Keystone Physician Magazine - Winter 2018 by PA Academy of Family Physicians

WINTER 2018

EVENT COVERAGE PAFP NEMACOLIN CME CONFERENCE

MEMBER NEWS PAFP LAUNCHES OPIOID RESOURCE CENTER

Representing Individual Physicians & Physician Groups Charles I. Artz, Esq. Health Law

PAFP CAREER CENTER

ACCELERATE YOUR JOB SEARCH Whether you're just getting started with a

717-238-9905 FAX: 717-238-2443 cia@artzhealthlaw.com

career in health care or you're looking for the next great opportunity, PAFP's online jobs center has the tools you need to accomplish

Preferential Contract Review Rates for PAFP Members Third party payer overpayment and fraud cases Fraud and abuse compliance plan development and implementation Third party payor reimbursement counseling and litigation Medical board licensing defense Medical employment contracts Medical hospital staff privileges/credentialing disputes MCO contract negotiation Physician MCO credentialing/due process Medical practice employee issues Medical corporate transactions HIPAA Privacy Compliance

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T N S E T A THE L INFORMATIO & Y L I NEWS A D ... KP MAGAZINE ARCHIVE VISIT THE BACK CATALOG OF KEYSTONE PHYSICIAN AND MAKE YOUR OWN HEALTH CARE NEWS AND INFORMATION REMIX

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PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS & FOUNDATION 2704 Commerce Drive, Suite A Harrisburg, PA 17110 717-564-5365 • TOLL FREE 1-800-648-562 • FAX 717-564-4235 www.pafp.com

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MANAGING EDITOR Director of Media and Public Relations

Bryan Peach - bpeach@pafp.com

Keystone Physician, member magazine of the PA Academy of Family Physicians, is digitally published four times a year. Editorial opinions and advertisements in this publication do not necessarily reflect the views of the PAFP and Foundation, unless so stated. © 2016. Unless stated otherwise, nothing may be reproduced either wholly or in part without permission from the Editor-in-Chief.

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SUPPORTING MEMBERS WITH

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2017-18 OFFICERS PAFP President PAFP President-Elect Foundation President PAFP and Foundation Treasurer PAFP Board Chair and Immediate Past President

David O'Gurek, MD - Philadelphia Mary Stock Keister, MD - Fogelsville Tiffany Leonard, MD - Willow Grove Chris Lupold, MD - Lancaster Edward Zurad, MD - Erie

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DELEGATES TO THE AAFP CONGRESS Delegate Delegate Alternative Delegate Alternative Delegate

Bradley Fox, MD - Fairview Madalyn Schaefgen, MD - Allentown Dennis Gingrich, MD - Hershey Kevin Wong, MD - Jeannette

BOARD OF DIRECTORS Board Member Board Member Board Member Foundation President Foundation Vice President Student Chair Resident Chair

Margaret Baylson, MD - Philadelphia Tracey Conti, MD - Monroeville D. Scott McCracken, MD - York Mary Scott Keister, MD - Fogelsville James Joseph, MD - Cattawissa Kyle Gleaves - Williamsport Jenna Fox, MD - Lancaster

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CONTENTS

PRESIDENT'S MESSAGE Reflecting on successes, challenges in season of thanksgiving

MEMBER NEWS

PAFP member testifies on the ‘disease of addiction’

PAFP launches opioid resource center

Thanks for supporting us on Giving Tuesday!

FEATURES

Event Coverage: PAFP brings fall fun and CME to Nemacolin

Doctors learn to listen to patients’ stories through narrative medicine

Highlights of the 2018 AAFP Congress of Delegates Meeting in New Orleans

PAFP Leadership Institute kicks off with live event at Nemacolin

COVER STORY Storytelling has the potential to do more than simply entertain. In a recent learning session held at Wellspan York, Catherine Rogers, MFA, MS and Andre Lijoi, MD taught students and residents about the power of utilizing well-crafted narrative practices in medicine.

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WINTER 2018 VOLUME 78 | NUMBER 4

GOVERNMENT AFFAIRS

Pa. election results: Dems gain ground as Wolf gets 4 more years

PAFP 2019-20 State Legislative Agenda

PAFP receives AAFP Leadership in State Government Advocacy Award

PRACTIVE MANAGEMENT Disclosure of patient information in light of the opioid crisis

LEGAL AND COMPLIANCE UPDATE

HIPAA Security violation: Spear phishing cyberattack $16 million fine

Medical marijuana: still illegal under federal law

EDUCATION Online CME Catalog

44 WWW.PAFP.COM

PRESIDENT'S MESSAGE DAVID O'GUREK, MD, President president@pafp.com

Reflecting on successes, challenges in season of thanksgiving n this season of thanksgiving, it’s truly fitting to look back and reflect on the many things for which we should be thankful. I can think of no greater profession than being a family physician. We have the absolute honor and privilege to serve our communities across the Commonwealth. Having the unique opportunity to share in people’s lives, we extend beyond the borders of our biological families to let others into our own lives. In doing so, each of us finds our version of “family.” The PAFP is no different. We are indeed a family dedicated and committed to something greater, and in supporting each other, it’s always a joyous time to reflect on the past year. The PAFP has a lot to be thankful for, starting with a phenomenal staff who work tirelessly and are so incredibly supportive of our specialty and our members. Their efforts and their work often go behind the scenes; however, they truly are an essential part of the foundation of our Academy. This work has clearly facilitated significant successes this year. You do awe-inspiring things every day. The advocacy work that each of you are doing in the exam room, in your practices, in your systems, and in your communities makes an indel6

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ible imprint on the fabric of advancing health. With family physicians completing one out of every four ambulatory visits nationally, our footprint on health is quite large. That work and your inspiration has facilitated interest in our specialty among medical students, with two of our medical schools’ FMIGs winning AAFP Program of Excellence awards this year. We have seen growth in the number of family medicine residency programs across the state with our programs consistently recruiting future leaders in the field. Notably, two of the twelve AAFP awardees for excellence in graduate medical education were from Pennsylvania. While you already do so much to guide our students and residents, I encourage you at this time to consider donations to the FM INSPIRE campaign, which further builds a home for future family physicians. Your commitment and dedication create opportunities for the PAFP to expand and grow our footprint in legislative advocacy work as well as in public health sectors. Your participation in our prior authorization survey and opportunities for reform led to our Academy being awarded one of the AAFP Leadership in State Government Advocacy Awards, the third time we have

won this honor in the past five years. While we face real challenges, your continued focus on opportunity in adversity for the betterment of your patients and your communities is what provides the substance to share with legislators and the public on the value of family medicine in the Commonwealth.

face. A changing health care landscape across the state; public health crises including violence and opioid use disorder; health inequities and social challenges; scope of practice issues; and ever-increasing regulatory demands are realities that the PAFP continues to tackle on your behalf and will do so in the upcoming year.

