis. Competency testing available through the LifeGuard program is offered in

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collaboration with the NBME and Federation of State Medical Boards (FSMB). According to new Association of American Medical Colleges workforce projections, nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020. In a 2011 research study sponsored by the 2011 American College of Surgeons, Richard Cooper, MD, senior study author and professor at the Perleman School of Medicine at the University of Pennsylvania predicted a national physician shortage increase of seven to eight percent annually. The LifeGuard® Program helps to solve the Pennsylvania physician shortage by putting physicians back to work in a manner that responsibly assesses their needs, provides a program of remediation, and tests to insure that knowledge or skill has been increased and competency criteria has been achieved. Upon completion of the program, a report is issued to satisfy credentialing/ licensure expectations of the state and/ or health system. This report provides critical information that helps to ensure that the physician has reached a level of competency that assures a high level of patient safety. The program graduates return to the workforce as safe and certain physicians. The Foundation’s Board of Trustees provides program oversight and LifeGuard’s staff has worked closely with Bureau of Professional and Occupational Affair’s administrative staff to structure appropriate assessment and/or remediation services that are customized to meet the unique circumstances of each case. For more information Foundation of the Pennsylvania Medical Society Foundation. foundationpamedsoc.org Contact LifeGuard® at 717.909-2590


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

LMS Foundation Updates

Elimination of Federal Subsidies for Student Loans**

Since 1991, the Foundation has

awarded over $250,000 in scholarship funds

According to the Association of American Medical Colleges, which has been trying to address the problem for nearly a decade, young doctors who graduated from medical school last year had an average debt of $158,000, or $2.3 billion for the group as a whole. Almost a third of students owed more than $200,000, a number that will only increase with the addition of interest over payback periods of 25 to 30 years.

Lancaster Medical Society Foundation PAYING-IT-FORWARD TO STUDENTS PURSUING A CAREER THAT LEADS TO CARING FOR PEOPLE FIRST, WHILE STRENGTHENING COMMUNITIES AND THE PRACTICE OF MEDICINE.

T

he board of the Lancaster City & County Medical Society knows that a medical education isn’t cheap, and it’s not getting any cheaper. With decreased funding for graduate school and a physician shortage predicted for Lancaster County* in the coming years, LCCMS is determined to pay-it-forward to students following the career path that leads to caring for people first, strengthening communities, and strengthening the practice of medicine. In 1991, the Lancaster City & County Medical Society established the Lancaster Medical Society Foundation. Since then, the Foundation has awarded over $250,000 in scholarship funds to Lancaster County residents attending medical school.

In 2012, the Foundation Board received the greatest number of applications to date. This seems to point to what is already known: there is an increased need for medical students to receive financial assistance. The Lancaster Medical Society Foundation hopes to be able to provide greater assistance to more Lancaster County students in the future. The Foundation is taking seriously the need to raise funds for this goal. In 2012, a record-breaking $29,100 was raised at the medical society’s Annual Holiday Social event. Members, physician practices, and community partners contribute funds directly to the scholarship and sponsor the event. The 2012 Scholarship recipient is Michael Stengel. Michael grew up in

The Budget Control Act of 2011 leaves the Pell Grant program roughly $1.3 billion short for 201213, and eliminates the federal subsidy of loans for graduate students. On average, medical students currently graduate with $160,000 of educational debt. Many graduate with school loans in excess of $250,000. Eliminating these loan subsidies would increase this amount by $10,000 or more.

Pennsylvania is among one of the states with the highest cost of liability insurance. Many physicians across the state already find it difficult to recruit young physicians to practice in Pennsylvania, and increasing the debt burden would only add to that difficulty. For some medical students, such large debts may mean forgoing a medical career altogether. “While some may counter that future doctors can well afford such increases and loans, the rising debt load has had and will have repercussions on patients, particularly those in greatest need,” said Pauline Chen, MD, in a recent article in the New York Times. PAMED, March 28, 2013 pamedsoc.org

*Pennsylvania Medical Society, “State of Medicine,” pamedsoc.org LANCASTER

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Lancaster NeuroScience & Spine Associates

Central Pennsylvania’s Premier Brain & Spine Team

SERVICES

(standing) Eddy Garrido, MD • Chris Kager, MD • Keith Kuhlengel, MD Bill Monacci, MD • Elliot Sterenfeld, MD • Tony Ton-That, MD (seated) John Gastaldo, MD • James Thurmond, MD

• The NeuroSpine Center Outpatient Surgery

• The Center for Spine Care Pain Management

• Physical Therapy Rehabilitation Services 1671 Crooked Oak Drive, Lancaster • 717.569.5331 1510 Cornwall Road, Lebanon • 717.454.0061

A History of Remarkable Outcomes

LMS Foundation Updates

Avid field hockey player and Nurse Lisa’s disc herniation was affecting all aspects of her life. Day-to-day tasks became unbearably painful...

Chronic back pain was a way of life for Kimberly. She never thought she would be pain free...

Read our patients’ stories at

www.lancasterneuroscience.com Over 40 years of compassionate care and outstanding results! Physical Therapy helped Berit return to the active lifestyle she was accustomed to living...

www.lancasterneuroscience.com

Lancaster and is a third-year student at Penn State College of Medicine in Hershey, where he is pursuing a career in family medicine. Michael is the son of the late Dr. Robert Stengel in whose footsteps he intends to follow by bringing great care to his patients, as well as having a positive impact on his community. Michael cites his father and his father’s colleagues as being the inspiration for his chosen path. In his scholarship application, Michael noted, “Just three months into my medical school training, my father, Dr. Bob Stengel, passed away after nine years of treatment for leukemia. Since losing my greatest role model and supporter, it has taken time to truly appreciate the lessons and experiences that have shaped my being. I have chosen a path in medicine not because

of my dad’s illness, but for the example he set. The character, integrity and strength I have witnessed have compelled me to continue that legacy. Even more so, I [am] especially attracted to family medicine for the opportunities available to have an active role in the community a physician serves.” The Lancaster Medical Society Foundation intends to support more students like Michael. Those eligible for the scholarship must be Lancaster County residents attending medical school who exemplify good character, motivation, academic excellence, and demonstrate financial need. Students may apply each year of their medical school education. Those who are not chosen for a scholarship in a particular year are encouraged to apply again the following year.

