Lancaster Physician Winter 2015 by Hoffmann Publishing Group

Winter 2015

OfďŹ cial Publication of The Lancaster City & County Medical Society

Embracing Population Health Management at Lancaster General Health

EBOLA: How Prepared Are Lancaster County Hospitals?

How to Treat Common Winter Allergies & Ailments

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PAD raises the risk for heart attack and stroke. Pam was worried about the pain in her legs—they often felt heavy, fatigued and cramped after walking. Then, her doctor told her about the new Vascular Clinic at the Lancaster Heart & Vascular Institute. There, she met with a specialist and learned it was Peripheral Artery Disease (PAD), a serious condition that could increase her risk of heart attack and stroke. With proper diagnosis and treatment, Pam is on her way to better health. The Vascular Clinic at the Lancaster Heart & Vascular institute offers multidisciplinary care and testing in one convenient location. To refer a patient for consultation, please call 717-544-6565 and we will select the most appropriate provider for your patient’s care.

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Contents

2015 BOARD OF DIRECTORS

WINTER 2015

OFFICERS James M. Kelly, MD President

Lincoln Family Medicine

David J. Simons, DO President Elect

Community Anesthesia Associates

Robert K. Aichele, MD Vice President

Aichele & Frey Family Practice Associates

Paul N. Casale, MD Past President

The Heart Group of Lancaster General Health

C. David Noll, DO

Best Practices 8 EBOLA: How Prepared Are Lancaster County Hospitals? 14 The Low-Down on Laser Spine Surgery 16 Financially Speaking, What Does Retirement Look Like?

Secretary Ephrata Community Hospital

Stephen T. Olin, MD Treasurer

Lancaster General Hospital

DIRECTORS

EBOLA:

Charles A. Castle, MD

How Prepared Are Lancaster County Hospitals? (p.8)

Stacey Denlinger, DO Laura H. Fisher, MD Alyssa K. Jones, MD John A. King, MD Venkatchalam Mangeshkumar, MD

In Every Issue

Karen A. Rizzo, MD, FACS Jennifer Zatorski, MD

6 President’s Message 18 Healthy Communities

Interim Editor: Dawn Mentzer

24 Patient Advocacy

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

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.

Common Winter Allergies & Ailments …and How to Treat Them (p.18)

26 Legislative Updates 32 Restaurant Review 34 News & Announcements 38 LMS Foundation Updates

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

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

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President’s Message

Big Gains For PAMED

In Fall 2014

James Kelly, M.D. President

often hear the question from prospective county and state members, “What does the Pennsylvania Medical Society do for me?” I sometimes agree (while practicing under my LGH shelter) that maintaining our relevance amongst a group of increasingly employed physicians has been a challenge. This fall, organized medicine in Pennsylvania saw major wins that will ultimately benefit physicians and patients. In looking back at my ten years of membership, the fall of 2014 was among the most productive for PAMED. Therefore, I thought it would be helpful to review several recent gains that will directly affect Pennsylvania physicians.

MCare: As most physicians are aware, the MCare fund was initially created to help offset the high cost of malpractice insurance premiums. In 2009, an excess of funds was present, indicating that physicians were in fact being overcharged for insurance premiums. In lieu of reducing fees or reimbursement, the excess funds were transferred to help balance the state budget. After a five year fight, PAMED was finally successful in returning these overpayments to physicians and hospital systems. Monies will be disbursed within the next 2 years. Controlled Substance Database: Unintentional overdoses with prescription drugs are significantly higher in PA than the national average. In 2014, with PAMED support, our state lawmakers passed legislation that will create a statewide controlled substance database to be active in June 2015. This database will improve physicians’ upfront knowledge regarding prior prescriptions written for or filled by a patient. We anticipate this will protect against misuse and diversion of controlled substances, ultimately saving patient lives. Administration of Life Saving Medications: At many public and private schools, students do not have access to medical personnel throughout the entire school day. This can be disheartening to parents who have children potentially needing emergency medications, such as epinephrine or glucagon. Legislation passed this fall will permit trained school employees to administer an epinephrine auto-injector that meets the prescription on file for the school in the event that the employee in good faith believes that a student is having a severe allergic reaction. In addition, with PAMED’s support, Governor Corbett signed legislation allowing first responders to administer naloxone to patients with a suspected opioid overdose.

Visit lancastermedicalsociety.org

Maintenance of Certification (MOC): In our last issue, I discussed physician frustration with the onerous licensure process developed by their individual specialty boards. This includes tasks beyond routine continuing medical education (and more specifically Part IV Practice Performance Assessments) that can be time consuming, expensive, and many times have little relevance to direct patient care. In 2014, PAMED established a task force to tackle these concerns and was successful in gaining attention from the American Medical Association. Matters continue to be addressed at both the state and national levels, with progress expected in 2015. We are in a very exciting time for organized medicine, and physicians can be assured PAMED is at the forefront with their interests in mind. Agenda items for 2015 include physician led team based care initiatives, CRNP scope of practice, medical marijuana, and telemedicine expansion. I invite any physicians with concerns that need to be addressed at the state level to contact me through the Lancaster City and County Medical Society at 717-393-9588 or at jxkelly@lghealthorg.

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best

pr ctices EBOLA: How Prepared is Lancaster County? Laser Spine Surgery Financially Speaking, What Does Retirement Look Like?

How Prepared Are Lancaster County Hospitals? DAWN MENTZER Lancaster Physician Interim Editor & Freelance Writer

ith the 2014 Ebola outbreak standing as the disease’s most widespread outbreak in history, the fear and unrest it has generated worldwide is also unprecedented. It is the first outbreak in West Africa and currently has country-wide transmission in the nations of Guinea, Liberia, and Sierra Leone.1 Within the United States, there have been two imported cases (including one death) and two cases in health care workers who acquired the disease locally while treating Ebola patients. The last report of Ebola in the U.S. was on October 23, 2014.2

Africa—Outbreak Distribution Map, CDC (Centers for Disease Control and Prevention) website, accessed 12/10/2014, http://www.cdc.gov/vhf/

According to the CDC (Centers For Disease Control and Prevention) website, “CDC and partners are taking precautions to prevent the further spread of Ebola within the United States. CDC is working with other U.S. government agencies, the World Health Organization (WHO), and other domestic and international partners and has activated its Emergency Operations Center to help coordinate technical assistance and control activities with partners. CDC has also deployed teams of public health experts to West Africa and will continue to send experts to the affected countries.”

2 Cases of Ebola Diagnosed in the United

Even though the disease doesn’t appear to pose a significant risk here in the United States, people still have concerns. Are our Lancaster County hospitals prepared to handle the very unlikely yet possible scenario of encountering an Ebola case locally?

1 2014 Ebola Outbreak in West

ebola/oubreaks/2014-west-africa/ distribution-map.html

States, CDC (Centers for Disease Control and Prevention) website, accessed 12/10/2014, http://www.cdc.

gov/vhf/ebolaoutbreaks/2014-westafrica/united-states-imported-case.html

In this Q&A, you’ll read about the measures Lancaster General Hospital, WellSpan Ephrata Community Hospital, Lancaster Regional Medical Center, and Heart of Lancaster Regional Medical Center are taking to address the Ebola risk.

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Winter 2015

Ebola Q&A

3. What should someone expect upon arriving at your facility if she suspects she—or someone she knows—might have Ebola?

WellSpan Ephrata Community Hospital Answers contributed by:

Brett Marcy Regional Director, Public Relations & Communications, WellSpan Health

1. What screening procedures does your facility have in place when dealing with patients exhibiting symptoms similar to those of the Ebola virus?

All WellSpan Health hospitals—including WellSpan Ephrata Community Hospital, WellSpan York Hospital, WellSpan Gettysburg Hospital and WellSpan Surgery and Rehabilitation Hospital—have implemented clear and consistent Ebola screening procedures to ensure the safety of our patients, our visitors and our staff members. This strategy is focused on safety and preparedness procedures for our front-line staff at our acute patient care sites, including our hospital emergency departments, primary care locations, walk-in urgent care locations, pre-hospital assessment services and direct admission. Our goal is to rapidly assess any risk of Ebola within the first 30 seconds of our welcoming patients to the location.

2. What training have your staff members

received to prepare them for dealing with people infected with Ebola?