The PAFP has a proud tradition of investment in leadership. At our most recent CME meeting, we kicked off the PAFP Leadership Institute to assist our members with developing leadership skills to serve them in different settings. At our upcoming meeting, we will be electing our new leaders and have leadership positions available to those interested in applying. We are lucky to have so many leaders within our state that inspire us to spread our wings to regional and national engagement. Our own Dennis Gingrich, former PAFP President and Board Chair, was elected to the AAFPâ&#x20AC;&#x2122;s Board of Directors at the recent Congress of Delegates in New Orleans, and Douglas Spotts, former PAFP President and Board Chair, assumed his role as president of the AAFP Foundation. Many of our members are similarly making their impact nationally.

We have built stronger partnerships with other primary care organizations in the state and will be building bridges with new legislative leadership in Harrisburg. We will continue to strive to be an outspoken leader on public health issues facing our communities as well as working to advance educational opportunities for our members. We will also strive to support current efforts as well as develop new opportunities for students to explore family medicine in the state.

And while I can continue a litany of accomplishments of our members and the great work all of you are doing, I find it important to acknowledge during this time of thanksgiving that we do recognize the challenges that many of you

All of this is possible as we are refreshed by our reflection and our experience of the family of family medicine. That experience enlivens within us the notion to inspire, create, and lead much the way many of you have done over the past year. And so, while I take this time to reflect on what I am thankful for, let me take this opportunity to once again express the sincere privilege it is to serve as your president. And in this season of thanksgiving, clearly one of the things I am thankful for is you. Thank you for all that you are and all that you do. WWW.PAFP.COM

MEMBER NEWS THE LATEST NEWS AND INFORMATION FOR PAFP MEMBERS For more, visit: www.pafp.com

PAFP on twitter

PAFP Connect

PAFP member testifies on the ‘disease of addiction’ On Oct. 2, PAFP member Brad Miller, DO, FAAFP, Program Director for UPMC Susquehanna Family Medicine Residency in Williamsport, provided expert medical testimony on the opioid crisis to The Center for Rural Pennsylvania, a legislative agency of the Pennsylvania General Assembly on the topic “The Disease of Addiction.”

“The politically correct thing to say is that addiction is a disease, it is not a moral failing,” said Sen. Gene Yaw, chairman of the Center for Rural Pennsylvania board. “But we don’t treat it like a disease, we just pay a lot of lip service to the problem.

Miller and other family physicians, as well as Pa. Secretary of Health and Physician General Dr. Rachel Levine, convened at the State Capitol as part of a four-year examination of the statewide opioid crisis, with a focus on treating addiction as a disease. “This is a physiologic, chronic disease of the brain, not something that you can wish away,” said Miller during his testimony and presentation. 8

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“We must remove the stigma around the disease of addiction, and highlight the medication assisted treatment options that are available, such as methadone, buprenorphine and Vivitrol,” he said. Please see the full hearing, including Dr. Miller’s testimony, in this video:

Brad Miller, DO, FAAFP Program Director, UPMC Susquehanna Family Medicine Residency, Williamsport

WINTER 2018

https://www.senatorgeneyaw.com/2018/09/28/ public-hearing-on-thestate-of-addiction/

PAFP launches opioid resource center The PAFP has just launched its Pain Management & Opioid Misuse Resource Center. A comprehensive tool for PAFP members in the wake of Pennsylvania’s massive opioid epidemic, this resource center contains information and education on how family physicians can combat opioid use disorder (OUD). The Pain Management & Opioid Misuse Resource Center is split into four distinct sections: ¡ AAFP Resources The American Academy of Family Physicians (AAFP) has assembled a collection of resources to help physicians guide their patients through pain management issues.

¡ Treatment of Opioid Use Disorder (OUD) Overviews on medication-assisted therapy (MAT), buprenorphine, and other interventions. ¡ PA Licensing Requirements Information on the Pennsylvania Prescription Drug Monitoring Program (PDMP), clarification on education requirements, and more. ¡ PAFP CME Webcasts The PAFP has produced a series of CME webcasts on these topics. The Pennsylvania Academy of Family Physicians will continue to produce education offerings on opioid-related issues (more to be added).

Pain Management & Opioid Misuse Resource Center If you know of an additional resource that visitors to this page may find useful, please click here. WWW.PAFP.COM

MEMBER NEWS

Thanks for supporting us on Giving Tuesday! This year, our Giving Tuesday centered around #FMInspire, our media push in support of the PAFP Foundation. From educational experiences to exciting events that help students and residents invest in their family medicine, the PAFP Foundation is where it all happens. The social media campaign highlighted beneficiaries of the PAFPâ&#x20AC;&#x2122;s Foundation programs with photos and testimonials such as the tweets shown here. To see all of them, check out our full Twitter campaign.

Just because it's no longer Giving Tuesday doesn't mean you can't still support the foundation â&#x20AC;&#x201C; CLICK HERE to donate!

KEYSTONE PHYSICIAN

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PAFP brings fall fun and CME to Nemacolin So, what do you have when more than 200 family medicine providers invade the Laurel Highlands? A fun-filled weekend full of learning and networking with the PAFP for our November CME Conference at Nemacolin Woodlands Resort! The Nemacolin CME Conference kicked-off with a very special keynote speaker, Dr. Dan Diamond, who helped attendees focus their mindset to become more engaged and effective leaders under pressure. Attendees had the opportunity to roll up their sleeves and participate in strategies for problem solving, learning when to use divergent, convergent, and emergent thinking strategies. Throughout the conference, attendees had ample opportunity to get up and move about, both in and out of sessions, learning how to exercise with a purpose with Doug Lentz, MS, CSCS, Director of Fitness and Wellness for Summit Health, who once again energized doctors 12

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as the PAFP keeps wellness front and center at its events. Lentz demonstrated new movements and exercises to help increase blood flow to activate muscles, enhance metabolic reactions, and improve range of motion. In keeping with our board review track, the conference’s first day featured a series of sessions on a previously identified disease state followed by a moderated Q-and-A segment of boardreview-like questions concentrating on that specific area of focus. Each conference offers a different board review segment, and this time it was Nephrology. The PAFP’s CME events always bring a significant number of Patient Safety sessions – in fact, most often, more than the 12 required for each licensure cycle at just one conference. Opioid sessions from Nemacolin that meet state licensure mandates were recorded and are now on the PAFP’s online CME catalog. The Nemacolin CME Conference also marked the inaugural

installment of PAFP’s Leadership Institute. Click here for complete information on this new program. The PAFP would like to extend a hearty thank you to our 2018 corporate supporters. Their support helps keep our costs reasonable, and we love passing these savings on to our valuable members. Keystone Level: MedPro Group and Patient First; Liberty Level: The Beef CheckOff, Capitol One Spark Business, Geisinger, and UPMC Pinnacle; Independence Level: Abbvie, Allegheny Health Network, AmeriHealth Caritas Pennsylvania/AmeriHealth Caritas Pennsylvania Community Health Choices, Dedicated Senior Medical Center, and Primary Health Network; and Patriot Level: Ideal Protein of America, Janssen Pharmaceutical, Kowa Pharmaceuti-

Among the educational sessions at the Nemacolin CME Conference, physicians were able to take a Knowledge Self-Assessment (KSA) study group on the subject of genomics.

cals, Marley Drug, Novo Nordisk, PD-Rx Pharmaceuticals, Inc., Pennsylvania Society of Physician Assistants, Quest Diagnostics, Steward Healthcare – Sharon Regional Medical Center, Summit Health, U.S. Army Healthcare Recruiting, and White Deer Run Treatment Network. Save the dates for these upcoming CME events... March 7-10, PAFP and WellSpan Health join together at the Wyndham Gettysburg March 7 – 10 for an incredible CME conference also featuring PAFP’s Annual Business Meeting and Research Day. From August 8–10, 2019, PAFP will be at the Lake Raystown Conference Center in Entriken, Huntington County for an experiential CME event combining Dermatology and Outdoor Medicine. November 8-10, 2019, the PAFP will be at the Omni Bedford Springs Resort.

