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A MONTHLY NEWS MAGAZINE OF SPOKANE COUNTY MEDICAL SOCIETY – MARCH 2013

EXCITED? AMAZED? OVERWHELMED? CONFUSED? By Anne Oakley, MD SCMS President

THE GROWING NEED FOR HEALTH IT WORKERS BEACON COMMUNITY OF THE INLAND NORTHWEST UPDATE RURAL MEDICINE


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Answers you can trust. March SCMS The Message Open2

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Table of Contents

2013 Officers and Board of Trustees Anne Oakley, MD President

E xcited? Amazed? Overwhelmed? Confused? .

David Bare, MD, President-Elect

The Growing Need for Health IT Workers . . . . . . . . . . . . 2

Terri Oskin, MD Immediate Past President

Does This Sound Familiar? . .

Shane McNevin, MD Vice President Matt Hollon, MD, Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Karina Dierks, MD Clinton Hauxwell, MD Charles Benage, MD J. Edward Jones, MD Louis Koncz, PA-C Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – David Bare, MD

A Small Fish in a Big Ocean .

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Membership Recognition for March 2013 . .

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Beacon Community of the Inland Northwest Update .

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Group Health Update: IT Priorities For Our New Integrated Delivery System . . . 6 Teleconferences Are Balm for Chronic-Pain Cases . . Physician Leadership Resource . .

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Health Information E xchange – an Update . . . . . . . . . . . . 9 Providence Health EPIC Healthcare Intelligence . .

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9 Issues Facing Doctors in 2013 (and After) .

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Facing Issues? Or Taking Them On! . . . . . . . . . . . . . . 12 AMA Advocates for You . .

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Olympia Legislative Trip . . . . . . . . . . . . . . . . . 16 In Memoriam . Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. The annual subscription rate is $21.74 (this includes the 8.7% tax rate). Advertising Correspondence Quisenberry Marketing & Design Attn: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

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The Future of Health Care: . . . . . . . . . . . . . . . . 17 Rural Medicine .

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Robotic Telemedicine Brings Stroke E xpertise to Community Hospitals . . Idaho Health Data E xchange .

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Opinion . . . . . . . . . . . . . . . . . . . . . 21 Prescription for a Healthier Practice .

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In The News . . . . . . . . . . . . . . . . . . . . 22 HIE, Now You’re Talking . .

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New Physicians / Positions Available .

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2013 SCMS Events Calendar .

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CME, Meetings, Conferences & Events . Classified Ads .

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my friends , the spring is come; the earth has gladly received the

embraces of the sun, and we shall soon see the results of their love !”

–S itting B ull

March SCMS The Message Open3


Excited? Amazed? Overwhelmed? Confused? By Anne Oakley, MD SCMS President If that is how you view the world of Health Information Technology, join the rest of your colleagues in considering its effects on you and your patients. Most of us have forgotten (or never even known) the days of thumbing through large books to look up drug interactions or a description of a rare genetic condition. We pull out our phone and click, question answered! On the other hand, most of us did not become physicians with plans of a second career as a data entry technician and our patients do not like seeing their doctor stare at a little box instead of their faces. Where do these worlds meet? What are the strengths and limitations of “sharing” all this data about our individual patients and what are our roles in ensuring best care with its usage? The medical record began as a tool for patient safety. The patient’s history, medications, allergies and timeline of care could all be in one place. Sometime in the 1980s the medical record evolved to take on a new role as a malpractice defense document. These days it also serves as a complicated billing document. The complexity enables a vast quantity of data to be readily available, but often buries the important facts in a mass of minutia. How do we maximize the safety aspect of this tool without allowing patient harm to result if important facts become lost? This simple answer to all those questions is that we, as medical professionals, need to become experts at utilizing these tools, just as we learned how to use our stethoscopes. Using the

information available to us through web research is becoming second nature to most practitioners, but there is an art to doing this efficiently that only comes with practice. Recording data from our patient interactions without being distracted from the more important job of being a good doctor is harder for most of us. Dr. Abraham Verghese, author of the bestselling novel Cutting for Stone and professor of internal medicine at Stanford University, spoke at last fall’s Washington State Medical Association annual meeting about the lost art of the physical exam. He began his lecture by describing rounds at Stanford and observing that every med student and resident reached into their pockets to look up patient information instead of just looking the patient in the eye and listening to him or her. Once again, practice is the only way to be able to look someone in the eye, listen attentively to their voice and check all the important and unimportant boxes on their Electronic Medical Record, all at the same time. And practice is the only way to improve the speed and efficiency with which you can search your patient’s record for significant history and test results. I doubt most of us will ever possess the level of computer expertise to absolutely guarantee patient privacy with these records; we will have to entrust the experts, while doing our share by guarding our access and passwords. What is the role of your Medical Society in the world of Health Information Technology? We have resources for those of you who may be truly struggling with this huge transition in medicine. At our last Board Meeting we learned that over 40% of practicing physicians admit to signs and symptoms of clinical depression and many relate those feelings to being overwhelmed by these types of practice changes. You are not alone if this is a difficult transition. This edition of The Message contains articles on the work of our Medical Informatics Committee, as well as what is happening in the Health Information Technology arena in Spokane right now.

March SCMS The Message 1


The Growing Need for Health IT Workers By Kevin Dudley Marketing and Communications Coordinator Greater Spokane Incorporated Imagine there was little or no paperwork to be done when your patients visited your office or that they could look up their medical records online. Imagine they could schedule an appointment with the click of a button. Imagine you could measure your all your patients’ outcomes and be able to spot medical trends. Imagine you could see a summary of your patients’ health record with information pulled from the patient’s specialty provider and pharmacist. Those scenarios are becoming a reality as the health information technology (HIT) sector grows and evolves. Jobs in HIT are growing for a number of reasons – the Affordable Care Act and innovative technologies, to name a couple. Jobs in the HIT area are plentiful. Phyllis Gabel, the Chief Human Resources Officer at Inland Northwest Health Services (INHS), sees the HIT industry growing as hospitals and clinics are more reliant on technology. “IT is growing and not just in health care,” she said. “Technology is just so robust in how it’s developed and how it evolves. The health care reform law has furthered the need for health care technology.” The Affordable Care Act has provisions that incentivize health care providers using more technologies. “If doctors move further from paper, they receive federal dollars as recognition for their achievement,” Gabel said. “Over time there will be penalties associated with not having proper health care technology systems.” This, Gabel says, will lead to a further need for more employees in the HIT sector. “I think we’ll need more people that have good analytical and business intelligence skills,” she said. Those skills are just a few that will be required to land an HIT job. Gabel says the industry will need computer operators, desktop technicians, software developers and others to create IT platforms in health care. Those platforms will need data miners and managers. Gabel said health care providers are also looking for people that can analyze various health care trends. Tech aficionados aren’t the only people that can succeed in HIT jobs, though. If someone has worked at a health care provider, they might know enough to step into an HIT role. “We can also use people that have been in a health care setting and are familiar with how a medical office works,” Gabel said.

But where do health care providers find the talent? The industry is growing, so more positions will eventually need to be filled. Gabel said INHS is able to find talent in the local Spokane area by using various online job search sites, though she did say that occasionally the company will look outside of Spokane for more specialized jobs. “There are currently enough qualified folks (in the Spokane area), but that may not continue,” she said. “All over the country people are having a challenging time finding IT staff. In Spokane, those trends tend to impact us later so we anticipate this is going to be a growing issue.” So how can the community fill the anticipated HIT workforce gap? “Spokane is a very creative region and has been successful in bringing groups together in collaborating and being innovative,” Gabel said, while also praising the STEM (Science, Technology, Engineering and Math) education model. Eastern Washington University (EWU) has an undergraduate degree offered in Health Informatics Technology – an area Gabel says will have a big demand soon and an area that requires a wide variety of skills. The program is in its infant stages, as it only began in the fall of 2012. The implementation of the program “mainly corresponds to national trends and the need for an area workforce,” said Dr. Atsushi Inoue, EWU’s Health Informatics Technology and Management (HITM) Director. “Companies are facing a severe lack of employees in the field of IT and they need the workers as soon as possible.” Dr. Inoue said the program is under the guidance of the HITM Advisory Board, which will meet twice a year to discuss the program’s evolution. The board is made up of health care professionals from across the region. “We have developed our curriculum using the input from the advisory board,” Inoue said. Greater Spokane Incorporated’s (GSI) Workforce and Education program is working to fill the workforce gap in a number of industries, with a strong emphasis on STEM fields. Through GSI’s Teaching the Teachers program, area teachers tour businesses and learn about the skills needed in those fields. This helps connect the business community to the education sector. The field of HIT is a relatively new and growing industry. Today’s educators will need to know what skills students need to fill the number of jobs that will be available. The advisory board that helps develop the curriculum at EWU’s HITM program connects the business community to the higher education sector as well. Technology is changing all over the place and customers rely more and more on ease of use – something technological advances provide. “I think consumers are saying, ‘I want to go online, I want to see my records and communicate with my physician online.’” Gabel said.