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Kim’s back pain was restricting her ability to care for her two young children. She now feels like a new person...

To apply for the 2013 Lancaster Medical Foundation Scholarship...

Visit LancasterMedicalSociety.org or call 717.393.9588.

The Lancaster Medical Society Foundation is an incorporated non-profit charitable organization, 501(c)3. Contributions to the Foundation are tax deductible.


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

Learn more at

pamedsoc.org/pillscamnr

Patient Advocacy... A Physician’s Perspective

Recent efforts of physicians within the Pennsylvania Medical Society’s Council on Patient Advocacy have zeroed in on several pressing issues facing the medical community and affecting public health. Two of these issues have gained significant media attention, and signify the need for action and change. An interview with Robert Aichele, Jr., DO, of Aichele and Frey Family Practice Associates in Willow Street, PA, helps to provide insight from a physician’s perspective on several advocacy issues currently on the table.

Prescription Drug Abuse

PHYSICIANS ARE OFTEN PRESENT WHEN THE REALITY OF DRUG AND ALCOHOL ABUSE OVERCOMES THE ABUSER, OR WHEN GUN VIOLENCE TRAGEDY UNFOLDS...HOW CAN THE MEDICAL COMMUNITY RALLY TOGETHER TO IMPROVE POLICIES TO SUPPORT THIS INITIATIVE? Phyllis J. McLaughlin

T

housands of nationwide health issues, an ever changing health care system, and a predicted shortage of primary care providers— these are only a few of the challenges today’s physicians and patients face, and it’s an overwhelming situation all the way around. But as a result of grassroots efforts within the medical community and motivated by the desire to ensure the best possible patient care, physicians are actively supporting initiatives. By rallying behind the passing of new legislation, physicians are collectively impacting today’s health care environment as advocates for improved health for their patients and their communities. Patient advocacy has been around in the form of organizations such as The American Cancer Society, Alzheimer’s Association, American Heart Associ-

ation, and many others for decades. These organizations were founded and rose to meet the needs of patients suffering from specific health issues, their main purpose being to provide a central referral and support system for the general public. They serve as individual patient advocates, helping patients navigate the bureaucracy of large health plans or government provided services. On a wider scale, patient advocacy may include groups which develop policies and legislation designed to better serve the public. The physician-patient relationship is the starting point for patient advocacy. Both the physician and the patient are able to offer valuable insight into the development of best practices for addressing the growing and changing needs in the health care system.

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The Pennsylvania Medical Society’s Council on Patient Advocacy is currently running a campaign to address prescription drug abuse. According to the council’s April 2013 report, several factors have contributed to pushing this initiative into action:

PA physicians are practicing in the only state in this region without an effective drug data base.

The misuse and abuse of prescrip- tion drugs continues to escalate in PA and nationwide.

PA has 15.1 deaths from overdose for every 100,000 residents.

PA physicians continue to report strong concerns over the rising number of “doctor shoppers” they are seeing, and their ability to assess and maintain appro- priate pain medication for their patients in need while minimizing risk to their practice.

Physicians are being blamed in the national media for the rise in overdose deaths from prescription medications.

“PAMED is urging members to support legislation to enact a Controlled Substance Database (CSDB) that will provide a series of coordinated communications linking physicians to


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Patient Advocacy

give them the benefit of the doubt. If you maintain careful records, and have a good system, abusers will eventually weed themselves out of a practice, however they simply move on to another.”

“...the most important factor remains the patient’s motivation to make the changes...” Robert Aichele, Jr., DO, Aichele and Frey Family Practice Associates in Willow Street

resources which identify patients whose intent is the illicit use of controlled substances.” The greatest issue here is allowing physicians to appropriately treat those patients who require narcotics to control legitimate pain while not enabling narcotic abusers to continue their pattern of self harm, harm to others, and expense to the general public. McLaughlin: How do this problem

and the PAMED campaign directly impact your practice?

Dr. Aichele: “Significantly...primary

care physicians do most of the treatment of these patients...we are actively involved in prescribing their medications. The habits of illicit prescription drug users are very savvy. They frequently go doctor hopping, and go as far as crossing state lines to get medication prescribed. These individuals are difficult to track. Having them listed in a central data base which all physicians could access would be very beneficial.” McLaughlin: Is doctor shopping/

substance abuse a serious issue in the Lancaster community? Dr. Aichele: “Yes...absolutely. Drug

abuse is rampant in all communities, and Lancaster is not exempt. People tend to think Lancaster is pristine and closed off from this, however it affects every practice. Physicians want to believe our patients, and we want to

PAMED continues to promote education for patients, physicians, media, legislators, and other stakeholders on this important issue, and when final legislation that meets physicians’ needs is up for a vote, PAMED members and the grassroots network will be asked to communicate with legislators to support passage. McLaughlin: The campaign is urging

PAMED members to play an active role in supporting legislation to enact a CSDB by creating a grassroots action group. Do you see a positive response from Lancaster physicians to this call for action?

Dr. Aichele: “I believe that everyone

is on the same page...I don’t believe that this legislation will require doctors gathering on Capitol Hill. I believe that on its own merits it will pass.”

A second issue which has drawn heated debate from the public has prompted the American Medical Association (AMA) to adopt policies on gun control. In lieu of this recommendation, PAMED took an action to “explore opportunities to improve the provision of mental health and drug and alcohol care in Pennsylvania as it relates to homicide and firearms violence. McLaughlin: In today’s society, the role of the physician has grown tremendously. You are often present when the reality of drug and alcohol abuse overcomes the abuser, or when gun

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violence tragedy unfolds. In your opinion, how can the medical community rally together to improve policies to support this initiative? Dr. Aichele: “I believe that anything

that we can do to make it more difficult for the unstable individual to get their hands on a gun is a reasonable policy. We must jump through hoops for any number of rights that we have. A driver’s license requires testing and a period of time to obtain the right to drive...why not the same for firearms... where do you draw the line?”

