Keystone Physician Magazine - Summer 2019

SUMMER 2019

PAFP PRESIDENT MARY STOCK KEISTER, MD

PRIOR AUTHORIZATION REFORM RALLY GETTYSBURG CME CONFERENCE ANNUAL MEETING RESEARCH DAY PAFP VISITS PCOM MATCH DAY

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

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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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PENNSYLVANIA ACADEMY OF FAMILY PHYSICIANS

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

T WIT TER.COM/ PAFPANDF

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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.

EXECUTIVE VICE PRESIDENT John S. Jordan, CAE - jjordan@pafp.com

SUPPORTING MEMBERS WITH

GOVERNMENT AND PRACTICE ADVOCACY CONTINUING MEDICAL EDUCATION (CME) PROFESSIONAL AND CAREER RESOURCES STUDENT AND RESIDENT PROGRAMS DEDICATED MOBILE APP

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2019-20 OFFICERS PAFP President PAFP President-Elect Foundation President PAFP and Foundation Treasurer PAFP Board Chair and Immediate Past President

Mary Stock Keister, MD - Fogelsville Tracey Conti, MD - Monroeville Tiffany Leonard, MD - Willow Grove Chris Lupold, MD - Lancaster David O'Gurek, MD - Philadelphia

THE LATEST NEWS AND INFORMATION MEMBER DISCOUNTS AND SERVICES RECOGNITION AND LEADERSHIP OPPORTUNITIES

i Remember, your membership with the PAFP means you’re also a member of the American Academy of Family Physicians.

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DELEGATES TO THE AAFP CONGRESS Delegate Delegate Alternative Delegate Alternative Delegate

Bradley Fox, MD - Fairview Madalyn Schaefgen, MD - Allentown Nicole Davis, MD - Wyncote 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 Susan Fidler, MD - Abington D. Scott McCracken, MD - York Tiffany Leonard, MD - Willow Grove Jason Woloski, MD - Wilkes Barre Chelsea Kolodziej - Erie Lily Payvandi, MD - Belle Mead, NJ

www.pafp.com

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CONTENTS

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PRESIDENT'S MESSAGE Finding the joy in family medicine

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MEMBER NEWS

House of Medicine meets with Representative Dean

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PAFP member wins STFM research award

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PAFP Board member makes PAMED’s ’40 Under 40’

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Student member chosen to participate in AAFP leadership institute

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PAFP member joins Governor Wolf for Female Veterans Day

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GOVERNMENT AFFAIRS COVER STORY PAFP President Mary Stock Keister, MD joined dozens of other representatives of medicine at the State Capitol to rally for prior authorization and fail first reform.

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Stage is set for prior authorization reform

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Prior authorization rally: PAFP President video, background information, rally event photos

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SUMMER 2019 VOLUME 79 | NUMBER 2

FEATURES

Event Coverage: Three days and 10 scores of family physicians: the Gettysburg CME Conference and Annual Business Meeting

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Co-Exemplary Teacher of the Year: Gordon Liu, MD

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Co-Exemplary Teacher of the Year: Allison Myers, MD

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Public Health Award Winner: Elizabeth George, MD

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Family Physician of the Year: William Taddonio, MD

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Match Day 2019: PAFP visits PCOM for celebration

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LEGAL AND COMPLIANCE UPDATE Pharmaceutical company inducements to physicians: Anti-Kickback statute/ False Claims Act implications

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EDUCATION Online CME Catalog

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PRESIDENT'S MESSAGE MARY STOCK KEISTER, MD, President president@pafp.com

Finding the joy in family medicine don’t know about all of you, but really, when it comes down to it, I love being a family physician. Now, I don’t love the way the work is organized or the way health care in the U.S. is organized and funded. But, at its core, I love being part of a community, helping to guide people to better health and being witness to the challenges and transitions of life.

nizations on this and a bill has been introduced with an aim to decrease the burden of prior authorizations on front line health care personnel. This represents a start. Getting meaningful legislation enacted takes longer than many of us would like. So keep checking your email and social media sites for blasts from the PAFP letting you know how you can help.

So when I think about family medicine, I want to do all I can to improve the specialty and the lives of family physicians and the patients they serve. And I can’t think of a better way to do that right now than by being exactly where I am. The funny thing about being the president of a professional organization is how long it takes to reach the position and how quickly the term goes by.

A focus of the PAFP strategic plan for the last several years has been the “pipeline” of bringing new medical students into the family medicine family and “sealing the deal” by matching them into family medicine residency programs. One Pennsylvania win has been the Primary Care Practitioner line item in the state budget which has allowed for the funding of four additional residency positions in the state. These positions, one apiece at Crozer Keystone, Latrobe, U Penn and UPMC Altoona, have averaged an additional almost 2,000 patient visits over the course of their residencies, allowing local citizens to receive care. But we also know that as Pennsylvania approaches a physician shortage, that we must continue to think about the future of our specialty and what makes it attractive to medical students.

The work of the PAFP revolves around the needs of its members. As leaders in the organization, we reach out to the members and ask them what they want. We use your answers to set our path. When we asked you about your top legislative priority, you answered: prior auth reform. I am so pleased to tell you that we have been working with several other medical orga6

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Spring is that time of year for new beginnings, and as the weather warms and the earth becomes green and fertile again, it gives us all some hope. Let’s harness that and work together for the benefit of all Pennsylvania’s family physicians, our patients and communities.

PAFP President Mary Stock Keister, MD and her family, including PAFP member Drew Keister, MD

Specifically, I’m thinking about the AAFP 25 x 2030 Student Choice Collaborative. The big, audacious goal: to increase the percentage of U.S. medical students going into family medicine from its current level of approximately 12 percent to 25 percent by 2030. Now that’s one goal that will take the work of several different organizations to bring to fruition. But each one of us can do our part.

