Lancaster Physician Winter 2022 by Hoffmann Publishing Group

Winter 2022

What's Ahead for Health Care in 2022? PERSPECTIVES FROM LOCAL HEALTH CARE PROFESSIONALS

plus Cervical Cancer: HPV Vaccination and Screenings Are Vital for Saving Women’s Lives Jessica Krebs, MD, Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

COVID, BIAS, AND WOMEN IN MEDICINE REBEKAH APPLE, MA, DHSC

Coming spring 2022:

Lancaster Pediatric Center

Penn State Health Children’s Lancaster Pediatric Center

Pediatric services and specialties:

will offer Lancaster County residents convenient and

Adolescent medicine Allergy/immunology Behavioral health Cardiology Dermatology Endocrinology Gastroenterology Imaging Infectious disease Laboratory services Nephrology Neurosurgery

comprehensive pediatric care in an environment completely designed for children, teens and their families. Refer your patients from Lancaster County and the surrounding area to our new center for expert pediatric specialty care. Penn State Health Children’s Lancaster Pediatric Center 1430 Harrisburg Pike Lancaster, PA 17601

Ophthalmology Optometry Orthopedics Otolaryngology Primary care Psychiatry Pulmonology Rheumatology Surgery Urology Walk-in appointments

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contents 2021/2022 BOARD OF DIRECTORS OFFICERS Laura H. Fisher, MD President

Lancaster Family Allergy

Stacey Denlinger, DO

WINTER 2022

COVER STORY

What's Ahead for Health Care in 2022? p. 24

President Elect

UPMC Highlands Family Practice & UPMC Wound Healing Center

Sarah Eiser, MD Vice President Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

Stephen T. Olin, MD Treasurer

Penn Medicine Lancaster General Health Walter L. Aument Family Health Center

Robin M. Hicks Secretary

UPMC Supportive Care & Palliative Medicine

Robert K. Aichele Jr., DO Immediate Past President

Penn State Medical Group - South Lancaster

DIRECTORS Marco A. Cunicelli, DO | Resident

Best Practices 6 Penn Medicine Lancaster is Combatting Food Insecurity in Lancaster County 8 Penn State Health Expands Access to Pediatric Specialty Care with New Lancaster Pediatric Center

10 WellSpan Teams Reflect on the Pandemic 12 HR Management: How the Pandemic Has Shaped My Perspective on Practice Management

Lena Dumasia, MD David J. Gasperack, DO Lauren M. Hammell, DO | Resident James M. Kelly, MD Karen A. Rizzo, MD, FACS Christopher R. Scheid, DO Susanne Scott, MD, MPH Danielle Rubinstein, DO | Resident

EDITORS Dawn Mentzer

In Every Issue 5 President’s Message

24 Perspectives

14 Healthy Communities

28 Legislative Updates

18 Patient Advocacy

32 Foundation Updates

23 Passion Outside of Practice

35 News & Announcements

Beth E. Gerber Lancaster City & County Medical Society Robert K. Aichele Jr., DO Immediate Past President

Penn State Medical Group - South Lancaster

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

Content Submission The Lancaster Physician magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Lancaster City & County Medical Society. For more information or submission suggestions, please email bgerber@lancastermedicalsociety.org.

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA HoffmannPublishing.com 610.685.0914 SEE PAST ISSUES AT LP.HoffmannPublishing.com FOR ADVERTISING INFO CONTACT: Sherry Bolinger, Sherry@hoffpubs.com, 717.979.2858

RECEIVE THE LATEST UPDATES BY FOLLOWING US ON SOCIAL MEDIA

WINTER 2022

President’s Message

s we welcome 2022, I would like to thank all of you for your continued service in your practice of medicine in Lancaster County this past year. Everyone is working harder, adapting, and continuing to make Lancaster an example for other counties in Pennsylvania.

Lancaster City & County Medical Society will continue to be involved in county-wide initiatives for public health. We also would like to support our members and continue our commitment to fighting physician burn out. As we progress through the next year, look for some small group engagement of NON-MEDICAL topics, hosted by physicians in our area. In late spring, we hope to finally bring everyone together for an outdoor social in place of our indoor annual holiday event.

Laura H. Fisher, MD Lancaster Family Allergy Visit lancastermedicalsociety.org

We are appreciative of everyone who contributed to the scholarship fund. We had outstanding winners this past year and look forward to having them as future colleagues. As the pandemic changes, we would like to engage our members and support you. Please reach out to us with ideas or areas of need. At this time, I would like to thank Beth Gerber, who has worked tirelessly through the pandemic. She has gone the extra mile delivering PPE to independent practices in need, organizing physicians with Lancaster’s other health organizations, coordinating with PAMED, and keeping things running smoothly in general. Finally, I encourage everyone as the year goes forward to make your voices heard. While we are all short on extra time, it’s more important than ever for us to be advocates for our patients and our profession. I encourage everyone to reach out to their representatives locally and at the state level especially. Introduce yourselves, offer yourselves as a resource, and foster relationships that will keep Lancaster physicians and their patients at the forefront as a healthy community.

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

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best

pr ctices ALSO IN THIS SECTION

• Penn State Health Expands Access to Pediatric Specialty Care with New Lancaster Pediatric Center • WellSpan Teams Reflect on the Pandemic...Memorial program enables healthcare workers to process complex feelings and experiences • HR Management: In My Eyes…How the Pandemic Has Shaped My Perspective on Practice Management

COMBATTING FOOD INSECURITY IN LANCASTER COUNTY Penn Medicine Lancaster General Health’s Food Farmacy Program Educates, Provides Access to Nutritious Foods, and Empowers Patients to Improve Health LANCASTER

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ood and nutrition play an important role in sustaining health, preventing disease, and as a therapy for people with conditions or in situations that respond to dietary changes. Penn Medicine Lancaster General Health’s Food Farmacy program aims to decrease food insecurity — or the lack of access to enough food to live an active and healthy life — and improve nutrition knowledge and dietary habits in Lancaster County patients. The program works closely with local food pantries as well as patients’ health-care providers. The Food Farmacy integrates access to healthy food and nutrition education into the overall care plan for patients with metabolic syndrome, prediabetes, diabetes, or other nutrition-related conditions. Patients meet regularly with an LG Health registered dietitian at a local food pantry, where they receive nutrition counseling and “shop” for healthy food for themselves and their families. “Our goal is to help patients implement healthy diet and lifestyle changes to improve their overall health and prevent chronic disease, such as heart disease, diabetes and cancer,” said program manager Laura Rodgers, MS, RD, LDN. “Many of our patients have seen very promising results, including weight loss and reductions in body mass index and blood pressure.” Elizabeth Doherty, MD, Penn Medicine Lancaster General Health Physicians Family Medicine Buck, often talks with her patients about changes they can make to their diet or habits to help improve their health. Even so, she said, many patients don’t know exactly where to start, and some are unable to access or afford healthy food, such as fresh fruits and vegetables, or foods that are low in sodium.

The Food Farmacy integrates access to healthy food and nutrition education into the overall care plan for patients with metabolic syndrome, prediabetes, diabetes, or other nutrition-related conditions. “Most changes like this require more follow-up and discussion than we can usually provide to our patients in a routine office visit,” she said. “Being able to work one-on-one with someone who can spend time with them, and have that linked to providing healthy food, is really powerful.” The number of Americans experiencing food insecurity was declining for over a decade before the COVID-19 pandemic. However, that number is now rising and projected to reach 10.2 percent this year, according to Feeding America. While there are many food assistance organizations in Lancaster County, food security is about more than just having enough food, Rodgers said. People also need access to healthy foods that support their individual dietary needs. The Food Farmacy is one component of LG Health’s larger Food is Medicine community benefit initiative, which aims to address barriers to healthy eating in

Lancaster County, particularly for low-income, food-insecure individuals and families. In 2019, LG Health launched a two-year pilot of the Food Farmacy in collaboration with three existing food pantries in Lancaster City, Paradise, and Quarryville. The Food Farmacy proved to be a success during the pilot period, with overwhelmingly positive responses from patients, medical providers, and food pantry partners, Rodgers said. Locations are now planned for Columbia, Elizabethtown, and Lebanon, along with the hiring of additional registered dietitians. Patients meet with their registered dietitian regularly, at no cost to the patient. Promising results from the pilot included weight loss and a lower body mass index in 88 percent of patients and a lower waist circumference in 94 percent of patients. In addition, 69 percent of patients improved their blood pressure, and 75 percent improved their HDL cholesterol. In post-program surveys, a large majority of patients reported their intentions to eat a healthier diet, as well as increased nutrition knowledge and confidence in the kitchen. Rodgers has witnessed both large and small successes in her patients. One woman lost 35 pounds and 8.5 inches off her waist. Another began encouraging her granddaughter to eat healthy snacks, such as rice cakes with peanut butter, and go on walks with her. Doherty said the greatest benefit she has seen in her patients who have utilized the Food Farmacy is a newfound sense of empowerment over their own health. “Working with the Food Farmacy seems to leave them with knowledge about what choices they can make to help improve their health and access to resources that make those choices possible,” she said.

TO LEARN MORE ABOUT THE FOOD IS MEDICINE INITIATIVE AND THE FOOD FARMACY PROGRAM, PLEASE CALL 717-544-3531. LANCASTER

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Best Practices

P E N N S TAT E H E A LT H

Expands Access to Pediatric Specialty Care with New Lancaster Pediatric Center

hen it opens in spring 2022, Penn State Health Children’s Lancaster Pediatric Center will significantly expand access to a full spectrum of medical and surgical consultative care for children from infancy through age 18. It will be the single largest pediatric outpatient practice center in the county, offering the most advanced care in nearly every pediatric specialty and subspecialty.

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“For families who live in Lancaster County, this new pediatric center means easier access and less travel time when kids need care," said Penn State Health CEO Steve Massini. “Whether a child needs a routine wellness appointment, to see a specialist or to undergo an X-ray or bloodwork, everything is conveniently located here.” The physicians practicing at Lancaster Pediatric Center will be board-eligible or board-certified by the American Board of Pediatrics and nationally recognized with advanced subspecialty training in pediatric medicine. Each will be supported by Penn State Health Children’s Hospital, the region’s only inpatient acute care pediatric facility, located just 30 minutes away in Hershey. Lancaster County patients with complex care needs — such as surgery — can access the advanced care available at the Children’s Hospital. U.S. News & World Report has ranked Penn State Health Children’s Hospital as one of the nation’s best in multiple specialties. “We understand that travelling to Hershey for appointments may be challenging for parents and caregivers due to their work schedules,” said Dr. Peter Dillon, Penn State Health executive vice president and chief medical officer. “It’s also challenging for community physicians and pediatricians whose patients need a referral for a higher level of care and want to receive that care closer to home. Families in Lancaster County will now have easier access when their children need expert care from Penn State Health.”