McLaughlin: Do you see “preventive medicine” as having the major role in turning the tide of violence, drug, and alcohol abuse? Dr. Aichele: “Absolutely...as a family

practitioner I begin talking about it on a regular basis to both patients and the parents of grade school and middle school age children. I talk to them about tobacco, alcohol, drugs, and even sex. I tell parents that screen time needs to be limited. I personally believe that there is a limit, and children are desensitized by too much television and computer time, and not enough time outside playing. These issues are more readily addressed today than in the past, but it depends on each physician’s level of comfort discussing these issues.”

McLaughlin: What can the local medical community do to strengthen the population within their reach against the onslaught of gun violence and substance abuse? Dr. Aichele: “Education. Starting with

the younger generations; reaching them when you have a captive audience – perhaps through the schools. My son attended a local school where every freshman goes through a ‘life learning’ course. This would be a good starting point to address issues of substance abuse and violence.”

McLaughlin: What collaborative Continued on page 27


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Restaurant Review lccms member reviewed!

made with crispy wontons which were quickly devoured. My wife’s crab cakes were moist and delicious, held together with very little filler, allowing the crab to really shine through. They were served with a slice of a potato frittata and steamed spinach. My favorite was the homemade seafood ravioli with a parsley hazelnut sauce. The ravioli were served al dente with a very nice blend of flavors from the sea. Dessert portions were also on the small side, but beautifully presented. The chocolate banana bread pudding was a solid comfort food pleaser, but the light praline mousse was the unanimous favorite.

Checker’s Bistro BY KEITH WRIGHT, MD AND GWENDA WRIGHT

C

hecker’s Bistro in downtown Lancaster near Franklin and Marshall College immediately came to mind when we were presented with the opportunity to share one of our favorite local restaurants. My wife and I had been there twice before, and both experiences were great. You can check out their changing seasonal menu and hours on their website in addition to the ample beer and wine list. Reservations are highly recommended at this popular spot whose advertising we guess must mainly be by word of mouth. Adequate parking is available off the street behind the restaurant. The fresh mocha brown exterior was brightened with flower-filled window boxes, and music playing on the exterior speakers helped set the mood. The staff made us feel like regular VIPs with warm smiles and welcomes as they showed us to our table. The restaurant quickly filled with guests, but we could talk without having to shout. Soft lighting added to a comfortable atmosphere

suitable either for enjoying friends or a romantic dinner. We sent our daughter to the restroom to check it out and she came back giving the thumbs up for cleanliness and commenting about how great the soap smelled. The menu is not large, but making a choice was difficult, as the options were intriguing with a range of ethnic influences. Our server, Emily, took time to help us out, even suggesting and pouring samples of the wine before we chose a bottle to accompany the meal. The bread slices came out fresh and warm with olive oil and balsamic for dipping. In general, the portion sizes are not large by American standards, but were sufficient. We chose the lobster bisque and apple salad for appetizers. The tomato based bisque was smooth and peppery, somewhat lacking in lobster flavor but tasty. The salad was refreshing, with slivers of apples and candied walnuts. Our daughter chose one of the small plates for her entrée, Asian-spiced duck tacos

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The entire meal for the three of us was $125, including the bottle of wine. While we felt this was quite reasonable for the choices we made, there are menu items to be enjoyed for less, such as pizza, fish and chips, burgers, and sandwiches. We couldn’t help staring as they served a lobster pizza at the next table. We will have to try that next time—it looked awesome. We left feeling satisfied and happy. Each of the staff we saw on the way out smiled and wished us a good night. Would we recommend Checker’s Bistro? Absolutely yes! It appeals to people of all ages – young adults to senior citizens-who enjoy fine dining with great service. If you have young children, we would recommend leaving them with a sitter. Overall, it was a great place to relax after a long day of seeing patients and dealing with the stress of implementing a new electronic health record system. Just what the doctor ordered!

CHECKER’S BISTRO checkersbistro.com 717.509.1069 300 W James St. Lancaster


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UPCOMING EVENTS

efforts are currently in place, or could be developed to support patient advocacy in your community? Dr. Aichele:“I am involved with a collaboration of physicians as

part of a Community Transformation Grant who are working to reduce hypertension and hyperlipidemia within the community. We are practicing patient-centered medical care for a population of patients. We’re working as a group of physicians, specialists, and pharmacists; all on the same page so patients don’t slip through the cracks. Our goal is to make people healthier and cut down on medical costs.”

McLaughlin: Are there any last words on patient advocacy that you would like to share for the article? Dr. Aichele: “As much as patient advocacy exists to benefit

and support the patient, the most important factor still remains the patient’s motivation to make the changes, and make the transitions to be accountable for their own health.”

Pennsylvania Medical Society Annual Business Meeting & House of Delegates

Physicians, in collaboration with allied health care providers, are working proactively as individuals and within community programs to educate patients in Lancaster County about how they can play a greater role in their own wellness.

October 25 - 27 Hershey Lodge and Convention Center This year's meeting will be the "make or break" opportunity to change the format of future annual meetings. Be there to vote!

Phyllis McLaughlin is a freelance writer who maintains a

studio/office at The Goggleworks Center for the Arts in Reading, PA.

Lancaster City & County Medical Society Holiday Social

CAMPUS EYE CENTER

December 14, 6:30 p.m. Lancaster Country Club

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.

Lee A. Klombers, M.D.

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

• Eye infections • Eye injuries • Eyelid growths • Foreign bodies • Glaucoma • Macular degeneration

This event benefits the Lancaster Medical Society Scholarship Foundation.

