Berks County Medical Society Medical Record Summer 2016 by Hoffmann Publishing Group

Medical record Your Community Resource for What’s Happening in Healthcare

SUMMER 2016

BERKS COUNTY MEDICAL SOCIETY

Improving Transitions of Care –

Medication Reconciliation

Alternatives to Prescribing Controlled Substances for Chronic Pain The Biggest Patient Safety Problem at Home:

medications

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Medical record BERKS COUNTY MEDICAL SOCIETY

A Quarterly Publication

To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

Berks County Medical Society MEDICAL RECORD Lucy J. Cairns, MD

Contents

SUMMER 2016

Features

Improving Transitions of Care – Medication Reconciliation

Editorial Board

D. Michael Baxter, MD Daniel B. Kimball, MD, FACP Betsy Ostermiller

Berks County Medical Society Officers Andrew R. Waxler, MD President Gregory T. Wilson, DO, President Elect D. Michael Baxter, MD Chair, Executive Council Michael Haas, MD Treasurer & Chair, Finance Committee Anne Rohrbach, MD Secretary Lucy J. Cairns, MD Immediate Past President T. J. Huckleberry, MPA Executive Director Betsy Ostermiller Executive Assistant

Berks County Medical Society 875 Berkshire Boulevard, Suite 102B, Wyomissing, PA 19610 Phone: 610.375.6555 | Fax: 610.375.6535 Email: info@berkscms.org

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society. Manuscripts offered for publication and other correspondence should be sent to 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. The editorial board reserves the right to reject and/or alter submitted material before publication. The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 875 Berkshire Boulevard, Suite 102B, Wyomissing, PA 19610. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices. POSTMASTER: Please send address changes to the Berks County Medical Record, 875 Berkshire Boulevard, Suite 102B, Wyomissing, PA 19610.

The Biggest Patient Safety Problem at Home:

medications

14 Alternatives to Prescribing Controlled Substances for Chronic Pain 16 Seniors and Substance Use: SBIRT Aids in Screening and Intervention 20 Substance Abuse Task Force 21 Recap - Resident’s Day & Memorial Lecture 22 Members in the News 23 Dr. Dan Kimball 24 Welcome New Member: Varuna Sundaram, M.D. 26 Balance Billing: We can do better 31 2016-2017 Directory of Physicians Corrections 34 Recap - BMCS’s 25th Annual Legislative Breakfast 35 BCMS Upcoming Events Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”

In Every Issue

4 6 8 28 32

Editor’s Comments President’s Message Compass Points Foundation Update Alliance Update

Content Submission: Medical Record magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Berks County Medical Society. Submissions can be photo(s), opinion piece or article. Typed manuscripts should be submitted as Word documents (8.5 x 11) and photos should be high resolution (300dpi at 100% size used in publication). Email your submission to info@berkscms.org for review by the Editorial Board. Thank YOU!

Medical Record magazine is published by Hoffmann Publishing Group, Inc. 2921 Windmill Road, Reading, PA 19608 | HoffmannPublishing.com | 610.685.0914 FOR ADVERTISING INFO CONTACT: Tracy Hoffmann, 610.685.0914 or Tracy@HoffPubs.com

Editor’s Comments

Safety in Transition

Lucy J. Cairns, MD Editor

www.berkscms.org

he importance of devoting more attention and resources to improving patient safety made headlines earlier this year with the publication of an article by experts at Johns Hopkins who concluded that medical errors are the third leading cause of death in the U.S.1 Their findings were not based on new information, but rather on an extrapolation from an analysis of four large studies carried out between 2000 and 2008. The methodology and conclusions of this study have been criticized by other patient safety experts as unsound and resulting in an inflated estimate of the number of preventable deaths, but there is no debating the fact that despite all the efforts to reduce preventable harm introduced since the landmark 1999 Institute of Medicine Report “To Err is Human,” we still have a long way to go. While the meanings of the terms ‘patient safety’ and ‘medical error’ are in part selfevident, the study of these issues requires precise definitions. In the 1999 IOM report, safety is simply defined as freedom from accidental injury. In a compendium of articles on patient safety published by the Agency for Healthcare Research and Quality of the US Dept. of Health and Human Services, an article titled “What Exactly is Patient Safety?” by Linda Emanuel, M.D., Ph.D., et al offered the following definition: “We define patient safety as a discipline in the health care professions that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. We also define patient safety as an attribute of health care systems that minimizes the incidence and impact of adverse events and maximizes recovery from such events.” Medical error is defined in the 1999 IOM report as follows: “Error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. According to noted expert James Reason, errors depend on two kinds of failures: either the correct action does not proceed as intended (an error of execution) or the original intended action is not correct (an error of planning). Errors can happen in all stages in the process of care, from diagnosis, to treatment, to preventive care.” One of the more common errors of execution is when a failure of communication occurs in relation to a patient’s care being transitioned from one care setting to another. Faulty transition-related communications have been implicated in 80% of serious medical errors.2 A frequent scenario in which a patient experiences multiple transitions of care is that of a nursing home resident who is sent to the local ER, admitted from the ER to the hospital, and then transferred to a rehabilitation facility before being discharged back to the nursing home. At each transition point, accurate, complete, and effective communication must occur to prevent medical

“THE SINGLE BIGGEST PROBLEM IN COMMUNICATION IS THE ILLUSION THAT IT HAS TAKEN PLACE.” GEORGE BERNARD SHAW

error. Achieving such communication requires a commitment of time and effort, and the challenges are complicated further when the receiving caregiver is not a medical professional, as when a person is discharged to home care from a hospital or rehabilitation facility. A joint study by the National Alliance for Caregiving and the AARP Public Policy Institute has put a spotlight on the need for improved communication with non-medical caregivers when patients are discharged to home. Based on interview data collected in 2014, “Caregiving in the U.S. 2015” found that 53% of the recipients of home care (by family or friends) had been hospitalized in the past 12 months. Of the caregivers, 85% are relatives of the recipient, 60% are women, and nearly 10% are 75 years old or older. One focus of the study was to learn about the circumstances of caregivers providing 21 or more hours of care per week (‘higher-hour’ caregivers). Members of this group were more likely than those in the lower-hour group to be in fair or poor health themselves and more likely to feel emotional distress and physical and financial strain. Caregivers in this group were also more likely to have to perform medical/nursing procedures (such as injections, tube feedings, catheter and colostomy care) for their loved ones (83% vs. 45% of the lowerhour caregivers). Shockingly, 63% of these higher-hour caregivers reported having no preparation to perform such tasks. Administering medications is a task performed by 34% of lower-hour caregivers and by 71% of higher-hour caregivers. To avoid potentially harmful errors, it is vital that home caregivers—and patients without such caregivers—receive instruction at the time of discharge from a hospital or rehab facility regarding any changes in medications made during the inpatient stay and the details of properly administering or taking the medications. On April 20, 2016, Governor Tom Wolf signed into law Act 20, the Caregiver Advise, Record, and Enable (CARE) Act. This legislation, developed by AARP, is designed to improve the process of transitioning patients with designated caregivers from hospital to home. Patients will have the right to name a lay caregiver who then

must be consulted by the hospital in the discharge planning process and must be provided instruction in all necessary tasks described in the discharge plan. By recognizing the important role of the lay caregiver, involving them in planning prior to discharge, and mandating instruction for tasks which are often beyond the caregiver’s experience, there should be fewer communication failures in this type of patient transition. We invited Constance Morrison, President and CEO of Home Health Care Management, Inc., to give us her perspective on the patient safety challenges encountered by her staff related to the transition from hospital or rehab to home. In her article, medication management is singled out as the source of most confusion and errors. For those patients eligible to receive care from a visiting nurse as part of their discharge plan, such professional help can clear up any confusion and stop errors before they happen. From the point of view of a physician responsible for an institution’s role in the discharge transition, BCMS member Dr. Patti Brown, Medical Director of HealthSouth Reading Rehabilitation Hospital, contributed a description of the medication reconciliation process and her assessment of its importance. She points out that while patient safety is best served by a team effort, it is physicians who are ultimately responsible for ensuring the accuracy of a patient’s medication list at every transition point. More than once or twice, in my writings for the Medical Record, I have said that trust is the foundation upon which any therapeutic doctor/patient relationship is built, and we need to continually strive to be worthy of that trust by working together to improve patient safety. Makary MA, Daniel M. Medical error—the third leading cause of death in the US. BMJ 2016;353:i2139

Joint Commission Center for Transforming Healthcare. Project Detail: Hand-off Communications. http://www.centerfortransforminghealthcare.org/projects/detail. aspx?Project=1. Accessed June 16, 2016.

