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MCMS

Fall 2013

Official Publication of the Montgomery County Medical Society of Pennsylvania

PAMED annual House of Delegates Meeting

Concussions: Diagnosis isn’t as cut & dry as it may seem

Proposed 2014 Physician Fee Schedule Impact


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Contents FALL 2013

2013-2014 MCMS BOARD OF DIRECTORS Stanley Askin, MD Frederic (Rocky) Becker, MD Immediate Past President

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Suzanne Ben-Kane, MD Charles Cutler, MD

Genesis of a Story

Madeline Danny, DO President

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Tita de la Cruz President, MCMS Alliance

James A. Goodyear, MD

Concussions

Immediate Past Chairman

George R. Green, MD Dennis Jerdan, MD

Educating Community

William W. Lander, MD Mark A. Lopatin, MD Robert M. McNamara, MD Rudolph J. Panaro, MD Mark F. Pyfer, MD Chairman, Public Relations Committee

Jay Rothkopf, MD Treasurer & Chairman, Finance Committee

Carl F. Schultheis, Jr., MD Scott E Shapiro, MD Chairman, Board of Directors

James Thomas, MD President-Elect

Martin D. Trichtinger, MD Chairman, Political Committee

Patricia Turner Practice Manager

MCMS Staff Toyca Williams Executive Director

montmedsoc@verizon.net MCMS Physician is a publication of the Montgomery County Medical Society (MCMS). The Montgomery County Medical Society’s mission has evolved to represent and serve all physicians of Montgomery County and their patients in order to preserve the doctor-patient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and health care within the community, Montgomery County and Pennsylvania.

Features 6 7 8 10 12 13 14 15 17 18 22 23 24

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Physicians Continue to Learn About Concussions Meet Your MCMS President– Madeline A. Danny, DO From Thought to Paper: Genesis of a Story A Legacy of Healing: Remembering William Stepansky Communication Important in Hospitalist Model Political Update:What’s Happening on the Hill PPACA Updates How the Proposed 2014 Physician Fee Schedule Impacts Physicians Smart Banking Put Health and Fitness Into Your Desk Job Year-round Montgomery County Medical Society Speaks Out On Healthy Living Educating Community: Montgomery County Health 4 Chairman’s Remarks Department Services 5 Editor’s Comments Pennsylvania’s Physicians 27 Membership News Health Programs & Announcements

In Every Issue

MCMS Physician is published by Hoffmann Publishing Group, Inc. Reading, PA I HoffmannPublishing.com I 610.685.0914 I for advertising information: karen@hoffpubs.com


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Chairman’s Remarks

We’re proud to present MCMS Physician

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ou see the face of medicine in your health care provider. Physicians examine the body of medicine in each patient.

The editor of this magazine, Jay Rothkopf, MD, will share how he uses his love for writing to balance the challenges he faces every day as an internist working with critically ill patients. PAMED Legislative Counsel Scot Chadwick will provides an update on legislative matters that may affect the scope of practice and a patient’s treatment of care. Montgomery County Health Department will provide helpful information to address public health needs in the community. MCMS and the physician community were instrumental in helping to establish your public health advocate in Montgomery County. MCMS provides several services to its members through the Howard F. Pyfer Fund and the MCMS Medical Student Scholarship Fund. The late Norristown physician Dr. Howard Pyfer created a provision upon his death to assist young physicians in medical education by providing reimbursement for courses taken. Through our partnership with the Pennsylvania Medical Society, a host of benefits are also provided such as patient safety and risk management CME, a physician reimbursement and practice economics resource, and third party payer advocacy.

Together, we make up an important team in addressing the health care needs of this community and the changing healthcare environment. For more than 165 years, the Montgomery County Medical Society (MCMS) has been a pillar in the community, advocating passionately about safe and quality health care for the profession and most importantly, the patients. We are proud to present MCMS Physician, a quarterly magazine, to Montgomery County physicians and their patients. This magazine will further organized medicine’s commitment to the preservation of the doctor-patient relationship and the maintenance of safe and quality care. It will serve as one tool in communicating with MCMS members as well as the community at large by providing comprehensive information on issues concerning quality health care in Montgomery County. Montgomery County is very fortunate to have a wealth of health professionals to take care of the medical needs of this community.

We hope these connections will enhance, engage and expand a successful health care team among physicians, mid-level providers, managing staffs and patients. Through effective communication, MCMS Physician will share how both communities can work together to live well and understand the changing health care environment. As a strong health care team, we look forward to a winning season. If you want to join the voice of medicine, contact MCMS, 610-878-9530 or email montmedsoc@verizon.net.

With its distribution throughout Montgomery County, MCMS Physician will educate the patient community about the role of the physicians, professionally and personally. Each quarter, physicians will share what is happening in the profession, educate the community on various health-related topics, and provide a personal glimpse in passions outside medicine.

I look forward to the dialogue. Scott E. Shapiro, MD Chairman, MCMS Board of Directors

montmedsoc.com

I would love to hear from you. If you have suggestions, general comments or ideas for future issues, please email Scott E. Shapiro, MD or the MCMS Executive Director Toyca Williams, montmedsoc@verizon.net. MCMS

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In future is to contin sues, I hope u interestin e to provide stories a g and engaging bou our com t our patients, mun our profe ity, and ssion.

Editor’s Comments

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Hello and Welcome

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his is the first of hopefully many issues of a new magazine by Montgomery County Medical Society. My name is Jay Rothkopf, M.D., and I am pleased to serve as editor for this publication. It is a challenging time for the medical profession. Erosion of autonomy, declining reimbursement, and regulatory uncertainty have complicated the process of caring for our patients. With MCMS Physician, our goal is to not only focus on the many issues important to us, but to shine a light on the more human side of what it means to be a doctor. We look forward to having you along on this journey. So, where to begin? There’s an old Chinese proverb: May you live in interesting times. I think we can all agree that for doctors in 2013, this adage more than applies. Our profession lies at a crossroads. The ACA, HIPPA, EHRs, tort reform; with what seems like alphabet soup, it can be easy to lose sight of what drew us to medicine in the first place. Oftentimes, our days are steeped in frustration over things that we can’t control; despite touching many lives on a daily basis, we need an escape.

Our first issue jumps right in with a profile of two physician authors. Exploring passions outside medicine, it will serve to highlight the importance of having a hobby. The first article, which I penned, details my experiences over the past year putting together a science-fiction trilogy “from scratch.” The second, titled “Last Family Doctor,” by brothers Paul E. Stepansky, Ph.D. and David W. Stepansky, M.D., details the memoir of their father, who was a physician in Trappe, PA. Things are changing, and we must rise to meet the challenge. Organized medicine will play a vital role in that, but our collective commitment is essential. Also included is the HOD Sidebar, which will list the members of the MCMS delegation and provide an opportunity to hear from our delegates as they “sound off.” We also hope to highlight the ways in which your dues are being put to use to advance not only the profession,

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but the community as well. As such, our first issue details the practice management seminars held in both the fall of last year and the spring of 2013, as well as a regional collaboration with other county medical societies, also held this past spring. Another vital part of our mission is educating the community; through such venues as group presentations and individual speaking engagements, we hope to further knowledge and understanding amongst our patients. We will also discuss services offered by the Montgomery County Health Department, along with a brief overview of its history. No less important is our political update: It will feature commentary on legislation in Harrisburg which affects the profession, as well as the status of our efforts. Each issue will also feature a spotlight on philanthropy and an article on health-related topics that we can share with our patients, both directly and in our waiting rooms. Our sponsors USI Affinity, PMSLIC, and TD Bank have also generously agreed to contribute articles on such topics as how to effectively communicate with your physician and other educational pieces; they also offer multiple services in which our members can participate. Our debut issue also features a welcome list of new members for 2013. We also feel it is important to highlight donations to the MCMS Medical Student Scholarship Fund, which is made in honor of deceased members. We invite the membership to join us in gift-giving with a spotlight on our Toys for Tots program, which has been a mainstay of MCMS’s annual holiday dinner each December. It’s a lot to digest, but I’m very excited about the potential of this magazine. In future issues, I hope to continue to provide interesting and engaging stories about our patients, our community, and our profession. With that in mind, I want to hear from you: tell us what you want to see, and we’ll do our best to make it happen. This publication is for you, the readers. I hope you enjoy it.

