York County Medicine Winter 2022

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Your Community Resource For What’s Happening In Healthcare 1ST ANNUAL DAY OF GRATITUDE



heryl Fishel Memorial ah Dietrich, LPN

trich, LPN demonstrates quality r patients. She exemplifies a rse which is demonstrated in the re she gives every day. She is ling to help others."

Staff Member: Imani Payton Unit: Transport, UPMC Harrisburg Recognizing: Transport Department "We don't get enough recognition and we've been working very hard especially at these times." Official Publication of the York County Medical Society

Staff Member: Charmaine Hall Unit: HR, UPMC Harrisburg Recognizing: LaTasha Cunningham, Vicki Clelan, Alex Schaffer "Thanks for the great job that we all do. The "A" Team."

Staff Member: Latasha Cunningham Recognizing: Sheila Julius "Ms. Sheila Julius has been with UPMC, formerly PinnacleHealth, for so many years. I enjoy and still enjoy her so much. She is an awesome caregiver and wouldn't have it any other way. Thanks so much, Ms. Sheila. You're the best!"

Staff Member: Ashley Ambrose Unit: Staff Education, UPMC Harrisburg Recognizing: Courtney Lykins "All her hard work for keeping the education team afloat with her kindness and memes. She is always giving a helping hand to all her staff and patients."

u for believing in me and pushing me er and supporting me. I greatly it."

eler, I've had such a fantastic e while being here. The sense of is hospital is certainly one you very often. Everyone here has t and this was definitely a great e. Thank you UPMC!"

tricia Bryant


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Staff Member: Anonymous

zier Sweeney Unit: Housekeeping, UPMC Harrisburg rsing Department, UPMC Memorial Recognizing: Terry Burmett alie Miller "She goes above and beyond!"

eja Moore-Goodwin orial MC Memorial


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FIRST PLACE to turn for CARE.

Cold and flu season is here. Your UPMC primary care team is the first place to turn to for treatment of cold symptoms, earaches, coughs, stomach aches, and rashes. Your doctor’s office can help you with the best care option, whether it’s an in-person or a video visit. And the UPMC Central PA portal provides on-demand video appointments with UPMC providers. For more information about our care options, or to find a doctor, visit UPMC.com/CentralPARightCare.



IN EVERY ISSUE 5 Letter from the Executive Director YORK COUNTY MEDICAL SOCIETY PO Box 7346, York, PA 17404

(717) 843-6744 • yorkcomedsoc.org

Medicine Partner to Fight Cancer in South Central Pennsylvania

Kathryn T. Palisoc, DO President


Paul Burcher, MD Immediate Past President

UPMC: An Interview with Dr. Steven Zanders



Catherine Bene, MD President-Elect

IN THE NEWS 24 Women’s Physician Section

Stacey G. Robert, MD Treasurer

Diane Shih-Della Penna, MD Secretary Liz Torres Executive Director


Michael Daniels, DO D. Scott McCracken, MD Jonathan Rhoads, MD Andrew Shorb, MD

Staff Mem Unit: HR, U Recognizi Alex Schaf

"Than "A" Te

Staff Mem Recognizi

"Ms. S forme enjoy awes other the b

PA Medical Society House of Delegates Weekend Business Meeting

DOH Proposes Updates to Its Long-Term Care Nursing Facility Regulations



Suzette Song, MD



Diane Shih-Della Penna, MD

"We d been times



D. Scott McCracken, MD


UPMC Pinnacle Foundation 1st Annual Day of Gratitude

Kathryn Hosey, DO Vice President



FEATURES 8 Get to Know our Board Members 10 WellSpan Health and Johns Hopkins

Staff Mem Unit: Trans Recognizi

Staff Mem

PA Legislature Extends Regulatory Waivers for Additional 6 Months Unit: Staff


Senate Aging and Youth Committee Approved HB 1082

Understanding the No Surprises Act: Federal Legislation Passed Aimed at Curbing Surprise Billing and Interim Final Rule Issued

Staff Mem Unit: Hous Gratitude Changes Everything. The UPMC Pinnacle Foundation 1st Annual Day of Gratitude offered Recognizi


UPMC Central Pa. patients and staff the chance to give back by sharing their words of thanks and gratitude to their healthcare heroes. We hope you enjoy reading these words of appreciation from patients across UPMC Central Pa.! The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the York County Medical Society. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.

"All h team She is staff a

York Medicine is published by Hoffmann Publishing Group, Inc. Reading, PA | HoffmannPublishing.com | 610.685.0914 SEE PAST ISSUES AT YCM.HoffmannPublishing.com SPREAD THE WORD #PAYorkMedMag FOR ADVERTISING INFO CONTACT: Sherry Bolinger, Sherry@hoffpubs.com, 717.979.2858


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This edition of York County Medicine is dedicated to all the medical professionals, frontline staff, nurses and all those who have selflessly invested their time and talent in the care of patients in York County during a pandemic that seems to have no end in sight. Thank you seems like such an inadequate response for such a sacrifice. Last summer everyone was hopeful that the worst was over and by fall that hope faded and there was another surge in hospitalizations. Currently, the second variant, omicron, is filling beds to capacity and once again taxing our medical community to their mental and physical limits. Millions took advantage of the vaccines that diminish the need for hospitalization for an individual that tests positive for COVID. Millions of others did not. You all have my utmost respect and appreciation for your commitment, caring, and sacrifices that have been made and continue to be made for the well-being of patients in York County. Life may never really be “normal” again. Hoping there will soon be light at the end of the tunnel. Liz Torres, Executive Director York County Medical Society

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April 1-10, 2022 Reading, PA