One of the features of PAFP CME events is an exhibitors’ hall, where vendors share information and tools with family physicians during breaks in programming.

WWW.PAFP.COM

FEATURE

The registration desk is always a busy place, whether attendees are looking for information or simply want to chat with their friends on PAFP staff.

At the conference, the Government and Practice Advocacy Committee (GPAC) met to discuss legislative priorities and the November general election.

Education at the Nemacolin Woodlands Resort featured a huge number of clinically relevant topics â&#x20AC;&#x201C; many of them patient safety â&#x20AC;&#x201C; such as eating disorders, nephrology, diabetes, chronic pain, and clinically integrated networks.

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Primary care opportunities Geisinger is seeking experienced and newly graduated providers to join our growing primary care team throughout central, south-central and northeast Pennsylvania. Geisinger’s primary care model Access and quality care are top strategic priorities for Geisinger. Team members from all areas collaborate to continually improve and produce best-in-nation outcomes and experience for both patients and providers with a focus on: • Patient appointments: Twenty-minute appointments for routine visits and 45-minute appointments for our elderly patient population (age 65+) • Daily huddles: With all care team members to review schedules, patients, resource needs and coordination of care. • Support staff: Including nursing, clinical staff, clerical staff, pharmacists, care managers, health managers, clinic health associates and coding educators • Electronic health record: Epic, our fully integrated system A special reception including delicious hors d’oeuvres and wine allowed attendees to spend some time with vendors in the exhibitors’ hall.

• Teaching opportunities: Training the next generation of physicians, advanced practitioners, nurses and other healthcare professionals Incentives: • Competitive compensation: Base salary model • Loan repayment: Many sites qualify for the Pennsylvania State Loan Repayment Program • Visa sponsorship available: H1b and limited J1 • Benefits: Comprehensive medical/retirement benefits effective day 1 • Medical malpractice: Claims made with tail coverage • Relocation: No dollar limit to move normal household goods, paid house-hunting trip, temporary storage and more • CME: Paid CME days and funds for CME activities For more information, visit GeisingerJobs.org/community-medicine or contact: Tammy Bonawitz: tlbonawitz@geisinger.edu or 570-214-4777

All PAFP conferences feature live event coverage on Twitter with the hashtag #pafpcme. Here, PAFP EVP and CEO John Jordan, MD poses for a quick social snap with his wife, Bonnie.

Miranda Grace: mlgrace@geisinger.edu or 717-899-0131

FEATURE

Keynote speaker Dan Diamond, MD presented a compelling lecture on thriving under pressure, featuring wisdom he learned from recovery efforts during Hurricane Katrina.

More than 200 family physicians joined the PAFP at the Nemacolin Woodlands Resort for the weekend-long event.

Other CME topics presented at the conference included an ophthalmology, osteopathy, womenâ&#x20AC;&#x2122;s health, adult immunizations, and opioid prescribing guidelines.

Doug Lentz, MS, CSCS, Director of Fitness and Wellness for Summit Health covered exercise during breaks.

Dan Diamond, MD followed up his keynote speech with a workshop on disaster improvisation and problem solving under pressure.

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Doctors from across the state get ample opportunities to sit down, have a bite, and catch up with old friends.

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Visit www.pafp.com for details and registration WWW.PAFP.COM

The Latest Health Care News...

The Pennsylvania Academy of Family Physicians’ PAFP Connect app is available no (iPhone, iPad) and Android (Samsung Galaxy, Google Nexus, Motorola Moto X, Ama

Scouring the latest headlines from reputable media sources across the globe, PAFP Connect brings you the most relevant, up-to-date news and information that affects your practice and your patients. At 1 p.m. daily, PAFP Connect posts the Afternoon Family Medicine news digest – headlines that take a deeper look at family medicine in the U.S., covering all the angles so that you can head into the rest of the day with a deeper understanding of the forces that impact you.

Available Now! Downloading the app is easy! Just search for PAFP Connect on your iPhone’s app store to get started. Alternatively, click on the icon for the app store that matches your device.

Afternoon Family Medicine puts the news into context, telling you what it means and why you should care. In addition to collaborative groups, information, a schedule of events, and links to other PAFP resources like Keystone Physician, Afternoon Family Medicine is one more reason to log on to PAFP Connect daily.

PAFP Connect was built in-house exclusively for PAFP members. To access the mobile app you will need to know your AAFP member ID number. For login assistance, email Michael Zigmund, PAFP’s Chief Communication Offic 18

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. Everyday.

ow for download on iOS azon Kindle Fire) devices!

cer WWW.PAFP.COM

Andre Lijoi, MD

Catherine Rogers, MFA, MS

Associate Program Director, Wellspan York Hospital Family Medicine Residency Program

Lecturer, Columbia University Narrative Medicine Department

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FEATURE

Doctors learn to listen to patients’ stories through narrative medicine aculty and residents at WellSpan York got a chance to listen to stories – and tell some of their own – at a recent learning session on the topic of narrative medicine. Playwright and performer Catherine Rogers, MFA, MS of Columbia University delivered WellSpan’s second annual Hoover Lecture (see editor’s note at the bottom of this piece). Rogers is a lecturer at Columbia’s Narrative Medicine Program, which centers around the foundational aspects of the practice: close listening, representation of what is heard or seen, and the rich affiliation with patients that consequently occurs. What does this look like in practice? A major portion of the lecture involved a group reading – including the participation of everyone in the room – of a modern take on Euripides’ ancient Greek tragedy The Trojan Women, with each reader taking on the role of a woman from Troy after the Athenians destroyed the

city and killed all the men. Participants were then asked to write their own lines for a “part two” of the play, once again embodying a Trojan woman, this time reacting to their first time viewing Greece from a boat upon arrival in their new home. The purpose of the exercise was simple, but profound: we all have a story to tell. Some are triumphant, some are tragic, but these narratives affect the way physicians see, relate to, and ultimately treat their patients. “Some responses expressed dread, some fear, some hope, some were light and funny,” said Stacy Robert, MD, Family Medicine Residency Program Director. “I felt like it mimicked the way different patients experience illness – each person experiences the same thing differently. “We must observe carefully how our patients embrace the next steps in their journey and WWW.PAFP.COM

FEATURE meet them there if we want to serve them best,” Robert said. “We all have a role in the care of our patients that was demonstrated by the diversity of the participants and the way each participated. I felt connected to each person who helped ‘write the next line.” Andre Lijoi, MD, Associate Program Director for the Wellspan York Hospital Family Medicine Residency Program, who brought Rogers to Wellspan, said his love of narrative medicine began nearly two decades ago.

said Lijoi. “At Columbia, I’m learning from the best in this field. They pioneered it, and really are quite a troupe of explorers: undaunted, curious, visionary, and gifted. Catherine was one of our lecturers at the workshops, and I just remembered what a compelling presenter she was – articulate, engaging, and compassionate about narrative medicine. “She’s got this profound understanding of family medicine,” he said.