Warm regards, Jay Rothkopf, MD

Editor

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COVER STORY

Physicians Continue to Learn About Concussions DIAGNOSING CONCUSSIONS AND POST-CONCUSSION SYNDROME ISN’T AS CUT AND DRY AS IT SEEMS

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ome concussion sufferers feel fatigued, others feel dizzy. Some hear ringing in their ears, others suffer more subtle symptoms. “That can be a problem,”said Dr. Brad Klein, medical director at Abington Headache Center and a member of the Montgomery County Medical Society. “Because there are no routine tests available that show damage to the brain, we rely on the patient’s symptoms to determine their injuries,” Dr. Klein said. “This can make it difficult for friends, family, coaches, teachers, colleagues, and/or bosses to understand and appreciate what they are experiencing.” Contact sports such as football and post traumatic brain injury among military personnel have increased the public’s awareness of concussions. Dr. Klein said scientists are developing

specialized imaging called Diffusion Tensor Imaging (DTI). This will allow for 3D imaging of individual nerve fiber tracts in the brain by tracking the flow of water through nerves. When nerves are sheared, we may be able to see the problem on the imaging, Dr. Klein said. “It is hard to predict when this will be available for prime time, as the technology continues to evolve and improve further,” Dr. Klein said. “I am hoping within the next few years we begin to see this technology used.” Other imaging tests exist for brain injury evaluation but do not offer as much detail as DTI, Dr. Klein said. One such test is the Positron Emission Testing (PET scan), which helps people with traumatic brain injury demonstrate decreased glucose (sugar) use, even if they are still conscious. MCMS

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It is sometime difficult to tell if someone has suffered a concussion. You do not have to pass out or lose consciousness. Symptoms include headaches, blurry vision, nausea, balance issues, memory complaints, and poor concentration. Dr. Klein said people can also become depressed or anxious. He has seen people’s personality change, including people who were outgoing become more reserved. While most symptoms resolve in a few weeks, some symptoms persist. If you think you have suffered a concussion, Dr. Klein recommends a visit to your physician. While the best method of recovery is rest, physicians can prescribe medication if symptoms persist after several weeks. “It’s like when you have a bruise or cut (on your skin),” Dr. Klein said. “Just like a cut, you need to give your brain time to heal.”


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Meet Your MCMS President– Madeline A. Danny, DO

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adeline A. Danny, DO, a board certified internal medicine physician, serves as the president of the Montgomery County Medical Society (MCMS), a 166-year-old organization that has a history of helping physicians adapt to the changing health care environment. Dr. Danny is the first osteopathic physician to be inaugurated as president. She is currently serving the second year of a two-year term. As the national debate continues about how to make health care more efficient and cost effective, Dr. Danny said it is important that physicians take a lead role in shaping modern health care delivery.

“We are currently taking action under the advisement of the state medical society to address the urgency of the situation in the best interest of our patients,” Dr. Danny said. “The physician is the ultimate voice and patient advocate. It is important for Montgomery County residents to know that there is a real wealth of medical resources in our community.” Dr. Danny has treated patients with diverse backgrounds and ages, ranging from 18 to 105 years old. She hopes to address access to patient care issues in a county that has changed dramatically over the past few decades. Dr. Danny, a native of South Bend, Ind., comes from a family of

physicians. Her father, Peter S. Danny, DO, practiced ophthalmology and otorhinolaryngology for 35 years. Dr. Madeline Danny is a 1982 graduate of Purdue University, West Lafayette, Ind., and a 1986 alumna of the Chicago College of Osteopathic Medicine, Hyde Park, Ill. She and her family moved from Chicago to Philadelphia. She began her private practice in 1991 after completion of her residency at Bryn Mawr Hospital. Dr. Danny is an active staff member of the Main Line Health System. Her son Andrew P. Rothstein was born in Norristown at Suburban General Hospital. He is a graduate of the Rubenstein School of Environmental Science, University of Vermont, class of 2011.

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From Thought to Paper: Genesis of a Story BY JAY ROTHKOPF, MD

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was sitting in rush hour traffic on the drive home from work. As usual, Route 202 North was jammed right at 29, the heart of the construction zone. Realizing I was going nowhere fast, I flipped on NPR. The news had concluded, and “All Things Considered” was featuring a local author. I don’t remember her name, but the work of fiction upon which she was laboring got me intrigued. The basic plot involved a change in the speed of the earth’s rotation, which made the days and nights something other than 24 hours. What an interesting idea, I thought. And so, inching along at an average speed of five miles per hour, the wheels began to turn. By the time I made it home, a plot was born. I’ve always been interested in writing, but I’d never seriously contemplated attempting a novel, let alone three. Somewhere at my parents’ house lies a folder filled with bits and pieces of stories that had been started but

then cast aside. From the modern age to the space age, I’d always had ideas, but like so many before me, I’d fallen into the quintessential trap of getting exciting about the idea of writing, but never quite being able to get the rubber to meet the road. This time, however, was different. I can’t begin to tell you why, but I knew it from the get-go: once started, I would see it through. Maybe it was the fact that I was older, maybe – and this is my theory – my training as a physician, which is based in part on solving problems, wouldn’t let me quit. Whatever the reason, I knew it would be big. And so, after numerous discussions with my wife, I got to work. It wasn’t as easy as I thought...and that was just for starters. That first day, I rolled up my sleeves, put on some soft music, and sat down at my desk, a blank piece of paper and a pen before me. I had written one previous novel, a piece of autobiographic fiction, but relatively speaking, that had been easy: I’d MCMS

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had my previous life experiences upon which to draw for a plot. This time, I was starting from scratch. I knew where to begin, and where I wanted to end up, but had absolutely no idea how to get there. After an hour of sitting, the paper was still blank. So I decided to go for a walk. Back in eighth grade, a creative writing teacher said that to write successfully you had to “let your imagination go wild.” It sounded good at the time (and still does), but the question is: how? I didn’t know the answer then, but I do now: it’s to find your “theater of the mind.” What’s that, you’re wondering? Simple...it’s “the zone,” the place you go to get out of your head, to let the ideas flow. It’s different for everyone, but we’ve all been there. For me, it’s slipping on a pair of headphones, going for a walk, and listening to good music. Somehow, it works; my mind wanders along with my feet, and voila! The magic happens. And it did. After a good mile and


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a half, I had the basic outline I was looking for. I headed home, and with a renewed sense of determination, picked up my pen once more. A year later, I finally finished not one, but three books. My original idea had grown into a trilogy, and no one was more surprised than me. A week of writer’s block ten days in had burst into a creative tidal wave. I had the main idea, a prequel, and a sequel. There’s still more to do (editing, for example), but the sense of achievement was profound. I remember thinking about some of the major milestones in my professional life: graduating medical school, completing residency, passing the boards; the sensation was similar, of having done something unique, entirely my own. My passion for writing started with my late father. Always a lover of science fiction, he often rolled his eyes in disdain at what, as a kid growing up in the 80s, I considered great stories: MacGyver, V, the novelizations of the British sci-fi serial Doctor Who. In high school, I discovered the genre of horror, and ran around my house singing the praises of Stephen King, Dean Koontz, and Robert R. McCammon. That did it. To one who had grown up with the classics – Ray Bradbury, H.P. Lovecraft, Isaac Asimov, Arthur C. Clarke, Poul Anderson, and Frank Herbert, to name a few – my professions of love for novels such as It and The Stand were more than he could take. Determined to refocus my definition of “great literature,” he handed me a couple of books: Something Wicked This Way Comes (Bradbury) and Childhood’s End (Clarke). At first I read them with indignation; where was the violence, the raciness, the profanity that made a great writer? And then it hit me: you didn’t need any of that if you had a decent story. It’s the main difference between commercial writing and acclaimed writing, and as cliché as this sounds, it was very much a defining moment. I was hooked. After spending my last two years of high school plowing through his library

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of first editions, my initial belief that modern-day mainstream writers had ripped off the classics had been thoroughly washed away. By senior year, I was ready to give it a whirl...so I started a story. Today, at 37 years of age, I don’t even remember what it was about. Perhaps it was an astronaut who returns to Earth after three days in space to find a radically changed world, or something like that. Anyway, I never finished. My next attempt was far less bold. Like its predecessor, I don’t remember much of the plot, only that this time, I tried to write an outline first. It ended up in a drawer, unfinished and forgotten. To this day, I can’t even recall the title, the paper itself long since thrown in the trash.

“There were times when I was so desperate to finish a scene that I would wrack my brain until I literally had a splitting headache...”