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y name is Andrew R. Shorb, MD. I grew up in York, Pennsylvania before traveling to Nashville, Tennessee to attend Vanderbilt University. I earned a B.S. in Molecular Biology in 1997 and went on to graduate from Penn State College of Medicine in the Class of 2001. I completed my Otorhinolaryngology residency at the University of Maryland Medical Center/ Shock Trauma Hospital in Baltimore, Maryland in 2006. Following my residency, I returned to York, Pennsylvania to join York ENT Associates where I have been practicing for 15 years. Our practice serves the southcentral Pennsylvania and northern Maryland region and operates independently between the two local health systems. In addition, I have been serving as the Chair of the Division of Otolaryngology within the department of surgery. My interest in the Pa. Medical Society Leadership Academy began with the recognition that our expanding private group could not thrive without

MICHAEL DANIELS, DO Board Member-at-Large



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ichael Daniels, DO, is a board-certified nephrologist in York. He obtained a Bachelor of Arts from Lehigh University with a double major in Behavioral Neuroscience and Economics. He then attended medical school at Philadelphia College of Osteopathic Medicine and did both Internal Medicine residency and Nephrology fellowship at Lehigh Valley Health Network in Allentown. He has resided in the York area since 2016 where he is a partner at Nephrology Associates of York. He has a wife and two small children. In his free time, he enjoys reading, movies, spending time with family, outdoor activities, and playing the piano and the guitar. He is an avid Philadelphia

appropriate leadership and vision. Within the last three years, we have acquired two physicians, a nurse practitioner, an audiologist, and approximately 15 new staff members. We have negotiated an updated on-call agreement with two hospital systems as well as purchasing and renovating an office building. I am looking forward to the 2021 leadership program. What made you decide to become a physician and how did you choose your specialty? I entered medical school with an interest in surgery and one of the ENT doctors at Hershey sparked my interest and encouraged me to attend resident events in my 4th year. What do you do in your free time? I am an avid runner and a coach for the York Suburban Middle School Cross Country Team. I enjoy playing tennis, skiing, reading and traveling. What is your favorite vacation spot? One of my favorites is Jackson Hole, Wyoming.

Eagles fan. While vacationing is rare these days, when he has a chance to get away his favorite places to travel are Europe, Aruba, and family trips to Disney World. From a young age, the importance of education and a strong work ethic was instilled on him by his parents who are both educators. His love of learning and teaching others lead him to the medical field. He was lucky to have good mentors early in his studies that served as inspiration. In addition to healing and caring for others, the science and continual advancements in medicine make the field one of the most rewarding occupations. He enjoys his job as a nephrologist because of the challenge of understanding and applying renal physiology. He also likes being able to see a variety of patients in a number of different settings from the clinic and dialysis unit to the intensive care unit.

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DR. MATHAI CAN HELP! John Mathai, MD, FACS, FACC, formerly of Premier Vein Specialists, has partnered with Center for Vein Restoration, the nation's leader in varicose and spider vein treatment. Dr. Mathai offers in-office, minimally invasive solutions at two convenient locations in York and Hanover. Sixth Avenue Professional Center 1600 Sixth Avenue, Suite 110 York, PA

800-FIX-LEGS / 800-349-5347

Dr. John Mathai MD, FACS, FACC

Hillside Medical Center 250 Fame Avenue, Suite 220 Hanover, PA


Welcome Dr. Tim Ihrig Vice President, Chief Medical Officer Hospice & Community Care

“ I’m excited to join Hospice & Community Care’s team of

physicians, board certified in palliative and hospice care, who are working together to provide care and comfort for patients and families in York County. The community is fortunate to have an abundance of hospital systems and senior living facilities, and I look forward to enhancing the relationships that Hospice & Community Care already has with these institutions to learn, grow and connect with people in our community who care. ~Dr. Ihrig

(844) 422-4031 • www.HospiceProfessional.org.

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WellSpan Health and Johns Hopkins Medicine partner to fight cancer in South Central Pennsylvania Expanded collaboration provides increased access to complex cancer care


ellSpan Health and Johns Hopkins Medicine recently announced an increased collaboration to provide high quality, seamless, advanced cancer care for WellSpan patients. As part of WellSpan’s cancer program, WellSpan has had an expanded collaborative with the Johns Hopkins Kimmel Cancer Center since 2017 that provides access to clinical research trials and second opinions from Johns Hopkins Medicine cancer sub-specialists. With the expansion and opening of the new WellSpan York Cancer Center in July, there is an opportunity to deepen that collaboration with Johns Hopkins Medicine to increase the amount and complexity of cancer care for patients in WellSpan communities. In addition to second opinions and clinical trials, WellSpan will now have access to more cancer specialists, improved genomics capabilities, clinical protocols, quality review, participation in tumor conferences and educational opportunities to differentiate its cancer program. “Through our deepening collaboration with Johns Hopkins Medicine, our combined teams of physicians, faculty and research scientists will work closely with patients to offer the latest treatments and leading-edge therapeutic options within a state-of-the-art program for our friends and neighbors in South Central Pennsylvania,” said Roxanna Gapstur, Ph.D., R.N., president and CEO, WellSpan Health. “Our goal is to ensure the people in our communities receive complex cancer care when they need it, close to home and loved ones.” Starting at the WellSpan York Cancer Center, patients and community residents will begin to see the highly respected Johns Hopkins Medicine brand associated with WellSpan’s 10

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oncology services. As the new capabilities are spread across the service line to all its regions, it will be an important way to show communities that advanced, life-saving cancer care is available locally. “This relationship represents our shared approach to bringing the best care to patients in the South Central Pennsylvania region, and we are so proud to expand the collaboration to include clinical trials, peer-to-peer consultations and educational opportunities,” said Kevin W. Sowers, M.S.N., R.N., president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. Working together with Johns Hopkins Medicine, consistently ranked as one of the best cancer centers in the United States by U.S. News and World Report, WellSpan will deliver unparalleled cancer care for patients in its communities.