In addition to training staff on proper screening procedures, WellSpan has distributed new personal protective equipment (PPE) to all patient care locations, including the hospital emergency departments, walk-in urgent care locations and primary care offices. Strategic members of our hospital emergency departments have received enhanced training for donning and doffing PPE. In addition, key staff at primary care and walk-in care sites has received PPE training. All of WellSpan’s acute care hospitals have identified patient isolation rooms at each facility and conducted Ebola training drills to test their preparedness for a potential Ebola patient case.

If, during the screening interview, a patient is determined to be at risk for Ebola, our goal would be to immediately isolate that patient from the rest of the facility. Staff would immediately don personal protective equipment and would then properly quarantine the patient from all other staff and patients at that location. At that point, staff would work collaboratively with WellSpan Infection Control and Prevention and federal and state agencies to determine risk of Ebola infection and next steps. 4. If you discover a patient has Ebola, what is your course of action to: A. Protect staff and other patients?

If, during patient screening, staff determines that there is even a risk that the patient is infected with Ebola, our staff would immediately don personal protective equipment, and they would immediately quarantine the patient in an isolation room. These steps would protect our staff and other patients. B. Get the patient the treatment/ help needed?

If the patient tests positive for Ebola, our staff would work collaboratively Continued on page 10

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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

with the Centers for Disease Control to determine the best approach for treatment. In addition, WellSpan has developed an Infectious Disease Response Team, which would be deployed in the event of a confirmed Ebola patient case. That team would provide patient care and perform invasive procedures, if necessary. This team of volunteer staff members has been meeting regularly to document processes and practice patient care procedures in WellSpan’s simulation lab. 5. What informational resources (online, phone, print collateral, etc.) about Ebola and your preparedness and procedures are available for those interested in learning more? WellSpan has created an Intranet page for staff with regular updates, training information and important documents for Ebola preparedness. A photo gallery of the step-by-step PPE donning and

doffing process has been posted to the Intranet page. Our “Ebola Information Center” has been an effective resource for staff and has proven to be an excellent way of quickly sharing important information and updates with staff. The Ebola virus is still a threat that is limited to those who have recently visited specific West African countries and health care workers who have recently treated

Earn your Certificate in Population Health Tailored for front-line staff, Pennsylvania College of Health Sciences’ new Population Health Certificate provides an understanding of the principles of population health management and tactical skills to increase patient engagement. The 15-week, asynchronous online workshop is offered as a multidisciplinary cohort to emphasize collaboration among the care team and build skills that relate to day-to-day activities.

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Ebola-infected patients. Only a handful of people have been treated for Ebola in the United States, and no cases have occurred in Central Pennsylvania. For these reasons, we believe the CDC is the single best resource for those who want to learn more about Ebola. Online, visit www. cdc.gov/ebola for a wealth of information and resources on the virus, the outbreak in West Africa, and recommendations and guidance for health care professionals.

Winter 2015

Ebola Q&A

Lancaster Regional Medical Center & Heart of Lancaster Regional Medical Center August 26, 3. What should someone expect upon

arriving at your facility if she suspects she—or someone she knows—might have Ebola?

Answers contributed by:

Marla Konas, RN Market Infection Prevention Coordinator Walter Roth Market Emergency Management Coordinator

If the patient would answer yes to one or both of the questions (travel history or contact with person who has Ebola), the registration staff would stop the registration process and notify the emergency department staff. The patient would be moved to a designated isolation room by nursing staff wearing the appropriate PPE.

4. If you discover a patient has Ebola, what is your course of action to:

1. What screening procedures does your

facility have in place when dealing with patients exhibiting symptoms similar to those of the Ebola virus?

A. Protect staff and other patients? Our response plan is to identify the patient with suspected/possible Ebola and to isolate that patient to limit the possible exposure of staff/patients and the hospital environment to Ebola. We have identified specific rooms at both hospitals where we would isolate the possible Ebola patient and have the appropriate personal protective equipment staged.

All patients presenting to the hospital are asked if they have traveled to a country with Ebola or have had contact with a person diagnosed with Ebola. Additionally, the Emergency Room staff has a B. Get the patient the treatment/ help needed? screening question that they must answer in the electronic emergency department Once the patient is isolated, we would notify record before any treatment is given. The the CDC for direction on any testing that hospital-owned physician practices also would be obtained to confirm the Ebola have been educated to ask patients calling diagnosis. The hospital would begin to for appointments the above-mentioned coordinate arrangements to send the patient questions and directed to tell the patient to a designated Ebola treatment center. to go to the Emergency Room. While the patient is in the hospital’s care, the staff would do any routine interventions 2. What training have your staff members to stabilize the patient prior to transfer. received to prepare them for dealing with people infected with Ebola? 5. What informational resources (online, phone, print collateral, etc.) about All staff has received education about Ebola and your preparedness and the hospital’s response plan for Ebola. procedures are available for those Additionally, information is located on interested in learning more? the hospital’s intranet site. Selected staff received training on the type of personal The information and recommendations protective equipment (PPE) to wear and have changed frequently so we are referring the procedure for doffing and donning individuals to the CDC website and click of the PPE. on Ebola. This site is frequently updated.

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1976

Best Practices

Winter 2015

Best Practices

Ebola Q&A

Where Experience Meets Excellence

Lancaster General Hospital Answers contributed by:

Deborah K. Riley, MD Chair of Infection Control, Lancaster General Health System

1. What screening procedures does your facility have in place

when dealing with patients exhibiting symptoms similar to those of the Ebola virus?

We follow the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health (PADOH) protocols for patient screening, quarantine, transport and all aspects of clinical management; this includes looking for signs of fever, severe headache, muscle pain, diarrhea and vomiting, and if these symptoms are present, we ask the patient whether he or she has recently traveled to and returned from West Africa.

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2. What training have your staff members received to prepare

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While the risk of someone in Lancaster County contracting Ebola remains low, the health system has undertaken a major multidisciplinary effort to prepare for a possible case, in addition to existing rigorous infection control and isolation precautions. By mid-December, more than 140 LG Health staff members were trained, including 40 physicians in the emergency, trauma, infectious disease, anesthesia, pulmonary, obstetrics and other departments. In November, we conducted a drill to evaluate our readiness to identify and treat a possible Ebola patient.

3. What should someone expect upon arriving at your facility if

she suspects she—or someone she knows—might have Ebola?

We are prepared to isolate patients suspected of having Ebola per the CDC’s guidelines. Patients requiring admission to Lancaster General Hospital for evaluation or treatment of Ebola will be housed in a dedicated isolation unit within the hospital. Patients identified elsewhere within the LG Health system will be transported to LGH via ground transportation.

protective equipment. Posters have been administered on proper donning and removal, and demonstrations are posted on our employee intranet. B. Get the patient the treatment/help needed? We developed a rapid response team trained and continuously prepared to triage and care for any suspected or confirmed cases of Ebola within our health system. That team will work with the CDC’s Response Team if LG Health receives a confirmed patient with Ebola.

5. What informational resources (online, phone, print collateral, etc.) about Ebola and your preparedness and procedures are available for those interested in learning more?

We adhere to the most current recommendations from the CDC and encourage readers to visit http://www.cdc.gov/vhf/ebola/ for detailed information. The Pennsylvania Department of Health also has excellent resources if you go to http://www.portal.state. pa.us and click on its health section.

4. If you discover a patient has Ebola, what is your course of action to:

A. Protect staff and other patients? Our frontline clinical staff has been given extensive, in-person instruction in the proper donning and removal of personal

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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

The Low-Down On Laser Spine Surgery

WILLIAM T. MONACCI, MD, FACS Lancaster NeuroScience & Spine Associates

aser surgery is not new. Lasers have been widely utilized in medicine since the early 1970s. The ability for lasers to both cut and coagulate with a no-touch technique and minimal tissue trauma propelled their usage during the technology’s early stages of development. When continuous wave lasers were introduced, applicability to neurosurgery was made possible. This type of laser energy reduced the explosive effects of pulse wave lasers and allowed more accurate cutting and removal of tissue. With improved instrumentation, surgeons could access more narrow surgical corridors.

