Winter 2014

Employed vs. Independent A Physicianâ€™s Perspective

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Contents WINTER 2014

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

Suzanne Ben-Kane, MD Charles Cutler, MD Madeline Danny, DO

18 Colorectal Cancer

President

Tita de la Cruz President, MCMS Alliance

Walter I. Hofman MD James A. Goodyear, MD

Immediate Past Chairman

George R. Green, MD Dennis Jerdan, MD Walter Klein MD 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

Editorial Board Jay E. Rothkopf MD, editor George Green, MD Mark F. Pyfer, MD Scott E. Shapiro, MD Toyca D. Williams 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.

Employed vs. Independent

Drag Boat Racing

Features 6 9 10 12 14 15 16 17 18 19 20 22 24 25 26 27

Employed vs. Independent: A Physician’s Perspective Frontline Groups - 100% Committed to MCMS Dragon Boat Racing: A Welcome and Intense Stress Relief Political Update: What’s Happening on the Hill The Game of Life It is a CME Year - Let PAMED Help You Meet Your License Requirements Rioja - Age-Worthy Red Wines 4 Chairman’s Remarks Three Things You Can Do to Ensure 5 Editor’s Comments You’re Prepared for ICD-10 28 Membership News Implementation on Oct. 1 1 in 3 Adults Have Not Received & Announcements Recommended Screening Tests for Colorectal Cancer Montgomery County Doc Provides Tips for Managing Allergies Meet Your County Medical Society Leaders Montgomery County Hospital Snapshots Stepping Up Health Care in Pennsylvania Nine Steps for Responding to Unanticipated Outcomes New Leadership Says PAMED Has Your Back Physicians’ Health Programs Welcomes New Staff Members

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

MCMS Works for You

ne of my colleagues eloquently explains in this issue why he couldn’t see a world with the county and state medical societies advocating on behalf of physicians, their practices and their patients. He asked who would stand up for patients when insurance companies interfere with our practices and our physician-patient relationships. Who would advocate on behalf of all physicians, across all specialties on issues that affect our profession locally, across the state and at the national level? Who would advance the cause to fund medical education for the future of medicine? It is hard to imagine fighting some pretty tough battles alone. You don’t have to because your county and state medical societies advocate for all physicians on more issues than you realize.

Dr. Arkoosh’s campaign, too. PAMPAC uses member contributions to support the election and retention of promedicine candidates. PAMPAC also campaigns against vulnerable incumbent legislators who consistently vote against the interests of patients and physicians. Contact Larry Light, PAMPAC executive director, at (800) 228-7823, ext. 7821, or llight@pamedsoc.org.

Your CMS Supports Young Physicians

Physicians under 45 years of age can receive up to $500 in reimbursement for expenses related to continuing medical education. Applications for the MCMS Howard Pyfer Fund are taken year-round. Only tuition, registration cost and major transportation cost are considered for reimbursement. For 2013, 11 members were awarded reimbursements of about $5,300 and there was additional funding available. I encourage you to take advantage of this member benefit. The deadline to submit applications for 2014 is Jan. 12, 2015. Download your application from the MCMS web site, www.montmedsoc.com, or request one by e-mail, montmedsoc@verizon.net.

Send Physician Advocate to Congress

Your CMS Supports Your Practice

We certainly can use more advocates, and you can do your part in sending one to Congress. Dr. Valerie Arkoosh is running for the 13th Congressional seat and needs your support so that she can continue to fight to expand access to quality, affordable health care, provide all our kids with a great education and create good-paying jobs so all families have the economic stability they deserve. PAMPAC supports her candidacy and you should too. She is a Philadelphia anesthesiologist who says she is not a politician but a parent, physician and community leader. Currently, women hold 99, or 18.5 percent, of the 535 seats in the U.S. Congress. Twenty women are in the Senate and 79 are in the House of Representatives. And there are even fewer physicians in Congress. Twenty physicians currently serve in the 113th Congress which includes three senators, 16 representatives and one delegate. Of that 20, there is one woman physician. In addition to your vote, you can further support this physician-friendly candidate and others by contributing to PAMPAC. Through PAMPAC’s support, the AMA’s AMPAC will financially support

Recently, it was brought to my attention that Independence Blue Cross has created a Hospital Tier Placement program that affects Keystone HMO Proactive commercial products only. IBC places the various hospitals in tiers – 1, 2 or 3 – and patient liability is based on the tier in which the hospitals falls. For example, a patient’s out of pocket expenses may be affected by the tier in which you are placed. Patients need to understand that placement is in no way an indicator of the quality of services. These designations are more reflective of the contractual relationships between the hospitals and IBC. IBC plans to reevaluate this program in a year. A group of physicians and PAMED staff are actively looking into this issue to determine how patient access, physician reimbursement and the physician-patient relationship may be affected by this program. Your input is valuable. Any comments regarding these issues should be sent to montmedsoc@verizon.net.

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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winter 2014

Editor’s Comments

I have a confession to make: I loathe this time of year.

on’t get me wrong – I love the holidays: the lights, the rituals, the time with family... the food. From Labor Day to New Year’s, the weeks, while busy, have always held for me a sense of anticipation and excitement, ever since childhood. It’s what comes after that I can’t stand. Once January 1 passes, time seems to slow to a crawl. Whether it’s the bone-numbing cold (we’ve had more than our fair share of that this winter) or the gradual lengthening of the days that just can’t come fast enough, the first four months of the calendar year always make me feel tired and sluggish, as if someone has poured a tub of molasses into my gas tank. Seasonal Affective Disorder? Perhaps, but I think it’s more of a post-holiday let-down, an acknowledgement that culturally we’ve entered the doldrums – a period devoid of collective milestones unless you count Valentine’s Day, a holiday on which I usually end up on call. So how to overcome it? How to fill the space between the end of the year and new beginning of spring? For me, the answer is simple: staying engaged. “With what?” you may ask. Here, the answer is also simple: with something that is both meaningful and important. Obviously, this will be different for everyone, but in this issue of the MCMS Physician, I’d like to offer a glimpse at how our colleagues across the county are doing precisely that. We kick off this issue with our cover story, a personal perspective on employment vs. private practice. With more and more physicians joining large health systems, this piece takes a look at the employment decisions I’ve made since residency and the internal and external conflicts that have resulted from them. It’s a topic that in many ways goes to the heart of the debate over the direction of American medicine, and I hope you’ll find it a worthwhile read. Next, we highlight the importance of a silent but preventable killer: colon cancer. March is National Colorectal Cancer Awareness month. Of the cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the U.S. We know that proper screenings can save your life. While winter may not be everyone’s ideal time for outdoor fun, that doesn’t mean we can’t write about it. In “Passions Outside of Medicine,” Dr. Robert McNamara, a member of MCMS

Montgomery County Medical Society’s (MCMS) board, shares how his “once in a lifetime” opportunity to dragon boat race has turned into a 30-year stress reliever and passion that he shares with his family. Three of his four children are active racers. Each year, Dr. McNamara, an emergency room physician, leads a team of Temple University Hospital physicians in this exciting and fast-paced sport. MCMS returns value to membership throughout the year. Look inside to learn more about the 2013 Howard Pyfer Fund recipients, the medical student scholarship winners, community grant recipients, and the 2014 Tools for Success Practice Management Seminar. In an effort to educate the community about the health care systems, we will feature several hospitals in our county. Montgomery County is fortunate to have several topnotch hospitals and many of our members work within their networks. You will also hear about improvements made in Pennsylvania health care from the leadership of the Pennsylvania Medical Society (PAMED) and the Hospital & Healthsystem Association of Pennsylvania (HAP). With 2014 an election year, staying abreast of changes in Harrisburg is more important than ever. PAMED lobbyist Scot Chadwick will share information about legislative successes such as the apology bill and continuing challenges related to scope of practice bills. This edition, our Patient Education section takes a look at allergy season and what patients can do to prepare as spring looms. Board certified allergist Dr. George Green shares proactive steps allergy sufferers can take to manage their symptoms. We don’t want to forget it is a CME reporting year. PAMED has numerous articles and activities to help you meet your CME requirements, as well as an online tracking tool to help you stay organized. We then delve into what we hope will also become a regular feature: our new food and restaurant review. To kick the column off, we feature Joe Allen of the Allen Investment Group of Raymond James. Mr. Allen will discuss both his love of fine wine and his favorite red wines. It’s a busy issue, but a worthwhile read. We’ve set sail; the port is now behind us, the open ocean lies ahead. We’re in uncharted waters, our path uncertain, but with your support and guidance, I know we’ll reach our destination.

Let’s go find it together. Jay Rothkopf, MD

Editor

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Feature

COVER STORY

Employed vs. Independent A Physician’s Perspective BY Jay E. Rothkopf, MD

his is not my father’s profession. Or my grandfather’s. In fact, if either were alive today, they would probably both retire. At the very least, they would be in for a rough ride. Why? Because they were both “old school”: fiercely independent, unflinchingly loyal, their patients no less important to them than their family. Nights, weekends, house calls; whatever it took, they were there. It’s no exaggeration to say that they were the single biggest influence on my decision to enter medicine. Their confidence, ownership, and most important, professionalism were ideals to which I continue to aspire.

Six: A Magical Age I’ve wanted to be a doctor since I was six, the age at which my grandfather began telling me stories of serving as a flight surgeon in the Burma Theater during World War II. Soon thereafter, it was diseases from his old 1967 Merck

Manual. As I matured, so did my interest and commitment, which eventually culminated in a medical degree. To them, owning your own practice, being your own boss, was the epitome of what it meant to be a doctor. There was simply no substitute.

My Journey Was Different So why then did I choose to become an employed physician? As a resident, I was for the first time exposed to the realities of practice in a much more fundamental way. I quickly learned that there was a lot more to being a doctor than exciting stories, classroom knowledge, and quixotic notions. Suddenly, I had real responsibility, and it was scary. I vividly remember my first day as an internal medicine intern at Abington Memorial Hospital. Fresh off a pep-talk from our program director (a motivational speaker if there ever was one), it was time to hit the wards. I began my career in the

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role of “cross-cover”: I was the individual called to enter basic orders, address erroneous test results, and generally put out fires. Later, I would go to the ER to assist with admissions, and then, after two weeks, onto night float. From there, it was the floors, then the ICU. The year, which went by in a blur, was absolutely transformative, but did little to prepare me for the “real” world. I had so much more to learn. Needless to say, residency is a harrowing experience on many levels, not the least of which is the pressure to decide “what you want to be when you grow up.” For me, an initial choice of anesthesiology turned out to be a poor fit, and I returned to internal medicine to complete my training. Throughout my R2 and R3 years, the question loomed: What to do? While my final decision took time, and was influenced by many factors, I can with a fair degree of certainty say that the process began in my R2 year.