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Domani Wealth, LLC (“Domani”) is an SEC registered investment adviser with its principal place of business in Lancaster, Pennsylvania. Domani and its representatives may only transact business in states where they are appropriately notice-filed and registered, respectively, or exempt from such requirements. For information pertaining to the registration status of Domani, please contact the SEC or the state securities regulators for those states in which Domani maintains a notice-filing.

W I N T E R 2022 | York County Medicine


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An Interview With

Dr. Steven Zanders

Associate Director of Intensive Care for Medical Critical Care for UPMC Memorial System System Director for Neurologic Critical & Stroke Patients


r. Zanders has spent the last 21 months in ICU units and has dealt with the physical and mental trauma brought on by the COVID 19 pandemic. The trauma continues as he deals with patients who made the decision not to be vaccinated. I asked Dr. Zanders several questions relating to his role as an ICU physician during the pandemic and the variants that are now present and affecting thousands of people every day.

Were you surprised by the behaviors of humanity? I have been more surprised by the most recent behaviors of individuals refusing to be vaccinated. The research and testing have proven the vaccines work and are safe. Masks provide additional protection from the spreading of COVID and its variants. When individuals decide not to get vaccinated or wear a mask, they are basing that decision on what they consider


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their personal freedoms without considering the impact their choice has on others. And instead of thanking us for the care they or their loved ones receive, they are angry and even claiming that COVID isn’t real but something the government made up. Meanwhile, beds in many hospitals are full of unvaccinated patients leaving no room to bring in patients with other diseases requiring treatment. As of now we are at full capacity and there is danger for patients with non-COVID related disease in getting help.

What perspective have you gained from the last 21 months in the Intensive Care Unit? There would be a different outcome in the future. Nothing can change the polarized nature of this. There have been many deaths in the ICU. Treatment plans had to be changed and limited by age. The entire health care system will and is being affected. Nurses and doctors are digging in and not giving up

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To refer a patient please call or visit online. but are losing ground. Those 50+ years of age and needing advanced therapy have limited options now just based on the sheer numbers of patients currently in the ICU with COVID. At the end of January, we peaked around 300 COVID patients. By the end of May and into early June, the number of COVID patients declined to zero. At the end of the vaccine series, there were no patients in the unit. Now, with the variants, the higher death rates have resumed.

Do you foresee different ways of handling Intensive care patients in the next five to ten years? We are so heavy into the pandemic that we can’t even see one year ahead. I do see Telemedicine becoming more consistent in the future. It is a safe way to manage and care for patients.

Are there any positive outcomes? Treating COVID patients gave us something not only to believe in but to fight for much like a war. Working together gave us all a purpose and put doctors back at the baseline as a reminder not to forget why we do what we do. We worked with basic roots of medicine under science and physiology, human pathology with deeper thinking in regard to this new disease.

How are the medical teams holding up? It is important for each individual to take care of themselves. A lot of the nurses and providers are going to counseling and a larger proportion are leaving health care. There are numerous call outs with illness as the reason. They are dealing with alcoholism, living in unhealthy relationships and getting divorced. Individuals are trying to find counseling. Dealing with death at this level takes its toll on even the strongest individuals. We are now dealing with younger people contacting the disease and dying from it. We are dealing with families that are taking their anger out on us adding insult to injury. We will keep fighting.

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Hanover Office:

250 Fame Avenue Ste 204 Hanover, PA 17331 717.316.0900

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Patient Name: Meredeth McCann / McCann Family Staff Being Recognized: Nurses on 10N, Melissa, and John (ER), UPMC Harrisburg Unit: 10N "Thanks for taking great care of my mom. You treated her like a queen! We are so grateful for all of you and everything you do."

Patient Name: Dorothy G. Agostin Staff Being Recognized: Dr. Brenda Alton, UPMC Harrisburg Unit: Spiritual Care "You rock!"

Patient Name: Tammy and the kids Staff Being Recognized: Lydia Medina, UPMC Harrisburg "She's awesome and does a wonderful job. Over and beyond. Helps everyone."

Patient Name: Anthony McWhite/Delbra Danuel Staff Being Recognized: 2nd Floor Staff, UPMC Harrisburg Unit: Heart Center "A great group of individuals. All of the nurses and doctors on the 2nd floor heart center."

Patient Name: Kathy Etnoyer Staff Being Recognized: Lauren Hegel, UPMC Harrisburg Unit: M10 "Lauren was such a blessing to my husband when he was in the hospital during his stroke! Great nurse! GO LAUREN!" continued on next page >

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Patient Name: Robert Lee Newhouse Staff Being Recognized: All Dr., Nurses, Helpers (OP's and PT's), Administration, Housekeeping, and Kitche., UPMC Harrisburg "I was in ICU 13 days, 9 on the ventilator. 14 days on the 10th floor in Harrisburg Hospital. Had to learn to walk again. I had the fear of falling because I fell two times before I went in and I could not get up. My wife had to call EMS to help me up twice. Before I said take me to the hospital. From April 5th, 2020 to May 6th, 2020. Thank you all for using your God-given talents."

Patient Name: Rick White Staff Being Recognized: UPMC Harrisburg "Thanks for all you do. It's been a rough year but we all keep going on. May God bless you and lead you as you continue to provide all the care you give."

Patient Name: Bernice White, Rick White Staff Being Recognized: ICU staff, UPMC Harrisburg Unit: ICU "We appreciate all that you have done for us. My husband Martin White is in excellent hands. May God continue to bless your team. You are fantastic. Thank you so much."

Patient Name: Cynthia Butler Staff Being Recognized: ER Staff and 4 Main, UPMC Harrisburg Unit: ED and 4Main "They worked so hard to make my husband's stay comfortable. Very caring staff."