SUMMER 2016

President’s Message

U Andrew Waxler, MD, FACC President

nless you’ve been on a deserted island without media coverage for the last few months, you are certainly well aware of the growing and devastating opioid crisis. In fact, it is arguably the primary health care problem currently, both nationally as well as within our Commonwealth. This crisis was precipitated by a “perfect storm” of factors including: outside pressures on healthcare providers to adequately treat pain, the creation of pain as the “ fifth vital sign” to underscore the importance of addressing patients’ pain level, the development and somewhat misleading marketing of new, highly-addictive oral pain killers, combined with the growing power of patients’ evaluations (and the perception of doctors’ need to placate patients). Sadly, our Commonwealth is in the

top 10 of states with regard to opioidrelated deaths; in Pennsylvania, there are seven such deaths every single day!

Furthermore, is my understanding that Berks County abundantly contributes its share to that statistic. As leaders in our health care community, we at the Berks County Medical Society concluded that to effectively address this issue, proper education and advocacy were paramount. As such, the Berks County Medical Society Opioid Task Force (subsequently renamed the SubstanceAbuse Task Force) was created. This committee brings together all of the key stakeholders in Berks to address the health care aspect of this crisis locally. With a unified front, we will all be “rowing in the same direction.” Over the past couple of months we have had an immediate impact on our community. In April, we had a “drug take back” event at the Reading

Fightin’ Phillies stadium with the assistance of the DEA, the Berks County DA’s office, and the Reading police force. We brought in somewhere between 700 and 1100 POUNDS of unused, and potentially dangerous, prescription medications. By doing that, we have now prevented those medications from contributing to some tragic outcomes that could have been caused by misuse — either accidental or intentional. Next, we organized a very successful CME program in which we had the two top experts from Harrisburg give us the state perspective, and we had our local experts translate this into practical tips — all in an effort to educate our healthcare community regarding the scope, etiology, manifestations, and potential solutions pertaining to this vexing problem. This initial CME program will hopefully serve as a catalyst for future education programs on this subject. We have created posters for doctors’ offices, brochures to give out to patients, information sheets for doctors prescribing opioids to hand to patients along with the prescription, and a number of other educational outreach tools. We encourage all of you to reach out to T.J. Huckleberry, our Executive Director, to obtain these important materials for your office and patients. In short, we are so fortunate to have our “all-star team” of local experts who are willing to give their time and efforts to help address this ever-growing crisis. You can help out in any number of ways, first of all by simply becoming educated about this crisis. Going forward, we will be working on future programs and outreach opportunities, and your input and participation is very valuable.

Thanks again for your interest in working together to improve health care right here in our own community...... after all, isn’t that what it’s really all about?

www.berkscms.org

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C o m pa s s P o i n t s

Timothy J. (T.J.) Huckleberry, MPA Executive Director

The 2016 State of the Society Address

June 9th, 2016 The following is a completely fabricated Transcript of Executive Director T.J. Huckleberry’s State of the Society Address. While the setting is a complete figment of your extremely delusional Executive Director’s imagination, he is proud to say that the content is 100% true.

s many of you already know BCMS has decided to move from our office in the Berks Visiting Nurses Office Building to 875 Berkshire Boulevard, Suite 102B. We will officially be operational on April 1. Once again on behalf of the Medical Society we thank BVNA for housing us for so many years and I look forward to partnering with them in our future initiatives. (Dr. Baxter gavels Council into session) “Mr. Chairman, Mr. President, members of Council, distinguished physicians, and Betsy: Seeing that this date marks the one-year anniversary of my employment to this position, I feel that Council and our membership should be apprised of the State of our Society, and I am happy to report that 2016, in particular, has been a very active and vibrant year for BCMS!” (Mr. Huckleberry pauses for standing ovation from members of Executive Council) “We accomplished a lot this year and the credit belongs to all of our members, and the leadership of our Executive Council. We owe a great deal of gratitude to all the members of our society, whom without their support and hard work we could not have achieved the successes earned this year. Please allow me to highlight some of these unsung heroes. “The first individual is Betsy Ostermiller, our Executive Assistant. This was a year of transition for BCMS. We moved offices, we started new initiatives, explored new approaches to our finances as well as member recruitment and retention and, of course, had a brand new director at the helm. Through all of this Betsy has truly been invaluable. Her ability to nicely

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tell me when my brand new big idea is insanely stupid can only be matched by her ability to take my better ideas and improve them. BCMS is very lucky to have her on our team and I was truly lucky to have someone with Betsy’s patience, intelligence, and commitment in my first year.” (Camera pans to a mortified Betsy; Mr. Huckleberry pauses for standing ovation) “To be honest, it is hard to say that my second individual is “unsung” but Dr. Andrew Waxler’s ceaseless energy and drive helped spearhead our Substance Abuse Task Force’s events, culminating in a very successful CME and Drug Take Back event in May. I am very fortunate to have Andy as our President this year; we both came in with many goals for BCMS in 2016-2017 and I take great pride in working with him to achieve them.” (Camera pans to Dr. Waxler, who attempts to start a “four more years” chant) “Third, is a group of physicians whose generosity literally helped our recent CME get off the ground: Dr. Jerry Marcus, Dr. Kika Heller, and, again, Dr. Andy Waxler. During our March Executive Council Meeting, we introduced our plans for our May Opioid Abuse CME Forum and discussed the hefty bill that came with hosting such a large scale event. As the meeting adjourned, I barely was out of my chair before I was met by Dr. Marcus with a check. He saw the importance of hosting an opioid educational event and wanted to make sure it was a success. Not much later, Dr. Kika Heller and Dr. Andy Waxler also stepped up and donated to the CME event as well. There is no doubt, we could not have held the event without the financial support from these three physicians, and their generosity speaks volumes to our society’s ongoing commitment towards the education of not only our fellow physicians but our community as well. On behalf of BCMS – thank you again Dr. Marcus, Dr. Heller and Dr. Waxler.” (Camera pans to all three physicians – standing ovation given…Dr. Waxler has to be prompted by Dr. Baxter to sit down after trying to start another “four more years” chant) “So now that we have highlighted some of the good work we accomplished since last summer, allow me to tell you some of the goals I am focusing on for year two! “The first is to further engage our young physicians, residents, and new to the area doctors. During the interview process for this position, this was one of my main objectives. And while I am pleased with my initial work on the matter, I feel there is much more to do. In short, we need to get younger members as well as learn what aspects our early career physicians and residents value. In every organization it is essential to foster young leadership and attract lifelong members; we at BCMS need to double down on this approach.” (Mr. Huckleberry pauses once again for thunderous applause) “My second goal is to expand on our partnership with our practice administrators and management. To do my job well, I need to know what is going on in the trenches, and your practice

managers and staff are on the frontlines. I need to know how to better support them so the Society can add more value to your practices. That means more programs and initiatives and better dialogue between our office and your management. “I also am very pleased with the role our Society has played in our community. Our Substance Abuse Task Force will continue to educate the community and play an active role in addressing opioid and substance abuse in Berks County, and there are several new programs coming out in the near future. Stay tuned. In the meantime, I will continue to work to keep our Society active and vocal in our community.” (Camera pans to members of BCMS Substance Abuse Task Force; Mr. Huckleberry pauses for applause) “In closing, I cannot express to all of you how proud I am to be part of this Society. This was a year of learning for me. And while I still have no idea what a (insert medical jargon here) is, I do have a fairly firm grasp on who my members are; no matter what practice they represent, what affiliation they might be, what background they might have, each and every member I have met this year is a person who is willing to go the extra mile for their patients, their staffs, and to the advancement of medicine. It is truly a privilege to be part of this organization and thank you again for making this such an exciting and rewarding first year.” (Mr. Huckleberry adjourns)

