Medical Record Spring 2012

SPRING 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

Incoming President Dr. Bill Finneran’s Message......................... 8 Legislative and Regulatory Updates.........................................14 A Status Report on Meaningful Use.......................................... 22

What Happened to Haiti?

Kenbe la!........................18

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AA_Half_Vert_Ad_Color:Layout 1

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Medical Record

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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

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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

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.

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The Berks County Medical Record (ISSN #0736-7333) is published four times a year in February, May, August, and November by the Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices. POSTMASTER: Please send address changes to the Berks County Medical Record, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610.

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SPRING 2012

8

Presidents’s Message

14

Bill Finneran Takes His New Office

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

18

What Happened to Haiti? Kenbe la!

Dr. Pamela Taffera Helps in Haiti

30

Comments from Outgoing President

22

Notes From the Field A Status Report on Meaningful Use

Dr. Jerry Marcus

Departments: Editor’s Comments ............................................................................................................................................................... 6 Alliance Updates................................................................................................................................................................. 10 Calendar of Events.............................................................................................................................................................. 11 Foundation Report.............................................................................................................................................................. 12 Members in the News......................................................................................................................................................... 24 In Memoriam ..................................................................................................................................................................... 26 New Members.................................................................................................................................................................... 27 MEDICAL RECORD

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EDITOR’S COMMENTS

Lucy J. Cairns, MD, Editor

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he Medical Record has a new editor and a new look, so introductions are in order. Twenty years have passed since I began practicing ophthalmology in Berks County, so my name is familiar to many in the Berks medical community. Less well known is the fact that I have been a member of the BCMS Executive Council for most of those years. I will always be grateful to Dr. Don Loder for inviting me to my first Council meeting. The experience was quite a

Record be placed in members’ waiting rooms. After considering the importance of this proposal with regard to covering publication costs, and the benefits to the Society of increased public awareness of our activities, the Society agreed to this change.

As the years have passed, my initial impression of the BCMS as an effective, well-run organization has only been strengthened.

It serves important functions, professional and personal, in ways no

Berks County physicians are a talented, diverse group with an amazing range of interests and accomplishments beyond the practice of medicine. surprise – of the good kind! Never in my life had I been to a meeting run so efficiently. It started and ended on time, with every item on the rather lengthy agenda given its due. In one brief hour I learned much about the goals of the society, the activities which support those goals, and the operating style of the Executive Council. This was clearly a group of people with a sharp focus on their mission and the ability to move forward. I was inspired to contribute what I could, so despite the competing demands of work and the pull of family life, I have made time to continue being an active member of the BCMS ever since.

The Medical Record is a communication tool in support of the BCMS mission. In recent years, as the role of digital communication tools has expanded, we have periodically reexamined the utility and cost-effectiveness of continuing to produce a paper-and-ink magazine. So far, feedback from members has indicated a preference for continuing the magazine in its present form. Unfortunately, advertising revenue has not come close to covering publication and distribution costs, so the Medical Record has been represented by a large negative number on our financial balance sheet. Beginning with this edition, our costs will decrease dramatically while the quality of the publication will improve under the terms of our contract with the Niemczyk Hoffmann Group.

The benefits of this new arrangement include access to professional writers and photography, and professional marketing to potential advertisers. The editorial board retains the right to reject any advertisements or other content deemed contrary to the mission of the BCMS. To make the publication more attractive to advertisers, Niemczyk Hoffmann Group proposed that copies of the Medical 6 | MEDICAL RECORD

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other organization does. When issues affecting medical practice are in the news, local media outlets turn to our officers for the physician perspective. Members who want to tackle problems facing the local physician and patient communities will find like-minded colleagues and organizational support in the Society. In concert with PAMED members across Pennsylvania, Berks County physicians have maintained an articulate, respected presence in Harrisburg. This

We all need to regularly take a step back from the daily routine to renew our enthusiasm. has been absolutely crucial in achieving improvements in the liability climate, patient safety initiatives, and regulation of the insurance industry.

While “promoting and protecting the art and science of the practice of medicine” has always been a top priority for the Society, in my view promoting personal connections among members is equally important. Berks County physicians are a talented, diverse group with an amazing range of interests and accomplishments

Insuran isataGallen prou at Gallen Insurance sponsor Insurance I is a proud beyond the practice of medicine. We all need to regularly take a step back from the daily routine, which too often makes me feel as though I am furiously treading water while juggling raw eggs and trying to sing the national anthem! Aside from the sheer fun of participating in events such as the Fall Outing, Young Physician Social, and Night of the Arts, enjoying the fellowship of a community of people who face the same challenges goes a long way towards renewing one’s enthusiasm for finding ways to surmount those challenges. I invite all members to use the Medical Record not just to keep informed about Society activities and events, but to reach out to each other by submitting articles. I urge you to share your reflections on life in and out of medicine, your opinions on subjects affecting physicians and patients, and advances in your clinical field. This is your magazine. 

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PRESIDENT’S MESSAGE B Y S U S A N S H E L LY

Dr. William C. Finneran, III Sets Goals as 2012 President of Berks County Medical Society

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Dr. William Finneran, III is sworn in as the Medical Society’s 164th President

Dr. Ray Truex, Master of Ceremonies

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he Berks County Medical Society must be prepared to keep up with the changing face of health care in order to represent all its members, said Dr. William C. Finneran, III, who was installed recently as the 164th president of the Berks County Medical Society.