And that brings me to joy in practice. I’m willing to bet that each of you, at your core, loves being a family physician: not the incessant busy work or the highly changing atmosphere or the empty promise of EHRs as savior, but the work with patients. And whether that work is performed in an ultralight DPC practice, or a bustling academic medical center or practice setting in between, anywhere across the Commonwealth, it’s the meaning behind that

work that we need to share with medical students and residents. One of my sources of joy is in continuing to offer procedural skills to my patients. I try to maintain that scope of practice. I’m even considering whether to add OB care or someday, maybe even deliveries back (after my kids are graduated from high school).

What are the parts of this work that bring you joy, and how can you keep doing them, or start doing them? And how can the PAFP help you in that?

Spring is that time of year for new beginnings, and as the weather warms and the earth becomes green and fertile again, it gives us all some hope. Let’s harness that and work together for the benefit of all Pennsylvania’s family physicians, our patients and communities. Take care of yourselves and take care of each other.

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

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PAFP on twitter

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PAFP Connect

House of Medicine meets with Representative Dean On

Tuesday,

April

16,

Abington Family Medicine Residency

hosted

Rep.

Madeleine Dean (D-Berks, Montgomery) in conjunction with the “Group of 6: Representatives of Americas Frontline Physicians” (groupof6.org). Representatives from the PAFP and American Academy of Family Physicians (AAFP), American College of Physicians (ACP), American College of Obstetrics and Gynecology (ACOG), American Psychiatric Association (APA), and American Osteopathic Association (AOA) met with the Dean to discuss issues affecting all frontline phy-

Aaron Sutton, LCSW, Behavioral Health Consultant Abington Family Medicine Residency; Alyssa Style, DO, PGY1 Abington Family Medicine Residency; Lawrence D. Ward, MD MPH FACP, Governor, Pennsylvania Southeastern Chapter, ACP; Aarisha Shrestha, DO, PGY2 Abington Family Medicine Residency (front/shorter); Christine Arenson, MD, Chair, Department of Family and Community Medicine, Thomas Jefferson University; Keith Sweigard MD, Vice President, Jefferson Medical Group; Sarah Horvath, MD, MSHP, Darney/Landy Fellow, ACOG; Congresswoman Madeleine Dean; Hugh Lavery, Senior Vice President Government/External Affairs, Thomas Jefferson University; John Russell, MD, Program Director Abington Family Medicine Residency; Kenneth Certa, MD, Associate Professor Psychiatry, Jefferson University Hospital, APA Representative; David O'Gurek, MD, FAAFP, Board Chair Pennsylvania AFP; Joan Grzybowski, DO, President, Pennsylvania Osteopathic Medical Association; Susan Fidler, MD, Assistant Director, Abington Family Medicine Residency, PAFP Board Member; Dennis L. Gingrich, MD, FAAFP, AAFP Board of Directors; Daniel Fischer, MS4 Drexel College of Medicine.

sicians, including administrative burdens, prior authorizations, medication affordability, access to medical care and mental health care, and combatting the opioid epidemic.

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PAFP member wins STFM research award

PAFP Board member makes PAMED’s ’40 Under 40’

PAFP member Sukanya Srinivasan, MD has been selected by the Society of Teachers of Family Medicine (STFM) to receive its STFM Research Paper of the Year Award. The research, published in Sukanya Srinivasan, MD the Journal of the American Board of Family Medicine (JABFM), centered around the collaborative work of a project to deliver interconception care during well-child visits. PAFP members Stephen Ratcliffe, MD and Lisa Schlar, MD co-authored the research. Congratulations on earning this prestigious award!

PAFP Foundation President Tiffany Leonard, MD of Willow Grove has been honored as one of the Pennsylvania Medical Society’s (PAMED) 2019 “40 Under 40” physicians. According to PAMED, “[t]hroughPAFP Foundation President out the commonwealth Tiffany Leonard, MD are talented early career physicians, who already are performing at a high level. Pennsylvania's Top Physicians Under 40 recognizes on a yearly basis the best of the best early career physicians.” Congratulations to Dr. Leonard on this award!

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

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MEMBER NEWS

Student member chosen to participate in AAFP leadership institute PAFP student member Jason Spicher has been chosen to participate in the American Academy of Family Physicians’ Family Medicine Leads (FML) Emerging Leader Institute! The year-long FML focuses on ensuring the future of the Family Medicine specialty by increasing the number of future Family Medicine leaders and provides training for this important role.

The AAFP defines an emerging leader as “an individual who has shown historical aptitude for leadership and has exhibited to others a strong potential for future leadership. An emerging leader has little formal training or experience with leadership and is motivated to gain additional leadership skills and experience.” Congratulations!

Jason Spicher

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PAFP member joins Governor Wolf for Female Veterans Day

Jeanette South-Paul, MD

PAFP member Jeanette South-Paul, MD of the University of Pittsburgh School of Medicine joined Gov. Tom Wolf, First Lady Frances Wolf, Maj. Gen. Tony Carrelli, Pennsylvania adjutant general and head of the Department of Military and Veterans Affairs, and the Pennsylvania Commission for Women on March 27 at the fourth annual Female Veterans Day in celebration of Women’s History Month. Dr. SouthPaul, who served in the U.S. Army for 21 years and retired as colonel, was among 16 women from across the commonwealth “recognized for their military service and selfless sacrifice to Pennsylvania and the nation.” Congratulations on this honor, Dr. South-Paul!

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M S P S F SINE A P T HE UA L B U NCE & E N R E N F A N O Y C A E D M H C C , R G A R U R E SE B

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FEATURE

Three days and 10 scores of family physicians: the Gettysburg CME Conference and Annual Business Meeting n three days and with nearly 10 scores of family medicine clinicians, the PAFP brought forth to the Wyndham of Gettysburg an Annual Business Meeting and CME Conference with a dedicated board review track, state-mandated opioid education, patient safety credits for all conference content and the 3rd Annual Chili Cook-Off. Friday’s line-up included the PAFP’s Annual Business Meeting, election and installation of PAFP President Dr. Mary Stock-Keister and officers and board members. The famed Family Physician of the Year award went to Dr. William Taddonio, with Exemplary Teacher Award honors bestowed on Allison Myers, MD and Gordon Liu, MD, and the inaugural Public Health Award presented to Elizabeth George, MD. The day culminated with a president’s celebration at the Gettysburg National Military Park Museum and Visitors Center.