Winter 2014

Employed vs. Independent I’ve learned many things in the four-and-a-half years since leaving residency – a learning curve that will be lifelong. Some have been expected, others, not so much. I think the biggest surprise I encountered was the discovery that being employed would not “solve all my problems,” or protect me from the stressors that private-practice physicians have to face. Whatever one’s political leanings, medicine is still a business, and there is no escaping that reality. I may not be ultimately responsible for balancing the checkbook, but at the hospital where I currently work (a for-profit system), the pressure is always there to make sure diagnoses and lengths-of-stay fit into the proper “buckets.” I am constantly reminded that “I’m the physician,” and all final decisions rest with me... except when they don’t. While we must always do what’s best for our patients, not everyone’s a doctor, and sometimes, interests do conflict. Learning to balance those interests while providing the best possible care and maintaining professional relationships with other stakeholders is a vital skill, one which I continue to develop.

Challenges Too Great in Private Practice Since the early ’90s, I had listened to dad bemoan the “death of American medicine,” and I now saw firsthand many of the things he had warned about: loss of autonomy, declining reimbursement, and the explosion of excessive regulation on multiple fronts. Combined with the horror stories I constantly heard about the challenges of staying in private practice, it was no small wonder that I chose to become employed. After dealing with a significant amount of personal tragedy in my senior year, I didn’t want to worry about managing a staff, earning enough to cover my malpractice, or SGR. Sounds cynical, doesn’t it? It is, and for the first couple months of my career, it was pretty much how I felt. Don’t get me wrong: I was thrilled to finally be in practice. Most comfortable with the inpatient setting, I chose to join a hospitalist group in a mid-size community setting. With the help of several colleagues from residency who worked at the same location, I was soon comfortably settled in. Or so I thought. Having never been “on my own,” I wasn’t quite sure what to expect. I knew that with a salary and a “shift-model” schedule, my life would be more predictable than if I were in private practice, and the financial worries, at least to a degree, would be somewhat less. Beyond that, I was very much flying blind. By the end of my first year, that had completely changed.

What I Know Now So what are the upsides? Simply put, my patients. Or to say it another way, I love being a doctor. Despite its flaws, being employed does have advantages such as spending more time Continued on page 8

Reality Sets In . . . Employed Model Not For Me Whatever naiveté I had carried about employment freeing one from the hassles of running a business was quickly erased. Those worries were still there, they just took on a different form. What I had gained – an income guarantee, health benefits, malpractice coverage – was balanced out by the loss of not only autonomy, but even some respect. Fair or not, our practice oftentimes found itself on the receiving end of everything that went wrong, from dissatisfied patients to slow ED turnaround times. Changes were imposed with little or no input, and at times I felt I carried too high a patient load. Despite speaking with a unified voice, our suggestions for improvement often fell on deaf ears. Within several months of starting, the first of my partners left. I found myself dismayed, feeling almost cheated. I had not spent years of my life in education and training to constantly bump heads with hospital administrators. I felt frustrated, alone, even undervalued. Now, to be fair, not all positions are created equal. We are talking about southeastern Pennsylvania, where some of the nation’s lowest reimbursement rates and generally unfavorable malpractice climate exists. However, having lived here my entire life with strong family and social ties, I was not inclined to move.

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Feature

Employed vs. Independent

Employed vs. Independent Physician’s Perspective to focus on patient care or not being on the hook financially to purchase an electronic health record system. My malpractice is covered, and I work for and with a great group of physicians. In many ways, I am awed by my colleagues who remain independent, despite a difficult environment that will likely worsen over time. Even on my most challenging day, there are things that are being taken care of for me, and I am immensely grateful. I know some of my “traditional-practice” colleagues view employed physicians – for example, hospitalists, with their often 7-on, 7-off schedules – as not truly “invested” in their careers, or possessed with a shift mentality. That does exist, but it is far from universal. There is also the perception amongst some that a decision to become employed means that the physician has limited interests, or lacks an entrepreneurial spirit. To that, I unequivocally say hogwash. In my current position, opportunities abound, not only in leadership, but business development as well. Outside of practice, I have chosen to become involved in organized medicine, a decision which not only continues to pay dividends, but provides a real outlet from the sometimes maddening frustrations that physicians nowadays have to face. With more and more doctors choosing employment, this has taken on an extra level of importance. All you have to do is put yourself out there, take that

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extra step, and it can make a tremendous difference. For me, practicing under the umbrella of employment has freed up time and energy to focus on things I might not otherwise have been able to do because I was worrying about the nuances of running a business. For others, the tradeoffs in autonomy, control, and sometimes, professional respect will always be unacceptable.

No Regrets Looking back, I have no regrets, nor would I choose a different path. I am where I wish to be; it fits well with how I am “wired.” I go to work every day knowing that despite facing challenges, I believe I’m where I can do the most good. I often think about dad, and what he would say if I could share some of my experiences with him. He would probably roll his eyes and tell me he was glad to be nearing retirement. In many ways, I would agree with him. It’s a different world now, and the past is unlikely to return. Despite healthcare news that almost always seems bad, there’s still nowhere else I’d rather be. It isn’t perfect, but it works. At the end of the day, that’s all anyone can ask for.

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WINTER 2014

Feature

Frontline Groups

Frontline Groups – 100% Committed to MCMS Is your practice among an elite group who is 100 percent committed to the Montgomery County Medical Society? You can be. . . Frontline practices – three or more physicians in a group – stand on the front line of the medical profession by making a commitment to 100 percent membership in the Montgomery County Medical Society and the Pennsylvania Medical Society (PAMED). MCMS continues to provide a forum for physicians to work collectively for the profession, patients and practice. The Montgomery County Medical Society says thank you.

MCMS Frontline Groups as of December 2013: Armstrong Colt George Ophthalmology Center For Women’s Health of Lansdale Marlowe Zwillenberg & Ghaderi LLC Marvin H Greenbaum MD PC Northern Ophthalmic Associates Inc Pediatric Medical Associates Performance Spine And Sports Physicians Respiratory Associates Ltd William J Lewis MD PC ENT & Facial Plastic Assoc of Montgomery County Healthcare for Women Only Division Main Line Gynecologic Oncology Otolaryngology Associates Patient First - Montgomeryville Women’s Healthcare Division Abington Perinatal Associates PC Annesley Flanagan Stefanyszyn & Penne Berger/Henry ENT Specialty Group Hatboro Med Assoc King of Prussia Medicine LMG Family Practice PC Lower Merion Rehab Neurological Group of Bucks/Montgomery County North Penn Surgical Associates

North Willow Grove Family Medicine Rheumatology Associates Ltd Thorp Bailey Weber Eye Assoc Inc TriValley Primary Care/Franconia Office TriValley Primary Care/Lower Salford Office Abington Reproductive Medicine Advocare Main Line Pediatrics Endocrine Specialists PC Green & Seidner Family Practice Academic Urology-Pottstown Pediatric Associates of Plymouth Inc Abington Neurological Assoc Ltd Endocrine Metabolic Associates PC Tri County Pediatrics Inc Main Line Gastroenterology Associates-Lankenau Rheumatic Disease Associates Cardiology Consultants of Phila-Blue Bell Cardiology Consultants of Phila-Lansdale Surgical Care Specialists Inc Cardiology Consultants of Phila-Norristown Gastrointestinal Specialists Inc The Philadelphia Hand Center PC Abington Medical Specialists

Through your membership, the Montgomery Frontline members and practices receive special recognition and benefits including: • A 5 percent discount on your county and state dues. • A certificate of recognition to hang in your office. • Regional meetings covering topics like risk management, employment law and payer and regulatory matters. These meetings are designed exclusively for member practice managers and office staff, free of charge. • Additional discounts and services from county and state endorsed vendors. For more information on how your practice can become a Frontline practice, e-mail montmedsoc@verizon.net or call (610) 878-9530 or PAMED group relations at (800) 228-7823 or (717) 558-7750, ext. 1337. MCMS

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Feature

Passion Outside of Medicine

Dragon Boat Racing: A Welcome and Intense Stress Relief By Robert McNamara, MD

“once in a lifetime” opportunity has extended for 30 years. Back in 1984, as a second year emergency medicine (EM) resident at the Medical College of Pennsylvania, I came across an article in the Philadelphia Inquirer announcing tryouts for the U.S. Men’s Dragon Boat team. If you made the team, you were awarded an all-expense paid trip to Hong Kong for 10 days for the then de facto World Championship. The race was held in the Hong Kong harbor in 40-foot teak boats and they were looking for paddlers with an average weight of 163 pounds. I knew I had a shot at this boat. I had rowed four years at LaSalle as a lightweight, winning the national championship my junior year, and I had spent three years as a crew

coach while attending medical school at Thomas Jefferson University.

Once in a Lifetime – 30 Years Later I told my young wife that this was a “once in a lifetime” opportunity and she still brings that up as I am now entering my 30th year as a paddler and coach for the U.S. Dragon Boat team. Her complaints are “tongue in cheek” as it has been an awesome ride that has taken my family around the world to compete against the best paddlers. Hong Kong had an invitational regatta, a series of boat races, every year and came to Philadelphia, then the home of U.S. Rowing. They asked

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Jack Kelly, Philadelphia’s four-time Olympian and Olympic medal winner who was an avid oarsman and later a respected city councilman, to put a team together to represent the USA. Mainly composed of rowers, the U.S. team did very well in 1984 and placed third behind two teams from China. In 1986, I took on the coaching role in addition to continuing to paddle. Eventually a formal world championship was initiated under the auspices of the International Dragon Boat Federation (IDBF). The race ran on an every 2-year cycle beginning in 1995 in Yue Yang, China, in front of more than 100,000 spectators. The 1995

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Drag Boat Racing

Australia twice and throughout Europe including England, Poland, Germany, Italy, Hungary and the Czech Republic. Recently all of the trips have had my kids along as competitors. Since that first World Championship in 1995, the teams I have coached have won 91 medals, two Nations Cups and set two world records. You can read more about the team at www.phillydragonboat.com. To fund team USA, we host the Independence Dragon Boat Regatta in Philadelphia. It is open to public participation and held the first Saturday of each June on the Schuylkill River. The 8th Annual Independence Dragon Boat Regatta will be Juneac7. Any group of 16-25 people can enter regardless of experience. U.S. team members teach you how to paddle during three practice sessions. Temple had four boats last year and a lot of fun. Visit www.independencedragonboat.com to learn more.

team, mostly from Philadelphia with some added Olympiclevel canoeists and kayakers, stunned the dragon boat world by taking a silver medal in the 1000-meter race. We finished behind China but ahead of Indonesia which had never lost to a western team. In the next World Championship in 1997, held in Hong Kong, our team was almost all Philadelphia rowers and we reached the pinnacle of the sport by winning the gold in the featured 500 meter race.