“We want to make sure that we’re relevant to the members we have, and that we’re serving as a resource for younger doctors who are just coming into the field,” said Finneran, a cardiologist with Cardiology Associates of West Reading.

One of his primary roles as president, he said, will be to recruit new members to the Medical Society, while continuing to provide support for current members.

Finneran said the medical society needs to work to increase enrollment among a doctor population that is shifting from private practice to employee physicians.

“It may be that some doctors don’t feel the need to belong anymore because they no longer are maintaining a private practice,” Finneran said. “We have to be sure that we’re adapting to the needs of our members, and that we continue to attract new doctors who will be practicing medicine in a different sort of way.”

Finneran said he will concentrate on getting doctors just starting their careers and those who are transferring their careers into the area to join the county medical society.

“We can’t achieve our mission if doctors don’t join the medical society,” he said.

Other important roles and goals of the medical society include: • Making sure that uninsured members of the community receive the care they need. While the challenge of providing health care for uninsured patients is a national issue, the high level of poverty in Berks County makes it particularly daunting here.

Providing adequate care for the uninsured and underinsured will require resourcefulness and the ability to work together, Finneran said.

• Assuring that the high standards of physicians are upheld as other health care providers assume greater roles in patient care. As nurse practitioners, nurses and other non-physician providers become increasingly involved in direct patient care, the medical society must serve as a watch dog to assure the highest standards are upheld.

• Attracting new physicians to practice in Berks County. There

Left to right, seated: Pamela Q. Taffera, DO, MBA, President-Elect; William C. Finneran III, MD–President; Raymond C. Truex, Jr. MD–Chair, Executive Council. Left to right, standing: Jerome I. Marcus, MD– Immediate Past President; Christie L. Ganas, MD–Secretary; Kristen Sandel, MD–Treasurer

“ We want to make sure that we’re relevant to the members we have, and that we’re serving as a resource for younger doctors who are just coming into the field.” is a nationwide shortage of physicians in some areas, Finneran said, and that trend applies to Berks County. However, with two excellent hospitals and a desirable location, the county is better off than many areas of the country. Still, the medical society must remain mindful of the importance of attracting new doctors.

• Working cooperatively with the hospitals that employee many of the county’s physicians to increase membership in the county medical society. Finneran said he may suggest automatic enrollment in the medical society as part of a physician’s contract with a hospital. Hospitals and doctors share many of the same interests, he said, and it is to the benefit of both to have an active and involved medical society. 

About Dr. William C. Finneran, III

Specialty: Cardiology Medical School: Georgetown University School of Medicine Residency: National Naval Medical Center, Bethesda, Maryland Fellowship: Cardiology, Naval Medical Center, San Diego Board Certifications: Internal Medicine Cardiovascular Disease

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

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egative news often gets the headlines. An infamous one from last Fall was the New York Times article titled, “Reading, Pa., Knew It Was Poor. Now It Knows Just How Poor” which covered the factors that contributed to our city being named poorest in the nation. Despite negative news getting prominence, let’s not forget all the good that is going on in Berks County. We have been fortunate as Alliance members, to get to meet the leaders of many local organizations that are doing great things in the community, addressing problems, offering hope, resources, counseling and direction. A few from this past year include BerksTALKLINE, The Recovery Shop, Berks Women in Crisis, and IM ABLE Foundation. They are examples of inspiration and motivation, helping to write a new story for our town. These organizations have a “pay it forward” mentality that creates a positive chain reaction throughout the community. The money raised by the Holiday Fundraiser contributes back to these types of organizations, helping to make

the community a better place. Thank you for your generous support which makes this possible.

Holiday Brunch Thank you to Betsy Finneran for hosting the Annual Holiday Brunch and board meeting in December. We had a great turn out with over 30 people attending!

Holiday Card Fundraiser Thank you for your generous donations to the Holiday Card fundraiser! Together we raised $12,410. Look for scholarship and community organization recipients of these funds in the June issue of the Medical Record.

Spring Meeting Our Spring Meeting will be held at Corp Fitness on March 14th at 11:00am. Our speaker is owner and founder of the IM ABLE foundation, Chris Kaag. Chris, a disabled United States Marine, created the IM ABLE foundation to promote active lifestyles for individuals with disabilities and to find physical fitness modalities to meet their needs. He will speak on leading an active lifestyle at any age and ability level. One of his mottos says it all- NO EXCUSES…JUST MOVE! For more information visit his website, www.getupandmove.org .

We will be collecting donations for the Military Order of the Purple Heart Service Foundation, which provides a variety of disabled veteran services, programs and resources to help combat wounded and disabled veterans and their families.

Left to Right: Neha Majmudar, Dee Dee Burke, Lisa Geyer, Kalpa Solanki, Kelly O’Shea, Emily Bundy, Lisa Banco, Kristin Feightner, Shraddha Shah, Teresa Wexler, Jill Haas, Lindsay Romeo, Sara Tuanquin, Elizabeth Kann, Diana Kleiner, Kara DeJohn, Jody Menon, Becky Cunningham, Carrie Latman, Erin Dougherty, Carol Perlmutter, Betsy Finneran (present but not pictured: Gretchen Platt, Kathy Rogers, Marisa LaLuna).