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

Practice Managers: Would you appreciate timely educational programs held in Lancaster County? They're on the way! If you enjoyed our June seminar "Successful Communication and Professionalism for Physician Office Staff," presented by PMSLIC, we have more for you.

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

Stay tuned!

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

Willow Lakes: 717.464.4333

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

For more information

contact Kelly Lyons Schober at 717.393.9588 or kschober@lancastermedicalsociety.org. And check our website for additional educational opportunities and events: lancastermedicalsociety.org. Lisa J. Kott, O.D.

Olga A. Womer, O.D.

www.CampusEyeCtr.com

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

News & Announcements

Welcome New Physicians...

To publish new LCCM photos of S memb physician s, please s er ubmit digital cop ies to kschober@la ncastermedic alsociety.org

To date, for 2013 dues cycle

Louise R. Butler, DO

Eastbrook Family Health Center

Samantha Gettler

Debanjana Chakrabarti, MD

Practice Administrator Dermasurgery Center, PC

Manheim Family Medicine Stacey S. Denlinger, DO

Anders E. Martiny, DO

Doctors May-Grant Associates

Heart of Lancaster Regional Medical Center Graduate Medical Education James E. Harvey, MD

Donald D. Diverio, Jr, MD

AO Orthopedics, Inc.

The Heart Group of Lancaster General Health

Kent A. Meldrum, MD

Doctors May-Grant Associates Lee A. Meyers, CEO

Central Penn Management Group, Physicians’ Alliance, Ltd

Sarah E. Eiser, MD

Lancaster Physicians for Women

Mark J. Epler, MD

Cardiothoracic Surgeons of Lancaster General Health Pamela Gehman

Practice Administrator Meadowbrook Family Medicine Francis C. Gross, DO

Roseville Pediatrics

David E. Guyer, MD

The Heart Group of Lancaster General Health Towahna Holdren

Patrick J. Moreno, MD

Crozer Chester Medical Center Graduate Medical Education Joseph F. Motacki, MD

Lebanon VA Medical Center

Practice Adminstrator New Holland Family Medicine David E. Jones, MD

Anesthesia Associates of Lancaster Ltd

C. David Noll, DO

Northern Lancaster County Medical Group

Carolyn Keith

Practice Adminstrator Allergy & Asthma Center Anna Libby

Scott A. Schucker, MD

Medical Student

Twin Rose Family Medicine

Heather D. Harle, MD

Neurological Associates of Lancaster

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News & Announcements

Stephen J. Scull, MD

Lancaster Emergency Associates, Ltd Shanthi Sivendran, MD

Hematology/Oncology Medical Specialists Walter N. Stewart

Student Anitha Weaver, MD

Grace Pediatrics Dana Weinstein, DO

The Heart Group of Lancaster General Health

Todd A. Wood, MD

The Heart Group of Lancaster General Health

Frontline Groups Groups with 100% membership of their physicians in LCCMS/PAMED as of 6.1.13

Allergy & Asthma Center Argires, Becker, Marotti & Westphal Cardiac Consultants, PC Cardiothoracic Surgeons of Lancaster General Health Community Anesthesia Associates Community Services Group Conestoga Pulmonary & Sleep Medicine Dermatology Associates of Lancaster, Ltd Eastbrook Family Health Center Eye Associates of Lancaster, Ltd Eye Doctors of Lancaster Family Eye Group The Heart Group of Lancaster General Health Hospice & Community Care Hypertension & Kidney Specialists Internal Medicine Specialists of Lancaster County Lancaster Cancer Center, Ltd Lancaster Ear, Nose & Throat Lancaster Family Allergy Lancaster Neuroscience & Spine Associates Lancaster Physicians for Women Lancaster Urology Lincoln Family Medicine Maternal-Fetal Medicine Specialists OBGYN of Lancaster Orthopedic Associates of Lancaster, Ltd Otolaryngology Physicians of Lancaster, Ltd Plastic Surgery Associates of Lancaster Rothsville Family Practice Southeast Lancaster Health Services Surgical Specialists of Lancaster

New Practices LCCMS Members opened after June 2012

Lancaster Family Allergy Laura H. Fisher, MD Amanda J. Bittner, MD

730 Eden Road, Suite 301 Lancaster, PA 17601 717.569.5618

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

903 Red Rose Court, Suite 301 Lancaster, PA 17601 717.517.9083

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Necrology Richard L. “Dick” Bryson, MD

Richard L. “Dick” Bryson, MD, 86, of Landisville, passed away on August 21, 2012. Born in Ephrata, he was the son of the late William D. and Kathryn (Beck) Bryson. Dr. Bryson was the husband of Carolyn (Hiestand) Bryson who passed away in 2006. Dr. Bryson was a family doctor for generations of Landisville/Lancaster County residents for 38 years before his retirement in 1990. He was also the primary medical physician at Hempfield High School. Dr. Bryson was a 1945 graduate of Franklin & Marshall College. He received his medical degree from Jefferson Medical School in 1949 and completed his residency at Lancaster General Hospital. He then served in the United States Navy as a medical officer in Europe after World War II. Dr. Bryson was a member of Mount Joy Rotary, serving as president from 1979-1980, and secretary for 20 years. He was a member of the Lancaster City & County Medical Society and the Pennsylvania Medical Society. Paul G. Hess, MD

Paul G. Hess, MD, 94, of Lititz, passed away July 14, 2012. Born in Terre Hill, he was the son of the late Harry W. and Elizabeth Good Hess. He was married for 70 years to Revenda (Tunner) Hess who passed away in February of 2012. Dr. Hess received his B.S. from Elizabethtown College and his medical degree from Hahnemann Medical School. During World War II, he served as headquarters company physician with the U.S. Army in Europe. Continued on page 30


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

News & Announcements

LANCASTER’S CHOICE FOR PROFESSIONAL PORTRAITS

Commercial Team: Mark Buckwalter, Jeremy Hess & Donovan Roberts Witmer

medical dental legal real estate retail

www.jeremyhessphotographers.com Contact us to discuss your next project, 717-390-7050

Dr. Solomon was a general practitioner in Lancaster for 60 years, retiring in 1995. He was a member of the Lancaster City & County Medical Society, the Pennsylvania Medical Society, and the American Medical Society. He was chief of staff at the former St. Joseph Hospital.