March SCMS The Message 2


Does This Sound Familiar? By Kris Linden, Administrator OB/GYN Associates of Spokane PS A patient presents to your office. If you have not yet received a copy of their chart notes from the primary or referring physician, the task of obtaining patient history begins. Some patients are excellent historians, while many are not. After getting a history from the patient’s recollection, you try to piece together what tests were performed, when and where. Here’s where the real work starts. Typically, the process starts with calling the PCP or referring physician’s office and waiting for their medical records staff to send chart notes and labs to your medical records staff. You can also check to see if the patient has been seen in one of the area’s acute care facilities. You do this by logging onto the information system used by that particular hospital, but you can only access the information if your physician’s name is associated with that patient. If your physician is not associated, then log onto the other hospital’s system and repeat above. The other option would be to order the test you need.

for results availability is limited, and the information is limited to treatment received under that particular system. All of the “exchange” of information has been one directional. Health Information Exchange: The electronic movement of healthrelated information among organizations according to nationally recognized standards. As one of the goals for meaningful use, a Health Information Exchange certainly makes sense. In order to meet the lofty goal of “electronic movement of healthinformation among organizations,” it would require combining PHI from ambulatory care as well as acute care facilities, producing a more complete record of clinical data. This would eliminate the needless repeat of tests, lab work and perhaps procedures, resulting in timelier ordering and more cost efficient treatment. Until this goal is met and a truly shared repository of information is available, we are all trying to look for solutions. Meditech, and soon Epic, make their information available if you meet the right criteria. The clinics associated with Integrated Delivery System (IDS) can share information within the IDS, but are under the same limitations as independent clinics for outside information.

In the past, there was one information system shared by the large area hospitals and several of the rural outlying hospitals. If the providers in your clinic were “associated” with a patient in an acute care facility, their PHI was accessible to your providers. This was a great opportunity to obtain needed information about patients without having to know which facilities treated the patient.

Our clinic has battled the “black hole” of faxing information and is currently utilizing data cloud technology as a means of making our records available to the staff of a local Labor and Delivery department. Many other offices are using similar technologies to share their data. The inherent problem, however, is the cost of staff time in tracking and obtaining all of the information. The frustration level remains the same.

There are numerous limitations to our current system: The patient has to relate that treatment was received, the treatment facility needs to be identified, the physician needs to be “associated” with the patient on the treatment facility’s system, the timeframe

As we anticipate the ability to use a truly universal health information exchange, patient care and its associated costs will be largely affected by the scope of access to patient information.

March SCMS The Message 3


A Small Fish in a Big Ocean By Deb Wiser, MD Providence Family Medicine Residency Program The Providence Family Medicine Residency Program has just dived in to the large ocean of Epic, Providence’s new electronic health record. We “went live” on our new system last week, and it feels a bit like going from a flip phone to an iPhone; there are a bunch of bells and whistles in there, but I’m having trouble just making a call. As the “IT Doctor” in our program, one of the big questions I get is “why do we need to change systems?” The answer is easy - it’s about better serving the patient. Well, actually it is a little more complicated than that. At a residency program, we have an organizational goal that combines the importance of caring for our patient population with the education of our resident physicians. I expect the transition to Epic for us to help with both of those. Not only will we better serve our patients, but our residents will have a better understanding of their part in our broader medical community. The new electronic health record will have a tremendous impact on patient care. With the shared patient record across Providence, our patients will have one record across all specialists in this large organization. This is really a transformation of how we look at the patient record. Our pond was just the patients of our own clinic until last week; it really was “our record”. Since last Monday, it has become the patient’s record. When I update the problem list, it is no longer my list. It is my responsibility, the cardiologist’s responsibility and any other providers’ who touches the record, but it is now the patient who is the unifying part of that record. The patient receives a copy of that problem list at the end of every visit and so the patient, by nature of the process, is better engaged in his own care. Additionally, with the use of MyChart, the patient access portal, the patient also has better access to his own information. This is not just communicating with the provider, but is also seeing results automatically released and having access to his medications and issues as well as self-education in one place. By October of this year, our hospitals will be transitioning to the same system. Our inpatient service will have the ability to access data about our patients system-wide. This change brings great potential to avoid over-testing and medical errors due to omission of data.

Another reason for switching to the new system is, of course, Meaningful Use. By the first week, I already have access to immediate data on how many after-visit summaries our providers are printing, how many patients are signed up on MyChart and a multitude of pre-made reports that I have access to organizationwide. This allows much better visibility into physician performance and ensuring quality of care for our patients. It also provides us with the checkmarks we need for Meaningful Use. This transition is in many ways a step forward, but does not move us towards sharing health records across our local hospital and provider systems. Our community has been a leader in having one hospital record system for many years. Those systems split the local patient community health record more than a year ago, but Epic does not inherently break down any barriers between the two hospital systems. The Beacon project continues working to become a central data repository for both systems, but it requires a high level of engagement from all parties and a longterm dedication to achieving this patient-centered vision. As I prepare for another day of “go-live” with a learning curve as wide as the Atlantic, I a feel a little less underwater already. While taking a few deep breaths, I’m looking forward to that moment our team can say “we made it across” – but more importantly, “Mr. Smith, here is your after-visit summary. Thanks for sending me your blood sugars last month! You did an amazing job of adjusting your insulin and I’m glad I was able to help guide you with that. I see that your cardiologist dropped your metoprolol dosage as well and am glad that worked well for you.”

Membership Recognition for March 2013 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today. 20 Years Laurie Summers, MD David C. Hoak, MD Michael D. Kirsch, MD

3/17/1993 3/30/1993 3/30/1993

10 Years David H. Bare, MD Monica M. German, MD N. Scott Jackson, PA-C Geraldine A. Peterdy, MD Paul L. Ross, DO

3/26/2003 3/26/2003 3/26/2003 3/26/2003 3/26/2003

March SCMS The Message 4


Beacon Community of the Inland Northwest Update

• Coulee Medical Center and Clinic in Grand Coulee, Washington benefits from BCIN through broadening the services they can provide the community, including adding care coordination for their patients. This increases quality, efficiency and collaboration between all care providers, both in Grand Coulee and other communities.

By Jac Davies, MS, MPH Director, Beacon Community of the Inland Northwest Inland Northwest Health Services Two years ago, the Beacon Community of the Inland Northwest (BCIN) was named one of 17 communities across the country by the U. S. Department of Health and Human Services for a federally-funded project to highlight the value of health information technology in improving health outcomes. Originally funded by the American Recovery and Reinvestment Act, BCIN has worked closely with community hospitals and clinics to increase care coordination and disease management for patients with diabetes in rural and urban communities across eastern Washington and northern Idaho. We are beginning to see the fruits of our labors - practices having tools to help them transform the care they deliver to their patients, with an emphasis on population health and prevention; providers having additional information at their fingertips to support better clinical decision-making and patients better able to control their diabetes through active care coordination. • While being trained on the technology infrastructure and how to look at items added by other providers in the patient’s circle of care, one provider saw in the BCIN tool the results from a test that had been requested. The provider was delighted because those test results had not come back to the clinic by other means. • Care coordinator and registered nurse Deb Belknap who works with patients in the BCIN project to help them manage their diabetes sees improved outcomes for those patients. While working directly with patients, Deb is using the technology to see what care the patient is receiving from the primary care provider along with the work she is doing, helping keep the care consistent across locations. • Nimiipuu Health, a clinic serving the Nez Perce Tribe in Lapwai, Idaho, is using BCIN to help keep track of information from specialist appointments in Lewiston and Spokane for their patients when they come back to the clinic. This ensures that the Nimiipuu providers receive all the information, improves the level of care Nimiipuu can provide to patients and increases the comfort level for the patients that the right information is being shared with the providers they know and trust.

• Christ Clinic in Spokane, Washington is finding benefit in the technology through improved communication across the community, decreasing duplication in testing and diagnostics while improving diabetes care and information in the community. While new hospitals and clinics are continually joining, to date BCIN has connected 14 hospitals, one skilled nursing facility and 12 ambulatory care groups at 22 clinic sites in 20 communities across eastern Washington and northern Idaho. An average of 1.3 million distinct patient identifiers and nearly two million distinct patient records are now housed in the BCIN data repository. Participating health care organizations are seeing additional benefits beyond real-time sharing of patient information among BCIN participants, including having access to extensive technical support and training, and help in preparing to meet meaningful use and preparing for medical home or other payfor-performance reimbursement models that are currently under development by both public and private sector payers. While the early results are promising we anticipate seeing even greater results from the formal project evaluation that will be conducted over the next two years. What are we working on next? Expansion. Initially focused on type 2 diabetes, BCIN is now expanding to support care for all patients across a wider variety of health issues and health organizations. The robust technology infrastructure supports coordination of care between multiple disparate information systems in different health care organizations across our large geographic area. The practice transformation support and training are applicable to all practices that are looking to assess their current capacities and make changes necessary to survive and thrive in the rapidly evolving health care environment. The possibilities are endless in how this infrastructure can benefit providers and patients, regardless of the technology the practice has implemented. By working together as a health care community serving a common population, we can make a difference in health status and health outcomes for our family, our neighbors and our patients.

• Columbia Basin Health Association in Othello, Washington sees BCIN’s tools and data repository improving the amount and quality of information available to their providers to best serve patients.

March SCMS The Message 5


Group Health Update: IT Priorities For Our New Integrated Delivery System

Group Health and CMA’s informatics teams will also support our primary care doctors to make referrals to CMA’s specialists. Because we also intend to open up Group Health’s urgent and after-hours care to CMA’s primary care patients, our providers will need access to CMA’s EMR to assure the best care.

By Tom Schaaf, MD

3) Integrating Group Health with our specialty physician network.

Since Group Health and Providence Health Care formed a new integrated delivery system last year, we’ve set several priorities for health information technology (IT). Although we have a robust electronic medical record (EMR) for patients in our own medical centers, most of our Spokane members’ clinical records are scattered in multiple systems.