PAFP’s conference partner, WellSpan Health, featured dynamic faculty and riveting CME content. Continuing with our board review concept, the conference’s first day featured a series of geriatric care sessions, followed by a moderated Q-and-A session of board exam questions from the day’s sessions.

Our traditional focus on wellness carried throughout the weekend with healthy eating options and various exercise segments

by Doug Lentz, MS, CSCS, Director of Fitness and Wellness for Summit Health and Mahir Modi, DO from WellSpan Health, both of whom helped keep everyone energized with exercises focusing on mobility, static balance, and core strength. Two new features – Qigong, which demonstrated the ancient Chinese healing art and form of dynamic meditation, and Yoga Nidra, a guided systematic relaxation technique for deep relaxation and strengthen resilience – were both popular events.

Conference attendees had the opportunity to learn from Dr. Leonard Wong, a research professor in the Strategic Studies Institute at the U.S. Army War College, who presented ethical dilemmas in the military and in medicine. Dr. Wong’s session followed with a panel of physicians in various practice settings offering their viewpoints on key points of professionalism and strategies to prevent ethical fading in the medical profession – an exceptional program!

PAFP’s annual Research Day showcased top notch oral and poster presentations from resiWWW.PAFP.COM

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FEATURE dents, students, and faculty. The bar is raised each year on such an array of quality submissions! This year’s topics covered a variety of public health efforts, physician well-being, and quality Improvement projects. Research Day’s agenda included a professional development series for residents and students addressing best practices for managing education loan debt plus table talks featuring discussions with family physicians from various practice settings such as rural, FQHC, health system community practice, and Direct Primary Care. View the list of 2019 Research Day Award winners here. The professional development track was sponsored in part by the Pennsylvania Department of Health.

The conference’s final day was dedicated to state-mandated opioid education. Quality

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Insights of Pennsylvania presented two modules from the Department of Health’s “Evidence-Based Prescribing: Tools you can use to fight the opioid epidemic” series.

What better location to have a lesson on leadership than on the Gettysburg battlefield! Led by faculty at the U.S. Army War College, participants were led through various exercises drawing parallels between decisions made in battle and how those decision-making concepts can be applied to modern medicine. An amazing way to cap off the weekend!

Several of the conference sessions from the weekend will be available online for enduring CME credit. ALL online sessions are complimentary and meet the Patient Safety criteria! Please visit PAFP’s online CME catalog for a full listing.

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FEATURE

Members who attend the Annual Business Meeting have the opportunity to vote for a new slate of officers each year.

Family Physician of the Year William Taddonio, MD speaks to a captivated room at the PAFP Annual Business Meeting.

The PAFP welcomes its new Board of Directors during the installation ceremony at the Annual Business Meeting.

The Exhibitors’ Hall at PAFP CME conferences gives attendees the chance to talk with practice-relevant vendors.

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A special Gettysburg ride-along experience at the Gettysburg CME Conference related stories of war leadership to how physicians lead in practice.

Past AAFP and PAFP President Wanda Filer, MD installs Mary Stock Keister, MD as the PAFP’s new president.

Jeff Zlotnick, MD goes “hands-on” at one of many clinically relevant CME sessions during the Gettysburg CME Conference.

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The PAFP’s Research Day award winners. From left to right: Tiffany Leonard, PAFP Foundation President; Renata Carneiro, PhD, St. Luke’s Sacred Heart; Tristan Imhof, MD, St. Luke’s Sacred Heart; Karissa Thal, Penn State medical student; Cybill Oragwu, MD, Penn State Hershey; Kendra Keith, MD, UPMC St. Margaret; Thiri Bickel, MD, Chair, Resident and Student Affairs Committee

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FEATURE

PAFP members enjoy an evening out at the Gettysburg National Military Park Museum and Visitor Center in honor of new PAFP President Mary Stock Keister, MD.

PAFP Board Chair David O’Gurek, MD kicks off festivities at the Gettysburg National Military Park Museum and Visitor Center.

The registration desk at PAFP CME conferences is always a busy, bustling, and informative place for conference attendees.

The Pennsylvania Beef Checkoff hoists its trophy for winning the 2019 PAFP Chili Cook-off contest.

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PAFP members and vendors enjoy a quick break between CME sessions to relax and chat.

PAFP members kick back with dinner and drinks to support the PAFP Political Action Committee (PAFP-PAC).

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2019 PAFP AWARD WINNERS CELEBRATING EXCELLENCE IN FAMILY MEDICINE For more, visit: www.pafp.com

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PAFP Connect

Co-Exemplary Teacher of the Year

GORDON LIU, MD IN HIS OWN WORDS

EXEMPLARY TEACHER OF THE YEAR AWARD WINNER GORDON LIU, MD SPOKE WITH KEYSTONE PHYSICIAN ABOUT CHOOSING FAMILY MEDICINE AS A CAREER AND WHY TEACHING IS SO IMPORTANT AND REWARDING TO HIM. [Family medicine] was always something I think I wanted to do. Growing up in Toronto, in Canada, about 70 percent of physicians are family physicians. So that’s kind of what we know.

Seeing the family doctor and that relationship that you have with a doctor is very unique and very special. You can’t see a specialist unless you see a family doctor in Canada, so I think that’s why the majority of docs go into family medicine, because of that primary care aspect.

It’s very unique, and I think I have (ask my colleagues) a very outgoing personality, able to establish relationships, and I think that was probably one of the most important aspects – even during my time in Pittsburgh, having delivered one of my continuity patients, and now the child is almost 3 years old – getting the chance to see that, seeing them grow, is something that’s very unique.

It’s one of those few specialties where you really get to do it all. With my special training in HIV and Hepatitis C, it’s allowed me to get more 22

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into the infectious disease world, which helps as well. So really, the relationships you have not only with your patients, but also helping primary care in that aspect, in how big it is and how important it is, whether it’s here or in Canada, or anywhere else in the world, a lot of successful health care systems really need a good primary care background and physicians. That’s how I was pushed toward it.