, if

Dragon Boat Racing – It’s a Family Affair Needless to say the coaching, paddling and training took up a lot of time. But, it was a great diversion from the stress of work and once my kids became old enough to jump in a boat it transitioned into a family experience. My wife, who was a two-sport college star, even took a crack at drumming the boat which is sort of a coxswain role, calling commands, etc. The sport and team USA expanded into much more than that original men’s boat to encompass women, youth and older paddlers with current senior categories for over 40, over 50 and over 60. Philadelphia hosted the World Championship in 2001 and my two oldest sons, Rob and Kevin, won a silver and bronze medal as part of the U.S. youth team. From a team USA perspective, the ultimate achievement is to win the Nations Cup which is the point trophy for the World Championship adding up the results of the men’s, women’s and mixed racing. While in Sydney, Australia, in 2007, we reached that goal and my son Kevin, now a 4th year student at Temple University School of Medicine, and my daughter Colleen were paddlers on that team. We repeated this feat in 2011 when the Championships were held in Tampa. Most recently, in July of 2013 we were in Hungary where China reclaimed the team trophy but my kids, now including the youngest Will, each won at least one gold medal. It has been quite a ride and the ride has taken me all over the world. I have raced in Hong Kong 10 times, China and

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No Stopping Now . . . What’s Ahead? The “once in a lifetime” experience will continue on for the foreseeable future. I, along with the Premier Women’s Head Coach Hype Swan, have been asked by the U.S. Dragon Boat Federation to assemble a team of Premier Men and Women from the 2012 roster that raced in Szeged, Hungary, to travel to Fuzhou, China, to race in the first ever International Dragon Boat Federation World Cup, June 11-12. To learn more, visit, www.idbf.org. Currently I race in the over 50 group and have the over 60 category to look ahead to. Three of my four kids are still active racers and as long as they are getting a kick out of it, I will continue to coach. I would be happy to discuss the sport or this opportunity for you or your kids. Just send an e-mail to Robert.McNamara@tuhs.temple.edu. Dr. Robert McNamara is a longtime member of the Montgomery County Medical Society, a past president of the society and a current member of its board of directors. He is a professor and chairman in the Department of Emergency Medicine, Temple University School of Medicine in Philadelphia.

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Feature

Political Update:What’s Happening on the Hill PENNSYLVANIA MEDICAL SOCIETY LEGISLATIVE UPDATE December 2013 BY SCOT CHADWICK, LEGISLATIVE COUNSEL, Pennsylvania Medical Society

ihe state House and Senate have both recessed until mid-January, closing the books on legislative activity for 2013. The fourth quarter was a busy one, with action on several measures of importance to physicians and patients.

Apology Bill Thanks in large part to physician advocacy, on Oct. 25, Gov. Tom Corbett signed into law legislation preventing most physician apologies from being used against them in a medical liability lawsuit. Pennsylvania Medical Society (PAMED) members sent more than 1,300 messages to the state legislature in support of this legislation over the course of the twoyear campaign. The legislation, now Act 79 of 2013, will protect most physician apologies except for admissions of negligence, which will remain admissible. It removes a barrier to open

communication between physicians and patients after a poor outcome, which is essential to maintaining the physicianpatient relationship. The new law does not take any legal right away from injured patients or impair their ability to file a personal injury action against a health care provider. It also does not limit the amount that a patient can recover in such an action. The bill became effective Dec. 24. PAMED has put together a short webinar that goes over the nuances of the new law. It can be accessed on the society’s website, www.pamedsoc.org.

Controlled Substance Database A bill that would create a controlled substance database, giving physicians better knowledge of prescriptions written for and filled by a patient, is one step closer to becoming law. The House of Representatives passed House MCMS

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Bill 1694 on Oct. 21, by a vote of 191-7. The success was the result of two years of effort by the Pennsylvania Medical Society and its members, who recognize the value such a database would have in reducing doctor-shopping and controlled substance abuse. The PAMED “Pills for Ills, Not Thrills” campaign has played a major role in generating public support for the legislation. On Nov. 18, Sen. Pat Vance (R-Cumberland) introduced her own version of the legislation, Senate Bill 1180. The bill differs in several respects from the House-passed bill, HB 1694. PAMED is now working to reconcile those differences and get a final product to Gov. Corbett’s desk to make this important tool a reality for Pennsylvania physicians.

Physician Assistant Bills Signed Into Law On Nov. 27, Gov. Corbett signed two bills into law that will permit the physician assistant (PA) countersignature requirement to be relaxed under appropriate circumstances. The measures, House Bills 1348 and 1351, had the support of PAMED and the Pennsylvania Society of Physician Assistants, and became effective Jan. 26. Under the new laws, physicians are required to countersign 100 percent of PA patient records during the first 12 months of a PA’s practice post-graduation and licensing; during the first 12 months of a PA’s practice in a new specialty; and during the first six months of a PA’s practice in the same specialty under the supervision of a new physician. After that, the PA’s approved physician could choose to review on a regular basis a lesser number of patient records completed by the PA. The physician will select patient records for review on the basis of written criteria established by the physician and the PA. The number of patient records reviewed must still be sufficient to assure adequate review of the PA’s scope of practice. That written agreement would then be submitted to the State Board of

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Political Update

With millions more Pennsylvanians potentially gaining health insurance as the Affordable Care Act goes into effect, their physicians want to be sure that care is team-based and physicianled. In December, PAMED leaders and members gathered at the Capitol in Harrisburg for a media event with Gov. Corbett and Rep. Matt Baker (R-Tioga). Two bills that would help build a stronger framework for our health care teams have been introduced by Sen. Judy Schwank (D-Berks) and Rep. Baker. The bills, Senate Bill 1083 and House Bill 1655, propose a PatientCentered Medical Home Advisory Council at the Department of Public Welfare to help nurture the growth and development of patient-centered care in the Medicaid program. Following the media event, the physicians and physicians-in-training visited with their legislators to push for support of measures to help keep Pennsylvania’s health care teams strong, physician-led, and patient-centered. Member physicians also urged their legislators to support bills to improve access to care for the uninsured; retain and recruit the physician workforce, especially through student debt forgiveness and expanded residency slots; prevent prescription drug abuse through a controlled substances

Healthy Pennsylvania On Sept. 16, Gov. Corbett announced his Healthy Pennsylvania package of initiatives, and while his take on Medicaid expansion has grabbed all the headlines, the plan contains a number of other pro-physician, pro-patient measures. Among those proposals, the governor endorsed increased medical student debt forgiveness. According to a 2012 report, the mean debt for graduates from the class of 2012 was nearly $167,000, not including premedical educational debt, driving many graduates away from primary care to higher paying specialties. The governor also proposed additional funding to increase the number of in-state primary care residency slots, a move that could help the growth of the physician population in medically underserved areas. Finally, the governor announced his advocacy for health care technology and telemedicine. The Pennsylvania Medical Society strongly supports the development of a statewide health information exchange (HIE), and is pleased that the Corbett administration and legislature are moving forward with this initiative.

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On Dec. 18, Gov. Corbett signed into law a 10-bill package strengthening the state’s child abuse laws. The Sandusky scandal at Penn State had revealed a number of weaknesses in Pennsylvania’s child protection laws, and caused the General Assembly to establish a Child Protection Task Force to review the state’s existing statutes and recommend changes. The task force released a 427-page report in November 2012 recommending a wide range of reforms, which found their way into more than 30 House and Senate bills. While the 10 bills signed into law probably contain the bulk of the changes, there are still a couple more that will likely reach the Governor’s desk early next year. At least one of those will almost certainly have significance for physicians in their role as mandated reporters. Many of the changes enacted don’t go into effect until Dec. 31, 2014, in order to give mandated reporters and others assigned new responsibilities an opportunity to be trained. The new laws will broaden the range of persons who can be found guilty of child abuse, and significantly lower the threshold for the degree of injury, pain or impairment needed to trigger a report of suspected child abuse.

database; and improve access to health care technology in Pennsylvania.

you ne Trainin ed help with g, Billin g, etc? Compute r/IT su CALL We sp US AB ppor t, HI ecializ PA A Co OUT e in he We ha m OUR althca ve ex FREE pliance, IC re IT. pertise ICD-10 D-10 We in EM Impl TRAI R, Billin have been NING ementatio helpin g, ICDn PRO g man 10, HI GRA y prac M PAA an tices. d prac tice m anagem ent.

Child Protection Laws Strengthened

Physician Leadership Day Held At Capitol

ll us fo sess r a FREE men t (a $3 HIPAA 50 va /EMR/IT lue)! /ICD-1 0 o

Medicine or State Board of Osteopathic Medicine for approval, the final step before the agreement would go into effect. It is important to note that entering into an agreement with your PA to countersign fewer than 100 percent of his or her patient records is purely optional. If a physician wishes to continue to review and countersign all of a PA’s patient records, he or she is free to do so. PAMED believes this legislation is a good example of how physician-led, team-based care can be streamlined, ultimately increasing access to care.

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premiums, which will be as he grows to an adult. The combination of guaranteed issue term and permanent life insurance, which I elected as an employee many years ago, today provides me with peace of mind far greater than the few dollars I spend monthly for that coverage. It is not a huge amount of protection, but consider… Data on life insurance trends, published by LIMRA, indicates that:

The Game of Life

By Dani McCauley, Executive Vice President of Marketing, Univers

uring these cold winter months, my family has been passing the time by staying inside and doing what we love to do best – playing games. Whether it’s poker, cribbage, backgammon or any other board game, come to my house for a competitive battle. Recently, we were playing an old-school game of “Life” when I had an epiphany. My son had filled his plastic convertible with little blue and pink peg babies, stopped on a space, then picked a card and started complaining that he was required to “buy life insurance.” I tried to explain to him, in terms an eleven-yearold would understand, why he should consider this a “good thing.” I asked, “Why do we wear a sealbelt in the car every time we go somewhere?” He was pretty clear on the answer to this question. “We have to protect ourselves in case we get in an accident,” he said. I continued by asking, “Why do we were it every day, no matter what?” He was also clear on this one saying, “If we get in an accident, we could get really badly hurt and the seat belt makes it better.”