The Penn State Health Children’s Lancaster Pediatric Center will open in spring 2022 on the site of the former Toys “R” Us store at Harrisburg Pike and Route 30 in Manheim Township.

Located on the site of the former Toys “R” Us store at the intersection of Harrisburg Pike and Route 30 in Manheim Township, the 47,000-square-foot Lancaster Pediatric Center will feature 48 exam, consultation, and procedure rooms designed specifically for children, teens, and their families. The 20 specialties and subspecialties offered at the new outpatient facility will include pediatric cardiology, dermatology, neurology, ophthalmology, otolaryngology, rheumatology, behavioral health, and more. Families will have access to consultative and follow-up services with pediatric surgical specialists in surgery, urology, neurosurgery, and orthopedics. In addition to pediatric specialties, the outpatient center will provide imaging and laboratory services and will accommodate walk-in primary care appointments.

LANCASTER

While the new outpatient center will significantly expand local access to its expert pediatric care, Penn State Health has been providing primary and specialized care to children throughout Lancaster County for decades. Its robust network of Penn State Health primary and specialty care providers includes Penn State Health Lime Spring Outpatient Center, which opened in East Hempfield Township in 2019, and Penn State Health Medical Group practices in Lititz, Columbia and other Lancaster County locations. Following Lancaster Pediatric Center’s opening this spring, Penn State Health will open its fifth hospital, the new Penn State Health Lancaster Medical Center, in the fall. Located at 2160 State Road in East Hempfield Township, the 341,000-square-foot hospital will feature all private inpatient beds, an emergency department, various specialty inpatient services, an imaging lab, complete medical and surgical capabilities and an attached medical office building for outpatient services. “Our goal is to build a health care network where the majority of people who live in Lancaster County are within 10 minutes of our primary care providers, 20 minutes of our specialists and 30 minutes of one of our hospitals,” Dillon said.

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Best Practices

WellSpan Ephrata Community Hospital Chaplain Jacki Roderick (right, standing) pauses with intensive care unit staff as they reflect on their feelings about the pandemic.

WELLSPAN TEAMS REFLECT ON THE PANDEMIC

Memorial program enables healthcare workers to process complex feelings and experiences

small group of nurses and other team members gather in the intensive care unit at WellSpan Ephrata Community Hospital as monitors beep and ventilators whoosh in the glass-walled rooms of patients, most who have COVID-19.

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WellSpan chaplain Jacki Roderick asks each of the team members to take a smooth rock from a glass jar. Then the chaplain urges the group of caregivers to take a moment and recall all their feelings from the pandemic — exhaustion, sadness, anger, grief — and direct those feelings into the rock. It is quiet for a moment. Then one nurse murmurs, “I’m gonna need a bigger rock.” Everyone exhales and laughs. Then they all surrender their rocks, and hopefully some of their burdens, placing them into the jar. “The rocks are memories of all you have overcome, all you have conquered,” Roderick says, as the group stands in a tight circle, clasping hands and reflecting on a period that has included loss and grief but also healing and compassion. “Feel the strength from each other. Know that you are blessed and loved.” Chaplains across the WellSpan system are holding or planning similar ceremonies to allow staff to acknowledge, process and release their feelings from the pandemic and any other challenges in the past year. Chaplains are visiting nursing units and gathering with team members in other areas to do a variety of rituals. At WellSpan Chambersburg and Waynesboro hospitals, Kibreab Gudeta, director of pastoral services, is asking staff to write on a piece of water-dissolvable paper whatever they are carrying in their hearts — the death of a patient, an unshakeable pain, a shattered hope or dream — urging them to relinquish it to the piece of paper and then put the paper in a bowl of water. “As the paper fades away,” Gudeta tells staff, “let it go.” At WellSpan Good Samaritan Hospital, team members have written the initials of patients or loved ones on rocks to remember them. Nurses in one unit wrote the initials of a beloved team member who died from COVID-19; others wrote the names of family members or loved ones. Chaplain David Madara read the names or initials on each rock and placed them in a glass jar, pausing to allow people to share their stories. Then he urged team members to look at each other and acknowledge their team. “This usually resulted in giggles and shared gratitude with teammates,” he said. “We gave thanks together for making it through this far.”

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WellSpan team members wrote the initials of those they wanted to memorialize during ceremonies that allowed them to pause and reflect on the pandemic.

WellSpan York Hospital plans to provide each nursing unit a moment to reflect, remember, and rejoice — reflect on their resilience, remember their patients who died, and rejoice for the patients who recovered and could leave the hospital, said Elizabeth McCormick, manager of spiritual care and education. The hope, she said, is that this “symbolizes the hope and compassion that continue to inspire and invigorate the care that staff members offer to each other.” At the WellSpan Ephrata Community Hospital ICU service, nursing assistant Alyssa Wehr recalled a COVID-19 patient she helped to care for in Ephrata who was later transferred to WellSpan York Hospital. The last time she saw him, he was taking his first steps after months of being in the hospital. Seeing him “made me feel hopeful and happy that he had reached the end of this long recovery,” she said, writing his initials on a rock and placing it in a jar. Others will not be as fortunate. After the service, Laura DeHaven, a nurse in the Ephrata ICU, looked around at the COVID-19 patients who still fill the unit, noting some likely would not survive. “This has been a rough year here,” she said quietly. “It was good to decompress today.” Her colleague Allison Sigman, ICU clinical coordinator, said, “It’s helpful to have a time to pause and reflect and get together. Everyone needs this.”

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Best Practices

Practice Management Insights

ADDRESSING THE ISSUES, CHALLENGES, AND OPPORTUNITIES THAT IMPACT TODAY’S MEDICAL PRACTICES

IN MY EYES…

How the Pandemic Has Shaped My Perspective on Practice Management

DEBRA OHREL

Practice Manager, Penn Medicine Lancaster General Health Physicians Diabetes & Endocrinology

This article is about my experience as the practice manager of a busy endocrine office through the pandemic and the emotions that came with it. I have been in health care for over 23 years, working as a practice manager for 13 of those years. I thought I had seen and done it all until the pandemic. Some of what I experienced I hope never to have to go through again. However, what I have gained from the experience has helped me grow and look outside my box. During this unsettling time, I had a moment, as I am sure many managers have had, where I thought, “I can’t do this anymore. I do not have anything more to give. How do I lead our team through this? Am I the right person to lead us through our NEW normal?”

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Those negative thoughts swirled in my head every day. I felt like I was in a fog, and I could not see through it. It was starting to show in my expressions, in my walk and how I was interacting with my peers. I had always had a funny story to tell on Zoom calls with my fellow specialty managers, but I no longer had anything funny to share. I was tired, frustrated, discouraged, and disappointed in myself that I could not figure out how to fix what the COVID fallout was doing to my team. How do I convey to them how much they are appreciated? How do I acknowledge that they are the best and that we cannot do this without them? How do I make sure they are aware everything they do for our patients matters, and if we don’t get all the work done at the end of the day that is ok? How do I support them knowing they are tired of being short staffed, overworked, or defeated by angry patients who are forced to wear masks? How do I let them know we understand that you can only do the best you can in the moment, and that is all we are going to ask from them?

• “What made you want to come to work today?”

Patients don’t always realize our employees’ home lives have been turned upside down – just like everyone else’s –and they still show up every day to do the work with a smile and a caring heart.

Speaking with each of them gave us the strength to start rebuilding in the New Year. We cannot rebuild our office space to be bigger, but we have the power to rebuild our workflows, our schedules, and our mindsets to become stronger and more resilient.

Still, I had to stop the blame game; patients do not want to hear “due to COVID, we cannot do X, Y, or Z.” I had to stop blaming COVID for trying to tear my team apart. I had to acknowledge employees will leave, patients will be unhappy at times, and work will not get done in our “normal” time frame. COVID is real, and we need to accept what comes with it and rise above the storm. I realized we needed to REBUILD. The only way we are going to get through this is to accept the fact that the “new normal” can be a good thing. It is an OFI, an “opportunity for improvement.” COVID is my big OFI for 2022. I took it as an opportunity to meet with the clinical staff and asked the front office supervisor to meet with the front office staff to ask them:

• “What gives you the most personal satisfaction in your role?” • “Is there anything new you would like to try in the office? A new skill, more education, etc.? • “What do you think is working well, and what do you feel does not work well for the team?” • “ Would you like to be involved in a cohort to look at processes one by one and break them down and revamp them to help ease the burden of workload?” • “If I could do one thing (within reason) to make your life less complicated, what would you want?” • “If you were thinking about leaving in the last six months, what would convince you to stay?”

We began by defining areas of opportunity that will reduce workload. We identified tasks that were redundant and that created unnecessary work. We empowered our team to help solve the problems they faced. We created employee schedules that work with their children’s school/daycare schedules, whether four ten-hour days or reduction in hours to give them time for work-life balance. We identified people within the team that could work remotely if their child was quarantined or if the school closed for a snow day. We are planning to create some part time positions to provide flexibility on busier days. That will allow us to cover staff when they need time off to recharge themselves or take care of family without feeling they are leaving their coworkers stranded.

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After meeting with the team and deciding for the New Year, I have been able to let go of the negativity that was weighing on me. I realized I am not alone, and I do not have to fix everything myself. I just need to be present, listen, encourage and lead; together we will make it better. Our team has amazing ideas that I never thought of. And I’ve seen that staff members are more willing to do things differently when they know their coworkers have created the changes. I have an open door policy for our team members. They can come to me with whatever is on their mind – personal or professional. I have learned through this pandemic experience that we all need a minute in our day to vent, cry, laugh, share a picture of our family members (with or without fur), or perhaps take a moment to walk away. Working in health care is not only about productivity and numbers. It is about human kindness, something that many people have put aside due to their own personal issues. My key takeaway from this pandemic is that our staff is not expecting me to fix their problems. They need me to listen and truly hear what they are saying (and most importantly, what they are not saying). I have learned they already have the answers, but I never gave them the opportunity to shine outside of their everyday tasks and show us what they can bring to the table. Letting them tell me what they need to succeed and how other managers and I can help them become their best selves are the most meaningful things I could have done for them, myself, and the office. I wish all my fellow practice managers the best in the New Year. You are amazing. And we will get through this. Always remember, there is an OFI out there for you.