College came, followed by med school, and whatever time I had previously put aside for penmanship quickly disappeared beneath a flurry of classes, exams, and clinical rotations. Life went on: marriage, two children, the death of my mother-in-law and father, a personal illness, but the pull to go back to writing never completely faded. There was no specific trigger that made 2012 the year, but the year it was. In September, I got started. The process was harrowing, to say the least. I had not only seriously underestimated the amount of time it would take to accomplish, but also the raw effort. To most, imagination is relaxing, fun, a way to escape from everyday life. When it comes to writing though, it’s simultaneously your best friend and worst enemy. The journey from start to finish was anything but smooth; oceans of creativity were

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interspersed with deserts of writer’s block; ideas which seemed interesting and dynamic at first glance became superficial and rote upon a fresh viewing the following morning. There were times when I was so desperate to finish a scene that I would wrack my brain until I literally had a splitting headache which only a good night’s sleep could cure. I tried to keep to a schedule, but conjuring fiction is like turning lead into gold: it can’t be done. By the time I’d finished the first story – exhausted, haggard, drained – I wanted to quit, but didn’t. There was still number two, then three. The second one was easier, maybe because it was the “original” idea, the one I had wanted to write all along. Like its predecessor, there were good days and bad; my work schedule, seven on /seven off, became a yin-yang of flipping between “medicine” and “writing” modes. My “off” weeks were a blur; I wrote as much as eight hours some days, stopping only for meals, exercise, and playtime with my kids. My wife was incredibly patient, but also frustrated; what was this obsession that kept me in the library for hours at a time, curled up with my ipad and wireless keyboard? It’s hard for me to explain; the best analogy would be that the stories were my babies, something I had created, nurtured, and felt responsible for. Eventually, part two was wrappedup, and it came down to the final stretch. At first, the third story terrified me, mainly because I had only a vague, back-of-the-paper-napkin sketch to build upon, but somehow, it unfolded. I still can’t tell you how I was able to connect the dots; it just happened. For some unknown reason, as I approached the end, terror morphed into relaxation, and the pressure faded. I almost lingered, not wanting it to be over. By July of 2013, way ahead of schedule, it was completed. The next task is editing, something I’ve decided to do at a much slower Continued on page 10


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pace. A page here, a chapter there, and then maybe, who knows? Every amateur writer dreams of sitting atop the New York Times bestseller list, or maybe landing a starring role in their story’s movie adaptation, but I’m not that naive. While I definitely plan to “get them out there,” it’s more from a desire to have the world as my sounding board than any fanciful illusions of monetary success. Or as the saying goes, “it would be nice, but I’m not quitting my day job.” Even if they never see the inside of a bookstore,

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the journey is more than worth it, and that’s why I keep going. Speaking of which, has the process of writing had an impact on me as a physician? I’d like to think yes. How? It’s difficult to explain, yet something I’ve spent a fair amount of time thinking about. I guess I would say I’ve gained a better understanding of thoughts, words, and the ways in which expression guides human interaction. Attempting to write “real” dialogue – i.e., how people actually talk – requires a fair amount of concen-

tration and awareness. That awareness has helped me see the places where I can do it better, from answering a nervous patient’s questions about a test result to sitting down with a family to talk about end-of-life. Yes, I would say it has and continues to mature me. One can make a similar claim about any hobby for which one has passion, but this is where I’ve seen a difference. That, and learning a little more patience. It takes time to write a book; the road is long, and if you can’t see the big picture, you won’t get there. Kind of like becoming a physician.

A Legacy of Healing: Remembering William Stepansky PAUL E. STEPANSKY, PH.D. & DAVID W. STEPANSKY, M.D.

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ur father, William Stepansky, whose fascinating story is recounted in The Last Family Doctor: Remembering Our Father’s Medicine (Keynote Books, 2011), planted his shingle in Trappe, then a farming town of about 1,000, in September, 1953. The son of Jewish refugees who fled the Kievan Pogroms in 1921, he was six months old when his family docked at Boston Harbor in early September, 1922. A surgical tech in the European theater, a licensed pharmacist, a gifted violinist who studied with Emmanuel Zetlin of the Curtis String Quartet, our father practiced general medicine until his retirement 40 years later. Primary care physicians today continue to espouse generalist values,

but they practice far less procedural medicine. Even within the realm of postwar general practice, our father was remarkable: His practice encompassed pediatrics, internal medicine, cardiology, dermatology, podiatry, many ENT procedures, urology (e.g., passing a set of urethral sounds), gynecology, and psychiatry. He took and read his own EKGs. His specialist knowledge of hypertensive medicine led to appointment to the faculty of Jefferson Medical College, his alma mater, in 1964 (with promotions in 1966 and 1970); he gave one afternoon a week to the school’s hypertension ambulatory care clinic for more than a decade. In his office he performed what amounted to major

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minor surgery: setting fractures with plaster of Paris; dissecting-out invasive skin lesions; reattaching the top joint of fingers and toes severed by lawnmowers; cleaning, irrigating, and suturing deep and jagged wounds arising from farming accidents; and performing nerve blocks for extensive repair of the extremities. He administered complicated intra-articular injections and performed successful skin grafts in the office. He assisted in major operations at the hospital. Beginning in 1956, he did his own allergy testing and treatment,


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physician’s recommendations. Most patients no longer expect their providers to be paternalistic authority figures; they want physicians receptive to their input; they want to be members of the healthcare “team.” ac Many lessons can be drawn from this transformation, one of which is perhaps the greater need of contemporary , if generalists to be yo t educators than generaists of our father’s generation. y The downside of 60 years of medical progress is the greater difficulty getting to know patients as our father did: from top to bottom, from the inside out, psychologr his postwar cohort had the ically and medically. He and privilege of being inefficient. Our father took his time with his patients; he scheduled double sessions to provide supportive psychotherapy; he made daily house calls, met family members, and attended family events. The medical world of today is very different. The scrutiny of physicians by regulatory agencies; the everpresent threat of medical malpractice; and the stress on efficiency – these things have made it more challenging to provide the emotional support patients require. The comfortable and inviting consulting room in which William Stepansky invited patients to speak with him, intimately and often at length, has been replaced with the all-purpose exam room in which the physician, perched on a stool, interacts with the patient while entering information on a laptop computer. Make no mistake: Physicians continue to form and maintain special relationships with their patients. But the challenges are greater, and they call for flexibility and even imagination. This makes it all the more important to have before us the example of William Stepansky, who, working in a more facilitative environment, embodied the scientifically-guided healing art. Contemporary generalists cannot recapture his style of practice, but they can adopt to their own circumstances his lifelong commitment to his calling, his embracing humanity, and his understanding of the healing power of the doctor-patient relationship.

desensitizing patients with serums he prepared with concentrate supplied directly from the manufacturer. Our father’s obstetrical practice of the 1950s and 60s included the delivery of babies at Montgomery Hospital, but also, when nature demanded, outside it. He delivered babies in cars outside his office and in his waiting room. Among parturients who never made it to the hospital, one was a farmhouse delivery in the middle of the night. The latter would be unremarkable but for the fact that the newborn presented as a footling breech – a bonafide obstetrical emergency – and he managed a successful vaginal delivery without anesthesia and with the aid only of the parturient’s husband and mother. The evolution of our father’s medicine into contemporary primary care medicine – the latter embracing family medicine, general pediatrics, and general internal medicine – has both an upside and a downside. The upside is the flipside of the stunning technological progress of the past half century. The modernity of our father’s medicine looked backwards to medical advances made during World War II; it resided in things like childhood vaccination, routine obstetrics, the treatment of infectious disease, wound management, the setting of fractures, and the psychodynamic and pharmacological treatment of anxiety and depression. But consider all that is missing from this picture. During the first half of our father’s practice, there were no CT scans or PET scans or MRIs to order; no multidisciplinary pain clinics to refer patients to; no laparoscopic or laser-assisted or computer-guided or micro surgery. Transplant surgery was in its infancy, with the first kidney transplant in 1963 and the first heart transplant in 1967. Cancer treatment was, by current standards, primitive. Heart disease was managed with bed rest and a limited number of standard drugs, and laboratory studies were fewer and more basic in nature. So the broad-based procedural competence of postwar general practitioners like William Stepansky was predicated on a medicine far removed from the high-tech, subspecialized world of today. And who among us would give up these advances for the more quiescent world of our father’s medicine? Contemporary generalists – excepting those who serve remote rural areas – no longer cultivate a broad range of procedural skills. Their challenges are different: to solve diagnostic dilemmas and care for patients with severe and often multiple chronic illnesses, all the while functioning as “care coordinators” and “gatekeepers” overseeing specialty and subspecialty care. “Staying current” in a world of drug formularies, practice guidelines, and evidence-based medicine is a far cry from staying current a half century ago. No less importantly, medical practice has been dramatically affected by the evolving nature of public expectations. The skeptical world of today is a far cry from the deferential world of our father’s medicine. Patients now come to their doctors armed with information from the internet, eager to discuss their health and all too willing to question their

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Communication protocols can include: A method for the outpatient physician to discuss with patients how the hospitalist will be involved in care A plan for the outpatient physician to communicate with the hospitalist at or near the time of the patient’s admission A plan for sharing treatment and discharge information

Communication Important in Hospitalist Model BY KAREN DAVIS, RISK MANAGEMENT PMSLIC INSURANCE COMPANY AND THE NORCAL GROUP

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ospitalists are becoming well established in the U.S., and the concept of hospital medicine has expanded to pediatrics, obstetrics, and some other fields. Recognized benefits of the hospitalist model have fostered its quick and enthusiastic acceptance across the country. However, one concern about the hospitalist model is that it intentionally disrupts the continuity of care. Risk management experts often advise physicians to concentrate on the continuity of patient care because gaps in physician-patient communication can lead to bad outcomes. The hospitalist model has the potential to disrupt continuity of care by setting up a deliberate break in communication between the patient and his or her usual physician in the form of the transfer to another provider – the hospitalist. Robert M. Wachter, MD, who

coined the term “hospitalist” and who has been a leader in the development of the hospitalist concept, notes that from the early days, organizations using hospitalists have had to “[focus] on ensuring a smooth ‘hand off’ to prevent any ‘voltage drops’ at the inpatient-outpatient interface.”1 Because the transfer is premeditated, physicians can develop protocols to bolster and protect communication. Hospitalists and outpatient physicians should discuss the potential for communication failures and make specific plans for transferring patients and for communicating about the care they each render. Communication is especially crucial when new information about a patient becomes available after the patient has been discharged from the hospital. How does follow-up occur when, for example, a tissue sample

A plan for the hospitalist to be available to the patient if needed between discharge and the first visit back to the outpatient physician A plan for the hospitalist to phone the patient after discharge Any other procedures that facilitate clear and timely interaction between the patient and the physicians involved in care

evaluated as benign is subsequently interpreted as showing malignancy? Because follow-up is a known risk area, it is a good strategy to have a protocol for notification when new information comes to light after a patient is discharged. A good protocol has provisions for notification of both the outpatient physician and the patient. Hospitalists and the physicians who refer patients to them should think about areas where their communication with each other and with patients might be vulnerable to collapse. Any actions they can take to identify and diminish risks will improve patient care and decrease the likelihood of lawsuits. Reference 1. Wachter RM. The state of hospital medicine in 2008. Medical Clinics of North America. 2008;92(2):265-273.