Several studies have been conducted on more efficacious in the removal of larger utilizing laser technology in the removal mass lesions. The laser still has a place in of both intracranial and spinal tumors. cranial neurosurgery. Performed from 1976–1983, a study of 657 cases included several 100 intracranial The use of the laser in spinal surgery has tumors as well as 33 spine tumors. The been slower to develop given the success of authors noted the precise cutting of tissue spinal procedures with conventional tools. with simultaneous coagulation. It was noted Many surgeons would point to the marketthat removal with laser instrumentation ing value of a laser in spine surgery rather proceeded slower than more conventional than its actual utility. The general public has methods, and a wider corridor of approach been enamored with the ever-burgeoning was required for the bulky laser apparatus. growth of technology. Use of terms such as Over time, other tools were developed to “robot” and “laser” connote precision and include the ultrasonic aspirator, which was removal of the human element from surgery.

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Winter 2015

Laser Spine Surgery

Did You Know? The Physicians of Lancaster NeuroScience & Spine Associates offer a variety of non-surgical treatment options including:

Physical Therapy Pain Management Acupuncture

By implication, people expect there is less possibility of complication, less pain, and a higher success rate with a more “precise” method of surgery. However, lasers in spine surgery are simply additional tools, which have appropriate use and are not applicable for all situations. In fact, they are valuable in only the minority of typical spine cases. Many laser-assisted spine surgical cases involve endoscopic methods. They involve a smaller incision than with conventional microsurgery. A typical incision for a lumbar discectomy is 1 inch or less. In endoscopic, incision is measured in millimeters. Some argue that endoscopic methods limit visibility and thus the ability to achieve full anatomic decompression—which is the goal of the procedure. Therefore, case selection is important. In these cases, surgeons use the laser to coagulate or vaporize compressive tissues such as annular disc bulges. Stronger lasers may also remove bone tissue. More conventional open approaches actually cut or drill and remove the compressive

tissue. The superiority of either method has not been proven. There are limited well-performed studies documenting the effectiveness of laser discectomy in peer-reviewed medical literature. The most commonly used laser for spinal surgery is a Holmium– YAG laser. In general, the depth of cutting is 0.5 mm for soft tissue and 0.2 mm for bone. Laser energy is highly absorbed in water. The laser is typically operated in a wet environment with limited exposure to air to prevent the generation of heat. The proximity of the tissue to be removed with neural elements makes avoiding significant heat buildup

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essential. Using as much water as possible, as with suction-irrigation devices, minimizes accumulated heat. Endoscopic methods take advantage of this laser property. Personnel, including operating personnel, must undergo special training. Special eyewear and anti-reflective instruments are used. Regular maintenance of the laser apparatus is also required. In summary, the use of lasers provides another means to accomplish the objectives of the surgical procedure. Whether using a laser is superior to conventional methods is an open question. A patient’s selection, as in any surgical procedure, is vital to a successful outcome.

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Best Practices

seek out someone who maintains a primary focus on those types of policies. Many university alumni associations maintain relationships with independent insurance agents that deal with an assortment of good quality insurance companies. These agents and companies are highly motivated to do excellent work for you in order to maintain that referral source.

Financially Speaking,

What Does Retirement Look Like?

• A primary residence is not an investment. It does not generate an income. It provides a place to live and have good parties. A home is an exercise of paying off the mortgage vs. renting and paying off the landlord’s mortgage. When the time comes, the home is sold and the proceeds go to buy or make payments for another roof overhead in the form of a relative’s home or an institutional retirement home. A phenomenon that I have seen goes by the name of “downsizing.” In reality that can lead to much anxiety via a sizable outlay of money for a new home that—despite less square footage—is much more expensive.

• There are investors and savers. My observation is that investors can live with fluctuations in market value while residential living expenses may take the savers shy away from such uncertainty. place of travel and hobbies. Generally, I have seen investors own stocks and bonds (in mutual funds or • During retirement, an expense category individual securities). Savers, on the other that seems very popular with both chilhand, generally stay with CDs or bonds. dren and grandchildren is educational Assuming that success is nothing but good gifting. To prepare for this, 529 plans habits, savers save, and investors invest are tax advantaged and aim at post high enough money to generate an income in KEVIN HART KORNFIELD, M.B.A. school training. retirement. Before and after retirement, Kornfield Investment Management people usually are happy to keep their • At retirement a lot of people make the respective preferences about handling n anticipation of the years after you are mistake of taking Social Security (SS) at money. In either case, over-trading and no longer able to or wish to work, there the earliest possible date. Physicians have excessive risk are to be avoided both before are a couple of basic things you can do a good idea about how to live to 100, so and after retirement. to cushion your retirement years. Working taking SS at age 66 vs. 62 can add up to a with affluent investors since 1976, I have lot of extra money. Seriously, planning for All of the insight above is based on my made some observations about life during a long life seems very prudent, and setting experience in working with investors, and retirement and can offer some insight about your sights on age 100 isn’t beyond reason. it offers no guarantees. As you plan for your what to consider as you plan for your future: retirement, I encourage you to consult with • I see a regular succession of older people an investment management company that • Before activity declines in later years, who benefit from long-term care (LTC) specializes in supervising portfolios that are insurance policies. LTC is a very special- invested in stocks and bonds for long-term household budgets are frequently similar ized insurance product, and you should growth and income. to the working years. Later on, health and

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Healthy Communities

Common Winter Allergies & Ailments …and How to Treat Them ROSE BOETTINGER

he wintertime tends to bring with it a cornucopia of colds, so how is it possible to distinguish the difference between a cold and allergy symptoms? Both cause discomfort and can thwart productivity, but a cold typically lasts about a week; whereas, allergy symptoms can last significantly longer. According to Laura H. Fisher, MD, co-founder of Lancaster Family Allergy, common allergy symptoms include but are not limited to itchy eyes and frequent sneezing in addition to a runny nose. Cold weather can be both beneficial and harmful to those with sensitive allergies and asthma. Frost kills ragweed pollen, temporarily alleviating common allergy problems, and Dr. Fisher states, “A good solid ground freeze usually kills outdoor mold.” However, it is important to note that people shoveling driveways or partaking in other time-consuming outdoor activities risk the chance of experiencing cold-induced hives (urticaria) or cold-induced asthma. These conditions can occur in people who are not properly dressed to perform these outdoor activities, so Dr. Fisher advises to bundle up even for warmup and cool down exercises to

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Winter Allergies & Ailments

prevent extreme body temperature changes. To treat urticaria, she suggests consulting a doctor about nonsedating antihistamines or epinephrine auto-injectors. Eczema is another skin condition that may afflict people exposed to cold weather for extended periods of time. Eczema is a condition caused by the inability of the skin to retain moisture. According to the National Eczema Association, nearly 30 million people may suffer from it.1 To prevent or relieve dry skin, Dr. Fisher recommends applying longer and produce better results. In order a non-fragrance and non-food moisturizing to keep lips moisturized, Dr. Fisher says, cream, such as CeraVe, after a daily bath or “Flavored chap stick may taste better, but shower to help seal in moisture for smooth the chemicals in chap stick may irritate your and healthier skin. She also suggests avoid- skin. Petroleum jelly is better for chapped ing lotions; they contain alcohol, which in lips.” For severely chapped or sensitive even small amounts can prevent skin from lips, Dr. Fisher points out that Crisco is a retaining moisture. The effects of creams relatively inexpensive and highly effective and moisturizers on the skin ultimately last treatment method.