“I first learned about narrative medicine from an article that [narrative medicine founder] Rita Charon, MD, Ph.D. in literature, published around 2000 about narrative medicine,” said Lijoi. “However, I discovered it on my own when I was working in Appalachia in the ‘80s, my first job in after residency. “The people in Appalachia, their tradition was narrative,” he said. “Even when you asked a scripted question, they’d give an unscripted answer. Eventually, I discovered how helpful the accounts these patients were giving of themselves were in caring for them. I didn’t have a name for it, and I didn’t have a methodology, until I met Dr. Charon.”

Andre Lijoi, MD discusses a close reading of a passage from The English Patient during the faculty portion of the narrative medicine event.

Lijoi, who is taking courses in Columbia University’s Narrative Medicine program, said Rogers was a perfect fit for the Hoover Lecture event. “I was approached to find someone in narrative medicine to bring to the Hoover Lecture,” 22

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Event attendees had the opportunity to write for themselves and workshop their material with their colleagues.

THE

PAFP FOUNDATION Your donation builds a home for future docs

â&#x20AC;&#x153; For continued growth of the PAFP Foundation and to help the organization support its members through advocacy and education it needs ongoing support for all its members so that we as family physicians continue to provide the best health care in our communities.â&#x20AC;? Munima Nasir, MD Penn State Hershey Medical Group Middletown, PA

An all new online donation form makes giving simple and fast.

DONATE TODAY CLICK HERE

Thank you for your support! FM InSpIRe (Family Medicine INfluencing SPecialty Interest REvolution) is a new PAFP initiative to create awareness 23 WWW.PAFP.COM || 23 of the PAFP Foundation and raise funds that directly support residents andwww.pafp.com students.

FEATURE Lijoi – who has lectured or presented on narrative medicine 50 times in the last two years – said he’s still positively reeling from the event. “I just got a rush,” he said. “It took me a week for my feet to hit the ground again. I get chills when I think about it.” The Hoover Lecture program is endowed by the family of the late, longtime York family physician Dean Strayer Hoover, MD, who was committed to lifelong learning and medical education. This endowment is aimed at promoting the intended purpose of medicine and family medicine: the cutting-edge care of patients, steeped in caring.

For those wanting to know more about Narrative Medicine and hear Dr. Lijoi....join us at the March CME Conference in Gettysburg and hear Dr. Lijoi first-hand! Click here for the current Gettysburg agenda.

A reading of the ancient play The Trojan Women featured some excellent off-the-cuff acting from every person in the room.

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To learn more, contact Recruitment Coordinator Eleanor Hertzler at 804-822-4478 or eleanor.hertzler@patientfirst.com, or visit www.patientfirst.com/PatientFirstCareers

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Family Medicine Opportunities in Southeastern PA Tower Health Medical Group, a non-profit affiliate of Tower Health, is seeking boardcertified/board-eligible Family Medicine Primary Care physicians to join our community and provide medical services in the general care and treatment of patients in an existing outpatient practices in SE Pennsylvania.

Tower Health Medical Group is a physician network with 2,000 physicians, specialists and providers across 75 convenient locations. We offer leading-edge, compassionate healthcare and wellness services to a population of 2.5 million people.

Tower Health Medical Group Opportunity Locations: •

Berks County: • Chester County: - Birdsboro - Downingtown - Kenhorst - Exton - Kutztown - Oxford - Wyomissing - West Grove

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Montgomery County: - Norristown

Tower Health is a strong, regional, integrated healthcare provider/ payer system that offers leading-edge, compassionate healthcare and wellness services to a population of 2.5 million people. With 11,000 team members, Tower Health includes six acute-care hospitals: •Reading Hospital, a teaching hospital based in West Reading •Brandywine Hospital in Coatesville •Chestnut Hill Hospital, a teaching hospital in Philadelphia •Jennersville Hospital in West Grove •Phoenixville Hospital in Phoenixville •Pottstown Hospital in Pottstown Tower Health also includes: •Reading Hospital Rehabilitation at Wyomissing •Reading Hospital School of Health Sciences •All Tower Health facilities participate in our provider-payer plan, Tower Health/UPMC Health Plan

We offer: • Competitive salary • Comprehensive benefits, including health, • • • • • • • •

professional liability and disability insurance Generous time-off allowance Educational Loan Assistance Relocation assistance CME stipend Occurrence-based malpractice insurance 403(b) and 457(b) retirement plans H1-B and Green Card support Supportive health system to advance goals For additional information contact: Tameka Pizarro, Medical Staff Recruiter 484-628-4523 Tameka.Pizarro@towerhealth.org www.towerhealth.org careers.towerhealth.org

Equal opportunity employer.

GOVERNMENT AFFAIRS BRENT ENNIS, Deputy Executive Officer / Chief Operation Officer bennis@pafp.com

Pa. election results: Dems gain ground as Wolf gets 4 more years lection night 2018 sealed another four years for Gov. Tom Wolf, and Democrats gained ground in both the Pa House and Senate. In the House, Democrats had 14 pickups – eight where GOP incumbents were defeated and six open seats due to retirements, taking the House party tally to 110 Republicans and 93 Democrats, with two vacancies that will exist through swearing-in day in January, 2019. On the Senate side, Democrats flipped five seats. This ends the Republican’s “super majority” in the Senate that aided in Senatorial

appointments and tentatively brings the Senate to 29-21. Both Sen. Majority Leader Jacob “Jake” Corman and House Speaker Mike Turzai fended off tough challengers, as did Senate Appropriations Chairman Pat Browne who won by 3 percent. Please note that the PAFP Political Action Committee Board of Directors, chaired by Dr. Mike Baxter, will be hosting a fundraising reception on Thursday evening, March 7 at the Wyndham Gettysburg beginning at 6:30 p.m. Your support is critical, and we hope you will be able to attend.