Dr. Hess began his practice in Lititz in 1946. With the addition of Dr. Swan and Dr. Holder the practice became the home of a new family practice, Hess, Swan & Holder. In 1976, the office became Lititz Family Practice and moved to its current location which, in 1996, became known as Lancaster General Medical Group. Dr. Hess retired in 1984. Dr. Hess served on the boards of Farmers First Bank and Lititz Mutual Insurance Company and their affiliates Penn Charter Mutual, Farmers & Mechanics Mutual, and Livingston Mutual. He was a member of the Lancaster City & County Medical Society, the Pennsylvania Medical Society, and the American Medical Society.

Herbert L. Tindall, Jr., MD

Herbert L. Tindall, Jr, MD, 97, died October 4, 2012. Born in Philadelphia, he was the oldest child of the late Herbert L. Tindall, Sr. and Edith May Kelley Tindall of Elkins Park, PA. He was preceded in death by his second wife, Dorothy S. Tindall, who died in 2011, and by his first wife, Julia C. Tindall, who died in 1994. Dr. Tindall graduated from Upper Darby High School, the University of Rochester, and Hahnemann Medical School. After his internship at Hahnemann, he went on active duty in the United States Navy, serving as a medical officer aboard the USS Newman, in both the Atlantic and Pacific theaters.

Elias M. Solomon, MD

Elias M. Solomon, MD, 104, of Lancaster, passed away on September 6, 2012. Born in New York, NY, he was the son of the late Hermon and Dora Rosenberg Solomon. He was the husband of the late Shirley Stotsky Solomon who died in 1971. Dr. Solomon was a 1930 graduate of Franklin & Marshall College, and a 1934 graduate of the University of Pennsylvania School of Medicine. After graduation, he returned to Lancaster as an intern at St. Joseph Hospital. He enlisted in the United States Army and served as a Captain during World War II. Dr. Solomon participated in five major campaigns after landing on Utah Beach in 1944, including the Battle of the Bulge. LANCASTER

Dr Tindall established his private practice of family medicine in Christiana, PA in April 1946 where he practiced for 25 years. He also served at Lancaster Deputy Coroner from 1946 to 1970. He was affiliated with Lancaster General Hospital, St. Joseph Hospital, and Coatesville Hospital, where he served as Chief of Staff from 1967-1970. In 1971, he worked as an emergency department physician at Coatesville Hospital. From 1971 until his retirement in 1981, he was 30

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News & Announcements an associate director of Lancaster General Hospital’s Family Practice Residency Program, where he directed the Walter L. Aument Family Practice Center in Quarryville.

Research Confirms Use of CO2 During Colonoscopies Reduces Pain

Dr. Tindall was a Fellow of the American Academy of Family Physicians and a life member of the Lancaster City & County Medical Society, the Pennsylvania Medical Society, and the American Medical Association. He served as the president of the Christiana Board of Health and as a clinician for the State Child Health Clinics in both Lancaster and Chester Counties. Richard H. Weber, MD

Richard H. Weber, MD, 82, died April 29, 2013. Raised in Allentown, he was the son of the late Richard and Amelia Kulowitsch Weber. Dr. Weber is survived by his wife of 60 years, Shirley Batori Weber. Dr. Weber graduated from Columbia College at Columbia University. He earned his doctorate in medicine from Hahnemann Medical College, Drexel University in 1956, and completed his internship at Misericordia Hospital in Philadelphia. Inducted into military service in 1957, he served as chief of the General Practice Clininc and Emergency Medicine at Andrews Air Force Base Hospital, Washington, DC. In 1959, Dr. Weber entered a residency in family practice at Lancaster General Hospital and then opened his family practice office in Lancaster in 1960 where he cared for patients for over 50 years. From 1964-1966, Dr. Weber served as secretary of the Lancaster City & County Medical Society. In 1970, he became a charter member of the American Board of Family Practice. He held the positions of president and vice president of the medical and dental staff at Lancaster General Hospital and served on the board of directors. He took great pleasure in forming the Auscultation Brass Band with his fellow physicians in 1985.

The use of CO 2 has been proven to reduce pain and bloating, decrease recovery time and improve patient satisfaction. RGAL is the only gastroenterology practice in Lancaster that uses CO2 (instead of room air) during colonoscopies. CO2 is used at the Oregon Pike and Harrisburg Pike centers. No additional cost and less pain. Wouldn’t your patients prefer CO2?

Charles R. Winter, MD

Charles R. Winter, MD, 90, of Lancaster, passed away on February 21, 2013. He was the husband of Anita B. Bratz Winter, with whom he celebrated 56 years of marriage. Born in Magdeburg, Germany, he was the son of the late Carl and Margaret Maedle Winter. Dr. Winter served in the Medical Corps providing medical service for six years. Dr. Winter had been a nationally-recognized physician and orthopedic surgeon, providing care at St. Joseph Hospital, where he served as Chief of Orthopedic Surgery, and in his own practices, Winter Orthopedic Clinic, and Colonial Hall Rehabilitation Center. In 1963, he garnered national attention after reattaching a severed arm, then again in 1970 for successfully attaching one of the nation’s first Myo-Electric prosthetic arms. His practice spanned over 45 years. Dr. Winter was a member of the Pennsylvania Medical Society and the LCCMS, graciously opening his home for the annual holiday dinner to raise funds for the Society’s scholarship foundation.