I went on to share that life insurance is the way people protect their families if one person dies, so that everyone else in the family could go on living their lives as normally as possible. Okay, simplistic and perhaps a little dark. But this conversation had me thinking that our industry needs to encourage a renewed discussion with employers about the value of offering life insurance to their employees, even on a voluntary basis. You see, I am also the mother of a son with cerebral palsy, who is considered “uninsurable.” I understand, in very personal terms, that access to even a modest amount of guaranteed issue coverage is critical to completing my family’s protection. While term life insurance is certainly less expensive, we are fortunate to offer both term and permanent coverage options through payroll deduction. Why both? Given that my son’s condition will be lifelong, rendering him “uninsurable” for any coverage requiring evidence of insurability, we also have permanent life insurance. That policy allows for stable and level Statistics cited are from LIMRA “Facts About Life 2011” MCMS

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• More insured adults depend solely on group life insurance for their only life insurance coverage than in the past. • However, the percentage of adults having group life insurance has dropped (down four percentage points since 2004), which is the first decline since group insurance was introduced. So, I hope that our carrier and broker consultant partners will remember that the insurance products you help employers offer (even on a voluntary basis) will provide real and meaningful protection to employees, at the most affordable rates possible. I hope you will help people like me, and my family, to buckle up for the “game of life” by giving them access to voluntary term and permanent life insurance – offered with some level of guaranteed issue coverage. USI Affinity, an endorsed partner of the Montgomery County Medical Society of PA, will continue to provide updates on this topic. Please feel free to contact a USI Affinity representative for your insurance needs. The MCMS liaison is Jim Pitts, (800) 265-2876 ext. 11377.

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It is a CME Year

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pamedsoc.org

to learn more about CME requirements

cycles ending on Dec. 31 of each even year) • A minimum of 20 of the total credit hours in Category 1 • 12 credit hours in the areas of patient safety or risk management (either Category 1 or Category 2)

It is a CME Year – Let PAMED Help You Meet Your License Requirements

nterested in learning how Pennsylvania’s new apology law affects physicians? Concerned about the risks associated with the use of long-acting opioids? Looking to better understand meaningful use? There is no better time than now to gather this information and meet your continuing medical education requirements through CME activities provided by the Pennsylvania Medical Society (PAMED). PAMED has designed relevant CME activities that also meet patient safety and risk management requirements. 2014 is a license renewal year for Pennsylvania MDs and DOs. By taking a few simple steps, fulfilling the CME requirements can be hasslefree:

1. Make sure you know your username and password for www.pamedsoc.org in order to access free CME activities. Members who are new to the website can create an account. For assistance, please call the Help Desk at (800) 228-7823, ext. 1549 2. Receive email alerts for new PAMED activities. www.pamedsoc.org/subscribe 3. Familiarize yourself with the state CME requirements. www.pamedsoc.org/cmefaq Licensure Renewal Requirements for MDs • 100 total credit hours of CME in the two-year license cycle (with license

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Licensure Renewal Requirements for DOs • 100 total credit hours of CME in the two-year license cycle (with license cycles ending on October 31 of each even year) • A minimum of 20 of the total credit hours in AOA Category 1-A • 12 credit hours in the areas of patient safety or risk management (either Category 1 or Category 2) Here are the highlights of the most recent CME activities sponsored by PAMED. A full list of CME offerings is available on the PAMED web site, www.pamedsoc.org/cme.

Webinars and Videos • Six-Part Webinar Series on LongActing and Extended-Release Opioids Become better equipped to help your patients with the nuances of pain management and to identify those who may be doctor shoppers or in need of addiction assistance • Admission or Observation: What’s a Physician to Do? Familiarize yourself with the documentation requirements for an admission and better determine the appropriate place of service Continued on page 16

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Rioja – Age-Worthy Red Wines

It is a CME Year

continued from page 15

Converge • Using Population-Based Health Care to Improve Patient Outcomes Through our real-world example, prepare to meet the clinical quality measures that are required to successfully achieve Stage 2 meaningful use • S’WOT’s Data Got to Do with It? Use EHR data to conduct a SWOT (Strength, Weakness, Opportunities, Threat) analysis

intouch • The Communication Side of Meaningful Use—Patient Engagement Identify the changes needed to meet meaningful use Stage 2 criteria and learn how to implement strategies to communicate the required changes to staff and patients

• Improving Patient Outcomes Via Team-Based Care Learn how to define the goals of teambased care and its role in improving outcomes and improve the skills required to implement team-based care

Studies in Patient Safety • Distractions and Their Impact in Patient Safety Discover how to assess sources of distraction present in health care settings and indentify strategies for decreasing the potential for distraction and harm • Analysis of the Multiple Risks Involving the Use of IV FentaNYL Find out how to address the risks associated with the dosing of IV fentaNYL, including medication errors and adverse drug reactions, and identify risk reduction strategies

Managing Risk • Risk Management Approaches to Disclosures and Apologies in Medicine Learn about Pennsylvania’s new apology law and appropriate language for expressing compassion and empathy which will not be held against a physician in a lawsuit • Urgent Care Centers—Managing Patients’ Perceptions Gain familiarity with methods to assess your urgent care center’s advertising, signs, and general policies to ensure they give clear and appropriate information to your patients To keep track of CME, members can use a free CME tracker account, www. pamedsoc.org/tracker. PAMED-sponsored CME activities are automatically loaded into each account.

Rioja – Age-Worthy Red Wines By Lara Brooks, Associate Director, Payer Relations, Pennsylvania Medical Society

ost wine drinkers do not have the money, the storage space or the patience to wait years as their bottles age to maturity. Consumers expect wines to be ready, or at least enjoyable, immediately after they buy them. Few wine stores, and even fewer restaurants, offer aged wine. Wine producers around the world have altered their methods in an effort to make wines more accessible when young. But, many wines, especially red wines, benefit from prolonged aging. High-quality red wines develop complexity in the bottle. The tannins soften, interesting aromas emerge, and flavors become more harmonious. In the wine region of Rioja, in Spain, four different red wines are produced – and each one comes with specific aging requirements. The first, simply labeled Rioja, is the youngest, spending less than a year in an oak-aging barrel. A Crianza is wine aged for at least two years, at least one of which was in oak. Rioja Reserva is aged for at least three years, of which at least one year is in oak. Finally, Rioja Gran Reserva wines

have aged at least two years in oak and then an additional three years in bottles before release. Some producers will go beyond these aging requirements and release when they’re ready. Last year, I enjoyed a great 1998 La Rioja Alta Gran Reserva “904” that was just released! Many of the Reserve Riojas are highlyrated wines. Cune Rioja Imperial Gran Reserva 2004 took the No. 1 spot on the 2013 Wine Spectator Top 100. They are also reasonably priced. Case in point, one of my favorite wines released last year – the 2005 Bodegas Muga Prado Enea Gran Reserva – sells for approximately $40. Neal Martin of the Wine Advocate rated the wine 95 points. He said, “The 2005 Prado Enea Gran Reserva spends 36 months in oak, and nine months in new oak after which it is racked into American oak that is “semi-new” (i.e. a new barrel that is “broken in” with a wine beforehand). It has an unashamedly opulent bouquet of primal, ripe, boysenberry, mulberry, dark chocolate and crushed violets that blossom with aeration. The palate is fullbodied with crisp acidity cutting through MCMS

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the pure blackberry and cassis fruit. It has wonderful focus and intensity, though the finish demonstrates convincing composure. This is an outstanding Gran Reserva whose silky texture will instantly win you over. Drink 2013-2030+.” Another nice 2005 Rioja recently released and a little more moderately priced is La Rioja Alta Reserva Vina Arana (approximately $24). Mr. Martin rates this wine 93 points. “The 2005 Vina Arana Reserva has a fresh bouquet of orange blossom, quince, violets and dark cherries. The palate is succulent on the entry with vivacious maraschino cherry, red currant and blood orange. It displays a very fine build and a silky smooth texture that segues to a poised, mint-tinged, bright and animated finish. Drink now-2020.”

I agree with each sip. Mr. Allen is Senior Vice President of Investments for the Allen Investment Group of Raymond James. His team consults for non-profits, corporate retirement plans, and retail investors. He enjoys fine wines and is thrilled to share some of his recent favorites.

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Three Things You Can Do pamedsoc.org to learn more

Three Things You Can Do to Ensure You’re Prepared for ICD-10 Implementation on Oct. 1

BY Lara Brooks, Associate Director, PAMED Practice Economics & Payer Relations

he October 1, 2014, transition to ICD-10 will be a huge change for physicians and the entire health care industry. The Centers for Medicare and Medicaid Services (CMS) has made it clear there will be no more delays. Lack of preparation for the transition can put your revenue at risk. Knowing where to start can be the hardest part of any project, especially one this complex. Here are a few things you can do to get the ball rolling toward ICD-10 readiness if you haven’t already done so. 1. Identify changes to workflow and business processes The easiest way to do this is to inventory the practice, looking for any use of ICD-9 codes on superbills, forms, policies, reports, and health plan information. Because of the move to more specific and detailed ICD10 codes, it’s important to review all policies and procedures associated with disease management, tracking, and quality reporting. Payers may require you to report with the highest specificity instead of non-specific codes. They also may modify the terms of their contracts for billing, medical review auditing, and coverage. For these reasons, it is essential that you understand your payer’s payment schedules and bill using the appropriate ICD-10 codes. 2. Speak with EHR and billing system vendors Most health plans have indicated that they will be ready for ICD-10 testing.

The fear in the health care community has been that EHR and billing system vendors may not be. When it comes to ICD-10, you want to ensure that your vendor is knowledgeable and committed to helping you meet your ongoing ICD-10 goals, offering the technology needed to help you get there quickly and efficiently. Now is the time to check with your vendors to establish a formal plan of action. A questionnaire developed by the Pennsylvania Medical Society (PAMED) can be used to test your vendor’s readiness and determine how you can work together to make the transition as smooth as possible. 3. Documentation and training One of the most common concerns we’re hearing from practices is how to educate physicians on documentation so that ICD-10-CM codes can be assigned to the highest level of specificity. Once we wrap our arms around the fact that it’s not about 69,000 new codes, but rather a dozen or so new documentation elements that must be learned, the task does not seem so daunting. It’s absolutely critical that providers understand that their financial well-being in ICD-10 will be a direct reflection of the degree of documentation and the extensiveness and specificity of that documentation. In an effort to help physicians and their staff prepare, PAMED members have access to discounted online training through the American Academy of Professional Coders (AAPC). These three-hour specialty

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specific courses are designed to teach ICD-10 documentation requirements to physicians. Learn more and register at www.pamedsoc.org/ ICD10documentation. This spring, PAMED will be holding regional workshops to prepare staff for ICD-10. This comprehensive code set training includes an in-depth look at ICD-10-CM guidelines and conventions, as well as hands-on coding exercises. The workshop in Warrington is scheduled for March 26. For more information and to register, go to www.pamedsoc.org/ icd10workshops.