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Annual Health Project This year’s Health in Balance lecture series, Managing DIABETES in the School Setting, will be held Tuesday, April 17, 2012 from 8:00am-2:30pm at Glad Tidings Church in West Lawn, PA. Program registration information will be available in February. For more information, please contact Kalpa Solanki at healthproject@berkscmsa.org or visit our website at www.berkscmsa.org.

Health Project Panel of Speakers: Dr. Arti Patel, MD, CNSP, Staff Endocrinologist, Reading Hospital and Medical Center Ralph Cincinnati, MSN, CRNP, Diabetes Specialist, Berks Endocrinology Gary Scheiner, MS, CDE, Owner/Clinical Director Integrated Diabetes Services

Music of the 60s, 70s and 80s

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Membership We are always looking for new members and ideas to keep the organization thriving. Interested in joining or coming to a meeting? Contact Amy Impellizzeri at aimpell@gmail.com. 

SPRING CALENDAR Thursday, March 15 7am

BCMS Quarterly Coffee Break 5th Ave Conference Center Rm 14

Monday, March 19

noon

Retired Physicians Luncheon

Friday, March 30

7am

Administrative Committee

Saturday, March 31 7pm

Dancin’with the Stars- Reading Planetarium

Thursday, April 5 7:30am

BVNA Healthcare Champion Breakfast

Thursday, April 5

6:30 pm

Executive Council Meeting

Friday, April 13

8 am-2 pm Memorial Lecture/Resident’s Day

Tuesday, April 17

8:00 am

Alliance Health Project

Friday, April 27

7 am

Administrative Committee

Thursday, May 3

6:30 pm

Executive Council Meeting

Friday, May 18

7 am

Legislative Breakfast

Friday, May 25

7 am

Administrative Committee

Thursday, June 7

6:30 pm Executive Council Meeting

Reading Museum Planetarium 500 Museum Road • Reading

Saturday March 31, 2012 7pm-10pm Cocktails & hor d’ouevres Star Show Dress: Spiffy Casual

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FOUNDATION REPORT B y S usan L indt

A Report of the Foundation of the Pennsylvania Medical Society

Ray Truex, Jr., MD and Virginia Henning, Executive Director of the Foundation of the Pennsylvania Medical Society

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he email contained the sort of candid opinions offered in private discussion among like minds from the same team. It was never meant to be seen by others.

But with a single misguided keystroke, the details of the confidential conversation about a controversial matter were distributed to every player on both teams. It was, in a word, awkward.

And in fact, Virginia Henning, well-rooted as executive director of The Foundation of the Pennsylvania Medical Society, recognized her blunder at once. She quickly offered her resignation to the nonprofit charitable organization’s Board of Trustees.

Dr. Raymond Truex was one of those trustees and he still remembers the fallout.

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“Turned out, sending that email the way she did was the best thing she could have done,” he said. “Political correctness was out the window and that’s exactly what had to happen to get things done.”

Virginia’s uncanny ability to turn even a rare faux pas into elegant political mastery is one of the traits Dr. Truex will miss when she retires from her executive director post this spring after nearly nine years on the job.

“That email was the only mistake I ever saw her make, but it turned out to be the best thing that could have happened,” Dr. Truex said.

As the philanthropic arm of The Pennsylvania Medical Society, the Foundation was established in 1954 and charged with managing and awarding medical student scholarships and low-interest loans. The Foundation operates the Physicians’ Health Programs (PHP) to help doctors impaired by addiction, and physical or mental disabilities. The Foundation also offers programs to enhance physician education and clinical skills.

Virginia Henning was a natural fit for the executive director’s role when she stepped up to it after nine years as the Foundation’s finance director. Dr. Truex felt an immediate connection when he was a new trustee just introduced to her.

“Ever since I first met Virginia, I bonded with her,” said Dr. Truex, chairman of Berks County Medical Society Executive Council. “I knew I could work well with her. I admire her intelligence. Beyond that, she’s an elegant woman and has great sensitivity toward other people.”

And as with any organization, there were rough waters ahead, although neither of them necessarily knew it at the time.

“She’s the reason I took the job as chairman of the (Foundation) board of trustees,” Dr. Truex said of Henning, a Maine native who lived in Savannah, Ga., before settling in central Pennsylvania. “As chairman, I would have been lost without her. We’ve had some tough times.”

The first sign of real trouble was the 2008 economic crush, when Foundation contributions abruptly halted. Then

“ I carry with me the belief that giving back is an essential part of medical professionalism,” she said. “I will remain a lifelong contributor to the Foundation’s effort to sustain the future of medicine in Pennsylvania.”

Instant message her. “ I knew I could work well with her. I admire her intelligence.

Beyond that, she’s an elegant woman and has great sensitivity toward other people.” investments nosedived. Henning, having earned her bachelor’s in chemistry before becoming a CPA, certainly had the wits to deal with the numbers. But during those lean days, Dr. Truex also saw her massage morale and keep things afloat as leader of a lost ship.

“We lost 30 percent of our investments,” Dr. Truex said. “But Virginia saw how to institute economies. And at the same time, she instinctively knew how to preserve morale of people in the Foundation. She really came through.”

Dr. Truex also forecast trouble last year with the departure of Gregory Gable, a founder of the Foundation’s longstanding Physicians’ Health Programs. In the midst of that transition, Virginia worked from home as she faced down a life-threatening medical crisis.