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

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Political Update:What’s Happening on the Hill PENNSYLVANIA MEDICAL SOCIETY LEGISLATIVE UPDATE SEPTEMBER, 2013 BY SCOT CHADWICK, LEGISLATIVE COUNSEL, PAMED

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ith the enactment of the annual state budget on June 30th, the General Assembly recessed for the balance of the summer and returned to Harrisburg on September 23rd. A busy fall is anticipated, though the legislative appetite for controversial issues will wane as the year winds down and members start gearing up for next year’s elections in their newly-reapportioned districts. Speaking of the 2013-2014 state budget, this was the third consecutive year during Governor Tom Corbett’s administration that the annual spending plan was completed on time. The $28.4 billion budget represents a 2.3 percent spending increase over the prior fiscal year. While the budget was finalized in a timely manner, the legislature failed to address three major priorities of the Governor: tackling PA’s transportation infrastructure needs, liquor privatization, and pension reform. All three

issues remain unresolved. Medicaid expansion also remains unresolved as language within the Welfare Code requiring Governor Corbett to move forward with an expansion of Medicaid under the Affordable Care Act was stripped by the House. Moving on to other health carerelated issues, sooner or later all tort reform initiatives have to pass through the Senate Judiciary Committee, where they generally never see the light of day. That problem has been solved this session, at least for PAMED’s apology bill. Senator Pat Vance (R-Cumberland) shrewdly attached the measure to a bill (SB 379) extending the life of the CHIP program, which was referred instead to the Senate Banking and Insurance Committee, chaired by tort reform champion Don White (R-Indiana). Senator White’s committee promptly approved the measure, and the Senate subsequently amended and passed it 50-0. The House Judiciary Committee

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gave its stamp of approval in late June, and a House vote is anticipated early this fall. The bill would make physician apologies and other benevolent gestures (except outright admissions of fault or negligence) to patients after a poor outcome inadmissible by plaintiffs in medical liability lawsuits. Scope of practice is always on the front burner in Harrisburg, where non-physician providers regularly seek legislative permission to expand what they can do. In July, Senator Vance introduced Senate Bill 1063, legislation that would entitle CRNPs to practice independently, to be recognized as primary care providers under managed care and other health care plans, and to be reimbursed directly by insurers and other third-party payers. The proposal would also take priority over the authority of the Department of Health and the Department of Public Welfare to regulate the types of health care professionals who are eligible for medical staff membership or clinical privileges, along with the authority of a health care facility to determine the scope of practice and supervision or other oversight requirements for health care professionals practicing within the facility. PAMED opposes the measure, and is considering an alternative proposal focusing on the team-based patient care model. Another key initiative for PAMED is the creation of a statewide controlled substance database. Representative Gene DiGirolamo (R-Bucks) has introduced House Bill 317, legislation that would require dispensers (primarily pharmacists) to enter filled prescriptions of scheduled drugs into the database and permit physicians to access information regarding their patients. Rep. DiGirolamo introduced similar legislation last session, which was approved by the House Human Services Committee but went no further. However, PAMED’s “Pills for Ills, Not Thrills” campaign has generated significant support for a CSDB in the governor’s office and legislature, and we are optimistic that a good bill can be enacted this year.


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PPACA Updates A REVIEW OF KEY PROVISIONS AFFECTING EMPLOYER-SPONSORED COVERAGE THAT ARE INCLUDED IN THE COMBINED LEGISLATION. USI AFFINITY WILL CONTINUE TO PROVIDE UPDATES ON THIS TOPIC

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n early July, the Obama Administration announced a delay in the Employer Mandate portion of the Patient Protection and Affordable Care Act (PPACA). This delay has reignited the debate on Health Care Reform and caused a significant amount of confusion about what has been delayed and what will continue to go into effect in January 2014. While this has a significant impact for employers of over 50 lives in 2014, it is important to realize that this is merely a delay. Depending on whether or not transition rules apply, it may become effective for all employers over 50 employees on January 1, 2015. Now that the focus has been taken off large employers, much of the attention is on the small and individual marketplace. January 2014 will begin the implementation of the Employer Mandate which requires individuals to pay a tax if they do not have qualifying

health insurance. Much of the individual enrollment will be processed through the exchange programs. Exchanges are scheduled to open October 1, 2013 with coverage effective January 1, 2014. The delay does not impact an individual’s ability to receive a premium tax credit in the Exchange (also called the Health Insurance Marketplace) if s/he satisfies certain household income requirements and is not eligible for affordable, minimum value coverage and is not enrolled in minimum essential coverage. The Exchanges are primarily designed to process subsidies. Subsidies are available to individuals within 100-400% of the Federal Poverty Level without access to affordable, minimum value employer plan. Since the employer penalties are delayed until 2015, employers will not be penalized based on an employee’s eligibility for

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a subsidy in 2014. The Exchange is required to verify applicants’ attestations and determine whether applicants are eligible for a subsidy. Part of this process requires the Exchange to contact employers to determine whether the applicant is enrolled in an eligible employer-sponsored plan or is eligible for employer-sponsored affordable, minimum value coverage. However, this verification has also been delayed until 2015. In addition to the subsidized care, the implementation of PPACA will have a significant impact on small group health insurance. Small insured group health plans must offer essential benefits, limit deductibles (cannot exceed $2,000/individual, $4,000/ family), and limit benefit offerings to Metallic Plans. Insurance carriers will be subject to new underwriting rules for small, insured groups. Instead of using experience rating, carriers will use community rating and rating restrictions will be restricted to (a) benefit coverage elected (plan and tier), (b) geographic area, (c) age, limited to a ratio of 3 to 1 for adults, and (d) tobacco use, limited to a ratio of 1.5 to 1. These changes will have a dramatic positive and negative impact to pricing in the small market. One major issue to watch for in the next year will be the future guidance on discriminatory plan designs. While the discrimination rules were due to be implemented in 2011, we have been waiting on guidance on how the rules will be applied. USI Affinity will continue to provide updates on this topic. Please feel free to contact a USI Affinity representative to see how this Health Care Reform will affect your business. Your Association’s liason contact is Jim Pitts. Reach Jim at USI Affinity’s Headquarters toll free at 800.265.2876 x11377.


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pamedsoc.org

to learn more about the proposed rule

Complex Chronic Care Management

How the Proposed 2014 Physician Fee Schedule Impacts Physicians BY MARY ELLEN CORUM, DIRECTOR PAYER RELATIONS, PAMED

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he proposed 2014 Medicare fee schedule for physician services, which the Centers for Medicare and Medicaid Services (CMS) published on July 19, 2013, provides a preview of changes in Medicare programs and policies. Here are some of the key provisions in the proposed rule that may impact physicians.

Fee Schedule RVUs/SGR The proposed rule does not include any provisions for an update to fees or

the sustainable growth rate (SGR). In March, CMS estimated the fee schedule update would be-24.4 percent. H.R. 2810, which passed by a vote of 51-0 through the Energy and Commerce Committee, will come to a full vote of the House upon Congress’s return in the fall. The bill has several elements, but starts with repealing the SGR and providing five years of stable Medicare payments beginning next year, with reimbursements growing 0.5 percent for each year between then and 2018.