LANCASTER

Four Convenient Locations • Lancaster Health Campus • Oregon Pike-Brownstown • Women’s Digestive Health Center • Elizabethtown www.RGAL.com • 717.544.3400

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News & Announcements

Local Health & Wellness Advocates Receive Awards

PRACTICAL REALITIES OF CREATING A SUSTAINABLE HEALTH CARE SYSTEM IS FOCUS AT THE

Lancaster Medical Society’s 169th Annual Meeting

T

he Lancaster City and County Medical Society (LCCMS) recently held its 169th Annual Meeting, featuring keynote speaker Len Nichols, PhD. More than 100 medical society members turned out to hear this nationally-recognized speaker and to honor the contributions made to the Lancaster community by local health and wellness advocates. Dr. Nichols’ presentation “Payment Reform in the Real World: Moving Past Politics into the Practical Realities of Creating a Sustainable Health Care System” provided an economist’s view of health care reform. Nichols’ observed,“‘Business as usual’ is

over...payment models are being redesigned based on quality of care and the efficiency of service delivery, not just volume. “Population health for exam- Len Nichols, PhD ple, managing diabetes, hypertension, and obesity, has assumed a lead role in health care policy development.” “Health care reform is a participatory sport. Many solutions will be developed at the local level, and physicians will be important to the process.”

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Dr. Nichols is Professor of Health Policy and Director of the Center for Health Policy Research and Ethics at George Mason University. At George Mason University, he continues the work he began at the New America Foundation, bridging the worlds of health economics and health research. He previously served as vice president of the Center for Studying Health System Change, a principal research associate at the Urban Institute, senior advisor for health policy at the Office of Management and Budget during the Clinton Administration’s health reform effort, and chair of the Economics Department at Wellesley College. He has advised the World Bank and the Pan American Health Organization, as well as various state and federal government departments and agencies. He founded and directed the Health CEOs for Health Reform, a group that was pivotal in helping policy makers see that delivery system reform and health insurance reform are necessary and feasible complements. He is a nationally-recognized leader in health economics and health services research. With a reputation as an honest and knowledgeable health policy analyst, Dr. Nichols has testified frequently before Congress and state legislatures and is frequently interviewed and quoted by major media outlets. He has published widely in a variety of health journals, and is a highly sought after public speaker on health policy and politics. Dr. Nichols received a BA from Hendrix College and a MA in economics from the University of Arkansas at Fayetteville. He received an MS and PhD in Economics from the University of Illinois at Champaign-Urbana.


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News & Announcements

Benjamin Rush Award Presentaions Each year the Lancaster City & County Medical Society recognizes an individual and an organization that have made a significant contribution to the health and welfare of Lancaster County residents with the Benjamin Rush Award. This year’s recipients were: Rush Organization Award Friendship Community Gwen Schuit, CEO, and Charles Kahler, President of the Board, accepted the award for Friendship Community’s outstanding service to individuals with developmental and intellectual disabilities. Founded in 1972 through the efforts of concerned parents and a local church group, Friendship Community has the distinction of opening Lancaster County’s first group home for adults with developmental and intellectual disabilities. It is a faith-based, non-profit organization whose values include relationships, integrity, spirituality and excellence. Since its inception, the organization has evolved from serving 12 people to currently serving 145. Friendship Community offers a range of programs from Community Home Living to Respite Services and Home-Based Services Rush Individual Award R. Michael Peck Chair of the Board of Directors of The Lancaster Heart & Stroke Foundation Since 1993 The Lancaster Heart & Stroke Foundation has donated all earned income from clinical research trials to fund community services in Lancaster County, and Peck has been a driving force in leading these charitable efforts. In particular, he has been a leader in the Foundation’s AED program. The Foundation donated 145

defibrillators to police departments throughout Lancaster County and taught over 600 officers how to use the devices. The cost of implementing this program in Lancaster was over half a million dollars, and Lancaster County was one of the first communities in the United States to have every police vehicle equipped with lifesaving defibrillators. Peck continues to lead the charitable mission of the Lancaster Heart & Stroke Foundation which includes the education and patient assistance programs. The Foundation provides free CPR training and teaches individuals to use defibrillators. Churches, schools, shopping malls, health clubs, golf clubs, retirement communities, physician office staff, and Lancaster County Courthouse staff are among those in our community who have benefited from the Foundation’s educational efforts and public access defibrillation program.

In addition, the Lancaster Heart & Stroke Foundation coordinates a Patient Assistance Program. Each year, hundreds of Lancaster County residents receive free life-sustaining medication through this program including patients from over 40 physician offices and residents of the Water Street Ministries.

Also recognized were Distinguished Service Award Laura Good, MD

Suzanne Andrews, MD

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Dr. Lawrence Bonchek

started the open heart surgery program in Lancaster County in 1983, served for many years as Chief of Cardiothoracic Surgery at LGH, and is currently the Editor-in-Chief of the Journal of Lancaster General Health.

Dr. Leigh Kendall, a general surgeon who practiced in Lancaster from 1971 until 2007, served as Chair of the Department of Surgery and Section Chief of General Surgery at St. Joseph Hospital, now Lancaster Regional Medical Center.

Dr. Stephen Lockey, in practice in

Lancaster since 1970 and currently is Chief of the Division of Allergy and Immunology at Lancaster General.

Dr. Roger Peterson, a radiologist

who practiced in Lancaster from 1971 until 1998, served as Chief of Diagnostic Radiology at Lancaster General.

Dr. John Rutt, a family physician who served the Lancaster community from 1971 until 2003, is a graduate of Hahnemann University Medical School. Dr. Ernest Wood, who practiced

Certificate of Appreciation

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Six physicians were recognized for 50 years of service in medicine.

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in Lancaster from 1972 to 2002 and served as Chair of the Department of OB/GYN at Lancaster General.


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

MEMBER Spotlight better ways to treat their illnesses. To that end, he participates in clinical research with the Lancaster Heart & Vascular Institute of Lancaster General Hospital. His passion for treating patients with multiple sclerosis has also earned him a leadership award from the National Multiple Sclerosis Society.

“A brain is the most wonderful, most exotic computer ever made.”

