Berks Medical Record

Medical Record WINTER 2012

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Berks County Health Assessment Antibiotic Armageddon...............................................................8 BCMS Salutes Bruce Weidman................................................. 21

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of the Berks County Medical Society

THE LAW OFFICES OF

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The Berks County Medical Record

Lucy J. Cairns, MD, Editor Editorial Board

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Margaret S. Atwell, MD Charles Barbera, MD Betsy Ostermiller Bruce Weidman

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D. Michael Baxter, M.D.

Antibiotic Armageddon

By Robert Jones, MD

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Berks County Medical Society Officers

23rd Annual Golf Outing

Pamela Q. Taffera, DO, MBA, President Kristen Sandel, MD , President-Elect D. Michael Baxter, MD, Chair, Executive Council Michael Haas, MD, Treasurer Andrew Waxler, MD, Secretary William C. Finneran III, MD, Immediate Past President Bruce R. Weidman, Executive Director Publisher: Hoffmann PUBLISHING Group, Inc. Reading, Pa | 610.685.0914 | hoffmannpublishing.com For advertising information contact MedAds@nhgi.net

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or visit hoffmannpublishing.com/media Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, 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.

All manuscripts and letters should be typed double-spaced on standard 8 1/2"x11" stationery.

The Berks County Medical Record (ISSN #0736-7333) is published four times a year in March, June, September, and December by the Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, 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, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610.

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Foundation Report

The Foundation’s LIFEGUARD® Program offers help to physicians

Departments: Editor’s Comments ............................................................................................................................................................... 7 In the News........................................................................................................................................................................ 21 Legislative and Regulatory Updates..................................................................................................................................... 22 Alliance Updates................................................................................................................................................................. 26 New Members.................................................................................................................................................................... 29 Foundation Report.............................................................................................................................................................. 30 Lecture Series..................................................................................................................................................................... 32 MEDICAL RECORD

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EDITOR’S COMMENTS

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Lucy J. Cairns, MD, Editor

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t is mid-December as I sit down to write, and for weeks now my mailbox has disgorged a steady stream of pleas for one more, end-of-year charitable contribution to the causes I support (and some I don’t!). In each plea is a description of actions vitally important to the cause and language designed to make me feel that all that is needed for final victory is for me to put my pen to my checkbook one more time.

All of us have causes we care passionately about and do our best to support. As physicians, members of the Berks County Medical Society are passionate about their patients and the health of our local community as a whole. In this edition of the Record you will find calls to action from Dr. Robert S. Jones and Dr. Michael Baxter in support of a healthier Berks County. Please take the time to read these articles carefully and consider stepping up your contribution to a cause you are uniquely qualified to support in ways that do NOT involve your checkbook!

Dr. Baxter’s article gives us his perspective on the recently updated Berks County Health Assessment. It will come as no surprise that there are unmet needs for medical care in our county, especially for those who live within Reading city boundaries. The recent opening of a Federally Qualified Health Center in the city represents a giant stride toward meeting those needs (and resulted from the efforts of a task force to which Dr. Baxter devoted much time and energy). However, the Center needs to significantly expand its capacity, and lack of access to specialty physicians, dental care, and mental health care is a continuing problem. Berks County physicians are called upon to be part of the solution.

The title of Dr. Jones’s article, “Antibiotic Armageddon” does not exaggerate the magnitude of a problem which threatens the health of every resident of Berks County and beyond. The age of having effective treatment for a wide range of infectious disease is drawing to a close, or will do so unless major changes are undertaken in our use of antibiotics and the development of new drugs takes a giant leap forward in the near future. In his article, Dr. Jones reviews the rise of antibiotic-resistant strains of microbes and our woefully inadequate response. Every physician who prescribes antibiotics, and every person who expects a prescription from their doctor, needs to become better informed and change their behavior to ameliorate this threat. In addition, to accelerate the development of new antibiotics we need to reduce the

a regulatory burden on drug developers and address the lack of economic incentives for bringing new antibiotics to market. In his article, Dr. Jones lists a number of very specific actions we can all take today and points us toward some excellent online resources.

Once you have read these articles, resist the urge to go back to bed and pull the covers over your head. Instead, open your eyes wide and turn the page to find the Berks County Medical Society’s new Vision Statement. It sets a high bar for involvement by Members in making Berks County a better place to practice medicine and a healthier place to live. In particular, I note that this brief statement includes the words “engage,” “assure,” “educate,” “act,” “protect,” and “celebrate.”

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Antibiotic Armageddon

By Robert Jones, MD

W

hether you agree or disagree, we as physicians have helped create a world-wide public health crisis. Antibiotic resistance is out-pacing our ability to develop and produce new antimicrobials. This situation has been recognized for some years by national and international agencies (Infectious Diseases Society of America, Institute of Medicine, American Society of Robert Jones, MD Microbiology, US Office of Technology and Assessment, and the World Health Organization). Antibiotics have been available since the mid 1900’s and have had a significant impact on healthcare. However, as we have learned over the years, overuse or misuse of antibiotics can have detrimental effects (rising drug costs, bacterial resistance, and even poor patient management).

Appropriate or inappropriate antibiotic use is associated with selective pressures that lead to the emergence of resistant bacteria. In the past such terms as antibiotic control, antibiotic restriction, etc. have been interpreted as being intrusive in physician autonomy. Good antimicrobial stewardship involves selecting an appropriate drug and optimizing its dose and duration to cure an infection while minimizing toxicity and conditions for selection of resistant bacterial strains supported by evidence based medicine. Studies conducted over the years indicate that antibiotic use is unnecessary or inappropriate in as many as 50% of cases in the United States.

Resistance The discovery of antibiotics in the 1930s fundamentally transformed the way physicians care for patients, shifting their approach from a focus on diagnoses without means to intervene to a treatment-focused approach that saves lives. When antibiotic use began, the genes encoding antibiotic resistance already existed unseen, either as mutants in infecting strains awaiting antibiotic selection or elsewhere in the larger bacterial

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world awaiting antibiotic mobilization. Three billion years of bacterial evolution had invented these genes, but only 70 years of antibiotic use has now selected, mobilized and spread these resistance genes through infecting bacteria.

Antibiotic resistance is not a new problem. Articles published over 50 years ago in the New England Journal of Medicine acknowledged antibiotic resistance. The in-patient use of tetracycline was associated with a 30% increase in nasal carriers of staphylococci, in comparison to the 11 % of untreated fellow patients. In 56 of the 60 tetracycline-treated patients, who acquired staphylocci while in the hospital, the new strains were tetracycline resistant. This was not the first time this type of phenomenon had been reported.

In a later study performed at the Atlanta VA in Atlanta, Blumberg, et al presented data on the rapid development of ciprofloxacin resistance in methicillin resistant Staphylococcus aureus (MRSA). Before the introduction of ciprofloxacin to the Atlanta VA all MRSA and methicillin susceptible Staphylococcus aureus (MSSA) were collected. In the three years prior to the introduction of ciprofloxacin to the formulary, all S. aureus isolates (159 MSSA and 131 MRSA) were susceptible to ciprofloxacin. Ciprofloxacin was added to the formulary in May of 1988, all S. aureus isolates were collected afterwards from June 1988-July 1989. Within 3 months of the introduction of the drug, ciprofloxacin resistance developed and by one year 79% of all MRSA isolates were resistant to ciprofloxacin. By June and July of 1989, all patients from whom MRSA was isolated for the first time had ciprofloxacin-resistant isolates. Ciprofloxacin resistance also developed in MSSA but not as quickly.

The rate at which antibiotic resistance develops is unique to the drug and the organism in question. Despite decades of use, Streptococcus pyogenes (Group A Streptococcus) remains universally susceptible to penicillin and remains the drug of choice. However, the same cannot be said for clindamycin and erythromycin.

Although extended-spectrum beta-lactamases (ESBL) are often referred to as a single entity, they are actually a complex group of enzymes capable of hydrolyzing a wide variety of beta lactam substrates. The genes that code for each ESBL are often linked on plasmids with genes that produce aminoglycoside or quinolone resistance factors. These genes have existed for over 15 years. Carbapenem resistance was relatively uncommon at that time, but this has become much more common with the development of carbapenemase enzymes.