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SUMMER 2016

M e d i c a l R e c o r d F e at u r e

Improving Transitions of Care – Medication Reconciliation by Patti J. Brown, M.D. Physical Medicine and Rehabilitation Medical Director, HealthSouth Reading Rehabilitation Hospital

t is that time of year again. Our hospital’s Joint Commission Accreditation is due and we are reviewing Patient Safety Goals. When reviewing the goals it is easy to see the true meaning and purpose behind them. Acute Rehabilitation hospitals are licensed as acute care hospitals and are subject to the same rules as acute care hospitals. The patient safety goal of medication reconciliation has been easy to embrace at rehabilitation hospitals. An accurate list of the patient’s medication is imperative to good transitions of care. Medication reconciliation is the ongoing process of documenting appropriate medication orders at each transition of care. Since HealthSouth Reading is a postacute facility this involves an extra step. We must first determine the patient’s medication use at home. We then review medication changes made at the acute care hospital and, with the patient’s and family’s input, determine a medication list which is appropriate for the patient at our facility. At the time of discharge from the rehabilitation hospital, another medication reconciliation is performed. The process consists of again determining what medication the patient has at home, reconciling changes made at the acute care hospital with changes made at the rehabilitation hospital, and the final step of determining medication orders for discharge.. The patient must be given prescriptions for new medications and instructed to get rid of medications they are no longer on. An accurate list is then forwarded to the primary care physician to ensure the continuum of care. The process sounds complicated and it is. Rehabilitation hospitals have a long history of using the team approach to provide good care to our patients, and medication reconciliation is a good use of that approach. The patient and patient’s family is involved in every step and the pharmacist and nurse can help in obtaining accurate lists. But ultimately the responsibility of appropriately ordering medication and discharging patients on the appropriate medication is the responsibility of the physician. Therefore it is important for the physician to be involved at every step. The pharmacist or nurse may assist physicians in the medication reconciliation process, but it is the responsibility of the physician to know how the lists are obtained. The electronic medical record has helped and hindered this process. In many cases the lists of discharge medications are maintained in the system. The difficulty arises if changes are made outside of the system and not incorporated at the next episode of care. It is also too tempting to push the button “resume all meds” at discharge, not taking into account changes that have been made during the hospitalization. Hospitals, post acute hospitals, post acute agencies and physicians should embrace medication reconciliation. It is one of the most important aspects in patient care and deserves the time and effort spent by physicians in ensuring a good process. The medication reconciliation process is the step that ensures the good care you give your patients translates into a manageable, appropriate, and affordable plan at discharge. Please review Ms. Morrison’s article in this issue. She has done an excellent analysis of the problems our patients face at home. She points out the importance of educating our patients each step of the way and the importance of in-home followup. Good patient care and assuring good outcomes are the responsibilities of the entire healthcare team.

www.berkscms.org

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M e d i c a l R e c o r d F e at u r e

The Biggest Patient Safety Problem at Home:

medications by Constance Morrison President and CEO of Home Health Care Management, Inc.

Patients in the acute care facilities across the

country receive high quality care every day and then go home. Often times alone because the family at the bedside disappears. They go home to a home that is not quite as easy to maneuver as the floors and bathroom at the hospital. They go home using a device that they never had before like a cane or a walker, and then forget everything that they were taught before they got back to the house. They try to cook for themselves but forget what to do with the walker when they do. Often times after that admission they have lost mobility and tire easily. They are unable to go shopping for the food they need.

www.berkscms.org

Now what and how can you help? Consider everything above before you discharge your patients. What we have seen as the number one problem with patient safety at home is unclear instructions about the new disease and the medications they need to control it. Many of our patients leave with prescriptions that are new. They forgot or never understood the purpose of the new medications. More importantly they cannot recall if they take the old medications and the new ones: both or just one? If the patients went to the emergency room they are embarrassed to call and ask. If they saw the hospitalist at the hospital they donâ€™t know how to call them back. This is where we can all make a difference. Sometimes the patients know what to do but cannot get to the pharmacy. Often the problem is they simply cannot afford those medications. We often hear from patients: â€œI will use up all my old medications first because I already paid for them and then try the new ones after those old ones run out.â€? A home care skilled nursing visit can be an answer to just such a problem because they focus on such issues. We recently had a case where the patient went to the emergency room with shortness of breath. She had pneumonia. The wonderful physician ordered Zithromax and home health for the patient. So when the nurse arrived and began her assessment, she asked about the medications. Turns out that the cost of the Z-Pak was more than the patient could afford. Her honesty to the nurse, who was there with her in her home, allowed the nurse to call the ER physician directly. The nurse requested another medication and was given an order for Pen V-K, which is free from Wal-Mart and many other pharmacies.

We can tell you multiple stories just like this one, where patients mislead the very staff trying to help them so that they can go home. The transition to home is confusing and scary. We all know of patients who really should not have left but leave anyway. They are unsteady on their feet and at risk of falling. Or perhaps the patient has no help and little understanding of the importance of a follow up appointment. The home health nurse can assist in all of these scenarios. The transition to home in many areas is now looked upon as an opportunity to connect with the patients and help them to really understand that they have a part in the discharge process, and in their own care, and what that should look like. In many cases this transition is a way to keep an eye on our patients and to be certain they understand what is next and how to achieve that goal. Often times a social worker is more help than anyone. The MSW is aware of the county and state programs that the patient may be eligible for and also helps patients to get signed up for things such as transportation, Meals on Wheels and other programs like Adult Day. Patients go home every day, and now we have been tasked to work with them more closely than ever and be a part of the home environment. Patient compliance is as big an issue as ever, but face this head on. How compliant a patient are you? Personally I am terrible. So why do we expect our seniors to be any better? Let’s work with them to help them understand how to be compliant and how to communicate with providers. Patient safety is a high priority. We used to believe that falls at home were caused by throw rugs and oxygen tubing, but we came to find out that medication is the number one reason for falls and other readmissions. Let’s partner with our home care nursing agencies and use our valuable resource of the pharmacist to keep our people safe and where they want to be: HOME. Patient safety is your responsibility even when that patient is not at the hospital. Let us do everything possible to make certain that our patients understand instructions and the medications they need to take. If you think they may not follow your instructions, order Home Health. The nurses have time to spend with the patient. They can look in the medication cabinet, the bedside table, and under the sink to see what is really happening in the home. Let them be your eyes and ears. Then your patient can stay home and be safe! Freeland KN, Thompson AN et al. Medication Use and Associated Risk of Falling in a Geriatric Outpatient Population. The Annals of Pharmacotherapy 2012; 46 (9):1188-1192 Medication’s Impact on Falls By Nancy C. Brahm, PharmD, MS, BCPP, CGP, and Kimberly M. Crosby, PharmD, BCPS, CGP Aging Well Vol. 2 No. 5 P. 8 Today’s Geriatric Medicine November/December 2009

