Medical Record October 2012

FALL 2012

Medical Record o f

t h e

B e r k s

C o u n t y

M e d i c a l

S o c i e t y

Taking the Pulse of Berks County Medicine Legislative & Regulatory Updates............................................ 14 BCMS Salutes Bruce Weidman................................................. 21

It takes a team to put cancer in its place.

St. Joseph Medical Center Cancer Center’s collaboration with Penn State Hershey has brought their most talented Oncology specialists to Berks County – where they work every day – to provide academic-level cancer care right on our Bern Township campus.

It’s a clinically integrated approach that sets the standards for the best outcomes for our patients.

St. Joseph’s Cancer Center is accredited by the American College of Surgeons Commission on Cancer

and is led by Medical Director Marc Rovito, M.D. Dr. Rovito is a member of the Penn State Hershey Medical Oncology Group and is an assistant professor within its Hematology Oncology Department. He is Board certified in medical oncology and internal medicine. Leonard Tuanquin, M.D. is an active member of the Penn State Hershey Cancer Institute clinical faculty and is a Board certified radiation oncologist. Both doctors are joined by Ayodele Ayoola, M.D.

who is Board certified in hematology, oncology, and internal medicine. Our physician team is supported by an experienced and compassionate staff of clinical professionals dedicated to helping patients face down this biggest of health challenges.

Overcoming cancer is not a battle that can be fought alone, and with St. Joseph and Penn State Hershey Cancer Institute working together, you will never have to.

Medical Director

Marc Rovito, MD

Medical Oncologist

Leonard Tuanquin, MD Radiation Oncologist

TO SCHEDULE A PATIENT APPOINTMENT OR TO SPEAK F A L LONCOLOGIST, 2012 TO| AN CALL 610-378-2117.

2 | MEDICAL RECORD

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Medical Record

of the 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.

The Berks County Medical Record

Lucy J. Cairns, MD, Editor Editorial Board

Margaret S. Atwell, MD Charles Barbera, MD Betsy Ostermiller Bruce Weidman Berks County Medical Society Officers

William C. Finneran, III, MD, President Pamela Q. Taffera, DO, MBA, President-Elect Raymond C. Truex, Jr., MD, Chair, Executive Council Kristen Sandel, MD, Treasurer Christie L. Ganas, MD, Secretary Jerome I. Marcus, MD, Immediate Past President Bruce R. Weidman, Executive Director Publisher: Niemczyk Hoffmann Group, Inc. Shillington, Pa | 610.685.0914 | nhgi.net For advertising information contact MedAds@nhgi.net or visit nhgi.net/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

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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.

FALL 2012

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Taking the Pulse of Berks Medicine

By Lucy J Cairns, MD & Michael Baxter, MD

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Legislative and Regulatory Updates A Report From the Associate Director of Governmental Affairs of the Pennsylvania Medical Society

21

BCMS Salutes Bruce Weidman As he celebrates 25 years as Executive Director

22

Alliance Update New officers installed for 2012-2013

25

Summary of Benefits &Â Coverage (SBC) Requirements Deadline The Final regulations under the Health Care Reform law are released

Departments: Editor’s Comments ............................................................................................................................................................... 6 Alliance Updates................................................................................................................................................................. 22 Calendar of Events.............................................................................................................................................................. 23 Foundation Report.............................................................................................................................................................. 28 New Members.................................................................................................................................................................... 27 Members in the News......................................................................................................................................................... 33 MEDICAL RECORD

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EDITOR’S COMMENTS

Lucy J. Cairns, MD, Editor

a

W

ill the Berks County medical community be able to attract and retain enough physicians, with the right mix of primary and subspecialty care practitioners, to meet the future needs of county residents? This was the question I found myself asking after reading an article on the health status of the local population published in the Reading Eagle last spring. Dr. Michael Baxter and I decided to ‘take the pulse’ of the Berks

What you will find is that most had a personal connection to the area, value the lifestyle our county offers, and find the people of Berks County are a wonderful and rewarding population to care for. The quality of our local medical facilities and supportive working relationships with fellow physicians are other positive factors mentioned.

Over the next decade Berks County is going to need

There is a need to develop a collaborative system for monitoring important indicators of the ‘health’ of our physician population.

County physician community by seeing what data we could collect that would have a bearing on the answer to this question.

We also went directly to the source – asking a number of our colleagues and physician recruiters to give us their insights. The results are presented in this edition of the Medical Record.

As is often the case with research projects, we did not arrive at a definitive answer. We searched for data that would reveal recent trends in the number of physicians in active practice in Berks County, the age distribution of those physicians, the turnover rate among employed physicians, reimbursement rates from public and private insurance companies, and liability insurance rates. Some of this information was readily available, but much was either not available at all or very difficult to find.

In addition, time constraints precluded an examination of the particular challenges facing subspecialties. This project was a learning experience, and one conclusion we reached is that there is a need to develop a collaborative system for monitoring important indicators of the ‘health’ of our physician population and the position of Berks County in competing for physician talent.

Going into this project, my personal focus was on comparing physician compensation and the medical liability climate in Berks and Pennsylvania in general with that in other states. My assumption was that these factors were likely to be among the prime determinants of the attractiveness of Berks to physicians deciding on a location to practice. However, if you read the responses we received from our colleagues when we asked them to reflect on their decision to live and practice in Berks County, you will not find these factors mentioned at all.

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$449,000

hundreds of additional physicians to replace those who will retire or leave, and to meet the needs of an expanding and aging population. The most important lesson I learned from this project is that many of our best prospects for maintaining a robust medical community are those physicians with a preexisting personal connection to our area. For those concerned about the future of health care in Berks County, this suggests a number of avenues to explore. What more could be done to encourage bright young Berks Countians to pursue a career in medicine? Many pre-med college students (and even high school students) are interested in opportunities to shadow practicing physicians. Many local physicians are happy to provide such opportunities, but perhaps the BCMS could be instrumental in organizing and expanding these opportunities. Keeping in touch with such students while they are in medical school through a mentoring arrangement would be a way to maintain their ties to Berks County medicine while they are out of the area. Finding ways to support the recruiting efforts of the residency programs at SJMC and TRHMC, and to support the quality of these training programs, should also be given high priority.There might also be opportunities to support the recruiting activities of local medical practices and institutions. The Berks County Medical Society invites members who would like to help get such initiatives off the ground, or who have other ideas to contribute, to get in touch and get to work!

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Taking the Pulse of Berks County Medicine

By Lucy J Cairns, MD & Michael Baxter, MD

A

ccording to U.S. Census data, the population of Berks County increased by almost 38,000 (roughly 10%) between 2000 and 2010. Many of the current total belong to demographic groups in which multiple chronic illnesses are common: approximately 60,000 are age 65 or older, close to 30% are obese, and slightly more than 40% of those within Reading city boundaries live in poverty. Within and outside these groups, the prevalence of chronic disease is rising. The Affordable Care Act is designed to significantly expand the number of people with health insurance. Given these trends, we can predict with great confidence that the demand for physician and other health care services in Berks County will surge in the foreseeable future.

Less certain is whether our local physician community is robust enough to comfortably meet the expanding need for medical care.

In this article we will examine indicators of the ‘health’ of the Berks County physician community.

Ideally, Berks County residents should have prompt access to high quality primary and most subspecialty care close to home.

Prompt access requires a desirable physician-to-population ratio.

The availability of affordable private health insurance or coverage under a public program are also key determinants of access, but the effect of insurance coverage is limited if physician numbers or participation rates are low. Fair insurance reimbursement rates, and reasonable administrative burdens, are therefore additional requirements for a high level of access to care. Once access is obtained and a relationship of mutual respect and confidence is established between patient and physician, continuity of the relationship over time promotes quality care. Therefore, a low turn-over rate in the physician community is generally desirable from the patient’s point of view, and a high turn-over rate would suggest low job satisfaction among physicians.

While there is general agreement that Pennsylvania as a whole and Berks County in particular face a significant challenge in meeting the growing need for physician services, obtaining data to illuminate the magnitude of the challenge for Berks County has proven difficult. Perhaps this article will represent a starting point for a collaboration between the Berks County Medical Society and leaders in our county health care system to create a system for assessing and tracking the ‘health’ of Berks County medicine.

In the meantime, I will present the information we have gathered so far and briefly review actions which would enhance the recruitment of physicians to our county and help retain those who are recruited. Since primary care is the area where the threat of shortage is the largest, particular attention will be paid to it.

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According to a 2010 PA Department of Health report, roughly 45% of Berks County physicians provide primary care (General Practice, Family Medicine, Internal Medicine, Pediatrics, OB/ GYN, and GYN).

According to data available at www.countyhealthrankings.org, the ratio of primary care physicians to population in Berks County is 1:1068. This compares unfavorably with the state average of 1:838.

The age distribution of currently practicing physicians suggests the likelihood of significant attrition from retirement in the foreseeable future. Statewide, about one-fourth of practicing physicians are 60 or older, and only one-fifth are younger than 40. In Berks County, close to 50% of physicians providing direct patient care are 50 or older, and almost the same percentage have indicated that they plan to retire or leave the area over the next decade (2010 Pulse of Pennsylvania’s Physician and Physician Assistant Workforce). Unless some of these doctors change their plans, this means we will need to bring about 400 new physicians to Berks just to maintain the current number. And if the population increases as much in the second decade of this century as it did in the first, an additional 40 or so primary care doctors will be needed just to maintain our current, less-than-desirable ratio in this one area.

Over the last few years, many Berks County primary care physicians have transitioned from private practice to employee status. Some aspects of this change would be expected to strengthen recruitment efforts and increase job satisfaction levels.