These classes of antibiotic neutralizing enzymes belong to 3 classes of beta-lactamases. Carbapenemases can effectively hydrolyze carbapenems and all other beta-lactam antibiotics (all penicillins and cepahlosporins). The carbapenemase-producing Enterobacteriaceae have rapidly emerged as a significant threat to global health.

The most recent development of multi-drug resistant organisms is also in the gram negative class or organisms. In 2008 we saw the emergence of Klebsiella with a metallo betalactamase (NDM1).enzyme. By 2010 this organism had migrated to the US, UK, Japan, and Canada. This plasmid carries 14 drug resistance genes making them resistant to nearly all known antibiotics. This resistance is seen mostly in E. coli and Klebsiella, but the plasmid responsible for this resistance is promiscuous and can be seen in other gram negatives as well.

The problem of antimicrobial resistance is not specific to bacteria—medically important viruses (e.g., HIV, influenza), fungi (e.g., Candida, Aspergillus), and parasites (e.g., malaria) also develop antimicrobial resistance.

Drug-resistant infections take a staggering toll in the United States and across the globe. MRSA alone kills more Americans every year than emphysema, HIV/AIDS, Parkinson’s disease, and homicide combined.

Nearly 2 million Americans per year develop hospital-acquired infections (HAIs), resulting in 99,000 deaths – the vast majority of which are due to antibacterial-resistant pathogens. Based on studies of the costs of infections caused by antibiotic-resistant pathogens versus antibiotic-susceptible pathogens, the cost to the U.S. health care system of antibiotic resistant infections is $21 billion to $34 billion each year and more than 8 million additional hospital days.

Selection of antibiotics Selection of the appropriate antibiotic is based upon understanding host factors, the microbiology (bug) and the pharmacodynamics and pharmacokinetics of the antimicrobial.

Of these probably the most important are the host factors and specifically the site of the infection (table 3).

Host Factors

Immune status Site of infection Function of body systems responsible for absorption and elimination of drug Allergies

Age Pregnancy

Drug allergies are frequently self-reported and inaccurate. In one study by Raja et al, the false positive reporting rate for penicillin allergy was over 90%.

Sometime the most appropriate action is to not prescribe antibiotics. It is estimated that 50% of out-patient antibiotic use is inappropriate, commonly given for viral infections where there is no activity.

The length of antimicrobial therapy is a key feature in minimizing resistance. The standard of care for uncomplicated urinary tract infection (UTI) in women is three days of trimethoprimsulfamethoxazole DS one tablet twice a day or macrodantin 100 mg twice a day for 5 days, not a fluoroquinolone. The rationale is that fluorquinolones have collateral damage (increased rate of Clostridium difficile colitis, development of resistance, etc) and should be reserved for more serious infections. Similarly, antibiotic length of therapy should be restricted to 5-7 days for community acquired pneumonia, 8 days for health-care associated pneumonia (unless it is Pseudomonas) and 5-7 days for acute rhinosinusitis (remember that 90% of acute rhinosinusitis is likely viral).

Antibiotic Research and Development The Infectious Diseases Society of America (IDSA) launched its Bad Bugs, No Drugs advocacy campaign in 2004. Unfortunately, antibiotic resistance and the waning approvals of new antibiotics have only worsened since 2004 (Graph 1). In 2010, in recognition of the need for creative, new ideas to address the research and development problem and a measurable goal by which to gauge progress, IDSA launched the “10 × ’20 initiative”.

This initiative calls for the development of 10 novel, safe and effective, systemic antibiotics by 2020. Forty-five public health organizations and professional societies across the spectrum of medicine, including the American Medical Association and American Academy of Pediatrics, have endorsed the 10 × ’20 initiative. Unfortunately, to date there has only been one drug approved by the FDA to fulfill the initiative. There are currently 10 new compounds in clinical development active against Gram negative organisms as intravenous therapy. However, it is still the case that none of these pipeline drugs have activity against Gram negative bacteria resistant to all currently available antibiotics.

One of the reasons there has been a shortfall of new antimicrobials is the economic disincentive for the research and development of these compounds. In summary, the future of new antibiotics on the horizon to battle multi-drug resistant organisms is bleak.

Antibiotic Stewardship A comprehensive evidence-based antibiotic stewardship program (ASP) includes multiple elements based upon local antimicrobial use, resistance problems, available resources and the size of the institution or clinical setting. A multi-disciplinary team should compromise the stewardship program and include Continues on page 10 MEDICAL RECORD

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Table 1

Antibiotic Armageddon continued from page 9 an ID physician, a clinical pharmacist with ID training, a clinical microbiologist, an information system specialist, an infection control professional, and a hospital epidemiologist. Collaboration and expansion of this team with their respective departments and other departments is crucial. Other department representatives can be considered given the clinical setting, resources and initiatives to accomplish.

The elements of an active antimicrobial stewardship contain multiple strategies. The prospective audit of antimicrobial use with direct interaction and feedback to the prescriber, performed by either an ID physician or a clinical pharmacist can result in reduced inappropriate use of antimicrobials. Formulary restriction and pre-authorization can lead to immediate and significant reductions in antimicrobial use and cost. Education is considered to be an essential element of any program designed to influence prescribing behavior and can provide a foundation of knowledge that will enhance and increase the acceptance of stewardship strategies. Multidisciplinary development of practice guidelines incorporating local microbiology and resistance patterns can improve antimicrobial utilization. Streamlining or de-escalation of empirical antimicrobial therapy on the basis of culture results and elimination of redundant therapy can more effectively target the causative pathogen. A systematic plan to convert medications with excellent bioavailability from parenteral to oral medications when the patients’ condition allows can decrease length of stay and health care costs.

Computer-based surveillance can facilitate good stewardship by more efficient targeting of antimicrobial interventions, tracking of antimicrobial resistance patterns, and identification of nosocomial infections and adverse drug events.

The antibiotic armory is decreasing due to increasing emergence of bacterial resistant to currently available agents, coupled with a dwindling pipeline for new drugs. New agents are urgently needed, but as noted by Dennis Maki at the 1998 IDSA meeting, “The development of new antibiotics without having mechanisms to insure their appropriate use is much like supplying your alcoholic patients with a finer brandy.”

Antibiotics are also commonly used outside of humans.

Guidelines need to be established to eliminate the non-judicious use of antibiotics for growth promotion, feed efficiency, and routine disease prevention purposes in animal agriculture.

Conclusion It is difficult to accurately convey the enormous impact effective antibiotics have had in saving patients’ lives and eliminating tremendous suffering in the US and throughout the world. The most fundamental impact of the introduction of antibiotics was a dramatic decline in death from bacterial infections of all types.

For example, the overall mortality rate from infectious diseases in the US fell by - 220 per 100,000 population (75%) over the first 15 years of the antibiotic era.

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Antibiotics have fundamentally transformed the profession from a diagnostic, non-interventional field to a therapeutic, interventional profession. Circumstances have now allowed the reality of not having the availability of appropriate antibiotic therapy.

The loss of effective antibiotic therapy due to antimicrobial resistance and the withering antibiotic R&D pipeline will result in a great increase in deaths from infections. The availability of effective antibiotics is not a ‘‘lifestyle’’ issue, and the loss of such agents is not theoretical. We are facing a worldwide health crisis that already is resulting in deaths and maiming of patients, and will increasingly do so in the coming decades unless urgent action is taken. The time for debating the problem has passed, immediate action is required.

References Blumbert, etal. Rapid Development of Ciprofloxacin Resistance in Methicillin-susceptible and –Resistant Staphylococcus aureus. JID 1991;163:1279-1285 American Society of Microbiology. Report of the ASM Task Force on Antibiotic Resistance. Washington, D.C., 1994.

U.S. Congress, Office of Technology Assessment. Impacts of Antibiotic Resistant Bacteria (OTA-H-629). Washington, D.C., 1995 American Society of Microbiology. New and Reemerging Infectious Diseases: A Global Crisis and Immediate Threat to the Nation’s Health, The Role of Research. Washington, D.C., 1997.

Institute of Medicine, Forum on Emerging Infections. Antimicrobial Resistance; Issues and Options. Washington, D.C., 1998.

Bernsten CA, McDermott W. Increased transmissibility of staphylococci to patients receiving an antimicrobial drug. N Engl J Med 1960;262:637-42.