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SUMMER 2016

M e d i c a l R e c o r d F e at u r e

Alternatives to Prescribing Controlled Substances for Chronic Pain by Patti J. Brown, M.D. Physical Medicine and Rehabilitation Medical Director, HealthSouth Reading Rehabilitation Hospital

he treatment of chronic pain has been a hot topic lately due to the opioid crisis our country is presently facing. As a physical medicine and rehabilitation specialist my interest in treatment of chronic pain has been long-standing. PM and R specialists have been trained in alternatives to opioids in the treatment of pain. When I started in practice in the 90s our rehab hospital had a multidisciplinary pain clinic based on non-narcotic approaches to pain. However, around that time the media and pharmaceutical companies started touting pain relief at all costs. It is my opinion that this approach is responsible for the crisis we are now facing. For that reason I was anxious to write this review article on a comprehensive treatment approach to chronic pain. Chronic pain is among the most common reasons persons seek medical attention. It is reported by 20 to 50 percent of patients seen in primary care. Ten to 15 percent of the working population is affected by back pain each year. Acute pain can be linked to a precipitating event. It may be accompanied by anxiety, anger and requires a temporary lifestyle adjustment. Acute pain has a high rate of successful cure. It is generally self limiting. Treat acute pain aggressively, the longer pain persists, the less likely complete resolution becomes. Patients must be educated on preventative measures. Address pain relief through modalities â€“ RICE. Rest,

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ice, compression and elevation. Regain normal muscle length through range of motion. Address gradual muscle strengthening and exercise. Chronic pain is persistent pain that lasts greater than six months. Complications of chronic pain are physical, psychological, and environmental. Secondary physical pain develops due to inactivity. Patients develop decreased range of motion, myofacial pain and weakness due to deconditioning. Patients develop weight gain. They may develop drug dependency. Psychological complications of chronic pain include depression, sexual dysfunction and marital stress. Environmental complications of chronic pain include lost working days, decreased productivity, and escalating costs of workers compensation. The characteristics of chronic pain patients is a person with low level of activity, high demand for medication, high verbalization of pain and inability to work. These patients are best approached in a multidisciplinary model. The multidisciplinary approach includes a rehabilitation specialist for a clinical evaluation, psychologist for depression and motivation, interventionist for procedures and physical therapy for modalities and exercise. Occupational therapy should be available to address function and daily activities. Treatment goals should be to teach patients to control

or cope with the pain, improve their quality of life, improve functional capabilities, decrease dependence on drugs, decrease visits to physicians, increase physical activity and return to employment. This pain treatment approach begins with patient education. Empower patients. Make them active participants in their own treatment program. Help patients understand what is causing the pain. Give them the appropriate tools – heat, ice, range of motion, non- narcotoic medication to deal with exacerbations. Instruct patients in a home exercise program. Instruct patients in proper body mechanics. Physical modalities should be used in the acute phase and for exacerbations. They should be used in combination with active exercise. Examples of physical modalities includes cold therapy which decreases pain, decreases muscle spasm and decreases inflammation. Heat therapy increases blood flow and decreases inflammation. Deep heat therapy such as ultrasound is used to decrease inflammation and increase range of motion. Sensory modulation such as TENS, acupuncture and contrast baths utilizes the Gate theory, which is activation of large afferent fibers to inhibit the transmission of painful impulses. Assistive devices can be used to support and decrease stress to the affected area. Orthoses such as casts, splints and braces can be used. Gait aids such as canes, crutches, and walkers can be used but only temporarily. The eventual goal should be restoring range of motion and function. In the multidisciplinary approach, the patient should be instructed in behavioral and self regulation techniques. These include relaxation methods, such as breathing, meditation, yoga, and self hypnosis. Coping skills such as distraction and imagery can be used. Biofeedback can be a useful adjunct. Biofeedback involves using a relaxation technique to modify a physiologic parameter such as heart rate or breathing. Therapeutic exercise is an important adjunct in pain therapy and should be used judiciously in acute pain. With acute pain and exacerbations rest should be limited to a very few days. Isometric exercises can be performed with range of motion to the point of pain. Range of motion and flexibility is addressed as inflammation subsides. Strengthening and aerobic exercise is added as pain improves. Chronic pain developes in part due to immobilization and deconditioning. Work through pain slowly to achieve increasing goals. Non narcotic pharmacologic interventions should be addressed. Adjuvant analgesics are drugs primarily approved for treatment of conditions other than pain but act as analgesics in selected circustances. Antidepressants work on serotonin and norepinephrine pathways, increase pain thresholds, improve sleep, improve mood and alter perception of pain. Anticonvulsants work by stabilizing neuronal membranes. Antiinflammatories, muscle relaxants and scheduled analgesics can be used.

Invasive techniques include joint or soft tissue injections with corticosteroids and local anesthetics. Nerve blocks can be used and are most successful when followed by therapy. Trigger point injections address myofascial pain. Injections should be followed by routine, regular stretching. Epidural blocks are steroid injections into the epidural space close to the nerve root, often a series of three, several weeks apart. Neuroablation such as rhyzotomy and cordotomy are reserved for severe cases. Modulating techniques are available such as implantation of drug infusion systems such as intrathecal morphine pump and chronic stimulators such as dorsal column stimulator. Chronic pain is a difficult area of medicine. However, it is also an important one, due to the enormous consequences for the quality of patients lives. Patients appreciate when physicians listen attentively to their symptoms and make sincere efforts to intervene in ways that improve their quality of life. The physical medicine approach is a multi-disciplinary approach with a goal of decreasing dependence on narcotic medications. Goals should be — give patients control, improve function and improve quality of life.

Robinson James P. Chronic Pain. Phys Med Rehabil Clin N Am 18 (2007)761-783

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SENIORS AND SUBSTANCE USE

SBIRT Aids in Screening and Intervention by Joseph Garbely, DO Medical Director, Caron Treatment Centers

As physicians, we are well aware of the growing senior population. One of the greatest challenges we face is one that is not always obvious. That is, possible alcohol or drug use and the potential for addiction. The fact is that substance use in adults 65 and over is Americaâ€™s fastest growing health issue, with 6%-10% of elderly hospital admissions resulting from a drug or alcohol problem. Substance use can mask or exacerbate other underlying conditions, making identification and intervention critical. The SBIRT screening and intervention process can help. 16

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Is It Aging – or Addiction? Time available to spend with patients, the complexities of age-related medical conditions, and minimal addiction training create challenges for physicians in diagnosing the cause of a patient’s symptoms. Separating out the potential effects of substance use is critical in reducing the risk of over treating. Just as essential is the importance of preventing health issues by identifying dangerous patterns of drug or alcohol use.

The SBIRT Process: Efficient and Effective Developed by SAMSHA, SBIRT is a process for substance use Screening, Brief Intervention and Referral to Treatment. The process has been designed to work with a physician’s need for efficiency and the short length of time available with each patient. SBIRT can be performed in minutes by either the physician or ancillary staff. It is reliable, verifiable and translatable to different practices. Most importantly, SBIRT is effective in identifying substance-use risk, and providing a process for intervention. While the SBIRT process is applicable to all patient populations, it can be adapted specifically to older patients, with methodologies focused on the issues, attitudes and challenges of seniors.

Screening: Identifying Risk The validated SBIRT process begins with screening – a quick method of identifying possible unhealthy use of alcohol or drugs, or misuse of medications. In as few as ten questions, feedback can be gathered that may indicate a risky pattern of substance use. The questions may also be helpful when working with the adult child of a senior. The son or daughter may have observed behaviors, but not have recognized them as potential symptoms of hazardous or harmful substance use.

Brief Intervention: Diving Deeper If the SBIRT screening raises a red flag, a Brief Intervention offers physicians an opportunity to dive deeper into the patient’s patterns of use and enhance the patient’s understanding of the potential risks. Often, senior patients are not aware that the aging process creates a decreased tolerance for alcohol, drugs and medications. The individual whose drinking patterns haven’t changed over the years may now have a problem. Additionally, patients may be unaware of the way alcohol and drugs can interact with other medications. Principles of pharmaocodynamics and pharmacokinetics may need to be explained in their most basic terms.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) 2.5 CME’s will be awarded Saturday, November 5, 2016 Registration begins at 7:00am Breakfast: 7:30am Program: 8:00am-10:00am Location: Highlands of Wyomissing Cultural Center Cost for attendees-FREE On line registration at

www.berkscms.org Beginning September 1

While older patients may acknowledge the potential for risk, long-held beliefs and attitudes, feelings of shame or stigma, or a resistance to change can create roadblocks to open dialogue. The SBIRT process offers a way forward for physicians through a discussion technique known as motivational interviewing.