An outdoor allergy trigger that is best prepared for early in the year is grass pollen. Although it begins to appear in early spring, it is important to take precautions to prevent allergic reactions early on. Dr. Fisher advises seeing an allergist or physician early in the new year—January or February—in order to receive prescriptions to prevent or reduce the risk of severe allergic reactions when new grass begins to grow. When it comes to seeking comfort indoors, it is important to monitor the humidity levels within the home. Balancing humidity in the home between 40 and 50 percent can help prevent the development of allergy symptoms. “Higher humidity can induce mold growth and dust mite proliferation inside the home,” Dr. Fisher explains, “and lower humidity can lead to dry skin and nosebleeds.” Homeowners with sensitive Continued on page 20

1 “Eczema,” National Eczema Association, accessed 12.23.2014, http://nationaleczema.org/eczema

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allergies and whose houses have humidity levels higher than 50 percent should consider investing in specially made covers for box springs, mattresses, and pillows to help aid against the growth of dust mites. On the other hand, homeowners with particularly low humidity levels this time of year may want to invest in a humidifier. Placing a pot of water on a cooling rack atop a wood burning stove when in use is also an inexpensive way to raise the humidity level in that area of the home. Although it may slightly reduce moisture in the air, heating a home is not necessarily hazardous to those with allergies. “No specific allergies are triggered by the use of fireplaces,” Dr. Fisher shares. However, she notes that smoke from any fireplace can irritate the eyes, causing symptoms also associated with allergies, such as itching and watering. The only concern correlated with fireplaces is the firewood. If the wood is damp, it should not be inside the home. Homeowners should avoid burning damp wood if possible, because doing so leads to creosote buildup in chimneys, increasing

Winter Allergies & Ailments

heed the advice of Dr. Fisher: “If you’re not sure, don’t eat it. Make sure you have your epinephrine with you at all times.” Those without food allergies should be courteous and avoid any chance of cross contamination by thoroughly washing all equipment and utensils used when cooking and baking various foods before moving on to the next recipe. This will help prevent potential allergy triggers for other guests who do have food allergies.

and its generic form cetirizine; Allegra and its generic form fexofenadine; and nasal sprays like Nasacort. Dr. Fisher shares, “The generic equivalents tend to work just as well as brand-name antihistamines.” She also suggests receiving allergy shots, which expose the body to small doses of allergens that cause the reactions. This can help boost the body’s tolerance levels against specific allergens. To help prevent or reduce the risk of allergic reactions, those who are allergic

Pet dander is another trigger of allergies year-round but particularly pesky during the winter when people spend more time indoors due to colder weather conditions. According to the Asthma and Allergy Foundation of America, people who have other allergies or asthma are more prone to pet allergies. Of people with allergies, 15 to 30 percent have allergic reactions to cats and dogs.2

to pet dander should aim to keep pets out of their bedrooms.

Many families open their homes to new pets around the holiday season, which can result in more people experiencing the risk of chimney fires. Damp logs also allergic reactions to pet dander. Dr. Fisher carry mold, which may release mold spores also points out that if pet owners were into the air and trigger allergy symptoms. away from their pets while traveling for the holidays, their tolerance of pet dander Winter also brings risks for those with may have decreased, leading to an increase food allergies. Choosing what to eat at hol- in allergy symptoms upon their return. iday gatherings can be a perilous process for There are various pharmaceutical over-theguests with food sensitivities. If hosts and counter treatments for allergies related to other guests are unaware of food allergies pet dander, including but not limited to another guest may have, that guest should Dr. Fisher’s list of the following: Zyrtec

People still unsure of whether they are suffering from colds or just pushing through another season of allergy symptoms should consult their physician or allergist to receive treatment from licensed professionals to help alleviate these struggles. About Laura H. Fisher, MD Dr. Fisher attended Princeton University as an undergraduate student and went on to pursue her medical degree at Penn State Hershey Medical Center, where she completed her internal medicine and allergy fellowship. She has been actively practicing in Lancaster County for the past eight years, specializing in internal medicine as well as allergy and immunology. Dr. Fisher has spent the last two years at Lancaster Family Allergy, which she and a fellow coworker formed on December 12, 2012. Dr. Fisher is also a board member of the Lancaster City and County Medical Society.

2 “Pet Allergies,” Asthma and Allergy Foundation of America, accessed 12.23.2014, http://www.aafa.org/display.cfm?id=9&sub=18&cont=236

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Do Lancaster County Winters Get You Down? It Might Be Seasonal Affective Disorder SUSAN SHELLY

“Lancaster is very good for farming, but the flip side is that we have these very cloudy winters,” Nepps pointed out.

f you live in Florida or Arizona or another very sunny spot, you’re not very likely to be affected by seasonal affective disorder (SAD), a type of depression that is related to changes in the seasons. If you live in Lancaster County, however, your chances of being afflicted increase significantly.

The further away from the equator you live, the more likely you are to experience SAD. Studies indicate that nearly 10 percent of people who live in New Hampshire suffer from SAD, while only 1.4 percent of Floridians do. However, Nepps shared, if you live in a place like Idaho or Wyoming, which get a lot of snow but also a great deal of sunshine, you’re less likely to suffer from SAD. “Yeah, it snows, but it’s really light,” Nepps said. “It can be blindingly light. And that makes a big difference.” The exact cause of SAD is not known, but it’s thought to be related to circadian rhythm, levels of serotonin (a brain chemical that affects mood), and levels of melatonin (a hormone that plays a role in sleep patterns and mood). Although SAD can also occur in the spring or early summer, winter SAD is much more common. Nepps explained that SAD occurs along a continuum, with some people experiencing more severe symptoms than others. Even people who don’t suffer from SAD probably experience some changes in brain chemistry when seasons change.

“I can say that it seems more common in Lancaster than in other areas where I’ve lived and worked,” said Dr. Margaret M. Nepps, a psychologist at Lancaster General Health who serves on the faculty of the family medicine residency program.

“I suspect there are seasonal changes in all our brains, but it’s more pronounced in some people than others,” Nepps said.

Nepps believes the reason for increased incidence of SAD in the Lancaster area is related to the same factors that make the area so suitable for farming. Sufficient rainfall in most years means that most Lancaster County farmers don’t need to rely on irrigation systems. The clouds that produce the rainfall, however, also make for gray winter skies.

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While many people experience winter “blahs” and have less energy when the days get short and cold, there’s a distinct difference between those feelings and SAD, according to Dr. Michael D. Bowen, a Lancaster General Health physician who specializes in psychiatry and behavioral health.

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Seasonal Affective Disorder

“It’s true that many people experience a change of mood in the winter,” said Bowen. “You might feel blah and find that you’re less active. But, that’s not the same as having seasonal affective disorder.”

Light boxes can be purchased online and in stores including Target and Bed Bath & Beyond. Prices typically range from about $40 to $300.

SAD is a true depression, Bowen explained, characterized by symptoms that may include:

Other treatments include use of an antidepressant drug, cognitive therapy to manage thought processes, and exercise.

O irritability

If you think you may be suffering from SAD, talk to your family doctor or consult a therapist or psychologist. Education is important because it can be frightening to be feeling bad and not understand why.

O increased appetite, especially craving carbohydrates O trouble sleeping or sleeping too much O low energy O a sense of heaviness in the arms and legs

“People are usually relieved to find out that there’s a name and a cause for how they’re feeling,” Nepps said. “And, they’re really happy to hear that there are things we can do to make them feel better. It’s very rewarding for me to see people who are able to improve and get on with their lives, regardless of what season it is.”

O feeling down and depressed most of the day, every day O feeling hopeless or worthless O loss of interest in activities you used to enjoy O withdrawal from social activities O agitation O difficulty concentrating O thoughts of death or suicide

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“Most people experiencing seasonal affective disorder notice a definite change in their mood and functioning, and it’s a lasting change,” Bowen said.

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Women are more likely to develop SAD than men—as are people who are already prone to mood issues. Young people have a higher risk of winter SAD than older people, and the condition may be linked to family history. Also, those who suffer from bipolar disorder are more susceptible to mood swings when seasons change than other people.

Kerry T. Givens, M.D., M.S.

Nepps shared that if you are an adult and have never suffered from SAD, it’s highly unlikely that you would suddenly develop symptoms. “This isn’t something that you’d suddenly develop at age 40, but if you have symptoms and you’ve always had symptoms, it’s very possible that you have seasonal affective disorder.”

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While SAD is a serious issue that can be disruptive and even debilitating, there are therapies that can be quite effective. Light therapy, which involves using a light box that mimics natural light, is one of the best methods of treating SAD. Using the light box for 30 minutes every morning has proven to help many people.

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“There have been a lot of studies that show that light therapy can be very effective,” Bowen said.

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Patient Advocacy

E M B R AC I N G

Population Health Management

at Lancaster General Health

COLLEEN MILLIGAN, MBA

learning needs in this new delivery model, focus groups with staff were conducted across LGHP. Feedback revealed a lack of recognition of the “why” behind new documentation and processes. It also indicated a need for improved skills in motivating patients— especially those with co-existing conditions—to set and achieve health goals. The focus group results led PA College to develop a Population Health Management Certificate aimed at front-line staff.

s hospitals and health systems transform the delivery of health care, provider accountability and patient engagement are at the core. The health care industry’s pursuit of the triple aim relies heavily on its ability to manage population health to improve patient experience and lower costs. Locally, Lancaster General Health and its affiliated education arm, Pennsylvania College of Health Sciences, have embarked on several consecutive initiatives around population health management.