For some physicians, however, the loss of autonomy is likely to reduce job satisfaction, and employee status will make it easier for those who are unhappy to leave the area if they find more attractive opportunities elsewhere. The net result is currently unclear.

Success in recruiting is dependent in no small part on the supply of physicians available. Currently, the U.S. trains about 27,000 physicians each year. Given the expected increase in demand due to the aging of the population and prevalence of chronic disease, significant physician shortages were forecast even before accounting for expansion of insurance coverage under the ACA, especially in primary care. While the Council on Graduate Medical Education recommends that at least 40% of the physician workforce be primary care, and a 50/50 split is advocated by others, fewer than 20% of U.S. medical school graduates are currently choosing primary care specialties. The reasons for this trend include the income disparity between primary and specialty care, the ballooning debt burden of medical school graduates, and young doctors placing more importance on having time for family.

Choosing a primary care path has become more problematic as physician reimbursement lags behind rising medical school tuition costs and the consequent huge debt burden carried by many new graduates. Choosing to practice any specialty in Pennsylvania is likely to mean accepting lower insurance payments than are available in many other states. A study by PAMED comparing average private insurer reimbursement for 15 E&M codes in Pennsylvania, Delaware, Maryland, New Jersey,

New York, Ohio, Virginia, and West Virginia in the year 2009 found that reimbursements in Pennsylvania were generally in the middle or on the low side, and that average payment for all codes studied except 99213 decreased from 2008 to 2009 in our state. The same study found that Medicaid reimbursement in Pennsylvania also compared unfavorably, with rates that generally placed PA fifth or sixth out of the eight states studied.

The medical liability climate in Pennsylvania has improved, thanks to legislation passed over the last decade after years of hard work by PAMED and other medical organizations. Nevertheless, despite ranking 6th among states in total population in 2010, Pennsylvania ranked 2nd for aggregate medical liability payouts in 2011.

Pennsylvania is fortunate to have 7 M.D. programs and 2 D.O. programs in the state. However, only 1/3 of those who earn their degree in PA remain in the state (ranking PA 32nd of all states), and only 2/5 who complete residency training here decide to practice in Pennsylvania (ranking PA 35th). In Berks County, residency programs at St. Joseph Medical Center and TRHMC make a major contribution to the supply of primary care physicians. Over the years, approximately 1/3 of graduates of TRHMC programs have elected to remain in the area. Currently, of the Internal Medicine and Family Medicine physicians involved in primary care who are on staff at The Reading Hospital, 40%

Graduates on TRHMC Staff Internal Medicine Primary Care 19/47 Hospitalist 21/49 Family Medicine 48/115

40% 43% 42%

180 total program graduates 59 practicing in Berks County (highest percentage of grads)

OB/GYN 19/57

33%

Total Graduates on TRHMC Staff

121

are locally trained. A similar percentage of the Hospitalist staff are local graduates, and 33% of the OB/GYN staff trained at the hospital.

Given the crucial role of local hospitals and residency programs in supplying well-trained physicians for our community, leaders at SJMC and TRHMC were asked to comment on the challenges they face in filling openings with highly qualified applicants. The response from St. Joe’s indicated that, for applicants not familiar with Berks County, publicity regarding the high rates of poverty and crime in the City of Reading are a barrier to recruitment. Reading Hospital’s physician recruiter, Robert Carper, echoed this observation and commented that Continued on page 10

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there just are not enough newly-trained physicians in a number of specialties. On the plus side, the reality is that life in Berks County is very attractive to many once they experience it, especially as a place to raise children. In addition, our two hospitals have beautiful, modern facilities and close working relationships with major teaching institutions.

To re-cap, the barriers to developing and maintaining a robust physician community in Berks County include 1) an insufficient number of newly-trained physicians, especially in certain specialties, 2) relatively low public and private insurance reimbursement rates in PA compared to other locations, 3) Pennsylvania’s relatively poor medical liability climate, and 4) misperceptions regarding the quality of life in Berks County and lack of more widespread knowledge of the high quality of our medical facilities.

Improving the medical practice environment in our county and our state is possible when physicians support PAMED and other physician-led organizations. PAMED has a highly effective and experienced staff representing member interests on the legislative and regulatory front. Act 13 of 2002 and the Fair Share Act of 2011 included provisions that significantly improved the liability climate in Pennsylvania. These pieces of legislation were the result of many years of sustained effort. The Governmental Affairs arm of PAMED has an equally important role in monitoring for and working to squelch proposals which would role back the gains we have made.

Among the legislative initiatives currently being given high priority are House Bill 1763, which addresses issues of importance in physician/health insurer contracting, and House Bill 1551, which would eliminate the unnecessary delays that often occur when physicians apply to be credentialed by health insurers.

The society’s 2011 The State of Medicine in Pennsylvania report (found on PAMED’s website) describes the forces behind the looming physician shortage in our state and outlines specific policy responses at the state level to mitigate this crisis. The 2012 edition of this report will be available soon.

PAMED’s agenda is entirely driven by member concerns, and is dependent on the active involvement of members for its successes in Harrisburg. Members in Berks County constitute one of the largest and most active of all the county societies.

The efforts of our members help shape and energize PAMED initiatives which protect and improve the medical practice environment in our state, making Berks County more attractive to physicians and supporting access to care for county residents.

Most of Berks County Medical Society’s activities, however, take place right in Berks. These activities are designed by and are for the benefit of our members. They include opportunities to get to know and spend time with our colleagues outside the office, a grievance resolution service, a voice for physicians in the local news media, and channels for physicians to educate the public on health topics. Welcoming young physicians to our community and encouraging the professional development of residents-intraining at SJMC and TRHMC are the focus of several annual events sponsored by our county society. All members benefit from 10 | MEDICAL RECORD

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these activities, but of course those who are directly involved reap the greatest rewards. Insofar as these activities promote fellowship among physicians and offer a way to effect desirable change through cooperative action, they make Berks a better place to practice medicine.

The efforts of the Berks County Medical Society to aid members in staying ‘on course’ as we navigate the rapidly changing landscape of present and future medical practice can be illustrated as the four points of a compass: If you have the desire to get involved, don’t hesitate to call our office at (610) 375-6555 for further ‘direction.’

Taking the Medical Practice Pulse of Berks County Physicians If U.S. healthcare is in the midst of a hurricane of change then it may seem that Berks County is in the eye of the storm.

After years of remarkable stability, the practice of medicine in this county has recently undergone dramatic transformation from the predominance of the private solo practice model and small groups to multi-specialty employed group practices. In addition primary care physicians, primarily in the disciplines of Family Medicine, General Internal Medicine and Pediatrics, have increasingly given up their once active in hospital patient care roles. Indeed the fastest growing area of medical practice in Berks County (as in other areas of the U.S.) is the rise of the Hospitalist (both adult and pediatric) as the primary provider model for in hospital care.

How is all of this affecting Berks County physicians and what does it portend for the future of our profession and for the care and health of Berks County patients?

Data provided by Reading Hospital (Richard Mabel, Senior V.P. for Community and Government Relations) and St. Joseph Hospital (Mary Hahn, V.P., Strategy and Business Development and Michael Hendel, Manager of Strategic Analytics) indicate that we indeed have a shortage of physicians in Berks County and a disproportionate mix of primary care and specialty physicians.

Berks County has approximately a 37% primary care and 63% specialty distribution (similar to national ratios) while the suggested “ideal” mix for the projected system changes is 50/50.

Our physicians’ average age is 52 which is slightly higher than Pennsylvania state and U. S. national benchmarks. (According to the Hospital and Healthsystem Association of PA, 2010 data, 1 in 4 PA physicians are 60 or older and 1 in 5 are under the age of 40).

No one has been affected more than Berks County primary care physicians (Family Physicians, General Internists, and to a lesser extent Obstetrician Gynecologists and Pediatricians). From a dominant model of private small group or solo practice for many

years, a large percentage of these physicians are now employed by either the Reading Hospital or St. Joseph Hospital Medical Groups or a few private large groups. Dr. Marc Aynardi, former Board Chair of the Reading Hospital Medical Group (TRHMG) was recruited to Berks County by Dr. Pat Hildreth almost 30 years ago following completion of his IM training at Presbyterian Hospital in Pittsburgh. He joined a small group and actively practiced hospital as well as office based medicine. However the combination of declining reimbursement, increasing business demands, expanding regulations and looming costs of an electronic health record (EMR) implementation compelled his practice and others to join TRHMG which now encompasses nearly 120 physicians. Concurrently there has been a rapid rise in the number of Hospitalists, a relatively new specialty which provides a large portion of in-patient care at both local hospitals.

Marc notes the negative side of these moves including the sacrifice of practice independence, the loss of continuity with one’s hospitalized patients and the need to balance many different opinions (and styles) within such a large group. However, he also believes that the development of such large groups has essentially preserved the viability of primary care in our community, afforded improved business practices including the essential introduction of an EMR system and offered lifestyle benefits by improving practice coverage and reducing on call demands. Overall Marc remains positive about the practice of medicine in Berks County and has two sons who are entering the profession.

On the other hand Dr. Jin Xu of Berks Family Physicians in Blandon has remained in solo practice in spite of the many demands that other physicians have faced. Dr. Xu came to this country from China in 1989 and to Berks County in 1995 when her engineer husband accepted a position with Carpenter Technology.