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Healthy Communities

Cer vical Cancer HPV Vaccination and Screenings Are Vital for Saving Women’s Lives

JESSICA KREBS, MD

Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

lobally, cervical cancer is one of the most common cancers among women. It ranks fourth among cancers in females. Worldwide, over 300,000 women die from the disease each year. Evidence linking the human papilloma virus (HPV), an extremely common virus transmitted through sexual contact, to cervical carcinoma is extensive. Virtually all cases of cervical cancer are attributed to HPV. Although most of the infections with HPV resolve spontaneously and cause no symptoms, persistent infection can lead to cervical cancer in women. It is the prolonged exposure to high-risk HPV that increases a woman’s risk of cervical dysplasia and cervical cancer. There are over 100 HPV types, but only 40 types are specific for the anogenital epithelium. Fifteen HPV oncogenic types are known to cause cervical cancer. Persistent infection with HPV types 16 or 18 accounts for 70 percent of cancers, HPV type 31, 33, 45,52 and 58 account for 19 percent. Over 50 percent of new HPV infections are cleared in six to 18 months, and 80 to 90 percent will have resolved within two to five years. Transient infections are particularly common in young patients.

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Persistent infection, which occurs in 10-20 percent of women infected with oncogenic HPV subtypes, is a key factor in development of high-grade cervical lesions and cervical cancer. Effective primary (HPV vaccination) and secondary prevention approaches (screening for and treating precancerous lesions) will prevent most cervical cancer cases. HPV Vaccine There is evidence that supports a declining prevalence of the incidence of HPV infection as well as HPV-related disease following the introduction of HPV vaccination. The vaccine is cost effective and successful in preventing initial HPV infection and therefore subsequent HPV associated disease. Three different vaccines, which vary in the number of HPV types they contain and target, have been clinically developed, although not all are available: • Human papillomavirus quadrivalent vaccine (Gardasil) targets HPV types 6, 11, 16, and 18. • Human papillomavirus 9-valent vaccine (Gardasil 9) targets the same HPV types as the quadrivalent vaccine (6, 11, 16, and 18) as well as types 31, 33, 45, 52, and 58. • Human papillomavirus bivalent vaccine (Cervarix) targets HPV types 16 and 18. In the United States, only the 9-valent vaccine is available which provides protection against 90 percent of HPV-associated cancers and diseases including cervical dysplasia, vulvar dysplasia, and genital warts In the United States, uptake of HPV vaccination has been suboptimal. In 2015, based on results of a national survey among adolescents, the estimated vaccine coverage among females and males aged 13 to 17 was 63 and 50 percent for at least one dose and only 42 and 28 percent for at least three doses.

Lack of opportunity does not appear to be a major reason for low vaccine coverage. Of the unvaccinated females in the survey described above, 84 percent had at least one medical visit at which they were given a different vaccine but not the HPV vaccine. Surveys have shown a lack of understanding about the rationale for HPV vaccination on the part of the child’s caregiver and highlight the important role of the health care provider in consistently and clearly educating caregivers about vaccination. The implications of these findings are significant. Increasing HPV vaccination coverage to 80 percent in females could prevent approximately 53,000 additional cases of cervical cancer in the United States over the lifetimes of those currently aged ≤12 years. Screening and Treating Since large populations globally and in the United States remain unvaccinated, pap smear screening and surveillance remains a priority for cervical cancer prevention. Screening can detect precursors and early-stage disease for both types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Treatment of cervical dysplasia and early-stage cervical cancer can prevent the development of invasive cervical cancer and reduce cervical cancer mortality.

The USPSTF recommends initiating screening at the age of 21 with cervical cytology every three years through the age of 29. Rationale for these recommendations include the following: • Prior to the age of 21, cervical cancer is rare (0.1 percent of incident cancers are diagnosed in this age group). Starting at the age of 21, the benefits of cervical cancer screening outweigh the potential harms (i.e., increased number of colposcopies and treatment procedures). • Cytology, rather than HPV testing (either primary or co-testing), is preferred (for patients ages 21 through 29 years) based on a meta-analysis of randomized trials and observational studies that demonstrated higher false-positive rates with HPV testing because of the higher rates of transient infection in this age group. Age 30 to 65 — The recommendations are continued cervical cancer screening in all asymptomatic, immunocompetent patients with a cervix between the ages of 30 and 65. Any of the following strategies is acceptable in this patient population: •

Primary HPV testing every five years; or Co-testing (Pap and HPV testing) every five years; or

•

There are no randomized trials comparing mortality rates among the various screening strategies in the United States. However, the USPSTF (United States Preventive Service Task Force) found that screening strategies that included HPV testing (i.e., primary HPV testing or co-testing [Pap test with HPV testing]) were associated with fewer cervical cancer deaths compared with screening strategies that included Pap testing (i.e., Pap testing alone or reflex HPV testing). In this model, cervical cancer deaths associated with screening that included HPV testing ranged from 0.23 to 0.29 deaths per 1,000 patients versus 0.30 to 0.76 deaths per 1,000 patients with screening that included Pap testing.

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•

Pap test alone every three years

Data supports discontinuing screening at age 65 in patients of average risk with adequate prior screening. We have the tools to make cervical cancer a rare disease by treating adolescents with the HPV vaccine and routine pap smear screening.

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Healthy Communities

Understanding

Mitral

Valve

Prolapse

JEREMY R. MCGARVEY, MD, FACS

Cardiovascular Surgeon, Penn Medicine Lancaster General Health Physicians Cardiothoracic Surgery; Clinical Assistant Professor of Surgery at the University of Pennsylvania Perelman School of Medicine LANCASTER

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itral valve prolapse is a common heart valve condition that affects approximately 2 percent of the U.S. population, according to the American Heart Association. For many people, the condition is not considered dangerous, but it does need to be managed and monitored by a physician. When the prolapse and associated regurgitation through the valve is severe, an intervention may be necessary to correct the problem.

referred for an echocardiogram or MRI— the best ways to determine the severity of leakage. As the degree of the regurgitation worsens, symptoms often follow.

What Is the Mitral Valve? The mitral valve is an important valve in the heart that separates the left ventricle (the main pumping chamber of the heart) from the lungs. The valve is comprised of two flaps, or leaflets, that open and close with each heartbeat. Regurgitation, or leakage through this valve, is relatively common and is a result of the two leaflets not closing properly to create a perfect seal.

If the regurgitation is severe (even if there are no symptoms), cardiologists may recommend a surgical procedure. If not treated for an extended period of time, the regurgitation can eventually lead to heart failure and death.

The most common cause of regurgitation—which can range from mild to severe—is mitral valve prolapse. With this condition, one or both of the valve leaflets bulge (prolapse) upward into the left atrium. This finding is often a result of the valve stretching or a tear/rupture in the support structures (chordae tendineae) that attaches the valve to the underlying left ventricle.

Symptoms of Mitral Valve Prolapse Symptoms of mitral valve prolapse can include: •

Fatigue

•

Shortness of breath with activity

•

Difficulty lying flat

•

Irregular heart rhythms

•

Swelling in the legs

Mitral Valve Prolapse Treatment Initially, cardiologists often treat mitral valve prolapse with diuretics, blood pressure medications, and blood thinners used to treat irregular heart rhythms. Patients with less severe regurgitation should be monitored regularly by their cardiologist.

Surgical Repair of the Mitral Valve In otherwise healthy individuals, mitral valve surgery is an option that has an excellent safety record and excellent results. A March 2020 study, in fact, showed that surgical repair of the mitral valve for mitral valve prolapse restores life expectancy to that of the general population. For most patients, their own mitral valve can be repaired to correct the regurgitation. This procedure can be done using minimally invasive techniques, particularly if there are no other heart problems that need to be addressed at the same time. Surgeons make a small 2-3-inch incision near the right armpit, often using a camera to help see the valve very clearly. The prolapsed and regurgitant valve is corrected by removing that area of the valve, restoring torn support structures, and/or tightening the valve with a supportive ring. A minority of individuals with mitral valve prolapse cannot have their own valve repaired and must have it replaced. This can be with a bioprosthetic valve (cow or pig) or a mechanical valve.

However, many patients show no symptoms and only learn of their condition when their doctor detects a heart murmur during a routine physical exam. They are often

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MitraClip® Procedure for High-Risk Patients In individuals at high risk for surgery, a less invasive, catheter-based option called MitraClip is offered at Penn Medicine Lancaster General Hospital. A team from LG Health Physicians Cardiothoracic Surgery and The Heart Group work together to attach a small device to the mitral valve that allows it to close more completely, helping restore normal blood flow to the heart.

Staying Healthy with Mitral Valve Prolapse Most people with mitral valve prolapse live normal lives. To help prevent complications: •

Don’t smoke Eat a heart-healthy diet and exercise regularly (after consulting your family doctor)

•

Take all prescribed medications as directed

•

Visit your doctor for all scheduled physical exams and notify your doctor if you notice common cold and flu symptoms, such as a sore throat, achiness, and fever. These symptoms could signal endocarditis (a bacterial infection that affects the lining of the heart valves).

•

Maintain good oral hygiene which has been found to reduce the risk of endocarditis.

•

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Patient Advocacy

COVID, BIAS, AND

WOMEN IN MEDICINE REBEKAH APPLE, MA, DHSc

n July 2020, Dr. Linda Brubaker wrote, “There is no appropriate stereotype for a woman physician.”