Paul Conslato, MD, LGHP Senior Medical Director, said, “We recognized a need to provide more context to the change transformation taking place at the practices.”

Marion McGowan, Lancaster General Health Executive Vice President & Chief Population Health Officer, said, “We are in the midst of a systemwide shift toward population health management that will improve the care we provide our patients and the community. Touch points across our system are linked through our EMR, providing us with valuable data to proactively deliver care and track outcomes. Every day, we move closer to care focused on optimizing health for all individuals, and away from reactive sick care.”

In a team-based environment, clinical and support staff at all levels—not just the physician—interact with and support patients through regular communication, motivational interviewing and goal setting. This increased interaction requires the development of skillsets beyond clinical and administrative skills. “We wanted to help front-line staff better see the big picture that is Population Health Management, while helping them develop the skills to make PCMH a continued success. We strive to provide staff with ongoing opportunities for learning and career development; the Population Health Certificate is an excellent way to do that,” Conslato said.

In support of a shift from fee-for-service reimbursement to a population health based model of care delivery, Lancaster General Health Physicians (LGHP) practices began a two-year journey to receive Patient-Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA). By 2014, twenty-five practices were certified as Level III PCMH, with most practices scoring 99/100 on criteria assessments. Brian Young, MD, Medical Director of LGHP Care Transformation, stated, “Ongoing transformation within the practices will be key to our future success. We understand that changing how we deliver health care does not stop with PCMH recognition. We continue to work to align our policies, processes, and technology in order to manage the health of our population of patients.”

Mary Grace Simcox, EdD, RN, has been at the helm of the Pennsylvania College of Health Sciences (formerly Lancaster General College of Nursing & Health Sciences) for nearly two decades. “This offering is a prime example of how the College continues to be an educational resource to health care professionals throughout their career.” “In developing the Population Health Management Certificate, we saw an opportunity to build the needed skills for front-line practice staff while introducing innovative class offerings to prepare health care professionals for the future of health care delivery.”

At the core of PCMH is team-based care aimed at multiple touch points with patients to increase engagement and achieve optimal health outcomes. Reimbursement, driven by improved patient outcomes, not just volume, places a high emphasis on process, data collection, and outcomes. To garner staff perspective and identify

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Embracing Population Health Management

Lancaster General Health Foundation saw promise in the budding program and underwrote costs to pilot two cohorts for LGHP staff to participate in the 15-week training certificate, which began in January. Enrollment is ongoing for future cohorts. Covering topics from health care delivery models to population health concepts, to understanding behavior change and using motivational interviewing skills to empower patients, the Population Health Certificate was designed to be a key educational tool to support the PCMH model and triple-aim pursuit. Aislynn Moyer, DNP, RN, led the development of the course and instructs the inaugural offering. “Our Population Health Certificate is unique in that it is aimed at all front-line staff from nurses to practice managers, care coordinators and support staff.” The asynchronous online program brings together multidisciplinary team members within a single cohort in an effort to increase coordination among the care team. “We worked with leaders in the field to develop the curriculum, but wanted to keep the focus on skills building that would be useful in participants’ day-to-day tasks. Assignments relate back to the learners’ work environments, while providing an understanding of why the national health care system is embarking on the shift to population health management.”

Registration is being accepted now for upcoming cohorts of the Population Health Management Certificate. Interested participants may contact:

“Practice care is changing before our eyes,” said Jodi Hecker, LPN, Nursing Supervisor at Diabetes and Endocrinology and a participant in the inaugural Population Health Management Certificate cohort. “Teamwork is more important than ever. We need to support each other in order to support our patients. The Population Health cohort is a great opportunity to learn more about the changes taking place in health care delivery and learn new tools to engage patients in their care.”

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Aislynn Moyer 717-544-4912, ext. 70976 am094@PAcollege.edu

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Legislative Updates

Pennsylvania Medical Society Quarterly Legislative Update December 2014

he upcoming 2015–2016 session of the General Assembly began on January 6, 2015, when House and Senate members were sworn in. However, Governor-elect Tom Wolf will not be sworn in until January 20. Wolf, a Democrat, will face an overwhelmingly Republican legislature, with the GOP controlling the House 119-84, and the Senate 30-20. It should make for an interesting two years. State legislators ended the 2013–2014 legislative term with a flurry of activity, enacting several health care-related measures. To follow is a summary of the significant initiatives enacted this year.

Regulation of Tanning Salons

Culminating years of hard work by PAMED and its allies, on May 6, 2014, Governor Corbett signed a new law banning use of tanning facilities by minors under the

age of 17 and requiring parental consent for seventeen-year-olds. The new law (formerly HB 1259, now Act 41) also requires: • Tanning facilities to post warning signs on the premises, and keep records for three years • Customers to sign a written warning statement prior to tanning • Tanning devices to meet federal and state standards • Employees of tanning facilities to have training in both the use of the devices and recognition of customer skin types

There have been several versions of tanning bills over the years supported by the Pennsylvania Medical Society (PAMED), the

Pennsylvania Academy of Dermatology and Dermatologic Surgery, and the Pennsylvania Chapter of the American Academy of Pediatrics. In past sessions, tanning legislation would pass the Senate but stall in the House. However, persistence has paid off, and the new law went into effect on July 5, 2014.

Lyme Disease Bill Signed Into Law

Lyme disease is the most commonly reported vector-borne illness in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2012 it was also the country’s seventh most common nationally notifiable disease, despite the fact that 95 percent of the cases are reported from just 13 states. Pennsylvania sits at the top of that unfortunate baker’s dozen, joined only by Massachusetts as states with more than 5,000 confirmed or likely cases in 2012. Senate Bill 177, signed into law by Governor Corbett on June 29, 2014, will establish a task force in the Department of Health to make recommendations to the Department regarding a wide range of surveillance, prevention, information collecting, and education measures. The Department will be charged with the task of developing a program of general public and health care professional information and education regarding Lyme disease, along with an active tick collection, testing, surveillance and communication program. The Department will also be directed to cooperate with the Pennsylvania Game Commission, the Department of Conservation and Natural Resources, and the Department of Education to ensure that

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the information is widely disseminated to the general public, as well as to school administrators, school nurses, faculty and staff, parents, guardians, and students. The Pennsylvania Medical Society has long supported legislation calling for the state to take a more active role in information gathering and public education regarding Lyme disease. Unfortunately, earlier versions of the legislation also contained problematic language statutorily endorsing long-term antibiotic therapy, a controversial treatment protocol rejected by the CDC, which ultimately doomed those bills to failure. However, the new law does not contain that highly contentious provision, and the Society is pleased with the bill’s enactment.

Controlled Substance Database Legislation Enacted

On October 27, 2014, Governor Corbett signed Senate Bill 1180 into law, authorizing the creation of a statewide controlled substance database. The database will be housed at the Department of Health, where it will be run by a board consisting of the Secretaries of Health, Human Services, Drug and Alcohol Programs, State, Aging, the Insurance Commissioner, the State Police Commissioner, the Attorney General, and the Physician General (if the Secretary of Health is not a physician). The board will aid prescribers in identifying at-risk individuals and referring them to drug addiction treatment programs. It will also refer information to the appropriate licensing board when the system produces an alert that there is a pattern of irregular prescribing or dispensing data. It will also create a written notice prescribers and dispensers will use to let patients know that information regarding their prescriptions for controlled substances is being collected by the program. Prescribers will not be required to submit prescribing information to the program,

but dispensers must electronically submit information to the program regarding each controlled substance dispensed, no later than 72 hours after dispensing a controlled substance. However, prescribers at a licensed health care facility who dispense controlled substances limited to an amount adequate to treat a patient for a maximum of five days, with no refills, are exempted from the requirement to submit that information to the program. While the language is a bit awkward, the intent is that prescribers are not absolutely required to query the database in all circumstances prior to prescribing a controlled substance, though the bill provides strong guidance for when that should take place. Specifically, a prescriber “must query the program for each patient the first time the patient is prescribed a controlled substance by the prescriber for purposes of establishing a base line and a thorough medical record, or if a prescriber believes or has reason to believe, using sound clinical judgment, that a patient may be abusing or diverting drugs.” Prescribers will be able to designate employees for purposes of accessing the program on their behalf, and prescribers will be permitted to query the program both for an existing patient and for prescriptions written using their own DEA number. Dispensers may query the program for a current patient to whom the dispenser is dispensing or considering dispensing any controlled substance. All law enforcement and grand jury queries of the program must be funneled through the Attorney General’s office. Those queries may take place without restriction for Schedule II controlled substances, but for all other schedules, a court order based on an active investigation will be required. Access to the database is also granted to various other state officials for specifically enumerated purposes.