Group Health wants to share patient records more effectively with our specialty partners, particularly those seeing high volumes of our members. Once we have a consolidated record between Group Health, Providence and CMA, Group Health will extend similar access for ambulatory specialists in Spokane. We’ve already made some progress—Group Health is using an Epic tool that presents a summary of the patient record to providers and CMA has the ability to present a “light EMR” view to providers through Allscripts.

Health IT supports care delivery and it can improve collaboration between providers. It also enables good measurement and reporting. Using technology to support rapid and secure collaboration between providers is still largely an untapped area in IT. Unless clinicians share the same system, most rely on old methods such as phone calls or secure email transmitted over several business days. We can make collaboration easier and faster. We also rely on IT to help measure and report the quality data that we share with providers as feedback. This is the industry’s focus right now and the Centers for Medicare and Medicaid Services has offered hundreds of quality measures for medical groups to report on. A physician committee is now identifying the clinical measures that are most important to capture and report in the new integrated delivery system. It will need to be a balance between what doctors ideally want (everything, but presented simply) and what’s easily importable into their EMRs.

Physician influence Our doctors have been very hands-on at defining which data sets are most critical to flow back and forth between medical groups in the integrated delivery system. They are also exploring better functionality so contracted providers can order ancillary services (such as CBCs) at our medical centers. Physicians also shape our online protocols in primary care. One example is a powerful pre-visit button in our EMR that tells doctors whether their patients are due for lab and screening tests. We are now asking ourselves whether Group Health can transfer some of those applications to clinicians in the integrated delivery system and to other Epic users and if we can help clinicians set up processes similar to ours.

These are the IT priorities for the integrated delivery system:

The payoff

1) Integrating Group Health and Providence’s EpicCare systems. Providence is now implementing Epic as its EMR and we plan to integrate our records through the Epic Care Everywhere platform. We’ll start with Providence’s urgent care centers, inpatient providers and specialists; with a completion date of year-end 2013.

Long-term, we want physicians to have a shared health IT platform with complete EMR and tools to help them provide quality care. The technology exists, but the big step is choosing a single platform to implement with hundreds of practices and training providers to use it.

2) Integrating Columbia Medical Associates (CMA) and Group Health. CMA’s group of primary and specialty care providers is wholly owned by Group Health, however CMA’s providers use Allscripts and Group Health’s use Epic. Today our delivery systems only share some basic imaging, pharmacy and medical review data. For now we can communicate with each other using Healthbook and Epic Link. Long-term the doctors from Group Health and CMA will ideally work together on Epic. We’re now analyzing the cost and timing to implement Epic at CMA.

By having standard care processes and a shared data platform across multiple settings, we can make improvements to care more widely throughout the integrated delivery system and measure our results. Primary care doctors and specialists will communicate more effectively with each other and avoid duplicate tests, lowering costs. By having good, clear protocols and communication, we can meet our patients’ needs with less hassle, time and expense. We are at the stage where we have articulated the vision for integrated care in Spokane. Now with our partners and with assistance from IT, we are beginning to create it. Tom Schaaf, MD, is the assistant medical director for Group Health Cooperative’s Eastern Washington/North Idaho District.

March SCMS The Message 6


Teleconferences Are Balm for Chronic-Pain Cases

doctors feel ill-prepared to manage patients’ chronic pain – and what guidance from experts can help bridge that gap. “The presenter might be embarrassed to acknowledge, ‘I have dug a big hole for this patient and I need to know how to get out of it.’ I remind clinicians that all of us have found ourselves in these holes.”

By Brian Donohue Senior writer UW Medicine Strategic Marketing & Communications UW Medicine CONSULT Winter 2013 If you want to take Rachel Stappler to lunch, don’t suggest Wednesday. On that day, almost unfailingly, the physician assistant in southern Oregon is tuned in to TelePain, a weekly noontime consult between UW Medicine experts and front-line clinicians who want help managing patients’ pain. The teleconferences, Stappler said, are “a huge asset for me, as a mid-level working in a rural setting. I get some tough cases to manage – people on astronomical doses of opiates and benzodiazepines together. I wanted to know more about morphine-equivalent dosing. “Providers don’t always know what to do, and these sessions let you know you’re not alone,” she said. “As you listen to other doctors presenting cases and diagnoses, you hear something and wonder, ‘Why didn’t I think of that?’ You’re always learning.”

Dr. David Henzler, A Spokane, Wash., neurologist presents a patient case as other sites listen in to TelePain. Photo by Clare McLean.

Rachel Stappler, PA of Medford, Ore., has participated regulatory in TelePain sessions for a year, she said.

UW Medicine’s pain panel, representing primary care, anesthesia, psychiatry, addiction and rehabilitation medicine, tees off each 90-minute session with a didactic, then takes up three patient cases, one by one, presented by clinicians at remote sites. Like any brown bag, the virtual gathering is structured but informal. The amiable host, Dr. David Tauben, is apt to ask the 20-40 participants what’s for lunch as they nibble in view of laptop cameras and in higher-tech conference rooms.

During a TelePain session, Dr. Anjana Kundu is one of several UW medicine pain panelists reviewing patient cases presented by remotely located physicians. Dr. David Tauben, rear leads the session. Photo by Clare McLean.

TelePain was created in March 2011, supported by the National Institutes of Health and modeled on the University of New Medico’s Project ECHO (Extension for Community Health Outcomes).

It’s important that participating clinicians feel safe and interpret the panel’s questions and suggestions as helpfully intended, not as criticism, said Tauben. As a primary-care doctor who is also board-certified in pain medicine, he knows that many primary-care

TelePain’s intent was to share best practices across the expansive WWAMI region, where few clinicians have a pain expert nearby. In addition, Washington physicians needed to understand the implications of a new state law restricting opioid prescriptions for those with chronic non-cancer pain. Now other states are mulling such legislation, and TelePain’s audio-video streams reach Colorado and New York. Teleconference questions commonly involve the use of high-dose opioids with complicated risk factors and co-occurring medical and psychological disorders. “A patient could have, for instance, chronic back pain, be depressed with post-traumatic stress and have gone through a previous addiction,” Tauben said. “Or when a patient failed therapy, maybe it really was a failure to identify the correct therapy.” “In these sessions we present guidelines and demonstrate how to implement tools in practice. Doctors learn what questions to ask, how to ask them, how to record results consistently and how to interpret the treatment response.” And there’s a bonus: Participants can collect more than 80 hours of Category 1 CME credit. In 2011, TelePain translated to more than 2,000 training hours for 1,500 clinicians. At the Lower Elwha Health Clinic in Port Angeles, Wash., Dr. Ron Bergman has practiced family medicine for six years. As with Stappler, he’s a TelePain regular.

March SCMS The Message 7

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“Their presentations are very up-to-date, so you get the latest on how to manage patients with chronic pain: Do the physical therapy, do the tapering, lab and x-ray studies. They talk about complementary care like acupuncture, exercise, massage, even chiropractic – because if you’re telling patients that medication will be less, you want to give them something else” Bergman said.

Diagnostic Excellence Spanning the State

Computer specialist Rande Gray facilitate the teleconferences so rural clinicians (left monitor) can present patient cases and receive guidance from pain specialists (right monitor). Photo by Clare McLean.

“We inherit these patients who are already at a higher dose, so we’re kind of stuck. How do we turn it around and get opioiddependent or -addicted folks back to more appropriate dosing? The UW faculty gave me the tools to be firm and establish that opioid levels need to come down. They gave me confidence in my direction.” For details on TelePain, please contact Cara Towle, director of Telehealth Services, at 206.459.7956 or ctowle@uw.edu.

Two premier laboratories have joined forces to deliver progressive diagnostics and patient care to the Northwest.

Physician Leadership Resource A link for any of the resources listed can be found at the SCMS website (www.spcms.org) Leadership Resources tab.

InCyte Pathology and Eastside Pathology have entered into a merger agreement.

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The merger will create a northwest

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Stephanie Vance was a prominent speaker at the 2013 WSMA Legislative Summit in Olympia.

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March SCMS The Message 8


Health Information Exchange – an Update

• Enterprise priorities come first. In most cases leaders prioritize meeting their internal enterprise needs over external exchange. OneHealthPort often encounters trading partners who are very interested in information exchange but their organization is not ready. In many cases that lack of readiness is due to internal needs that conflict with external exchange priorities.