2019-2020 PA SENATE AND HOUSE LEADERSHIP ELECTION RESULTS (as of 11/19/2018) SENATE REPUBLICAN LEADERSHIP Interim President Pro Tempore: Joe Scarnati (R-Jefferson) Leader: Jake Corman (R-Centre) Appropriations Chairman: Patrick Browne (R-Lehigh) Whip: John Gordner (R-Columbia) Caucus Chair: Bob Mensch (R-Montgomery) Caucus Secretary: Richard Alloway (R-Franklin) Caucus Administrator: To be appointed by the President Pro Tempore Policy Chair: David Argall (R-Schuylkill) 26

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SENATE DEMOCRATIC LEADERSHIP Leader: Jay Costa (D-Allegheny) Appropriations Chair: Vincent Hughes (D-Philadelphia) Whip: Anthony Williams (D-Philadelphia) Caucus Chair: Wayne Fontana (D-Allegheny) Caucus Secretary: Larry Farnese (D-Philadelphia) Caucus Administrator: John Blake (D-Lackawanna) Policy Chair: Lisa Boscola (D-Northampton) HOUSE REPUBLICAN LEADERSHIP Speaker-Nominee: Mike Turzai (R-Allegheny) Leader: Bryan Cutler (R-Lancaster) Appropriations Chairman: Stan Saylor (R-York) Whip: Kerry Benninghoff (R-Centre) Caucus Chair: Marcy Toepel (R-Montgomery) Caucus Secretary: Mike Reese (R-Westmoreland)

HOUSE DEMOCRATIC LEADERSHIP Leader: Frank Dermody (D-Allegheny) Appropriations Chairman: Matt Bradford (D-Montgomery) Whip: Jordan Harris (D-Philadelphia) Caucus Chair: Joanna McClinton (D-Philadelphia) Caucus Secretary: Rosita Youngblood (D-Philadelphia) Caucus Administrator: Neal Goodman (D-Schuylkill) Policy Chair: Mike Sturla (D-Lancaster)

WWW.PAFP.COM

GOVERNMENT AFFAIRS

PAFP 2019-20 State Legislative Agenda NURSE PRACTITIONER INDEPENDENCE Nurse practitioners (NPs) are integral, valuable members of the health care team, held in the highest regard by family physicians. However, patients are best served when a physician-led, highly coordinated health care team provides care. Therefore, the PAFP opposes legislation that would expand their scope of practice and eliminate collaborative agreements. PRIOR AUTHORIZATION REFORM Prior authorizations have become significantly burdensome to family physicians, and more importantly result in delays and jeopardized quality care to patients. The PAFP supports reforms that would maximize electronic communications for authorizations as well as adverse determinations, and define consistent response times for authorizations, rejections, appeals, and external utilization review. 28

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DIRECT PRIMARY CARE (DPC) AUTHORIZING LEGISLATION DPC is a model of care outside the bounds of health insurance and an emerging option for patients and physicians. The PAFP supports legislation that specifies direct primary care agreements are not insurance and therefore not subject to insurance laws or regulations. HEALTH INSURER CREDENTIALING REFORM Delays in credentialing of new physicians or existing physicians changing practices create undo hardships most notably on the communities they serve. The PAFP supports legislation that would standardize the credentialing form and set processing standards. RESTRICTIVE COVENANTS In this age of health system consolidations, the PAFP supports legislation limiting restrictive

David O'Gurek, MD, PAFP President Every legislative session, the PAFP develops a state legislative agenda to guide its advocacy over that two-year period. For the 2019-20 Pennsylvania legislative session, the PAFP released its agenda in a live Facebook event, coinciding with a survey allowing PAFP members to rank these legislative action items in order of importance to them. This will help the Government and Practice Advocacy Committee (GPAC) to determine how best to prioritize its advocacy efforts over the next two years.

covenants in health care practitioner employment agreements. BUPRENORPHINE MEDICALLY ASSISTED TREATMENT ACT Access to care for patients suffering from substance abuse disorder is critical, and state regulation could significantly jeopardize access to office based opioid treatment (OBOT). The PAFP opposes legislation that would require prescribers of buprenorphine to be licensed by the state and pay any state licensing fee. POLST LEGISLATION Working with the Pennsylvania Medical Society, the PAFP supports updating and revising Pennsylvania law to include codification of Pennsylvania Orders for Life Sustaining

Treatment (POLST) to be used by medical professionals across all health care settings for patients who voluntarily wish to execute a POLST order. WORKPLACE ACCOMMODATIONS FOR NURSING MOTHERS The PAFP supports legislation that requires employers to provide employees time to express breast milk in a sanitary environment for her nursing child. The PAFPâ&#x20AC;&#x2122;s State Legislative Agenda is developed through the Government and Practice Advocacy Committee with position decisions made by the Board of Directors. Questions or comments? Please contact Brent Ennis, PAFP Deputy EVP/COO and State-Registered Lobbyist at bennis@pafp.com. WWW.PAFP.COM

GOVERNMENT AFFAIRS

PAFP receives AAFP Leadership in State Government Advocacy Award Susan Fidler, MD, Chair of the PAFP Government and Practice Advocacy Committee, accepted the American Academy of Family Physicians’ (AAFP) Leadership in State GovSue Fidler, MD ernment Advocacy Award on behalf of the PAFP at the AAFP Annual State Legislative Conference. The PAFP was

recognized for its advocacy work on the issue of prior authorization reform. Through PAFP members' overwhelming response to a survey, the results have aided in advancing the issue with lawmakers. “This is an important issue to our members and the patients we serve, and we’ll continue to push for practical reforms with our state legislature in 2019,” said Fidler.

T h e Pe n n sylva n ia Ac a d e m y o f F a m ily P hy s i ci ans

Political Action Committee

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www.pafp.com | 30

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FEATURE IN-DEPTH COVERAGE ON TOPICS THAT MATTER MOST TO YOU Join the discussion on this topic and others at PAFP Connect

Highlights of the 2018 AAFP Congress of Delegates Meeting in New Orleans hapter Delegates assembled in New Orleans for the 2018 AAFP Congress of Delegates. Five Reference Committees heard testimony related to treating opioid use, national immunization registry, climate change, AAFP board certification, graduate medical education funding, PCP services, prior authorization reimbursement, electronic health records, single payer, elective abortions, and gun violence prevention. There were many other issues related to patient care and practice management. John Cullen, MD of Alaska, was installed as the 71st President of the American Academy of Family Physicians. The AAFP Congress of Delegates elected Gary LeRoy MD, of Ohio as the Academy's President-Elect. Others elected or chosen by acclamation for the following positions: • Speaker of the Congress – Alan Schwartzstein, MD of Wisconsin • Vice Speaker of the Congress – Russell Kohl, MD of Kansas • Board Directors – James Ellzy, MD of Uni32

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formed Services; Dennis Gingrich, MD of Pennsylvania; Tochi Iroku-Malize, MD of New York • New Physician Board Director – La Tasha Seliby Perkins, MD of Washington D.C. • Resident Board Director – Michelle Byrne, MD of Illinois • Student Board Director – Chandler Stisher of Alabama Highlights of a few resolutions are highlighted below. You can review all resolutions by going to the AAFP website at www.aafp.org. ADVOCACY The New York Chapter introduced a resolution titled “Single Payer as a Viable Option to America’s Health Care Crisis and the Need to Educate Physicians about Single Payer.” The resolved is for the AAFP to actively support for a single payer national health plan in its advocacy for health system reform. The reference committee heard testimony both in support of and opposition to the resolution.