There is, however, stereotypical treatment of women physicians in the workplace. Gender-based expectations continue to bolster biases, as they have since the mid-1800s

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AS 2021 NEARS ITS END AND THE WORLD CONTINUES ITS STRUGGLE WITH COVID, WOMEN PHYSICIANS CONTINUE THE STRUGGLE AGAINST STIGMATIZATION. when Elizabeth Blackwell became the first woman to receive a medical degree in the United States. As we begin 2022 and the world continues its struggle with COVID, women physicians continue the struggle against stigmatization. Bias against women physicians not only has a well-documented history but also an acknowledged persistence. Assumptions related to gender are made by physicians, colleagues, and patients. A 2018 survey revealed male and female patients expected female physicians to exhibit more empathy than male physicians (Moyer, 2020). In spite of years spent studying and discussing the topic, women physicians are still judged according to a notion of what women should be. Conversations about implicit bias have become common in professional healthcare settings. Striving toward the admirable goal of appreciating differences, many institutions implement diversity and inclusion training and workshops. COVID has underscored the need for such initiatives to produce results. For years, many women physicians have been perceived as less committed to their careers than men. As more physician mothers worked from home when lockdown kept children out of school, opportunities grew to view women

physicians through a biased lens. As a result, according to the University of Michigan study of almost 300 physicians, there have been “disproportionate consequences for the mental health and careers of physician mothers” (Frank et al., 2021). The pay gap between men and women physicians has hovered at approximately 25 percent, according to a 2020 Doximity physician compensation study. Even prior to reducing work hours during the pandemic to care for children, women physicians — across all specialties — were being paid less. It has been noted that more men than women enter certain high-paying specialties (e.g., orthopedics). But consider this from the chicken-and-egg perspective. Are fewer women choosing to pursue high-paying specialties because of implicit biases? A study published in Clinical Orthopedics and Related Research earlier this year revealed that “women were more likely to receive awards bestowed through a blinded process than an unblinded process” (Gerull, Hulton, Rhea & Cipriano, 2021). It is reasonable to wonder if information such as this helps to shape the career plans of women medical students and gender distribution across specialties. Similarly, it is reasonable to question how career trajectories for women in medicine may have been derailed as a result of COVID-related absences at work. Dr. Uzma Shah of Harvard Medical School and Massachusetts General Hospital suggested creating a “report card for leaders…to eliminate lip service and support action” (Zimmerman, 2020). Shah recommended having institutional leadership review the number of women physicians and their promotions, speaking arrangements, editorial board positions, and action-based committee memberships. Examining data such as this would reveal meaningful truths about any organization. Women physicians have been endeavoring to improve their workplace situations for centuries, and conversations about bias have been ongoing for decades. When health care systems are able to rebound from COVID chaos, it would be appropriate to consider

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how the profession can best compensate the distinctive contributions of all physicians, regardless of gender. REFERENCES Brubaker L. Women Physicians and the COVID19 Pandemic. JAMA. 2020;324(9):835–836. doi:10.1001/jama.2020.14797 Doximity. (2020). Physician compensation report: fourth annual study. [White paper]. https://c8y.doxcdn. com/image/upload/Press%20Blog/Research%20Reports/ compensation-report-2020.pdf FitzGerald, C., Hurst, S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18, 19 (2017). https://doi.org/10.1186/ s12910-017-0179-8 Frank E, Zhao Z, Fang Y, Rotenstein LS, Sen S, Guille C. Experiences of Work-Family Conflict and Mental Health Symptoms by Gender Among Physician Parents During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(11):e2134315. doi:10.1001/ jamanetworkopen.2021.34315 Gerull KM, Holten A, Rhea L, Cipriano C. Is the Distribution of Awards Gender-balanced in Orthopaedic Surgery Societies? Clin Orthop Relat Res. 2021 Jan 1;479(1):33-43. doi: 10.1097/ CORR.0000000000001364. PMID: 32555007; PMCID: PMC7899733. Moyer DV. Let's Get Loud: Time to Unleash a JEDI Healthcare Workforce. Present at: Women in Medicine Summit; Oct. 9-10, 2020 (virtual). Newman C, Templeton K, Chin EL. Inequity and Women Physicians: Time to Change Millennia of Societal Beliefs. Perm J. 2020 Sep;24:1-6. doi: 10.7812/TPP/20.024. PMID: 33482936; PMCID: PMC7849280. Zimmerman, B. (2020, September 10). Race and gender equity in academic medicine — a fireside chat with Harvard's Dr. Uzma Shah. Becker’s Hospital Review. https://www.beckershospitalreview.com/hospital-management-administration/ race-and-gender-equity-in-academic-medicine-a-fireside-chat-with-harvard-s-dr-uzma-shah.html

Continued on page 20

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Patient Advocacy

Trust Your Patients are in Good Hands with Our Experienced Team

WOMEN PHYSICIANS SECTION

• Board-certified Physicians and Nurse Practitioners working with an extensive interdisciplinary team. • Hospice, Palliative Medicine and Supportive Care available for patients and families coping with life-limiting illness.

The preceding excerpt was written as a follow-up to a presentation on implicit bias in medicine that Rebekah Apple shared as part of the October 27 annual meeting of the Pennsylvania Medical Society Women’s Physician Section.

• 24/7 support for your most complex patients saves you time and provides you peace of mind. Proudly serving Lancaster and surrounding counties.

In October 2018, the House of Delegates created the Women Physicians Section (WPS), which was the intended space for female physicians to connect, provide support and allow for discussion of factors that uniquely applied to women practicing medicine. WPS has become vocal in addressing issues such as discrimination and pay disparity. The members bring forward personal experiences of balancing medical practices while raising children. They share stories of both triumphs and frustrations in professional advancement. It has become a place where female physicians can find camaraderie and understanding.

To make a referral, call (844) 422-4031 or visit www.hospiceprofessional.org.

The Point Residences 101 N Queen, Lancaster

For all female physicians in Pennsylvania, please consider becoming active in WPS and sharing your stories and experiences. WPS offers educational webinars as well as live presentations addressing concerns. Visit pamedsoc.org/membership/ women-physician-section for more information about WPS.

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Meet the T Health Care Team

here are numerous professional licenses within the health care field. Holders of these licenses have fulfilled the necessary training, education, and other requirements to become licensed in their chosen professional fields. With the numerous titles and acronyms within the health care team, it can be very easy for patients to not fully understand the credentials of the licensed practitioners providing care to them. This article seeks to help you make sense of the “alphabet soup” of health care.

UNDERSTANDING COMMON TITLE ACRONYMS IN MEDICINE ANDREW C. HARVAN, ESQ.

Assistant Legal Counsel, the Pennsylvania Medical Society

MD – MDs are Medical Doctors or Doctors of Allopathic Medicine. In Pennsylvania, the State Board of Medicine is the licensing authority for MDs. To become licensed as a MD in Pennsylvania, an applicant must first meet certain requirements established by the Medical Board. These requirements include graduation from a medical college and passing a licensing examination acceptable to the Board (the three-step United States Medical Licensing Examination (USMLE) is the current exam accepted by the Board). They must also successfully complete a graduate medical training program, the length of which depends on whether the applicant is a graduate of a foreign medical college or one within the United States and Canada. DO – DOs are Osteopathic Doctors or Doctors of Osteopathic Medicine. In Pennsylvania, the State Board Continued on page 22

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Patient Advocacy

of Osteopathic Medicine is the licensing authority for DOs. Similar to MDs, DOs must complete certain licensing requirements set by their Board to become licensed in Pennsylvania. These requirements include graduating from an approved osteopathic medical college and completing an approved osteopathic internship. They must also successfully pass both a national licensing exam — the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) — and the Pennsylvania Osteopathic Manipulation Therapy Examination. PA – PAs and PA-Cs are Physician Assistants. In Pennsylvania, PAs can be licensed by either the State Board of Medicine or Osteopathic Medicine. To become licensed as a PA, an applicant must graduate from a physician assistant program recognized by their Board and successfully pass a physician assistant examination (both medical boards currently recognize the exam administrated by the National Commission on Certification of Physician Assistants). They must also have a baccalaureate degree or higher from a college or university and successfully complete at least sixty hours of instruction in pharmacology. The board under which a PA is licensed depends on the type of physician a PA is working with and enters into a written agreement with. Written agreements are the formal documents that outline the working relationship between a PA and a supervising physician. Recent legislation — Acts 78 and 79 of 2021 — streamlines the process physicians and PAs must navigate to establish this relationship. Acts 78 and 79 enable written agreements to become effective upon submittal to their respective board. Prior to these Acts, board approval of written agreements was required before PAs could begin work pursuant to the agreement’s terms. CRNP – CRNPs are Certified Registered Nurse Practitioners. CRNPs are licensed by the State Board of Nursing. The requirements for CRNPs are established by the Nursing Board. To become a CRNP, an applicant must first hold unrestricted license as a

professional nurse in Pennsylvania. CRNPs are Pennsylvania-licensed professional nurses who are certified by the Nursing Board in a specialty and who, while functioning in the expanded role as a professional nurse, performs acts of medical diagnosis or prescription of medical therapeutic or corrective measures in collaboration with a Pennsylvania licensed physician. To become certified as a CRNP in Pennsylvania, an applicant must first meet certain education and certification requirements. Regarding education requirements, a CRNP applicant must first complete either: 1) an accredited, Nursing Board-approved master’s or postmaster’s nurse practitioner program or other Board-approved program that awarded an advanced degree, or 2) a course of study considered by the Board to be equivalent to that required for certification at the time the course was completed. Applicants must also hold current National certification in the specialty in which the professional nurse is seeking certification in. CRNPs practice in collaboration with physicians pursuant to collaborative agreements. Collaborative agreements are written and signed agreements between CRNPs and collaborating physicians in which they agree to the details of their collaboration. To prescribe and dispense drugs as well as other medical therapeutic or corrective measures, CRNPs must enter into a prescriptive authority collaborative agreement (PACA) with a collaborating physician. To be eligible for prescriptive authority, a CRNP must first successfully complete at least forty-five hours of coursework specific to advanced pharmacology at a level above that required by a professional nursing education program. Similar to collaborative agreements, PACAs are agreements between CRNPs and collaborating physicians outlining the collaborative relationship between the parties. The specific elements of PACAs include identification of the categories of drugs from which the CRNP may prescribe or dispense. DPM – DPMs are Doctors of Podiatric Medicine. Under Pennsylvania law, Podiatric Medicine is defined as the diagnosis

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and treatment (including mechanical and surgical treatment) of ailments of the foot. They also specialize in diagnosing and treating the anatomical structures of the leg governing the functions of the foot and the administration and prescription of drugs incidental thereto. DPMs are licensed by the State Board of Podiatry. To become licensed as a DPM, an applicant must be a graduate of an accredited school of podiatric medicine and surgery and must pass a national examination with results received from the Federation of Podiatric Medical Boards. DMD – DMDs are Doctors of Medicine in Dentistry. DMDs are licensed by the State Board of Dentistry and must fulfill certain educational and examination requirements before becoming licensed. DMD applicants must graduate from an accredited dental school. Additionally, candidates for DMD licensure must also pass the National Board Dental Examination (written examination) and one of several dental clinical examinations enumerated in the Dental Board’s regulations.

WHERE CAN I FIND ADDITIONAL INFORMATION? Additional information on the standards and requirements in Pennsylvania for health care practitioner licenses can be found within Title 49 of the Pennsylvania Code as well as on the website of the Professional Licensing Board that issues the license of interest. To determine the applicable board, please visit the “Professional Licensing” page on the Pennsylvania Department of State’s website at www.dos.pa.gov. The Pennsylvania Medical Society (PAMED) also has a number of resources regarding professional licensure particularly related to the licensing of physicians and allied health care practitioners. Visit www.pamedsoc.org for additional information on licensure requirements.