By Richard D. Rubin, CEO OneHealthPort OneHealthPort operates Washington’s statewide Health Information Exchange (HIE) as part of a unique public/private partnership. The OneHealthPort HIE is operated and managed by the private sector under oversight from community stakeholders and the Health Care Authority. The HIE received initial funding from OneHealthPort and the federal government, its ongoing costs are paid by the trading partners who use the service. The statewide HIE was created to “fill the gaps” and provide information exchange capability that is needed by practices, hospitals, payers and public health agencies across the state. If required, the OneHealthPort HIE can also connect to other HIE Hubs. The OneHealthPort HIE has seen a significant uptick in adoption. In the fourth quarter of 2012, the HIE exchanged almost five million transactions. As the Lead HIE Organization for Washington State OneHealthPort gets to observe HIE work locally and across the country. Our quick summary of how it’s going could best be summed up with the phrase – uneven progress. On the “progress” side:

It is hard to estimate how the “uneven” and the “progress” will balance out globally in the world of HIE over the next few years. There are a number of wild cards that could retard or accelerate progress: • The pace of change in the industry toward care coordination and new payment models • Movement by the vendor community toward adoption of real interoperable standards • Disruption by non-traditional “outsiders” (e.g. consumers, entrepreneurs, etc.) pushing or demanding their own solutions In this context the only thing that seems a sure bet is the next few years will be a time of transition for HIE. We won’t see the fully interoperable HIE vision realized but we are already past the old proprietary status quo. The emphasis will be on what’s “Exchangeable.” For busy practices coping with an avalanche of change, our suggestion relative to HIE is to focus on pragmatic

• There is an ever-increasing installed base of electronic information systems. To exchange health information electronically requires information in electronic form and applications at the end points to access it. • Standards are maturing. Many of the Electronic Health Records (EHRs) are certified and have some form of standard exchange capability built in. It’s far from perfect, but it is a big improvement from the proprietary formats of the past and it is moving in the right direction. • Coordinated care is becoming more important to all parties. Coordinating care requires that members of the team treating the patient have access to timely information across the continuum of care. This strengthens the business case for HIE. On the “uneven” side: • HIE is seen by some as their private business interest. Everyone agrees HIE needs to occur, the questions are; who makes it happen, who benefits and how do potential competitors interoperate? The resolution of those issues can slow progress and make it more difficult for trading partners who want to exchange but are doing business with competing vendors. • Standards are not mature enough. There are different standards, different versions of the same standards and the cost of adopting standards can be challenging. Robust and ubiquitous information exchange standards are not yet a reality in health care as they are in other industries.

“Intermediate” steps: • Pick a specific trading partner(s) and a specific transaction that adds value to both parties and can simplify your work flow when exchanged electronically • Avoid building yet one more one-off; try to leverage standards and some common form of connection like an HIE • Learn the HIE lessons now so you can incorporate HIE in your practice without having to force fit it in the future under urgent time pressures Consistent with the “gap filling” mission assigned to us, the OneHealthPort HIE is positioned to help Spokane area practices exchange information with their trading partners. Detailed information on Washington’s statewide HIE can be found at http://www.onehealthport.com/hieindex.php.

March SCMS The Message 9


Providence Health EPIC Healthcare Intelligence

of who can change the data; who is the custodian; and how do you accomplish this work in a competitive environment? He asked who is responsible when the data is wrong or bad – chart stewardship? Providence is working toward a system that requires everyone who accesses the chart be responsible for it. This may be difficult for some specialists.

By Keith Baldwin, SCMS CEO At a recent Medical Informatics Committee meeting Dr. Dick Taylor, Providence Health and Services, discussed the Providence Health EPIC Healthcare Intelligence. Dr. Taylor noted that he first was involved in Information Technology and then became a physician. He has worked in numerous environments and used a number of different Electronic Medical Records (EMRs) and information systems. He has been learning the long and rich history of information systems in Spokane and is now leading the Providence Health System in Spokane through the EPIC implementation process. He noted that Providence Health is in transition as to their management model and becoming more centralized. The EPIC implementation occurred first in Anchorage and then spread to ambulatory sites and Everett. They are in the middle of the implementation for all ambulatory and acute sites. The ambulatory sites in Spokane will go live on EPIC in March of 2013 with the acute hospitals, including Colville and Chewelah, in September and November respectively. Dr. Taylor noted the options and tools available for each instance of EPIC such as the data repository, Health Information Exchange (HIE) capabilities and data extracting capabilities. How does the EPIC tool set fit into the community record? EPIC is a single longitudinal patient record across multiple settings. The priority for implementation is first to have information at the point of care including decision support for physician to physician communication. Secondly, is population management and third is process management and quality assurance/ improvement. What is not known yet is how to share risk and revenue streams within a system.

Dr. Taylor noted that EPIC is an HIE and can talk with any other HIE if there are other interested community partners. They would need to use standard protocols for queries and use the “pull” method for accessing data. This is the “federated” model for HIE use and he noted that the patient index can be difficult in the process. He said that Providence will be “provisioning” EPIC to affiliate providers who are not part of the Providence system and who may not have EPIC systems now. Dr. Taylor wants to be available for future discussions and will be in the community more in the future.

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Dr. Taylor posited that he would like to know what physicians in the community see as gaps in information or systems and what patient data sets or information they want or need to be available and shared between provider sites. He would like to talk to physicians in their offices about their systems and what information they need. He noted that technology was available to do anything given enough time and money which are both in short supply. It is the social and operational issues that need to be solved. A number of questions were posed for Dr. Taylor including; how do we deal with the “flood” of data; how can the data be customized for different specialties; who owns the data? Dr. Taylor noted that there is a need for systems that are better at filtering data and placing the “interesting” information first for the provider to see; constituency focused. He believes that the way providers present data to each other needs to be changed. He also thinks that ownership was really a question

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March SCMS The Message 10


9 Issues Facing Doctors in 2013 (and After) By Joe Cantlupe, for HealthLeaders Media, December 27, 2012 Heading into 2013, the Sustainable Growth Formula (SGR) issue remains unresolved. Despite the enormity of the SGR, which proposes reduced payments to doctors, it isn’t even foremost in the minds of some physicians because of so many other complicated dilemmas. A few weeks ago, when top officials of The Physicians Foundation went to Washington, D.C., to visit Congressional offices, they were greeted with: “We know what you’re going to be talking about,” recalls Lou Goodman, PhD, the foundation president, in a recent conversation with HealthLeaders Media. Sure, it was going to be the SGR. If Congress doesn’t impose a “doc fix” to avoid significant cuts, the shortfall is pegged at 27% beginning January 1. Not so. “No, I’m not going to talk about the S-word,” Goodman said, shocking them into listening. Instead, Goodman wanted to talk about the foundation’s annual Watch List, covering major issues confronting physicians. The list is based on a compilation of Physicians Foundation reports over the previous year. For 2013, much of the Watch List is focused on ramifications of the Patient Protection and Affordable Care Act (PPACA), questions about physician autonomy, hospital consolidation, physician administrative burdens, and the impending 32 million more uninsured into the healthcare system, as well as the overall “despondency” and “unhappiness” of doctors. The SGR didn’t make the list because, Goodman says, it is “a symptom of other issues. It is something we have to figure out, and roll into what we do as we go forward.” As more doctors become part of hospital systems and payment models such as bundling or gainsharing are evaluated, the “issue of SGR loses its significance, [and] really [becomes] a focus of individuals and private practice,” he says. As Goodman sees it, 2013 will be a “watershed” year. “So many doctors are unhappy and concerned what the future is bringing,” he says.

2. The consolidation movement. The foundation is worried that while large hospital systems and medical groups continue to acquire smaller/solo practices at a high rate, “increased consolidation may potentially lead to monopolistic concerns, raise cost of care, and reduce the viability and competiveness of solo/ private practice,” Goodman says. With everything from ACOs to hospital consolidation with practices, “We believe there’s a mad rush toward getting bigger,” he adds. 3. The uninsured. As the PPACA expands eligibility for Medicaid and provides tax credits that make insurance more affordable, the Congressional Budget Office projects that 32 million people will have more insurance by 2019. By 2014, companies with 50 or more full-time workers must provide health insurance that the government deems affordable and fair. “As the 12-month countdown to 30 million continues across 2013, physicians and policy-makers will need to identify measures to help ensure [that] a sufficient number of doctors are available to treat these millions of new patients—while also ensuring the quality of care provided to all patients is in no way compromised,” the foundation notes. 4. Physician autonomy. The Physicians Foundation believes that physician autonomy—particularly related to a doctor’s ability to “exercise independent medical judgments without non-clinical personnel interfering with these decisions”—is deteriorating. Add to that decreasing reimbursements and liability/defensive medicine pressures. In 2013, “physicians will need to identify ways to streamline these processes and challenges, to help maintain the autonomy required to make the clinical decisions that are best for their patients,” the foundation says. Of all the issues facing doctors this coming year, “the erosion of physician autonomy concerns me the most,” Goodman says. 5. Administrative burdens. Increasing administrative and government regulations were cited as one of the chief factors contributing to pervasive physician discontentment, according to the foundation’s 2012 Biennial Physician Survey. “We’re not making widgets, but providing care and making life and death decisions,” Goodman says. “We don’t need to be involved in wearing green eye shades, but financial decisions need to be reviewed by doctors. Doctors have to be involved in the conversation.”

Let’s start with what The Physicians Foundation sees as the top five issues facing its members in the upcoming year. And I’m throwing in four concerns of my own, related to quality and clinical achievements. 1. The “nebulous” PPACA. The foundation sees a swirl of uncertainty around a host of issues that contribute to widespread physician pessimism: accountable care organizations, health insurance exchanges, the Independent Payment Advisory Board, Medicare physician fee schedules.