She had practiced as a Pediatrician in China, but re-trained as a Family Physician in the Reading Hospital Family Medicine Residency Program. Although she initially practiced in a small group she has bucked the trend and remains in solo practice since 2004. She acknowledges all of the pressures pushing her toward a larger group; however she is committed to maintaining her independence in order to ensure continuity with her patients and to preserve her staff while managing her practice the way she believes best. She has her frustrations including negotiating with insurance companies but prefers these to the frustrations of having someone else tell her how to run her practice. She prides herself in her close patient relationships and debunks the stereotype of narrow minded Berks County by reciting a comment from a favorite patient who told her “Who would have thought a little Chinese lady would be my Family doctor!”

Both Dr. Aynardi and Dr. Xu agree that Berks County is good place to practice and a great location to raise a family. However, the appeal of this area is perhaps no stronger than among those medical families who have at least two generations of Berks County physicians. Dr. Ed Zobian, who has practiced Ophthalmology here for nearly 40 years and his son David who is in a Pediatric group practice, both credit their excellent colleagues and the outstanding quality of care in Berks County for their high level of practice satisfaction. David, in particular, fondly remembers the impact of his father as well as others such as his own childhood Pediatrician, Mauro Paolini, on his choice to become a physician. He and his wife, Megan also a native of Berks County, knew that this was a great place to raise a family, a large factor in their return to this community.

However, most Berks County physicians have no prior connections to this community.

One such physician is Dr. Carrie Shulman who recently joined RPS Spine and Brain Neurosurgery.

Carrie, who no doubt had many other practice opportunities to explore, was attracted to this position as she realized the major commitment (in facilities and program) that was being made here to the development of a comprehensive center for neurosciences.

She was impressed with the innovative ideas and the engaging staff, and the people of Berks County. She is clearly excited about the opportunities here.

One of the newest and fastest growing specialties in medical care is the development of Hospitalists as a dominant model for medical inpatient care at both Reading and St. Joseph hospitals.

The rapid growth of the program at Reading Hospital has been especially remarkable as there are now 54 Hospitalists responsible for 14,000 discharges and 7,000 consults annually. Like other changes in health care, according to Dr. Walt Bohnenblust, Medical Director of Hospitalist Services, there have been plusses and minuses in this development. Issues concerning “hand-off” between office based and in patient physicians as well as patient

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concerns about meeting a new physician to care for them when they are often at greatest need remain challenges. However, the benefits of a 24/7 Hospitalist service well trained and oriented regarding standard protocols, utilization management and “core measures” of care have improved outcomes and quality measures.

There is little doubt that this model offers new career options for physicians and will be a further recruitment and retention challenge for our health care institutions.

Berks County will continue to be challenged by physician supply needs in many specialty as well as primary care disciplines as our demographics demonstrate an aging cohort of doctors even while the demand for medical care increases. (See previous article in this issue of the Medical Record). It will thus be important to entice young physicians with local ties to return to Berks County. However we will still need to recruit the bulk of our new physicians from those with little or no ties to the area. How difficult a task is this? According to Robert Carper, Director of Staff Recruitment for The Reading Hospital, it is increasingly difficult to recruit new physicians due primarily to the competition that exists for primary care physicians and many specialists. In addition the negative publicity surrounding Reading’s poverty and crime statistics compounds recruitment difficulties. However, according to Mr. Carper, if one is able to attract a candidate for an interview, they are often impressed by both the level of care as well as the quality of life (especially for families with children) in this community.

An excellent source of physician recruitment is of course the residency training programs at St. Joseph’s Hospital (Family Medicine) and the Reading Hospital (Family Medicine, Internal Medicine including Cardiology fellows and Obstetrics and Gynecology).

Both institutions have been successful at retaining their residents after graduation.

Dr. Pamela Taffera, Assistant Program Director of the St. Joseph FM Residency, who herself was recruited from that residency, agrees that recruitment into the residency program as well as retention of residents onto the medical staff is always a challenge. However the strong support of the St. Joseph administration and medical staff have created an atmosphere that enhances resident connections to the community and has contributed to their recruitment and retention success.

While Pam is optimistic about the future of health care, she is concerned that her primary care graduates are facing profound problems from high debt load to insufficient reimbursement and

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lower salaries compared to other physician specialties.

Dr. Lee Radosh, Director of the Reading Hospital Family Medicine Residency program, came to Berks County as a junior faculty soon after completing his residency in Lancaster County. He agrees with others that the greatest recruitment challenge is to get applicants here and once they see the quality of our institutions and the amenities of life in Berks County they are often “sold” on our program. Lee is particularly encouraged by the increased opportunities for residents to practice in Berks County and by efforts to develop an integrated health system here that can contend well with whatever competition and challenges face our medical community. Lee is a strong advocate with expertise in the Patient Centered Medical Home concept for improving the coordination and quality of primary care services to patients.

In conclusion, it is clear that medical practice is changing rapidly in Berks County, presenting great challenges as well as opportunities for improving the quality and efficiencies of care while offering lifestyle benefits to our physicians. And yet we face the challenges that rapid change and the uncertain effects of this change will bring to bear on the new health care environment (e.g. Accountable Care Organizations, bundled payments, pay for performance, etc.). At this time when we all hope for stability and clarity for our practices and our lives, a consistent message from the physicians interviewed was that Berks County is a good place to be - a place where the culture continues to respect physicians, where quality is emphasized, and innovation (although perhaps initially behind other areas) is advancing; as well as a great place to live and raise a family. We all face these challenges and if ever there was a time for physicians to join together to promote our common principles and unified goals that time is now. Perhaps it is not surprising that several of these local physicians challenged the Medical Society to rise to the occasion and to take the lead in moving us forward for the future of our profession and the enhancement of health care for our patients and our community.

Dr. Lucy J. Cairns is an ophthalmologist with Campanella & Pearah Eyecare Associates and is Editor of The Medical Record.

Dr. D. Michael Baxter is Chair of the Department of Family and Community Medicine, The Reading Hospital and Medical Center.

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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

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y the time the PAMED House of Delegates meets in late October, the General Assembly will likely have wrapped up legislative activity for the 2011-2012 session. Although three weeks of session remain as this report is being written in July, little of controversy is expected to be considered when legislators return to Harrisburg briefly in late September and early October, as members will be focused on their reelection campaigns and the upcoming November general election. And, as the Senate leaders have already declared that there will be no “lame duck” session after the election, it is clear that anything meaningful, or at least controversial, was probably done before the summer recess.

Governor Corbett’s top priorities for his first term – tort reform, sale of the state liquor stores, and an on-time, no-taxincrease state budget – have met with mixed results. Corbett’s number one tort reform priority, reform of joint and several liability, was passed, and the House passed PAMED’s apology legislation. Unfortunately the Senate showed little interest in further tort reform, so progress on that issue going forward remains slow. Sale of the liquor stores still looks like a long shot, as does repeal of the state’s prevailing wage law. However, the 2011-2012 budget was completed on schedule, as was the 2012-2013 edition. Although the latest budget contains further spending cuts, legislative leaders restored many of Governor Corbett’s proposed reductions, particularly in the areas of education and health care. More on that below.

Following is a status report on key legislative and regulatory activities in Harrisburg.

2012-2013 State Budget During the late hours of Saturday night, June 30, 2012, Governor Corbett signed the $27.656 billion 2012-13 state 14 | MEDICAL RECORD

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budget. The budget contains no tax increases and is below the spending plan of the 2008-09 budget. This budget represents a $370 million increase over the 2011-12 budget and is approximately $500 million more than the Governor proposed in back in February.

Among beneficiaries of the higher spending level were Penn State, the University of Pittsburgh, Temple, and Lincoln, as well as state-related academic medical centers, back to 2011-12 levels.

The legislature also rejected the Governor’s proposed cuts and maintained funding at 2011-12 payment levels for trauma centers, burn centers, and obstetric/neonatal services. Funding for critical access hospitals increased by $500,000 above the 2010-11 payment level. Funding was also restored from the Governor’s proposed elimination to regional poison control centers, epilepsy support, bio-technology research, Tourette syndrome, and ALS programs.

The legislature also rejected Gov. Corbett’s proposed cut in Medical Assistance (MA) rates paid to hospitals, adding $12.5 million in state funds to restore the funding eliminated by Gov. Corbett. The rate restoration was offset by a reduction

With nearly a year remaining in the 2011-2012 session, PAMED and its allies are continuing their push to enact comprehensive liability reform. in hospital reimbursements, resulting in a net loss in hospital payments. The Governor’s proposal transferred some or all of the line items to the Human Services Development Fund as a block grant program for counties with a 20 percent cut. This was lessened to a 10 percent cut with the block grant being done as a pilot project. State funding also shifted from MA-Inpatient and MA-Outpatient to MA-Capitation in the final budget agreement due to the expansion of moving enrollees from fee-for-service to managed care.

Lastly, the General Assembly rejected the Governor’s proposed plan to merge the Pennsylvania Health Care Cost Containment Council (PHC4) and the Patient Safety Authority (PSA) into the Department of Health. They will continue to remain as independent entities.

Tort Reform The House has made good on its promise to enact broadbased tort reform in the 2012-2013 session. The Republicancontrolled chamber passed House Bill 495, PAMED’s apology legislation (171-27), and House Bill 1, the long-sought reform of joint and several liability (112-88). The House also passed House Bill 1907 (103-89), which would extend the existing cap on punitive damages against physicians to nursing home liability

cases. Other proposals in the House queue included PAMEDrequested reform of the certificate of merit requirement, liability protection for ER care and uncompensated care, and a number of pro-business reforms already obtained by physicians in Act 13 of 2002.

As expected, the difficulty in enacting these reforms was in getting the Republican controlled Senate to act. All tort reform bills in the Senate, whether Senate bills or House bills already passed by the lower chamber, are referred to the Senate Judiciary Committee, which is chaired by tort reform opponent Sen. Stewart Greenleaf (R-Montgomery).