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Passion Outside of Practice

Thomas Andersen, MD

Penn Medicine Lancaster General Health Physicians Family Medicine Lititz

It’s our pleasure to highlight a Lancaster City & County Medical Society member’s “passion outside of practice” in each issue of Lancaster Physician. Beyond their commitment to health care, LCCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature Thomas Andersen, MD, and his passion outside of practice. program that provided free textbooks to students and onsite childcare for their babies and toddlers. They partnered with another Lutheran church to offer free bus transportation to and from class. As a Penn Medicine employee, I got the chance to apply for and receive several Penn Medicine CAREs grants for Grace ELL. In 2019, I participated in a Penn Medicine video highlighting the program. This video has been re-released recently on Twitter and Facebook. In March of 2020, I remember visiting Grace ELL and talking with the students about the developing COVID-19 crisis. A few days later, Grace ELL had to discontinue their in-person class and begin to make the transition to online teaching.

L: Tom is demonstrating how to use one of the Grace ELL computers. Tom helps the program by getting grants, delivering supplies, and helping individual students. R: Helping with building repairs is one of the ways Dr. Andersen uses his skills to help New Americans resettle comfortably in their new homes.

Assisting new Americans IN ESTABLISHING THEIR LIVES IN LANCASTER COUNTY Would you briefly describe your passion outside of practice for those who might be unfamiliar with it?

My passion is helping New Americans (refugees and recent immigrants) get resettled in Lancaster County and learn or improve upon their English skills.

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

I developed an interest in refugee resettlement when my church, Grace Lutheran Church in Lancaster, sponsored a family through Church World Service. Since my wife and I enjoy helping people, we joined

the resettlement team right away. I especially love repairing cars, fixing broken furniture, refurbishing bicycles, and doing home repairs. I learned these skills from my dad, who was an electrical engineer and the son of Danish immigrants. I put my practical skills to work for the resettlement team. Both my wife and I ended up developing a deep and lasting friendship with the family. My interest in Grace ELL (English Language Learners) began when my wife and several other team members decided to start an English class. They were inspired by the plight of three women in the family who could not attend English classes because they lacked both childcare and transportation. Barbara and her team set up Grace ELL to be an all-volunteer

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Now that Grace ELL is completely online, I continue to support the program by looking for grants to cover expenses and assisting students with practical needs outside of class. I recently helped one of the students buy a car and get the tires aligned.

How long have you been participating in this activity?

I have been helping New Americans since 2016 and supporting Grace ELL since 2018.

Why is this pursuit special to you? When I help resettle a family, I get to put practical skills to work for others. It makes me happy to see a family become independent and empowered while living in their new community.

What else would you like readers to know about this passion?

As both a family doctor and a volunteer with Water Street Health Services, I regularly see patients from around the world. However, I think an even better way to get to know New Americans is to become involved in refugee resettlement. I also think that giving New Americans opportunities to learn English is an important part of the journey.

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Perspectives

What's Ahead for Health Care in 2022? REPRESENTATIVES FROM LANCASTER COUNTY HEALTH SYSTEMS SHARE THEIR PREDICTIONS BY SUSAN SHELLY Writer

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ith the ongoing COVID19 pandemic, supply shortages, staffing concerns, and other issues, 2021 was not an easy year for the health care industry, to say the least. By the end of the year more than 50.8 million Americans had contracted the virus and more than 805,000 had died as a result, despite the availability of vaccines. Millions of people quit their jobs in what’s being called the “Great Resignation,” leaving employers in many industries — including health care — vulnerable and frustrated. The industry worked to adjust to a shift in patient experience and expectations; offer continuing telehealth services, as applicable; and address issues around cybercrime, the cost and access of care, hospital safety, emerging technology, and other areas. With 2021 at its end, we wanted to find out what Lancaster County health care leaders are looking ahead at for 2022. Lancaster Physician reached out to learn what trends, challenges, triumphs, and concerns our health care systems are anticipating in the new year. Representatives of Penn Medicine Lancaster General Health, WellSpan Health, Penn State Health, and UPMC responded. Brian Burgess, Chief Strategy Officer, Penn Medicine Lancaster General Health

While moving toward a sense of normalcy after a period that has been anything but normal, Penn Medicine Lancaster General Health is addressing issues of a challenging labor market, consumerism, the continued use of telehealth, and others as it moves forward with several ambitious construction projects aimed at improving medical services and care for patients throughout the region. “In a lot of ways we’re emerging,” said Brian Burgess, Chief Strategy Officer for Penn Medicine Lancaster General Health. “We’re just trying to figure out what the new normal will look like.”

A two-phase, $183 million project to double the size of the Lancaster General Hospital Emergency Department continues, with construction of a new emergency department currently underway and expected to open to patients in summer 2022. A renovation of the existing emergency department space will follow, opening about 18 months later. The expansion project is the culmination of years of planning by LG Health to ensure the most strategic approach to addressing the growth of demand for emergency services. The other project underway is an addition to the Penn Medicine Lancaster General Health Ann B. Barshinger Cancer Institute that will house a proton therapy center, which is expected to begin offering this innovative radiation therapy to local patients this summer. “That will be very exciting,” Burgess said. “It’s the first such center for this entire region.” Burgess expects COVID-19 will continue to affect the health care industry in 2022, but said that Lancaster General Health, along with others in the industry, has learned to better handle the future and seasonal surges. As always LG Health will continue to balance patients’ needs for surgeries and procedures while caring for patients both with and without COVID-19. “Much like other parts of the economy, we’ve gotten better at it,” he said. All of Penn Medicine Lancaster General Health’s facilities have reopened and are up and running, despite some challenges with keeping facilities fully staffed, which are present throughout the industry. Environmental services is a particularly challenging area, Burgess said, as employees can find many available opportunities in industries other than health care. Burnout among health care providers is real and a factor the system is dealing with, explained Burgess. The plan for 2022 is for Penn Medicine Lancaster General Health to continue to concentrate on maintaining a culture that is supportive and provides opportunities for employee growth.

“Continuing to build a culture that supports people will be critical for us going forward,” Burgess said. A trend Penn Medicine Lancaster General Health will be watching in 2022 is the issue of how patients look to find and access care. Studies show that many patient decisions regarding their health care are based on convenience, such as location, waiting time, whether they’re able to communicate online with their doctors, extended office hours, and so forth. Those in health care must be aware of and address what patients want, Burgess said. “We as a health care system need to be reactive to those wishes,” he said. “Responding to what consumers are asking for is part of the challenges ahead of us.” Many patients embraced telehealth during the pandemic, but it is unclear as to how many will continue using it as opposed to meeting with care providers in person. Telehealth remains especially popular for behavioral health appointments, Burgess said, but it’s not yet clear what its long-term impact will be. Also, he explained, it is unclear whether insurance companies will continue to reimburse at the same rates for telehealth and in-person care, a policy put in place as a result of the pandemic. “We’ll just have to wait and see what happens,” Burgess said. Dr. Mark Goedecker, Vice President and Chief Medical Officer, Primary Care, WellSpan Health When looking to 2022, Dr. Mark Goedecker, Vice President and Chief Medical Officer, Primary Care for WellSpan Health, believes that COVID-19 will once again occupy center stage. “That’s what jumps out at me for next year,” Goedecker said. “We’re still trying to figure out how to deal with it, and the Continued on page 26

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variants make it even more difficult. It’s going to be a focus again in 2022 because it’s something we just can’t seem to escape.” Pressure will continue for people to get vaccinated against the virus, Goedecker predicted, and hospitals will continue to struggle to keep up with demand for care. Health care, like many industries, has been affected by what is being called the “Great Resignation,” and while WellSpan has retained enough employees to safely reopen all its offices and facilities that closed during the height of the pandemic and care for patients in its hospitals, there are shortages of workers in some areas, such as phlebotomy, and some urgent care centers have had to adjust their hours due to staff shortages. “People, including health care workers, are tired,” Goedecker said. He is concerned that a sustained need for medical care for COVID patients, coupled with more extensive treatments needed for patients who delayed care, could overwhelm workers and systems. “With increasing illness and a decreasing number of health care workers, as we look at 2022 and beyond, our goal has to be to keep people healthy,” Goedecker said. He predicted that virtual medicine, which has come into its own since the pandemic halted in-office visits, will continue to improve and provide opportunities for ongoing monitoring of patient care, along with easing pressure on health care workers as artificial intelligence (AI) capacities increase and are better able to supplement the work of physicians and others. WellSpan is working on a program called Duo Healthcare, an online primary care system that keeps patients and doctors connected, with doctors constantly monitoring changes in patient health. “So instead of getting care when you’re in front of a doctor, you’re getting it all the time,” explained Goedecker.

In other areas, WellSpan will be looking at workplace diversity and how its staff can assure every patient feels safe and welcomed, despite background, ethnicity, sexual orientation, or religion.

“We get to design them from the ground up and include everything we’ll need to provide the best health care for years to come,” she said. “It’s a once-in-a-lifetime experience for those who are involved.”

“We’ve been working hard to address that,” Goedecker said.

The increased use of technology will be essential as the health care industry overall faces staffing shortages. An example of its use in the new hospital in Cumberland County includes an app visitors can download that enables them to use their phones to access directions to different parts of the hospital from QR codes on hospital signage, eliminating the need to ask a busy staff member for help.

He also said WellSpan is addressing how it approaches and will train the next generation of health care workers in order to assure that safe, quality care can continue. “We need to reach out at the high school level to educate students about opportunities in health care careers,” Goedecker said. “Health care is different than it was previously, and we need to keep up with addressing challenges while looking for new opportunities.” Deborah Addo, Executive Vice President and Chief Operating Officer, Penn State Health The use of innovative technology will become increasingly important to health care systems in 2022 as they confront the challenges of staffing shortages, limited resources, and patients who expect an enhanced level of services, predicted Deborah Addo, Executive Vice President and Chief Operating Officer of Penn State Health. “Technology gives us the ability to maximize our resources, which is becoming more and more important,” Addo said. Penn State Health is incorporating enhanced technology into its two new hospitals, Penn State Health Hampden Medical Center, which opened October 1 in Enola, Cumberland County, and Penn State Health Lancaster Medical Center, which is under construction near the intersection of State Road and Harrisburg Pike in East Hempfield Township and expected to open in fall 2022. Having the opportunity to plan and design the hospitals has been an extraordinary experience for Penn State Health’s teams, according to Addo.

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“I wish I could say that Penn State Health is exempt from the Great Resignation, but we are not,” Addo said. “We are starting to see and feel shortages in all segments of our operations.” To enhance the patient experience, the hospital will incorporate technology that enables patients to access virtual reality visits to Hershey’s ZooAmerica and experience virtual rides at Hersheypark from their hospital rooms. “No one wants to be in the hospital, but what we can do is give patients an experience that makes the stay more pleasant,” Addo said. The use of high-level telehealth will continue, Addo predicted, providing a tool for satisfying patients who want care on their terms, not dictated by office hours or the availability of a care provider. “Our customers look to us as they do any other commodity,” Addo explained. “They want great customer service and services available when they want them. Patients today are educated and health care savvy.” Another product of consumer expectations is a rise in the number of surgery centers, which normally are smaller than hospitals and may be able to provide enhanced patient services.