March SCMS The Message 11

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6. Overutilization. Whether it’s stents, angioplasty, or spine and cardiovascular surgeries, excessive and unnecessary clinical procedures are creating a growing uproar among doctors themselves, as well as academics, and in some cases, government investigators. In a recent speech, Don Berwick, MD, former administrator for the Centers for Medicare & Medicaid Services, said 50% of stenting and coronary bypass surgeries performed today don’t resolve symptoms and don’t extend life or prevent heart attacks. Stents are under the microscope now more than ever, especially with the recent focus on the for-profit hospital chain HCA in the wake of a New York Times report. Then there’s the tendency for physicians to fall in love with expensive medical devices, particularly implantable ones used in cardiology and orthopedic procedures, and the companies that make them. A General Accountability Office report points out potential problems of the physician–device maker connection. 7. Embrace the data. More than 69% of primary care physicians reported using electronic medical records in 2012, up from fewer than 46% in 2009, according to a Commonwealth Fund report published in Health Affairs. Yet the presence of this technology is among the reasons U.S. doctors are moving out of their existing private practices and toward hospital employment, according to a report from Accenture. For physicians to fully embrace EMRs, health systems must improve record-keeping and quality controls, Goodman says. “From a doctor’s perspective, they are being bogged down in collecting information as well as compliance issues,” he says. 8. Malpractice malady. The Health Leaders Media 2012 Industry Survey shows that a whopping 58% of physician leaders said they ordered a test for a procedure primarily for defensive medicine reasons in the past year. But their worries may make things worse, keeping mistakes under wraps or encouraging too many tests or procedures. 9. Teamwork. Team-based protocols and efficiency approaches are more and more important today. “One of the problems of medicine is that a lot of people are very stuck in their preconceived notions of what is right and wrong, and things are not as well understood as one would hope,” neurologist Thomas Hemmen, MD, PhD, director of the stroke program at UC San Diego Medical Center, recently told me. Another physician leader, Michael J. Dacey, MD, FACP, senior VP for medical affairs and CMO for Kent Hospital in Warwick, RI told me earlier this year that doctors “must be more collaborative, work as a team. There’s a different-mindset.” For physicians looking ahead to the New Year, that about says it all. Maybe politicians should take a page from this playbook, too? Joe Cantlupe is a senior editor with HealthLeaders Media Online.

Facing Issues? Or Taking Them On! Keith Baldwin Sounds Off (notice that there are two ways to interpret that statement!) Hopefully, you have read the article before this “sound off” titled, “9 Issues Facing Doctors in 2013 (and After).” If so, you read about the most often noted issues from surveys and other sources. They are big topics and there isn’t any way to really get into the detail of any of these topics. For instance, “The “nebulous” PPACA isn’t clear to me either. I think it is accurate to say, that a law that is over 1500 pages in length and takes 30,000 plus pages to write the rules, cannot be understood in its entirety by anyone! It’s the IMPACT of the law and rules and how it affects me, which is so difficult to understand. I think a lot of the information is pretty straight forward if you’ve read about the triple AIM as authored by Dr. Berwick when he was the CEO of CMS – improving the experience of care, improving the health of populations and reducing per capita costs of health care. Who can argue against those principals? I believe the fear of the unknown for me gets in the way of understanding, e.g. what if physicians and hospitals don’t get paid appropriately, or what if it requires new ways to actually deliver the care of physicians in their office or in the hospital or will insurance companies reduce their administrative costs and pay providers more appropriately and will people really have greater access to health coverage from a health benefit exchange? It is clear that the traditional approaches to providing or doing business in health care don’t seem to support the goals to lower the cost and provide care more efficiently at the same time we provide care more effectively. It seems we will need to share information more readily in real time using sophisticated information technology (oops, banks already did this a long time ago with credit cards); use information and evidence based “large data” to prevent illness and improve health; incentivize providers to improve outcomes rather than billing for episodic services and we might even have to gore some “sacred cows” such as the traditional acute care models (hospitals) and insurance companies who have stockpiled billions in reserves (For what purpose? To protect themselves from catastrophic events?). I still hear that most physicians and physician assistants decided to go into medicine to provide quality care. That isn’t the business of care. Business is the development of a product that people want to buy at a cost that is less than what they pay. Well, let’s figure out how to do that. I know, but what about all those unfunded mandates and regulations? You’ve got me there. Although, I think some physicians are making their way through all the questions CONTINUED ON NEXT PAGE

March SCMS The Message 12


and unknowns and will be successful in this new environment. They have low cost/high quality outpatient centers and they communicate with their patients often and in numerous ways, e.g. phone calls, emails and patient coaches. Some are actually organizing models for care coordination, especially for higher acuity patients. They might even be going to the patients’ home to help them coordinate all their appointments, medications and daily life needs. Now that’s getting to the triple AIM. Aside from the nine issues already mentioned, I do want to share several more local issues that haven’t been raised as they seem very important at the local level; Spokane and Eastern Washington. The Executive Committee thinks that we should at least advocate for these three significant issues at every opportunity. 1. Funding of the operational costs of the Academic Health Sciences Center (AHSC) for the four years of WWAMI medical education in Spokane on the WSU Riverpoint Campus. 2. Sustainable funding for the Prescription Drug Monitoring Program (PMP) including education of physicians in accessing and utilizing the program. It was also suggested that the SCMS make a significant effort to publicize the process of accessing and utilizing the program while also encouraging incorporation of educational components into the Primary Care Update and other physician conferences. 3. Support changes to the Washington Practitioner Application (WPA) by the WA Credentialing Standardization Group which is enforced by MQAC and the DOH licensing division, to negate the annual reporting requirement of complaints/investigations found to have no validity. These are worthy of your time and energy and will impact the lives of medical professionals locally. Please take the time to advocate for these issues whenever possible so our voice is consistent and unified.

AMA Advocates for You By Rodney L. Trytko, MD, MBA AMA Delegate Since 1847, the AMA has been dedicated to promoting the art and science of medicine, and the betterment of public health. No other physician group has more resources, expertise and opportunity to improve the future of health care in this country than the AMA. Also, the AMA is the only organization that represents all physicians on a national scale. New Strategic Plan The AMA recently unveiled its new strategic plan. The plan calls for the AMA to focus its efforts and unify its message. There are three primary components: professional satisfaction, health outcomes and medical education. Professional satisfaction is the first component. The physician delivery system is undergoing a rapid and massive shift. The independent fee-for-service practice of medicine is being replaced. A wide range of various models are now appearing. The AMA will study those models in order to identify which ones work best for physicians in terms of professional satisfaction and sustainability. Health outcomes have become an extremely important issue in this era of finite health care resources. The AMA will identify a set of medical conditions with a high disease and cost burden, develop a consensus on strategies for reducing those burdens, engage providers to adopt those strategies and track population-level outcomes. The AMA has been a key player in medical education ever since its landmark Flexner Report in 1910. Over a century later, it has become evident that current student physicians are not being adequately trained to meet the future needs of our medical system. For this reason, the AMA will work with medical schools to develop innovative new flexible and outcomes-based education models. Those models will promote patient safety, performance improvement, teambased care and professionalism. Medical education also needs a new and more stable system of financing. 2013 Advocacy The AMA is aggressively involved in advocacy efforts related to the most vital issues in medicine today. Already this year, the AMA has been advocating for the following:

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March SCMS The Message 13


1. Repeal the Flawed SGR Formula.

5. Grassroots Campaign to Preserve Residency Slots.

The AMA successfully convinced Congress to postpone a massive 26.5 percent cut of Medicare physician payments on January 1. Unfortunately, it was only postponed for one year. The AMA position has always been that the flawed SGR formula must be completely repealed. In the past, the associated costs for complete repeal were so massive that it seemed impossible. However, because of slower growth in physician spending over the last three years, the most recent Congressional Budget Office estimates for the cost of a 10-year repeal (starting in 2014) has decreased from over $400 billion two years ago to $138 billion today.

Also as a result of the budget sequester, Graduate Medical Education is slated to be cut on March 1. Even without a reduction in funding for residency programs, the U.S. is expected to experience a shortage of 62,900 physicians within two years and 130,000 by 2025. Also, the number of U.S. medical school graduates will exceed the number of available residency slots as soon as 2015. 6. Reform Medical Education.

The AMA successfully lobbied to include in the Affordable Care Act a provision that would raise Medicare primary care fees 10% and raise Medicaid primary care fees to the Medicare level. That also took effect on January 1.

As part of its new strategic plan, the AMA recently announced a $10 million competitive grant initiative to transform the way medical schools train future physicians. Specifically, funding will be awarded to medical schools to develop new methods for teaching medical students; promoting exemplary methods to achieve patient safety, performance improvement and patientcentered team-based care and enhance the development of professionalism.

3. Care Transition Payments.

7. Independent Payment Advisory Board (IPAB) Repeal.

The AMA CPT Editorial Panel created new codes to capture transitional care management services. The codes allow for the efficient reporting of time spent discussing a care plan, connecting patients to community services, transitioning patients from inpatient settings and preventing readmissions. Rules are currently being written by Noridian. Those care transition payments are projected to raise primary care fees about 5%.

The AMA successfully lobbied to introduce bipartisan legislation to eliminate the IPAB. IPAB would likely be an arbitrary system that balances budgets by solely relying on payment cuts to physicians.

2. Primary Care Fees Increase

4. Lobby to Prevent the Medicare pay cut of 2 percent set for March 1 under Budget Sequester. Physicians will see a 2 percent reduction in Medicare payments beginning March 1 unless Congress can agree upon a plan to prevent the across-the-board federal sequestration budget cuts. The AMA has been urging Congress to avoid the sequestration and come to a solution that prevents cuts in Medicare and other domestic health programs.

8. Reform Meaningful Use Criteria. The AMA submitted formal comments to the Office of the National Coordinator for Health Information Technology on its proposed requirements for Stage 3 of the Medicare meaningful use electronic health record. Among other concerns, the AMA contends that the 100 percent pass rate is not the right approach and program requirements should be more flexible and better structured to accommodate various practice patterns and specialties. In so many ways, the AMA is working on your behalf. If you are an AMA member, you understand the value of the AMA and its associated benefits. If you are not a member, now is a great time to get involved in order to help shape your future.