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CMS is developing and implementing a number of initiatives to enhance care coordination for Medicare beneficiaries. Currently, payment for non-faceto-face care management services is included into the payment for faceto-face evaluation and management (E&M) visits. However, the E&M codes do not reflect all the services and resources required to furnish the kind of comprehensive, coordinated care management that is required for patients with multiple chronic conditions. Beginning in 2015, CMS agrees and has proposed to pay for the non-face-to-face complex chronic care management services for patients who have two or more significant chronic conditions. Two separate G-codes will be developed for establishing a plan of care and furnishing care management over 90-day periods. Patients must have had an Annual Wellness Exam (AWE) or an initial preventive physical exam, as the AWE can serve as an important foundation for establishing a plan of care. CMS is proposing that services be provided by a single practitioner and that the beneficiary must consent to receiving these services over a one-year period. CMS will establish practice standards necessary to support payment. Potential standards would include access to a U.S. Department of Health and Human Services certified electronic health record (EHR) at the time of service and written protocols, such as steps for monitoring medical and functional patient needs. CMS may recognize patient-centered medical home (PCMH) designation as one means for a practice to demonstrate that it has met the requisite practice standards. CMS did not propose any RVUs for these services at this time. Continued on page 16


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Physician Quality Reporting System (PQRS) The proposed rule allows for PQRS incentives to continue through 2014 and penalties to begin in 2015. CMS is proposing the addition of 47 new individual measures and three measures groups to fill existing gaps. The proposed rule includes changes in individual, group practice, and registry. Here are some of those proposed changes that may be of interest to physicians and their practices:

Changes to Individual Reporting increases the number of measures required to be reported via claims or registry from three to nine Reporting threshold for individual measures via registry decreases from 80 percent to 50 percent Eliminates the claims-based measure groups reporting option

Criteria for using Clinical Data Registries:

Report at least nine measures to the registry covering at least three of the National Quality Strategy domains Report each measure at least 50 percent of the time Group Practice Reporting Option (GPRO) Eliminates the GPRO web interface reporting option for groups that have 25-99 physicians Adds Certified Survey Vendor Reporting for 25+ groups where Clinician and Group Consumers Assessment of Healthcare Providers and Systems (CG CAHPS) reporting would meet criteria for reporting in 2014 and avoid 2016 penalties Increases the number of measures from three to nine and 50 percent threshold (instead of 80 percent) for groups reporting individual measures via registry

2014 physician fee schedule

Please note: Physician practices that don’t report PQRS in 2013 will experience a 1.5 percent adjustment that will be imposed in 2015. You can avoid the penalty in 2015 by reporting at least one PQRS measure or one measures group on one claim for at least one patient in 2013. Read more at www.pamedsoc.org/PQRS.

Physician Value-Based Payment Modifier

quality-tiering component which evaluates performance on quality and cost measures. Quality-tiering is mandatory for groups of 100 or more physicians and has a maximum downward adjustment of 2 percent for groups that are classified as low quality/high cost and a -1 percent for groups classified as either low quality/ average cost or average quality/high cost. Groups of 10-99 participating in quality-tiering methodology can receive either an upward or neutral adjustment, but are exempt from any downward adjustments under quality-tiering in 2016. In the 2013 physician fee schedule final rule, CMS established a policy to create a cost composite for each group of physicians subject to the VBPM. They have since examined the distribution of cost scores among groups of physicians and solo practitioners to determine whether comparisons at the group level are appropriate when applied to smaller groups and solo practitioners. They found that their current peer grouping methodology could have varied impacts on different physician specialties. Therefore, they are proposing to refine their current peer group methodology to account for physician specialty mix.

A provision of the Affordable Care Act (ACA) implements a new value-based payment modifier (VBPM), which is directly linked to participation in PQRS. The VBPM will begin to be applied in 2015, starting with groups of 100 or more eligible professionals (EPs) and all physicians in 2017. Under the proposed rule, the group size threshold would drop to 10 or more beginning in 2016, estimating that nearly 60 percent of physicians would be under the VBPM in 2016. Application of the VBPM will use a two-category approach based on PQRS participation. Under the proposed rule, Category 1 includes physician groups of 10 or more that used the group reporting option (GPRO) to successfully report PQRS for 2014 (avoiding 2016 standing downward adjustment) or groups of 10 or more physicians who did not use the More on VBPM at GPRO to report in 2014, but at least pamedsoc.org/valuebasedmodifier. 70 percent of the physicians within Please visit the Pennsylvania Medical the group successfully reported PQRS Society’s website at www.pamedsoc.org (individually). This category will not be for more details on the proposed rule. subject to a downward adjustment by VBPM. Category 2 includes groups Have you or someone you know been of 10 or more not diagnosed with Alzheimer’s disease? meeting either of the above two standards and will The Alzheimer’s Association be subject to a 1.0 Delaware Valley Chapter can help. percent adjustment. Category 1 EPs will have an opportunity to increase 24/7 Helpline: 800.272.3900 their payments if they participate in alz.org/desjsepa Online: the VBPM

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Avoiding Costs at the ATM Non-bank ATM fees accrue when consumers make transactions at ATMs that are not in their own bank’s networks. Transactions at non-bank ATMs typically cost between $2 and $4 per transaction. This cost can be avoided with a bit of planning and some simple choices: Choose a bank with convenient hours, locations and ATMs – Think about daily routines and habits and choose a bank that is available when and where you need it. If your bank has a store that you pass on the way to work or the gym it will reduce the temptation to use an ATM that’s not affiliated with your financial institution. Investigate accounts that reimburse ATM costs – If you know you’ll be using ATMs outside of your bank’s network, then look to accounts that reimburse these costs. For example, TD Bank’s Premier Checking account offers high-value services including the reimbursement of any ATM fees for customers who keep a minimum balance of $2,500. Take advantage of features like remote deposit capture and online and mobile banking – In today’s banking world Continued on page 19

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Simple Steps to Skip Fees & Add Value to Your Checking Account RYAN BAILEY, EXECUTIVE VICE PRESIDENT OF DEPOSITS AND PAYMENTS, TD BANK US

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checking account is a fundamental building block of healthy finances, but many bank customers are frustrated with the rising cost of banking services. According to the TD Bank Checking Experience Index, a national study conducted by TD Bank and Angus Reid Public Opinion, nearly 60 percent of Americans now associate at least one fee with their primary checking account with the most frustrating costs being ATM fees (38 percent), overdraft fees (27 percent) and minimum balance fees (13 percent). But consumers don’t need to pay for checking. By making smart choices and using new technologies and resources from banks, account holders can minimize their banking costs and have a better understanding of their finances.

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could be as simple as walking a greater distance from your car to the office building or taking the stairs instead of the elevator. When you’re in the office, occasionally do some office rounding to get extra steps and take time at your desk to stretch.

When at work, a few ideas for simple stretching and exercise might include:

Put Health and Fitness Into Your Desk Job Year-round SOMETIMES AN OFFICE JOB CAN BE AN UNHEALTHY ONE WHEN YOU SIT MORE THAN YOU MOVE

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n fact, sitting in one position too long, combined with work-related stress and a lack of physical activity is probably the wrong formula for achieving optimal health at the office. “It’s a good idea to build physical activity into your daily office routine,” said Madeline Danny, DO, president of the Montgomery County Medical Society and a board certified internist who treats patients with diverse backgrounds and ages, ranging from 18 to 105 years old. “You owe it to yourself to factor in fitness each day.”

Physicians across the state agree that it’s not a bad idea to build health and fitness into your daily office routine. Researchers have found that sitting too long can lead to a number of health concerns including obesity, high blood pressure, high blood sugar and excess body fat. “Unfortunately, many Americans spend a lot of time sitting,” Dr. Danny said. “That’s not necessarily good for flexibility, muscular strength, and the health of our lungs and heart.” Incorporating fitness and health

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Stretches Shoulder shrugs Neck roll Side bends Upper body twist Torso stretch Hip rotation Toe touch exercises Toe raisers Seated leg extensions Wall push-ups Doorframe push Book curls and overhead press Stair climb

Dr. Danny also points out that diet and nutrition are equally important in overall good health. Unhealthy snacking, overeating at lunch and purchasing vending machine snacks could cause long-term health problems. Water should be the number one beverage option and better snack options include fruits and vegetables, she added. Montgomery County Medical Society is a member driven and responsive organization to more than 1,000 physicians and health care professionals. MCMS remains committed to the preservation of the doctor-patient relationship, the maintenance of safe and quality care for all and to enhance the role of medicine within the community and the state.


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Smart banking

consumers can check balances, deposit checks and find their closest store or ATM through their mobile phone. Instead of looking to an out-of-network ATM to check your balance, use a computer or smart phone. If you don’t have a smart phone, many banks allow you to check your balance by dialing a toll-free number – check the back of your debit card for your bank’s contact information. Some banks even offer 24/7 live phone support. Get Cash Back – Swinging into the supermarket or drug store? Pay with your debit card and get cash back to avoid a trip to a non-bank ATM.

MEDICAL MALPRACTICE INSURANCE BROKERS ARE YOU PAYING FOR YOUR MEDICAL MALPRACTICE INSURANCE? ARE HIGH OVERHEAD COSTS HURTING YOUR PRACTICE?

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Out Plan Overdrafts Overdraft fees occur when checking account holders spend more than is available in their account. If overdrafts are authorized on your account they can help pay a bill, access cash or make a debit transaction in a pinch. But not all overdraft services are the same. Some link checking and savings accounts, others depend on a line of credit and some just cover overages for your debit card – and not all services are priced the same way. Talk to your bank to know what overdraft services may be right for your account and take the time to monitor your account balance so you don’t pay unnecessary costs. Always know your balance – Making a phone call, spending a few minutes on the computer, checking your mobile phone or tablet or stopping at one of your bank’s ATMs or stores are four ways that you can check your balance for free. Make a point to always know your available balance and keep track of outstanding checks and scheduled bill payments so you’ll know if you’re in danger of overdrafting. Schedule automatic bill payments through online banking – Many banks offer bill pay services through their website. By automatically scheduling and spacing out your reoccurring monthly costs, you can avoid having multiple bills hit at the same time.