With just a few months remaining until the Oct. 1 deadline, it’s imperative that physicians think strategically about the impact of ICD10 to their practice. Although there are many competing priorities right now – HIPAA, meaningful use, and other quality programs, just to name a few – ignoring ICD-10 will not make it go away. Check out our wealth of ICD-10 resources, designed to help member physicians and their practices prepare for the transition, at www.pamedsoc.org/icd10.

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1 in 3 Adults

1 in 3 Adults Have Not Received Recommended Screening Tests for Colorectal Cancer

arch is National Colon Cancer Awareness Month, so there couldn’t be a better time to learn the facts about colon cancer and get tested. It could save your life. An estimated 96,830 new cases of colon cancer and 50,310 deaths from colorectal cancer are expected in the United States for 2014. Colorectal cancer is the third most common cancer in both men and women. Incidence rates have been decreasing for most of the past two decades, which has largely been attributed to increases in the use of colorectal cancer screening tests that allow for the detection and removal of colorectal polyps before they progress to cancer. Screening can detect and allow for the removal of colorectal polyps

that might become cancerous, as well as detect cancer at an early stage. However, when treatment is usually less extensive and more successful, about 1 in 3 adults aged 50 to 75 have not received any of the recommended screening tests for colorectal cancer, according to a new report from the Centers for Disease Control and Prevention. Richard Wender, M.D., chief cancer control officer, American Cancer Society, comments on this new report and offers the following statement: Screening Tests Can Save Lives Colon cancer screening saves lives, but millions of Americans aren’t getting screened. Screening will substantially reduce their risk of suffering and death

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due to colon cancer. The benefits of colorectal cancer screening, whether it’s fecal occult blood testing, using a home guaiac stool test (FOBT) or an immunochemical stool test (FIT), or colonoscopy, are proven. These tests decrease risk of colorectal cancer death by 35 percent or more, both by preventing the development of colon cancer and by finding colon cancers at an early, curable stage. Patients Have Test Options There are a variety of reasons why people do not get tested for colorectal cancer, but this study reiterates that among the most important is having health insurance and a regular source of care. Although the study showed that FOBT/FIT was used in only 1 in 10 of those who did get screened, it

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also showed that those states with higher screening rates were more likely to use FOBT/FIT, suggesting that increasing the use of this simple, inexpensive and very effective test may be one key to closing the gap. Ultimately, though, patient preference, i.e., the ability to select the test patients prefer after being presented with all of the recommended options, appears to be one of the strongest determinants of whether or not patients complete the screening. Second-Deadliest Cancer in Men and Women Colon cancer is the third most commonly diagnosed cancer in men and women and the second-deadliest among men and women combined. In order to increase screening rates, we must do more to develop and support screening systems that ensure that all eligible people are offered screening and have the resources and support to complete screening using one of the recommended tests. The American Cancer Society recommends colorectal screening for everyone aged 50 and older. Appropriate screening includes FOBT or FIT yearly, or colonoscopy every 10 years. Other approaches to screening, such as sigmoidoscopy, are effective but are rarely used in the U.S. Information prepared and submitted by the Eastern Central Division of the American Cancer Society (ACS). The American Cancer Society offers free materials to help clinicians continue encouraging colorectal cancer screening among their patients 50 and older. Health care providers play the most important role in getting people screened for colorectal cancer. If patients don’t hear about screening from their physician, they may not think they need it. ACS’s clear, concise materials can help you explain colorectal cancer tests to patients. A number of tools to assist you in your practice, such as a CME course, screening and followup reminder letters for your patients, can be found by visiting http://www.cancer.org/ healthy/informationforhealthcareprofessionals/ colonmdclinicansinformationsource/index

Managing Allergies

Montgomery County Doc Provides Tips for Managing Allergies By Toyca Williams, Executive Director, MCMS

T is never too early to think ahead when you suffer with allergies. For many, treatment is reactive. However, Dr. George Green, a board certified allergist and internal medicine specialist, advises that allergy sufferers should be proactive. They should take preemptive steps to manage their symptoms before they take hold. “Once they flair up, it usually takes less allergen to make it worse,” Dr. Green said. “Start to treat symptoms before the season begins.” Allergy symptoms result from your immune system overreacting to an allergen. Once your body is exposed, the chemical histamine is released, thus causing the cells in your body to swell. Typical symptoms include itchy, running nose; nasal and sinus congestion; repeated sneezing; watery eyes; inflamed sinuses; and, in severe cases, difficulty breathing. In the days ahead, unusually warm winter weather can produce an unwanted byproduct for those who suffer from season allergic rhinitis, also known as hay fever. Dr. Green, a member of the Montgomery County Medical Society board of directors, also said there is not always a link between pollen count and symptoms. MCMS

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However, he recommended following these tips to manage your allergies: 1. Avoid outside activities in the late afternoon, because that’s when the pollen count reaches its peak. 2. Avoid excessive pollen exposure caused by such activities as cutting your grass or jogging. If you must do those activities, Dr. Green suggests wearing a mask while doing it. 3. Start treatment with an oral non-sedating antihistamine such as Allegra (Fexofenadine) or Claritin (Loratadine) at the very beginning of the seasonal symptoms. Both can be purchased over the counter without a physician prescription. 4. Add local therapy with nasal corticosteroids promptly if symptoms are not well controlled with oral antihistamines. These medicines are sprayed or inhaled into the nose to help relieve stuffy nose, irritation, and discomfort of hay fever. 5. Keep windows closed if possible.

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Meet Your County Medical Society Leaders

he Montgomery County Medical Society (MCMS) is the third largest county medical society in Pennsylvania. Established in 1847, MCMS remains a strong health care advocate for the preservation of the doctor-patient relationship and the maintenance of safe and quality care for all. To move that mission forward, MCMS has a 21-member board of directors, comprised of physician volunteers, one practice administrator and the MCMS alliance president. A longtime member of that board and 36-year member of the medical society is Charles Cutler, MD, FACP, an internist who practices in Norristown. Respected by his peers and patients, Dr. Cutler remains on the front line of physician and patient advocacy at the local, state and national levels. In each issue of the MCMS Physician, we will profile a member of your county medical society leadership team.

Name: Charles Cutler, MD, FACP Specialty: Internal Medicine Currently Practices: Norristown Internal Medicine Associates, 1411 Powell St., Norristown Hospital Affiliation: Einstein Medical Center Montgomery Medical School: Temple University School of Medicine, 1970-1974 Internship/Residency: Temple University Hospital, 1974-1977 Native: Born and raised in Philadelphia Residence: Merion Station; lived in Montgomery County since 1978 On a Professional Note Why I chose a career in medicine: I decided to be a doctor in college. First day freshman year, a test at the career counseling center revealed that I had the wrong personality to be a physician. For fun, I decided to prove them wrong.

Why internal medicine: I wanted a broad knowledge base before deciding which medical subspecialty was right for me. I’m still trying to decide. Most rewarding about my career: Patients, sometimes complete strangers, trust me with the most important details and decisions of their lives. I’m good at what I do because of my passion, persistence and patience. A week rarely passes in which I don’t have a patient thank me for a relatively minor action on my part. I’m amazed how thankful patients can be for the simplest doctor-patient encounter. Had I cured cancer or performed life-saving heart surgery, the degree of thanks would be warranted. But merely listening to a patient’s complaints and offering a kind word of support often results in the most profound outpouring of gratitude. What in life is more rewarding than experiences like this?

Charles Cutler with his family.

Jonathan Schor, Stacey Schor, Charles Cutler MD, Bev Cutler, Aaron Kim, Ali Cutler, Racine Cutler, Len Cutler, Jennie Cutler, Andrew Goldfrach MCMS

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Meet Your County Medical Society Leaders Leadership positions: Since 1990, I’ve held various positions within MCMS, Pennsylvania Medical Society (PAMED), American Medical Association (AMA), American College of Physicians (ACP) and PA Chapter of the ACP. • Chair, MCMS Board of Directors, 2000-2006; MCMS President, 1996-1997; MCMS board member since 1992 • Chair, ACP Board of Regents, April 2013-April 2014 • Governor, ACP Pennsylvania Chapter, Southeastern Region, 2006-2010 • Chair, ACP Board of Governors, April 2010 April 2011 • Chair, Pennsylvania Delegation to the AMA, 2004-2009 • Member, Executive Committee, PAMED Practice Advocacy Council, 2006-2012 • Member, PAMED Board of Trustees, 2004-2009 On a Personal Note Interesting childhood fact: As a child I was lucky to connect with a group of friends in grade school. More than 50 years later we travel, vacation, and dine together on a regular schedule. We tell the same childhood stories over and over. They get funnier as the years go by.

Worth Noting Most interesting moment in medicine: In 1998, after completing my MCMS term as President, I was invited to hear President Bill Clinton speak on “The Patient’s Bill of Rights.” I was part of a small group of doctors and nurses who gathered in Memorial Hall in Fairmont Park. The President told the group that all Americans needed guaranteed access to health care providers, access to emergency services, confidentiality of medical records, and grievance and appeals processes for consumers to resolve their differences with their health plans. These are now well accepted patient rights, but in 1998 these were highly controversial proposals. Not surprising, President Clinton worked the room afterwards and greeted many of us. Being virtually face-to-face with an American president is an experience no one ever forgets. Why do you stay involved in organized medicine? Can any of us imagine a world without the Pennsylvania Medical Society? If so, it’s a world with no one standing up for patients when business practices of insurance companies interfere with patient care. It’s a world with no one advocating for a level playing field in the med-mal courtrooms. It’s a world with no one fighting to fund medical education for the next generation of doctors. Losing those advocacy efforts and many more that are the life-blood of the medical society is a thought that is nearly unimaginable to me.

Alone at the Top?

An achievement most proud of: I ran in a 5-K race and beat my U.S. congressman.

A 24/7 sounding board, expert advice and support is only a call away...

What interests me outside medicine: Anything done outdoors. I enjoy biking and jogging. My goal (unfilled) is to run every day. I also enjoy listening to NPR on my ride to work each morning and watching commercials during the Super Bowl – Madison Avenue’s finest hour.

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My family: My wife, three daughters and three sons-inlaw, too – all different and all great guys.

Helping passionate business owners navigate growth and profitability

You may not know: Most nights I have the same dinner: imported extra virgin olive oil, artichokes, and feta cheese. Add tomato, lettuce, and carrots. Nothing better! If I could be anything other than a physician: I would be . . . a judge on the U.S. Supreme Court. I greatly admire: Sacagawea. The single most important guide and interpreter during the exploration of the American West; all accomplished as a teenager.