RBRVS MEDICARE PAYMENTS FOR CY 2013 CPT1

Status

Description

Physician Work RVUs Non-Facility PE RVUs2 Facility PE RVUs MalPractice RVUs Global

99495 Active Trans care mgmt 14 day disch

2.11

2.57

1.71

0.14

XXX

99496 Active

3.05

3.54

2.56

0.2

XXX

Trans care mgmt 7 day disch

March SCMS The Message 14


March SCMS The Message 15


Olympia Legislative Trip David Bare, MD, SCMS Vice president, attended the Greater Spokane Incorporated (GSI) Olympia legislative trip with 86 other community leaders. The group met with Representatives Eileen Cody (D-Seattle) and Joe Schmick (R-Colfax) and Senators Randi Becker (R-Eatonville) and Karen Keiser (D-Des Moines). All are on health care committees either as the chair or the most senior member or representing the minority party leader.

7. Explore the possibility of gains sharing between DSHS and health care entities that through case management decrease the heavy utilization of Medicaid’s PRC (Patients Requiring Case management) population. Information on details of this will be forthcoming by Lee Taylor Director of the Spokane County Medical Society's Project Access. 8. Enact legislation that would change health care payment method to allow compensation of all work done on population management as defined by the American Academy of Family Physicians’ Patient Centered Medical Home model. To read more about the trip go to the GSI website at http://www.greaterspokane.org/blog.

IN MEMORIAM Ausey (Robbie) H. Robnett, MD

David Bare, MD listens as rep schmick speaks to greater spok ane, inc group.

The following issues were put forth by the delegation: 1. WSU expanding health sciences education and research in Spokane: Request $5 million in the 2013-14 budget for medical education and $2 million in onetime funding for scientific instrumentation. 2. Provide sustainable funding for the Prescription Drug Monitoring Program whose grant runs out in July 2013. The program helps providers with patient safety by allowing access to all prescription information the patient has had in the state. 3. Support e-prescribing (e-Rx) legislation that conforms to state and federal laws allowing for the safer practice of e-Rx of Schedule II medications. 4. Support legislation that amends the Physician Assistant (PA) Practice Act by increasing the number of PAs a physician can supervise. This allows organizations a cost effective, quality means to serve patients better. 5. Support changes in the Washington Practitioner Application by the Washington Credentialing Standardization Group with the support of the Medical Quality Assurance Commission (MQAC). Currently practitioners must list all complaints that have been brought against them through the MQAC process even if they have not been found to have merit in processing of said complaint. 6. Set standards for monitoring the implementation of health exchanges and other elements of the Federal Affordable Care Act in light of costs to health industry and business, especially small businesses.

On February 19, 2013 Ausey (Robbie) H. Robnett, M.D. passed away at the age of 95. He was born in Colorado to Ausey and Mary Robnett. His father was a career naval medical officer. Robbie decided to follow in his father’s footsteps and became a surgeon. After graduating from Northwestern University Medical School, he joined the Navy shortly before the start of World War II. He became a commissioned naval officer and was stationed at the Navy Hospital in San Diego. Robbie left the Navy and accepted a surgical residency at the Cleveland Clinic. He remained on staff at the Cleveland Clinic for several years. In 1951, he met the woman who became his wife, Elizabeth “Betty” Robnett, on a blind date. They married in 1952 and enjoyed more than 50 years of marriage until her death in 2006. Robbie and Betty moved to Spokane in 1954 where he entered private practice as a general surgeon. He and his partners, Milt Durham, Pen Harper and Dick Alquist, formed a partnership that endured for years. During the course of his practice, Robbie practiced at all the major hospitals in Spokane. He served as President of the Spokane County Medical Society (1991), Chief of Staff at Deaconess and on the Board of Directors for Deaconess Hospital and Empire Health. Robbie retired from his surgical practice in 1981 to accept a position with the University of Washington Medical School, helping to coordinate the training of third and fourth year medical students in Spokane. He often remarked that he enjoyed working with the young doctors who would carry on the tradition of excellent medical practice in Spokane. He served in that capacity until 1990. Robbie later married Margaret Larsen and the two of them enjoyed each other’s company until her death. He is survived by his sons Rusty, Jerry, Doug and Paul their respective spouses/significant others and nine grandchildren who will all miss his good cheer, generosity and banter. Robbie’s skill as a surgeon and his compassion and counsel benefited many people throughout the Inland Empire. He made a difference in the lives of many and will be missed.

March SCMS The Message 16


The Future of Health Care: Affordable Care and the Changing Health Care Landscape

Sources: Greater Spokane Incorporated program of the same name on February 14, 2013 and a companion publication of the Journal of Business, Volume 28, Issue 4

Tom Gates, Delta Dental/WA Dental, really impressed on the audience the fact that medical inflation has been a significant driver in the move toward health care reform. He noted that the purpose of the PPACA was to improve access by covering more people. Washington is leaning towards expanding Medicaid to support this effort using federal subsidies (at least in the early years). He also noted that dental coverage will be required in the essential benefits for plans through the age of 19. There is no mandate to provide dental coverage for adults.

By Keith Baldwin, SCMS CEO There are a lot of mixed messages these days about the future of health care. Physicians and physician assistants would certainly be considered part of the bulls-eye when it comes to having conversations about what the future will look like. In Washington State there are other major players in the conversation as well - health system mergers and acquisitions, work-force concerns and the WA State Health Benefit Exchange (now called the HealthPlanFinder). At the presentation facilitated by GSI and sponsored by a number of health and higher education related entities, it was all about how employers will be affected by the Patient Protection and Affordable Care Act (PPACA). Dr. Christine Johnson, Chancellor, Community Colleges of Spokane, moderated a panel that provided different perspectives on the issue. I can’t duplicate their messages here although you should read the companion publication of the Journal of Business to get an additional dose of what we heard at the meeting. Heidi Alessi, K&L Gates, LLC mentioned the complexity of the new law for employers who are trying to determine whether they will be considered a “large employer” under the law. Trust me, if you are trying to find a way to not provide coverage for your 50 plus full-time equivalent employees, as a large employer, you will need a lawyer, an insurance broker and an accountant to figure out how to meet all the regulations and not be penalized for your work to get out from under providing this benefit to your employees. On the other hand, Josh Neblett, CEO of Green Cupboards, is quoted as saying in the Journal, “Rather than waiting for the government’s mandate to start in 2014, we opted to start offering health benefits at the start of 2013.” I guess health coverage for employers is sometimes a “what frame of mind am I in” decision for them. Mark Patrick, Moloney + O’Neill Benefits, LLC, really emphasized the fact that many of the rules have not been forthcoming from the federal government in a timely manner so there is still a lot that isn’t known about what rules employers will need to follow; especially about the use of the Benefit Exchanges (noting that there will be government run exchanges for individuals and small business including private exchanges and the existing market that we know today). He also emphasized that wellness incentives can work with appropriate planning.

Finally, Diana Rakow, Vice President of Public Affairs for Group Health Cooperative, posed the question, “what is driving the system-wide changes we are seeing now?” She noted the significant move to affiliations by health care entities through mergers and acquisitions as a sign of significant change occurring in health care. It is clear to her that the incentives in the health systems need to be aligned among the providers of care, insurers and government to achieve the Triple Aim. Shared savings from reducing cost while maintaining quality and patient satisfaction are key to a successful health reform movement. She also believes that consumers need to be more engaged through patient medical home models. So, what is the point of all this jawing about the PPACA if we don’t know all the rules yet, can’t determine how providers will be affected specifically and don’t understand yet why the government is getting so involved in health care? That’s the point! Providers should be trying to know what their patients want out of health reform and begin to build a strategy that keeps you, as the provider, in a strong relationship with your patient. Attend some meetings and see what businesses think about providing health coverage so patients can see you when they need to. And, to make the world right again, hire a good attorney, broker and accountant team to keep you informed (tongue in cheek!).

Becky

March SCMS The Message 17


Rural Medicine

“Last week I delivered two babies, one by C-section. The week before I amputated a man’s leg because it had contracted gangrene,” she told them. “This is a perfect fit for me. I get to work in intensive care, in OB and our clinic.”

By Doug Nadvornick, WSU Spokane Six months into the academic year first-year medical students look for any opportunity to break away from the routine of lectures, labs and quizzes. When the University of Washington School of Medicine assistant regional dean Dr. John McCarthy offered to rent a van and take Spokane first-year students for a day-long field trip, a dozen signed up. Their destination was Colville, a town of about 4,700 located 70 miles north of Spokane. It has become a health care center for residents in the northeastern corner of Washington (Ferry, Stevens and Pend Oreille counties) who don’t want to drive to Spokane to see the doctor. Colville is home to about 25 physicians. It enjoys a new state-of-the-art hospital (Providence Mt. Carmel) and is home to the nation’s oldest rural family medicine training track.

Gardner also, in her off-hours, makes house calls to see mothers and their newborn children. In a survey after the tour, several of the medical students, including Targeted Rural Underserved Track (TRUST) student Kameron Firouzi, said they are seriously considering applying for rural training. “Rural medicine is absolutely something that I want to pursue,” Firouzi wrote later. “I grew up in Moses Lake and would love to one day go back and practice there or in a small community like it.”