Managing Minimum Balances Many bank accounts stipulate that users must maintain an average or daily balance to avoid paying a monthly fee. Minimum balances vary by account and by financial institution so take the time to understand any requirements on your account. Investigate accounts that have no or low minimum balance requirements - TD Bank’s Simple Checking skips the minimum balance requirement by offering consumers a consistent and low monthly cost that they can budget for every month. TD Bank’s Convenience checking only requires a $100 minimum balance to avoid any monthly fees. Investigate your local financial institution and find an account that fits your needs. Set Balance Alerts – Many bank’s online systems allow users to set up “balance” alerts with just a few clicks of the mouse. Look to see if your bank offers this service for free and set up an email alert to let you know if you’re at risk of dropping below your balance threshold. Research from the American Banker’s Association notes that only 55 percent of consumers report paying fees for their account. By doing some homework and making smart choices, consumers can bank on all the value of a checking account without paying a cent. MCMS

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The Howard F. Pyfer Fund

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he Montgomery County Medical Society supports its young physician members through the generosity of the late physician Howard F. Pyfer, MD of Montgomery County and the future of medicine through its medical student scholarship program. Both programs advance the medical society’s mission to advocate for the preservation of the doctor-patient relationship, the maintenance of safe and quality care for all and to enhance the role of medicine within the physician and patient communities. Donations to the medical student scholarship program are welcomed throughout the year. Scholarship recipients are recognized at the annual membership dinner in June.

Howard F. Pyfer Fund Guidelines Thanks to the generosity of Howard F. Pyfer, MD, the Montgomery County Medical Society offers reimbursement for Continuing Medical Education (CME) credits to MCMS members under the age of 45. Eligible physicians may receive a maximum reimbursement up to five hundred ($500) dollars.

MCMS Supports Temple Student with Scholarship

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ontgomery County Medical Society (MCMS) awarded a scholarship in the amount of $1,000 to Kathryn A. Stockbower, of Fort Washington. Stockbower is now a second-year medical student at Temple University School of Medicine, Philadelphia. She is the daughter of Gregory and Anne Marie Stockbower. Stockbower is interested in pursuing pediatrics as she is a life-long patient of her pediatrician who served as a role model practicing patient-centered medicine. Stockbower is also committed to incorporating her international perspective gained as a Fulbright scholar in Germany where she learned the value of exchanging ideas across cultures. She participated in Abington Memorial Hospital’s Pre-Med program the summer after her sophomore year of undergraduate studies which further solidified her desire to become a physician. While spending hours shadowing in the emergency room and observing surgeries in the operating room at Abington, she said she witnessed both the wondrous and tragic sides of medicine and healthcare. Stockbower said, “I saw hope brighten the eyes of some patients, while fear and mistrust clouded the eyes of others. I saw life sustained and life come to an end. Observing the compassionate care given by doctors, physicians’ assistants and nurses helped me to realize that medicine was my calling in life.” This award is possible, thanks to contributions from the Montgomery County Medical Society members and area physicians. “For many years, MCMS has invested in medical students’ education by providing financial assistance,” Dr. Scott E. Shapiro, chair of the MCMS board of directors, said. “These students should be applauded for desiring to serve others in one of the world’s noblest professions.” The Foundation of the Pennsylvania Medical Society administers the fund for MCMS. The Foundation, a nonprofit affiliate of the Pennsylvania Medical Society, sustains the future of medicine in Pennsylvania by providing programs that support medical education, physician health, and excellence in practice. It has been helping to finance medical education for more than 40 years. For more information about this scholarship, call (717) 558-7854.

THE FOLLOWING CONDITIONS APPLY: •

Reimbursement will be considered only for CME courses taken within the calendar year, January through December, preceding the January deadline for submitting applications.

Reimbursement will be provided for post-graduate courses accredited by a recognized medical group only. Courses which lead to certification, are not eligible for reimbursement. Tours and seminars sponsored through travel agencies and pharmaceutical firms, where the educational component is incidental, will not qualify for consideration. Expenses incurred in subscribing to correspondence courses, and/or educational tapes, as well as self-assessment courses, will also not qualify.

Only tuition or registration cost and major transportation cost will be considered for reimbursement.

Tuition / Registration should exclude: Meals, Special events, golf outings, entertainment. Major Transportation only includes: Airplane and/or train travel cost along with parking.

Verification of registration and proof of attendance must be provided. Photocopies of checks and original invoices must be submitted.

Physicians 45 years of age and over are not eligible.

All decisions of the Pyfer Fund Committee approved by the Board shall be final. All interested members must submit a completed application and appropriate documentation on or before January 6, 2014. Applications can be obtained through the MCMS website, www.montmedsoc.com or contact MCMS, 610-878-9530. Montgomery County Medical Society I Attn: Pyfer Fund Committee I King of Prussia Medical Center 491 Allendale Road, Suite 323 I King of Prussia, PA 19406 MCMS

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MCMS Ends Year Giving Back to the Children of Montgomery County

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he MCMS Board of Directors end the calendar year with a gift-giving spirit. For several years, the board of directors have collected unwrapped gifts for the Montgomery County Toys for Tots program during its end of the year holiday dinner and board meeting. For 2013, any MCMS member can brighten a child’s holiday by donating at the MCMS office, 491 Allendale Road, Ste. 323, King of Prussia. For more information, contact MCMS staff, montmedsoc@verizon.net or call 610-878-9530.

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Feature A list of topics and a speaker request form can be found at montmedsoc.com/speakersbureau

Speakers Bureau

Montgomery County Medical Society Speaks Out On Healthy Living

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ontgomery County Medical Society (MCMS) physicians want to assist in educating the community about its health so that an ounce of prevention is truly worth a pound of cure. The medical society has established a Speakers Bureau, comprised of MCMS physician members who have agreed to speak to various groups on health-related issues. A list of topics and a speaker request form can be found on the MCMS website, www. montmedsoc.com/speakersbureau. “This is an important opportunity for physicians to engage directly with their communities. We strive daily for a healthy community by educating our patients on what is needed to maintain a healthy mind and body,” said Mark F. Pyfer, MD, MCMS board member and chairman of its Public Relations Committee. Dr. Pyfer is also a respected Montgomery County ophthalmologist.

“I think we all want to live healthy, long lives. The Montgomery County Medical Society Speakers Bureau

“...physicians have to be even more diligent in communicating with patients outside traditional exam rooms or hospitals.” allows us to educate beyond the exam rooms,” Dr. Pyfer added. Recently, MCMS physicians visited a Montgomery County senior living community to educate them on emergency room care and how medical liability affects the physician and

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patient community. In 2014, plans are underway to educate seniors on geriatric eye care. “My engaging with the residents was a wonderful opportunity to share an area of medicine that is often misunderstood by the general public,” said Rheumatologist Mark Lopatin, MD, MCMS board member and speaker on medical liability. He partnered with lawyer and physician Jonathan Briskin, MD, JD, to give the lecture. “These talks are a win-win for all involved. An educated public is an educated patient community.” Robert McNamara, MD, an MCMS board member and emergency room physician, agreed. “The medical society is committed to preserving the doctor-patient relationship. With this changing healthcare environment, physicians have to be even more diligent in communicating with patients outside traditional exam rooms or hospitals,” he said. “Hopefully, we can accomplish this through MCMS.” Upon request, physician members can share valuable information about their area of specialty on health-related topics. The topics range from talks about hypertension, often called the silent killer, to treatment options for macular degeneration to a discussion on managing your allergies. Physician volunteers have also agreed to speak on the state of medicine and share the challenges physicians and patients face in this changing health care environment. Visit the website to learn more about the county medical society, www.montmedsoc.com or call 610.878.9530. Montgomery County Medical Society is a member driven and responsive organization to more than 1,000 physicians and health care professionals. MCMS remains committed to the preservation of the doctor-patient relationship, the maintenance of safe and quality care for all and to enhance the role of medicine within the community and the state.