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Staff Member: Michael Fedor Unit: Many on the NICU Maternal-Fetal Medicine and ICU teams, UPMC Harrisburg Unit: ICU "The nurses, doctors, and staff of UPMC saved the lives of my son and wife in 2017. I will be eternally grateful for the kindness, generosity, and love every single member of the UPMC staff shared with us for those 40 days in September - October 2017. What was supposed to be routine labor and delivery turned into a life and death struggle hour by hour for Serena and Luke. Their story is too long to write here and too many people should be thanked one by one. If contacted I would be happy to share my notes and names of all the incredible people who helped change our lives for the better by never ever giving up hope that Serena and Luke would live!"

Staff Member: Linda Bryson Unit: All the nurses, Respiratory therapists, nurses aides, and doctors, UPMC Harrisburg Unit: ER/ICU/Respiratory "I am alive and still working because Pinnacle Health saved my life following a respiratory arrest 24 years ago. I would never have seen my children get married or meet my 9 grandchildren. Every person who worked there was instrumental in saving my life, Forever grateful. P.S. This may have sparked my daughter's interest in nursing. She is one of yours."

Staff Member: Carrie Bryson Unit: Woodward & Associates, UPMC Harrisburg Unit: Maternity & NICU "I delivered 5 kids at Pinnacle and spent 35 days in NICU with the twins. We were so well cared for by the doctors, nurses, and staff. Wouldn't go anywhere else!"

Staff Member: The Sweeney Family Unit: Dr. David Loran, UPMC Harrisburg Unit: Maternity & NICU "Dr. Loran is a kind and caring person who really made us feel at ease during my husband's open heart surgery procedures. He explained it in such a way that was easy to understand and answered all of our questions as they arose. Keep up the awesome work you do Dr. Loran!"

Staff Member: Kelly Kintzel Unit: Dr. Terry Tressler, UPMC Harrisburg Unit: Maternal Fetal Medicine "Dr. Tressler and Dr. Barber successfully delivered my premature twins and saved my life from the effects of preeclampsia. From there the wonderful people of the NICU took over care of my babies. MFM had their hands full as I relapsed into preeclampsia postpartum." continued on next page >

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Staff Member: Anna Marie O’Leary Unit: Dr. Kit Lu, Hillman Cancer Center "Dr. Lu and her staff have been my caregivers for 6.5 years. Dr. Lu is not only kind and caring of her patients as a whole person but her professional knowledge has helped me have a good quality of life. The staff at the Hillman CA Center including the Infusion therapy nurses are also very caring and kind and try to make all their patients feel comfortable during a difficult time. The office staff is also exceptional as are the many nurses I have encountered. Thank you."

Staff Member: Kelly Kintzel Unit: Dr. Steven DeLuca, Orthopedic Institute of Pennsylvania "Dr. DeLuca has given me my life back. I have required multiple surgeries, with two more scheduled, and Dr. DeLuca has skillfully and compassionately them all. He has a great bedside manner from office to operating room. I highly recommend him for orthopedic care and thank him for sharing his skills with our community."

Patient Name: Jaime Staff Being Recognized: Katelynn, UPMC Hillman/Ortenzio Cancer Center "Thank you for taking the time to explain my situation and being proactive with the treatment!"


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Patient Name: Anonymous Staff Being Recognized: Oncology staff, UPMC Hillman/Ortenzio Cancer Center "I rang the bell today!! You all are a God-sent person and a blessing at this time in our life."

Patient Name: Anonymous Staff Being Recognized: Oncology staff, UPMC Hillman/Ortenzio Cancer Center "Thank you for all you do! You make such an impact in peoples lives!"

Patient Name: Mujidat Hakeemolowu Staff Being Recognized: Jennifer Ashbridge, UPMC Hillman/Ortenzio Cancer Center "Thanks, Jennifer for the warm care given to me during my breast treatment. It really meant so much to me. God bless you."

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Patient Name: Kelly Kintzel Staff Being Recognized: Sheila Julius, UPMC Harrisburg Unit: Antepartum "Ms. Sheila took the best care of me during my high-risk twin pregnancy. I was a resident for 23 days. Sheila made sure that I had fresh fruit available to help manage my gestational diabetes. I felt like I was being picky, but she never made me feel like I was a bother. She lovingly brought a delicious party to us every Friday. Sheila even cared for my baby girl with an emergency surgery 13 months later. She has the biggest heart and we love her so much. ❤ "

Patient Name: Alfred T. Irvin Staff Being Recognized: Dr. Mumtaz, UPMC Harrisburg Unit: UPMC Heart and Vascular Institute "Dr. Mumtaz and his staff were excellent when I had recent heart surgery. I am so pleased that I had this surgery at UPMC Harrisburg, and the care was excellent. Every day is getting better as I am healing and look forward to riding my motorcycle again. Thank you so much."

Patient Name: Vicky Whary Staff Being Recognized: 4th Fl. Staff, UPMC West Shore Unit: 4th Fl. "To all on floor 4 - thank you for everything you do every day!"

continued on next page >

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Staff Member: Patrick Berry Unit: Environmental Services, UPMC Memorial Recognizing: Environmental Services, UPMC Memorial "I am grateful for all my coworkers and managers and supervisor in EVS. Thank you all!"

Staff Member: Anonymous Unit: Environmental Services, UPMC Memorial Recognizing: Barry and Tonya "Great management. Always listening and helping. Goes above and beyond for their staff."

Staff Member: Shannon Unit: Volunteer Services, UPMC Hanover Recognizing: Volunteer Services "The volunteers are dearly loved. Even in these trying times, they are dedicated to our patients!"