Reversing the tide of antibiotic resistance. N Engl J Med 1960;262:578-9

Basic principles of antibiotic use • Define the pathogen • Any culture (from relevant site) beats none • Contact outside labs for early culture results • Reculture if new fever (etc.)

• Treat the patient, not the culture • Match aggressiveness of treatment to severity and tempo of disease • Source control • Drain, debride, discontinue devices • Imaging, interventionalists • Antibiotics are not always benign; use with care • Allergy and adverse drug events (rash, GI, fever, cytopenias, renal, etc.)

• Be aware of drug-drug interactions Table 2

• Use and develop new technologies to make more rapid/accurate diagnoses

Chow AW, etal. IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults. Clin Inf Dis. March 2012. downloaded from http://cid.oxfordjournals.org

• Follow treatment guidelines that have been established

Kalpana G etal. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Disease Society of America and the European Society for Microbiology and Infectious Diseases. Clin Inf Dis. 2011;52:e103-e120

• Develop infection control programs

Resources

http://www.cdc.gov/getsmart http://www.idsociety.org http://www.antibioticsnow.org

Causal associations between antimicrobial use and the emergence of antimicrobial resistance • Changes in antimicrobial use are paralleled by changes in the prevalence of resistance • Antimicrobial resistance is more prevalent in health care–associated bacterial infections, compared with those from community-acquired infections • Patients with health care–associated infections caused by resistant strains are more likely than control patients to have received prior antimicrobials • Areas within hospitals that have the highest rates of antimicrobial resistance also have the highest rates of antimicrobial use • Increasing duration of patient exposure to antimicrobials increases the likelihood of colonization with resistant organisms.

Graph 1

What can we do to prevent the emergence of resistance?

Raja AS, Lindsell CJ, Bernstein JA, Codispoti CD, Moellman JJ. The use of penicillin skin testing to assess the prevalence of penicillin allergy in an emergency department setting. Ann Emerg Med. 2009 Jul;54(1):72-7 Dellit TH, etal. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clin Inf Dis. 2007;44:159-177.

http://cid.oxfordjournals.org/content/52/suppl_5/S397.full

Table 4

• Educate patients

• Know local resistance patterns (antibiogram) • Use evidence based medicine • Develop antibiotic stewardship program, in- patient and out-patient • Immunize patients • Judicious use of antimicrobials in agriculture MEDICAL RECORD

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The Health Status of Berks County 2012 D. Michael Baxter, M.D.

residents.Diabetes mellitus has been diagnosed in 14% of Berks County adults, 19% of Reading adults.

•

Mental Health conditions e.g. anxiety, depression or bipolar disorder are present in 15% of adults (46,000); however, only 39% report currently receiving treatment.

•

Late or no prenatal care occurs in 1/3 of all Berks County births, 1/2 of births to Reading women.

•

Low birth weight occurs in 7.7% of county births, 8.8% of Reading women births. (The National “Healthy People 2020” goal is 7.8%).

Chair, Department of Family & Community Medicine

I

f you ask someone in Berks County how healthy they are, the answer may well depend on where they live. While the overall health of Berks County residents is generally good, comparing favorably with United States trends, those who live in the City of Reading have significantly worse health status and face substantial barriers to improved health. These were the major findings of the recently concluded “Berks County Health Needs Assessment Report” commissioned by the Berks County Community Foundation, United Way of Berks County, the St. Joseph Regional Health Network and The Reading Health System. The study was conducted by the Research and Evaluation Group of the Public Health Management Corporation of Philadelphia and included a survey of 1,1001 randomly selected Berks County households, interviews of key community leaders and stakeholders and focus groups concentrating on Latinos, African Americans and older adults. In addition, the study authors utilized government and other research that compared Berks data to regional and national statistics.

Major findings of this report include: • • •

Berks County health status compares favorably to state and national trends including access to health care. (Figure 1).

Berks County residents are overall in good health with 84% reporting excellent to good health and 88% of adults stating they have a place to go for care when they need it.

However, 33% of City of Reading residents report fair or poor health. Nearly 20% report no regular source of care reflected in the fact that 25% of city residents are uninsured compared to 13% across the county. The percentage of uninsured adults has increased over the past four years from 8.7% to 13.3%.

With regards to personal health behaviors, a large percentage (72%) of Berks County adults do not eat the recommended 4-5 servings of fruits and vegetables daily and nearly 1/2 (48%) of residents eat fast food at least once a month.16 % of Berks County adults do no regular exercise and just over 1/2 (55%) say they exercise 3 or 4 days a week following recommended guidelines.

One in five Berks County adults smokes tobacco which is just below the statewide rate of 22.4%. The highest local percentage is nearly 30% in the City of Reading. Excessive alcohol consumption was measured as binge drinking defined by the Centers for Disease Control as five or more drinks on one occasion. Almost 40 % of Berks county adults admitted to such behavior on at least one occasion within the previous month with the City of Reading having the highest percentage at 47.5%.

•

Mortality rate for Berks County is 731per 100,000 lower than the statewide rate of 760. However, the city of Reading has an overall mortality rate of 929 per 100,000 population. (Leading causes of death are similar to national statistics-heart disease, stroke and all forms of cancer particularly lung cancer and breast cancer).

•

Obesity percentage is 30%, which meets the Healthy People 2020 (a health promotion program of the U.S. Department of Health and Human Services) goal of 30.6%

Other findings included lower rates of communicable diseases, e.g.

Hepatitis B, Lyme disease, varicella, chlamydia and gonorrhea, in Berks County as compared to statewide rates. In addition the Berks

•

Hypertension rate is 33.4% although 40% for Reading

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LoWEr ratEs

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Fig. 1

The researchers also looked at health screening for Berks County residents and found that nearly 70% of adults over the age of 50 have had a colonoscopy within the past 10 years although the percentage varies by region with 1/3 of city residents unscreened while nearly 80% of Western Berks residents have had a colonoscopy. 41% of Berks County women had not received a PAP test within the past year and 40% of women age 40 and over have not had an annual mammogram (comparable to statewide statistics).

Other findings include:

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County prevalence rate of HIV/AIDS, 218.7 cases per 100,000 population is less than the statewide rate of 224.9 per 100,000.

Within this group in Berks County, 65% are men, 46% Latino, 34% White and 20% African American.

The most common health concern of Berks County adults studied is the cost of health care--insurance coverage, co-pays and deductibles. The second most common concern is that of chronic diseases. (Figure 2)

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Fig. 2 One of the most dramatic findings of the study is the direct impact of economics and in particular the problem of poverty on access to health care and the status of one’s health. (Figure 3) Median household income for Berks County is $55,000.00 while in the city of Reading median income is $29,000.00. Although 13% of Berks County families with children fall in the poverty category, 37% of Reading families with children are at the poverty level. This number is expected to rise over the next year. In addition this research demonstrates that many of those patients with limited access to care depend on our local Emergency Rooms for primary care which result in both higher health care costs and overcrowding of these important community resources. (Figure 4) Richard Mable, Senior Vice President for Community and Government Relations with the Reading Health System and a Steering Committee Co-Chair for the study has summarized the findings as follows: “Although the Community Health Needs Assessment highlights several health issues in Berks County, the greatest disparities in health status rest within subpopulations of the City of Reading. Higher rates of poverty and unemployment among city residents are clearly correlated with greater problems accessing essential health services. These barriers result in the incidence rates of medical problems being disproportionately greater for Reading compared to the overall norms for the county at large. Reducing these disparities will clearly require a coordinated response by a broad cross-section of health and human service resources in the community.”

The recent opening of the Berks Community Health Center, a Federally Qualified Health Center (FQHC) in Reading, is a most welcome resource to help address unmet health needs for the most at risk populations. However the challenges identified by this study are greater than any single entity can meet.

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Dr . Pat r ic k B or j a , C h i rop r a c tor

3 9 3 3 Pe r k i o m e n Av e n u e , R e a d i n g , PA 1 9 6 0 6 • w w w. s p i n e a n d w e l l n e s s . o r g • ( 6 1 0 ) 7 7 9 - 4 5 8 8

Fig. 4 As this article for the Medical Record goes to press, there will certainly be further meetings planned and additional calls to action throughout the community. The Berks County Medical Society has been a major force for improving the health of the people of Berks County for over 180 years. Addressing the needs identified in this latest report may be one of the greatest challenges we have faced.