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low-income parents succeed by fostering healthier pregnancies and improving the health and development of their children. Families develop confidence and skills for parenting and economic self-sufficiency by volunteering to work with a nurse home visitor from this proven program. Specialized nurses visit families regularly during a 2½ year period, beginning in pregnancy. MCHD offers free educational programs to organizations, schools and worksites in the community. Programs are developed based on grant-funded opportunities and state/ regional partnerships. Education programs are available in the following areas:

Educating Community: Montgomery County Health Department Services

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he Montgomery County Health Department (MCHD) was established as a result of a 1989 voter referendum. Following a brief period, the department was certified by the Pennsylvania Department of Health on September 1, 1991, and began to provide a full range of prevention-oriented public health services one month later. We are governed by a five-member Board who are required to meet at least once every three months. It is the mission of the Montgomery County Health Department to assure the provision of services that promote, protect, and preserve the public’s health. Located at three different health centers throughout the County, MCHD is accessible to our residents in the Norristown, Pottstown and Willow Grove areas. MCHD offers a range of free clinical services including immunizations,

TB testing, HIV testing, STD testing and treatment and home visiting. Immunizations are administered to individuals without insurance coverage and can be obtained by appointment. TB testing is targeted to individuals who are considered high risk. If at risk, a test for tuberculosis infection is recommended. Infected individuals are treated by clinicians at one of our clinics. We also provide HIV/STD testing and counseling services and STD treatment. The Maternal-Child Home Visiting program is for pregnant women, new mothers, new fathers, and their babies. A public health nurse will visit the family in the home to offer guidance on a variety of prenatal care, infant care, and parenting topics. The nurse refers the family to an array of resources and services. The Nurse-Family Partnership (NFP) helps first-time,

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Cancer Prevention and Support: Adult programming available for Sun Safety, Tobacco Awareness and Breast Cancer education. Nutrition and Physical Activity: Programs developed by a Registered Dietician and Certified Exercise Specialist. Injury Prevention and Transportation Safety: Youth and Adult programming. Child Passenger Safety: MCHD offers free car seat inspections by appointment to all residents of Montgomery County.

To protect the health of our residents, MCHD staff conducts surveillance on all reportable diseases and conditions, provides recommendations for the control and prevention of outbreaks or unusual occurrences, and offers disease education as needed, including investigating animal bites to humans, domestic animals and pets that present with bite wounds of unknown origin. Annual low-cost rabies vaccination clinics are offered throughout the County on Saturdays in June and one time every September for dogs, cats and ferrets.


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Pennsylvania’s Physicians’ Health Programs

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he Physicians’ Health Programs (PHP), a program of The Foundation of the Pennsylvania Medical Society, provides support and advocacy to physicians struggling with addiction or physical or mental challenges. The program also offers information and support to families of impaired physicians and encourages their involvement in the physician recovery process. The PHP is funded by grants and contributions from physicians, hospitals, and others interested in physician health issues. The PHP began as a volunteer-based impaired physician program in 1970. Physician volunteers handled the casework, with assistance from a part-time Pennsylvania Medical Society staff member. In the 1980s, the Medical Society responded to the growing need for services by hiring a medical director and case managers. Since then, the program has grown significantly in reputation and in services. It is now one of the largest and most fully-developed physicians’ health programs in

the country. The PHP has a cooperative working relationship with the State Board of Medicine, State Board of Osteopathic Medicine, and the Pennsylvania Medical Society, and are contracted by the Pennsylvania Dental Society to assist all licensed dental professionals. Many hospitals, medical staffs, and managed care organizations in Pennsylvania use the services offered by the PHP.

Educational Programs and Materials PHP staff is available to give presentations upon request to medical students, residents, medical staffs or hospital administrations, county medical societies, and others interested in learning more about impairment issues. Staff will tailor a presentation to address an organization’s issues. Mike, an internal medicine resident, was referred to the Pennsylvania Physicians’ Health Programs because a colleague cared enough about him to reach out for help. When Mike arrived at the hospital

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with alcohol on his breath, the hospital Physician Health Committee contacted the PHP with the name of a potential referral. They placed him on administrative leave and informed him of the need to contact the PHP within five days. Mike contacted the PHP and spoke with our case manager about completing an evaluation, all the while denying there was any problem. A PHP representative informed Mike that he was referred because there was concern about his behavior in the hospital. Colleagues reported tardiness, sloppiness and “partying” at night. Like many individuals who are addicted, Mike didn’t see the effects of his alcoholism as interfering with his ability to practice medicine. He also did not see the toll it was taking on him personally. The PHP evaluation included collateral contacts, toxicology screens, and other testing measures performed to determine if there was a diagnosis.

Some areas of concern might include: What Constitutes Impairment and How to Recognize It Signs and Symptoms of Addiction in Health Care Professionals Addiction and Depression Establishing a Physicians’ Health Committee for Your Hospital Physicians’


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Feature

Health Programs Case Study PHP determined that Mike met the criteria for a diagnosis of alcohol dependence. The PHP medical director informed Mike that inpatient treatment would be the most appropriate and provided him several PHP-approved treatment centers from which to choose. After completing ten weeks of treatment, Mike presented to the PHP office and signed a five-year monitoring agreement that included individual and group therapy, toxicology and Phosphatidylethanol (PEth) testing, 12-step meeting attendance, quarterly reports from a peer and workplace monitor and monthly check-in calls to the PHP office. Mike eventually admitted that treatment was probably the best thing that he had done for himself. He felt that he got his life back and it was so

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much better than before. He appreciated that the PHP was there for him and he was able to obtain advocacy that he was compliant with his agreement and was safe and sober to continue to practice medicine. The PHP has assisted over 2,000 physicians since 1985 to “enjoy

life without drugs or alcohol” and continue to practice as successful physicians. Contact the PHP at 866.747.2255 or 717.558.7819 Mon thru Thurs 7:30 am to 5:00 pm or email php-foundation@pamedsoc.org.

Frontline Groups Frontline Groups are truly special and significant for membership. Groups with a 100 percent membership are recognized. They are 100 percent committed and we are thankful. Abington Medical Specialists Abington Perinatal Associates PC Abington Reproductive Medicine Academic Urology-Pottstown Advocare Main Line Pediatrics Annesley Flanagan Stefanyszyn & Penne Armstrong Colt George Ophthalmology 25 Bala Cardiology Consultants of Phila-Norristown Cardiology Consultants of Phila-Blue Bell Cardiology Consultants of Phila-Lansdale Endocrine Metabolic Associates PC Endocrine Specialists ENT & Facial Plastic Assoc of Montgomery County Family Practice Assoc of King of Prussia

Gastrointestinal Specialists Inc Green & Seidner Family Practice Hatboro Med Assoc LMG Family Practice PC Lower Merion Rehab Main Line Gastroenterology Associates-Lankenau Rheumatic Disease Associates Main Line Gynecologic Oncology Marlowe Zwillenberg & Ghaderi LLC Marvin H Greenbaum MD PC Montgomery Orthopaedic Associates Neurologic Group of Bucks/ Montgomery County Northern Ophthalmic Associates Inc North Penn Surgical Associates

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North Willow Grove Family Medicine Otolaryngology Associates Pediatric Associates of Plymouth Inc Performance Spine and Sports Physicians Respiratory Associates Ltd Rheumatology Associates Ltd Surgical Care Specialists Inc Thorp Bailey Weber Eye Assoc Inc Timothy A Woods MD PC Tri County Pediatrics Inc TriValley Primary Care/Franconia TriValley Primary Care/Lower Salford William J Lewis MD PC Women’s Health Care Group of PA-Pottstown


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News & Announcements

Annual Dinner

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News & Announcements Best Practices

Welcome New Members...

To publ new M ish photos of physici CMS memb er ans, p digital lease submit cop montm edsoc@ ies to verizon .net

MCMS is pleased to welcome the following individuals who joined the Society in 2013:

Nasrin Ashouian, MD Scott H. Fredd, MD Stephen Tai, MD Patricia Wong, MD Katiemarie Gale, Med Student

March Lisa Heller, MD Elias Karkalas, MD Scott Pugh, MD Jill Render, MD Barry Goldstein, MD

June

April

Jan 1 – Feb 28

Thulasi Gogireddy, MD Jamie Redwing, MD Pamela Del Buono, Administrator Michele Miller, Administrator Raghava Reddy Levaka Veera, MD Tami Lee Berry, MD

May John E. Bair, MD Suzanne Ben-Kane, MD Bruce J. Goldstein, Administrator Henry P. Schoonyoung, MD Allison J. Keen, MD

Christine M. Johnson, Administrator Mark W. LaSorda, Administrator Susan R. Medalie, Student Kate A. Hentschel, Student

July Robert B. Copper, II, DO James F. Rowley, MD Akhil Kher, Student Anthony Le, DO

August Eric Rudofker, Med Student Anthony Kent, Med Student

Necrology Report MCMS REGRETS THE LOSS OF THESE SOCIETY MEMBERS IN 2013 Rodman B. Finkbiner, MD Irvin M. Gerson, MD Elena Gitelson, MD Eli B. Harmon, MD

Ivan W. Hess, MD Joel H. Jaffe, DO Harry J. Kenworthy, MD Daniel W. Kirkpatrick, MD

Ronald A. Kirschner, DO Abraham A. Lurie, MD Patrick J. McDonough, MD Richard W. Moscotti, MD

Michael F. Rafferty, DO Lester Sablosky, MD

MCMS Medical Student Scholarship Fund

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CMS is dedicated to helping medical students achieve their educational goals. Each year, the Society bestows $1,000 scholarships to two qualified students who reside in Montgomery County. These scholarships are made possible through contributions to the MCMS Medical Student Scholarship Fund, administered by the Foundation of the Pennsylvania Medical Society. In honor of a loved one or an MCMS member who has passed, consider making a donation to the MCMS Medical Student Scholarship Fund. For more donation and application information, visit montmedsoc.com/Main-Menu-Categories/ StudentsResidents/Scholarships.