McCarthy hoped the field trip would open students to the possibility of practicing in a rural area after medical school. “I wanted to dispel their myths about rural areas in terms of quality of care and help them understand the excellence that is needed in rural areas when they don’t always have back up help,” said McCarthy, who practiced for many years in Tonasket in north central Washington. “I wanted to introduce them to what I think is the most fun and meaningful type of medicine there is.”

Colville medical residents Katrina Gardner and Matt Kaiser tell medical students about the broad range of procedures they handle.

Though the students report they enjoyed touring Mt. Carmel and talking with its doctors and administrators, their favorite part of the trip was their lunch with Colville’s two medical residents and a first-year Spokane resident who will spend his next two years in Stevens County. They heard third-year resident Katrina Gardner praise her Colville experience for its variety.

Twelve Spokane medical students recently toured Colville’s Mount Carmel Hospital to get a feel for rural medicine.

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Robotic Telemedicine Brings Stroke Expertise to Community Hospitals

hands-on practice is difficult without the face-to-face encounter.” She continues, “The ability for the consulting stroke neurologist to visually share in the experience¬—to participate in the examination as if they were at the bedside with the community ER physician—is invaluable in detecting stroke mimics and in differentiating the ‘bread and butter’ stroke from the potentially catastrophic stroke.”

By Liz De Ruyter, Providence Health Care Community hospitals in the Inland Northwest can now provide a higher level of care to patients experiencing a stroke as part of a new robotic telemedicine program offered by Providence Sacred Heart Medical Center. The program links the resources of Sacred Heart’s stroke center with primary care physicians at participating community hospitals throughout the region, allowing patients and their physicians access to neurologists 24 hours a day, 365 days a year. Patients at Lincoln Hospital in Davenport are the first to benefit by the program. A number of other hospitals throughout the region will join the network in the near future. “Our goal is to bring expert stroke care to patients in community hospitals, allowing patients to remain under the care of their primary physician and close to home whenever appropriate,” says Tena Cramer, director of neuroscience services at Providence Sacred Heart. By using technology to bring the neurologist into the community, patients and physicians in rural areas have access to a wider range of specialists, technologies, and services that are otherwise unavailable, thus reducing the need for transfer to a high-level medical referral center like Providence Sacred Heart. “In those instances when a higher level of care is needed for more seriously ill patients, transfer to Providence Sacred Heart is seamless. Because patients have already been evaluated by a neurologist and their treatment plans prepared prior to arrival, patients receive more efficient and cost effective care,” Cramer adds. The program is designed as a partnership between community hospitals and Providence. Within moments of a request for a medical consultation, a Providence specialist can interact and converse with a patient, the patient���s family, physician or nurse through live, two-way audio and video. The specialist maneuvers the robot to view vital signs on monitors and charts, and assesses the patient as though they were in the same room. Stroke expert Madeleine Geraghty, MD, explains. “As our system currently stands, our community partner physicians take a rapid and thorough stroke assessment when the patient first arrives in their Emergency Department. That detailed evaluation is then relayed verbally to the Providence neurologist over the telephone; management decisions are made jointly between the two doctors. Yet so many times, the nuances of an atypical examination or the subtle finding on a CT scan are difficult to describe verbally. An experienced ER physician many times may be instinctually aware that a potentially dangerous inconsistency has arisen, but quantifying that gut feeling based upon years of

“The capability of physicians and staff at hospitals like Lincoln to request an immediate neurological consultation for a patient becomes increasingly important as our population ages – resulting in higher incidents of stroke and neurological issues,” says Tom Martin, chief executive of Lincoln Hospital in Davenport. “This technology gives our community access to a higher level of care and the ability to keep patients at Lincoln Hospital,” he says. The Providence Telemedicine Program at Sacred Heart initially offers neurological and stroke expertise to community hospitals. However, it has the potential to expand to include internal medicine and other specialties based on needs identified by participating hospitals. “Demand for physician subspecialists will only grow as our population ages. That, in conjunction with a national shortage of physician subspecialists make this program vital to the health of rural communities,” says Martin. The program also includes an educational component. When requested by participating hospitals, Providence will provide additional training to hospital staff so that more patients are able to stay in their local hospital. Providence is providing the robots to participating hospitals at no cost. Savings are incurred when patients are able to receive care without the additional cost of being transferred to a regional referral center. Program costs will be covered over time through consultation fees. “It is part of our mission to expand access to health care, and provide that care in the most economical way possible,” says Cramer. The telemedicine program is expanding to Tri-State Memorial Hospital in Clarkston, Idaho, and Providence Mount Carmel Hospital in Colville, Washington, within the next few months. Additional community hospitals are expected to join the network within the year.

From Providence Sacred Heart Medical Center, stroke expert Madeleine Geraghty, MD, can interact with a patient and caregiver in smaller community hospitals. Photo by Steven Navratil

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Idaho Health Data Exchange By Matt McGraw Senior Marketing Coordinator, IHDE The Idaho Health Data Exchange (IHDE) is the state designated health information exchange for Idaho. The IHDE was founded in 2007 by then Governor Risch in response to the national trend of medical records going from paper to digital. The IHDE electronically and securely connects patient medical records from IHDE participating hospitals, providers, labs, insurers and EMRs and converts the records into a single, interoperable record using Health Language 7 (HL7). With a username and password providers and their care teams can access and retrieve patient records within seconds from the IHDE 24x7 and in real time. Available patient data includes ADT, demographics, Labs, Radiology, Reports, Allergies, Medications, Progress Notes, Problems and more. Images from St. Joseph Medical Center and St. Luke’s Regional Medical Center are also available within seconds in the IHDE including full, diagnostic quality X-rays, CT-scans, PET scans, MRIs and Ultrasounds. Instead of logging on to multiple health care systems and calling/faxing/ sending paper medical records, providers and their care teams can easily and quickly access their patients’ medical records in seconds. Health Information Exchange is all about helping to improve health care by enabling providers electronic and secure access to patient medical records, enabling providers to communicate and collaborate and helping to reduce health care costs. For more information go to the IHDE website at www.idahohde.org. Click on the second to the last tab on the left to see a list of participants. Below are excerpts from interviews with IHDE participants. Dr. Lisa Nelson is a Hospitalist on staff with Saint Alphonsus Regional Medical Center (SA) since 2009. Dr. Nelson accesses the Virtual Health Record (VHR) 400-500 times a month. “Quite a few of our patients, at least here in the valley, have their care split between providers from St. Luke’s (SL) and SA. Before we had access to the IHDE, it was more complicated to get records. When we are admitting patients overnight, it is really important to know if their illness or condition is chronic or acute, what other medical problems they have, and what medicines they use. Since we’ve had access to the IHDE, it’s been great to be able to log on and see that two years ago, a patient was admitted to the ICU at SL, even though the patient may tell me that they have not had any other recent hospitalizations. With the IHDE, I can provide better care for them when they are hospitalized at SA, because I have a better understanding of their past or current medical history.” “IHDE helps us with the immediate access and availability of obtaining patient information, and helpful in directing the treatment plan while the patient is hospitalized. It’s certainly better to have some information on a patient than none, especially with a patient

who has dementia and cannot tell you anything. It’s definitely improving patient care in that the VHR answers many questions that I already would be asking the patient, saving time and improving the accuracy of the history. In an ideal world, it would be great to call up a PCP and have a conversation every time a patient is admitted, but I don’t think that’s practical from either a hospitalist’s or PCP’s standpoint. PCP’s are constantly pulled in many directions and their time is so valuable, and sometimes I feel badly about having to pull PCP’s from an exam room to get patient data. So, it’s nice having access to the IHDE because much of that information is available at your fingertips. Getting a greater portion of the provider community to input records would be beneficial. We get a lot of transfers from some of the smaller community hospitals. Just letting those providers know that their shared data is important, because the more information we can get in there (the VHR), the better it is for the patient. If there is a lot of data, I can sift through it because that’s part of my job. And having access to the data is really key.” Eric White, SARMC Physician Relations Executive, is one of three representatives in Physician Relations covering all of Ada and Canyon counties. Physician Relations enhance relationships through frequent communication with providers and staff; help remove obstacles between the hospital and providers and disseminate information regarding services, new providers, hospital updates, technology, forms, etc. “When information is needed for a patient’s chart, clinic staff want a fast turnaround when they call medical records, but they don’t realize the complexities often going on behind the scenes that can create delays. With some requests, especially those that go back 8-10 years, a considerable amount of detective work has to be done to obtain the right information. Being a trauma center, you can imagine the amount of records that can quickly accumulate after a patient has been here (at SARMC) for several weeks. So while we would like to improve our turnaround time for clinics that need records quickly, sometimes other factors can cause a delay. The beauty of the Idaho Health Data Exchange is clinic staff can quickly log onto the site and get the records they need within minutes.” Karen Fleming, Director of SARMC Medical Records Department, is one of four full-time people in Medical Records. The SARMC Medical Records office is open Mon-Fri from 8 am - 5 pm. Their two main responsibilities are to send medical records and digitize medical records. “When the IHDE was first started years ago, I was suspicious of it and so were other HIM directors. We worried about patient privacy and how it would all work. It has taken a little bit of coaching and getting used to the idea of the IHDE, but from my perspective, I totally support this. It’s a great thing. The mission is to ensure that accurate medical records are delivered. If you can get to it electronically, that’s the whole point. You can get medical records from the IHDE at a moment’s notice. No more requests, no more faxing, no more waiting.”