Staff Member: Jane Alwine Unit: CPU, UPMC Hanover Recognizing: CPU, UPMC Hanover "I have been employed here at UPMC Hanover for 33 years. I have worked with many wonderful coworkers. Hanover Hospital is my home. When here as a patient I have always been treated with kindness and respect. My current manager Tayna Lynn has been a great manager. She is very fair to the coworkers in the department. " 20

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Staff Member: Krystal Hopwood Unit: 1st Floor Cardiac Services/CDU, UPMC Hanover Recognizing: Cardiac services/Nuclear med/IV therapy/HVU "Cardiac services work great as a team. We are always ready to help each other out when needed. Nuclear medicine is always ready to help us out when we need an IV started on patients. HVU and IV therapy are always willing to help out when they can with IV's also."

Staff Member: Ramona Bacon Recognizing: Emergency Management Team, UPMC Hanover "The entire Hanover staff stepped up to help one another when the pandemic started. Every department worked together to ensure constant quality service while also taking care of the needs of the family. Danielle Mostoller was amazing handling all of the constant changes as the emergency management person. She made herself available 24/7 for over a year and did it all with a smile."

Staff Member: Kyle Downes Unit: Security/Information Desk/Lobby, UPMC Hanover Recognizing: Ramona "They always show up with a positive attitude and ready to help people. They strive to put a smile on every persons face that walks through the UPMC doors. They will go above and beyond to find a solution for any questions or problems that are brought to their attention. Their hospitality is what makes UPMC the place to be!"

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Staff Member: Jen Hedrick Unit: CDU, UPMC Hanover "I love lifting my patients' spirits up. They are scared, not feeling well, and I always get so much joy in getting them to smile or laugh… take their mind off whats happening."

Staff Member: Chelsea Smith Unit: Foodservice, UPMC Hanover Recognizing: Dan Slavin "Dan is a very hard worker and works with you on the schedule. Can't beat him, an amazing supervisor!"

Staff Member: Anonymous Unit: ED, UPMC Memorial Recognizing: Emergency Department Team, UPMC Memorial "The emergency department time is the best!! They are resilient, bold, courageous, and CARE for the sick/injured better than anyone. KEEP ROCKIN' IT! "

Staff Member: Lisa Zeigler Recognizing: Robin Deibler and Mary Jane Theissen "Robin Deibler and Mary Jane Theissen in preop are very kind and compassionate."

Staff Member: Dr. Harold Yang Unit: Transplant Recognizing: Laura Bubb "Patients always feel great. Frontline-rooming all patients, including those with COVID-19." continued on next page >

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Staff Member: Imani Payton Unit: Transport, UPMC Harrisburg Recognizing: Transport Department "We don't get enough recognition and we've been working very hard especially at these times."

Staff Member: Charmaine Hall Unit: HR, UPMC Harrisburg Recognizing: LaTasha Cunningham, Vicki Clelan, Alex Schaffer "Thanks for the great job that we all do. The "A" Team."

Staff Member: Latasha Cunningham Recognizing: Sheila Julius "Ms. Sheila Julius has been with UPMC, formerly PinnacleHealth, for so many years. I enjoy and still enjoy her so much. She is an awesome caregiver and wouldn't have it any other way. Thanks so much, Ms. Sheila. You're the best!"

Staff Member: Ashley Ambrose Unit: Staff Education, UPMC Harrisburg Recognizing: Courtney Lykins "All her hard work for keeping the education team afloat with her kindness and memes. She is always giving a helping hand to all her staff and patients."

Staff Member: Anonymous Unit: Housekeeping, UPMC Harrisburg Recognizing: Terry Burmett "She goes above and beyond!"


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Staff Staff Member: Member: Lori Lori Miller Miller Unit: Unit: Staff Staff Education, Education, UPMC UPMC Harrisburg Harrisburg Recognizing: Recognizing: Courtney Courtney Lykins Lykins

Staff Staff Member: Member: Judy Judy Kern, Kern, Volunteer Volunteer Recognizing: Recognizing: UPMC UPMC Carlisle, Carlisle, Denise Denise Garman Garman

"Courtney "Courtney Lykins Lykins is always is always going going above above and and beyond. beyond. She She always always puts puts herher patients patients before before herself. herself. Courtney Courtney sends sends thank thank you you notes notes just just because. because. She She checks checks in on in on all all herher employees employees and and patients. patients. Courtney Courtney values values everyone everyone as as a family a family member member and and treats treats them them all all with with respect." respect."

Staff Staff Member: Member: Tamara Tamara Clark Clark Main 5, UPMC Harrisburg Unit: Unit: Main 5, UPMC Harrisburg Recognizing: Angela Krappe Recognizing: Angela Krappe "Angela "Angela has has been been onon Main Main 5 for 5 for it it seems seems like like a lifetime! a lifetime! :) She :) She has has been been onon thethe leadership leadership team team forfor over over 10 10 years years and and still still maintains maintains a positive a positive attitude. attitude. Her Her tenacity, tenacity, professionalism, professionalism, and and listening listening earear create create a warm a warm and and welcoming welcoming presence presence onon thethe unit. unit. WeWe areare really really appreciative appreciative of of her!" her!"

Staff Staff Member: Member: Emily Emily Nye Nye Unit: Unit: M7M7 IC7, IC7, UPMC UPMC Harrisburg Harrisburg Recognizing: Recognizing: M7M7 IC7 IC7 Staff Staff

"UPM "UPM Carlisle Carlisle deserved deserved recognition recognition forfor allowing allowing meme to to come come in every in every day day and and help help make make this this a great a great place place to to volunteer. volunteer. I am I am grateful grateful forfor thethe opportunity opportunity to to help help thethe great great staff staff of of employees employees dodo their their jobs jobs in in thethe way way capacity capacity that that I can. I can. It is It is great great to to bebe able able to to share share how how I feel I feel when when I walk I walk through through thethe door door each each morning morning to to know know that that I am I am helping helping to to make make this this a great a great hospital. hospital. I am I am also also grateful grateful to to have have a fine a fine leader leader in Denise in Denise Garman. Garman. She She inspires inspires us us to to dodo ourour best. best. Thank Thank you, you, UPMC UPMC Carlisle." Carlisle."