“It was a difficult time,” Dr. Truex said. “Greg stepped down.

Virginia got sick. But somehow she managed to keep things running from home.”

As Foundation trustees interview candidates for the executive director job, Dr. Truex is optimistic for new leadership, but will miss Virginia’s style.

“I look at the candidates and think, ‘Can this person be Virginia Henning?’” Dr. Truex said. “But I know they’re not going to be Virginia.”

For her part, Virginia said she takes from the Foundation the very message she tried so hard to instill in others while on the job.

“I carry with me the belief that giving back is an essential part of medical professionalism,” she said. “I will remain a lifelong contributor to the Foundation’s effort to sustain the future of medicine in Pennsylvania.”

Virginia said she is ready for an early retirement to spend more time with her husband, Pete, and her grandchildren. And she plans to spend more time traveling – one of her loves.

“I wish Virginia good health and happiness in retirement,” Dr. Truex said. “I think she should do all those things she never had time to do.” 

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LEGISLATIVE AND REGULATORY UPDATES F r o m : J . S c o t C h ad w ic k , V ice P residen t , G o vern m en t al A ffairs ———————— A m y C . G reen , A ss o cia t e D irec t o r , G o vern m en t al A ffairs P enns y lvania Medical S o cie t y

Tort Reform The House made good on its promise to enact broad-based tort reform in 2011. The Republican-controlled 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). Other proposals in the House queue include 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.

These reforms has been in As expected, the difficulty in enacting getting the Republican controlled Senate to act.

All tort reform bills in the Senate, whether Senate bills or House bills already passed by that 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 is 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.

With nearly a year remaining in the 2011-2012 session, PAMED and its allies are continuing their push to enact comprehensive liability reform.

Mcare Pursuant to Act 13 of 2002, this spring 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.

Meanwhile, Senator John Rafferty (R-Montgomery) has expressed interest in advancing Senate Bill 811, his legislation to freeze the primary and Mcare limits at current levels for a

With nearly a year remaining in the 2011-2012 session, PAMED and its allies are continuing their push to enact comprehensive liability reform. number of years. PAMED has discussed the legislation with Senator Rafferty in some detail, and suggested improvements including a shorter freeze and a requirement that Mcare yearend surpluses be used to reduce the following year’s assessments.

HAP is also advocating legislation to raise the primary limits by $100,000 to $600,000, using the current Mcare “surplus,” estimated to exceed $140 million, to offset the increased out-ofpocket 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.

(Continued on page 16)

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Prompt Credentialing

Fair Contracting

On May 18, 2011, Representative Bryan Cutler (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. In addition to easing the burden on physicians, it would also help ensure access to care for Pennsylvanians and reduce patients’ out-of-pocket expenses.

Once again PAMED is seeking enactment of legislation to level the playing field between physicians and payers. In an effort to break the long-standing 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: 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.

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Act 110 ID Badge Regulations

• Written fee schedules • Precertification • Written notice of policy and procedure changes • Disclosure of claims payment practices • Dispute resolution • All products clauses • Termination without cause

• Medical necessity • Timelines for clean claims • Automatic downcoding • Gag clauses • Most favored nation clauses • Arbitration • Overpayment recovery limitations

Act 110 (House Bill 1482), which passed at the close of the 2009-2010 General Assembly Session, requires that health care practitioners in non-health care facilities wear photo identification badges clearly identifying their practice, i.e. “physician”, “nurse”, etc. PAMED supported passage of this legislation as a means for patients to avoid confusion in identifying the health care practitioner(s) providing them care.

You Didn’t Go to Med School to Perform Data Entry

PAMED is seeking enactment of legislation to level the playing field between physicians and payers.

On December 10, 2011, the interim regulation was published in the Pennsylvania Bulletin indicating that the regulation shall take effect immediately. The Department of Health implemented a 30-day comment period, which ended on January 9, 2012. The Society sent in comments indicating some concerns and suggestions to be taken into consideration before the drafting of the final regulation. One of the concerns that were expressed was that some of the key requirements for the identification badge including the size, location and ½ inch strip of the practitioner’s title, were not copied over from the statute into the interim regulation. To avoid confusion, all requirements for the badge should have been repeated.

We also recommended that the Department consider completing §53.4 of the regulation regarding the titles, as well as any other reserved section, along with the final regulation deadline to avoid going through an onerous regulatory process twice. Those individuals who are required to have an ID badge currently whose titles are not listed in the four pre-determined titles within the statute need guidance from the Department on what titles are to be used, especially those who are not licensed or certified but still work directly with patients.

The Society also suggested that the Department provide an example of what the badge should look like that would be deemed acceptable per the 2015 standards. This will allow physician practices to avoid the time and expense of creating two ID badges.

Since the implementation of the interim regulation, there has been some backlash from members indicating their lack of support and confusion regarding this new law. The Society is currently creating blogs and web articles to clear up any confusion and to assist physicians in developing the ID badges.

The Department of Health plans to work on the draft final regulation this spring. Final regulations are to be completed and adopted by July 22, 2012. 

Healthcare is changing and many are not happy with its current direction. EMR is forcing doctors to spend more time entering data on their laptops and less time on face-to-face patient conversation. Use of a hybrid dictation/EMR model works and provides more time for doctor/patient interaction. Here are the facts!