Instant message her.

D. Michael Baxter, M.D. Chair, BCMS Access to Care Committee

Berks County Medical Society Vision 2012: The Berks County Medical Society will be the leading advocate for a healthier Berks County by providing a forum for physicians, hospitals, and patients to engage in dialogue in order to: • •

• • •

Assure that the highest quality and state of the art care is delivered efficiently to our community by harboring a healthy environment with preventive medicine and wellness.

Educate and provide vision for young physicians entering our profession and bridge gaps across generations of physicians, while acting as a resource for physician communication and retention in our community.

Act as a as a genesis for political action and education and provide a respectful medium for political views and discussion.

Protect the practice and the art of medicine by being the best county medical society with active participation and involvement from its membership.

Celebrate and promote this collegial community of physicians who will actively pursue this vision.

Broadcasting Square Shopping Center Wyomissing • 610-374-9330 • VanScoy.com

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Our expert physicians discuss the latest advancements in health and wellness.

Berks County Medical Outing October 11, 2012

T

he Berks County Medical Society, under the leadership of our President, Dr. Bill Finneran revamped our annual Fall Outing in an effort to attract more golfers to the event and raise funds for our radio talk show “Health Talk.”

Our 23rd Annual Fall Outing was held at the beautiful LedgeRock Golf Club in Mohnton on October 11, 2012. A total of 92 golfers participated and a total of 24 sponsors helped fund the event.

We were thrilled with the participation, the venue and with the proceeds that will be used to perpetuate “Health Talk” and the educational services of the Berks County Medical Society. A big “thank-you” to Dr. Finneran and his wife Betsy for their efforts in making the golf outing a huge success. Information about next year’s outing at Ledge Rock will be available after the first of the year and please remember to patronize our fine sponsors!

First Flight Winners (BCMS members) Score Robert Early, Sneed Shadduck, Robert Thomas, Bob Jones 58 First Flight Winners (Ringers) Tom White, Brad White, Dan O’ Shea, Jim Blickle 61 Second Flight Winners Marc Aynardi, John Casey, Eric Jaxheimer, Bob Brigham 64 Ladies First Flight Winners Rhonda Hanley, Christine Unger, Noel Garapola, Toni Barbine 76 Ladies Second Flight Winners Beth Morelli, Amy Rothermel, Meg Shields, Janice Miller 85 Men’s Long Drive Sneed Shadduck Ladies Long Drive Diane Luchetta Closest to Pin #2 Men: Sneed Shaddock-2’-2” Ladies: Amy Rothermel-27’-1” Closest to Pin #4 Men: John Carlson-15’-11” Ladies: Michelle Davis-12’-5” Closest to Pin #10 Men: Mike Romeo-11’-1” Ladies: Chrissy Auman-17’-1” Closest to Pin #14 Men: Lou Sutherland-7’-10”

Watch on TV, listen on the radio, or view our full video library online at readinghealth.org

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Health Care Reform Post-Election PPACA Implementation: What Employers Should Be Thinking about for 2013

Golf Uuting continued from page 17

accounts (FSAs) (limit applies on an individual basis; effective for plan years beginning in 2013);

P

resident Obama has been reelected, and although there were some changes in Congress, the political make-up of the House and Senate remains the same, with Democrats controlling the Senate and Republicans controlling the House of Representatives.

Notifying employees of the availability of health insurance exchanges (guidance not yet released; intended to be effective March 2013); and 0.9% Medicare payroll tax increase on high income individuals (withholding required for employees earning over $200,000; effective for the 2013 tax year).

For employers and plan sponsors that have been adopting a “wait and see” approach before focusing on compliance with the Patient Protection and Affordable Care Act (PPACA), the time to wait is NEW 3.8% MEDICARE TAX EFFECTIVE IN over. PPACA’s insurance mandates, market reforms, and employer 2013 requirements generally will move ahead as scheduled, with most of PPACA becoming fully effective just a short year from now, in In addition to the 0.9% increase to the existing Medicare payroll 2014. Since the law left the task of working out many of the details tax discussed above, there is a new, non-payroll Medicare tax to the regulatory agencies (the Department of Labor, the IRS and effective starting in 2013. This new Medicare tax of 3.8% applies the Department of Health and Human Services), employers can to the lesser of (A) net investment income (defined below) or now expect that an enormous (B) the excess of modified number of regulations on many adjusted gross income of the unanswered questions For employers and plan sponsors that have been adopting a (AGI) over $200,000 and other types of guidance will “wait and see” approach before focusing on compliance with ($250,000 for joint filers). be issued between now and the Note that these threshold the Patient Protection and Affordable Care Act (PPACA), end of 2013. amounts are not indexed The BCMS sincerely thanks the following sponsors for their generous support:

Gold Level Sponsor Bill Finneran, MD. Cardiology Associates of West Reading Silver Level Sponsor Steve Banco, MD. The Reading Neck and Spine Center Golf Hole Sponsors Alan Ross and Company Audi Reading P. Kurt Bamberger, MD Surgery Consultants of Berks County Berks Visiting Nurse Association Berkshire Health Partners Fulton Bank/Clermont Wealth Strategies In Home Oxygen JKR Partners Architects Keystone Orthopaedics Medical Protective National Penn Bank Orthopaedic Associates of Reading, Ltd. Parente Beard Piazza Honda/Accura Power Kunkle Benefit Consulting Masano BMW St. Joseph Medical Center Stratix Systems The Reading Hospital & Medical Center VIST Financial WEIK investment Services West Reading Radiology Associates

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WHAT TO THINK ABOUT IN 2013

the time to wait is over.

2013 is clearly a critical planning year for employers and plan sponsors. Cost containment and compliance have to be the main focus. With respect to compliance, deliberate focus must be on PPACA’s many requirements that either are currently in effect or which will become effective soon, including: Covering additional preventive care services for women with no cost-sharing, including coverage for contraceptives (nongrandfathered plans only; effective for plan years beginning on or after August 1, 2012); Form W-2 reporting of the value of each employee’s health coverage (employers that issue fewer than 250 W-2s in a prior year are exempt; effective for the 2012 tax year); Issuance of Summaries of Benefits and Coverage (SBCs) to all eligible enrollees (60-day advance notice required for changes made other than in connection with the plan’s renewal; effective for open enrollment periods and plan years beginning on or after September 23, 2012); $2,500 limit on employee contributions to health flexible spending

to inflation in future years, which means that this tax may apply to more taxpayers in future years. Also, for most taxpayers, their modified AGI is simply their AGI. Generally, “net investment income” is the excess of gross income from interest, dividends, annuities, royalties, rents, passive activity income and capital gains, over any deductions allowed by the IRS that are allocated to such income. As such, net investment income does not include, for example, tax-exempt interest or distributions from tax qualified plans.

Note that this new 3.8% tax applies to an individual’s investment income in excess of the $200,000 / $250,000 threshold described above on an uncapped basis. Individuals who may be subject to this 3.8% Medicare tax should consult with their personal tax advisor to determine if it might be advantageous to recognize capital gains in 2012, thus avoiding the 3.8% tax. This also may be attractive in light of the possibility of the maximum federal income tax rate increasing to 39.65% in 2013 and thereafter.

Jessica Dean, Employee Benefits Consultant Power Kunkle Benefits Consulting

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EXCELLENCE HAS A HOME AT GRANITE POINT.

in the news

It’s like having 23 of the best ophthalmologists and eye care professionals right in your practice.

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he Retired Physicians Section of the Berks County Medical Society met on September 24th in the BVNA Auditorium. The program entitled Raptors Close Up was presented by Denise Peters, Education Specialist for Hawk Mountain Sanctuary. Denise brought along 2 special guests, a Hawk and a Kestrel for the presentation.

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WHATEVER YOUR PRACTICE OR SPECIALTY, you always want the best care for your patient. We all do. And to us, providing the best possible patient care begins with our board-certified professionals, clinical excellence and evidenced based practice.

True, when it comes to comprehensive eye care, our ophthalmologists and optometrists are some of the best that you’ll find anywhere. But more than that, our entire practice is committed to cooperative management of your patient.