Those who supported the resolution suggested the AAFP take a leadership role in favor of a single payer health system. Opponents noted the challenges of the military health system. The reference committee recommended that substitute language be adopted; the AAFP make available the data and conclusions of the 2017 board report on single payer health care system and the 2018 board report on health care for all in AAFP education and policy programs in the areas of health-care policy, healthcare economics and health-care systems. The Congress of Delegates approved the recommendation. The Minnesota Chapter introduced a resolution for “Health Care Payment Reform.” The resolved is that the AAFP ask the government to give a medical tax credit for US citizens buying direct primary care to transform American medical care into a more efficient primary care based personal health care. The reference committee heard support for the resolution, noting that employers receive a substantial tax benefit for employer-provided health insurance. The reference committee substituted the language as “AAFP support tax relief for those individuals purchasing direct primary care services similar to those tax benefits provided to employers.” The Congress of Delegates approved the recommendation. The Louisiana Chapter introduced a resolution titled “Elective Abortions.” The American

The PAFP’s own Dennis Gingrich, MD won his election for the American Academy of Family Physicians Board of Directors. Congratulations, Dr. G.!

Academy of Family Physicians opposes the performance of elective abortions in the United States at and after 20 weeks gestational age. Testimony in support of the resolution outlined statistics on American opinions on third trimester abortion from Gallup polls. In addition, there was shared patient stories, and the ethical dilemmas of partial-birth abortions were noted. There were several delegates testifying in opposition of the resolution, stating that this is not evidence-based science and would interfere with the doctor-patient relationship. The reference committee recommends the resolution not be adopted. The Congress of Delegates approved the committee’s recommendation. WWW.PAFP.COM

FEATURE ORGANIZATION AND FINANCE The Colorado Chapter introduced a resolution “Clean Energy Challenge: Take Action” and asked that the AAFP create a Clean Energy Goal to power at least 50 percent of our national offices, large meetings, and chapters using renewable energy, and that this goal can be adjusted annually for relevancy either after five years or upon achievement of the goal. In addition, the AAFP challenged both national offices and chapters to investigate and act on their own fiscally responsible local options to achieve the Clean Energy Goal of 50 percent renewable energy usage within their own business practices, not inclusive of or limited to energy efficiency audits and/or the purchase of renewable energy. Lastly, the national office and chapters would voluntarily report back to the AAFP about their progress or challenge in taking action towards Clean Energy Goal of 50 percent renewable energy usage. Testimony was heard in support of the need for the AAFP and its chapters to create a clean energy goals and to use renewable energy to power national and chapter offices and meetings. Chapters would not be required to join in on this effort but there is a greater chance of success in national and chapters working on this together. Timelines and progress towards the goal can be shared with members. There was an amendment from the Congress of Delegates that the AAFP establish a specific and measurable energy goal and share timeli34

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ness and progress toward the goal with members and encourage chapters to the same. The Congress of Delegates approved the amendment. The Wisconsin and Texas Chapters introduced a resolution “Address the Growing Loss of Rural Obstetrical Services,” that the AAFP and commissions work with the National Rural Health Association (NRHA), the American College of Obstetricians and Gynecologists (ACOG), and other engaged groups to address the growing loss of rural obstetrical services. The reference committee heard testimony in support of the resolution. A study by the Agency for Healthcare Research and Quality (AHRQ) identified a 45 percent increase in the number of serious and potential life-threating complications in childbirth. One reason for

the increase might be due to the shrinking number of family physicians offering obstetrical services. The number of rural hospitals closing across the country continues to grow. The AAFP needs to better align itself with its rural health partners to address this crisis. The Congress of Delegates approved the recommendation. PRACTICE ENHANCEMENT The Minnesota Chapter introduced a resolution titled “Protect the Future of Family Physicians and Our Patients.” The American Academy of Family Physicians would develop a policy to promote the appropriate compensation of physicians for oversight or nurse practitioners and physician assistants. In addition, the AAFP would support legislation that ensures patients receive accurate health care information by prohibiting misleading and deceptive advertising or representation in the provision of health care services. The reference committee heard testimony solely from the author of the resolution in support. The author noted it would be helpful to have a policy that members could take to their hospitals to improve payment. The reference committee recommended to refer the language, “The American Academy of Family Physicians develop a policy to promote the appropriate compensation of physicians for oversight or nurse practitioners and phy-

sician assistants” to the Board of Directors. The reference committee recommended to reaffirm the second resolved, “the AAFP support legislation that ensures patients receive accurate health care information by prohibiting misleading and deceptive advertising or representation in the provision of health care services” as current policy. The Congress of Delegates approved the committee’s recommendation. The Michigan Chapter introduced a resolution titled “Reimburse Family Physicians for Mental Health Care Services.” The AAFP would convene a meeting with the Relative Value Scale Update Committee, Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, National Health Plans, and other appropriate organizations to mandate full and adequate reimbursement of primary care physician-directed and supervised mental health. The reference committee heard limited testimony, most of which was in support of the resolution and its intent. Supporters of the resolution noted the cost-effective value of treating mental and behavioral health conditions within the context of primary care. Opposition stressed that AAFP lacks the convening authority described in the resolution and already routinely advocates with public and private payers on this issue. The reference committee decided the underlying issue addressed by the resolution merited further study and action by the AAFP, although the WWW.PAFP.COM

FEATURE committee was not persuaded that convening a meeting, as requested by the resolution, was necessarily the best action for the AAFP to take. The reference committee recommends the resolution be referred to the Board of Directors. The Congress of Delegates voted to support the recommendation. EDUCATION The Florida Chapter introduced a resolution titled “AAFP Board Certification.” The resolved is that AAFP commit to, by the year 2020, the development and implementation of an AAFP board certification in Family Medicine. In addition, the AAFP would commit to the development and implementation of an AAFP Board Certification in Family Medicine by 2020, expand the board certification process by 2021 to include the certificates of added qualifications (adolescent, geriatric, hospice and palliative, pain, sleep, and sports). Opposition indicated the new ABFM leadership is