PAMED is part of a large tort reform coalition which is comprised of organizations involved in health care, business, local government, and others. The coalition has been actively engaged in a coordinated campaign to generate Senate action on these important initiatives. After a lengthy and aggressive push by the coalition Senator Greenleaf eventually released from his committee a watered down version of the joint and several liability bill, which the full Senate promptly amended to restore the stronger language. The House quickly ratified the Senate action, and shortly before the legislature recessed for the summer Governor Corbett signed the measure into law as Act 17 of 2011.

Although PAMED and its allies have continued their push to enact comprehensive liability reform, little additional success has been achieved. In April the fifty organization-plus coalition sent a joint letter to the Senate urging action on the apology bill, but without result.

Mcare Pursuant to Act 13 of 2002, in the spring of 2011 Insurance Commissioner Michael Consedine examined the financial health of the state’s primary liability insurance carriers to determine their capacity to begin selling physicians and hospitals $750,000 in coverage, rather than today’s coverage level of $500,000. On July 29, 2011, Commissioner Consedine ruled that the primary insurance limits would NOT be increased for the next two years. A positive finding would have caused the primary limits to rise to $750,000 next January, with a corresponding reduction in Mcare coverage from its current $500,000 level to $250,000. A negative finding would have kept primary and Mcare insurance at current levels for another two years, when the process would be repeated.

An increase in the primary limits would have resulted in a significant rise in out-of-pocket liability insurance costs for physicians unless accompanied by transition relief. As it did the last three times the Commissioner has examined the private market (2005, 2007 and 2009), PAMED notified the Commissioner that it supports the phase-out of the Mcare Fund, but only in a manner that does not impose the cost of retiring the Fund’s $1.3 billion unfunded liability on the state’s physicians.

The Commissioner’s next review of the private market’s capacity will occur next spring, and the Corbett administration

has sent strong signals that sufficient market capacity likely exists to justify an increase in the primary limits to $750,000. Because of the harsh impact this finding would have, PAMED and HAP are discussing possible alternative phase-out scenarios that would reduce the impact on physician insurance costs, perhaps by spreading the cost increases over a longer period.

In that regard HAP has proposed legislation to raise the primary limits by $100,000 to $600,000, using the current Mcare “surplus,” estimated at $130 million, to offset the increased out-of-pocket costs for providers. The HAP proposal would then freeze the limits at this new, higher level and use future surpluses to reduce the following year’s assessment. In the event that a single year surplus of $75 million or more is realized, the primary limits would be raised by another $100,000, with the large surplus again helping to offset increased out-of-pocket costs for physicians. PAMED is studying this proposal. The Insurance Department has retained Price Waterhouse to run numbers on what this proposal and other possible phase-out scenarios might look like, and Representative Glen Grell (R-Cumberland) is drafting legislation to move the proposal forward if stakeholders approve. PAMED is coordinating its examination of this issue with the Pennsylvania Orthopaedic Society and other stakeholders.

HIV Testing After a years-long effort, PAMED achieved a major legislative victory in June 2011 on the issue of HIV testing. Working in close conjunction with PAMED, Senator Ted Erickson (R-Delaware) early in 2011 reintroduced his legislation to facilitate HIV testing by making testing a routine part of general care per CDC recommendations. As drafted, Senate Bill 260 eliminated the requirement of obtaining written consent before testing, replacing it with documented consent. The bill also permitted “opt-out” testing, where the subject is informed that the subject will be tested unless he or she refuses.

Thanks to the relentless efforts of Senator Erickson and Senator Pat Vance (R-Cumberland), who chairs the Senate Public Health and Welfare Committee, along with strong lobbying from PAMED, a breakthrough was achieved on this important public health initiative. On April 27, 2011, the Senate approved the bill by a vote of 50-0, and sent it on to the House for consideration. After inserting an agreed-to amendment assuring face to face counseling after a positive test result, the House passed the bill by an overwhelming margin of 177-24.

The Senate concurred in the House amendment 50-0, and on July 7 Governor Corbett signed the bill into law as Act 59 of 2011. The new law went into effect on September 5, 2011.

Community Based Health Clinic Funding On May 3, 2011, the Senate passed Senate Bill 5, legislation Continued on page 17 MEDICAL RECORD

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establishing a framework for funding community based health care clinics. As funds are appropriated, they would be distributed to various types of clinics around the state pursuant to a somewhat complex formula. As passed by the Senate, the bill contains no funding for the program. Further, the state budgets for FY 2011-2012 and 2012-2013 do not contain funding for the program, and the Department of Health indicates that it does not have any funding available for the program either.

The House Health Committee has approved the bill, and it is still possible at this writing that the bill could make it to the governor’s desk this fall. However, without funding to support the proposed clinics, enactment of the legislation might have little practical effect.

Regulation of Abortion Clinics As a result of highly publicized problems at a Philadelphia abortion clinic, legislation has been enacted that will increase regulation and oversight of facilities that perform abortions.

House Bill 574, the House version of the legislation, was broader in scope than the original version of Senate Bill 732, the Senate initiative. House Bill 574 applied to any public or private hospital, clinic, center, medical school, medical training institution, physician’s office, infirmary or other institution which provides surgical services meant to terminate a pregnancy. As originally drafted, Senate Bill 732 would not have applied to facilities licensed under the Health Care Facilities Act, and would only apply to facilities where abortions are performed on an elective basis.

The original Senate bill contained a comprehensive list of new requirements for abortion facilities, including licensure, announced and unannounced inspections, complaint handling, serious event reporting and follow-up regulations. The House bill took a somewhat different route, requiring facilities that perform abortions to meet the same standards as ambulatory surgical facilities (ASFs). However, the difference between the bills was largely eliminated in June, when the Senate amended SB 732 to replace the original language with provisions similar to those in the House bill, requiring abortion facilities to meet ASF standards.

The bill ultimately cleared both chambers and was signed into law on December 22, 2011. While the new law requires abortion providers to meet ASF standards, it also establishes a process for affected providers to request an exception where they believe one is appropriate. The act became effective on June 19, 2012.

Student Athlete Concussions Increasing understanding of the dangers associated with concussions, particularly in young people, has led to efforts to enact legislation dealing with concussions in student athletes.

Senate Bill 200, now Act 101 of 2011, introduced by Senator Pat Browne (R-Lehigh, Northampton), will bring some much needed structure and consistency to how concussions

are handled in student athletes. Under the new law, the state Departments of Health and Education will prepare informational materials that will be distributed to all student athletes, along with their parents and coaches. Students will be required to sign and return a form acknowledging receipt of this information.

A student who, as determined by a game official, coach, certified athletic trainer, licensed physician, licensed physical therapist or other official designated by the student’s school, exhibits signs or symptoms of a concussion or traumatic brain injury while participating in an athletic activity must be removed by the coach from participation at that time. The coach will not be permitted to return a student to participation until the student is evaluated and cleared for return to participation in writing by an appropriate medical professional. The law will apply to all interscholastic athletics, club activities and cheerleading.

Senate Bill 200 passed the Senate 50-0 on June 22, 2011, cleared the House with amendments 199-0 on October 5, saw Senate approval of those amendments 50-0 on November 1, and was signed into law by Governor Corbett on November 9, 2011.

The law took effect on July 12, 2012.

Definition of Ophthalmic Surgery PAMED is strongly supporting legislation amending the Optometric Practice Act to add a definition of “ophthalmic surgery.” House Bill 838, introduced by Representative John Bear (R-Lancaster), is a patient safety measure designed to insure that only qualified physicians perform surgery on the eye. Optometrists may not perform “surgery” under existing law, but other than use of lasers and injections the term is not further defined. HB 838 adds important specificity by identifying processes and procedures that constitute ophthalmic surgery.

Under HB 838 ophthalmic surgery is defined as a treatment or procedure, diagnostic, palliative, therapeutic, rehabilitative, cosmetic or refractive, for conditions or disease processes involving the eye or ocular adnexa, utilizing lasers, cautery, ionizing or nonionizing radiation, scalpels, probes, needles or other instruments in which the human eye or ocular adnexa is cut, drained, penetrated, thermally altered, vaporized, frozen, sutured, probed, injected or otherwise altered by any mechanical, thermal, light-based, electromagnetic, radiofrequency, ultrasonic, chemical or pharmacologic means.

HB 838 passed the House 133-68 on June 22, 2011, and has been referred to the Senate Consumer Protection and Professional Licensure Committee. Unfortunately PAMED has been unable to secure Senate action on the legislation, and it may need to be reintroduced next year when the new session begins.

Prompt Credentialing On May 18, 2011, Representative Bryan Cutler Continued on page 19 MEDICAL RECORD

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(R-Lancaster) introduced House Bill 1551, PAMED’s prompt credentialing legislation. A similar bill, Senate Bill 1224, was introduced by Senator Gene Yaw (R-Lycoming) on October 18, 2011. These bills are intended to eliminate the unnecessary delays that frequently occur when physicians apply to be credentialed by various health insurers.

Under the bills, insurers would have to notify applicants of the status of their application for credentialing within five business days after receipt, including their intention to continue the process and an itemization of any missing items. Insurers would have 60 days to act on a completed application, and physicians would be eligible for reimbursement within 15 calendar days from the postmarked date on the application.

From that point until the credentialing process is complete, health insurers would reimburse physicians based on their fee schedule rates applicable to nonparticipating physicians. If the physician applicant is a member of a medical group practice currently contracted with the health insurer he or she will be reimbursed at the group’s contracted rate. A health insurer would be required to accept the CAQH’s Provider Credentialing Application when submitted by a physician for participation in the health insurer’s provider panel.

On November 30, 2011, the House Insurance Committee held a public hearing on the bill, at which PAMED testified.