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A prescriber or dispenser who has submitted or received information from the program and has held the information in confidence cannot be held civilly liable or disciplined in a licensing board action for submitting the information or not seeking or obtaining information from the program prior to prescribing or dispensing a controlled substance. There are significant civil and criminal penalties for improperly accessing the database or misusing information obtained from it. The system is supposed to be up and running by June 30, 2015, so the Department of Health has a lot of work to do during the next eight months.

Naloxone/Good Samaritan Bill Also Enacted

On September 30, 2014, Governor Corbett signed another piece of opioid legislation into law. Senate Bill 1164, which cleared both the Senate and House unanimously, does two important things. As originally introduced and passed by the Senate, it provided Good Samaritan immunity to individuals who seek to obtain aid for someone experiencing a drug overdose. The reason this matters is that individuals with someone experiencing an overdose may have been engaged in illegal activity at the time (i.e. selling drugs), and may be reluctant Continued on page 28

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Legislative Updates

to seek help for fear of getting themselves in trouble with the law. The bill removes that obstacle, prohibiting law enforcement personnel from prosecuting an individual if he/she only became aware of the criminal activity because the individual was aiding a person experiencing a drug overdose. The House of Representatives added an equally significant amendment to the bill, allowing naloxone, a lifesaving opioid antagonist, to be prescribed to first responders like firemen and police officers, as well as to friends and family members of persons identified as being at risk of experiencing a drug overdose. The House amendment also provides liability protection to prescribers and the aforementioned individuals if they administer naloxone in good faith to someone who they believe is experiencing a drug overdose. The new law became effective on November 29, 2014.

Down Syndrome Bill Signed Into Law

Signed into law by Governor Corbett on July 18, 2014, House Bill 2111 (now Act 130) will require a health care practitioner that administers, or causes to be administered, a test for Down syndrome to an expectant or new parent to provide,

upon receiving a positive test result, educational information made available by the Department of Health to the expectant or new parent.

JOIN NOW! Membership in the Pennsylvania Medical Society is a statement of your commitment to the medical profession and to the patient-physician relationship. Here’s how to join today:

Talk to a member services assistant by calling 855-PAMED4U Complete an application online at www.pamedsoc.org/YourAdvocate

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Though well-intentioned, the new law will force a physician to use one-size-fits-all, state-issued material that may not be appropriate for every patient. The requirement became effective in September 2014.

Physician Dispensing in Workers’ Compensation

A legislative initiative to place limits on physician reimbursements for dispensing drugs in workers’ compensation cases has borne fruit, as the state House and Senate approved a bill which Governor Corbett signed into law on Oct. 27. It took effect on Dec. 26, 2014. House Bill 1846, introduced by Rep. Marguerite Quinn (R-Bucks), will cap the reimbursement rate for drugs and pharmaceutical services in the workers’ compensation system at 110 percent of the original manufacturer’s average wholesale price (AWP), calculated as of the date of dispensing.

Winter 2015

A physician seeking reimbursement for drugs dispensed by a physician will be required to include the original manufacturer’s national drug code (NDC) number, as assigned by the Food and Drug Administration, on bills and reports. A repackaged NDC number would be prohibited and would not be considered the original manufacturer’s NDC number. Additionally, under the bill no outpatient provider, other than a licensed pharmacy, will be permitted to seek reimbursement for drugs dispensed in excess of the following, commencing on the employee’s initial treatment following injury: •

For Schedule II drugs, one initial seven-day supply, and one additional 15-day supply if the employee needs a medical procedure, including surgery;

•

For Schedule III drugs which contain hydrocodone, one initial seven-day supply, and one additional 15-day supply if the employee needs a medical procedure, including surgery;

•

For all other prescription drugs, one initial 30-day supply.

A July 11, 2012 New York Times article asserts that these increased costs nationally amount to “hundreds of millions of dollars annually.” According to published reports, physician dispensing typically begins when drug distributing firms purchase large quantities of drugs (e.g. 1,000 to 10,000 tablets) and repackage the drugs into single prescription sizes (e.g. 14, 21, 28 tablets) appropriate for dispensing directly to patients. It is asserted that as part of the repackaging process, drugs are assigned a new national drug code (NDC) number and inherit a new average wholesale price (AWP), one that is typically far greater than the AWP established by the original manufacturer. Pennsylvania’s existing pharmacy fee schedule sets the maximum reimbursement rate at 110 percent of the AWP for workers’ compensation pharmaceuticals, but the claim is that the higher AWP of repackaged drugs allows physicians, middlemen, and drug distributing firms to earn millions of dollars in profits. Indeed, some dispensing firms advertise on their websites that physicians can earn hundreds of thousands of dollars in profits by dispensing drugs in their offices. The new law is intended to address that practice.

No outpatient provider, other than a licensed pharmacy, will be allowed to seek reimbursement for an over-the-counter drug. Proponents of the legislation asserted that there has been a rapid increase in physician dispensing of repackaged drugs in Pennsylvania, specifically within the workers’ compensation system. This practice is alleged to dramatically inflate costs borne by insurance companies, employers, and ultimately, by taxpayers.

Epinephrine Auto-injector (EpiPen) Bill Signed Into Law

The Pennsylvania Medical Society (PAMED) scored another end-of-session legislative victory this year as the state House and Senate approved a bill that will provide help for school children with severe allergies. Governor Corbett signed the measure into law on November 3, 2014. The bill was driven by the knowledge that in an anaphylactic emergency, prompt action is essential, and in theory the school nurse

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would be able to administer the auto-injector almost immediately. However, in practice, complicating factors may delay the quick administration of epinephrine to a child who is having an anaphylactic episode. The school nurse could be indisposed for any number of reasons, with catastrophic consequences. For that reason, in 2012 the PAMED House of Delegates endorsed legislation that would allow epinephrine auto-injectors to be stored in a secure location in a classroom, and to permit a school to designate one or more non-nurse staff members to receive training so they could administer the medication in an emergency. Working with Rep. Dick Stevenson (R-Mercer County) and Sen. Matt Smith (D-Allegheny County), PAMED steered the bill through the House and Senate without a single negative vote (a real rarity). The bill permits a public or private school to authorize a trained school employee to: 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

Legislative Updates 1. provide an epinephrine auto-injector that meets the prescription on file—for either the individual student or the school—to a student who is authorized to self-administer an epinephrine auto-injector; and 2. administer an epinephrine auto-injector that meets the prescription on file for the school to a student that the employee in good faith believes to be having an anaphylactic reaction.

Physicians and CRNPs will be able to prescribe epinephrine auto-injectors directly to the school for that purpose. Appropriately, the bill contains a number of safeguards to ensure patient safety: 1. A school that opts into the program may maintain a supply of epinephrine auto-injectors, but they must be kept in a safe, secure location.

4. When a student does not have an epinephrine auto-injector or a prescription for an epinephrine auto-injector on file, a trained school employee may utilize the school’s supply to respond to anaphylactic reaction under a standing protocol from a physician or CRNP. 5. In the event a student is believed to be having an anaphylactic reaction, the school nurse or an individual in the school who is responsible for the storage and use of epinephrine auto-injectors shall contact 911 as soon as possible.

Physicians who don’t see children in their practice still need to pay close attention to these changes, because they will now need to report suspected child abuse identified in certain circumstances outside their professional capacity. Additional changes include, but are not limited to: • The new definition of child abuse is more specific and has been expanded. • Physicians will no longer be able to fulfill their reporting obligation simply by making a report to their supervisor or other designated person in their workplace.