All physicians, whether they got into academia or private practice, part of being a physician, the definition, is to teach. Educating is really important because of the fact that, if I took care of a patient panel of 2,000 patients, those patients will hopefully say that they’re in good care and receiving good quality care from me. But if I’m able to teach and disseminate, that means I’m going to be affecting a larger population. If I teach here, for example, like 26 residents total in the program, even if each one of them only had 1,000 patients and they took one part of what I taught them, that’s affecting 26,000 patients.

2019 Co-Exemplary Teacher of the Year, Gordon Lui, MD (center) pictured here with PAFP Director of Resident and Student Initiatives, Molly Talley (left) and PAFP President-Elect, Traci Conti, MD (right)

That dissemination is important, and I think it’s especially crucial here. I got that drive when I was going through residency because I realized that primary care in the U.S. is very different than where I’m from in Canada. The health care model is different, it’s very specialty-driven, and a lot of the residents may not feel they’re respected, or that they always have to look to specialists for answers. Actually, if you were a strong primary care physician and were able to emulate that, you can provide a lot of care – not only quality care for your patients, but to help them coordinate care with the specialists.

I have a strong passion not only for primary care, but to bring that into teaching, I think, has helped to inspire not only medical students and residents, but to go into primary care and realizing how rewarding it is. In a health care system where primary care is not really reimbursed as much, and a lot of U.S. graduates have very expensive loans, they may be a little

more hesitant to go into primary care. But I always teach that want to go into something that you love to do. And if you don’t love it, no matter what specialty you do, you’re going to be miserable for the rest of your life. If you do enjoy that breadth of family medicine, where you take care of kids, adults, maternity care, women’s health, that gives you that diversity that you’re always staying active and on your toes and switching gears.

I obviously have a passion for it, and hopefully I’ve been able to inspire other residents and students to feel the same way.

I’m very, very humbled by this award. It actually caught me completely off-guard. I didn’t even know I was nominated, nothing was provoked, and I’m very humbled to the students and the residents that have given me feedback and changing techniques. It’s easy to teach, but it’s hard to be an effective and passionate teacher. Everybody’s learning style is different, and I want to continue to learn to master education. Maybe that’s a goal in the future: looking to some of my mentors who are master educators, where they can teach someone not only if they’re passionate, but maybe ones who are not as driven, and try to find ways to be an effective teacher that way. I’m very humbled – I was telling my wife, I can’t believe this, this is such a highlight, and I’m very thankful and very grateful.

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2019 PAFP AWARD WINNERS CELEBRATING EXCELLENCE IN FAMILY MEDICINE For more, visit: www.pafp.com

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PAFP on twitter

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PAFP Connect

Co-Exemplary Teacher of the Year

ALLISON MYERS, MD IN HER OWN WORDS

ALLISON MYERS, MD, WINNER OF THE PAFP’S EXEMPLARY TEACHER OF THE YEAR AWARD, SPOKE WITH KEYSTONE PHYSICIAN ABOUT THE WIDE SCOPE OF FAMILY MEDICINE AND THE UNDERSERVED LGBT POPULATION. think like most of us in family medicine, I didn’t want to give anything up, and wanted to see people of all genders and ages.

I was really torn between my love of women’s health and OB, and also doing procedures – inpatient, outpatient, all the things. When I finished residency and became an attending, I had the opportunity to do my family medicine dream job, which was basically doing all the things. I’m still able to see all my patients in an outpatient setting, and for me that includes building up an LGBT practice and seeing lots of transgender patients and doing procedures, being on our inpatient service, and I’m on our OB faculty so I still get the joy of delivering babies and doing prenatal care.

I think [teaching medicine is] the part that really energizes me. We all have those parts 24

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of our job that can be, you know, draining. But the teaching part is really energizing because you get to go back to when you were a learner and remember what brought you so much joy about medicine, whether it’s seeing something for the first time or doing something for the first time, or making a meaningful connection with a patient, so being able to work with learners – it not only directly brings me joy, but it also reminds me of the reason that I am doing this job.

I’ve always felt passionately about, and felt passionately about teaching [LGBT health]. It’s something I didn’t get very much formal teaching about when I was a student, so I had to do a lot of seeking out my own education. So when I was in a position to be able teach others, I really wanted to be able to extend peo-

ple’s knowledge base about the health disparities that affect the transgender community in particular – I mean, a lot of health disparities still exist among MSM, for example, there’s still a huge HIV disparity there, there’s still huge mental health disparities and access to care is still a big one.

I work in Philadelphia and there are still people who have a hard time finding a doctor who they would consider to be LGBT friendly, and that’s a much harder problem in most other parts of Pennsylvania and the country and the world, but even in a place like Philly that can be a challenge.

In the trans community, the most disheartening fact is the rate of suicide and mental health problems, but I think that access to good care and to gender-affirming care is something that can really make a huge impact. So if providers are aware of that and willing to take on that part of a patient’s care, whether that be hormone therapy or just an awareness, I think that has the ability to make a huge impact in a patient’s life.

2019 PAFP AWARD WINNERS CELEBRATING EXCELLENCE IN FAMILY MEDICINE For more, visit: www.pafp.com

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PAFP on twitter

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PAFP Connect

Public Health Award Winner

ELIZABETH GEORGE, MD IN HER OWN WORDS

ELIZABETH GEORGE, MD, WINNER OF THE INAUGURAL PUBLIC HEALTH AWARD, SPOKE WITH KEYSTONE PHYSICIAN ABOUT HOW SHE BECAME INTERESTED IN PUBLIC HEALTH AND WHAT A SUCCESSFUL INTERVENTION LOOKS LIKE. did all of the clinical rotations and I loved them all, but when I got to my family practice rotation it made the most sense, to put everything together. There wasn’t any way I was going to do just body parts or system parts or anything. That’s kind of why I went into medicine, also – I had done some microbiology research in the lab, and I didn’t keep doing it because I wanted to take care of the person part of it rather than some DNA or RNA. The wellness aspect [of family medicine] was always part of our modus operandi. We always emphasized a healthy lifestyle. Around 2010, the statistic came out from the CDC that the current generation is going to live less long from our generation, and I thought, we are just not making progress in this. I was looking at the statistics and there were towns and states with much better statistics than ours, so I started speaking to the community and saying “What’s going on with our community, and why are other 26

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communities healthier than ours?” That’s what had us start looking at the structure, the builtin environment that has people being active or eating healthy, the opportunities. And there was lots of research showing that the community you grew up in made a big difference in your health choices.