What does that mean? It means that we communicate and consult 360˚.We share information, and we provide direct cell numbers to our partner physicians. It means that we listen carefully to patients and their physicians and provide a wealth of patient and physician education materials. And ultimately, it means better outcomes for your patients. Most of all, it means that we never forget that it’s your patient, and that we are your partners in care.

When it’s your patient’s eyesight, trust the experts. Learn more about our commitment to clinical excellence and patient co-management. Call Cindy Castillo, Physician Liaison, at 610-378-1344, ext 3112 or visit www.EyeConsultantsOfPA.com.

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current board certification and the following printed or typed information: provider name, 13-digit provider number(s), and corresponding provider type and current provider specialty. MA is also developing an attestation form that will be accepted in the near future. Send the attestation or board certification to MA at: Email: Ra-ProvApp@pa.gov. Include the subject “PCP” Fax: 717.772.6765 and include “PCP” in the fax cover sheet

LEGISLATIVE AND REGULATORY UPDATES From: J. Scot Chadwick, V i c e P r e s i d e n t, G o v e r n m e n t a l Aff a i r s ———————— Amy C. Green, Ass o c i a t e D i r e c t o r , G o v e r n m e n t a l Aff a i r s P e n n s y l va n i a M e d i c a l S o c i e t y

Find Out How to Validate Your Specialty for the Medicaid Primary Care Pay Boost The Affordable Care Act (ACA) mandates that certain Medicaid primary care specialties rendering specified primary care services be paid at the Medicare rate for calendar years 2013 and 2014.

One area of concern for some physicians has been how to validate their specialty or subspecialty designation with Pennsylvania Medical Assistance (MA).

MA has responded to several concerns raised by the Pennsylvania Medical Society (PAMED) in recent discussions.

Following are MA’s answers to physicians’ questions:

MA has clarified that physicians who are board certified in the specialties of family medicine, general internal medicine, and pediatrics or boarded in the subspecialties of one of these three specialties, e.g. pediatric cardiology, adult cardiology, etc., qualify for the enhanced reimbursement. Primary care physicians who are not board certified, but who meet specific service utilization, (e.g., 60 percent of their MA claims are for evaluation and management codes) will also be eligible.

How do I request the enhanced reimbursement?

Qualified physicians can submit to MA a copy of their |

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Mail: DPW/OMAP/BFFSP Attention: Provider Enrollment/PCP PO Box 8045 Harrisburg, PA 17105-8045

You should only have to submit this information once.

Although the increases also apply to Medicaid managed care organization (MCOs) services, you will only have to submit your board certification information to the state, which will forward it to the MCOs.

What services qualify and how will I be paid?

Although MA is required to begin paying the enhanced reimbursement effective for service dates Jan. 1, 2013 through Dec. 31, 2014, MA will not be prepared to implement it at that time. MA is hopeful it will be ready to implement the increases in April 2013. Retroactive payments will be made to Jan. 1, 2013. MA will apply the increases to the current fee schedule.

The increase will apply to evaluation & management procedure codes and vaccine administration codes. Fees will increase to Medicare levels. The rate will be determined by calculating the mean (average) of the Medicare site-of-service and locality rates (four rates). Capitation rates, based on Medicare fee-for-service rates, will also be calculated.

What’s next?

Who is qualified for the enhanced reimbursement?

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MA will submit a State Plan Amendment to the Centers for Medicaid and Medicare Services outlining how it will implement the mandate. Additionally, MA will develop a “Quick Tip” and a Medical Assistance Bulletin outlining the details of the initiative. Finally, a web page dedicated to the ACA Primary Care Rate Increase information will be developed.

PAMED will continue to monitor the situation closely and provide additional details as they become available. If you should have any questions, please call the PAMED Division of Practice Economics and Payer Relations at (800) 228-7823.

Reprinted with permission from The Pennsylvania Medical Society

Summary of House of Delegates 2012

PAMED to Reinvent Itself as Faster, Leaner Machine

MDs Will Save More Than $300 on License Renewal for 2013-2014

Every year, physician delegates representing geographic areas and physician specialty organizations spend two days churning through hundreds of pages of reports and resolutions to arrive at new directions and policies for the Pennsylvania Medical Society (PAMED).

Most actively practicing MDs will save $360 this year as the Pennsylvania State Board of Medicine, that licenses allopathic physicians, recently announced there will be no renewal fees for the 2013-14 licensing cycle. “We hail the State Board of Medicine’s move to waive the license renewal fee for 2013-2014,” said Marilyn Heine, MD, past president of the Pennsylvania Medical Society (PAMED). PAMED has long advocated that the Board put surpluses to good use rather than let them accumulate.

The Board’s action

This democratic body of physicians, the House of Delegates, is aimed at identifying problems, from the smallest coding issues to the biggest public health crises, and then tasking the Board of Trustees to work on those problems throughout the year.

But this year the delegates acknowledged that their machine needs to be drastically retooled. It must be quickly brought up-to-date so that it’s faster, more responsive, and more strategically effective.

They decided that PAMED needs to not only make better use of modem communications technology to engage the young physicians who are the organizations’ future, but it also must become more relevant and strategic in its decision making.

To begin addressing this huge task, on October 27-29, the delegates to this year’s PAMED HOD launched a plan that may set into motion a wave of changes within PAMED. The major new directions could include:

• Downsizing the PAMED Board of Trustees, over time and through attrition, to a more manageable, strategically efficient size.

• Moving policy and decision making authority from the HOD to the Board of Trustees.

• Setting up a nominating committee that would use skills-based criteria to select trustees.

• Exploring the feasibility of acting on these bylaws changes at a special HOD meeting in advance of the regularly schedule 2013 October HOD meeting.

• Holding other educational and “town hall” type meetings at other times during the year.

• Expanding real-time, two-way communication with members.

• Expanding communication between PAMED and county and specialty societies.

None of this work can be done without effective 24/7, two-way communication between rank-and-file members and PAMED leadership at all levels. Our first critical task is to open up new communications channels so that members can be actively involved in decision making through real-time feedback to PAMED leadership.

Another essential step to set governance changes into motion is appropriate changes to PAMED bylaws. Because the House of Delegates must approve any bylaws changes, an additional meeting is being considered.

The Delegates also discussed a number of other important matters as this year’s meeting including: the use of restrictive covenants; prior authorizations; insurer claims “look back” periods; defining and licensing medical aestheticians; hospital protocols for patient transfers; the licensure of drug manufacturers selling products with Pennsylvania.

“We hail the State Board of Medicine’s move to waive the license renewal fee for 2013-2014,” said Marilyn Heine, MD, past president of the Pennsylvania Medical Society (PAMED). will help physician practices across Pennsylvania. Physicians will soon receive renewal information from the state board. If you have moved since the last licensure cycle, please make sure to update your mailing address with the Board. Do you have questions about renewing your license, such as how often you must renew, the process for renewal, or educational requirements for renewal? Read the Pennsylvania Medical Society’s (PAMED) FAQs for answers to these questions and more www.pamedsoc.org

Give Your Input into Initiative to Spread Medical Home Model Pennsylvania has a great deal of work to do to improve its health workforce and the health of its population. Currently, we rank 13th in the number of primary care physicians per 100,000 population, and 29th in overall health outcomes, such as adult diabetes, prevalence of cardiovascular disease, and cancer deaths per 100,000.

You can help by going to the PAMED website www.pamedsoc. org and complete the survey that is a first step in an initiative to address these concerns. You will also be entered into a drawing to win an iPad 2. The survey is designed to help identify the services primary care physicians need the most to improve patient care.

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2012 Summary of House of Delegates continued from page 23

Time’s Up for Apology Bill This Time Around...But We’ll Be Back!

Best in Berks Come Home to the

The state House of Representatives adjourned for the day Oct. 16, 2012, without voting on the PAMED-supported amendment to allow physician apologies, or on the bill to which it would have been amended, Senate Bill 1591.

This means that now there is no time for the apology measure to be voted on in both the House and the Senate before the legislature adjourns this week, ending the two-year legislative session. Despite one of the strongest grassroots responses this year from PAMED members, the bill joined several others that fell victim to the crush of bills vying for consideration prior to the 11 PM deadline. The good news is that well be bringing this critical legislation back next session with an even stronger showing of grassroots physician action.