New Hospital EMR ModelAverages 4.5 minutes per visit for doctors to enter patient data on their laptops leading to…

• Less consultation time or longer appointment times • Fewer appointment times as fewer patients can be scheduled in a day • Erosion of doctor/patient relationship as doctor needs to concentrate on typing • Doctors’ frustration spending more time on EMR systems and less time on medicine Hybrid Dictation/EMR Model Averages 1.5 minutes per visit for doctors to dictate data on voice recorder providing intangible benefits…

• Doctors spend more time communicating with patients • Doctors see same number of patients as before EMR implementation • Doctors verbalize symptoms and treatments instead of trying to type or spell words • Prognosis may not be as simple as selecting pre-determined boxes on database • Referring physician’s notes can be more detailed in less time • Most physicans are already working with this similar process Upland Processing is at the forefront of this hybrid transcription/EMR model, delivering automation, expediting delivery and eliminating time-consuming processes. We believe high quality patient care means physicians should have a choice in focusing on their patients instead of their computer screens.

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What happened to Haiti?

Kenbe la!

Pamela Taffera, DO, MBA

A child’s mural depicting the earthquake of 2010, painted on the wall of the orphanage

Dr. Taffera and orphaned Haitian child

T

here is just something about Haitian spirit. It is inspiring and renewing—full of love and faith. In an already broken world of poverty and lack of basic human rights, Haitian life was devastated by the 7.0 magnitude earthquake on January 12, 2010, followed only 6 months later by the most devastating cholera outbreak this small country has ever seen. During the earthquake, we comforted children who had suffered multiple amputations and whose entire families had succumbed to the earthquake. One year later, one of those children died in my arms from complications of AIDS. Around us, people died in masses from preventable cholera.

This beautiful island nation of the Caribbean is still the poorest

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nation in the western hemisphere. It is a place where 10% of children are deceased before their 5th birthday. It is a place where HIV and tuberculosis run wild, but where children and young adults are more likely to die from simple pneumonia, diarrhea, malnutrition, or other preventable diseases. And it is a place where every morning, prayer and song prevail through the smoke and smog that is the fever of life in Port au Prince.

Everyday, the song a dignified death and burial is the most honorable celebration of life. May the day never come that I am comfortable carrying the bodies of dead children to a crematorium, even with the warmth of the sun beating on my shoulders.

Few have wondered what happened to Haiti since the devastation of January 12th, 2010. Instead, most have wondered what ever happened to the monies they donated to help the people of Haiti. Rumors have milled that monies donated never reached the people of Haiti-never rebuilt a homes for a families, never fed communities of starving people, never purchased antibiotics for the ailing, and never furnished schools for children‌ So what happened to the money that was donated to Haiti? Haiti also remains a world of corruption and politics. But more importantly, what happened to Haiti? Well, they never gave up. Kenbe la!

Dr. Taffera and other medical alumni from The University of Scranton spend time teaching a Haitian community basic primary care

In our recent return to St. Damien Children’s Hospital and the St. Luke Foundation of NPH Haiti (Nos Petits Freres et Souers, Our Little Brothers and Sisters), I was once again rejuvenated by the Haitian way of life. Leaving behind my world of academic medicine, administrative duties, emails, phone calls, wedding planning, and daily life, my tired soul was renewed by the perseverance, solidarity, and unshattered spirituality of a people who have seen the truest of Hell. Each morning we prayed over the deceased of the last 24 hours and sang louder than the hum of the crematorium. We spent our days not only delivering primary care, but teaching the community how to deliver health care. One afternoon, we taught the young men of a community how to measure blood pressure, blood glucose, and vital signs, how to suture simple lacerations, and start IVS, and what the basic stock of a pharmacy entails. And so began the community clinic of St. Marie in Cite Soleil (Sun City).

In the evenings (to avoid the violence and theft of gangs) we unloaded containers and truckloads of supplies in Francisville, a production center for supplies and essential foods. We joined the staff and friends of St. Luke in a weekly trip to the morgue to

Remnants of the destruction of the 2010 earthquake

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retrieve the unclaimed dead, stocked in piles of liquefied bodies in an unrefrigerated room. Each body was blessed and driven out to land by the sea for a dignified burial in a personal grave, all to the song of a brass band and Haitian chants. It was a true celebration of life. And I witnessed 3 aspiring college students in the moments that will define their life as physicians. They have not yet been to medical school, but their experience in Haiti transforms their path in medicine. We saw children in colorful uniforms attending daily school, communities in shambles being rebuilt, and family businesses attempting to thrive again, in what truly can be described as a broken economy. There were moments when I would have preferred to stay in this third world country than return to my life at home. Upon return, I approach my family, friends, residents, and most importantly, patients, with a different sense of empathy and peace.

What happened to Haiti? Life went on. But the need for support in Haiti continues. It is that Haitian spirit that keeps them going. Kenbe la, they say: Never give up. 

Children of Cite Soleil

Under the direction of Dr. Richard Bevilacqua and the Medical Alumni Council, The University of Scranton has organized an annual medical mission trip to Haiti since 2001. Pamela Taffera, DO, MBA, is Assistant Program Director of the Saint Joseph Family Practice Residency Program and President Elect of the Berks County Medical Society. Dr. Taffera and other physicians from the Medical Alumni Council bring undergraduate pre-medical students to Haiti to work with Father Rick Frechette of NPH Haiti, Catholic priest and doctor of osteopathic medicine, with St. Damien’s Children’s Hospital and Foundation St. Luke in Port au Prince, Haiti.