It takes a long time to change, for example, infrastructure. It’s going to be a long time till we get side paths and bike lanes on the road. You feel like those are going to be big achievements! But the one that’s flying highest every time we do it, you can tell it’s just making a big difference, is the Healthy Eating Adventure [Editor’s note: a six-week-long public health intervention to get Franklin County residents to choose healthier eating options]. People so instantly, within a week and then by the end of the month, feel so much better. And they know that their health is better and there are obvious measures of better health from eating that way, but I can immedi-

ately see the benefits of that program. Plus the volunteerism for that is so great – it continues to be volunteer-driven, and that’s because they themselves feel the results and they also see the results for others. We’re all amazed at the end of a month of healthy eating. Every person, to a T, stands up and says “This is what happened to me, and I feel so much better, and my family’s paying attention!” It’s hard not to be excited about it.

I’m sure many [PAFP members] are doing public health on different levels, whether they’re involved with bike clubs or they’re involved with bigger projects, and they’re all to be congratulated. The mode of family practice is not just to take care of the person, but to take care of the person within their family, within their environment, so the very fact that they’re in family practice, they’re reaching out. We’re all doing something. They’re to be congratulated.

Every time a disease seems to be on the increase – obesity, diabetes, hypertension – we come up with a pill for it. There isn’t the emphasis on the environmental changes and the healthy eating and the activity. We talk it, but it’s just not pushed at all to the same degree. We too easily fall back on the pill solution and we don’t fight for our time in the office and time with the patient to talk about the other things. And we don’t fight for time outside of the office, to be given time outside of the office to do this kind of program.

So I feel, as individuals and as the PAFP and the AAFP, that is one thing that we could really work on and make a difference with.

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2019 PAFP AWARD WINNERS CELEBRATING EXCELLENCE IN FAMILY MEDICINE For more, visit: www.pafp.com

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PAFP on twitter

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PAFP Connect

Family Physician of the Year

WILLIAM TADDONIO, MD IN HIS OWN WORDS

FAMILY PHYSICIAN OF THE YEAR WILLIAM TADDONIO, MD SPOKE WITH KEYSTONE PHYSICIAN ABOUT WHY FAMILY MEDICINE IS SO UNIQUE AND HOW HE FEELS ABOUT HIS PATIENTS. hen people ask me that question, it’s funny because when I graduated from high school, my guidance counselor, when he signed my yearbook, he actually wrote in my yearbook “I hope to hear in four years your acceptance into medical school. My desire to go to medical school to be a doctor – it goes back so long, it’s what I always wanted to do, despite the fact that there were no doctors in the family. My older brother went on to become a family doctor, and he certainly was an inspiration, but it wasn’t the main reason why I wanted to do it. I always wanted to be that kind of family doc.

There are a number of things that are so unique to family medicine that you just don’t see I think in other specialties. Several of them that set us apart: you really become a part of the patient’s life. You become a part of their family. You develop friendships, caring friendships, 28

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over that time. You definitely have an impact and empower patients to take care of themselves and live healthier lives by being a part of them and practicing family practice, preventive medicine, caring for chronic illness. You make a difference in the patient’s quality of life.

Those are the kinds of things that make it different from other specialties because of the fact that you really, truly become a part of their lives and their family’s lives. You see multiple generations over time, you watch kids grow, you watch patients get older, you’re there for them when they get ill, you’re part of the family when a member dies. You just don’t see that in other specialties.

I don’t do as much newborns anymore, but I continue to take care of children, I continue to take care of adolescents, young adults, adults, and also geriatrics. I’ve kind of gravitated over

the years – as you can imagine, practicing for 30 years as your patients get older and the population gets older, a lot more of my practice becomes an older practice, more geriatrics. I think that’s just a natural progression that family doctors go through.

I wanted to approach my speech different [Editor’s note: At the 2019 PAFP Annual Business Meeting, Taddonio spoke in detail about Sir Luke Fildes’ popular painting “The Doctor”]. I hope it was different – because I could have sat there and spoke about challenges of practice, insurance reimbursement, quality of life, physician burnout. But all physicians know that. I wanted to come up with something so original that hopefully it would touch physicians – perhaps not even remember who talked about it, just to remember what we are as family doctors. And I think I got my point across.

I had no idea [about being nominated for the award] – I guess it’s just a statement of the type of thing that I take for granted, and that is how much patients really, truly feel that you make a difference in their lives. I take it for granted, and like I said in my speech, I really don’t think that I do anything different than any other family doctor does. But obviously my patients, who rallied regarding this, feel that I do a lot for them and their family.

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

Stage is set for prior authorization reform tate prior authorization and step therapy reform is set to begin with some changes from previous efforts. The bill will integrate step therapy language, involves many patient advocacy groups, and looks to amend an existing statute (Act 68 of 1998) as opposed to last session’s effort that would have been a stand alone bill (new statute). The PAFP will work with all our partners on this effort to affect change where change can occur at the state level, keeping in mind that does not include Medicare, Medicaid, or self-funded employer sponsored plans covered under the United States Department of Labor ERISA laws.

Thus, any reform can only affect roughly 25 percent of plans that cover Pennsylvanians. Nonetheless, it is our top legislative item and we will work diligently to advance the bill.

Representative Steven C. Mentzer

House of Representatives Session of 2019 - 2020 Regular Session MEMORANDUM Posted: April 25, 2019 04:28 PM From: Representative Steven C. Mentzer To: All House members Subject: Prior Authorization

We all know that administrative waste in the healthcare delivery system is significant.