Thank you to all PAMED members and supporters who took action so quickly. Since our email on Monday, Oct. 15, 2012, at 2 PM alerting members to contact their legislators, our physicians and supporters sent nearly 780 email messages to more than 163 legislators. Added to an equally impressive number of physician phone calls to legislators, this showing will serve us well in the new 2013-2014 legislative session.

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Schedule a private tour of this property by contacting:

Joan Florence, REALTOR RE/MAX of Reading Office: 610-670-2770 Cell: 610-763-6985 JFlorence@GoBerksCounty.com Custom built by LivingStone, Inc.  www.LivingStoneInc.org

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www.ddaberks.com  (610) 374-4401 24 | MEDICAL RECORD

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YOUR INSPIRAT IONAL RESOURCE GUIDE TO PLANNI NG THE PERFECT WEDDING

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Fall General Meeting

ALLIANCE UPDATE

This year our general meeting was held at the Reading Public Museum, where we were taken on a private tour of the museum galleries with Scott Schweigert, museum curator. Scott discussed new initiatives underway at the museum as well as upcoming exhibits and special programs. For information on membership check out their website!

E mily B undy B C M S A P resident - E lect

A

new chapter of Girls on the Run is coming to Berks County in the spring of 2013. Alliance members got a preview of this organization at our Fall Luncheon hosted by Lisa Banco on October 9, 2012. Local chapter leader, Kimberly Rivera spoke to us about how this program for girls 8-13 years old “creatively integrates running into a 12-week curriculum that includes lessons on self-esteem, peer pressure, working as part of a team and giving back to the community.”

Upon completing the program the girls participate in a 5K run to solidify the life lesson that if they are willing to work hard and persevere in the face of obstacles they can accomplish things they may not have realized they were capable of.

This program not only focuses on physical wellness but also on issues such as healthy behaviors and maintaining a positive body image. In a world where the media sends myriad messages about how young people should look and act, this program offers young girls a framework to process those messages and make good decisions. I recently came across a story within a book I was reading that can be applied. In the 2011 New York Times Bestseller, Real Happiness: The Power of Meditation by Sharon Salzberg, the author relays an old story told by a Native American elder.

A grandfather imparting a life lesson to his grandson tells him, “I have two wolves fighting in my heart. One wolf is vengeful, fearful, envious, resentful, and deceitful. The other wolf is loving, compassionate, generous, truthful and serene.” The grandson asks which wolf will win the fight. The grandfather answers, “the one I feed.”

Similarly, this program teaches young girls that it is important to feed positive thoughts about ourselves because whatever gets our attention flourishes. While this may seem like a simple lesson, it is something we can all remind ourselves of. Beyond teaching kids to feel good about themselves this program takes it a step further by sending the message you can make a difference regardless of gender, background or age. This is a wonderful lesson to instill in our youth, as they will become tomorrow’s leaders. In a world that is all about ME, it is refreshing to see people learning to look beyond themselves to help with the greater good. If you would like to learn more about this life-

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Try us out!

Potential new members are welcome to any of our events!

See our website for the 2012-2013 schedule of meetings or contact our Vice President of Membership, Amy Impellizzeri at aimpell@gmail.com. Our website is www.berkscmsa.org.

Doctor’s Grove

Current members of Girls on the Run of Berks. changing program or are interested in sponsoring a group of girls, contact Please contact Kim Rivera at gotrberks@gmail.com.

You can also find them on Facebook at Girls on the Run-Berks.

New Member’s Coffee

Our New Member’s Coffee was held on September 14, 2012 at the home of Amy Impellizzeri. We are very excited to welcome five new members, Wendy Davis, Katherine Marr, Dr. Sara Noori, Meghan White and Jacquie Fernandez. We look forward to seeing them Speaker Kimberly Rivera of Girls again and getting to know on the Run of Berks them better.

Left to Right: Lisa Banco, Scott Schweigert (Museum Curator) and Diana Kliener.

Holiday Brunch will be hosted by Carole Lusch on December 12, 2011 at 10:00am. If you would like to try out a meeting, we would love to meet you at this fun, informal social event. You may bring your children with you to this meeting, if needed.

Second New Member’s Coffee

The next New Member’s Coffee will be held February 7, 2013 at Gretchen Platt’s home. We have decided to have two new member’s coffees each year going forward. This will allow people who were unable to come to the one held in the Fall to have another opportunity to get involved without having to wait a whole year until the next one.

Facebook

We are working hard to increase our audience on Facebook.

Please like our page at “Berks County Medical Society Alliance.” Our goal is to have 100 likes by the spring.

Health Project

This year’s Annual Health in Balance Lecture Series entitled, “Practical Approaches to Managing Autism for the School Aged Child” will be held at Glad Tidings on April 4, 2013. There will be a daytime program that will have a cost to register and an evening program that is free and open to the public. More information and registration will be on our website as details are confirmed.

Holiday Card

Left to Right (back row): Kalpa Solanki, Judith Kraines, Jill Haas, Katherine Marr, Wendy Davis, Lisa Banco, Karin Donato, Amy Impellizzeri, Jody Menon, DeeDee Burke, Sara Noori.

Front Row: Lindsay Romeo, Emily Bundy, Kathy Rogers.

The Holiday Card total is in and thanks to the benevolence of local physicians $13,665 was raised! Due to your generosity, we will able to provide academic scholarships to students pursuing medically related careers in Berks County, as well as financial assistance to local charitable organizations that are working to make a positive impact on our community. Thank you for your faithful support!

Just as a reminder, if you are interested in purchasing a tree to be planted at Doctor’s Grove in the spring of 2013 please return your form.

Although the tentative deadline has passed, it is not too late to be a part of this project.

The form to order a tree is also available on our website. For clarification, the trees are not just planted in memory of someone. They can be planted for other reasons like those listed below. Our lovely photographer, Gretchen Platt took these photos of Doctor’s Grove this fall.

The informal planting ceremony will be held at the Berks Heritage Center on Friday, April 26, 2013 at 11:30am. More details will follow in the next Medical Record. If you have any questions about Doctor’s Grove please contact DeeDee Burke at joeanddeeburke@yahoo.com.

Reasons to donate a tree: • • • •

To mark a milestone, i.e. Retirement, 15 years of practicing medicine in Berks County In appreciation of someone’s work, i.e. to tell a family member thank you As an acknowledgement of an achievement, i.e. a promotion, a teaching award, etc.

As an expression of gratitude, i.e. patient or practice to relay their thankfulness Continues on page 28 MEDICAL RECORD

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Overnigh ns atio Accomod ble In Now Availahouse Our Farm

• •

To further the project, i.e. helping with Park beautification and the county lowmow initiative In memorial, i.e. to remember a physician who is now deceased or moved away from Berks County

Golden Oaks Golf Club & Restaurant....

Eat. Drink. Play Golf.

•

• • •

medical society of pennsylvania

 Award winning 18 hole Championship Golf Course  Open to the Public for Golf and Dining

Berks County Medical Society Revised New Members since July 2012

 Corporate Golf Tournaments and Charity Events

What you receive for your donation: •

New members

 Great Venue for Corporate Meetings and Dinners

A 10 to 12 foot, Autumn Glory Maple tree planted in Doctor’s Grove Name of the Donor and Recipient will be listed in The Medical Record, the Reading Eagle Newspaper and the Berks County Department of Parks and Recreation newsletter Invitation to the Tree Planting Ceremony Name of Donor and Recipient will be engraved on a brass leaf of the Tree of Life plaque Name of Donor and Recipient will be listed on our website under the Doctor’s Grove Tab

 Affordable Memberships available

Soja Anubkumar, MD

 Weddings, Rehearsal dinners and Banquet facilities  Our 1850’s Farmhouse for smaller intimate gatherings

Victor R. Araya, MD

 Overnight Accommodations in our Farmhouse

Kathy Bixler, Administrator

www.goldenoaksgolfclub.com | 610.944.6000 | Like us on Facebook

Jessica Lynn Capasso, DO Resident

Berks County Medical Society’s

HEALTH

Tune in to Health Talk Live on WEEU radio to hear live community conversations about health topics with members and guests of the Berks County Medical Society!

Join the discussion every Wednesday evening from 6 to 7pm when the Berks County Medical Society presents “Health Talk”. It’s your chance to call and chat with many of the region’s leading health care practitioners!

Take a look at the Berks County Medical Society’s

Julian Leonardo Castaneda, MD

FOr Live call in: (610) 374-8800 or 1-800-323-8800 to participate.