Staff Staff Member: Member: Jenny Jenny Shah Shah Unit: Unit: Pharmacy, Pharmacy, UPMC UPMC Harrisburg Harrisburg Recognizing: Recognizing: Kris Kris River River "Kris "Kris is always is always considerate, considerate, resourceful, resourceful, and and passionate passionate about about patient patient care. care. HeHe goes goes above above and and beyond beyond to to serve serve as as a resource a resource to to interdisciplinary interdisciplinary team team members. members. HeHe always always has has a smile a smile onon hishis face face and and a a positive positive attitude. attitude. I am I am grateful grateful to to him him forfor helping helping meme with with clinical clinical dilemmas, dilemmas, statistics statistics in excel, in excel, and and any any other other issues issues that that arise." arise."

"The "The staff staff onon M7M7 were were anan exemplary exemplary example example of teamwork of teamwork and and patient patient advocacy with a patient onon thethe unit. advocacy with a patient unit. They constantly work to to arrange dialysis, They constantly work arrange dialysis, outpatient visits, and coordinate their outpatient visits, and coordinate their Staff Staff Member: Member: Deloris Deloris Mulholland Mulholland heart failure care. This staff is the heart heart failure care. This staff is the heart of inpatient heart failure care!" of inpatient heart failure care!" Unit: Unit: Patient Patient Registration, Registration,

Staff Staff Member: Member: Kat Kat Mohr Mohr Unit: Unit: Nursing Nursing Administration, Administration, UPMC UPMC Harrisburg Harrisburg Recognizing: Recognizing: Nurse Nurse Leaders Leaders "During "During thethe pandemic pandemic time time from from thethe beginning beginning until until now, now, thethe nursing nursing leaders leaders have have shown shown how how thethe leaders leaders should should be.be. They They areare supportive supportive and care about their and care about their nursing staff." nursing staff."

UPMC UPMC Carlisle Carlisle Recognizing: Recognizing: Patient Patient Registration Registration Staff Staff "Patient "Patient registration registration at at thethe Carlisle Carlisle Hospital Hospital is wonderful is wonderful with with thethe patients patients and and always always willing willing to to help. help. They They have have worked worked through through so so much much over over thethe past past year year and and areare still still doing doing everything everything with with a smile a smile onon their their faces. faces. Thank Thank you you forfor all all you you do!" do!"

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HOUSE OF DELEGATES WEEKEND BUSINESS MEETING "On October 27, 2021, the Pennsylvania Medical Society Women’s Physician Section held its third annual Business Meeting during the Pennsylvania Medical Society House of Delegates weekend. The Women’s Physician Section Governing Counsel was joined by fellow Pennsylvania Medical Society members interested in issues related to women physicians with the goal of bringing together like-minded physicians to collaborate and strategize an approach to the House of the Delegates. Below are a few highlights. The keystone talk in the Business Meeting was a presentation on implicit bias by guest Rebekah Apple. Ms. Apple is the Director of the Master of Medical Management program at Heinz College of Information Systems and Public Policy. In addition to being responsible for the direction and strategy of a degree program for physicians and a faculty member of the Ethics course, she is a consultant on bias to hospitals and hospital systems throughout the country. The talk was instrumental in recognizing and addressing bias in our daily lives, providing tools that physicians can use to initiate conversations related to bias and how biases can be identified and addressed. Later in the meeting, the elections for Governing Counsel were reviewed and opportunity for additional candidacy was offered. Resolutions of pertinence to the Women’s Physician Section were reviewed and support provided to those who planned to offer conversation at the House of Delegates. Subcommittee reports were provided by subcommittee chairs. As the Women’s Physician Section continues to grow, we are looking for new members to learn from and with!" — Women Physician Section, Communications Committee 24

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he Pennsylvania Department of Health (DOH) has proposed updates to its long-term care nursing facility regulations. These updates will be proposed through five sets of proposed regulations that DOH will publish over the coming months. These regulations were last updated in 1999. The first set of proposals was published in July 2021. The second and latest set was published in the October 9, 2021 edition of the Pennsylvania Bulletin.

What does this second set of proposals include? This second set of proposals updates requirements related to alterations, renovations, and construction of long-term care nursing facilities. This set of proposals adds a new chapter to the existing regulations that will apply to plans for alterations, renovations or construction of long-term care nursing facilities submitted approved 6 months after these regulations are published as a final-form rulemaking. Additionally, this second set of proposals also deletes certain current provisions in the existing regulations regarding closure of facilities. DOH is proposing deletion of these existing provisions to eliminate duplication and to avoid unnecessary confusion and potential conflict between DOH’s regulations and the Federal requirements for long-term care nursing facilities. DOH proposes to add language to clarify that it is using the Federal requirements as the baseline standard for the closure of a long-term care nursing facility.

What did the first set of proposals include? The first set of proposed regulations focuses on adding 1.4 required hours of direct care for residents each day, increasing the minimum standard from 2.7 to 4.1 hours within a 24-hour period. This initial set also incorporates references to Federal regulations and the Centers for Medicare & Medicaid Services’ (CMS) Long-Term Care State Operations Manual. The existing regulations already incorporate many of the Federal requirements.

DOH cites that any burden by the expansion in the proposed regulations to incorporate the remaining Federal requirements will only impact those long-term care nursing facilities that do not participate in Medicare or Medicaid, of which only three such facilities do not. The first set of proposed regulations was published in the July 31, 2021 edition of the Pennsylvania Bulletin.