We have all, at one time or another, experienced our healthcare provider recommending a course of treatment or medication “pending the approval of your health insurance company.” This approval process is commonly referred to as prior authorization, or PA.

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As you might expect, PA is one example of an inefficient process that increases costs across the healthcare system--for both providers and patients--and one which routinely jeopardizes patient care by often delaying or denying treatment.

PA was initially used by health insurers to minimize the overuse of expensive healthcare services such as MRIs, CAT Scans, and other cutting-edge diagnostics and medications.

However, health insurers are now requiring physicians and other healthcare providers to secure prior authorization for routine tests, medications, and procedures that fall well within accepted standards of care. In fact, many health insurers are now requiring PAs for generic medications.

In addition to PA, my proposal addresses the issue of step therapy. Step therapy is routinely used by health insurers to limit how much is spent covering patients’ medications. Under a step therapy protocol, a patient must try one or more drugs chosen by their insurer—usually based on cost, not medical, considerations—before coverage is granted for the drug prescribed by the patient’s healthcare provider. Patients may be required to try one or more alternative prescription drugs that are of lower cost to the insurer, but which may not be the best therapy for them. While this process may seem benign, patient health often declines as they “try and fail” on alternative medications. I believe there needs to be a balance between cost control and patient need. This proposal would establish a basic framework for when it is medically appropriate to exempt a patient from step therapy.

The criteria for whether to approve a prior authorization request or to require step therapy varies widely from one health insurer to another, frustrating providers who want to treat their patients according to accepted clinical protocols and guidelines. In other words, they want to do what is in the best interest of their patients. While my proposal does not prohibit the use of PA or step therapy by health insurers, it does promote transparency and it establishes important safeguards to ensure that patients get the care they need.

I hope you will join me in supporting this legislation to help physicians and other healthcare providers deliver better and more appropriate care to their patients.

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GOVERNMENT AFFAIRS

HB 1194

Improving Prior Authorization and Fail First for Pennsylvanians Coalition of Partners

Mary Stock Keister, MD - PAFP President

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HB 1194 HB 1194 Improving Prior Authorization and Fail First for Pennsylvanians

HB 1194

Improving Prior Authorization and Fail First for Pennsylvanians

Improving Prior Authorization and Fail First for Pennsylvanians

What is Prior Authorization?

Informational Handout Prior authorizations (PA) require a physician to request health insurer approval of a prescription drug or other health care services What is Prior Authorization? before such care is delivered.

Health plans often use PA to restrict access to costly services anddrug therapies—particularly newer Prior authorizations (PA) require a physician to request health insurer approval of a prescription or other health care services treatments.

Health plans may also use PA to ensure that a therapy is appropriate and safe for a specific patient. before such care is delivered. Health plans often use PA to restrict access to costly services and therapies—particularly newer

treatments. Health plans may also use PA to ensure that a therapy is appropriate and safe for a specific patient.

What is Fail First?

Fail First (alsoFirst? known as step therapy) requires patients to try, and fail, on one or more prescription drugs chosen by What is Fail their insurance company – nottherapy) their healthcare professional - before gaining access to the drug thatdrugs was recommended Fail First (also known as step requires patients to try, and fail, on one or more prescription chosen by to treat their health condition. their insurance company – not their healthcare professional - before gaining access to the drug that was recommended

to treat their health condition.

Who is Affected?

Prior Who Authorization is Affected? and Fail First are often applied to patients living with a wide range of diseases and chronic conditions including, butFail notFirst limited to: applied to patients living with a wide range of diseases and chronic Prior Authorization and are often § Chronic Pain Related § Rheumatoid Arthritis Arthritis §conditions Cancer including, but not §limited to: § Psoriasis § Multiple Sclerosis §§ Diabetes § Diseases Chronic Pain Related § Rheumatoid Arthritis Cancer § Arthritis § HIV/AIDS § Autoimmune Disorders § Lupus §§ Hemophilia Diseases § Psoriasis § Multiple Sclerosis Diabetes §§ Heart DiseaseDisorders §§ Crohn’s §§ Epilepsy § HIV/AIDS Autoimmune Lupus Disease Hemophilia §§ Mental Illness §§ Colitis Heart Disease Crohn’s Disease § Epilepsy

§ Mental Illness § Colitis Why are Prior Authorization and Fail First a Problem?

This approach and to controlling care costs undermines and burdens providers, and may lead to Whyone-size-fits-all are Prior Authorization Fail First ahealth Problem? unnecessary delays, approach even denials, of care. This often causes health to deteriorate as lead they to await This one-size-fits-all to controlling health care costsPennsylvania undermines patients’ and burdens providers, and may authorization or try and fail on medications that don’t work for them.

There is currently no requirement that prior unnecessary delays, even denials, of care. This often causes Pennsylvania patients’ health to deteriorate as they await authorizations betry determined reasonablethat timeframes in addition toThere no clear step therapy exemption process. authorization or and fail oninmedications don’t work for them. is currently no requirement that prior authorizations be determined in reasonable timeframes in addition to no clear step therapy exemption process.

Health care decisions should be made by providers and patients!

Health care decisions should be made by providers and patients!

What HB 1194 Legislation Does: What HBhave 1194access Legislation Does: § Ensures prescribers to more efficient electronic prior authorization (“ePA”) and establish minimum § Ensures prescriberssystems have access to more efficient aelectronic approval duration period to expedite the prior authorization prior authorization systems (“ePA”) and establish a minimum process, reducing burdens for physicians, and approval duration administrative period to expedite the prior authorization ultimately, better serving patients in the health care system. process, reducing administrative burdens for physicians, and § ultimately, Ensures that fail first protocols are in based on clinical better serving patients the health care system. guidelines developed by independent experts. § Ensures that fail first protocols are based on clinical

§ guidelines Establishes adeveloped basic framework for when it isexperts. medically appropriate by independent to exempt patients from fail first, as well as an exceptions process § Establishes a basic framework for when it is medically appropriate that is transparent accessible towell patients health care to exempt patientsand from fail first, as as anand exceptions process providers. that is transparent and accessible to patients and health care providers.