Motivational Interviewing: A Collaborative Approach A collaborative, person-centered approach designed to inspire change, motivational interviewing helps physicians begin a conversation around a patient’s substance use. It is a non-judgmental approach that focuses on partnership and the development of a physician-patient alliance with the goal of improved health and quality of life. Rather than directing a patient to make a change, motivational interviewing techniques engage the patient with open-ended questions that encourage the individual to express his or her views, attitudes or concerns. The technique allows the physician to deconstruct misinformation or misunderstanding of substance use, while positioning the physician as a helper in the change process. Again, in keeping with the SBIRT approach of supporting efficient use of time spent with patients, the Brief Intervention and motivational interviewing process can be accomplished in as little as 10-15 minutes. continued on page 19 > SUMMER 2016

Seniors and Substance... continued from page 17

Psychologically, older individuals struggle with emotional issues not normally addressed in the larger patient population.

Referral to Treatment: Senior-Specific Care When a patient’s responses meet the diagnostic criteria for a substance use disorder, referral to treatment is recommended. But, it’s important to be aware that seniors are a special population with very specific medical and behavioral issues requiring a treatment approach that is just as specialized. At Caron Treatment Centers, we have treated seniors for many years, and our observations resulted in the establishment of a separate treatment program for older individuals – one that delivers quality, age-appropriate care, while respecting the dignity of patients. What we found in treating seniors is that the pace of everything is slower. Withdrawal takes longer, creating the need for a longer length of stay. Pain management is also a concern, as arthritis and other conditions present the real need for medications that can provide relief. Patients with ambulatory problems, who represent a fall risk, may need the help of an aide. Psychologically, older individuals struggle with emotional issues not normally addressed in the larger patient population. Seniors may be impacted by grief over the loss of a loved one, a decreased sense of identity or purpose, end-of-life concerns, isolation, problems with mobility, or a lack of independence – all of which must be addressed as part of the recovery process.

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Prevention: Moving the Process Upstream After a lifetime of work and raising families, our senior patients deserve to enjoy the best possible quality of life in their later years. It’s never too late to get sober or for physicians to intervene if a substance use issue is present. In fact, we have found that older men and women experience the highest rates of recovery of any age group following treatment. SBRIT provides a process for moving care upstream and possibly preventing full-blown addiction. In combination with training focused on its application to elderly patients, SBRIT can make a real difference.

Joseph Garbely, DO, is medical director of Caron Treatment Centers, a behavioral health facility specializing in substance abuse treatment located in Wernersville, PA. Dr. Garbely oversees all medical, psychiatric and psychological treatment at the PA facility, including detoxification, medical research and Caron’s Seniors, Chronic Pain and Healthcare Professionals Programs.

SUMMER 2016

M e d i c a l R e c o r d F e at u r e

Substance Abuse Task Force The BCMS Substance Abuse Task Force is a newly formed coalition between the Reading Health System, Penn State Health St. Joseph, and the member-physicians of the Medical Society with the goal to create a unified voice to better educate patients and health care providers on the best methods of addressing substance abuse, specifically opioids.

Drug Take Back On April 30th, BCMS hosted a very successful Drug Take Back Event at First Energy Stadium. Partnering with District Attorney John Adams, the DEA, the Reading Police Force, and the Reading Fightin’ Phils, our volunteers collected close to 1000 lbs. of prescription drugs. Nearly 300 members of our community took advantage of the opportunity to drive up and return their unused prescription medications (including potentially-dangerous opioids). Every pill that was collected and destroyed by the DEA represents one less pill in a medicine cabinet that could inadvertently find its way into our community and cause harm.

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Opioid Abuse CME Forum On May 10, BCMS presented its Opioid Abuse CME Forum at the Reading Double Tree. Over 150 physicians and community leaders were fortunate to hear PA Physician General Dr. Rachel Levine and Mr. Gary Tennis, PA Secy. of Drug and Alcohol, give their insight on how our growing opioid abuse epidemic is affecting the Commonwealth and how their offices are addressing this crisis. An expert panel of community leaders who are in the “trenches” also gave their perspectives and insight on opioid misuse and how it is affecting Berks County. This forum was an important first step in diagnosing the opioid epidemic and will serve as a starting point for future educational programs concerning the matter.

M e d i c a l R e c o r d F e at u r e

Recap – Residents’ Day & Memorial Lecture

he Berks County Medical Society’s annual Residents’ Day was once again held in conjunction with the Memorial Lecture on April 29, 2016 in the Berks Visiting Nurse Association auditorium. Attendees had the opportunity to review the 15 posters submitted before the winning four posters were presented. The winning posters and presentations were: Depression Screening in Spanish Speaking Community: Cultural Competency in an Evolving EMR Era Luis A. Murillo, MD; G. Alex Grekoff, MD; Colleen Conrad BSN RN Reading Hospital Family Residency Ovarian Artery Aneurysm in Third Trimester of Pregnancy Pabbati, A; Lingenfelter, B.M.; Sacks D.; Dougherty, J.J. Reading Hospital Family Residency

Percutaneous cholecystostomy with and without interval cholecystectomy Natalie Nowak, DO; P. Kurt Bamberger, MD Department of General Surgery Reading Hospital The Effect of Diabetes Education in an At-Risk Population Kathleen Henley, DO PGY-3 PennState Health St. Joseph Following the presentations a moment of remembrance took place for the physicians who passed away during the past year. They included Brian Wummer, MD; Edward C. Fischer, MD; S. Leroy Mairorana, MD; and Edward J. Zobian, MD. Our guest speaker, Travis A. Berger, Assistant Professor of Business at Alvernia University, presented a talk on the topic “In Pursuit of Leadership: High-Performers Required.” A buffet lunch ended the activities. Dr. Christie Ganas and Dr. Michael Baxter are Co-Chairs of this event.

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Members in the News

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Charles Barbera, MD, Honored with Two Notable Awards for Providing Quality Emergency Medical Care April 13, 2016 Charles Barbera, MD, is the recipient of two prestigious recognition awards for 2016: the Pennsylvania College of Emergency Physicians (PACEP) 2016 Meritorious Service Award and the Caron Foundation â€“ Jasper G. Chen See, MD, Healthcare Professional Award for the Berks County Region. 1 Dr. Barbera was presented with the PACEP 2016 Meritorious Service Award on April 7 in recognition of his exemplary service, dedication and commitment to advancing the specialty and patient care in the Commonwealth. He will receive the Jasper G. Chen See, MD, Healthcare Professional Award on May 26. Both awards recognize him as an outstanding healthcare professional who exemplifies the spirit of caring, compassion and commitment. Congratulations, Dr. Barbera on two well-deserved honors.

Caron Treatment Centers Honor Charles Barbera, MD June 1, 2016 Charles Barbera, MD, a specialist in Emergency Medicine, received the Caron Treatment Centerâ€™s 20th Annual Berks County Award Recipient.

ACP Announces New Masters and Awardees for 2015-2016 The American College of Physicians announced that Daniel B. Kimball Jr., MD, of Wyomissing received his Mastership from the American College of Physicians at its annual meeting in May 2016.

M e d i c a l R e c o r d F e at u r e

Dr. Dan Kimball D

r. Dan Kimball, a recent Eastern Region PA Governor for the American College of Physicians (ACP), was elected a Master in the ACP by the Board of Regents in October 2015. He was recognized at the recent ACP Annual Internal Medicine meeting at its convocation along with 55 other Masters. Masters comprise a small group of accomplished physicians who have been selected because of personal character, positions of honor, contributions toward furthering the goals of the ACP, eminence in practice or in medical research, or other attainments in the science and art of medicine.