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“I think you will see more and more of them,” Addo said. Already a problem before the start of the ongoing COVID-19 pandemic, a shortage of services and beds for behavioral health care patients will continue to cause concern in the future. “There aren’t enough behavioral health beds in our regions, and that reflects a national problem,” Addo said. “We’ll miss the mark in health care if we don’t continue to shore up those services.” With the continuation of the pandemic and other difficult factors, 2021 was not an easy year. However, Addo said, there were bright spots. The health care system overall has learned a lot from the pandemic, and dedicated workers continue to do their jobs to fulfill Penn State Health’s mission of serving its patients. “You can have all the technology and beautiful buildings you want,” Addo said. “But without the committed people who deliver the care, they’re nothing.” Dr. Eric M. Kutz, Orthopaedic Surgeon with Orthopaedic Specialists of Central PA – UPMC Advancing technology will continue to change and improve the way UPMC provides patient care, according to Dr. Eric M. Kutz, an orthopaedic surgeon with Orthopaedic Specialists of Central PA – UPMC. In his own practice, Kutz said, the use of robotic technology in surgeries has enhanced treatment and improved outcomes for patients. “This technology really adds precision and an additional layer of safety to the procedure,” he said. “It’s an improvement to the hip and knee replacements we’ve done in the past.”

“No one wants to be in the hospital, but what we can do is give patients an experience that makes the stay more pleasant.” Addressing staffing issues affecting health care systems across the country, Kutz said the problem is not new, but has been made worse due to the COVID-19 pandemic. “There’s always been a need for nurses, we just don’t have enough,” Kutz said. “So, when you add the pressures from the pandemic, it exacerbates the problem.” A continuing trend will be to provide more accessible and convenient care for patients, who increasingly expect health care to be delivered on their terms. Kutz said his office sees walk-in patients, intended to provide convenience and care when it’s needed. “We know that everyone is busy, and the more convenient we can make care the better,” he said. “Medicine is a service-based business and that includes being accessible to patients.” Changing expectations of patients has led to an explosion in the number of urgent care centers that don’t require appointments and are open outside of regular office hours, he noted. The way physicians relate to patients is changing as well, as patients become better educated regarding their care. Kutz said his patients expect to receive adequate information about their conditions and how they will be treated, and they want to participate in their care. “It’s encouraging that patients are now much better informed than they used to be,” he said.

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While Kutz believes the pandemic will continue to affect health care overall, he said health care systems have become, and will continue to become, better able to manage how they respond to patients and how care is administered. With conditions surrounding the virus constantly changing, challenges must be addressed as they occur. “It’s important not to paint with too broad a brush, but to look at specific issues as they come along,” he said. Fortunately, he said, health care is an inventive field that is used to scrambling to find better ways to do things. Recently, UPMC launched a new in-house travel staffing agency, UPMC Travel Staffing, as a solution to the nationwide nursing shortage and to attract and retain highly skilled nurses and surgical technologists to its workforce. Building upon its strong global reputation as health care innovators and leaders, UPMC is believed to be the first health system in the country to launch its own staffing agency—initially for registered nurses and surgical technologists, with the potential to evolve to include additional job roles. “We continue to figure out how to best take care of our patients, whether it’s during a pandemic or not,” Kutz said. “We’re constantly improving. The innovation in health care is amazing.”

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Legislative Updates

PENNSYLVANIA MEDICAL SOCIETY QUARTERLY LEGISLATIVE UPDATE 2021 YEAR-END LEGISLATIVE UPDATE

s the 2021 calendar year came to a close, we reached the midway point of the 2021-2022 regular legislative session of the Pennsylvania General Assembly. 2021 brought a “new normal” to the State Capitol amid the COVID-19 pandemic. While many legislators have been present on session voting days, remote voting is an option that many legislators have decided is the safest way for them to represent their constituents. Many offices, which had previously been easily accessible, are now locked or require advance appointments.

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Across the country, we’re seeing tensions rise in state capitols, and in Washington, over election reforms, mask and vaccine mandates, over-crowded hospitals, and the overall impact COVID-19 has had on businesses and our economy. It has been challenging for all, especially those dedicated to patient care. As 2022 begins, politics may very well trump policy as legislators and legislative candidates eye the May primaries and November General Elections. 2022 also marks the creation of new legislative district maps that could potentially change the composition of the General Assembly and leave some legislators to decide if they should bow out of office or face the harsh reality of running against a colleague. Moreover, the eyes of the nation have shifted to the Commonwealth as we near a primary election for an open U.S. Senate seat in addition to the election of a new Governor. At last count, there are currently ten announced candidates seeking the republican nomination for Governor while Attorney General Josh Shapiro stands as the only democratic candidate. Despite the current political environment, PAMED continues to work tirelessly to defend the practice of medicine, protect the physician-patient relationship, and ensure we are always mindful of legislation and regulation that could potentially impact the practice of medicine. The pandemic continues to provide policy issues and challenges in addition to the existing priority issues that PAMED advocates on behalf of, including scope of practice and prior authorization. Among the highlights of the current legislative session so far was the enactment of Senate Bill 425 as ACT 61 of 2021. ACT 61 was a PAMED-supported effort to provide a remedy to the Pennsylvania Supreme Court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. PAMED was able to support or provide neutrality on various agreements with Advanced Practice Providers including the passage of Senate Bill 416 (CRNAs) and Senate Bills 397/398 (PAs).

Senate Bill 225, an extensive effort to reform the prior authorization process, also saw movement. It advanced out of the Senate Banking and Insurance Committee for the first time, and there is optimism it may be taken up before the full Senate early in 2022. House Bill 681 seeks to provide a fair approach to both employed physicians and provider employers while setting specific requirements for the appropriate use of restrictive covenants. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House. Lastly, Senate Bill 705 that seeks to provide a legislative framework for the practice of telemedicine has advanced out of the Senate. In the past, this effort has reached the Governor’s desk only to be vetoed. However, we are hopeful it might reach a compromise in the second year of this session. In addition to the above highlights, detailed below is a list of other issues we are actively monitoring. PAMED continues to engage in a number of legislative issues and participate in a large coalition to prevent any changes to the current Pennsylvania Supreme Court Civil Procedure rules regarding venue in medical malpractice professional liability cases. House Bill 245 – (Kaufer) – International Medical Graduates (IMGs) – Seeks to modernize the process by which graduates of international medical schools become licensed. Passed the House (201-0) and has advanced out of the Senate Consumer Protection & Prof. Licensure Committee. Now awaits action from Senate Appropriations. We anticipate this bill to get to the Governor’s desk soon. Senate Bill 705 - (Vogel) – Telemedicine – This legislation was voted favorably out of the Senate (46-4) and has been referred to the House Insurance Committee. PAMED supports this effort and will work to move this bill through the legislative process. Senate Bill 416 – (Gordner) – This legislation officially recognizes certified registered nurse anesthetists (CRNAs) in

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the Commonwealth of Pennsylvania and outlines requirements for certification of CRNAs. PAMED followed the anesthesiologists lead in supporting this effort. This legislation has unanimously passed both the Senate (50-0) and the House (201-0). Signed into law as Act 60 of 2021. House Bill 931 – (Toohill) – House companion legislation Senate Bill 425 – (Gordner) – Informed Consent – PAMED supported this effort to provide a remedy to a court ruling which had changed how consent was obtained in hospitals and other clinical settings by attending physicians. Passed the Senate (500) and the House (201-0). Signed into law as Act 61 of 2021. House Bill 1420 – (Thomas) – Health Care Heroes Act – PAMED supports this effort to establish a public awareness campaign to provide information regarding the programs and services available for first responders, healthcare workers, and other workers suffering from mental health issues related to COVID-19. Having unanimously passed the House (202-0), this bill now awaits a vote in the Senate Health and Human Services Committee. House Bill 1082 – (DelRosso) – PAMED supports this legislation, which establishes an education program for providers on early diagnosis of Alzheimer’s disease and other dementias and incorporates information about the disease into existing public health outreach programs. This bill passed the House (201-1) and is now awaiting final consideration by the full Senate. House Bill 1280 – (Jozwiak) – Patient Test Results – PAMED will be working with the cardiologists to advance this bill through the House after it recently was voted favorably out of the House Health Committee. This bill amends the Patient Test Result Information Act in addressing how patients receive notifications after certain tests and procedures.

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Legislative Updates

Senate Bill 397 – (Pittman) – Physician Assistants (PAs) – Seeking to help physician assistants work and practice with increased efficiency. The bill calls for modernization to allow physician assistants to practice while maintaining their role under supervising physicians. This legislation has recently passed the Senate (50-0) and House (200-0); signed into law as Act 78 of 2021. (DO ACT) Senate Bill 398 – (Pittman) – This legislation has passed the Senate (50-0) and House (200-0) and has been signed into law as Act 79 of 2021. (MD ACT) Senate Bill 225 – (Phillips-Hill) – Prior authorization reform bills. There is a large coalition with multiple provider entities and patient advocacy groups seeking to make wholesale changes to the prior authorization process in the Commonwealth. PAMED has played an integral role in developing this legislation and working to advance it. While this legislation will require ongoing efforts to advance it through the legislative process, it was voted out of the Senate Banking and Insurance Committee. PAMED continues to work with a broad coalition to pass this important legislation. House Bill 225 – (Mentzer) – House companion legislation

Senate Bill 25 – (Bartolotta) – PAMED opposes this legislative effort which seeks to grant CRNPs independent practice authority. PAMED has long opposed these efforts, but last session agreed to listen/ negotiate a pilot program where CRNPs would be granted independent practice with specific guidelines and restricts. This bill was recently voted out of the Senate Consumer Protection and Prof. Licensure Committee, but we do not anticipate it will advance beyond the Senate in its current form. Likely, any movement on this issue would come in the form of a bill/amendment starting from the agreed upon pilot program. (HCO2108) – (Hickernell) – Co-sponsorship memo recently introduced to advance the pilot program legislation. House Bill 681 – (Ecker) – PAMED has worked closely with the sponsor of this bill, Rep. Ecker, to advance legislation dealing with restrictive covenants in health care practitioner employment contracts. This effort would seek to provide a fair approach to both employed physicians and provider employers while setting specific requirements for when the use of restrictive covenants is appropriate. This bill has advanced out of the House Health Committee and is awaiting final consideration before the full House.