How can I submit comments? Interested parties have 30 days from publication in the Pennsylvania Bulletin to submit comments to DOH. Comments regarding the second set of proposed regulations must be submitted by Nov. 8, 2021 and may be submitted as follows: By email to: RA-DHLTCRegs@pa.gov By mail to: Lori Gutierrez, Deputy Director Office of Policy 625 Forster Street Room 814 Health and Welfare Building Harrisburg, PA 17120 Comments should reference the following: Rulemaking 10-222 (Long-Term Care Nursing Facilities, Proposed Rulemaking 2).

What will the next three sets of proposals include? The next three updates will address change of ownership, staff development, staffing ratios and infection control and prevention. DOH plans to submit the final-form regulations once all five packages of updates move through the state’s regulatory review process. Note that the regulations will apply only to the 692 licensed skilled nursing facilities regulated by DOH. These facilities provide health services to more than 72,000 residents. Personal care homes and assisted living homes are regulated by the Department of Human Services under separate regulations.

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PA Legislature Extends Regulatory Waivers for Additional 6 Months


n Sept. 29, 2021, the Pennsylvania General Assembly unanimously passed a bill (HB 1861) to extend a number of regulatory waivers, which were granted in respond to the COVID-19 emergency and were set to expire on Sept. 30, another six months. With this extension, waivers will now expire March 31, 2022. Gov. Wolf has indicated that he will sign the bill into law. Gov. Wolf signed HB 1861 into law on Sept. 30, 2021 as Act 73 of 2021. Act 73 extends regulatory, statutes, rules, and regulations temporally waived by the Pa. Department of Health, the Pa. Department of State’s Bureau of Professional and Occupational Affairs (BPOA), and other state departments and agencies to March 31, 2022 unless terminated sooner by the authority that initially issued the waiver. BPOA has already terminated some waivers that have served their purpose in the response to the COVID-19 pandemic. A list of all the waivers issued by BPOA and their expiration dates can be found on BPOA’s website. BPOA has updated this information with the new March 31, 2022 expiration date. The Pennsylvania Medical Society (PAMED) will continue to monitor the expiration of regulatory waivers and provide updates to members accordingly. PAMED will alert members if any waivers related to physician practice or licensure are ended sooner than March 31, 2022.


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Senate Aging and Youth Committee Approved HB 1082


n Wednesday, September 22, 2021, the Senate Aging and Youth Committee unanimously approved House Bill 1082. This legislation establishes an education program for healthcare providers for the early diagnosis of Alzheimer’s disease and other dementias and further incorporates information about these diseases into existing public health outreach programs. House Bill 1082 directs the PA Department of Health to establish and maintain an “Early Detection and Diagnosis of Alzheimer’s Disease and Other Dementias” toolkit. The toolkit requires best practices and cognitive assessment protocols and educational

resources to assist the primary healthcare workforce in the detection, diagnosis, treatment, and care planning for individuals with Alzheimer’s disease and other dementias. Prior to the introduction of HB 1082, PAMED lobbyists had informal discussions with several legislators interested on this proposal and encouraged them to avoid mandating any program as part of physicians’ current CME requirements. With no physician mandate contained in the legislation, PAMED has been supportive of HB 1082.

Stay up to date on these and other issues at www.pamedsoc.org and in The Dose. W I N T E R 2022 | York County Medicine


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Understanding the No Surprises Act:

Federal Legislation Passed Aimed at Curbing Surprise Billing and Interim Final Rule Issued


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Updated: Oct 12, 2021

Understanding the No Surprises Act: Federal Legislation Passed Aimed at Curbing Surprise Billing and Interim Final Rules Issued The omnibus federal government spending and pandemic aid bill passed by the United States Congress and subsequently signed into law in December 2020 included significant provisions aimed at protecting patients against surprise medical bills and determining out-of-network provider payments. The portions of the legislation regarding surprise billing are referred to as the No Surprises Act (Act). Most provisions of the Act take effect with the plan year for 2022. The Act required the promulgation of federal regulations to implement certain provisions.

What Does the Act Provide? The Act establishes standards for plans and providers to resolve payment for nonemergency services provided by non-participating (out-of-network) providers at participating (in-network) facilities, emergency services provided by non-participating providers and facilities, and air ambulance services. Under the Act, providers and plans must first attempt to resolve payment disputes between themselves before final resolution in a binding arbitration process referred to as Independent Dispute Resolution (IDR). For services rendered by a non-participating provider (e.g., physician) at a participating facility or at a non-participating emergency facility: providers may not bill beyond the allowed cost-sharing amount imposed under the plan or coverage for such services. An initial payment, determined by the plan, or a notice of denial of payment will be sent to the provider from the plan within 30 days from when the provider transmitted their bill to the plan. Following receipt of initial payment or denial of payment, there is a 30 day window for either party (the provider or plan) to initiate open negotiations. The open negotiation period is a 30-day period during which the provider and plan may negotiate an agreement to resolve payment. If an agreement cannot be reached during the open negotiation period, the plan or provider has 4 days (from the last day of the open negotiation period) to notify the other party and the Secretary of Health and Human Services (HHS) that they are initiating the IDR process. The Act’s IDR process establishes an arbitration procedure that allows independent review of provider-plan disputes. Within 3 days following the date the IDR is initiated, the provider and plan must jointly select a certified IDR Entity (IDRE). The parties may continue negotiating during the 30-day IDR process and

may agree on an amount of payment before the end of the IDR process (in such case both parties will share the cost to compensate the IDRE). Within 10 days of IDRE being selected, the parties must submit final offers, information requested by IDRE, and additional information, subject to certain exceptions, the parties would like related to their offers. The IDRE has 30 days to select one of the offers. The Act lists the specific factors that the IDRE may consider in making its decision. Factors include the qualifying payment amount (QPA), contacted rates from the prior year, the patient’s acuity, the market share of the insurer and provider, teaching status of the facility, scope of services, any demonstrations of good faith efforts to agree on a payment amount, and other considerations (upon request by the IDRE or either party) such as the provider’s training and experience, the complexity of the procedure or medical decisionmaking. Note that the IDR entity cannot consider payment rates by public payors, including Medicare, Medicaid, CHIP, and Tricare rates. The party whose offer was not chosen by the IDR entity must pay IDR process costs. Payment, pursuant to the IDR entity’s determination, must be made to the provider within 30 days of the IDR entity’s decision. Previous versions of the bill had included benchmark payment provisions instead of an arbitration process. In 2019, the Pennsylvania Medical Society (PAMED) sent a letter to congressional representatives urging reconsideration of a benchmark payment standard.