PAMED is working aggressively to secure passage of this legislation, with support from the physician practices in our CEO Panel. The Panel then prepared a document that rebuts inaccurate hearing testimony provided by several insurers who oppose the bill. That document was sent to all committee members earlier this year. In addition to easing the burden on physicians, the legislation would also help ensure access to care for Pennsylvanians and reduce patients’ out-of-pocket expenses.

Regulation of Tanning Salons Senate Bill 349, which would regulate the state’s tanning facilities and set age limits for who can use them, was approved by the Senate on October 31, 2011, by a vote of 48-1. The bill subsequently cleared the House Health Committee on December 5, 2011, and is poised for final House passage.

SB 349, which PAMED supports, would prohibit children younger than 14 from using a tanning device without a letter from a physician. It would require parents to accompany all minors to the tanning facility for the initial visit and sign written permission forms every six months. The bill also would require tanning facilities to: • Have a license • Undergo inspections • Post signs warning of the hazards of ultraviolet rays • Have customers sign a warning statement • Report injuries to the state • Train operators of tanning beds While the previous version of the bill died in the House

during the last legislative session, it was reintroduced by Sen. Pat Browne (R-Lehigh, Northampton).

A tanning bill was also introduced in the House of Representatives by Rep. Rose Marie Swanger (R-Lebanon).

House Bill 369 takes a different approach than the Senate bill by prohibiting tanning salons from allowing use by minors, and making violations a crime. HB 369 is currently in the House Judiciary Committee.

Unfortunately, to date the House and Senate have been unable to reconcile differing views over the scope of the proposed legislation, and a bill may not make it to the governor’s desk before the end of the year. In any case, PAMED will continue to work to bring Pennsylvania into alignment with neighboring states like Maryland, Ohio, and New York, which have already regulated these facilities and established age restrictions.

Texting and Cell Phone Use While Driving Another PAMED-supported measure was enacted this session when the governor signed Senate Bill 314, now Act 98 of 2011, legislation designed to reduce the incidence of distracted driving due to cell phone use.

Introduced by Senator Robert M. Tomlinson (R-Bucks), Act 98 bans all texting, emailing and surfing the Internet while driving.

Violations are a primary offense, meaning that, unlike with seat belt use, a police officer may cite a violator even if the violator is not also committing some other primary offense like speeding, reckless driving, etc. Penalty-wise, violations will constitute a summary offense, with a fine of $50.

The new law became effective on March 8, 2012.

Fair Contracting Once again PAMED is seeking enactment of legislation to level the playing field between physicians and payers. In an effort to break the longstanding deadlock over fair contracting, Representative Nick Miccarelli (R-Delaware), has introduced House Bill 1763, legislation intended to closely track expired court settlements known as the Love settlements. The bill was referred to the House Insurance Committee.

HB 1763 addresses a long list of issues that have been problematic in physician/health insurer relations. Subjects dealt with in the bill include: • • • • • •

Written fee schedules Precertification Written notice of policy and procedure changes Disclosure of claims payment practices Dispute resolution All products clauses Continued on page 20 MEDICAL RECORD

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• • • • • • • •

Termination without cause Medical necessity Timelines for clean claims Automatic downcoding Gag clauses Most favored nation clauses Arbitration Overpayment recovery limitations

On November 29, 2011, the House Insurance Committee held a public hearing on the bill, which, as expected, generated considerable opposition from the Blues. Nevertheless, while resolving these issues has been a long and difficult road, PAMED is committed to persevere, and looks forward to working with Representative Miccarelli on this important legislation.

Deemed Status In an effort to jumpstart a long overdue update of Pennsylvania’s hospital regulations, the Hospital and Healthsystem Association of Pennsylvania (HAP) is attempting to bypass the lack of regulatory action via the legislative route.

House Bill 1570, introduced by Representative Doug Reichley (R-Lehigh), and referred to the House Health Committee, provides that facilities or specialized health care services accredited by a national accrediting organization approved by the Centers for Medicare and Medicaid Services (CMS) shall be deemed to meet state licensure requirements and shall be issued a license by the Department of Health (DOH). This would allow them to ignore inconsistent state licensing requirements.

PAMED is sympathetic to HAP’s desire to modernize the state hospital regulations, and indeed, supports such an endeavor. However, the blanket erasure of some significant state patient and physician protections through deemed status, is a major concern. Importantly, the bill would eliminate state regulations that ensure the protection of physician-led hospital medical staffs.

HAP and PAMED have worked to address those concerns, and that process has produced a DOH-endorsed agreement on all issues.

However, as of this writing the ultimate outcome of HB 1570 remains uncertain. Non-physician provider groups are attempting to use the bill as a vehicle to obtain an expansion of their hospital-based practice, and the bill’s fate has also become tied to an unrelated initiative that would give nurses input in establishing safe nurse staffing levels in hospitals.

Certificate of Birth Resulting in Stillbirth Resolution 07-401, introduced at the 2007 PAMED House of Delegates, called on the Society to advocate for and support Certificate of Birth Resulting in Stillbirth legislation. At the time 20 | MEDICAL RECORD

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Pennsylvania mandated a Fetal Death Certificate and burial or cremation, but did not recognize that there had been a birth in order to have a death certificate. Advocates of Certificate of Birth Resulting in Stillbirth legislation argued that failure to issue a certificate of birth fails to recognize that the mother and family went through the same process of pregnancy, labor, and delivery with only the outcome different. Twenty states have passed such legislation.

Resolution 07-401 was referred to the Board of Trustees for study, and the Board ultimately issued a report recommending that PAMED monitor the legislation, which was adopted at the 2008 House of Delegates.

That proposed legislation has now become law, as on July 7, 2011, Governor Corbett signed Senate Bill 326 into law as Act 62 of 2011. SB 326, introduced by Senator Jake Corman (R-Centre), is a straightforward measure that allows the parents of a stillborn child to request a Certificate of Birth Resulting in Stillbirth. The bill had broad support, passing the Senate 50-0, and the House 194-3. It became effective on September 5, 2011.

Controlled Substance Database (CSDB) On June 8, 2011, Representative Gene DiGirolomo (R-Bucks) introduced House Bill 1651, legislation intended to improve the Commonwealth’s ability to enable informed and responsible prescribing and dispensing of controlled substances and to reduce diversion and misuse of such drugs in an efficient and cost-effective manner that will not impede the appropriate medical utilization of licit controlled substances.

PAMED supports the creation of a CSDB, but had a number of concerns with the bill as drafted, including the lack of legal protection for physicians who opt not to use the database, and overly broad language permitting law enforcement personnel to surf the data looking for fraud.

PAMED worked with Rep. DiGirolomo and key stakeholders to address these concerns, and on December 6, 2011, a vastly improved version of the bill was approved by the House Human Services Committee. However, funding issues and internal House dynamics have thus far prevented further action on the bill. PAMED will continue its efforts in the next session.

s r a e 25y BCMS Salutes Bruce Weidman on his 25th Anniversary as Executive Director

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this summer marks the 25th year that Bruce Weidman has served as Executive Director of the Berks County Medical Society. When Bruce accepted the position in 1987 Dr. Jonathan Stolz, former Director of Radiology at Community General Hospital was President and Dr. Donovan Donly, a Family Physician was the Chair of the Executive Council. Bruce has served with 25 Presidents and 10 Executive Council Chairs.

Bruce is a native of the Hamburg area graduating from Sunbury High School and obtaining his Bachelor’s degree in secondary education from Bloomsburg State College. He subsequently earned a master’s degree in hospital administration from the University of Scranton. Prior to accepting his BCMS position, Bruce was the Director of Volunteer Resources at Allentown State Hospital.

Bruce’s wife Crystal is a retired English teacher and his son Matthew is Director of Widener University’s Exton Campus.

He takes great pride in his family and has a special twinkle in his eye when speaking about his 5 year old granddaughter, Samantha Kate, who started kindergarten this Fall.

Just as our members have experienced great change, Bruce has seen Berks County medicine evolve from a time when 95% of physicians were in private practice, when there was no such thing as managed care and when medical liability issues were not even discussed, to our current environment (see cover articles in this issue of the Medical Record). Through all of this, Bruce has worked with our physicians through the county and state Medical Societies

to address physician concerns and improve patient care. His proudest achievement has been “to work for bright people who really care about taking care of patients.” His remaining goals are to increase the funds in our Educational Trust in order to continue to fund “Health Talk,” Residents’ Research Day and the annual Memorial Lecture, Young Physician and other Recruitment events. He also is committed to BCMS initiatives to assure access to quality healthcare for all Berks County citizens.

Congratulations to Bruce and thank you for 25 years of very dedicated service to the physicians and patients of Berks County.

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

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he summer months go by faster than any other time of the year. The excitement of returning to school is just around the corner for my kids. As we started picking out school supplies and preparing to navigate the uncharted water of the next grade, I started thinking about the upcoming BCMSA events we, as alliance members, are looking forward to. Many exciting changes are in the works for this coming year. We are going to be revitalizing Doctor’s Grove, reaching out to resident’s spouses to become members, adding an additional new member’s coffee meeting later in the year and replacing direct email communication with a service such as Mail Chimp, which will provide us feedback as to who is receiving mail, opening the documents, etcetera, so we can improve the line of communication with our members.

Installation Luncheon: (left to right) Peggy Bundy, Carol Perlmutter, Diana Kliener, Deb Cordes, Judith Kraines, Jody Menon, Dee Dee Burke, Pam Charendoff, KalpaSolanki, Carrie Latman, Jill Haas, Lisa Banco, Lindsay Romeo, Amy Impellizzeri, Lisa Geyer, Emily Bundy and Kathy Rogers.