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House Bill 958 – (Zimmerman) – PAMED opposed this effort that would prohibit pediatricians from deciding not to provide care to unvaccinated patients or patients whose parent or legal guardians choose to utilize a vaccination schedule that varies from the vaccination schedule recommended by the CDC. While this bill advanced out of the House Health Committee, PAMED does not believe this effort will advance beyond there. House Bill 1033 – (Rapp) – This bill requires health insurers to cover treatment plans of Lyme disease or related tick-borne illnesses as prescribed by a health care practitioner. Debate exists over what type of treatments could be covered (experimental long-term antibiotic, for example). Although PAMED opposed this effort, this legislation has passed the House (136-66) and has been referred to the Senate Banking and Insurance Committee. Senate Bill 621 – (Brooks) – Publishing of vaccine availability by physicians– PAMED opposed this legislation which would require physicians that provide the COVID-19 vaccine to pay for the weekly publication of vaccine data, such as the number of vaccines they have available, in local newspapers. Further, it would require that physicians in private

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practice vaccinate any individual who shows up, even when an established relationship does not exist. This bill failed at the Senate Health and Human Services Committee level and has been referred to the committee by a motion to reconsider. Senate Bill 671 – (Hutchinson) – Retaining Health Care Innovations Act – PAMED opposes this effort to extend the emergency administrative regulation changes granted to health care facilities, practitioners, and providers by Governor Wolf during the COVID-19 pandemic. This bill has advanced out of the Senate Health and Human Services Committee and has been referred to Senate Appropriations. House Bill 1700 – (Sonney) – Disclosure of disingenuous physician complaints – This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical license if the case were closed without any formal action. PAMED supports this effort and will advocate to advance these bills. This legislation has been referred to the House Professional Licensure Committee. (DO ACT) House Bill 1701 – (Sonney) – (MD ACT) House Bill 192 – (Topper) – Interstate Medical Licensure Compact Act – PAMED supports this effort which would allow Pennsylvania to fully join the Interstate Medical Licensure Compact Act (IMLC). The IMLC provides a streamlined process that allows physicians to become licensed in multiple states with a mission of increasing access to health care. This bill has passed the House (201-0) and now awaits consideration in the Senate Consumer Protection and Prof. Licensure Committee. House Bill 1774 – (Flood) – PAMED supports this effort to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. This bill was signed into law as Act 72 of 2021.

Bill 1319 – (DelRosso) – This legislation is intended to curb the predatory practices of Pharmacy Benefit Managers (PBMs) by targeting the practices being used by them to interfere with the funding stream health centers and 340(b) plans use to fund the care they provide to low-income, uninsured residents. PAMED supports this effort and anticipates a committee vote in House Health during early 2022. House Bill 1440 – (Millard) – PAMED supports this legislation that would establish a Medical Imaging and Radiation Therapy Board of Examiners responsible for licensing and establishing qualifications for individuals in the Commonwealth of Pennsylvania who perform medical imaging or radiation therapy procedures. The House Professional Licensure Committee held an information hearing on the topic and the bill awaits action by this committee. House Bill 1562 – (Pickett) – PAMED strongly worked to oppose this effort to expand access to the PDMP. At the time of this writing, this legislation has yet to be brought up for a committee vote. It is currently sitting in House Insurance. We do not anticipate movement on this bill which grants private health care insurers access to the PDMP, even though they have no enforcement abilities and no compelling rationale for accessing highly sensitive information. House Bill 1005 – (Cox) – PAMED is opposing this effort that would require emergency physicians to provide information frequently not available during the time in which care to a patient is being delivered. Specifically, this bill requires information to be added to the PDMP when Narcan/Naloxone is used to combat an overdose by emergency responders or medical professionals. This bill advanced out of the House Health Committee, and PAMED will continue to work to prevent it from becoming law.

psilocybin-assisted therapy in the treatment of PTSD, traumatic brain injury, and various mental health conditions. PAMED has new policy to support clinical studies to determine the full efficacy of the use of psilocybin as appropriate. This bill is currently awaiting a vote by the House Health Committee. Senate Bill 196 – (Ward) – This co-pay accumulator legislation requires insurers or pharmacy benefit managers to count any amounts paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to the plan’s deductible. PAMED is still working through this effort to determine a position while the bill awaits action from the Senate Banking and Insurance Committee. House Bill 1664 – (Gleim) – House companion legislation House Bill 605 – (Ecker) – This COVID liability legislation specifically requires certain cases alleging personal injury damages because of exposure to COVID-19 to be subject to expedited compulsory arbitration programs. Having passed the House (107-94) this bill now awaits action from the Senate Judiciary Committee. Should this legislation advance to the Governor’s desk, it is likely to be vetoed as similar legislative efforts have ended in the same result. House Bill 1186 – (Quinn) – Legislation to amend the Acupuncture Licensing Act to provide for the title protection for licensed acupuncturists and practitioners. PAMED worked to provide language on amending this bill that resulted in a position of neutrality. HB1186 advanced as amended out of the House Professional Licensure Committee and is to now before the full House.

House Bill 1959 – (Pennycuick) – This legislation authorizes the clinical study of the efficacy and cost/benefit optimization of the

For the most up-to-date information on advocacy priorities and legislative issues, please visit

www.pamedsoc.org/advocacy LANCASTER

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Foundation Updates

2021 House of Delegates

WRAP UP O

n October 30, the Pennsylvania Medical Society (PAMED) held its 2021 House of Delegates (HOD) meeting virtually due to pandemic caution. While some may have missed the camaraderie of past in-person meetings, the teamwork of our speakers and staff and the flexibility of our delegates allowed for a successful meeting. In fact, the HOD survey results told us most attendees enjoyed the virtual platform and thought it was handled efficiently. Delegates had a healthy and productive debate on many of the issues that face health care today. Here is a look at some of the resolutions that delegates either adopted or directed to PAMED's Board for decision or further study. Keep in mind that this is not an exhaustive list. Information on all the resolutions addressed at the 2021 HOD is available online at www. pamedsoc.org/HOD. Advocacy for Syringe Service Programs in Pennsylvania PAMED supports advocacy for syringe service programs across the Commonwealth. Delegates voted to support the legalization and public funding of syringe service programs and harm reduction programs throughout Pennsylvania. Promotion of Sexual Orientation in EMR and Intake Forms PAMED supports, as appropriate, the introduction and collection of gender identity, sexual orientation, chosen pronouns, and chosen names in the EMR, personal health records, and intake forms, insurance, and legal documents. PAMED will also identify available LGBTQ-focused cultural competency educational resources for members addressing the collection and use of sexual orientation and gender identity data in a confidential, sensitive, and respectful manner.

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YOUR CANCER BATTLE IS HER CANCER BATTLE. Remove PAMED Opposition to Single-Payer Health Care PAMED amended current policy 165.997 Managed Competition to remove language opposing single-payer systems. Expanding Access to Buprenorphine for the Treatment of Opioid Use Disorder PAMED will support efforts to eliminate the requirement for physicians to obtain a waiver while continuing training requirements to prescribe and administer buprenorphine for the purpose of treatment of opioid use disorder. Additionally, PAMED is directed to support the elimination of the yearly patient cap on the number of patients one provider can prescribe buprenorphine to in the emergency room setting. Lastly, PAMED will support ACGME expanded residency training opportunities on medication-assisted treatment for opioid use disorder in the acute outpatient setting.

“Cancer is an unexpected and unwanted illness. It will change your life forever in a way that no other illness can. You have the power within you to battle it and in the end, emerge as a stronger person. As your physician, I will help you uncover that strength. This is my passion, role, and duty as your oncologist.” – Lena Dumasia, MD New patients and second opinions will be seen within 24 hours, call 717.291.1313.

Medical Use on Psilocybin in the Pennsylvania Commonwealth Delegates voted in favor of PAMED supporting the revaluation of psilocybin’s status as federal Schedule I controlled substance and further directed PAMED to support the National Institutes of Health (NIH) in implementing administrative procedures to facilitate grant applications and the conduct of clinical research into other medical utilities of psilocybin.

703 L ampeter Rd. • L ancaster, PA 17602 L ancaster Cancer Center.com • (717) 291-1313 H. Peter (Tracy) DeGreen III, DO • Lena Dumasia, MD

COME VISIT LCDS!

PAMED Support for Women’s Reproductive Health Delegates voted to have PAMED acknowledge support of women’s reproductive health and the role of physicians in providing said care. More specifically, delegates directed PAMED to support decision-making with respect to reproductive rights and education so that women fully understand both the physical and psychological effects of their decisions in their reproductive health. PAMED has been directed to oppose legislative measures that interfere with medical decision-making or deny full reproductive choice, including abortion, based on a patient’s dependence on government funding. Delegates also voted to reaffirm exiting PAMED policies protecting the physician/patient relationship and supporting comprehensive health coverage.

Open House January 22 & March 26 from 12 - 3 p.m. Visit to learn more about our caring teachers, curious students, challenging academics and the many other opportunities LCDS students have for personal discovery and growth.

LCCMS would like to extend a special thanks to the physicians who volunteered to represent Lancaster County for this year’s HOD: Delegates: Robert K. Aichele, Jr., MD; Victor M. DaCosta, MD; Laura H. Fisher, MD; Robin M. Hicks, DO; Joy L. Long, MD; Stephen T. Olin, MD; Karen A. Rizzo, MD, FACS; & Danielle Rubinstein, DO; and Alternates: Rodney E. Brenneman, MD; Stacey S. Denlinger, DO; Sarah E. Eiser, MD; James M. Kelly, MD; and Christopher R. Scheid, DO.

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Member Spotlight

News & Announcements

Where do you practice and why did you settle in your present location or community?

I am an electrophysiologist at Penn State Health Milton S. Hershey Medical Center, a cardiologist who focuses on heart rhythm disorders. After I completed my training at the medical center, I quickly realized the value and breadth of care I could provide to the community by staying on as faculty, especially in areas like Lancaster where there is obvious need for such specialized health. By having a clinic at Penn State Health Lime Spring Outpatient Center, I get that opportunity and outreach. I have also been privileged to care for our veterans referred through the Lebanon VA Medical Center. I originally moved to Lancaster because I can appreciate the history and the evolution of a sprawling city. I love the variety of restaurants available as it reminds me of the years I have lived in other urban areas. I love being so close to a multitude of hiking trails to share with my puppies.

What do you like best about practicing medicine?

I like that I get to practice medicine. I see and feel the difference it makes. I strive to do what is right for the person, to establish trust, and to provide comfort. That is a gift I honor. I hope as my years progress in academics that I can be a mentor to future electrophysiologists and cardiologists through research and teachings.