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hearing the concerns of AAFP members and ABFM Diplomates and developing better alternatives. Lastly, the cost and complexity of launching a new certifying board would be prohibitive. The reference committee believes the specialty will be best served by collaboration among family medicine organizations such as the AAFP and the ABFM. The committee recommended the resolution not be adopted and the COD decided not to approve. The Arizona Chapter introduced a resolution “Increase Opioid/Pain Management CME to Help Members Meet State Prescribing Requirements.” The resolution would ask the AAFP to create and make available continuing medical education in various forms, such as video modules and written materials that can assist to fulfill state opiate prescribing CME requirements for its members. The reference committee heard considerable testimony for and against the resolu-

tion. Testimony in support of the resolution indicated that it would help physicians whose state medical licensing boards require continuing medical education on the topic to have access to affordable, high quality noncommercially influenced CME. Testimony in opposition to the resolution noted sufficient high quality, affordable CME currently available to meet the requirements and that the constituent chapters are more appropriately positioned to develop CME to address those state-specific requirements. The Reference Committee recommended the resolution as written not be adopted in light of those concerns. The Congress of Delegates voted not to adopt the resolution. HEALTH OF THE PUBLIC & SCIENCE The New York Chapter introduced a resolution titled “Institutional Racism in the Health Care System.” The AAFP would adopt a policy opposing segregation of patient care within the health care system and within health care institutions by race, insurance status, or other demographics. In addition, the AAFP Center for Diversity and Health Equity would develop materials and provide education to increase awareness of how racism is manifested through institutional policies and how segregated care within the health care system is a cause of racial disparities in health outcomes. The reference committee heard testimony in favor of the resolution. The U.S. health system is racially segregated, with insurance

coverage and socioeconomic status as proxy. Testimony asked for the AAFP to raise awareness about and develop policies to fight segregation in our health system. The reference committee agreed that segregation should be specifically addressed by AAFP policy and that the resolution aligns with the ongoing work of the Center for Diversity and Health Equity. The reference committee recommended the resolution be approved. The Congress of Delegates approved the resolution. The Oregon and Wisconsin Chapters introduced a resolution “Reducing Gun Violence.” The AAFP would support sensible restrictions on gun ownership at the state level, support enforcement of existing gun laws, and support state laws that would protect children from dangerous or unsupervised gun use. The reference committee heard mixed testimony for and against the resolution asking the AAFP support sensible restrictions on gun ownership. Testimony in support of the resolution cited current statistics related to gun violence and the need to protect the health and well-being of patients, particularly children. Opposing views cited concerns around the interpretation of sensible restrictions and the potential implementation issues at the state level. The reference committee recommends the resolution be reaffirmed as current policy. The Congress of Delegates approved the resolution. WWW.PAFP.COM

FEATURE IN-DEPTH COVERAGE ON TOPICS THAT MATTER MOST TO YOU Join the discussion on this topic and others at PAFP Connect

PAFP Leadership Institute kicks off with live event at Nemacolin The PAFP kicked off its Leadership Institute with its first-ever live event coinciding with the Nemacolin CME Conference in November. The event, featuring executive coach and consultant Geno Schnell, Ph.D. as facilitator, featured in-depth discussion of why leadership matters in family medicine and reallife testimonials of how leadership skills have proved themselves invaluable in real-world scenarios. Appearing exclusively on video were several leaders from different fields: Alex Fried and Laszlo Varga of Proctor & Gamble headquarters in Mehoopany, Pennsylvania; Coach Ken Niumatalolo of the U.S. Navy football team; and incoming PAFP President Mary Stock Keister, MD. Each of these speakers shared unique angles on leadership, from the importance of compassionate decision-making and executing a successful plan to what parenting and military service can teach a family physician about leadership. The PAFP has several Leadership Institute events right around the corner! Register for one or all of these dynamic and impactful sessions. 38

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(clockwise) Alex Fried and Laszlo Varga of Proctor & Gamble, Coach Ken Niumatalolo of the U.S. Navy football team, incoming PAFP President Mary Stock Keister, MD

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PRACTICE MANAGEMENT SUSAN ORR, Esq., Rhoads & Sinon, LLP sorr@rhoads-sinon.com

Disclosure of patient information in light of the opioid crisis he Office of Civil Rights recently issued guidance explaining when HIPAA permits health care providers and other covered entities to share a patient’s health information with loved ones and other involved in a patient’s care when confronted with an overdose. Generally, HIPAA prevents a covered entity from disclosing a patient’s protected health information unless disclosure is authorized by the patient or if it meets any of the HIPAA permitted disclosures. Although HIPAA has been the law for many years, questions continue to arise as to when covered entities are legally permitted to share patient information. Provided below is a summary of the circumstances under which HIPAA allows covered entities to share information. HIPAA regulations allow health professionals to share health information with a patient’s loved ones in emergency or dangerous situations. Family support is crucial to the proper care and treatment of people experiencing a crisis situation, such as an opioid overdose. Health care providers have broad ability to share health information with patients’ family members dur40

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ing certain crisis situations without violating HIPAA privacy regulations. HIPAA allows health care professionals to disclose some health information without a patient’s permission under certain circumstances, including: • When the patient is incapacitated or unconscious. Sharing health information with family and close friends who are involved in care of the patient is permissible if the provider determines that doing so is in the best interests of an incapacitated or unconscious patient and the information shared is directly related to the family or friend’s

involvement in the patient’s health care or payment of care. For example, a provider may use professional judgment to speak to parents of an individual incapacitated by an opioid overdose about the overdose and related medical information. However, medical information unrelated to the overdose cannot be shared without an authorization from the patient. Under the minimum necessary requirement of HIPAA, only that information necessary for the intended purpose may be disclosed. • A duty to warn. Patient information may be shared with those individuals in a position to prevent or lessen a serious and imminent threat to a patient’s health or safety. For example, when a patient has overdosed on opioids, a health care provider may inform family, friends, or caregivers of the opioid abuse after determining, based on the facts and circumstances, that the patient poses a serious and imminent threat to himself or herself through continued opioid abuse. On the other hand, if the patient has the capacity to make decisions, a health care provider must provide a patient with the opportunity to agree or object to the physician sharing health information with family, friends, and others involved in the individual’s care or payment for care. If the patient has the capacity to make their own health care decisions and objects to the sharing of their information, the physician is not permitted to share health information

unless there is a serious and imminent threat of harm to health or safety of the patient or other individual, as described above. A patient’s decision-making capacity may change during the course of treatment. Therefore, when a patient regains the capacity to make health care decisions, the provider must offer the patient the opportunity to agree or object before any additional sharing of health information. For example, a patient who arrives at an emergency room severely intoxicated or unconscious will be unable to meaningfully agree or object to information-sharing upon admission but may have sufficient capacity several hours later. Nurses and doctors may decide whether sharing information is in the patient’s best interest, and how much and what type of health information is appropriate to share with the patient’s family or close personal friends, while the patient is incapacitated so long as the information shared is related to the person’s involvement with the patient’s health care or payment for such care. If a patient’s capacity returns and the patient objects to future information sharing, the provider may still share information to prevent or lessen a serious and imminent threat to health or safety as described above.