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Notes from the Field: A Status Report on Meaningful Use

B y S h err y L . Migli o re , M PA , FA C M P E , FA C H E ,

D irec t o r o f C o nsul t ing

I

t’s been about 10 months since the official start of the Meaningful Use incentive program. Much has happened since early 2011, and medical practices are in various states of learning what the requirements mean and how they need to make changes to their organizations to meet the requirements.

Some physicians are just in the process of purchasing and implementing EHRs. And yes, many are still debating whether they are going to get on board at all!

Even the EHR vendors are still catching up. Some of the vendors that have received certification status have not yet tested all of the clinical quality measures, or CQMs (Core Measure 10). For more information about this, go to the Certification Commission for Health Information Technology (CCHIT) website (www.cchit.org) and click on “Find Product” to see if your EHR vendor or one you are considering has completed the testing of these measures. The CQMs have been a source of confusion for many practices we’ve worked with—and judging by the number of Frequently Asked Questions (FAQs) on this topic on the Medicare website, this is a national trend as well.

In our work with practices that have either already attested or are close to attesting, it’s apparent that they have spent a great deal of time working on this to make sure they get it right. Some of the practices that have had an EHR for a while are finding that they now have to make changes to workflow and chart documentation because when they were originally trained, Meaningful Use was not on the horizon. So while they were trained initially to use their systems to efficiently document and manage patient care, they now have to make sure they’re also using the EHR in such a way as to ensure that MU requirements are met.

An example of this is the list of current medications. Prior to Meaningful Use, it was not generally thought to be necessary or important to note in the chart that “the patient does not have any active medications.” However, Core Measure 5 requires that 80% of all patients seen must have an entry about the status of current medications. If the patient is not currently taking 22 | MEDICAL RECORD

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any medication, then this too must be documented in the appropriate location in the EHR to be counted towards the 80% threshold. Similarly, Core Measure 3 requires an up-to-date problem list of current and active diagnoses or documentation that “no problems are known.”

Other challenges are being faced by practices in the process of transitioning to an EHR system and at the same time trying to attest as quickly as possible. A word of advice for physicians in this situation — don’t rush into attesting until you have at least 80% of your patients in the EHR. Also, be sure to read carefully the details of each measure on the CMS website. Each measure description includes a section called “additional information” where clarifications are provided. For example, the “additional information” provided on Core Measure 8, record and chart vital signs, states that this information does not need to be updated at every patient visit. The eligible professional has the discretion to determine based on the individual patient’s situation whether height, weight, and blood pressure need to be updated.

A word of advice — don’t rush into attesting until you have at least 80% of your patients in the EHR. Before attesting, be sure you have selected which of the five Menu Measures you are going to report on, keeping in mind that you must report on one of the two public health measures (Menu Measure 9 or 10). Finally, when attesting, be sure to keep a file with any backup material that you used such as reports from your EHR system or proof of your security risk analysis (Core Measure 15) and any deficiencies that were identified and corrected as a result of the analysis. Although a formal audit program has not been announced as of this writing, it is likely that CMS will at some point do just that!  Originally published in PMSCO Healthcare Consulting’s “News You Can Use,” dated December, 2011 (http://www.consultpmsco.com/inside-pmsco/newsletter.asp) Sherry Migliore is Director of Consulting at PMSCO Healthcare Consulting (PMSCO). Located in Harrisburg, PA, PMSCO is a subsidiary of the Pennsylvania Medical Society.

You can contact Sherry at: smigliore@consultPMSCO.com.

For more information about PMSCO, log on to www.consultPMSCO.com.

port on Me eaningful U Use Notes from the Field: A Sttatus Rep

By Sherry L. Mig gliore, MPA, FACMPE, FA FACH HE, Director oof Consulting

It’s been n about 10 months m since e the officiall start of thee Meaningfull Use incentive program.

Much ha as happened d since early y 2011, and medical m pracctices are in various stattes of learnin ng what the requireme ents mean an nd how they y need to maake changess to their org ganizations to

Department of Family MedIcine lecture series winter / spring 2 0 1 2

March 16 – Common Prostate Problems Encountered in Primary Care Carl Reese, MD, MSc, FACS, Assistant Professor, Division of Urology, M.S. Hershey Medical Center, Penn State College of Medicine March 23 – Adult ADHD – Diagnostic and Treatment Challenges J. Russell Ramsay, PhD, CoDirector, Adult ADHD Treatment and Research Program, Associate Professor of Clinical Psychology in Psychiatry, University of Pennsylvania

March 30 – An Overview of Sleep Disorders Encountered in Primary Care Karl Doghramji, MD, Medical Director, Jefferson Sleep Disorders Center, Professor of Psychiatry, Neurology and Medicine ,Program Director, Fellowship in Sleep Medicine, Thomas Jefferson University April 6 – Friday’s Child Lecture Series UTI: Diagnosis and Management Steven Wassner, MD, Professor of Pediatrics; Chief, Division of Nephrology & Hypertension, Penn State Children’s Hospital

April 13 – No Conference BCMS Memorial Lecture and Resident Research Day April 20 – Dysfunctional Uterine Bleeding Nabil Muallem, MD, Obstetrical Faculty, Family Medicine Residency Program, The Reading Hospital and Medical Center April 27 – Idiopathic Pulmonary Fibrosis Cecelia Smith, DO, Chair, Department of Medicine, The Reading Hospital and Medical Center

May 11 – Cardiovascular Update – New Guidelines Adam Feldman, MD, Cardiology Associates of West Reading, The Reading Hospital and Medical Center May 18 – No Conference BCMS Legislative Breakfast May 25 –GI Disorders in Children Don Middleton, MD, Professor, Department of Family Medicine, UPMC, Vice President of Family Practice, UPMC St. Margaret

May 4 – 5th Annual Conference on Primary Care and Child/ Adolescent Psychiatry, What is Normal Behavior?