What HB 1194 Does NOT Do: What HB 1194 Does from NOT using Do: fail first § It does not prohibit insurers nor limitnot theprohibit numberinsurers of allowed § It does fromsteps. using fail first

§ nor It does fromsteps. requiring prior limitnot theprevent numberinsurers of allowed authorization before covering a drug. § It does not prevent insurers from requiring prior

§ authorization It does not prevent from requiring beforeinsurers covering a drug. patients to try a generic drug if it is equivalent § It does not prevent insurers from requiring to the brand. patients to try a generic drug if it is equivalent to the brand.

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GOVERNMENT AFFAIRS

HB 1194

Improving Prior Authorization and Fail First for Pennsylvanians Capitol Rally - April 30, 2019

The PAFP joined dozens of other physicians groups April 30 at the Capitol in support of prior authorization and fail first reform. House Bill 1194, to be introduced by Rep. Steve Mentzer, would make several improvements the prior authorization and step therapy process, resulting in more efficient patient care and less bureaucracy for plans under state jurisdiction.

Rep. Steve Mentzer discusses the importance of prior authorization and fail first legislation at the Capitol rotunda.

PAFP President Mary Stock Keister, MD poses with Rep. Steve Mentzer, who will be introducing prior authorization and fail first legislation.

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Andrew Waxler, MD (Reading Hospital - Tower Health) discusses frustrations with the current prior authorization system

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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ON INSTAGRAM #pafpcme

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

Match Day 2019: PAFP visits PCOM for celebration atch Day 2019 is in the books! According to the American Academy of Family Physicians (AAFP), 2019 is the seventh year running that medical students matching into family medicine reached an all-time high: 3,848 medical students and graduates are beginning family medicine careers.

The Philadelphia College of Osteopathic Medicine (PCOM) held its first-ever Match Day celebration on March 15. Amid the balloons and tinsel, students were nervous and eager to find

out where they’ll spend the beginning of their careers.

“This is the last year that the AOA match is happening, so it’s all combining into the ACGME match, so it was a great opportunity to say that we’re going to be ending up with one Match Day anyway, so let’s start things off by bringing everyone together,” said class president Evan Gooberman, who matched to Abington. “We highlighted the people who did military match, who did AOA match, the urology match, San Francisco match – this way everyone could be together, find out, and celebrate.

“We had a really amazing committee that took hold of this event and turned it into the fantastic event that it was, so I’m really grateful,” he said.

“Become a doctor: check.” Dozens of PCOM students made it to the next step of their medicine journey on Match Day.

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“I can’t really describe it – I’ve been on this journey for about six years, I was a nontraditional student, and went back to school after my mom got sick,” said Joanna Dauber, who matched to Christiana. “This is kind of the culmination of all those years of hard work and kind of living out something that she didn’t get to see but is a really beautiful moment. I can’t describe it any way else.”

Dauber said she went into family medicine after seeing how family physicians cared for her ailing mother.

“Family medicine really called to me because the people who were in my mother’s life toward the end of her life were her family medicine doctors.

They took care of her and watched out for her when specialists and other people in medicine decided that they didn’t have anything else to help her with,” she said. “Her family medicine doctor came and did house visits and was still there up until the end. It’s a beautiful journey, especially as a specialty, and I’m excited to practice as a family medicine doctor.”

For Gooberman, family medicine is an opportunity to do it all.

“I was torn between pediatrics and family medicine. I really like primary care – I have a background in public health, so I wanted to continue on with primary care and prevention,” he said. “Family medicine seemed like the most well-rounded, I get to take care of all age groups, which I think is really special. I can help set people on the right path to a healthy life.”

Congratulations to all who matched into family medicine in 2019!

PCOM was buzzing with activity and nervous energy as students waited to find out where they’d be spending their residency years.

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PC

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COM’s family medicine graduates are excited to share the residencies they matched to on Match Day 2019.

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FEATURE

Penn State Student Assembly Board Chair Chris Davis matched at Penn State Hershey.

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Penn State Student Assembly Chair Kayley Swope is heading to residency at UPMC St. Margaret.

3rd Annual Dermatology and Outdoor Medicine Conference August 8-10, 2019 • Lake Raystown Resort and Conference Center Bedford CME Conference November 8-10, 2019 • Bedford, PA PAFP Annual Business Meeting & CME Conference March 5-8, 2020 • Hershey, PA

KSA

Bedford Springs CME Conference Saturday, November 9, 2019 Topic: Women's Health

Available Now All online sessions meet your Patient Safety requirement •

Advances in the Screening, Diagnosis and Treatment of Testicular and Prostate Cancer

•

CDC Opioid Prescribing Guidelines and PDMP Rules

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View the webcast catalog for all courses

www.pafp.com WWW.PAFP.COM || Visit www.pafp.com details on all of our CME offerings

41 41

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 42

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. Everyday.

ow for download on iOS azon Kindle Fire) devices!

cer WWW.PAFP.COM

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

Pharmaceutical company inducements to physicians: Anti-Kickback statute/False Claims Act implications new federal court decision applying very liberal interpretations of the AntiKickback statute and False Claims Act (FCA) to pharmaceutical company inducements to physicians is important to consider for compliance purposes.

In U.S. ex rel. Arnstein v. Teva Pharmaceuticals USA, ___ F.Supp.3d ___ (S.D. N.Y. 2019) (2019 WL 1245656), the whistleblowers alleged physicians were induced to prescribe medications manufactured by Teva through speaker fees, expensive meals and alcohol. After a lengthy period of discovery, the defendants filed a Motion for Summary Judgment attempting to have the case dismissed before trial. In a lengthy opinion, the federal judge denied the motion and will require the pharmaceutical company to stand trial on the kickback and FCA claims. The federal court’s important legal holdings include the following: 1. Under the Anti-Kickback statute, inducing referrals need not be the primary purpose 44

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for the kickback. Instead, a party need only prove that one purpose of the defendant’s remuneration given to physicians was to induce referrals.