The son of hardworking parents, Mangeshkumar believes the keys to success are “inspiration, perspiration, and commitment.” He applies these daily in his work. “I like to make a difference in the lives of my patients,” he says. His work is internationally recognized, and in 2007, he received a fellowship award from the Royal College of Physicians of Ireland.

Dr. Venkatachalam

Mangeshkumar I

n 2003, Dr. Venkatachalam Mangeshkumar founded Neurology & Stroke Associates, PC, in Lititz, a practice focused on treating a wide range of neurological illnesses. Mangeshkumar holds medical degrees in neurology, geriatric medicine, and internal medicine; and is one of only a handful of neurologists in Pennsylvania who are also certified in neuroimaging, specifically computed tomography and magnetic resonance imaging. Mangeshkumar grew up in Chennai, India, and earned his medical degrees in India and the United Kingdom. In 1993, he came to the United States to conduct his residency in neurology at Thomas Jefferson University Hospital, followed by a fellowship in stroke and neurological critical care at Allegheny

University Hospitals in Philadelphia. During his residency, he was identified as an outstanding immigrant physician, prompting an expedited application for U.S. citizenship. Since then, Mangeshkumar has treated a long list of neurological illnesses, including stroke, multiple sclerosis, Parkinson’s disease, neuropathy, migraine headaches, and memory disorders. His fellowship experience with stroke patients inspired him to take a special interest in stroke treatment. As a result, he served as the director of Lancaster General Hospital’s Stroke Program from 1998 until 2012. The word that best describes Mangeshkumar is passionate. He’s passionate about his patients and about finding

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Treating neurological illnesses, he explains, has given him a reverence for the complexity with which God created the human brain. “A brain,” he says, “is the most wonderful, most exotic computer ever made.” Mangeshkumar joined the Lancaster City and County Medical Society (LCCMS) in 2004 and became a board member in 2011. He joined the Society because he appreciates its focus on helping physicians to address patients’ immediate and future needs and because the Society “provides physicians with a platform to speak in one voice on health care issues.” As an internationally-trained physician, Mangeshkumar is also LCCMS board’s International Medical Graduates Representative to the Pennsylvania Medical Society. Additionally, he participates in the LCCMS’s scholarship fundraising efforts and actively recruits new members. When not treating patients or researching treatment options, he enjoys listening to music, traveling, and watching cricket matches. He also enjoys learning languages; he is fluent in two and comfortable with four more. He is the proud father of three children, one of whom is pursuing a career in medicine.


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

Legislative update

$8 million to expand the Children’s Health Insurance Program (CHIP)

By Scot Chadwick Vice president for governmental affairs Pennsylvania medical society

Legislative activity is in full swing. As usual in recent years, post-recession financial challenges will take center stage, as the governor and legislature struggle to deal with flat revenues, increased demand for social services, a huge state pension funding deficit and the transportation infrastructure funding shortfall. Those financial challenges will also factor into Governor Corbett’s ultimate decision regarding expansion of the state’s Medicaid program.

$40 million to provide critical services to an additional 3,000 adults and children with physical and intellectual disabilities

Following is a status report on key legislative activities in Harrisburg.

As a result of HealthChoices expansion, to be completed in March 2013, the outpatient services budget will decrease by $194 million, and inpatient services by $175 million. The capitation program, which funds managed care providers, will increase by $252 million.

2013-2014 State Budget

Level funding ($1.58 billion) for state and state-related universities. In exchange, university leaders promised to work to keep tuition increases as low as possible.

In his February budget address, Governor Corbett proposed more funding to increase access to health care in rural and underserved areas and turned down Medicaid expansion as too costly to Pennsylvania taxpayers. The proposal expands the Primary Health Practitioner Loan Repayment Program to incentivize physicians and other health care providers to work in rural and underserved areas. To further improve access to care in these areas, the budget dedicates $4 million to the creation of the Community-Based Health Care Subsidy Program to provide grants to health care clinics for preventative primary care services. The budget proposal also calls for the state to partner with primary care residency programs in Pennsylvania to expand the number of residency slots throughout Pennsylvania. In addressing the controversial topic of Medicaid expansion, Corbett said that without serious reform, Medicaid

Apology

expansion would be financially unsustainable for Pennsylvania taxpayers. However, negotiations between Corbett and the federal government on the issue are ongoing.

Other highlights of the state budget proposal include

The desire to modernize and consolidate the state’s health centers, with a focus on how the staff can see people outside of the health care center rather than requiring patients to come to them.

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As most are aware, sooner or later all tort reform initiatives eventually make their way to the Senate Judiciary Committee, where chairman Stewart Greenleaf (R-Montgomery) buries them. That problem has been solved this session, at least for PAMED’s apology bill. Senator Pat Vance (R-Cumberland) shrewdly attached the measure to a bill (SB 379) extending the life of


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Legislative update

the CHIP program, which was referred instead to the Senate Banking and Insurance Committee, chaired by tort reform champion Don White (R-Indiana). Senator White’s committee promptly approved the measure, and Senator Vance is now working to secure a vote by the full Senate. If enacted, the bill would prohibit the use of provider apologies and other benevolent gestures after a poor outcome in any subsequent medical liability action.

Deemed Status

protections through deemed status, is a major concern. Importantly, the bill as introduced would have eliminated state regulations that ensure the protection of physician-led hospital medical staffs. HAP and PAMED worked to address those concerns, and that process produced an agreement on all issues, an agreement that was endorsed by DOH and Rep. Matt Baker, who chairs the House Health Committee. However, a number of non-physician provider groups saw the bill as an opportunity to expand their role and scope of practice in a hospital setting. This and other complications resulted in a scuttling of the bill at the end of the session.

Regulation of Tanning Salons Last session Senate Bill 349, which would regulate the state’s tanning facilities and set age limits for who can use them, was approved by the Senate by a vote of 48-1. The bill subsequently cleared the House Health Committee on December 5, 2011, and was poised for final House passage.