Installation Luncheon State Officer, Kathleen Hall of Dauphin County, installed the new officers at our annual Installation luncheon in May 2012. Another great group of ladies have stepped up to the plate to serve as our 2012-2013 Executive Board!I like to set quantifiable goals to work towards and, with this team I feel confident we can make considerable progress in accomplishing this year’s objectives.

Incoming President, Emily Bundy and Outgoing President, DeeDee Burke

2012-2013 Executive Board Officers: (left to right) Kara DeJohn, Lisa Geyer, Amy Impellizzeri, Kathy Rogers, Emily Bundy, Lisa Banco, Dee Dee Burke and Kalpa Solanki.

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Scholarships and Philanthropy The money raised by the Holiday Fundraiser contributes to worthy local organizations, helping to make the community a better place. Our Holiday Card fundraiser brought in over $12,000, which helped towards providing seven $1,000 medical education scholarships as well as $ 5,150 to be dispersed among this year’s philanthropic recipients. The organizations chosen this year to receive funds include Berks Talkline, Reach Out and Read, IMAble Foundation, Western Berks Free Medical Clinic, Aaron’s Acres,Breast Cancer Support Services, Children’s Dyslexia Center, Berks Women inCrisis Camp Peaceworks and Sexual Assault Nurses Education (SANE) Luncheon. Thank you to all who donated; be assured your donations are being put to good use within our community.

Goals As President, I look forward to working together with officers and members to accomplish the following goals in the coming year: • Increase membership by 5-10 new members • Actively pursue resident spouses to join our organization • See Doctor’s Grove revitalized, publicized and

organized for future expansion • Tree planting ceremony with newspaper coverage on

Doctor’s Day 2013 • Expand information available on our website • Increase Facebook following • Switch from using personal emails to an email service

such as Mail Chimp to improve communication and

receive feedback • Have Scholarship recipients and Philanthropy covered

in the Reading Eagle, Facebook, Medical Record and

website, to increase awareness of our organization Thank you for the opportunity to serve and to this great group of volunteers who take goals and turn them into realities.

I look forward to being your 83rd president!

Emily L. Bundy

Save the Date: Doctor’s Grove Tree Planting Ceremony Doctor’s Grove was established in the late 1970’s by the Berks County Medical Society Alliance. It was dedicated in 1981 on Doctor’s Day, to honor or remember Berks County Physicians and their families. Currently there are around 80 maple trees planted at the site. In recent years few trees have been planted, many people opting instead to purchase an engraved leaf on the brass “Tree of Life” plaque that is located in the Medical Society’s Office. We are researching the cost of having new trees planted and as well as the cost for an engraved leaf on the plaque.

The Doctor’s Grove committee is working in conjunction with the Parks and Recreation Department to plan a tree planting

Berks County Medical Society’s Schedule of Board and General Meetings for 2012-2013

September 14, 2012 - New Member Coffee Board Meeting 9:00 New Member Coffee 10:00 (kid friendly event) Host: Amy Impellizzeri October 9, 2012 - Fall Luncheon- 11:30 Host: Lisa Banco Topic: Kim Rivera- Girls on the Run October 2012 - PA Medical Society and Alliance Convention Hershey Lodge, Hershey PA November 8, 2012 - Fall General Meeting- 9:15 Host: Diana Kleiner Topic: ReadingPublicMuseum

December 12, 2012 - Holiday Brunch (snow date December 13, 2012) Board Meeting 9:00 Brunch 10:00 (kid friendly event) Host: Carole Lusch February 7, 2013 - Second New Member Coffee Board Meeting 9:00 New Members Coffee 10:00 (kid friendly event) Host: Gretchen Platt March 19, 2013 - Spring General Meeting- 9:15 Host: Dee Dee Burke Topic: Tara-Kennedy Klein- The Multi-Level Mom April 24, 2013 - Board Meeting Board Meeting 9:15 BCMS office April 2013- PA Medical Society and Alliance Confluence Harrisburg, PA April 2013- Health Project TBA May 8, 2012 - Installation Luncheon TBA

ceremony for Doctor’s Day onSaturday, March 30, 2013.

We are hoping to have the event covered in the Reading Eagle this year. The names of those being honored will be listed in the Medical Record, local newspaper, Parks and Recreation’s newsletter, and BCMSA Website. If you are interested in finding out more on how to honor or remember a physician by dedicating a tree or engraved leaf you may contact Sue Russo at mrusso1641@aol. com. More information will follow.

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Berks County Medical Society

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Summary of Benefits & Coverage (SBC) Requirements Deadline

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he Departments of Health and Human Services, Labor, and the Treasury have released the final regulations under the Health Care Reform law to implement the requirement that health plans and health insurers provide consumers with a Summary of Benefits & Coverage (SBC). The stated purpose of the SBC is to “accurately describe the benefits and coverage under the applicable plan or coverage,” which will purportedly allow participants to better compare plan terms and benefits.

All group health plans will have to distribute a brief standard summary of benefits and must use and distribute a uniform glossary containing definitions for common terms (e.g. copay, deductible, etc.).

This requirement will apply to both insured and selffunded health plans, regardless of grandfather status. The SBC requirement is effective on the first open enrollment period beginning on or after September 23, 2012. For participants that do not have an open enrollment process, the compliance deadline is the first day of the first plan year beginning on or after September 23, 2012.

In order to be compliant with this fast-approaching deadline, there are a number of items that must be considered now.

For questions or assistance, please feel free to contact Power Kunkle Benefits Consulting at 610-685-1790 and reference this article.

Jessica Dean, Employee Benefits Consultant

Check with your carrier to confirm that it will produce an SBC for your group’s plan.

Most carriers have stated that they will produce an SBC for both their insured and self-funded medical plans.

Check with your carrier to see if there will be an additional cost associated with the production of the SBC. Most carriers marketed in Berks County have stated that additional costs would not be charged.

Investigate how your carrier intends to deliver the completed SBCs and whether or not they intend to distribute the SBCs to the group participants.

Most carriers have stated they will either post SBCs to a website or deliver a PDF of the SBC to the broker of record or group via email.

For this year, most carriers will not distribute the SBC to participants.

The sole responsibility for distribution of SBCs lies with the group.

Does your group have an HRA or FSA that covers expenses beyond just dental and vision?

A separate SBC is required for a stand-alone HRA. SBCs must contain information regarding how an HRA or FSA affects the medical plan.

If your carrier is not the administrator of the group’s HRA or FSA, will the carrier either produce a separate SBC or allow modification of the medical SBC to include HRA or FSA information?

Most carriers have stated that they will not produce an SBC for which they are not the administrator. Therefore, groups must check with the appropriate HRA/FSA administrator to see if it will produce an SBC for the HRA/FSA in question.

If the group does not have an administrator, or if the administrator is not going to produce an SBC, it is the group’s responsibility to create and distribute an SBC relative to the HRA/FSA. This year, most carriers have stated that they will not produce SBCs in a format that will allow modification for HRA/FSA. If an existing SBC cannot be modified, then an entirely new SBC will have to be produced for an HRA or FSA. Don’t forget about the glossary.

The final SBC regulations also require the distribution of a standard glossary of terms that cannot be modified. While the carriers may produce an SBC, they are not likely to provide the group with the glossary for distribution.

The glossary found on www.dol.gov should be distributed with the SBC.

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EXCELLENCE HAS A HOME AT GRANITE POINT.

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

EDWARD J. ZOBIAN, MD, FACS Board-Certified Ophthalmologist and Surgeon President, Eye Consultants of Pennsylvania, PC

Adam J. Altman, MD Leslie P. Brodsky, OD Jennifer Cho, OD Michael Cusick, MD Gary L. Dietterick, OD Maria R. Downey, OD David S. Goldberg, MD Dawn Hornberger, OD Y. Katherine Hu, MD Layla Kamoun, MD Sheldon J. Kaplan, MD Lawrence E. Kenney, MD Edna Z. Mahmood, MD Barry C. Malloy, MD Michael A. Malstrom, MD Thomas L. Manzo, MD Martin F. Miller, OD Jonathan D. Primack, MD Mitchell M. Scheiman, OD Brendon J. Weaver, OD Denis Wenders, OD Elliot B. Werner, MD Edward J. Zobian, MD, FACS

Board-Certified. Experienced. Accessible.

With a genuine commitment to patient co-management.

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.

Comprehensive Ophthalmology and Optometry | Cataract Surgery and Premium IOLs | Diabetic Retinopathy | Low Vision | Macular Degeneration | Retinal – Vitreal Surgery | Glaucoma Eye Care | Corneal Transplants | Bladeless Custom LASIK | Laser Vision Correction | Pediatric Ophthalmology and Optometry | Contact Lenses | Cosmetic and Reconstructive Eyelid Surgery

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TM

www.EyeConsultantsOfPA.com Wyomissing | Pottsville | Pottstown | Blandon

New members medical society of pennsylvania

Berks County Medical Society’s

Zachary Ryan McLaughlin, DO David C. Brock, MD Category: Resident Category: Active St. Joseph Medical Center Patient First 145 N. 6th Street 2960 E. Market Street Reading PA 19605-9468 York, PA 17402 Ronald Brown Category: Administer The Reading Neck & Spine Center 1270 Broadcasting Road Wyomissing, PA 19610

Austine Yujei Mengnjo, MD Category: Active/2nd Year in Practice Reading Nephrology, Ltd. 301 S. 7th Ave. Ste 355 Reading PA 19605-9453 Leena Rachel Philip, DO Category: Resident St. Joseph Medical Center 145 N. 6th Street Reading PA 19605-9453

HEALTH TALK 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 website, BerksCMS.org, for more information.