Parents who wish their child to be exempt from the provisions of the new law can • The penalties for failing to make a mandatory report are increased. simply sign a form and opt out. And school employees who administer an auto-injector pursuant to the law will have emergency • Physicians have new mandatory child abuse recognition and reporting response provider and bystander Good training requirements as a condition of Samaritan civil immunity. licensure.

2. A school that authorizes the provision of epinephrine auto-injectors shall designate one or more individuals at each school who will be responsible for the storage and use of the epinephrine auto-injectors.

The new law took effect on December 30, 2014, though the Department of Health has another 90 days after that to get the mandated training program up and running.

3. Individuals who are responsible for the storage and use of epinephrine auto-injectors must successfully complete a training program that will be developed and implemented by the Department of Health.

In the wake of the Sandusky child abuse situation at Penn State, significant changes have been made to Pennsylvania’s Child Protective Services Law, and many of the most important amendments have gone into effect on Dec. 31, 2014.

New Child Abuse Reporting Laws Go Into Effect

PAMED has developed a package of materials to help physicians understand and comply with the new requirements. The materials, which can be accessed on the PAMED website, include: • An overview of the physician reporting requirements • An explanation of the expanded definition of child abuse • Child abuse Frequently Asked Questions • Risk factors, signs, and symptoms of child abuse • An archived Dec. 4, 2014 webinar to help physicians understand the changes to the law

As mandated reporters, Pennsylvania physicians have always taken their responsibility to protect our children seriously. These materials will help them do so while remaining compliant with the significant changes to state law.

LANCASTER

PHYSICIAN

Helping your patients with a wide range of vascular procedures. Board-certified surgeon Matthew Bacharach, M.D., specializes in vein and artery procedures and vascular surgery for stroke prevention. He is backed by all the resources of Lancaster Regional Medical Center, Heart of Lancaster Regional Medical Center and The Wound Healing Center of Lancaster. Call 717- 735-7422 today to make a referral or visit GeneralAndVascularSurgeryOfLancaster.com for more info.

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12/16/14 12:36 PM

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

Restaurant Review

My wife ordered the Spinach, Beet, and Goat Cheese Salad, while I couldn’t resist my favorite appetizer on the menu, the famous Pickle Fries. For our entrees, we chose the Pumpkin Ravioli, and the delicious “Julie’s Meatloaf.” The huge portion of meatloaf was complemented with a side none other than baked mac-and-cheese.

FENZ

restaurant & latenight

DAVID SIMONS, D.O. Pain Specialists of Lancaster

lthough this was not my first time dining at FENZ, I have always enjoyed my experience there and wanted to give the restaurant the recognition it deserves in my first official restaurant review.

It was a Monday night around 8 p.m. as my wife and I were on our way out the door. We were uncertain as to whether or not FENZ was open on Mondays, but we called and were pleasantly surprised when a friendly voice answered and told us to “come on over.” Upon arriving, we were greeted by the always friendly and professional FENZ owner, Bob Fenninger. As you enter the restaurant on the bottom level, there is a small bar and cozy dining area. We, however, were led upstairs, where there is a larger bar and more seating. The upstairs also has patio seating with great views of the Lancaster Barnstormers stadium and fireworks in the summer. The restaurant was busy with a mixed crowd, including mostly young professionals.

FENZ is the perfect place for a relaxed and friendly experience, which is what my wife and I were looking for this night. We enjoyed a drink at the bar before being seated. The bartender made her a lemon-drop martini, with a sugar rim, just the way she likes it. After enjoying a drink at the bar, we were seated at our table. Our table was positioned at the top of the stairs, but it was still very comfortable. In the middle of the table, there was a beautiful flower arrangement, which was a perfect touch. Under the soft lighting and with music set to a perfect volume, we were able to thoroughly enjoy our evening. Our waiter was very knowledgeable about the menu and wine list, which made choosing our appetizers and entrees very easy. The entrees ranged from Pumpkin Ravioli to Fried Chicken to Scallop Risotto, so there is a dish that suits every palette. The appetizers range from $9-13, and the entrees $17-30. For the quality and deliciousness of the food, the prices are very reasonable.

LANCASTER

PHYSICIAN

As we finished our meal, we were feeling full, but knew we couldn’t resist the dessert menu. The menu features a wide variety for everyone, including Chocolate Peanut Butter Double Delight, Seasonal Cobbler, and Key Lime “Three-way” cake. We chose the Chocolate Mousse and the Carmen & David’s Bing Cherry Ice Cream, which was the perfect end to our amazing meal. Our entire experience at FENZ was phenomenal from start to finish, and it is the reason why I keep returning to this restaurant. If I hadn’t known better, I would have thought someone called ahead and informed the restaurant that “restaurant reviewers” were on their way. Just imagine what the experience would have been like if they knew they were being “reviewed”!

FENZ Restaurant & Latenight 398 Harrisburg Avenue, Ste. 100 Lancaster PA 17603 717.735.6999 www.fenzrestaurant.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

RGAL Recognized for Patient Safety and Quality of Care

Welcome…New Members October

November

Kristine Dziurzynski, MD Lancaster NueroScience & Spine Associates

Derick S. Brubaker, MD Southeast Lancaster Health Services

Cynthia F. Gessler, DO Ephrata Community Hospital Emergency

Jennifer Erin Brubaker, MD Southeast Lancaster Health Services

Evan Llewellyn Guthrie, MD Leacock Family Practice

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

Michelle Fegley, MD OBGYN of Lancaster

Mona M. Jhaveri, MD LGHP – Susquehanna Family Medicine

Jovanni Renee Neblett-Blackmon, MD OBGYN of Lancaster

Joanna Rodriguez, MD Lancaster Cancer Center

Shawn Erick Taylor Mastropietro & Associates Family Medicine

Wen Y. Wu Chen, MD Neurology & Stroke Associates

Adam Ryan Thode, MD Resident

• National Quality and Safety Recognition from the American Society of Gastrointestinal Endoscopy (ASGE) for commitment to quality and safety of the RGAL endoscopy centers. • Pennsylvania Patient Safety Authority Recognition as a leader in quality initiatives focused on patient safety.

Congratulations...Reinstated Members October Richard L. Grunden, MD LGHP – Susquehanna Family Medicine Sara Jane Helig, MD Dermatology Associates of Lancaster Eric F. Hussar, MD LGHP – Susquehanna Family Medicine Nelson R. Lehman, MD LGHP – Susquehanna Family Medicine Dale R. Lent, DO Dale R. Lent DO & Associates Gerald E. Miller, MD LGHP – Susquehanna Family Medicine Robert E. Roberts III, MD Lancaster NeuroScience & Spine Associates Kartik J. Shah, MD Lancaster Regional Imaging Associates PC

Shweta Soni, MD LGHP – New Holland Family Medicine Jennifer L. Zatorski, MD Lancaster General Hospital Graduate Medical Education November Brian T. Brislin, MD Brain Orthopedic Spine Specialists Jason A. Comeau, MD Surgical Specialists of Lancaster Austin Lewis Good Student David W. Jackson, MD Chris P. Lupold, MD LGHP – Strasburg Family Medicine

Four Convenient Locations

Poonguzhali Pichaimuthu, MD Internal Medicine Specialists of Lancaster County

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

In Remembrance…DECEASED Members Arthur B. Byler, MD

www.RGAL.com • 717.544.3400

Dr. Arthur Byron Byler, 90, of Willow Street, formerly of Downingtown, passed away on March 25, 2014. Born on Nov. 30, 1923 in West Liberty, Ohio, he was the son of the late Oliver Raymond Byler and Rose Arminda Stoltzfus Byler. He was married to Edria Elaine Antes Byler for 36 years. Arthur, or “Art” as he was known, was a 1955 graduate of Hahnemann Medical University (Drexel University). Art was a family practice physician of medicine for 42 years in Downingtown and was affiliated with Chester County Hospital.