Any questions regarding this article or to discuss HIPAA, please contact Susan Orr, Esquire, at Dilworth Paxson, LLP. Her contact information is as follows: sorr@dilworthlaw.com, 610-423-4200. WWW.PAFP.COM

LEGAL AND COMPLIANCE UPDATE CHARLES I. ARTZ, Esq., General Counsel cia@artzhealthlaw.com

HIPAA Security violation: Spear phishing cyberattack - $16 million fine new Office for Civil Rights (“OCR”) case imposing a $16 million fine and a corrective action plan against a covered entity for violating the HIPAA Security regulations based on a malicious software attack is important for family physicians to consider for compliance purposes. In In re Anthem, Inc., cyber-attackers gained access to Anthem’s Information Technology system through an undetected, continuous and targeted cyberattack for the apparent purpose of extracting data. This is known as an “advanced persistent threat attack.” The cyber-attackers infiltrated Anthem’s system through “spear phishing” emails after at least one employee responded to the malicious email and opened the door to further attacks. The cyber-attackers stole the electronic protected health information (“ePHI”) of almost 79 million people, including names, social security numbers, medical identification numbers, addresses, dates of birth, email addresses and employment information. OCR found the following potential violations of the HIPAA Security regulations occurred: 42

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1. The requirement to conduct an accurate and thorough risk analysis of the potential risks and vulnerabilities to the confidentiality, integrity and availability of all PHI. 2. The requirement to implement sufficient procedures to regularly review records of information system activity. 3. The requirement to identify and respond to detections of the security incident leading to the breach. 4. The requirement to implement sufficient technical policies and procedures for electronic information systems that maintain ePHI to allow access to only those persons or software programs that have been granted access rights under the regulations. 5. The requirement to prevent unauthorized access to ePHI. The $16 million fine was three times higher than the highest previous fine imposed by OCR. In practical terms, OCR found that Anthem failed to implement appropriate measures for detect-

ing hackers who gained access to their system to harvest passwords and steal people’s private information. They should have, but failed to, implement strong password policies and to monitor and respond to security incidents in a timely fashion. The compliance take-home points for family physicians’ Information Technology systems, HIPAA Security compliance and avoidance of fines and potential civil litigation include the following: 1. Routinely conduct “enterprise-wide” risk analysis. 2. Make sure sufficient procedures are in place to regularly review information system activity. 3. Promptly identify and respond to suspected or known security incidents. 4. Implement minimum access to controls to prevent cyber-attackers from accessing sensitive ePHI. 5. Train all staff about “spear phishing emails.” Our research independent of the decision indicates that, although an email may appear legitimate, some key indicators to identify an email as spear phishing can include: • A sender’s email address and name that does not contain the exact syntax of the name usually received by that sender.

• Spelling errors in the subject line of an email. • Generic addressee title such as “Dear Email User” or “Valued Member/Customer.” • An official looking link embedded in the email that goes to a malicious page. By placing your cursor over the link, a pop-up box will show the link’s actual address. If this address looks suspicious, do not click on the link. • Downloading an attachment that contains malware. All email attachments should be scanned using antivirus scanning software to ensure the safety of opening attachments. WWW.PAFP.COM

LEGAL AND COMPLIANCE UPDATE

Medical marijuana: still illegal under federal law new Philadelphia federal court decision addressing the conflict between federal drug laws and the Pennsylvania Medical Marijuana Act is important to consider in the context of medical marijuana certifications. In U.S. v. Bey, ___ F.Supp.3d ___ (E.D. Pa. 2018) (2018 WL 5303323), Bey pled guilty to conspiracy to manufacture and distribute cocaine and was sentenced to 120 months in federal prison followed by five years of supervised release. The terms of his supervised release prohibited him from committing another federal, state or local crime or unlawfully possessing a controlled substance except as prescribed by a physician. Bey obtained a medical marijuana prescription from his physician. During a meeting with his probation officer, he admitted to use of medical marijuana and tested positive for marijuana. He alleged he was prescribed medical marijuana as pain management to relieve chronic pain and that other medicines either exhausted him or otherwise affected his other prescriptions. Once the federal authorities confirmed his medical marijuana use, they attempted to have 44

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his supervised release modified. He claimed he acted on the advice of his physician and his attorney who advised him that it was permissible for him to use medical marijuana for pain management under Pennsylvania law. The federal court made the following important legal holdings: 1. Marijuana is contraband for any purpose. Marijuana continues to be characterized as a Schedule I drug under the federal drug laws. Congress expressly found that marijuana has no acceptable medical use.

2. The defendant’s use of medical marijuana is contrary to federal law in the context of his supervised release. 3. As a Schedule I drug, Congress classified marijuana as the most restricted designation for drugs having a high potential for abuse, lack of any accepted medical use, and absence of any accepted safety for use in medically supervised treatment. 4. The federal Controlled Substances Act contains no exception – express or implied – for medically-prescribed mari-

juana. The United States Supreme Court several years ago confirmed that position. 5. Specifically, the U.S. Supreme Court held that implying a medical necessity exception for marijuana is at odds with the terms of the Controlled Substances Act, which reflects a determination that marijuana has no medical benefits worthy of an exception outside of government approved research projects. The U.S. Supreme Court further held that marijuana has no currently accepted medical use at all.

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LEGAL AND COMPLIANCE UPDATE

This is the first Pennsylvania case we have seen specifically addressing the conflict between the federal Controlled Substances Act and the Pennsylvania Medical Marijuana Law 6. In rejecting a challenge under the Commerce Clause of the U.S. Constitution, the Supreme Court upheld the Controlled Substances Act as a valid exercise of Congress’ authority. 7. Mr. Bey may not use medical marijuana under federal law. A Pennsylvania statute or policy to the contrary cannot override a conflicting federal statute because the Supremacy Clause in the U.S. Constitution unambiguously provides that if there is any conflict between federal and state law, federal law shall prevail. 8. The federal supervisee’s state-authorized possession and use of medical marijuana violated the terms of federal supervised release. 9. Mr. Bey acted on the advice of his physician and attorney, who advised him that under the PA Marijuana Program it was permissible for him to use marijuana for pain management. Mr. Bey’s and his attorney’s interpretation, although incorrect, would not have been unreasonable. 46

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10. The court specifically found that Mr. Bey did not appreciate that his use of Pennsylvaniasanctioned medical marijuana was a violation of his release condition. The court gave him two weeks to find alternative means to address his chronic pain. This is the first Pennsylvania case we have seen specifically addressing the conflict between the federal Controlled Substances Act and the Pennsylvania Medical Marijuana Law. Notably, the physician who provided the medical marijuana certification to the patient was not charged with any illegal conduct. Only the patient, who technically violated his probation terms, was found to have acted improperly. The federal court’s statement that the advice Mr. Bey received from his physician and attorney was incorrect should heighten your sensitivities on this issue. Accordingly, as a practical matter, I recommend the following: 1. Before a family physician issues a medical marijuana certification, ask if the patient has any criminal history or current probation that precludes the use of any Controlled Substance including medical marijuana. 2. Family physicians should not certify a patient for medical marijuana if the patient has any history of a felony or misdemeanor conviction under federal or state drug laws and is currently on any type of probation that precludes the use of marijuana.

Pennsylvania Academy of Family Physicians Foundation

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member record after you complete the webcast or monograph post-test and evaluation. KEYSTONE PHYSICIAN | WINTER 2018