Ryan Drayton Schreiter, DO Category: Resident St. Joseph Medical Center 145 N. 6th Street Reading PA 19605-9453

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

Leonard Celi Tuanquin, MD Category: Resident St. Joseph Medical Center Reading PA 19605-9453 Kristen Leigh Hess, DO Karen Wojton Category: Resident Category: Administrator St. Joseph Medical Center Berkshire Orthopaedic Associates 145 N. 6th Street 2201 Ridgewood Road, Ste 250 Reading PA 19605-9468 Wyomissing, PA 19610

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

Berks Community Health Center Receives Designation as Federally Qualified Health Care Center In April 2006 the Berks County Executive Council adopted a resolution stating: Every resident of Berks County should receive the patient centered health care they need in a timely manner and in the appropriate setting at an affordable cost with emphasis on patient and health system accountability.

The “Access To Care Committee” under the chairmanship of D. Michael Baxter, MD proceeded to evaluate the issues affecting health care in Berks County, resulting in a list of recommendations.

One of the Committee’s recommendations stated: Support the creation of a Federally Qualified Health Center (FQHC) which will provide primary care to the uninsured / underinsured.

Through the collaborative efforts of the BCMS, the Berks Community Foundation, United Way, our local hospitals and government leaders, the Berks Community Health Center opened on June 4, 2012 at 838 Penn Street in Reading, at the former site of the Reading Health Dispensary. BCHC is a new, independent, community driven primary care center, run by a non-profit board

comprised of community members and BCHC patients.

On June 20, 2012 the Berks Community Health Center received the coveted designation of a Federally Qualified Health Center with an annual grant of $650,000.

“Reading needs a comprehensive family health center that is accessible and affordable,” said Art Grim, Co-Chair of the BCHC board and Senior Judge, Berks County Court of Common Pleas.

“The opportunity for a higher level of reimbursement through the establishment of a FQHC means that even more patients will be able to receive high quality care without the financial burden to themselves or the community at large.

The Center hopes to see 16,000 patients year one and double that in year two. As BCHC grows it will offer additional services such as dental, mental health, Ob/Gyn and podiatry at its Penn Avenue location.

Congratulations to Dr. Baxter and the Access to Care Committee for their vision to improve health care in Berks County!

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FOUNDATION REPORT B y S usan L indt

A Report of the Foundation of the Pennsylvania Medical Society Berks County Family Physician Named PHP Medical Director

D

r. Cliff Lyons retired Jan 6. And that lasted just about one solid month. He’s likely to be more successful in his new job than he was at retiring.

Dr. Lyons has taken a new post as Physician’s Health Program’s medical director, a program of the Foundation of the Pennsylvania Medical Society, based in Harrisburg.

“It’s funny because I promised myself I wouldn’t work for at least six months after I retired...I made it a month, anyway,” said Dr. Lyons, a Hamburg-based family practice physician especially interested in preventative, complementary and addiction medicine.

Dr. Lyons is board certified in family medicine and received his In spring of 2013, Dr. Cliff Lyons will become medical degree from the medical director of the Physician’s Health Temple University Program; a program of the Foundation of the School of Medicine.

Pennsylvania Medical Society.

He completed his residency at Reading Hospital and Medical Center.

Dr. Lyons has been involved with PHP for 18 years in various capacities.

“I first got into recovery in 1994. I came into (PHP) voluntarily. When I first came around, I had really hit a low,” Dr. Lyons said. “I think back to when I first walked in that door and people were there for me and supported me from day one.

They made me feel like I would be OK.” Dr. Lyons was soon given a chance to give back to the program he credits for saving his life. First he became a PHP advisor in 1997.

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Just a few years later, former PHP Medical Director Dr. Thomas R. Hobbs tapped Dr. Lyons to be an assistant medical director working in the northeastern part of the state. Assistant medical directors were appointed to provide immediate professional contact for new referrals in their geographical regions.

“I was so honored when they asked me to be involved,” Dr. Lyons said. “To be able to give something back to the program really meant a lot to me. I felt like, ‘Wow, I can’t believe they’re asking me.’ What a gift.”

That was just the start of giving back.

A stint on PHP Committee followed until last year, when he took a turn as a trustee on the board of The Foundation of the Pennsylvania Medical Society, for which he served as liaison to PHP Committee. Dr. Lyons resigned that position to take the part-time staff position as medical director.

Over the years, Dr. Lyons also put a face to PHP’s mission by introducing it at medical schools and residency programs, and to hospital medical staffs.

Meanwhile, until 2008, he had been a long-term partner at Hamburg Family Practice Center and subsequently worked for Lehigh Valley Physician Group. Dr. Lyons also worked at Hamburg Center, a state facility in Berks County for individuals with severe mental retardation.

Dr. Lyons also served as medical director from 2005 to 2008 at Hamburg’s Genesis Healthcare/Laurel Center, a short and long-term care center, and at CHD Meridian/Carpenter Technology in Reading.

After doing all that, plus 25 years of being on call at Hamburg Center every other day and every other weekend, Dr. Lyons had convinced himself he was ready for a long break, even if it turned out to be brief.

Yes, that is a curiously giant cactus behind Dr. Lyons in his photo. Until late spring, he’s “wintering” in Arizona, where his parents reside. Dr. Lyons will telecommute via Skype, teleconference and remote access to the PHP’s database until he returns to Pennsylvania in May. On the seemingly rare occasion when Dr. Lyons isn’t working, he enjoys hiking, camping, music, reading and travel.

And he’s grateful for the chance to use the medical director position to provide maximum service for participants.

“My main goal is provide meaningful outreach to grow the program,” Dr. Lyons said. “PHP helped to save my life and certainly my license too. I want to make sure PHP is there to help the next physicians.”

The Foundation of the Pennsylvania Medical Society thanks Dr. Lyons for his service and his financial support of its programs.

To learn more about PHP or how you can support the good work of the program visit www.foundationpamedsoc.org.

Department of Family Medecine

WRIGLEYS

The Reading Hospital and Medical Center

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

September 7 – Friday’s Child Lecture Series September 14 – Physician Burnout Lecture Teaching Generation Y (Faculty Development Session) Jodie Eckleberry-Hunt, PhD, ABPP, Associate Director of Behavioral Medicine, Beaumont Health system Family Medicine Residency Program, Associate Professor, Department of Family Medicine, Oakland University William Beaumont School of Medicine

Federico Ceppa, MD, Weight Management Center, The Reading Hospital and Medical Center October 5 – Friday’s Child Lecture Series - A Day in Pediatrics October 12 – Balance Problems and Vertigo in the Elderly Paul Brockman, MD, Lori Koch, PT, The Reading Hospital for PostAcute Rehabilitation

September 21 – No conference due to Stroke Quintessentials 2012

October 19 – Evaluating Cardiac Risks: To Test or Not To Test Andrew Waxler, MD, Berks Cardiologists, The Reading Hospital and Medical Center

September 28 – Treatment Options for Obesity

October 26 – No Conference (Residency In-training Exam)

Together we’ve RAISED service to a whole new level • Printing • Document Scanning • Office Supplies • Furniture • Promotional Products/Apparel

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Call today if you have questions about a potential project or to discuss current market conditions.

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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.

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A Higher Level of Care

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

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Berks County Medical Society’s

23rd Annual Fall Golf Outing Thursday, October 11, 2012

NEW LOCATION

We stand by our personal approach We stand by our to investing. personal approach to investing.

At Connors, we’ve been focused on our community—its people, businesses and culture—for more than years. on As our our At Connors, we’ve been40 focused legacy continues, so does our team’s community—its people, businesses and commitmentmore to providing clientsAswith culture—for than 40 years. our alegacy personal, disciplined and consistent continues, so does our team’s approach commitmenttotolong-term providinginvesting. clients with a personal, disciplined and consistent If you’re looking for a one-to-one approach to long-term investing. relationship backed by a unique combination of knowledge, experience If you’re looking for a one-to-one and resources,backed you’ll appreciate the relationship by a unique Connors approach. combination of knowledge, experience and resources, you’ll appreciate the Connors approach.

LedgeRock Golf Club 11:00 am -1:00 am Luncheon 1:00 pm Shotgun Start

Four-person scramble format. Hors d’ourves & cocktails following Tournament is limited to 144 golfers so don’t be left out!! $150 per golfer. Cost includes lunch, green fees, cart, scoring, prizes and refreshments following golf.

Registration and Payment Deadline is October 8, 2012.

Contact Betsy Ostermiller: 610-375-6555, or email bostermiller@berkscms.org for more information.

Contact Name:_________________________________ Address_______________________________________ City___________________State______Zip__________ Phone________________________________________ Email________________________________________ Other golfers you would like to play with: Name________________________________________ Name________________________________________

Registered Investment Advisor 1210 Broadcasting Road, Suite 200 Wyomissing, Pennsylvania 19610 Registered• Investment Advisor 610-376-7418 www.connorsinvestor.com 1210 Broadcasting Road, Suite 200 Wyomissing, Pennsylvania 19610 610-376-7418 • www.connorsinvestor.com

Make checks payable to Berks County Medical Society and mail to:

BCMS 1170 Berkshire Blvd., Wyomissing, PA 19610

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pearl from the past

Cocaine Intoxication And Its Dangers By Dr. A.B. Dondor

N

eed a tooth pulled? Afraid of the pain? Not looking forward to slurring your words and dribbling long after you’ve left the office? Back in 1898, dentists had a painless method for extracting teeth. Apparently all one needed was a shot of Cocaine!