Justin Lee Elder, DO John Gregory Fernandez, MD Marian Stefanov Georgiev, MD

CARE

A physical monument with the names of recipients will eventually be displayed on a sign or monument at the actual grove. We are exploring options for this, which may take a year or two to complete.

COMES HOME.

Amanda L. Gosling, MD Kristen Leigh Hess, DO Resident Shilu Joshi, MD Zachary Ryan Mclaughlin, DO Resident Maria Cristina Ordinario Frank, MD Leena Rachel Philip, DO Resident Erik J. Rupard, MD

Physician’s to be honored in spring 2013:

Ryan Drayton Schreiter, DO Resident Carrie L. Shulman, MD

Ronald Emkey, MD of Emkey Arthritis and Osteoporosis Clinic, by his son Gregory Emkey, MD. George Neubert, MD of The Reading Hospital OB/GYN Department, by Dr. and Mrs. Alex Massengale. Jason Bundy, MD of Center for Pain Control, by his wife and family. Barry S. Shultz, MD, given in memory of her husband, by Linda Shultz.Nirav Patel, MD given in memory, by friends of Dr. Patel.

Physicians of Berks County, by Berks County Medical Society Alliance. George Kershner, MD, of The Reading Hospital Emergency Department, by Dr. JoAnne Gordon. Michael Weaver, MD, given by his wife and family.

Marcia Q. McCrae, MD, given in memory by Nancy Alley. Samie A. Alley, MD, given by his wife Nancy Alley. Your name here.

Christopher Testa, MD Joshua Gardner Tice, MD

Your home. Our care. Peace of mind.

Susan Mary Trocciola, MD Florin Vlasie, MD

Everything is taken care of with the original VNA. Since 1909, Berks Visiting Nurse Association has provided the most comprehensive home health care in the area.

Discover a new kind of bank.

No one surpasses Berks VNA in offering quality, compassionate care to patients and families. Whether you need hospice care, therapy, or nursing, you want the absolute best care coming into your home.

Hosts include: Dr. John Dethoff (pictured) Dr. Chuck Barbera Dr. Andy Waxler Dr. Bill Finneran Dr. Pamela Taffera

Four generations of auto care excellence.

Taking care of your family like you’re part of our family.

Full lines of Goodyear, Dunlop and Kelly tires Major and minor repairs All repairs backed by nationwide warranty State safety & emissions inspection Alignments OE recommended maintenance performed

4427 Penn Avenue Sinking Spring, PA centraltireandautoservice.com 610.670.9999

“I can help!”

Full Cooperation with all Licensees

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Choose Berks VNA. TM

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When a group of local bankers and investors launched The Victory Bank, their aim was to create a new kind of bank. It was founded to optimize the financial lives of their clients by delivering an exceptional client experience based on honesty, high-integrity, respect, and unparalleled personal service. Discover the difference at The Victory Bank.

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RE/MAX of Reading 610.670.2770 x 3157

Loan Office | 200 Spring Ridge Drive, Suite 206, Wyomissing PA 19610 | 610.478.4090

1290 Broadcasting Road, Wyomissing, PA 19610

Non-profit 501(c)3, Accredited by CHAP, United Way Agency, People’s Choice Winner

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& AUTO SERVICE

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sponsor of

FOUNDATION REPORT

Objectiveness: Evaluations are based on data such as evidence of compliance with performance standards.

B y S usan L indt

A Report of the Foundation of the Pennsylvania Medical Society

Foundation’s LifeGuard program offers help to physicians ®

Reading-based Neurosurgeon Dr. Raymond Truex Jr., serves as chair of the Board of Trustees of The Foundation of the Pennsylvania Medical Society. He chose to undertake this leadership role to support the foundation as it offers programs that speak to improving the human conditions of wellness, knowledge and competency for every physician regardless of the political and economic influences that impact the practice of medicine.

“Ensuring high standards of professional conduct is the greatest responsibility of a professional and one that the public has a right to expect. It is the responsibility of the physician community to ensure that quality and safety of our colleagues’ performance is paramount to provide healthcare that is safe and certain for all Pennsylvania residents,” said Truex.

The Foundation offers programs that support physician wellness.

It administers the Lifeguard® program that assists physicians who need a seamless pathway for reentry into the workforce. The program provides remediation for those who may have fallen behind in clinical skills or continuing education, or about whom quality concerns have arisen through a peer review process.

Through the program, the Foundation offers the availability of a multi-component evaluation and assessment process to hospital medical staffs, medical executives, the State Board of Medicine, and other potential sources of referral. Physicians are also encouraged to refer themselves when appropriate.

LifeGuard® utilizes the medical model as its basis and a case management approach to provide components of the program as needed. No single pathway is appropriate for all referrals; rather, individualized evaluation, clinical skill assessment, and remediation/refresher plans are considered, depending upon the needs of the individual physician.

The LifeGuard® Program has three essential core characteristics:

Fairness: The evaluation process is open, unbiased, and it complies with labor regulations.

Responsiveness: Physicians enter into case management promptly and they are moved through the assessment and remediation phase in a timely manner to enable them to continue or return to the practice of medicine, when possible.

The pathways to address licensure and asses clinical competency include:

Protect What’s Most Important in Your Life.

Your family.

Your business.

Your home.

Your health.

Reentry

LifeGuard® provides licensing boards with a convenient process to help reinstate physicians who wish to reenter the practice of medicine after an extended leave. A unique and common component of the reentry case management process involves time in active practice settings through a customized preceptorship or shadowing arrangement. The duration of this component is based on each individual physician’s length of time away from active practice.

LifeGuard® develops individualized remediation plans based on the documented deficits by the physician and/or the licensing body, if applicable, as well as those identified through the assessment process. A variety of resources can be used to create such individualized plans, including services from specialized referral sources. The remediation experience affords the physician the opportunity to refresh knowledge and skills as well as use a real-time ongoing evaluation process conducted by a boardcertified, fully credentialed preceptor.

Call us at (610) 777-4123

Call us at (610) 777-4123 ator(610) 777 Call (610) 777-4123 visitCall ususatatus www.galleninsuranc visit us at www.galleninsurance.com v or visit us online at

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LifeGuard® provides a comprehensive report to the referring licensing board outlining the physician’s performance related to all assessment tools utilized within the individualized program, as well as evaluation of the physician’s practical phase of the program.

External Peer Review Assessment

This service is designed to assess actively practicing physicians when medical knowledge and/or clinical abilities in relation to medical responsibility are called into question. When a problem or deficit is identified and ongoing privileging is called into question, the LifeGuard® program can assess variations identified through the external peer review process. LifeGuard® utilizes an extensive panel of physician reviewers who are fully credentialed, board certified within their specialty, and are actively practicing in their field to provide external peer review assessments.

Aging Physician Assessment

For entities and organizations that need “ability to perform” assessments for senior physicians, the aging physician assessment measures abilities, competencies and health status. A core component of the assessment includes an objective measurement Continues on page 32

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of cognitive and physical abilities. Additional assessment options, including the National Board of Medical Examiners (NBME) practice based exams and proctoring for technical skill evaluation, are available based on the need identified by the requesting entity.

Competency Testing

Competency testing, a key component in the LifeGuard® program, is designed to assess a physician’s medical knowledge and decision-making skills. It is also used by physicians who want to assess their respective clinical and medical knowledge on a self-referral basis.

The Foundation’s Board of Trustees provides program oversight and LifeGuard’s staff has worked closely with Bureau of Professional and Occupational Affair’s administrative staff to structure appropriate assessment and/or remediation services that are customized to meet the unique circumstances of each case.

For more information: Foundation of the Pennsylvania Medical Society Foundation 777 East Park Drive, PO Box 8820 / Harrisburg, PA 17105-8820 Contact LifeGuard® at (717) 909-2590 / www.foundationpamedsoc.org

Department of Family Medecine

Objectives: The objectives of the LifeGuard® Program:

To protect the public welfare and ensure patient safety.

•

To increase the number of physicians in the Commonwealth of Pennsylvania, thereby increasing the workforce capacity to meet the health care needs of patients.

•

To provide a customized, unbiased process to address physician performance concerns.

•

To provide objective clinical assessment to identify and address concerns.