Location: Thun/Janssen Auditorium Time: 7:30a.m. – 12:30p.m.

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MEMBERS IN THE NEWS

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Berks County Medical S 24 | MEDICAL RECORD

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6.

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1. Dr. Bill Finneran poses with Dr. Jin Xu 2. Drs. Patti & Mike Brown chats with Dr. Kristen Sandel 3. Enjoying Brunch 4. Dr. Ray Truex, Master of Ceremonies 5. Dr. Mike Baxter offers the invocation 6. Virginia Henning, Executive Director Foundation of the Pennsylvania Medical Society 7. Denise Zimmerman, Executive Vice President Pennsylvania Medical Society 8. Marilyn Heine, MD, President of the Pennsylvania Medical Society

9. Dr. Peg Atwell and husband Jerry 10. Dr. & Mrs Joe Burke speak with Bruce Weidman 11. Dr. Marcus accepts a gift for his past year of service 12. Dr. Taffera unwillingly accepts a jar of red beets-her favorite!

13. Dr. Pam Taffera is sworn in as President-Elect 14. Dr. Bill Finneran is sworn in as the 164th President 15. Harpist, Betsy Scott Chapman entertains the group

10.

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l Society

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WRIGLEYS Together we’ve RAISED service to a whole new level • Printing • Document Scanning • Office Supplies • Furniture

Dr. Raylene A. DeVine, M.D., 71, of South Heidelberg Twp. passed away Feb. 23, 2012. Born in Easton, PA, she was a daughter of the late Raymond V. and Arlene (Dobes) DeVine. She was a graduate of Governor Mifflin High School, attended Mary Washington College and graduated from Howard Medical School. She completed her residency at New York Metropolitan Hospital, and was a staff pediatrician at Children’s Hospital.

A board certified pediatrician, Dr. DeVine operated a pediatric practice in Wernersville for 30 years. She was a member of the Wyomissing Art Institute, had an art studio at the GoggleWorks and was a certified member of the Berks County Medical Society. She was also a published author.

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In Memoriam

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Ethan L. Trexler, M.D., 99, of Phoebe Berks Village, Wernersville, passed away Feb. 23, 2012. Prior to moving to Phoebe in 1994, he resided in Fleetwood, where he had a general medical practice for 41 years before retiring in 1980. Born in Albany Township, he was a son of the late William K. and Missouri (Lutz) Trexler. He was the husband of Katherine E. (Em-mons) Trexler, who predeceased him in 2003.

Dr. Trexler received his medical degree from Hahnemann Medical College, after which he served an internship at Allentown Hospital. He served in the U.S. Air Force during WWII, and director emeritus of the Fleetwood Bank. He was a member and former president of the Berks County Medical Society, serving as chairman of the Committee on Discipline from 1974-1975.

Robert R. Schweizer, M.D., 81, passed away Jan. 11, 2012 in the Health Care Center of Phoebe Berks Village, Wernersville, where he resided.

He was the husband of Kathryn M. (Schlappich) Schweizer. Born in Pennsauken, New Jersey, he was a son of Herman E. and Violet M. (Renner) Schweizer. He graduated from Moorestown High School and Gettysburg College, A graduate of Temple University Medical School, he served his internship at Reading Hospital.

Dr. Schweizer served as a U.S. Navy doctor with during World War II, and as a U.S. Navy doctor at the U.S. Naval Dispensary in Washington, D.C. He practiced medicine in Robesonia for 41 years. A member of the Berks County Medical Society and its Board of Directors, he also was a member of the PA Medical Society, American Medical Society and American Academy of Family Physicians.

New members medical society of pennsylvania

Hakki Bolukoglu, MD Category: Active/Full Amount Cardiology Associates of West Reading 301 S 7th Ave, Suite 2020 West Reading PA 19611-1495 Phone: (610) 375-6565

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.

Shuaib Aziz Latif, MD Category: Active/Full Amount Cardiology Associates of West Reading 301 S 7th Ave, Suite 2020 West Reading PA 19611-1495 Phone: (610) 375-6565

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

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

Matthew M. Nolan, MD Category: Active/1st Year in Practice Cardiology Associates of West Reading 301 S 7th Ave., Suite 2020 West Reading PA 19611-1495 Phone: (610) 375-6565

Please Join Us for the

Eugene Palchik, MD Active/2nd Year in Practice St Joseph Medical Group Vascular Institute 2494 Bernville Road, Suite 203 Reading PA 19605-9468 Phone: (610) 378-2499

2012 Health Care Champion Breakfast Honoring Health Care Champion D. Michael Baxter, M.D. and Nursing Champion Mary Ann Glocker

Nirav R. Shah, MD, MPH Category: Active/Full Amount Digestive Disease Associates 2230 Ridgewood Road, Suite 100 Wyomissing PA 19610-3600 Phone: (610) 374-4401

Mahrouf Musah Yusif, MD Category: Active/2nd Year in Practice St Joseph Medical Group Hospitalists 2500 Bemville Rd Reading PA 19605-9453 Phone: (610) 208-4648 Neti nilesh vora, MD Category: Active/2nd Year in Practice St Joseph Medical Group Hospitalists 2500 Bernville Rd Reading PA 19605-9453 Phone: (610) 378-2000

WHEN:

Thursday, April 5, 2012 7:30 - 9:00 a.m.