2. Intent to violate the Anti-Kickback statute may be established by evidence that senior management failed to monitor the market-

ing representatives’ activities and did not impose discipline when the sales representatives were reported for non-compliance.

3. Because intent to violate the Anti-Kickback statute is all that is required, it does not matter whether a particular referral results.

The Anti-Kickback statute does not require evidence of quid pro quo in the sense that remuneration must successfully generate referrals.

4. The entity paying the remuneration may lawfully enter into a business relationship with the physician and even hope for or expect referrals from that physician, as long as the party paying the remuneration is motivated to enter into the relationship for legal reasons entirely distinct from its collateral hope for referrals. Therefore, the motivation behind the arrangement is the most important element.

5. The defendant had written compliance policies, and those policies contained all of the right language. But that means very little, since the existence of a written compliance policy says nothing about whether it was followed. Formal compliance policies are only as good as their implementation.

6. Evidence showed the defendants had a weak compliance department, with very little staff overseen by an individual with no formal compliance training, all of which evidences a lack of commitment to the written compliance policy.

7. The court cited the PhRMA Guidelines twice in the decision, again implying that noncompliance with the PhRMA Guidelines can establish a kickback violation.

8. There was an open question whether the speakers were paid at fair market value.

The defendants argued that there can be no intent to induce referrals if there is no excess payment above fair market value.

The defendants, however, did not provide any evidence that they made market comparisons. Evidence of fair market value violations included the cost of food and alcohol and speaker programs that exceeded $65 per person.

9. The proper fair market value calculation for physician compensation might be the hourly rate paid by other programs for the same service, rather than an annual cap across the company of what each speaker charged for non-lecture services.

10. Some of the speaker programs had no legitimate purpose, except to reward or increase speaker prescriptions. Any payments made to speakers for those programs automatically exceeded fair market value.

11. The evidence indicated that some of the speaker programs had no educational value when: • A physician who attended three or more events related to the same drug within six months; WWW.PAFP.COM

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LEGAL AND COMPLIANCE UPDATE • A physician who served as a speaker for a given drug then attended a lecture about the same drug within 12 months; • A physician who attended any speaker program when the food and beverage cost exceeded $65 per person; and • A non-healthcare professional who was the spouse of a physician attended an event related to a given drug.

12. On a technical legal issue known as “causation,” the court held that the Anti-Kickback statute only requires that a patient be exposed to an illegal referral; that a provider submits a claim for government reimbursement pertaining to that patient; and that a party to the transaction offers a kickback to the referrer in exchange for the referral. The whistleblowers only had to link payments to speakers to prescription-writing by the physicians in order to establish the required “causation.”

13. The Anti-Kickback statute and FCA can be violated by showing that a physician referred or recommended a patient to a provider after receiving an illegal payment from that provider.

14. Violations of the Anti-Kickback statute that occurred after the Affordable Care Act amendments went into effect in 2010 are “material” 46

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as a matter of law. That means a violation of the Anti-Kickback statute that is proven can result in virtually automatic FCA liability.

The compliance implications of this decision are significant, and include the following: 1. Never enter into an arrangement where one purpose of any remuneration is to induce or be induced to make referrals. The motivation to enter into any relationship must be for legal reasons entirely distinct from any collateral hope for referrals.

2. Do not participate in any pharmaceutical company educational programs where the meals exceed the local modest meal standards, such as $65 per meal. Spouses should never attend educational sessions and meals.

3. Only attend legitimate educational presentations that have a valid business justification.

4. Never accept speaker fees from any drug or device manufacturer that are either above fair market value or where the physician was selected based upon prescribing history.

5. Physicians should not attend three or more events related to the same drug within six months; serve as a speaker for a given drug then attend a lecture about the same drug within 12 months; or attend any speaker program where the food and beverage cost exceeds $65 per person.

You’ve spent 20 years building your career.

We’ve spent 60 years protecting your investment.

The defendants in this case are limited to pharmaceutical manufacturers and their affiliated corporate entities. The OIG and Department of Justice, however, are continuing to target the recipients of improper remuneration and inducements, illustrated most recently in U.S. v. Johnson/Halsell, in which physicians who allegedly accepted illegal kickback payments from a pharmaceutical company were required to pay $128,000.

You’ve worked hard establishing yourself as a family physician. And AAFP Insurance Services has spent decades creating insurance programs that protect your achievement … and the family you love.

Up to $2 million in AAFP 10 Year Guaranteed-Level-Premium Term Life Insurance is available to members at exclusive group rates. Find out more. Call today.

Call (866) 794-2513 or visit aafpins.com for more information including exclusions, limitations, rates, eligibility and renewal provisions.

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6. Compliance policies and programs are only effective if they are thoroughly implemented.

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PAFP FOUNDATION Your donation builds a home for future docs

“ Having been a benefactor of the PAFP in so many ways, my service is a unique opportunity to continue to give back.”

David O’Gurek, MD Assistant Professor, Family and Community Medicine Temple University

“ 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.”

Munima Nasir, MD

“ As a person transitioning to PA for residency, my opportunities to be involved in the PAFP allowed me to develop meaningful and lasting connections with mentors and colleagues, making my decision to stay in PA to practice a no brainer.”

Debra Bell, MD COE Medical Director/Hanover Site Lead Physician Family First Health - York, PA

“ I am so grateful for the foundation’s support when I was a medical student and resident, which allowed me to grow as a leader and advocate for family medicine.”

Jason Woloski, MD Geisinger Wyoming Valley Wilkes-Barre, PA

Penn State Hershey Medical Group Middletown, PA

The new online donation form makes giving simple and fast.

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VISIT WWW.PAFP.COM

Thank you for your support!

FM InSpIRe (Family Medicine INfluencing SPecialty Interest REvolution) is a PAFP initiative to create awareness of the PAFP Foundation and raise funds that directly support residents and students.

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NEW!

0.75 CREDIT(S)

WHEN TO STOP SCREENING AND TESTING – MAMMOGRAMS, PAPS, COLONOSCOPY NEW! 0.75 CREDIT(S)