B I O G R A P H Y: Daniel B. Kimball Jr. Mastership Dr. Kimball was a physician in academic medicine and Medical Director of Diakonâ€™s Hospice St. John of Berks County, Pennsylvania, until his retirement in 2010. Previous to that, he was Director of the Department of Medicine at the Reading Hospital and Medical Center as well as Clinical Professor of Medicine at Temple University. He served 25 years in the Army Medical Department, retiring in 1989 after commanding the Landstuhl Army Medical Center in Germany. He has served as an academic leader and has supported the personal and professional development of hundreds of trainees in both the Army and in Pennsylvania. Dr. Kimball has been a regional leader in the areas of organ donation and end-of-life care. Dr. Kimball was Chair of the Pennsylvania State Board of Medicine from 1997 to 1999, and he received the Distinguished Service Award from the Federation of State Medical Boards in 2005. He was Governor of the ACP Eastern Pennsylvania Chapter from 2011 to 2015 and received Laureate Awards from both the ACP Pennsylvania and Army Chapters.

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WELCOME NEW MEMBER

VARUNA SUNDARAM, M.D.

he Berks County Medical Society is pleased to welcome Dr. Varuna Sundaram, Assistant Professor of Vascular Surgery at Penn State Hershey and on staff at Penn State Health St. Joseph Medical Center. Dr. Sundaram earned a Bachelor of Engineering in Chemical Engineering from the Stevens Institute of Technology in Hoboken, NJ before attending Saint George’s University School of Medicine. She trained in Categorical General Surgery at Saint Barnabas Medical Center in Livingston, NJ from 2007-2012, and went on to complete a fellowship in Vascular Surgery at the University of Buffalo in Buffalo, NY from 20122014. She is Board Certified in both General Surgery and Vascular Surgery. This year she gave a presentation on minimally invasive and hybrid techniques to aneurysm repair at the Berks Cardiovascular Symposium. We are fortunate to have Dr. Sundaram’s expertise available to the Berks County community, and very happy she has chosen to support her profession with her medical society membership. To get to know Dr. Sundaram a little better, we asked her to answer a few questions: Describe the focus of your practice and any areas of special interest/expertise. Vascular surgery including open and minimally invasive endovascular techniques for limb salvage, peripheral arterial disease, carotid disease, hemodialysis access, venous disease and aneurysm disease, with a focus on purely percutaneous endovascular thoracic and aortic aneurysm repair and fenestrated and branched aortic aneurysm device grafts. Why did you decide to practice medicine in Berks County? I was hired by Penn State Hershey to be full time academic faculty but mainly based out of the Penn State Health-St. Joseph’s campus. It’s a wonderful community with great diversity. It allows me a wonderful opportunity to provide a much needed service to the community, and it’s close to my home state of New Jersey.

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What do you like best about practicing medicine? It’s a profession in which I can use my skills to make a difference for the people around me in my community. Particularly in vascular surgery, I feel we can see the benefit almost immediately after any intervention. This benefit for our patients can be seen across a wide spectrum whether it is for limb salvage or the ability to walk further without pain or preventing instant death from a possible ruptured aneurysm or from cosmetically unpleasing varicose veins. If you could change one thing about the current practice environment, what would it be? The restraints placed on medical providers by insurance companies. Being relatively new to the field, I have quickly learned how insurance companies can really limit our abilities as physicians to provide a service to our patients. With too much focus on costs and profits, too many patients fall through the gaps and don’t receive the adequate treatment and medications they need. Are you involved in any nonprofit/community groups at this time? I have been involved in medical mission trips to Haiti in the past and am excited at the prospect of doing more mission trips in the future. Please tell us a little about your family and the activities you enjoy outside of work. I am a New Jersey native but I thoroughly enjoy exploring Berks County and beyond in my free time. I particularly enjoy international travel when I can find the time to get away! Name one thing about your practice / field of medicine that you think all your patients should know. We, as vascular surgeons, are uniquely qualified to diagnose minimally invasively or invasively and to treat medically, surgically, or minimally invasively via endovascular techniques the gamut of vascular pathologies. Sometimes it’s equally as important to know when and when NOT to operate.

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Balance Billing:

We can do better by Heath B Mackley, MD, FACRO

s is often the case, it takes a New York Times article for a health care issue to enter the public consciousness. On 9/2/14, an eye-catching headline of “After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know” told the unfortunate story of Peter Drier, a 37-year-old bank technology manager who needed a neck surgery1. He went to an orthopedic surgeon in his health insurance network, and had an operation at a hospital that accepts his insurance. However, his surgeon needed the assistance of a neurosurgeon on the case, a physician Mr. Drier had not met previously. This physician was not in his network, so the “full bill,” not a negotiated fee, was charged to him. This was 19 times the fee his orthopedic surgeon, the primary surgeon, received for his part of the procedure. Not surprisingly, this was given the pejorative “drive-by doctoring,” likening it to highway robbery. This is clearly not fair to the patient. But what do we do to stop this from happening? The article further describes some hospitals and physicians in a very negative light, suggesting that they are deliberately seeking out these opportunities to “stick it” to unsuspecting patients. Somewhat surprisingly, the article portrayed the insurance companies as the defenders of the patients’ interests, often paying for the exorbitant fee on behalf of the patients even though they don’t have to. As would be expected, the author proposes a solution: a New York state law, which went into effect in 2015, absolves patients of personal responsibility for unforeseen out-ofnetwork charges beyond what they would have paid in-network, and directing the insurers and providers to negotiate directly or 26

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enter mediation. This sounds reasonable, until the unintended consequences are fully realized. How do insurance companies arrange for contracts with physicians and hospitals? It’s a balance of competing interests. The insurance company wants to drive down the fee so they can charge a smaller premium than their competitor and still make a profit. The providers also want to collect a fee that gives them a reasonable profit for the service provided. Providers can decide that a fee schedule is too low to be profitable, and decline participation with an insurance company. This makes the insurance company’s product less desirable as fewer physicians participate, but it means there is a population of insured patients that will not likely go to that provider, hurting their market share. In a fair playing field, this balance of interests will encourage providers and insurers to innovate and become more efficient, keeping costs at a minimum for patients, and providing a fair profit for all parties involved. What if, as the insurance companies would prefer, physicians are forced to accept the in-network reimbursement even if they are out-of-network? How will physicians be able to negotiate with insurance companies then? What if, as the hospitals would prefer, to be on the medical staff of a hospital, a physician must accept the insurance policies that the hospital accepts? This would incentivize the hospital to negotiate contracts with insurance companies that are good for the hospitals at the expense of the physicians. Is that good for the system as a whole? Finally, physicians of all specialties, unlike insurance company managers and hospital administrators, stand on the front lines, seeing patients at all hours of the night and

Let our family

SECURE your family on weekends and holidays, and they do not check the patient’s insurance status before they engage in the medical care that the patient needs. Don’t those physicians deserve some bargaining power, to be able to negotiate their own fee schedules, and to choose which insurance policies to participate in? These are thorny issues, to be sure, but that is why we need PAMED, with an engaged membership, to be active in any state-level discussion about insurance legislation or regulation. Additionally, the elephant in the room here is also the inadequacy of “narrow networks.” The fundamental reason for surprise billing is that there aren’t enough in-network physicians to provide the care the patients need. Patients want to pay lower insurance premiums, and insurance companies want to charge them lower premiums, but if this low-cost premium exists because only a few physicians will accept the low fee schedule the plan offers, then the patient will end up paying for a plan where they can’t find an in-network physician! They are then “forced” into seeing out-of-network physicians, and the insurance company either doesn’t have to pay for anything, or only has to pay for the balance beyond a very high deductible. How can that be called “health coverage” at all? A Robert Wood Johnson Foundation and University of Pennsylvania analysis suggests that 41% of health networks are narrow, only including 25% or less of the office-based physicians practicing in the area2. The AMA has created a thoughtful national model policy addressing this issue, calling for state regulators to enforce network adequacy requirements3. Insurance plans should be required to report quarterly on network adequacy measures to ensure compliance is maintained. Patients need financial protections when seeking necessary out-of-network care. Finally, the public needs full disclosure on the criteria of how health plans choose which physicians participate in their network. On the state level, recently PAMED has been communicating with Insurance Commissioner Teresa Miller, expressing our concern about access to care and out-of-pocket costs consumers face. This is one of countless ways that PAMED is important to physicians and patients alike. So stay involved; this issue isn’t going to be resolved fairly without our active involvement!