WHERE:

Reading Crowne Hotel $50.00 Per Person or $500.00 Per Table of 8 Seats RSVP by March 30, 2012 by calling 610.378.0481 x 3142

All proceeds benefit the charity care programs of Berks VNA. MEDICAL RECORD

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The Berks County Medical Society invites you to attend the third annual

Memorial Lecture In honor of physicians who dedicated their professional lives to serving the health care needs of our community.

This will be held in conjunction with Residents’ Day, Friday, April 13, 2012 in BVNA Auditorium.

Schedule of Events for Resident’s Day Maria J. Baker, Ph.D., M.S., Associate Professor in Medicine, will be our speaker. Maria Dr. BakerJ.received Baker, Ph.D., M.S.,Memorial Associate Professor in Medicine, will and the Lecture her Master’s degree in Genetics from the Penn be our speaker. Dr. Baker received her Master’s degree in Genetics 10am-11am Review of Residents’ Posters in the 1991.Penn State State University College of Medicine from University College of Medicine in 1991. She is a She is a diplomat of both the American Board of 11am-11:45am Presentation of Winning Abstracts diplomat of both the American Board of Medical Genetics Counseling Medical Genetics Counseling with dual certification 11:45am12:15pm Lunchcounselor and a Buffet with dual certification as a Master’s trained genetic as a Master’s trained genetic counselor and a 12:15pm -1:00pm Presentation by Ph.D. medical geneticist.

Ph.D. medical geneticist. Dr. Baker developed Maria J. Baker, Ph.D., M.S. and coordinates the Penn State Hershey Cancer Dr. Baker developed and coordinates the Penn State Hershey Cancer A talk entitled “Theentitled Genetics Program.

411 on “The 411 1170on Berkshire Boulevard Wyomissing, Syndromes” PA 19610 Genetics Program.

A talk Hereditary Cancer Predisposition Hereditary Cancer Predisposition Syndromes” Please RSVP to BCMS by April 9, 610.375-6555 or will be presented. will be presented. e-mail info@berkscms.org A Buffet lunch will be available prior to the presentation.

Please RSVP to BMS at 610-375-6555 or email at info@berkscms.org by April 9, 2012.

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OUTGOING PRESIDENT’S COMMENTS D r . J erome M arcus

I

t has been an honor to serve the Berks County Medical Society during 2011. 2011 proved to be a year of confusion with transition toward full implementation of the Affordable Care Act. As yet, we do not know if the Act will be held constitutional or if it will be eviscerated by the next administration.

Some trends, however, are evident. There is increasing effort being paid to moving paper and providing documentation and less time being spent looking at and treating the patient.

part of the essence of medicine in spite of attempts to force the physician into becoming a superfluous commodity.

Hopefully there will always be room for the best, but right now the future looks confused at very least.

Looking back and forward, I can say that though the future is unknown, the Medical Society remains the crossroads for all physicians and a safe home. For the minority in private practice, the medical society is and has been your best advocate. For the majority who are employed physicians, the medical society is your advocate and may one day be your life boat. What is in the best interests of the employer is often at odds with the best interests of the employed physician or the patient.

In looking forward, may the wind in life’s journey, professional and otherwise, always be at your back and may your frustrations, if not few, be manageable. Thank you. 

The physician is still the essence or is part of the essence of medicine in spite of attempts to force the physician into becoming a superfluous commodity.

Lowering reimbursements to providers is one strategy to lower costs. Increasing fees and taxes is one way to raise revenue.

Both of these strategies will be applied in greater abundance.

Some of these strategies are insidious. 2013, after the presidential election, is a landmark year. There is a 2.3% excise tax on medical devices other than on items like eyeglasses and hearing aids purchased at the retail level. There is also a 0.9% income tax for Medicare A on individuals earning $200,000 and couples $250,000 which for the first time includes investment income as a new source of healthcare revenue.

These trends will continue and will accelerate. One thing is certain: change is in process.

One of the reasons that health expenses have increased is that there are therapeutic modalities which did not exist in the past. People simple died from what is now creating ongoing cost.

What is the “fair” way to allocate resources and from where should the revenue come? These are subjects far more complex than this venue.

One thing is certain: the rules may change, but physicians will be needed. Practice is changing and more physicians are becoming employees, but the physician is still the essence or is

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Dr. John Beem accepts his 50-Year Award from Dr. Jerry Marcus as Dr. Truex looks on

get baCk

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

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

999 Berkshire Blvd  Suite 160  PO Box 6243  Wyomissing, PA 19610 P 610.685.1790  T 866.685.1790  F 610.685.1791 32 | MEDICAL RECORD

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SPRING 2012

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