Interim Final Rules To implement many of the Act’s provisions, the U.S. Department of Health and Human Services (HHS) in conjunction with several other federal agencies have issued a series of interim final rules (IFR). The first interim final rule was published in July 2021 and can be accessed here: https://www.cms.gov/files/document/cms-9909ifc-surprise-billing-disclaimer-50.pdf With another rule being published in the Oct. 7, 2021 edition of the Federal Register, this latest rule can be accessed here: https://www.federalregister.gov/ documents/2021/10/07/2021-21441/requirements-related-to-surprisebilling-part-ii Regarding the first IFR, a fact sheet published by the CMS provided this summary: • The interim final rule protects individuals from surprise medical bills for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances. • Coverage - If a plan or coverage provides or covers any benefits for emergency services, the interim final rule requires emergency services to be covered:

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Understanding the No Surprises Act continued from page 29 • Without any prior authorization (i.e., approval beforehand) • Regardless of whether the provider is an in-network provider or an in-network emergency facility • Regardless of any other term or condition of the plan or coverage other than the exclusion or coordination of benefits, or a permitted affiliation or waiting period • What do emergency services include? Emergency services include certain services in an emergency department of a hospital or an independent freestanding emergency department, as well as post-stabilization services in certain instances. • Cost sharing - The interim final rule also limits cost sharing for out-of-network services subject to these protections to no higher than in-network levels, requires such cost sharing to count toward any in-network deductibles and out-of-pocket maximums, and prohibits balance billing. These limitations apply to out-of-network emergency services, air ambulance services furnished by out-of-network providers, and certain non-emergency services furnished by out-of-network providers at certain in-network facilities, including hospitals and ambulatory surgical centers. The IFR specifies that cost-sharing amounts for such services furnished by non-participating emergency facilities and nonparticipating providers at participating facilities must be calculated based on one of the following amounts: (1) an amount determined by an applicable All-Payer Model Agreement under section 1115A of the Social Security Act; (2) if there is no such applicable AllPayer Model Agreement, an amount determined by a specified state law; or (3) if there is no such applicable All-Payer Model Agreement or specified state law, the lesser of the billed charge or the plan’s or issuer’s median contracted rate, referred to as the qualifying payment amount (QPA). Under the IFR, the QPA is generally the median of the contracted rates of the plan or issuer for the item or service in the geographic region. The most recent IFR was published in the Oct. 7, 2021 Federal Register. A fact sheet on this latest rule was published by the Centers for Medicare and Medicaid Services (CMS). The rule requires providers/facilities to provide good faith estimates to uninsured or self-pay patients starting Jan 1, 2022. The good faith estimate will include expected charges for the primary item or service the patient is receiving, as well as for any other items or services that would reasonably be expected to be provided as part of the same scheduled or requested items/services. The IFR also details on the IDR process that providers, facilities or providers of air ambulance services, and health plans or issuers will use to determine final payment beyond allowable patient cost-sharing for certain out-of-network healthcare services 30

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in situations where the No Surprises Act prohibits surprise billing. A certified IDRE will then work with the health plan and provider or facility to decide the payment amount. When deciding which offer to select in an IDR, the rule specifies that the IDRE must begin with the presumption that the QPA is the appropriate outof-network rate for the service under consideration. The IDRE must select the offer closest to the QPA, unless there is credible information submitted by the parties clearly demonstrating that the QPA is materially different from the appropriate out-ofnetwork rate, based on the additional circumstances allowed. More information on the latest IFR and the IDR process can be found in this general fact sheet.

Concerns With QPA Calculation and the IDR Process Concerns have been raised with the method used to calculate the QPA and the QPA’s importance in the IDR process. Specifically, there is concern that QPA calculation will generate rates not reflective of actual market-rate physician payments. Under the rule, small and large payment contracts will be weighted equally for purposes of calculating the QPA. This means that each contract is considered one data point to be used in determining the median contracted rate, regardless of how many providers’ rates may be covered under a contract. Because of this method of calculation, the QPA could be skewed lower than the actual median of all provider rates in an area. The American Medical Association (AMA) has raised these concerns with HHS and has urged that the QPA is considered by IDREs in context and does not play an oversized role in the IDRE’s decision making. There is concern regarding dispute resolution fairness if QPAs are calculated too heavily in favor of payors. More information on these issues can be found in a statement recently issued by the AMA, which can be accessed here: https:// www.ama-assn.org/delivering-care/patient-support-advocacy/dont-skew-surprise-billing-regulations-health-plans-favor

Additional Information CMS has launched a website dedicated to the No Surprises Act, which can be accessed here: https://www.cms.gov/nosurprises Additional information on the Act can be found on the AMA’s website here: https://www.ama-assn.org/delivering-care/patientsupport-advocacy/congress-provides-relief-medicare-paymentpasses-surprise The AMA has developed a detailed high-level summary of the Act, which can be accessed here: https://www. ama-assn.org/system/files/2020-12/no-surprises-act-summary.pdf as well as a guide, which can be accessed here: https://www.amaassn.org/system/files/2021-02/surprise-billing-provisions-guide. pdf

Your primary care provider is a partner in your health.

Dr. Chinwendu Opara

WellSpan Family Medicine, Roosevelt Ave

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