Keith Ordemann, founder, has 30+ yrs as a successful CEO, CFO, CPA and advisor to small, emerging growth and mid-market enterprises. He is passionate about helping entrepreneurs succeed throughout the life-cycle of their business. Please call or email for a free consultation.

KEITH@BERKSHIRECONSULT.COM

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610-223-4751

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Montgomery County Hospital Snapshots Montgomery County is very fortunate to have 10 premiere hospitals in the county. Being some of the largest employers in the county, these health systems provide a host of topnotch medical professionals, as well as services, to meet the growing health-related needs of this vast county. MCMS Physician would like to thank all hospital administrators and staff for gathering this information to share with our readers. By the Numbers – 2013 Abington Memorial Hospital Admissions: 32,052 Births: 4,843 Surgeries: 12,793 Inpatient Visits: 32,052 Outpatient Visits: 594,543 Emergency Room Visits: 102,620 Number of Beds: 665 Employees: 5,500 Physicians: 1,100 Name: Abington Health (Two hospitals in Montgomery County – Abington Memorial and Lansdale Hospital) Address: 1200 Old York Road Phone number: (215) 481-2000 Web site: www.abingtonhealth.org CEO: Laurence M. Merlis General Summary of Services: Abington Health is the umbrella organization that encompasses its flagship hospital, Abington Memorial Hospital, in Abington and Lansdale Hospital in Hatfield Township. Abington Health entities also include convenient outpatient facilities, Abington Health Center – Schilling in Willow Grove, Abington Health Center – Warminster in Bucks County, Abington Health Center – Montgomeryville in North Wales and Abington Health Center – Blue Bell. Together, these facilities serve more than 39,000 inpatients, 134,000 emergency patients and over 653,000 outpatient visits annually. More than 1,400 physicians are on staff at both Abington Memorial Hospital and Lansdale Hospital. Additionally, Abington Health employs a network of specialists and primary care physicians known as Abington Health Physicians. Abington Health employs more than 6,000 employees, making it one of the largest employers in Montgomery County. Health System Entities: Abington Memorial Hospital, Lansdale Hospital, Abington Health Center – Blue Bell, Abington Health Center – Schilling, Abington Health Center – Warminster, Abington Health Center – Montgomeryville

Lansdale Hospital Admissions: 5,323 Births: 0 Surgeries: 4,334 Inpatient Visits: 6,151 Outpatient Visits: 54,630 Emergency Room Visits: 26,827 Number of Beds: 135 Employees: 600 Physicians: 300 ________________________________ Name: Eagleville Hospital Address: 100 Eagleville Road, Eagleville, PA 19403 Phone number: (800) 255-2019 Website: www.eaglevillehospital.org ________________________________

Name: Einstein Medical Center Montgomery Address: 559 W. Germantown Pike, East Norriton, PA 19403 Phone number: (484) 622-1000 Web site: www.einstein.edu/montgomery Leadership: Barry Freedman, Chief Executive Officer, Einstein Healthcare Network CEO: Beth Duffy, Chief Operating Officer, Einstein Medical Center Montgomery MCMS

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General Summary of Services: Einstein Medical Center Montgomery provides medical and surgical specialty care and advanced diagnostic testing. Our 24-hour Leonard and Madlyn Abramson Family Emergency Department is staffed by board-certified emergency physicians. Einstein Montgomery offers advanced cardiac services, comprehensive cancer care including The Karabots Center for Radiation Oncology, a family-centered maternity care unit with the Level III Arthur and Lea Powell Neonatal Intensive Care Unit, comprehensive orthopedic care, home health, hospice and palliative care services, and general, minimally invasive and robotic surgery for various subspecialties. Einstein Montgomery has a network of primary and specialty care physicians, and outpatient centers throughout central Montgomery County. Health System Entities: Einstein Medical Center Montgomery, Einstein Medical Center Philadelphia, Einstein Medical Center Elkins Park, MossRehab, Belmont Behavioral Health, Einstein Physicians By the Numbers – 2013 Admissions: 10,799 Births: 1,783 Surgeries: 9,237 Inpatient Visits: 6,576 Outpatient Visits: 179,925 Emergency Room Visits: 36,319 Number of Beds: 170 Employees: 1,751 Physicians: 400 ________________________________

Name: Holy Redeemer Health System Address: 667 Welsh Road, Huntingdon Valley, PA 19006 Phone number: (800) 818-4747 Web site: www.holyredeemer.com CEO: Michael B. Laign

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Hospital Profiles General Summary of Services: Holy Redeemer Health System is unique among health care providers with its HealthCare, HomeCare, and LifeCare divisions, offering a wide range of healthcare and health-related services, including an acute care hospital, home health and hospice services, two skilled nursing facilities, personal care, an independent living community for seniors, low-income housing, an active living community, and a transitional housing program for homeless women and children. With corporate offices in Huntingdon Valley, Holy Redeemer Health System is a Catholic healthcare provider, serving southeastern Pennsylvania and 12 counties in New Jersey, from Union County south to Cape May County. Health System Entities: Holy Redeemer Hospital (Meadowbrook, PA), Holy Redeemer St. Joseph Manor (Meadowbrook, PA), Holy Redeemer Lafayette (Philadelphia, PA), Holy Redeemer D’Youville Manor (Yardley, PA), Holy Redeemer HomeCare and Hospice (PA, NJ), Drueding Center (Philadelphia, PA), Holy Redeemer Women’s HealthCare at Southampton, Holy Redeemer HealthCare at Bensalem, Holy Redeemer HealthCare at Huntingdon Valley (includes ambulatory surgery center), various outpatient physician offices. By the Numbers – 2013 Admissions: 11,018 Births: 2,647 Surgeries: 5,163 Inpatient Visits: Ambulatory Surgical Center surgeries (not inpatient visits) 5,446 Outpatient Visits: 136,543 Emergency Room Visits: 29,008 Number of Beds: 263 Employees: 4,126 Physicians: 598 ________________________________ Name: Main Line Health Address: 130 S. Bryn Mawr Ave., Bryn Mawr, PA 19010 Phone number: (866) CALL-MLH (866-225-5654) Web site: www.mainlinehealth.org CEO: Jack Lynch, President and CEO, Main Line Health General Summary of Services: Founded in 1985, Main Line Health is a not-forprofit health system serving portions of Philadelphia and its western suburbs. At

its core are four of the region’s respected acute care hospitals — Bryn Mawr Hospital and Lankenau Medical Centerin Montgomery County, Paoli Hospital and Riddle Hospital — as well as one of the nation’s premier facilities for rehabilitative medicine, Bryn Mawr Rehab Hospital; Mirmont Treatment Center for drug and alcohol recovery; and the Home Care Network, a home health service. Main Line Health also consists of Main Line HealthCare, one of the region’s largest multi-specialty physician networks, and the Lankenau Institute for Medical Research, a non-profit biomedical research organization located on the campus of Lankenau Medical Center. Main Line Health also consists of four outpatient health centers located in Broomall, Collegeville, Exton and Newtown Square. Health System Entities: Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital, Riddle Hospital, Bryn Mawr Rehab Hospital, Mirmont Treatment Center, The Home Care Network, Lankenau Institute for Medical Research By the Numbers – 2013 Admissions: 62,308 Births: 7,688 Surgeries: 38,985 Outpatient Visits: 1,053,608 Emergency Room Visits: 171,100 Number of Beds: 1,323 Employees: 10,432 Physicians: 2,070 ________________________________

Name: Mercy Suburban Hospital Address: 2701 DeKalb Pike, East Norriton, PA 19401 Phone number: (877) GO-MERCY (466-3729) and (610) 278-2000 Website: www.mercyhealth.org/suburban Executive Director: Tina Fitz-Patrick, MSN, RN General Summary of Services: Mercy Suburban Hospital, a Primary Stroke Center certified by The Joint Commission, MCMS

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received the coveted Target: Stroke Honor Roll Award and Stroke Silver Plus Quality Achievement Award. In addition, Mercy Suburban Hospital received the Get With The Guidelines — Gold Plus Heart Failure Quality Achievement Award and earned Core Certification for Congestive Heart Failure and the Gold Seal of Approval from The Joint Commission. For the past several years, Mercy Suburban has been recognized as Best of Montco for Cancer Care and One of the Best Hospitals in Montco by the Norristown Times Herald. Mercy Suburban Hospital’s comprehensive services include Mercy Cancer Center, a member of the Jefferson Kimmel Cancer Center Network; a sleep disorders center; vascular care; cardiac and stroke program; bariatric surgery; a Senior Behavioral Health Unit; Wound Care and Hyperbarics Center; and a robotic surgery program featuring the daVinci Robotic Surgery System. Recently, Mercy Suburban opened the Vein Center at Mercy Suburban Hospital and began performing single-site cholecystectomy surgery using the da Vinci Surgical System. Health System Entities: A member of the Mercy Health System of Southeastern PA. By the Numbers – 2013 Admissions: 4,714 Births: N/A Surgeries: 3,898 Outpatient Visits: 68,684 Emergency Room Visits: 23,931 Number of Beds: 126 Employees: 694 Physicians: 49 ________________________________ Name: Pottstown Memorial Medical Center Address: 1600 East High Street, Pottstown, PA 19464 Phone number: 610-327-7000 Website: www.pottstownmemorial.com ________________________________ Name: Valley Forge Medical Center and Hospital Address: 1033 W. Germantown Pike, Norristown, PA 19403 Phone number: (610) 539-8500 Website: www.vfmc.net

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Stepping Up Health Care in Pennsylvania

Feature

Guest opinion

Stepping Up Health Care In Pennsylvania Don’t endanger improvements with state or federal budget cuts By Andy Carter and Michael R. Fraser

n early November, Pennsylvania’s doctors and hospitals learned that fewer patients than ever are dying after heart surgery and fewer are having to return to the hospital because of incomplete care or other complications. These were among the conclusions in a Pennsylvania Health Care Cost Containment Council report, which examined more than 20,000 coronary artery bypass grafts and/or valve surgeries performed between July 1, 2011, and Dec. 31, 2012. This is great news for Pennsylvania patients, health care professionals and hospitals — and we celebrate these achievements as we simultaneously strive to drive the good numbers up and the bad numbers down even more. To further these improvements, however, it is important to know how and why we are where we are today. First, we can attribute these successes to the outstanding skill, professionalism and caring shown by teams of physicians, nurses, pharmacists, allied health professionals, hospital administrators and others who fulfill the awesome responsibility to care for Pennsylvanians during tens of millions of patient visits each year. Another key factor is the use of good data. PHC4 data collection and reporting, for example — on cardiac care, orthopedic care, HMOs, hospital performance, infections, finances and more — has helped hospitals and physicians provide outstanding, costeffective care to our families, friends and neighbors. Physicians and hospitals also work closely with the Pennsylvania Pa-

tient Safety Authority to promote best practices and to identify and fix flaws that could result in patient harm. Then there are the human elements. We see better communication and coordination among caregivers in smooth “handoffs” — from doctors to hospitals to rehab facilities, for example. We see it in simpler, clearer procedures in the operating room that reduce errors such as wrong-site surgeries and help ensure that we get it right every time. We see it in doctors, patients and families talking to, not past, each other, where members of the medical team value the wisdom and experience of patients and their families as much as the patients and families value the professional skill of the caregivers. So what does this mean going forward? We know that higher quality health care requires unprecedented levels of collaboration between physicians and hospitals — and between the medical community and the patients and families in need of our care, compassion, competence and communication. For our organizations — the Pennsylvania Medical Society and The Hospital & Healthsystem Association of Pennsylvania — this means working with each other and across the continuum of care to improve outcomes and the patient experience as well as reduce health care costs. Efforts to build on these achievements will be hampered, though, if budget cuts in Harrisburg and Washington target physician and hospital payments.