However, SB 349 was a “middle of the road” proposal which ultimately died in the tug of war between those who wanted a stronger bill and smaller government advocates who opposed any bill at all. PAMED will attempt to reconcile the two sides and get the strongest possible bill that can actually pass to the governor’s desk. New House and Senate measures have been drafted, and that process is under way.

In an effort to jumpstart a long overdue update of Pennsylvania’s hospital regulations, the Hospital and Healthsystem Association of Pennsylvania (HAP) is attempting to bypass the lack of regulatory action via the legislative route. Last session House Bill 1570, introduced by Representative Doug Reichley (R-Lehigh), provided that facilities or specialized health care services accredited by a national accrediting organization approved by the Centers for Medicare and Medicaid Services (CMS) would be deemed to meet state licensure requirements and would be entitled to a license issued by the Department of Health (DOH). This would allow them to ignore inconsistent state licensing requirements. PAMED was, and remains, sympathetic to HAP’s desire to modernize the state hospital regulations, and indeed, supports such an endeavor. However, the blanket erasure of some significant state patient and physician

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In the new session PAMED has worked with DOH and other stakeholders to craft language that reduces the likelihood of an assault on the bill by mid-level provider groups. While the language ultimately settled on by the Corbett administration isn’t as “tight” as we would like, DOH has issued a letter reassuring us that its interpretation of the legislation addresses our concerns. HAP has also sent a letter stating that they accept that interpretation. That language is contained in House Bill 1190, introduced by Representative Bryan Cutler (R-Lancaster), and as of this writing the bill has cleared the House Health Committee with no negative votes.

Controlled Substance Database (CSDB) Last session Representative Gene DiGirolomo (R-Bucks) introduced House Bill 1651, legislation intended to improve the Commonwealth’s ability to enable informed and responsible prescribing and dispensing of controlled substances and to reduce diversion and misuse of such drugs in an efficient and Continued on page 38


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Legislative update

cost-effective manner that will not impede the appropriate medical utilization of licit controlled substances. PAMED supports the creation of a CSDB, but had a number of concerns with the bill as drafted, including the lack of legal protection for physicians who opt not to use the database, and overly broad language permitting law enforcement personnel to surf the data looking for fraud. PAMED worked with Rep. DiGirolomo and key stakeholders to address these concerns, and ultimately a vastly improved version of the bill was approved by the House Human Services Committee. Unfortunately the bill went no farther. However, PAMED’s “Pills for Ills, Not Thrills” campaign has generated significant support for a CSDB in the governor’s office and legislature, and we are optimistic that a good bill can be enacted this year.

CRNP Independent Practice Senator Pat Vance has circulated draft legislation that would entitle CRNPs to practice independently, to be recognized as primary care providers under managed care and other health care plans, and to be reimbursed directly by insurers and other third-party payers. The proposal would also take priority over the authority of DOH and DPW to regulate the types of health care professionals who are eligible for medical staff membership or clinical privileges, along with the authority of a health care facility to determine the scope of practice and supervision or other oversight requirements for health care professionals practicing within the facility. The measure, though not yet introduced, will be discussed at PAMED’s May board meeting.

Managing Professional Risk Communication Important in Hospitalist Model

By Karen Davis, Risk Management, PMSLIC Insurance Company and the NORCAL Group

Hospitalists are becoming well established in the U.S., and the concept of hospital medicine has expanded to pediatrics, obstetrics, and some other fields. Recognized benefits of the hospitalist model have fostered its quick and enthusiastic acceptance across the country. However, one concern about the hospitalist model is that it intentionally disrupts the continuity of care. Risk management experts often advise physicians to concentrate on the continuity of patient care because gaps in physician-patient communication can lead to bad outcomes. The hospitalist model has the potential to disrupt continuity of care by setting up a deliberate break in communication between the patient and his or her usual physician in the form of the transfer to another provider—the hospitalist. Robert M. Wachter, MD, who coined the term “hospitalist” and who has been a leader in the development of the hospitalist concept, notes that from the early days, organizations using hospitalists have had to “[focus] on ensuring a smooth ‘hand off’ to prevent any ‘voltage drops’ at the inpatient-outpatient interface.”1 Because the transfer is premeditated, physicians can develop protocols to bolster and protect communication. Hospitalists and outpatient physicians should discuss the potential for communication failures and make specific plans for transferring patients and for communicating about the care they each render. Communication protocols can include: a method for the outpatient physician to discuss with

patients how the hospitalist will be involved in care; a plan for the outpatient physician to communicate with the hospitalist at or near the time of the patient’s admission; a plan for sharing treatment and discharge information; a plan for the hospitalist to be available to the patient if needed between discharge and the first visit back to the outpatient physician; a plan for the hospitalist to phone the patient after discharge; and any other procedures that facilitate clear and timely interaction between the patient and the physicians involved in care. Communication is especially crucial when new information about a patient becomes available after the patient has been discharged from the hospital. How does follow-up occur when, for example, a tissue sample evaluated as benign is subsequently interpreted as showing malignancy? Because follow-up is a known risk area, it is a good strategy to have a protocol for notification when new information comes to light after a patient is discharged. A good protocol has provisions for notification of both the outpatient physician and the patient. Hospitalists and the physicians who refer patients to them should think about areas where their communication with each other and with patients might be vulnerable to collapse. Any actions they can take to identify and diminish risks will improve patient care and decrease the likelihood of lawsuits. Reference

1. Wachter RM. The state of hospital medicine in 2008. Medical Clinics of North America. 2008;92(2):265-273.

Copyright 2013 PMSLIC Insurance Company. All rights reserved. This material is intended for reproduction in the publications of PMSLIC approved-producers and sponsoring medical societies that have been granted prior written permission. No part of this publication may be otherwise reproduced, edited or modified without the prior written permission of PMSLIC. For permission requests, contact: Karen Davis, Project Manager, at (800) 492-7898.

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Lancaster Physician July 2013  
Lancaster Physician July 2013  

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