•

To provide physicians with appropriate educational remediation to meet their learning goals/objectives.

•

To help medical organizations, the State Board of Medicine, physicians, and the general public through a collaborative effort to improve the consistency of care, enhance patient safety, and assure access to needed medical care.

According to new Association of American Medical Colleges work force projections, nationwide physician shortages are expected to balloon to 62,900 doctors in five years and 91,500 by 2020. In a 2011 research study sponsored by the 2011 American College of Surgeons, Richard Cooper, MD, senior study author and professor at the Perleman School of Medicine at the University of Pennsylvania predicted a national physician shortage increase of seven to eight percent annually.

The LifeGuard® Program helps to solve the Pennsylvania physician shortage by putting physicians back to work in a manner that responsibly assesses their needs, provides a program of remediation, and tests to insure that knowledge or skill has been increased and competency criteria has been achieved.

Upon completion of the program, a report is issued to satisfy credentialing/licensure expectations of the state and/or health system. This report provides critical information that helps to ensure that the physician has reached a level of competency that assures a high level of patient safety. The program graduates return to the workforce as safe and certain physicians.

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February 15 –Comprehending Worker’s Comp and Disability Miscellaneous

Endorsements Transfer from Contingency Margaret Atwell, MD Website advertising Chief, Section of Occupational Medicine

Reading Hospital

February 22 – Diagnosis and Management of Female Urinary

Reading Health system

lecture series F A L L / winter 2 0 1 2

DEPARTMENT OF FAMILY MEDICINE LECTURE SERIES WINTER/SPRING 2013 January 4 – Friday’s Child Lecture Series

Office Diagnosis of Proteinuria, a Case-based Approach Steven J. Wassner, MD, Professor of Pediatrics

Chief, Division of Nephrology & Hypertension, Dept. of Pediatrics

Penn State Children’s Hospital

January 11 – Spirometry: A Tool to Improve Clinical Outcomes

Berks County Medical Society BCMS Physicians Serving On PAMED & POMA Boards, Council & Commissions Margaret S. Atwell, MD-District V Trustee-PAMED Board of Trustees Daniel B. Kimball, Jr., MD-Primary Care (Internal Medicine) Trustee-PAMED Board of Trustees; AMA Delegate Benjamin Schlechter, MD-Chair, PAMPAC Board Raymond C. Truex, Jr., MD-Chair-Foundation of the PAMED C. Eve Kimball, MD-Patient Advocacy D. Michael Baxter, MD-Public Health Elaine Lewis, MD- Radiology Representative-Specialty Leadership Cabinet Andrew R. Waxler, MD-Cardiology Representative-Specialty Leadership Cabinet Richard T. Bell, MD-Alternate Delegate-AMA; Pulmonary Disease-Specialty Leadership Cabinet Kristen M. Sandel, MD-Young Physicians Section –PAMED Board of Trustees Gerard P. Egan, Practice Administrator-Practice Advocacy Executive Council Jane Weida, MD-Family Medicine Representative-Specialty Leadership Cabinet William C, finneran III, MD-Fifth District Trustee-AMPAC Board Robert S. Jones, DO-POMA Board of Trustees Pamela Q. Taffera, DO-POMA Committee on Professional Guidance of Young

Rocco Santarelli, DO Respiratory Specialists Reading Hospital

Carrie Shulman, MD Spine and Brain Neurosurgery Center Reading Hospital

January 25 – Pharm Show 2013: New Medication Review

Jane Weida, MD

Medical Director, Family Health Care Center

Faculty Associate, Family Medicine Residency Reading Hospital

February 1 – Friday’s Child Lecture Series

Kids and Vascular Health, 2013 Stephen E. Cyran, MD , Professor of Pediatrics

Chief, Division of Cardiology/Children’s Heart Group Director, Pediatric Exercise Laboratory, Dept. of Pediatrics

Penn State Children’s Hospital

February 8 – Optimizing Use and Limiting Abuse of Opiates for Chronic Pain

$239,400.00

Incontinence

Christopher Pugh, DO Salaries & Wages

$125,000.00

Center for Pelvic Health and Urogynecology Association Dues

$300.00 Reading Hospital Committees

$6,000.00

January 18 – Management of Cerebral Aneurisms

TOTAL INCOME

$ 500.00 $21,000.00 $10,000.00 $0.00

EXPENSES:

Competency testing available through the LifeGuard program is offered in collaboration with the NBME and Federation of State Medical Boards (FSMB).

•

Thomas Raff, MD, Faculty Associate, Department of Family Retired Physicians

$800.00 & Community Medicine Residents’ Day/Memorial

Martin Cheatle, PhD, Department of Psychiatry Lecture $5,000.00 The Reading Hospital and Medical Center PMS House of Delegates $1,000.00

Contributions $500.00 Copay Insurance Reimb. $1,500.00 Equipment Maintenance $1,200.00 Executive Director $ 500.00 Fall Outing

$9,000.00 Legislative Breakfast $1,000.00 Insurance-Employee

$9,600.00 Insurance-Society $6,500.00 Installation $5,000.00 Investment Fees $3,600.00 Legal/Accounting $4,500.00 Medical Record $2,000.00 Miscellaneous $1,000.00 Pension $7,500.00 PMS House of Delegates $7,000.00 Postage $2,500.00 Rent $20,500.00 Residents’ Day/Memorial Lecture $4,200.00 Retired Physicians $900.00 Supplies/Printing $3,600.00 Taxes - Payroll $10,500.00 Telephone $2,200.00 Travel/ Mileage $300.00 Website $3,000.00 Overage to Contingency/Trust $0.00

TOTAL EXPENSES $239,400.00

2013 budget and slate of officers FOUNDATION REPORT

Dues $155,000.00 Fall Outing $16,000.00 Directories

$18,600.00 Medical Record Advertising $0.00 Installation

$1,500.00 Interest

$10,000.00

BERKS COUNTY MEDICAL SOCIETY 2013 EXECUTIVE COUNCIL Slate of Officers President: Pamela Q. Taffera, DO, MBA Chair, Executive Council: D. Michael Baxter, MD President-Elect: Kristen Sandel, MD

Secretary: Andrew Waxler, MD

Treasurer & Chair, Finance Committee: Michael Haas, MD Immediate Past President: William C. Finneran III, MD

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get baCk

to What You Love At HealthSouth Reading Rehabilitation Hospital, we’re committed to one thing—getting you back to what you love. That’s why we’re dedicated to bringing you a higher level of care in everything we do. Our ongoing commitment drives us to offer the newest technologies and customized programs that have helped HealthSouth Reading earn The Joint Commission’s Disease-Specific Care Certification for Stroke, Brain Injury and Spinal Cord Injury Rehabilitation.

When you or a loved one needs rehabilitation, choose HealthSouth Reading Rehabilitation Hospital.

Disease-Specific Care Certification

by The Joint Commission for Stroke, Brain Injury and Spinal Cord Injury Rehabilitation

A Higher Level of Care

1623 Morgantown Road • Reading, PA 19607 • 610 796-6000 healthsouthreading.com ©2012:HealthSouth Corporation:516848

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BENEFITS CONSULTING & H U M A N R E S O U R C E S O LU T I O N S

Customized Plans  Benefits Administration  HIPAA, FMLA & Medicare D Compliance  Free COBRA Administration Health & Wellness Services  Licensed Client Managers  Employee Support Center  Human Resource Support

Experienced. Creative. Progressive.

Power Kunkle is one of the largest Benefits Consulting firms in Berks County and all of Eastern and Central Pennsylvania. We are a full service employee benefits firm focused on changing the traditional employer/broker relationship. Power Kunkle continually raises the bar on industry standards by providing progressive thinking, delivering effective plan designs and the best possible client-specific solutions. Our goal is to become an extension of your HR department, handling the ongoing administration of your employee benefits so you can focus on the things that make your company profitable.

See how we can help you manage employee benefits for a healthier, more profitable tomorrow.

For a free consultation call Mark Kunkle at 610-685-1790, or email mkunkle @ pkbenefits.com

999 Berkshire Blvd  Suite 160  PO Box 6243  Wyomissing, PA 19610 P 610.685.1790  T 866.685.1790  F 610.685.1791 3 6 | M E D I C A L R E C O R D | W I N T E R 2 0 1 3 pkbenefits.com