In his paper read before the Society in 1898, Dr. A.B. Dondor relates two different cases where cocaine was used to relieve the pain of tooth extraction. What follows is a summary of the article. {Read before the Society, March 8, 1898...} The first case was a Mr. S______, 58, 300 lbs., and suffering with “dilation of the heart, who whenever exposed to some excitement or bodily exertion, always became affected with dyspnoea...and a number of attacks of angina pectoris.”

Dr._________ injected cocaine into the gum in preparation to extract a tooth. The patient became almost unconscious and thought he was fainting or dying. The dentist gave him whiskey and worked with him until “he rallied sufficiently to send him home in a carriage.” Dr. Dondor was then sent for and “I found him in very bad condition: Weak pulse and irregular, respiration difficult, and color a livid palor. He was despondent. I prescribed nitro-glycerine and sulphate of strychnia, and he promptly was relieved of the above symptoms”.

“On Jan. 22, 1898 at 10:00 PM, while I was sitting in my office, there was a great commotion and ringing of the bell.”

Three ladies rushed in insisting that one, their aunt, needed something to quiet her nerves. “I would have said that the young lady was drunk.” We finally got her seated, and the others said that she had just had a tooth extracted and cocaine had been injected into her gum. The dentist took her to her home and prescribed whiskey to set her right. Her color was livid, face puffed, blood-shot eyes, asthmatic breathing, eyes dilated, chest pains, high exhilaration, and unable to remember anything at the dentist’s office. I gave her nitro-glycerine and sulfate of strychinia.

In one hour she was normal and rational.

Both cases happened at the same dentist. The first man had a very bad heart, and the second person, a young lady, was in perfect health. “In large doses, cocaine effects include depression, physical problems, mental and moral activities 32 | MEDICAL RECORD

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decline, weariness, general wretchedness and dependency. It is now being used in such diseases as epilepsy, whooping cough, asthma, chorea, paralysis agitans, alcoholism, senile tremors, and even a weak heart and angina.

“It becomes a dangerous agent in the hands of incompetent persons,...not familiar with...toxic action or how to employ antidotal remedies.”

In summary, “...a man who sees no danger in cocaine is not up to the times in his education.”

Remarks: Dr. Weidman.

“Did either of the two patients suffer from the sensation of

worms or insects crawling under the skin?”

Dr. Keiser. “in eye surgery it is the ideal anesthetic...used four grains to the ounce. With the introduction of cocaine has come the reckless use of it. A young man of one of the best families in this city called upon me on three different occasions and begged me to give him a hypodermic injection of cocaine...I absolutely declined.

Dr. Bertolet, (John M.).

“I think the downfall of many persons addicted to the use of these narcotics can be directly attributed to physicians.

Cocaine continues to plague society today in 2012, one hundred and fourteen years later.

Everything I touch turns to SOLD!

W

hether you’re thinking of selling or buying, it can pay to work with Lisa Tiger. She knows our communities, knows values, knows how to network, and knows how to market. Her clients’ success is her success, and she is committed to it.

These skills, dedication and 17+ years of experience make Lisa a stand-out, award-winning performer who has sold many of the area’s most prestigious properties. She is currently the #1 Century 21 agent in Berks County and has won the national centurion award four times 2005, 2006, 2010 and remarkably in 2011.

When it’s time to buy or sell, having a TIGER on your team will make all the difference.

Lisa Tiger LisaTigerHomes.com 610.779.2500 | 610.207.6186

MEMBERS IN THE NEWS

Congratulations to Dr. Minassian on his educational achievements Dr. Minassian has been appointed as a Clinical Associate Professor of Ob/Gyn at Jefferson Medical College by their Board of Trustees. As Section Chief of Reproductive Endocrinology and Infertility at The Reading Hospital and Medical Center he directs the reproductive endocrinology education at Reading for third year students at Jefferson, as well as for Drexel and Penn State.

The 2012 APGO Teaching Award was presented to Dr. Minassian at The Reading Hospital and Medical Center’s recent Ob/Gyn Department Awards ceremonies in June. The APGO Award, presented by the Association of Professors of Obstetrics and Gynecology, is the most prestigious accolade in Ob/Gyn student education in the country. This is the second time Dr. Minassian has won this award. A nationally recognized medical student educator, he has been responsible for the placement of over 200 medical students into Ob/Gyn residencies, and ran one of the more successful medical student Ob/Gyn career placement programs in the U.S.

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What is Home Infusion Therapy?

O

ver 30 years ago, the only means to maintain infusion therapy for a patient was to remain in-hospital for the entire duration. Times have now changed. Our medical knowledge has expanded to emphasize safety and costcontainment strategies and implement new ways to administer intravenous (IV) medication. Many individuals requiring long term IV medication may be candidates for home infusion services, which will allow them to return to normal work activities, and prevent a financial burden on society. Though a well described safe, effective, and efficient approach, Medicare and other insurers have not fully come around to embrace this treatment modality.

In brief, home infusion services are reserved for patients requiring long term parenteral medication. Common diseases treated include infections, cancer treatment, pain management, dehydration, GI disease (Crohns, etc), rheumatoid arthritis, multiple sclerosis, and many others. Of course, an initial patient and home setting assessment is performed to ensure safety. The services involved in providing infusion therapy, as well as the pharmacy licensure requirements, make these suppliers distinguishable from typical durable medical equipment (DME) suppliers or typical pharmacies.

The economic benefits of home infusion services are vast.

From the insurance company perspective, the usual charge for a day of IV antibiotic treatment in a hospital is currently >30% than outpatient antibacterial therapy. The patient may or may not realize savings, but assuredly the ability to return to work or maintain an income is critical in supporting the family. Another obvious benefit is the reduction of nosocomial infections and related costs with home infusion services. A 2005 study in hospital infections in Pennsylvania showed the average charge for patients who developed an infection ($173,206) was nearly 4 times as high as for patients admitted with the same diagnosis and severity who did not contract an infection ($44,367).

Statewide 2 billion dollars in hospital charges were added that year. Pennsylvania is a prime example of where improvements can be made.

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Home infusion therapy has been covered by private insurers for decades as well as many state Medicaid programs, the Veteran’s Administration, etc. Medicare is the only major payor that does not cover all the essential components of home infusion therapy. Despite the fact that Centers of Medicare and Medicaid Services (CMS) has acknowledged that home infusion is a cost-effective therapy, it has unwisely excluded coverage for the services, supplies, and equipment integral to administering home therapy, essentially making home infusion therapy unavailable to enrollees. If CMS does not take action, these patients will be deferred to in hospital service thus skyrocketing costs to 30% over home treatment.

In a brief attempt, The Medicare Home Infusion Therapy Coverage Act of 2011, was introduced concurrently in the Senate (S.1203) and in the House (H.R. 2195) to try to close this gap. One of the bills co-sponsors, Senator John Kerry (Mass) said, “It’s wrong and stupid to drag senior citizens out of their homes for medical care when they can get safer, more cost-effective infusion therapy right at home.” Clearly we need a grass roots effort, especially in Pennsylvania, to support this legislation.

Furthermore, Dr. Thomas Slama, Infectious Disease Society of America president, notes that “Medicare beneficiaries who need antimicrobial infusion services often must be admitted to an extended-care facility, where they are less comfortable and more likely to be exposed to hospital-acquired infections that increase the likelihood of treatment failure and avoidable readmission. Not only is this unnecessary, inconvenient and difficult for the patient, but it also is costly to the Medicare program.”

In summary, Home Infusion Therapy helps promote improved care for individuals, improve population health, and lower per capita costs for healthcare – by reducing hospital stay, limiting complications, and decreasing cost.

Emma Singh, RPh, M.D. Healthcare Evolution Home Infusion Services References:

MM Pen g et al., “Adverse Outcomes from Hospital-Acquired Infection in Pennsylvania Cannot be Attributed to Increased Risk on Admission,” American Journal of Medical Quality 21.6 Supplement (2006): 17S-28S. Tretler, M. “Coverage of Home-Based Infusion Therapy Currently Denied Would Provide Immediate Financial Relief to Medicare Program.” NHIA. 2011. 16 Aug. 2012 <http://www.nhia.org/press_release/pr_061611.html> Paladino JA, Poretz D. Outpatient parenteral antimicrobial therapy today.

Clin Infect Dis. 2010 Sep 15;51 Suppl 2:S198-208. Review. PubMed PMID: 20731577

Reading Symphony oRcheStRa one hundRed yeaRS Fabio Bidini, Piano

50% off Liang Wang, Oboe

new SeASOn SubScriptiOnS

Christopher Collins Lee, Violin

As a thank you to all who work in the legal profession in Berks County.

Join RSO’s 100th Anniversary Season with wonderful classical music throughout 2012 & 2013. Enjoy composers such as Rachmaninov, Beethoven, Brahms, Mozart and many more!

Baltimore Choral Arts Society

Midori, Violin

William Wolfram, Piano

Each of the six classical concerts boasts an accomplished soloist, who are brought in from all over the world. Among the upcoming season’s performers are Midori— world-renowned violinist and Fabio Bidini—top-flight Italian pianist.

Concerts are on the following dates: Oct. 13, 2012 nov. 17, 2012 Feb. 23, 2013

Mar. 23, 2013 Apr. 20, 2013 May 11, 2013

All concerts are Sat., 8 PM in the Sovereign Performing Arts Center, 136 N. 6th St., Reading.

For more information, visit our website at www.ReadingSymphonyOrchestra.org.

Call 610-373-7557 to order your subscription.

Mention this ad to receive your discount.

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BENEFITS CONSULTING & H U MA 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 36 | MEDICAL RECORD

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P 610.685.1790  T 866.685.1790  F 610.685.1791 FALL 2012 pkbenefits.com