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Dr. Mackley is a Radiation Oncologist at the Penn State Hershey Cancer Institute and 5th District Trustee, representing physicians of this county. http://www.nytimes.com/2014/09/21/us/drive-by-doctoringsurprise-medical-bills.html?_r=0 2 http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/ rwjf421027 3 http://www.ama-assn.org/ama/pub/news/news/2014/2014-11-10ama-policy-protect-patient-choice-access-care.page

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of the

P e n n s y lva n i a M e d i c a l S o c i e t y

Helping Finance P h y s i c i a n E d u c at i on

The Foundation of the Pennsylvania Medical Society, a nonprofit affiliate of PAMED, sustains the future of medicine in Pennsylvania by providing programs that support medical education, physician health, and excellence in practice. It has been helping finance physician education for more than 60 years.

“We recognize that medical students play a vital role in the future of medicine in Pennsylvania, so we proudly administer scholarships to deserving students across the commonwealth,” says Heather Wilson, the Foundation’s executive director. Applications for several scholarships will be accepted July 1-Sept. 30, 2016. Allegheny County Medical Society Medical Student Scholarship. Residents of Allegheny County can apply for a $4,000 award. Applicants must be enrolled full-time at a Pennsylvania medical school as third- or fourth-year students. Blair County Medical Society Medical Student Scholarship. Blair County residents attending a United States medical school may apply for the $1,000 award. Applicants must also be enrolled full-time as second-, third-, or fourth-year students. Endowment for South Asian Students of Indian Descent Scholarship. Pennsylvania residents of South Asian Indian heritage may apply for this $2,000 award. Additionally, applicants must be enrolled full-time as second-, third-, or fourth-year students at a Pennsylvania medical school. Lehigh County Medical Auxiliary’s Scholarship and Education Fund Scholarship. Lehigh County residents attending a U.S. medical school full-time may apply for this $2,500 award. Lycoming County Medical Society Scholarship. Lycoming County residents attending a U.S. medical school full-time may apply for a $3,000 award. Two recipients will be selected.

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It’s where they help builders. Montgomery County Medical Society Scholarship. Montgomery County residents attending a U.S. medical school as first-year students may apply for this $1,000 award.

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Myrtle Siegfried, MD, and Michael Vigilante, MD, Scholarship. Students residing in Lehigh, Berks, and Northampton counties and entering their first year at a U.S. medical school may apply for the $1,000 award. Additional scholarships are available each year with alternate deadlines:

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VISTBank.com

Alliance Medical Education Scholarship. Pennsylvania residents attending a Pennsylvania medical school as second- or third-year students may apply for a $2,500 award. Multiple recipients will be selected. Postmark deadline: Feb. 28. Scott A. Gunder, MD, DCMS Presidential Scholarship. Second-year students at Penn State University College of Medicine who are Pennsylvania residents may apply for this $1,500 award. Postmark deadline: April 15. To find out more about scholarships, call the Foundation at 717-558-7852, or visit the Student Financial Services page at www. foundationpamedsoc.org. Since 1948, more than $19.6 million in loans and scholarships has been awarded to nearly 4,500 students. Thank you to the generous contributors who have made these scholarships possible! If you would like to donate to the future of medical education through any of these designated funds, make your check payable to The Foundation of the PA Medical Society, and indicate which scholarship you would like to support in the memo line. Mail your gift to the Foundation of the Pennsylvania Medical Society, 777 E. Park Drive, Harrisburg, PA 17105. If you have questions regarding support of student scholarships, please feel free to contact Marjorie Lamberson, CFRE, via email at mlamberson@pamedsoc.org or by phone at 717-5587846.

Helping Healthcare Professionals Sustain Their Careers And Reclaim Their Lives Healthcare professionals can be just as vulnerable to addiction as the patients that they care for. Our treatment includes: • A separate and distinct unit with specialized programming specific to the needs of healthcare professionals • A multidisciplinary medical team that coordinates with referents, colleagues, and licensure boards when appropriate • Highly individualized recovery plans that address practice re-entry issues and barriers to sustained sobriety specific to healthcare professionals VISIT:

Caron.org/Professionals | 800-678-2332 SUMMER 2016

Physicians’ HEALTH Program The Foundation of the Pennsylvania Medical Society

30 Years of Change – Transforming Lives

“ONE IN TEN

people suffer from addiction. At any time, there could be as many as 3,000 doctors in the state whom we could be helping.” Raymond Truex Jr., MD, FAANS, FACS

“Physicians, like the rest of the population, are vulnerable to chemical dependency, physical disability or breakdowns in mental health. Your support of the 30 Years of Change Campaign will make sure the Physicians’ Health Program will always be available to our fellow health care providers.” Raymond Truex Jr., MD, FAANS, FACS, Honorary Chair of 2016 PHP 30 Years of Change Campaign

•

WHY SHOULD I SUPPORT THE PHP?

For 30 years the PHP has provided confidential support, monitoring and advocacy to those who may be struggling with addiction or physical or mental challenge. • The PHP relies on contributions from physicians, hospitals and others so that the cost to the participant can be kept as low as possible during challenging times. • Your gift TODAY is an investment in an established endowment ensuring that the PHP will have funding support in perpetuity. • Your gift provides a transformational opportunity for your fellow health care providers who deserve a chance to live life in recovery and good health.

HOW CAN I HELP? PHP is a program of The Foundation of the Pennsylvania Medical Society – the charitable arm of PAMED. The program assists all physicians, physician assistants, medical students, dentists, dental hygienists, and expanded function dental assistants.

Please consider a gift to the PHP in honor of this anniversary to ensure that physicians will always have a place to go to when help is needed. Let’s make the most of it! In celebration of this milestone, the campaign has received a $30,000 challenge grant from an anonymous physician – by making your gift TODAY you will help us to take full advantage of this generous matching fund opportunity! Go to www.foundationpamedsoc.org to see true stories of transformation and recovery.

Contact the PHP at (717) 558-7819 or php-foundation@pamedsoc.org.

If you want to learn more about how to make a contribution to the PHP Endowment, visit www.foundationpamedsoc.org. You can also contact Director of Philanthropy Margie Lamberson, CFRE, at mlamberson@pamedsoc.org or 717-558-7846.

The official registration and financial information of the Foundation may be obtained from the Pennsylvania Department of State, Bureau of Charitable Organizations, by calling toll-free within Pennsylvania, (800) 732-0999. Registration w w w . b e r does kscm . o r g endorsement. nots imply

777 East Park Drive • Harrisburg, PA 17105-8820

Please make th ese corrections in your new 2016-2017 DIRECTORY OF PHYSICIANS: Please take note of the following changes: Michael B Russo, MD

FAX 610-378-5131

Shirish Parikh, MD

FAX 610-376-3999

Ivan Bub, MD Gateway Family Medicine 1020 Grings Hill Roade Reading, PA 19608 PH 610-898-5030 FAX 610-777-3474

Bringing Better Health Care into the Community The first annual Berks Festival of Trees by the DoubleTree Hotel by Hilton, Reading offers a series of fundraising events to enhance the quality of health care for our region by benefitting the Berks Visiting Nurse Association (Berks VNA). Sponsor a Tree for only $1,000 We’re asking businesses and individuals to become designers for the first-ever Berks Festival of Trees. Sponsors will create an exciting and eye-catching tree display that beholds imaginative colors, textures and ornaments. Sponsors can also use their company’s products to decorate the trees in a unique and attractive way.