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News & Announcements

Pennsylvania Medical Society Holds Annual House of Delegates Meeting

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n October 26-27, 2013, more than 200 members of the Pennsylvania Medical Society (PAMED’s) House of Delegates gathered in Hershey to discuss and debate several important policy issues. The Montgomery County delegation included Frederic S. Becker, MD, Suzanne Ben-Kane, MD, William N. Bothwell, MD, FACS, Charles Cutler, MD, James Goodyear, MD, George R. Green, MD, Dennis A. Jerdan, MD, Mark A. Lopatin, MD, Mark F. Pyfer, MD, FACS, Scott E. Shapiro, MD, and James Thomas, MD. Also representing Montgomery County from the PAMED Young Physicians Section were Brad C. Klein, MD, MBA, and Jay Evan Rothkopf, MD. Sherry L. Blumenthal, MD, Joanna M. Fisher, MD, and Walter M. Klein, MD, all from Montgomery County, served as Specialty Delegates. The PAMED House of Delegates met to consider public health, physician reimbursement, and practice management directives. Among the primary resolutions addressed during the House of Delegates were behavioral

Scott E. Shapiro, MD, testifies during the PAMED House of Delegates meeting on Saturday, October 26, 2013.

organization’s Board of Trustees representing hospital-based specialty physicians. He served as chair of the board from 2003 to 2009. PAMED delegates voted to address psychiatric bed shortages by endorsing the development of a bed tracking system for behavioral health and detoxification beds across the state. Due to funding cuts, the availability

James Thomas, MD (l), and Scott E. Shapiro, MD at the PAMED House of Delegates. health emergency room shortages, gun violence as a public health issue, the hazards of electronic cigarette smoking, especially among school-age students, and opposition of the creation of a second civil action in addition to medical malpractice resulting from physicians’ treatment of patients. During the two-day meeting, PAMED also installed its 164th president, Bruce MacLeod, MD, FACEP, an emergency physician in Pittsburgh. “We are in the middle of a major shift in health care which began even before the Affordable Care Act,” he said to delegates at the meeting. “But this change is not like a tsunami, which implies that processes, institutions, and organizations would be washed away. Rather, it is an earthquake where the ground is moving, a shift in the foundations which will have many of the same structures and institutions but many will be doing different things.” Dr. MacLeod has been a PAMED member for more than 14 years. Prior to his election as president of PAMED, he served two terms on the

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The following physicians served as Montgomery County Medical Society Delegates to the 2013 PAMED House of Delegates in Hershey, October 26-27, 2013: Frederic Becker, MD Suzanne Ben-Kane, MD William Bothwell, MD Charles Cutler, MD James Goodyear, MD George R. Green, MD Dennis Jerdan, MD Mark A. Lopatin, MD Mark F. Pyfer, MD Scott E. Shapiro, MD James Thomas, MD Brad Klein, MD, and Jay Rothkopf, MD, of Montgomery County served as delegates from the Young Physicians Section of PAMED.


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House of Delegates

Members of the Montgomery County delegation discuss the proceedings of the 2013 PAMED House of Delegates meeting.

involve urging Pennsylvania schools to address the hazards of electronic cigarettes within their student tobacco education units. The resolution opposing the creation of a second civil action in addition to medical malpractice resulting from physicians’ treatment of patients arose from the attempts of plaintiff’s attorneys in California to bypass malpractice caps by using a civil tort of elder abuse (permissible under California tort law.) Pennsylvania tort law has no such statute, but the Continued on page 30

of inpatient behavioral health beds has declined, leaving emergency departments as the only alternative for those in need of mental health assistance. In the emergency room, behavioral health patients may wait for hours or days to be properly evaluated because it is thought that they can wait for treatment. This exacerbates the issue of emergency room crowding and is especially an issue in Pennsylvania. A centralized exchange would keep track of what beds are available at psychiatric centers and detoxification units so that emergency room and hospital beds aren’t being held by behavioral health patients. Delegates also resolved to advocate that gun violence be researched to better understand its sources and causes from a medical perspective. They voted to communicate with state and federal officials that gun violence is a significant public health problem. More research and information is needed on the topic; without information, it is difficult to formulate a plan of action to disrupt the pattern of gun violence. Electronic cigarettes should have the same safeguards as tobacco, such as taxation and banning sales to minors, delegates decided. PAMED will address this issue by calling upon state legislature to enact laws that treat electronic cigarettes the same as tobacco cigarettes. This campaign will also

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House of Delegates

Montgomery County delegates gather at the PAMED House of Delegates in Hershey. L-R: Charles Cutler, MD, Mark A. Lopatin, MD, Dennis Jerdan, MD, Frederic Becker, MD, Mark F. Pyfer, MD, FACS, James Thomas, MD, and George R. Green, MD.

resolution adopted by the PAMED House of Delegates addresses the principles at stake. PAMED will continue to advocate for physician reimbursement and practice management issues and will work with policymakers and stakeholders to ensure that consumers whose individual health plans were recently cancelled due to the Affordable Care Act are able to renew or extend their coverage until comparable replacements are available, oppose efforts by the State Board of Medicine to require the “maintenance of licensure” program as a condition of state medical licensure, and require all health insurers to make statewide fee information available online. PAMED will also work with policymakers and stakeholders to oppose the use of claims based data as the sole determinant of quality of care and require all Pennsylvania payers to reimburse physicians directly for emergency services, whether the physician is an in-network or outof-network provider.

Montgomery County Physician Elected Vice President of the Pennsylvania Medical Society

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A member of PAMED since he was a medical student in 1997, Dr. Shapiro served on its board of trustees from 1999 to 2012. Since becoming a physician, Dr. Shapiro has been active in several medical organizations and has completed volunteer work to serve his community. In addition to being a member of PAMED, he is a member of the American Medical Association (AMA) and represents Pennsylvania physicians as a delegate to the AMA House of Delegates. Dr. Shapiro was recently appointed to the Montgomery County Board of Health and is also a Fellow in The American College of Cardiology. Outside of organized medicine, Dr. Shapiro is an active alumnus of the University of Miami, where he received his bachelor’s degree in 1994. He is also a graduate of the Temple University School of Medicine and currently practices as a cardiologist at Abington Medical Specialists in Abington, Pennsylvania. He is also a co-founder of OnCall Physician Staffing with locations throughout New Jersey, Philadelphia, and the surrounding suburbs.

ontgomery County Medical Society is pleased to announce that its past president and current board chair, Scott E. Shapiro, MD, was recently elected by his peers to serve as vice president of the Pennsylvania Medical Society (PAMED). Dr. Shapiro is a cardiovascular disease and internal medicine specialist from Lower Gwynedd, Pennsylvania. He will serve one year as vice president, one year as president-elect, and in October 2015, he will take over as president of the statewide organization. “I am most looking forward to being as active as I can in advocacy work for physicians and patients in Pennsylvania,” Shapiro said. “Serving as vice president, and ultimately president, is exciting because I will be working with physicians across the state. Hopefully we can bring everyone together at the table and realize that we have more in common.” MCMS

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News & Announcements

Meetings Can Be a Valuable Resource for Practice Managers

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n a daily basis, practice managers deal with the frustration of decreasing reimbursements, insurance and regulatory hassles, quality measures, and so much more. To help practice managers across

the state make sense of these details, the Pennsylvania Medical Society (PAMED) collaborates with its county societies to host practice manager meetings that are free to PAMED members and their staff. Usually held in the fall and spring, these meetings educate

participants about changes in the law and keep them aware of the latest news. Discussion revolves around Medicare, Medicaid, and other payer updates, insight into regulation and rules changes, and those in attendance enjoy Q&A sessions with PAMED’s expert staff. Within the past year, PAMED hosted two practice manager meetings in Bucks County that were also well-attended by registrants from practices in Montgomery County. Held at the Health & Wellness Center in Warrington both times, the meetings featured such discussion topics as Medicare cuts due to the SGR payment formula, PQRS/ePrescribing changes, HIPAA and EHR audits, the Sunshine Act, the value-based payment modifier, and many more. PAMED members have access to many valuable practice management tools, including original PAMED

publications such as the HIPAA Security Toolkit (available at www. pamedsoc.org/store), members-only material on the PAMED website, and direct, personal access to the expertise of PAMED’s Practice Economics and Payer Relations staff who are available to answer member questions regarding a variety of practice management issues. For more information about the Pennsylvania Medical Society or upcoming practice manager meetings, contact 800.228.7823 or stat@pamedsoc.org.

Speakers Bureau Montgomery County Medical Society MCMS SPEAKERS BUREAU Visit www.montmedsoc.com/speakersbureau to schedule a medical professional to speak to your organization. Since 1847, MCMS has been the leading healthcare advocate for physicians, patients and practices in Southeastern Pennsylvania. Is your doctor a member? Call MCMS for more information.

610.878.9530 Email: montmedsoc@verizon.net MCMS

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Montgomery County MCMS Physician Fall 2013  
Montgomery County MCMS Physician Fall 2013