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For physicians, Medicare payments are scheduled to be cut by as much as 24.7 percent due to a flawed formula known as the “sustainable growth rate” that is pegged to growth in GDP. For hospitals in Pennsylvania, Medicare cuts of $155 million already are in the pipeline. Our organizations will press Washington policy makers to eliminate this formula and shore up Medicare’s finances in others ways so as not to degrade health care. Here at home, we’re encouraged by Gov. Tom Corbett’s Healthy PA plan to expand and reform Medicaid, but continued state budget deficits put critical Medicaid and other hospital and physician payments at risk — further ratcheting up the pressure on providers. Our organizations are excited by our members’ patient-care successes, as documented in the recent PHC4 report. We will continue to work together to improve quality and value in health care, bringing together medical professionals and hospital leadership to build a health care system that works for all. And we will continue to encourage lawmakers in Harrisburg and Washington to adopt that same collaborative spirit as they set the public policy that guides Pennsylvania health care in the years to come.

“Ultimately, though, future progress in health care means never forgetting that ours is a fundamentally human endeavor, regardless of the political, financial, and technological landscape. Pennsylvania’s hospitals and doctors will keep that in the forefront of everything we do.” Andy Carter is president and CEO of The Hospital & Healthsystem Association of Pennsylvania and Michael R. Fraser is executive vice president of the Pennsylvania Medical Society.

winter 2014

Nine Steps for Responding

Feature

Nine Steps for Responding to Unanticipated Outcomes By Mary-Lynn Ryan, Risk Management NORCAL Mutual Insurance Company and the NORCAL Group

ne of the most difficult aspects of medical practice is disclosing an unanticipated adverse outcome, but it has to be done. The following nine steps provide a strategy for taking corrective action, maintaining the provider-patient relationship and decreasing professional liability exposure. Depending on the circumstances, the order in which the following steps are completed may vary. In every instance, however, caring for the patient’s immediate needs should come first.

1. Take Care of the Patient Obtain necessary consults, assign primary responsibility for providing care and make sure the patient/ family has contact information for the primary provider. Because a patient may need extra accommodations to rebuild rapport, staff should also be aware of the situation and be involved in the process.

2. Preserve the Evidence Preserve equipment and/or supplies that may have contributed to an unanticipated outcome. Without evidence of properly (or improperly) operating equipment, a provider involved in a professional liability claim must depend on assumptions and memories – evidence that is more easily challenged than direct evidence of equipment status.

3. Document Document, in detail, events that led to, took place during and followed an unanticipated outcome. This documentation can be instrumental in showing that the care at issue was

appropriate, even though the outcome was not expected.

4. Complete Mandatory Reports In a hospital setting, providers should contact the risk manager, relevant department managers and the peer review committee to determine which reports must be completed. When unsure of reporting requirements, providers can seek guidance from state medical associations, healthcare organizations and professional liability insurers.

5. Notify the Medical Liability Insurer If an incident occurs that could lead to a lawsuit, providers should notify their medical liability insurer as soon as possible.

6. Disclose the Unanticipated Outcome Sympathetically inform the patient or patient’s family about the adverse outcome as soon as appropriate. This can dispel anger, confusion and distrust. Questions should be answered honestly, without speculating, blaming or admitting liability. Feelings of not being told the whole story or of not being given the opportunity to ask questions and vent feelings can provoke a decision to seek the advice of an attorney.

7. Analyze the Unanticipated Outcome to Prevent Recurrence and Improve Future Outcomes Perform a thorough analysis of the events that led to the outcome. The goals of an event analysis are to MCMS

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prevent such outcomes in the future and to improve their detection and the processes for responding to and reporting them. Based on the event analysis, a Corrective Action Plan (CAP) should be developed and implemented.

8. Follow Through with Subsequent Disclosure Discussions To meet the patient’s healthcare needs and to address ongoing questions and concerns, schedule regular appointments or phone calls with the patient. This will help rebuild rapport and maintain communication.

9. Heal the Healthcare Team An often-overlooked aspect of unanticipated outcomes and disclosure is the emotional toll on the individuals who provided care to the patient. Providers should recognize and honor the need to discuss feelings about an adverse outcome with family, friends and colleagues. Discussions of feelings should be distinguished from discussion of the facts of the patient’s care and any event analyses that are confidential.

Conclusion

Using these nine steps for responding to unanticipated outcomes can help preserve the physician-patient relationship, ensure that the patient’s medical needs are met, generate corrective action and possibly prevent medical liability litigation. Copyright 2011 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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Features

Q: Name one change members will see right away under your leadership. A: You’ll see a revamped and revised communications strategy focused on getting the best, most relevant information to members as quickly as possible so they can make informed decisions and know what is impacting the practice of medicine in PA. You’ll also see a new, focused strategy to engage county medical societies and specialty medical societies in meaningful and collaborative ways both in advocacy and program development, and membership recruitment and retention.

ichael Fraser, Ph.D., joined the Pennsylvania Medical Society (PAMED) as its new executive vice president in August 2013. With more than 15 years of public health agency and national association experience, he has supported and served healthcare organizations and federal, state and local public health agencies. Prior to joining PAMED, Fraser was chief executive officer of the Association of Maternal and Child Health Programs (AMCHP) in Washington, D.C., where he worked for six years. During his tenure, AMCHP was nationally recognized for its work in supporting state maternal and child health programs. Most recently, AMCHP received the Maternal and Child Health Bureau’s Director’s Award in October 2010 and the American Public Health Association’s MCH Section “Outstanding Leadership and Advocacy” award in November 2010. Fraser has published several research articles and professional publications and is on the adjunct faculty at the University of Maryland’s University College. He serves on several non-profit boards and has worked as a strategic planning consultant and facilitator for many local, state and national groups. With a little over six months on the job, Fraser has come to understand the challenging environment Pennsylvania physicians face. His travels across the state visiting with physician leaders have given him some insight to how PAMED can be a stronger advocate for their needs.

Q: Why should a physician remain a member of PAMED? A: Together we are stronger – when you join PAMED you are making a commitment to the profession and to your patients and supporting our advocacy for physicians across the state. PAMED is working hard to provide you with the best resources, tools and technical assistance possible to help you sort through the uncertainty and change that is taking place in medicine today. We need your support to continue that important part of our work. We want to be your source for information and education as well – by taking advantage of our CME programs you can more than pay for your membership dues. Q: Why should a member join PAMED? A: If you are looking for a place to get relevant and timely information about the practice of medicine in PA, I urge you to join. If you are interested in being part of organized medicine, connecting and networking with physician colleagues from across the state, I urge you to join. If you want to be part of our advocacy on behalf of all Pennsylvania’s physicians and patients, I urge you to join. PAMED membership adds value to your practice in so many ways. We’d love to have you take advantage of our member benefits and be part of the PAMED family.

Q: What significant changes have transformed the physician environment and how will PAMED address those issues? A: There are many, many issues impacting physicians across the Commonwealth including consolidation of physician practices, changes in the employment setting for many physicians, and the pressures and uncertainty introduced by the Affordable Care Act. We want PAMED to be the premiere physician advocacy organization for all PA physicians – we want physicians to know that despite these changes and transformations, we “got your back.” We also want PAMED to be the first place that physicians come to get useful information and helpful resources about what these transformations mean for their practices, the profession, and their patients.

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Q: Where do you see PAMED in five years? A: You’ll see an organization that has transformed to meet the needs of members across the state; an organization moving nimbly to support all PA physicians. You’ll see members engaged in all aspects of our work, developing programs and resources that truly demonstrate value and relevance to our physician community. You’ll see an organization that supports our members through meaningful educational programs and leadership development with a robust catalog of offerings and CME resources. You’ll see us continue to maintain and increase our advocacy as the “voice” for physicians in Harrisburg and throughout the Commonwealth.

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Physicians Health Programs

Feature

Kendra Parry (L) and Tiffany Condran (R)

Physicians’ Health Programs Welcomes New Staff Members

he Foundation of the Pennsylvania Medical Society Physicians’ Health Programs welcomed new case managers Tiffany Condran and Kendra Parry this year. The Physicians’ Health Programs (PHP) ensures physicians have the supportive resources and tools to stay healthy so they can continue providing healthcare for others. Physicians, like the rest of the population, are vulnerable to chemical dependency, physical disability or breakdowns in mental health. A physician who is having problems or who has concerns about a colleague (e.g. addiction, physical disabilities, or neuropsychiatric disorders) should reach out to the PHP. “We are thrilled to expand our PHP staff to better serve our participants,” said Foundation of the Pennsylvania Medical Society Executive Director Heather Wilson. “Tiffany and Kendra both bring a strong background in counseling and each provides a unique perspective on our core mission. Our program will continue to strengthen with their experience.” Tiffany, Pennsylvania State Board Certified Alcohol and Drug Counselor, most recently worked as a counselor at Gaudenzia Inc., in Mechanicsburg. Tiffany joined the PHP staff because she was impressed with the philosophy and

mission of the PHP and was interested in utilizing her clinical skills in a different professional environment while continuing to help people through the recovery process. “I enjoy having the opportunity to build relationships with our participants and having the privilege to be a part of their recovery journey,” she said. Through PHP, she plans to help support individuals through their recovery process so they can continue to practice medicine and contribute to society’s health and wellness. “I have professional experience in both mental health and addiction therapy at multiple levels of care so I believe this will help me make appropriate referrals for treatment needs, build rapport with participants and their families, and have a solid understanding of the challenges and triumphs that individuals encounter through this process,” she said. When she is not at work, Tiffany enjoys kayaking, motorsports, going for walks, spending time with her family, gardening, and going to the movies. Kendra, Pennsylvania State Board Certified Alcohol and Drug Counselor, most recently worked as a counselor at Gaudenzia Inc., in Harrisburg. Kendra joined the PHP staff because she felt it was a great opportunity to help others.