LANCASTER

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

PHYSICIAN

Winter 2015

News & Announcements

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

Brain Orthopedic Spine Specialists

Cardiac Consultants PC

LGHP – Susquehanna Family Medicine Neurology & Stroke Associates PC

Lancaster Cancer Center Ltd

Community Anesthesia Associates

OBGYN of Lancaster

Lancaster NeuroScience & Spine Associates

Community Services Group Dermatology Associates of Lancaster Ltd

Otolaryngology Physicians of Lancaster Rothsville Family Practice

Lancaster Physicians For Women

Eye Associates of Lancaster Ltd

Southeast Lancaster Health Services Inc

Lancaster Radiology Associates Ltd

Family Eye Group

LGHP – Lincoln Family Medicine

Hypertension and Kidney Specialists

LGHP – Manheim Family Medicine

Internal Medicine Specialists of Lancaster County

Leasing

Keyser & O’Connor Surgical Associates Ltd

Southeast Lancaster Health Services – Arch St Surgical Specialists of Lancaster

LGHP – New Holland Family Medicine

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For more information contact:

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Donna Deerin Ward (717) 569-9373 x 915

LANCASTER

YORK OFFICE

1200 Greensprings Dr. York, PA 17402

www.LMS-PMA.com

PHYSICIAN

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

News & Announcements

LANCASTER GENERAL HEALTH & UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM

Explore A Consolidated Relationship

ancaster General Health and the University of Pennsylvania Health System are pursuing a consolidated relationship to improve access to cost-effective, high-quality care, and to strengthen their complementary teaching and clinical research missions.

services at LG Health,” Beeman said. “We will continue to explore further integration in specialties such as oncology, trauma, cardiovascular care, genetics, neurosciences and other areas, including Graduate Medical Education.”

Leadership for both organizations signed a Memorandum of Understanding to explore ways to integrate beyond their Strategic Alliance announced previously in February.

No timeline or strict deadline exists to complete the explorative work. One of the top academic medical centers in the nation, UPHS is world-renowned for its clinical and research excellence; LG Health is nationally ranked for its clinical quality.

Thomas E. Beeman, President & Chief Executive Officer of Lancaster General Health, noted that since the results of that alliance are positive, both sides are aggressively pursuing a broader relationship between two of the Top 5 systems in Pennsylvania, as ranked by U.S. News & World Report.

“Our organizations are among the financially strongest and clinically advanced systems in Pennsylvania,” said Ralph W. Muller, Chief Executive Officer of UPHS. He added that UPHS and LG Health will strengthen its already-successful collaborative efforts, while building new ones in the clinical, teaching and research space.

“The advancements built during nearly 30 years with the Penn Cancer Network laid the foundation for us to strengthen other

Muller noted that UPHS provides access to advanced, highly specialized medicine, such as genomics, organ transplantation, advanced clinical trials and proton therapy. This level of care could complement LG Health’s extensive primary-care network, supporting a Population Health model that provides a full spectrum of services to improve health outcomes and the overall patient experience. The healthcare industry is undergoing unprecedented transformation, where health systems are pursuing new strategic alliances, acquisitions and mergers, driven in part by healthcare reform, Beeman noted. He said that LG Health’s decision—influenced by its Strategic Plan—follows significant evaluation of potential partners and relationship models.

LANCASTER

PHYSICIAN

Winter 2015

News & Announcements

Lancaster Physician Sworn in as 165th President of the Pennsylvania Medical Society

aren A. Rizzo, MD, FACS, an otolaryngologist/ENT from Lancaster, was sworn in as the 165th president of the Pennsylvania Medical Society (PAMED) on October 18 during the organization’s annual statewide meeting held in Hershey, Pa.

Swearing Dr. Rizzo into office was John J. Pagan, MD, chairman of PAMED’s Board of Trustees and a general surgeon in Bucks County. More than 400 guests and dignitaries attended the ceremony including Pennsylvania’s Physician General Carrie DeLone, MD and medical leadership from the Wisconsin, Delaware, and Ohio state medical societies. In addition, representatives from the American Medical Association, Pennsylvania Bar Association, and Pennsylvania Dental Association attended the event. A 29-year member of PAMED, she served on its board of trustees from 2003 to 2011 as a surgical specialty trustee. She was vice chair of the board from 2009 to 2011. Currently, Dr. Rizzo is a member of PAMED’s Political Advocacy Council, Task Force on State of Medicine, and Task Force to Improve Governance Processes and Structures. She also has aided several other councils in the past and served as the chair of the Specialty Leadership Cabinet from 2009 to 2011.

LANCASTER

Since becoming a physician, Dr. Rizzo has been active in several medical organizations and has made humanitarian trips to Vietnam, South Africa, and Egypt. In addition to being a member of PAMED, she holds memberships in the American Medical Association and was president of Lancaster City & County Medical Society from 2008 to 2010. She was also president of the state chapter of the American Academy of Otolaryngology/Head & Neck Surgery from 2001 to 2003, and a member of the Keystone Chapter of the American College of Surgeons. Currently, she is on the Board of Governors for the American Academy of Otolaryngology/Head and Neck Surgery. Outside of organized medicine, Dr. Rizzo is an active alumna of Villanova University. She was inducted into the Philadelphia Big Five and Villanova University Basketball Hall of Fame. Dr. Rizzo is a graduate of the Temple University School of Medicine, and currently practices medicine at Lancaster Ear, Nose, and Throat. In addition, she is a magna cum laude graduate of Villanova University. She and husband Jay, a general dentist, reside in Lancaster. They have two daughters, Nicole and Marci.

PHYSICIAN

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

LMS Foundation Updates

Lancaster Medical Society Foundation Awards Scholarships to Three County Residents

he Lancaster Medical Society Foundation, a foundation of the Lancaster City & County Medical Society, is pleased to announce the recipients of the 2014 Foundation scholarships. These students have outstanding academic and leadership credentials, and they have been involved in both research and clinical experiences.

Many Thanks to the 2014 Scholarship Champions

Platinum $2,000 or more Lancaster General Health* Lancaster General Hospital Medical Staff Heart of Lancaster Regional Hospital Medical Staff

Caitlyn R. Moss

Katelyn Rittenhouse

Elizabeth Thayer

WellSpan Ephrata Community Hospital Medical Staff

Caitlyn was raised in Gap, graduated from Washington College, and is now a second-year student at Penn State College of Medicine in Hershey. She plans to practice as a pediatrician in an underserved, rural area, teaching children and their families about healthy habits that will benefit them for the rest of their lives.

Katelyn grew up in East Earl and is in her first year at the University of North Carolina School of Medicine. After graduating from Eastern University, she worked in clinical research at Lancaster General Hospital for 18 months. She plans to return to Lancaster to practice after completing her medical training.

Elizabeth, who grew up in Lancaster, is a first-year student at Penn State College of Medicine in Hershey. After graduating from Wellesley College, she worked as a research assistant examining the pathobiology of vascular inflammation at Brigham and Women’s Hospital in Boston. She has a deep appreciation for the study needed to develop effective means to improve human health and looks forward to being involved in patient care.

Lancaster Regional Medical Center Medical Staff

Lancaster Medical Society Foundation scholarships are given to residents of Lancaster County who are attending allopathic or osteopathic medical schools. Applicants must demonstrate academic achievement, exhibit good character and motivation, and show financial need. The Scholarship Foundation is generously supported by the Lancaster County medical community, individual medical society members, and local businesses.

LANCASTER

PHYSICIAN

Silver $1,000 – $1,499 Brain Orthopedic Spine Specialists Neurology & Stroke Associates Orthopedic Associates of Lancaster

Bronze $500 – $999 Regional Gastroenterology Associates of Lancaster Susquehanna Bank

* $10,000 Donor

Cancer care as personalized as it is advanced. For more than 24 years, Robert Conter, M.D., and his staff have helped doctors care for and treat patients in all stages of cancer. He provides general and specialized cancer surgical services, including procedures for gallbladder disease, hernia repair, Mediport placement, pancreatic cancer and more. Call 717-735-9187 today to make a referral or visit BestSurgicalOptions.com for more info.

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12/16/14 1:51 PM

It’s your brain that hears. Not your ears.

Hearing loss is associated with 5 times increased risk of dementia* When the sound signals from your ears are compromised, your brain has to work even harder to fill in the gaps. This extra effort can take its toll. In fact, studies have shown that, over time, hearing loss can lead to isolation and depression. That’s why it makes sense to take care of your patients’ hearing health the same way you care about the rest of their health: There’s a lot more riding on it than just their hearing. Hearing Care is Health Care.

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

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