Save the Dates

Event Kick-Off | Wed., July 27th at 5 p.m. Sponsor Rally Event | Wed., September 28th at 5 p.m. Tree Lighting | Wed., November 2nd at 5 p.m. Auction Party | Wed., December 2nd at 5 p.m.

2016 Berks Festival of Trees Additional Sponsorship Opportunities Exclusive Sponsorships: • Auction Party Event Sponsor: $15,000 • Kick-off Event Sponsor: $5,000 • Rally Event Sponsor: $5,000 Entertainment and Activity Sponsorships at the Auction Party: • Bar Sponsor: $2,500 • Take Home Gifts: $2,500 • Cookie Table: $2,000 • Photobooth: $2,000 • Hot Beverage Table: $1,000 In Kind sponsorship opportunities also available! *All Berks Festival of Trees events take place at the DoubleTree Hotel by Hilton, Reading. For complete information about this important new Berks County event visit

www.hhcminc.org/about/special-events.

SUMMER 2016

Berks County Medical Society Alliance

Summer...

... a time to relax, rejuvenate, travel and most importantly enjoy the long beautiful days of sunshine with our families. Typically, the Alliance takes the summer “off,” but the new board has been hard at work planning our 2016-2017 year. It is my pleasure to introduce our new executive board installed May 5, 2016 downtown in the lovely Double Tree Hotel. A special thank you to last year’s board and our out-going president, Amy Impellizzeri, for her dedication, enthusiasm and guidance. President Elect – Kara DeJohn Vice Presidents of Membership – Kelly O’Shea & Kathy Rogers Vice President of Health Project – Kathryn Marr Treasurer – Amanda Abboud Assistant Treasurer – Michelle Trayer Recording Secretary – Kim Gent Corresponding Secretary – Heidi Lindsey Directors – Lindsay Romeo and Amy Impellizzeri

Pictured L-R; Amy Impellizzeri, Director; Kathy Rogers, VP of Membership; Heidi Lindsay, Corresponding Secretary; Amanda Abboud, Treasurer; Kara DeJohn, President-Elect; Allison Wilson, President; Kathleen Hall, PMSA

Spring was busy for the Alliance. On Thursday, April 7th, the Health Project committee, chaired by Lisa Banco, held its Health Project, titled “Status Update: The Connection between Adolescent Mental Health and Social Media,” at the Inn at Reading. Forty-five attendees listened as Erin Johnson from Penn State Berks, Gwen Seidman from Albright College, and Rick Wolf from the Governor Mifflin School District shared their expertise in teen mental health. We were honored to be joined by Caryl Schultz, President of PMSA, and Kathleen Hall, also from the state medical alliance. Special thanks to Lisa and her committee for their dedication to our educational endeavors. 32

www.berkscms.org

Also in April, a lovely Doctor’s Grove ceremony was held at the Berks County Heritage Center. Seven trees were dedicated this year. Trees were planted in honor of Dr. Martin Jacobson, Muhlenberg Medical Staff; Dr. Marshall M. Fester III by Jane Feaster; Dr. David Texter by Alex & Ker Massengale; Dr. Robert I. Rudolph by Alex & Ker Massengale; and Dr. Edward L. Pan by Sue Pan. Trees were also planted in memory of Dr. Edward J. Zobian by Eye Consultants of PA, and Dr. Paul K. Nase by Eye Consultants of PA. Thank you so much to Dee Dee Burke for coordinating this special event. Relating to Doctor’s Grove, the tree plaque has found a home at the new Berks County Medical Society office. It will soon be updated with this year’s recipients.

As always, we would like to thank all of our medical families for their generous contributions to our Holiday Card Fundraiser. In April we allocated $7,000 in scholarships and $7,000 in philanthropy to students and organizations in Berks County. We are proud to support the following organizations this year: Aaron’s Acres, Children’s Home of Reading, Saint Catherine of Siena Elementary School, Reading and Berks YMCA and Girls on the Run. One of my main goals as president of the Alliance is to work together with the medical society to promote the practice of medicine in Berks County while honoring the physician family. We are looking to hold more joint activities that will allow for physician camaraderie and family participation. All physicians and their spouses are invited to attend the “All Member Social” on August 4th at the Berkshire Country Club. This is a great opportunity to reconnect with old friends as well as to meet physicians new to Berks County. I hope to see you there! It is a great honor to serve the Berks County Medical Society Alliance. I am looking forward to serving as its 87th president!

UPCOMING ALLIANCE EVENTS:* Friday, September 23rd – 10:15 AM – New Member Coffee; Hostess, Kathy Rogers Thursday, October 13th – 11:30 AM – “Travel” Luncheon; Hostess, Kathryn Marr *New members are always welcome. Please contact Kathy Rogers @ kathyjrog@gmail.com.

advertise in

Medical record BERKS COUNTY MEDICAL SOCIETY

Your Community Resource for What’s Happening in Healthcare

Read by more than 30,000 Berks County Residents, Physicians, Dentists, Practice Managers and other Engaged Readers! For Advertising Information Contact: Alicia Lee 610.685.0914 x210 Alicia@HoffPubs.com

Publishing Group

www.hoffpubs.com SUMMER 2016

M e d i c a l R e c o r d F e at u r e

Berks County Medical Societyâ€™s 25th Annual Legislative Breakfast was held on Friday, May 20th at VIVA. The following legislators were in attendance: Senator David Argall, Senator Judith Schwank, Representative Mark Gillen, Representative Barry Jozwiak and Representative Jerry Knowles. Approximately 60 members and guests were in attendance. Dr. Waxler served as the M.C. for the breakfast. The Society would like to thank the legislators that participated for sharing their legislative insights with the group.

www.berkscms.org

Berks County Medical Societyâ€™s Upcoming Events Mixer for All Members and Residents* Thursday, August 4th, 6-9 PM Mixer for All Members and Residents Members are encouraged to bring a non-member! Berkshire Country Club

*Online reservations will be accepted beginning July 1. There is no charge for this event but reservations are required.

Annual Golf Outing* Wednesday, September 21st Golden Oaks Golf Club â€“ shotgun start at 1PM Join us for lunch, golf, dinner or any of the scheduled events. *More information will follow via email.

SUMMER 2016

Sunday, October 16

R E A D I N G H O S P I TA L

ROAD RUN H A L F M A R AT H O N

5K Run • 1–Mile Fun Run/Fitness Walk

EXPERIENCE DOWNTOWN READING’S PREMIER HALF MARATHON, 5K AND 1-MILE FITNESS COURSE! The Friends of Reading Hospital are excited to offer a one-of-akind running experience with the 2016 Reading Hospital Road Run on Sunday, October 16! Participants will enjoy a beautiful scenic course in the city of Reading and Lower Alsace. Additionally, half marathon runners will traverse Mount Penn and sprint past the historic Pagoda as they race for cash prizes and glory! To register, view course maps, or to find hotel and parking information, visit www.RHroadrun.com.

All proceeds benefit programs funded by The Friends of Reading Hospital including HeartSAFE Berks County.

Hoffmann Publishing Group

Published on Jul 7, 2016

Berks County Medical Society Medical Record Summer 2016

The official publication of the Berks County Medical Society. www.berkscms.org. Medical Record is published by Hoffmann Publishing Group, In...

Berks County Medical Society Medical Record Summer 2016

Published on Jul 7, 2016

The official publication of the Berks County Medical Society. www.berkscms.org. Medical Record is published by Hoffmann Publishing Group, In...

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