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“I love working in human services, especially in the field of addiction. Previously, I had worked in addiction counseling, and saw the chance to continue to challenge myself and to expand my knowledge and skill set,” she said. “I think being able to advocate for people is the best part of working for the PHP.” Kendra said that after a short time working as a counselor, she found that one of the best ways to help someone is just by listening. For so many people who struggle with addiction they just need to know someone is there to listen and to care about what they are saying. “I always felt one of my greatest strengths was my ability to listen and hear what others are saying so it was a natural fit. My goal for the PHP is to become a contributing member of this already great team of people. I hope to be able to help make the program better in any way that I can. My coworkers are some of the hardest working and caring people I have met,” she said. When she is not at work, Kendra likes to spend time with her family and friends. She is recently married. She loves to watch baseball and football, and goes to as many Phillies and Ravens games as she can fit in. She also enjoys reading, crocheting and cooking. The PHP has restored careers, families and confidence by helping more than 3,000 physicians seek and receive the recovery care that enables them to remain a vibrant part of the physician workforce.

CONTACT US 777 East Park Drive, PO Box 8820 Harrisburg, PA 17105-8820 Toll Free: (866) 747-2255 (in PA only) Phone: (717) 558-7819 Friday–Emergencies Only– 7:30 a.m. to 5 p.m.: (717) 558-7817 Email: php-foundation@pamedsoc.org www.foundationpamedsoc.org

mon t m e d s o c .c om

News & Announcements

Welcome New Members...

December Holiday Board Meeting The dinner was held at Mortonâ€™s Steakhouse in King of Prussia. We were treated to a wine tasting and physicians brought donations for Toys4Tots.

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

September 2013

David Halpern, Medical Student Andrea Haman, Practice Administrator Scott Douglas, Medical Student

October 2013

Rose Jensen, MD Roberta Scherr, MD Christine Strunk, DO Thomas J. Gillon, MD

November 2013

John Finley, IV, MD Gregg Gagliardi, MD Jennifer Hwang, Medical Student

December 2013

Beth Maisel, MD Donald Sesso, DO Adrienne Smallwood, Medical Student

Necrology Report MCMS regrets the loss of these society members in 2013:

MCMS Gives to the Kids

Lewis J. Brandt, DO Rodman B. Finkbiner, MD Irvin M. Gerson, MD Elena Gitelson, MD Eli B. Harmon, MD Ivan W. Hess, MD Joel H. Jaffe, DO Hymen Kanoff, DO Harry J. Kenworthy, MD Daniel W. Kirkpatrick, MD Ronald A. Kirschner, DO Abraham A. Lurie, MD Leopoldo E. Margarida, MD Patrick J. McDonough, MD Richard W. Moscotti, MD Robert D. Pelicata, DO Michael F. Rafferty, DO James F. Rea, DO, FACN Lester Sablosky, MD

MCMS Executive Director Toyca Williams (far left) with staff of Sen. Daylin Leach. Sen Leachâ€™s office is one of many drop off sites for Toys4Tots in Montgomery County.

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winter 2014

MCMS Awards Two Scholarships to Medical Students

H Hallie A. Rozansky

Adrienne N. Smallwood

allie A. Rozansky and Adrienne N. Smallwood, both first year students at University of Pennsylvania Perelman School of Medicines, were recently awarded $1,000 scholarships by the Montgomery County Medical Society (MCMS). Thanks to your contributions to the MCMS Scholarship Fund, MCMS continues to fulfill its mission to invest in medical student education. “When I become a doctor, I want to continue to be many other things – an advocate, an educator, a counselor, a scientist, and a source of strength for my patients. I want to care for whole patients, bringing a nuanced understanding of the world they live in and developing lasting relationships,” said Rozansky, who plans to specialize in internal medicine and pediatrics. Through medicine, she hopes to bring together diverse elements of medicine, from the scientific to the socioeconomic, the personal and the global. She has volunteered in community health programs and consulted for an AIDS research think tank. Through that experience she realized that medical care is one piece of the puzzle in prevention and treatment of disease. She plans to earn a master’s degree in public health along with her medical degree. Smallwood, who plans to become a surgeon, participated in neurobiology research with a Harvard Medical School professor at the Beth Israel Deaconess Medical Center and volunteered at Brigham and Women’s Hospital and in a student-run community health clinic. She said these experiences allowed her to learn about the many disparities in healthcare and how physicians can be a part of the solution. “I became certain of my choice to pursue a career as a physician after realizing that this career would allow me to combine my interests in serving others while satisfying my curiosity with science,” she said. Both students will be recognized at the Annual Installation and Membership Dinner, June 3, William Penn Inn. If you want to invest in the future of medicine, contributions to the scholarship fund are taken throughout the year. Your tax deductible donation should be made payable to The Foundation of the Pennsylvania Medical Society with MCMS Scholarship noted in the memo line. The Foundation administers the fund for MCMS. Send donations to 777 E. Park Drive, Harrisburg, PA 17105 or call 610-878-9530 or (717) 558-7854.

Member Physicians Under 45 Receive CME Reimbursement

leven young physicians were awarded continuing medical education reimbursements through the MCMS Howard F. Pyfer Fund. Through the fund, member physicians under the age of 45 are awarded reimbursements up to $500. Only tuition, registration cost and major transportation cost are considered for reimbursement. Reimbursements are considered each year for CME courses taken within the calendar year, January through December. The deadline to submit applications is the following January. Members can submit applications now for 2014, with the deadline being Jan. 12, 2015. Download your application from the MCMS web site, www.montmedsoc.com, or request one by e-mail, montmedsoc@verizon.net.

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mon t m e d s o c .c om

News & Announcements

Last Round of Community Grants Awarded to Nonprofits

ixteen nonprofit organizations were awarded grants totaling $10,000 by the Foundation of the Pennsylvania Medical Society on behalf of Montgomery County Medical Society. Grants ranged from $250 to $1000 each. For more than 40 years, the medical society foundation has distributed almost $400,000 in grants to requesting organizations. However, two years ago, MCMS decided to dissolve the foundation and redirect its charitable donations to medical student education. The Foundation was established in 1964 with donations from the Polio Immunization program conducted throughout Montgomery County. The Montgomery County Medical Society strongly believed those public donations should be returned to the community. With those funds, the medical society established the foundation to distribute grants annually to charitable organizations that provide services to improve the mental and physical well-being of Montgomery County residents. “As a physician-run organization, the health of our community is very important to us. These deserving organizations help every Montgomery County physician provide competent and compassionate medical care,” said Madeline A. Danny, DO, president of the Montgomery County Medical Society.

Connect your products and services directly to your target audience.

Physician For advertising information contact Karen Zach, 484.924.9911 karen@HoffPubs.com or Andrea M. Krantz, 610-685-0914 x205 andrea@HoffPubs.com

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Carson Valley Children’s Aid

Central Montgomery Mental Health & Retardation Center

Child, Home & Community

Developmental Enterprises Corp

Family Services/Contact

Health Link Medical Center

Interfaith Hospitality Network-Main Line

Inter-faith Housing Alliance;

Literacy Council of Norristown

Montgomery County Emergency Services, Inc.

National Multiple Sclerosis Society Greater Delaware Valley Chapter

Penn State Extension Unit

Retired & Senior Volunteer Program of Montgomery County and Victim Services Center

Winter 2014

Save the Date Practice Management Seminar in May

Employed vs. Indepe ndent A Physician’s in Pe

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The final recipients to receive these grants are Acquired Brain Injury Network of PA, Inc.

rspective

Three things yo prepared for u can do to ensure you’re ICD-10 Implem entation Health syste m Snapshots : Who is Taking Care of Your Community?

MCMS will co-host the 9th Annual Tools for Success Practice Management Seminar, May 8-9, Springfield Country Club, 400 W. Sproul Road, Springfield. Topics include compliance plans for small practices, risk management, practice management/payer relations issues, electronic communications, ICD-10, legislative and regulatory updates, and other challenges that may impact your practice.

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Visit the MCMS web site for additional information, www.montmedsoc.com.

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winter 2014

Seniors Learn More About Their Eye Health

bout 30 members of the Upper Merion Senior Service Center recently heard the latest news in eye health issues affecting those over 65 years of age. Dr. Mark Pyfer, a respected Montgomery County ophthalmologist and MCMS board member, shared with the group new technologies for diagnosis and treatment of cataract, glaucoma, age-related macular degeneration, dry eye syndrome and blepharitis. MCMS established a Speakers Bureau, comprised of physician members, to educate the community about health-related topics. Topics can range from talks about hypertension to emergency room care to medical liability reform.

“We all want to live healthy lives,” Dr. Pyfer said. “The Speakers Bureau gives us a chance to take these messages beyond the exam room.”

Dr. Pyfer

Senior Center about eye health issues affecting seniors.

Montgomery County Medical Society

You can learn more about requesting a speaker through the MCMS web site, www.montmedsoc.com, or call 610-878-9530.

MCMS SPEAKERS BUREAU Visit www.montmedsoc.com/speakersbureau to schedule a medical professional to speak to your organization.

JESSIC A PANET TA, MA, RD, LDN

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Office locations in Huntingdon Valley, Fort Washington, & King of Prussia 267.627.2977 | JessicaPanettaRD@gmail.com www.NutritionForEveryDayLiving.com

MCMS

speaking to Upper Merion

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

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The exclusively endorsed Medical Professional liabiliTy insurance coMPany of The MonTgoMery counTy Medical socieTy

PMSLIC is committed to its physician-policyholders, therefore we promise to treat your individual needs as our own. You can expect caring and personal service, as you are our first priority. For more information contact your agent, or call Laurie Bush at PMSLIC at 800-445-1212, ext. 5558 or email lbush@pmslic.com. Or visit www.pmslic.com/start for a premium estimate.

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Hoffmann Publishing Group

Published on Mar 25, 2014

MCMS Physician Winter 2014

Montgomery County Medical Society of Pennsylvania MCMS Physician Winter 2014 issue. Visit www.montmedsoc .com to learn more about the healt...

MCMS Physician Winter 2014

Published on Mar 25, 2014

Montgomery County Medical Society of Pennsylvania MCMS Physician Winter 2014 issue. Visit www.montmedsoc .com to learn more about the healt...

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