Are you involved in any community, non-profit, or professional organizations? If so, please list the groups: I am currently a designated Fellow of the American College of Cardiology and a member of both the Heart Rhythm Society and the Pennsylvania Medical Society.

Gregory Burkman, MD

What are your hobbies and interests when you’re not working?

Penn State Health Lime Spring Outpatient Center

My dogs! I can’t spend enough time with them. Hikes are the best; it keeps us active, healthy, and together. I am also a skilled cook of savory dishes and bakery sweets. That means lots of different gadgets and cookware.

For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?

I joined the Lancaster City & County Medical Society through the Pennsylvania Medical Society because no other organization ensures and provides the education necessary for physicians to practice in accordance with current guidelines and needs. However, I came to truly understand the value of being a member when I had to transition my training apart from Hahnemann University Hospital due to its unfortunate and abrupt closure. The Medical Society held frequent forums, instruction, and guidance so that I could navigate the process protected and assured of my future. I believe in the mission of the Medical Society.

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News & Announcements

Frontline Group Spotlight

Community Anesthesia Associates

L-R: Dr. David Simons, President, CAA; Dr. Manda Null, Chair, department of anesthesia, UPMC Lititz; Dr. Ivan Shorter, Faculty, anesthesia residency program

ommunity Anesthesia Associates (CAA) is a long-standing provider of anesthesia services at UPMC Lititz Hospital. Our board-certified anesthesiologists take great pride in delivering a full spectrum of surgical, obstetrical, and non-operating room anesthesia care. Our physicians work collaboratively with a team of UPMC-employed anesthesiologists, certified nurse anesthetists, anesthesia residents, and anesthesia technicians. The practice emphasizes patient and surgeon satisfaction in delivering safe and efficient care. We focus on providing an outstanding patient experience by responding to the needs of our patients in a timely and compassionate manner. CAA was founded in 1983. The hospital units covered by the practice include the obstetrical suites, operating rooms, endoscopy, radiology, intensive care unit, and chronic pain suite. UPMC Lititz supports 24/7 in-hospital physician anesthesiologist coverage for emergency surgical and obstetrical care. Dr. David Simons is the president of CAA and is the program director for the ACGME-accredited UPMC Lititz anesthesiology residency program. CAA physicians are an integral component of the graduate medical education student and resident experience. They regularly participate in educating

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The practice of anesthesiology is evolving and ever-changing students and residents. Teaching responsibilities include case presentations, lectures, quality initiative projects, and other scholarly activities. The practice of anesthesiology is evolving and ever-changing. CAA physicians have embraced the exciting developments and advances in the delivery of safe and efficient care to our community. It is our pleasure to continue to support the Lancaster City & County Medical Society as a Frontline Group.

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News & Announcements

Deaths:

Paul retired from full time work in 2000, but briefly served as the Physician for the Pennsylvania Legislature in Harrisburg, PA. Throughout his career Paul was actively involved with the American Medical Association and served on the board of the American Cancer Society Lancaster Unit.

Paul R. Grosh, MD Paul Grosh, MD, 83, passed away peacefully, surrounded by loved ones, at Magnolias of Lancaster on October 5 after a nearly decade-long battle with Alzheimer’s disease. Paul was born on December 27, 1937 at Lancaster General Hospital to Dr. and Mrs. Joseph W. and Mabelle (Stultz) Grosh of Lititz, PA. Paul’s father ran his medical practice on the first floor of their home on the town square in downtown Lititz. With this front row seat, Paul became fascinated with medicine at a very young age, an interest that grew when a close family member was treated for a rare blood disorder.

Clarence H. Rutt, Jr., MD, FACS Dr. Clarence H. Rutt, Jr., of Lititz, passed away on October 10, 2021. He was 90 years old. Born in New Holland on February 20, 1931, he was the son of the late Clarence H., Sr. and Elva Sauder Rutt. He was the widower of the late Helen Althouse Rutt, whom he married on August 6, 1955, and shared fifty-eight loving years of marriage until the time of her passing on September 13, 2013.

Paul followed in his father’s and older brother Joe’s footsteps by enrolling at Franklin and Marshall College where he was a member of the Chi Phi fraternity. He graduated in 1960 with a major in pre-med. Later that year he enrolled at Hahnemann Medical College in Philadelphia, PA.

Clarence was a 1949 graduate of Lancaster Mennonite High School, a 1953 graduate of Eastern Mennonite College and a 1957 graduate of Hahnemann Medical School. He served in medical missions with Mennonite Central Committee in Indonesia from 1958 to 1967. Afterwards, he completed his surgical residency in Philadelphia in 1971 and moved to Lancaster. He was a General Surgeon from 1971-1996 at St. Joseph’s Hospital in Lancaster, Columbia Hospital and later at Lancaster General Hospital, where he assisted in heart surgeries. He retired from his medical career in 2000.

After graduating from Hahnemann in 1964, Paul began an internship at Lancaster General Hospital and was drafted into the military in 1965. He trained at Fort Sam Houston in San Antonio, TX, followed by a one-year medical position at the Pentagon in Arlington, VA. Paul’s service then took him to San Francisco, CA to board a troop ship bound for Vietnam, where he was a part of the Headquarters Company, serving in the rank of Captain as the Medical Platoon Leader.

Clarence was a member of the Mennonite Medical Association, the Lancaster City & County Medical Society, the PA Medical Society, and the American College of Surgeons. He held leadership positions in several of these organizations. He assisted in natural disaster recovery efforts in Indonesia, Pakistan and Haiti and sang with the Lancaster Franconia Choral Singers. He enjoyed woodworking, crossword puzzles, playing ping pong, playing water volleyball, bike riding and doing volunteer work.

During his time in Vietnam, Paul spent much of his time in the field on numerous operations with his fellow troops in a dangerous area known as the Iron Triangle. He was often transported into remote areas via helicopter, jeep, or armored personnel carrier to provide medical assistance to troops and Vietnamese civilians. He was subsequently awarded the Combat Medic Badge in May of 1967, an honor his father earned during the Battle of the Bulge in World War II. Paul was eager to resume his civilian medical practice and in 1968 he and his wife Carol Ann moved to Rochester, MN where Paul began a four-year residency in hematology and oncology at the Mayo Clinic. In 1972 they moved back to Lancaster, and joined the staffs at Lancaster General Hospital and Saint Joseph’s Hospital, and he also founded Hematology and Oncology Associates of Lancaster with Dr. John Grosh and Dr. Robert Gottlieb. The practice is still in existence today.

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LCCMS EVENTS 2 0 2 2

Saturday, May 7

Thursday, September 15

Spring Social & Foundation Benefit

Annual Dinner & Awards Celebration

Lancaster Country Club (outdoor)

The Inn at Leola Village Casa di Fiori

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FRONTLINE GROUPS WINTER 2022 Frontline Practice Groups (with three or more physicians) have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.

 Argires Marotti Neuro Surgical Associates of Lancaster

 P enn Medicine Lancaster General Health Physicians Family Medicine Lincoln

 Clinic for Special Children

 P enn Medicine Lancaster General Health Physicians Family Medicine Manheim

 Community Anesthesia Associates  Community Services Group

 P enn Medicine Lancaster General Health Physicians Family Medicine New Holland

 Dermatology Associates of Lancaster Ltd  Dermatology Physicians, Inc.

 P enn Medicine Lancaster General Health Physicians Family Medicine Norlanco

 The ENT Center  Eye Associates of Lancaster Ltd

 P enn Medicine Lancaster General Health Physicians Family Medicine Susquehanna

 The Heart Group of Lancaster General Health  Hospice & Community Care  Hypertension & Kidney Specialists

 P enn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

 Lancaster Radiology Associates Ltd

 Penn State Health Medical Group – Eastbrook

 Manning Rommel & Thode Associates

 Surgical Specialists of Lancaster – UPMC  Union Community Care

 P enn Medicine Lancaster General Health Physicians Diabetes & Endocrinology

New Members Elizabeth S. Doherty, MD Penn Medicine Lancaster General Health Physicians Family Medicine Buck Michelle L. Jordan, DO Penn Medicine Lancaster General Health Physicians Hospitalists Tonia R. Novosat, MD Penn Medicine Lancaster General Health Physicians Pain Management Tyler Murphy, DO resident, UPMC Lititz Graduate Medical Education Neva A. Ouilikon, MD Ouilikon Medical Associates PC Kyle Perezous student

Anne M. Ramsey, MD Penn Medicine Lancaster General Health Physicians Family Medicine East Petersburg Mossum K. Sawhney, MD Children’s Hospital of Philadelphia Mark J. Titi, MD Allergy & Asthma Center Dinara Triantafyllou, MD

 Union Community Care – Water Street Leigh Ann DeShong, MD Penn Medicine Lancaster General Health Physicians Geriatrics Gladys M. Frye, MD Penn Medicine Lancaster General Health Physicians Walter L Aument Family Health Center Michael W. Gish, MD Orthopedic Associates of Lancaster, Ltd. Kristen L. Hess, DO Penn Medicine Lancaster General Health Physicians Family Medicine Norlanco

Reinstated Members Caitlin A. Basile, MD Penn Medicine Lancaster General Health Physicians Family Medicine Norlanco Pamela J. Boimel, MD Penn Medicine Lancaster General Health Physicians Radiation Oncology

John A. Hoover, MD Penn Medicine Lancaster General Health Physicians Family Medicine Norlanco Tiara M. Heisey James, MD Penn Medicine Lancaster General Health Physicians Family Medicine Abbeyville Seth M. Katz, MD Lancaster Emergency Associates Ltd

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Kari L. Oftedal Moreno, MD Penn Medicine Lancaster General Health Physicians Family & Maternity Medicine Christopher J. Putney, MD Penn Medicine Lancaster General Health Physicians Family Medicine Strasburg Michael J. Reihart, DO, FACEP, FAEMS Lancaster Emergency Associates Ltd Andrea L. Stern, MD Penn Medicine Lancaster General Health Physicians Family Medicine Mount Joy Michael J. Walker, MD Penn Medicine Lancaster General Health Physicians Family Medicine Willow Street

The

FIRST PLACE to turn for CARE.

Cold and flu season is here. Your UPMC primary care team is the first place to turn to for treatment of cold symptoms, earaches, coughs, stomach aches, and rashes. Your doctor’s office can help you with the best care option, whether it’s an in-person or a video visit. And the UPMC Central PA portal provides on-demand video appointments with UPMC providers. For more information about our care options, or to find a doctor, visit UPMC.com/CentralPARightCare.

Lancaster Physician Winter 2022

Articles from Lancaster Physician Winter 2022