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Opinion

Prescription for a Healthier Practice

Article reference: Medicare Payments to CRNAs Irk Anesthesiologists, Again From the February 2013 The Message As one of many physicians who have concern for new legislation that will pay nurse anesthetists (CRNAs) to practice interventional pain management, I would like to add my voice to Drs. Hatheway and Weigel’s recent comments in the February edition of the SCMS Newsletter. I too am a board certified anesthesiologist, with additional board certification in pain medicine. I have been practicing as an anesthesiologist and interventional pain specialist in Spokane for 23 years. Chronic pain management is the practice of medicine. Nurse anesthetists have neither the education nor the training to perform chronic pain services. The American Association of Nurse Anesthetists’ (AANA) own “Standards for Accreditation of Nurse Anesthesia Education Programs” specifically cite that no clinical experience with “Pain management (acute/chronic)” is required as part of nurse anesthesia training. Chronic pain care is not a subset of anesthesia or of care related to the provision of anesthesia. Chronic pain is multidisciplinary; to be ABMS board certified in pain medicine, a physician must complete a fellowship program and pass a board certification examination created by a multidisciplinary committee with representatives from the fields of Anesthesiology, Physiatry (Physical Medicine & Rehabilitation), Neurology and Psychiatry. A variety of physicians with specialty training in chronic pain provide chronic pain services. Adopting a national policy to include nurse anesthetists is unnecessary, unwise and will not improve access. Medicare’s own data shows that nurse anesthetists provide few, if any chronic pain services likely due to lack of education and training, and, in particular, do not provide these services in rural areas. Medicare’s own data shows that physicians are the overwhelming providers of pain services, even in underserved areas, delivering over 99.8 percent of all services. The article by the very biased Ms. Pecci, heavily pro-nurse (and many say anti-physician), ignores many of the facts of this debate, repeats fantasy arguments regarding solving access to care issues and minimizes real patient safety issues. Although the misinformed AARP and a myopic local politician have promoted CRNAs to perform Pain Medicine procedures, those ARNPs’ lack of adequate medical training will put patients at risk for serious complications and questionable results. All practitioners in this community should consider this when considering Pain Medicine consultations for their patients. Respectfully, George M. Momany, MD

These tips are a part of the AMA Practice Management Center’s “Prescription for a healthier practice” series to help physicians and their staff examine how their practices are performing in key administrative processes. Claims Revenue Cycle Check-Up Perform this check-up to evaluate your practice’s capability to submit claims efficiently and accurately; analyze health insurer payments for accuracy; and effectively address delays, denials and reductions in payment. Don’t worry if you can’t check every box—you can refer to the provided resources for help. This check-up is a part of the AMA Practice Management Center’s monthly “Prescription for a healthier practice” check-up series. Streamline your overpayment recovery processes Streamline your overpayment recovery process by reducing manual workflows and creating efficiencies in your claims revenue cycle. Start with “Questions to consider when addressing payer overpayment recovery requests on individual claims.” Sign up for Practice Management Alerts e-mails at www.ama-assn.org/go/pmalerts to stay up to date with new check-ups in the monthly series.

Assistant Clinical Dean for WWAMI Spokane Position Announcement The University of Washington School of Medicine (UWSOM) WWAMI program has a position available for a part-time Assistant Clinical Dean with responsibilities for developing, coordinating, and maintaining clinical medical education activities in Spokane. In this role, the Assistant Clinical Dean will represent and advocate for UWSOM and WWAMI as well as be a liaison between Spokane clinical educators and faculty at the UWSOM. The position description is available at http://www.washington. edu/admin/acadpers/ads/aa3246.html. If interested in the position, please send a letter of interest and CV to: Gretchen Burke Executive Assistant to Suzanne M. Allen, M.D., M.P.H., Vice Dean for Regional Affairs The University of Washington School of Medicine c/o The Idaho Water Center Building-WWAMI Office 322 East Front Street, Suite 442D Boise, Idaho 83702 Phone: (208) 364-4552 Fax: (208) 334-2344 Email: gretburk@uw.edu

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In The News

HIE, Now You’re Talking

Hakan Kaya, MD Performs 100th Stem Cell Transplant

By Matthew Weinstock Hospitals & Health Networks Senior Editor From H&HN Daily February 14, 2013

On February 6, Dr. Hakan Kaya, Director of the Inland Northwest Myeloma/Lymphoma & Transplant Program of Cancer Care Northwest performed his 100th Stem Cell Transplant in Spokane. The program has significantly grown since the first transplant done in August 2005, having performed 25 transplants in 2012 alone. The annual number is expected to rise in 2013. “We are very happy to offer this state of the art therapy to this region’s cancer patients” said Dr. Hakan Kaya, “We have taken care of patients not only from Spokane but from surrounding areas including Lewiston, Wenatchee, TriCities, Yakima, Coeur d’Alene, other parts of Northern Idaho and Western Montana.”

Washington State Representative Eileen Cody Recognized with AMA’s Top Government Service Award in Health Care The American Medical Association (AMA) honored Washington State Rep. Eileen Cody with the Dr. Nathan Davis Award for Outstanding Government Service, its top award for government service in health care. Rep. Cody was honored with the award at the AMA’s National Advocacy Conference in Washington, D.C. “Rep. Cody has led efforts toward improving health care access for low income individuals and transforming mental health services in Washington state,” said AMA Board Chair Steven J. Stack, M.D. “Her dedication to public health has also earned the state national recognition for its long term health care services and support system.” Rep. Cody was nominated for this award by the governor of Washington State, Christine Gregorie.

If there was ever was a perfect storm for HIE, it may be right now. The Office of the National Coordinator’s (ONC) John Rancourt may be the master of understatement. In a blog late last month, the program analyst stated, “Health information exchange is not easy.” Ain’t that the truth? If it were, HIE (the noun) probably wouldn’t even be in our lexicon. The industry would have solved the problem somewhere between CHMIS and RHIOs (CHIN was my favorite acronym). But Rancourt is right. Health information exchange (the verb) is hard. Even as many of the technological challenges fall by the wayside, there are lingering questions over how a health information exchange (the noun) can be sustained. And as John Morrissey points out in our latest Connecting the Continuum article, there are multiple competing models vying for your attention. But if there ever was a perfect storm for HIE (verb and noun), it may be now. In a cover story two years ago, we pointed out the strong business case for health information exchange. That shift started with passage of the HITECH Act, which gave rise to meaningful use, and it has accelerated with health reform and the shift to a value-driven delivery system. The more at risk providers are for a patient’s continuum of care, the more records need to flow freely from one setting to another. Some states, regions and providers have been working for a while to get out in front of this issue. It’s something we talked to Russ Branzell about in August 2011. At the time, he was CIO at Poudre Valley Health System in Colorado and leading the charge for HIE. Earlier this week, Branzell was named CHIME’s new CEO. Back to Rancourt’s blog, though. In it, he identifies five new reports from ONC aimed at helping the industry advance the cause of HIE. The reports range from a how-to guide for, as he says, “navigating the major business considerations for HIE,” to one on consumer engagement. Is your hospital, state or region moving toward some form of HIE? If so, we’d like to hear about it. Email your comments http://www. hhnmag.com/hhnmag/HHNDaily/hhndaily@healthforum.com.

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The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS Nye, Andres M., MD Family Medicine Med School: Albany Medical College (1997) Internship & Residency: Lancaster General (2000) Fellowship: Spokane Family Medicine (2004) Practicing with Providence Family Medicine Residency 03/2013 Rajendra, Rajeev, MD Internal Medicine/Oncology/Hematology Med School: Dr D>Y> Patil Medical College (India) (1996) Internship & Residency: Ball Memorial Hospital (2010) Fellowship: U of Washington (2013) Practicing with Medical Oncology Associates 08/2013

PHYSICIANS PRESENTED A SECOND TIME Harbour, Chad M., MD Orthopedic Surgery Med School: Loma Linda U (2004) Practicing with Providence Medical Group- Orthopedic Specialties 03/2013 Payne, Erik J., MD Anesthesiology Med School: Loma Linda U (2002) Practicing with Anesthesia Associates 02/2013 Ordonez Castellanos, Miguel, MD Gastroenterology Med School: U Francisco Marroquin (Guatemala) (2003) Practicing with Rockwood Digestive Health Center 07/2013

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME Moore, Carly M., PA-C Physician Assistant School: U MEDEX Northwest (2012) Practicing with Alpine Orthopedic & Spine 12/2012

POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/ work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Toni Weatherwax at (509) 444-8888 or hr@chas.org. QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at (800) 260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm.com to learn more about our company. PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical! CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide. OPI owns and operates plasma collection centers critical to the development of lifesaving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma.com. Apply today by sending your resume/CV to Careers@OctapharmaPlasma.com! PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com. CONTINUED ON NEXT PAGE

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FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at (509) 4590688 or e-mail at BorgwaD@fammedspokane.org. SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PA-C N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider. Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org. PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income! We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380. EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, (509) 565-4352, email maikeshi@dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

NORTHWEST MEDICAL SPECIALTY EVALUATIONS - Physicians wanted for medical disability exams in our Spokane office. Excellent pay. Work is low stress with minimal paperwork and no ongoing patient care responsibilities. We can schedule around your availability seven days per week. For more information call (509) 588-7340.

PROVIDENCE HEALTH & SERVICES has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Regular 8-5 hours, fiveday week. New physicians will join Providence Medical Group, our physician-led multispecialty medical group with clinics throughout the metropolitan area. Excellent compensation and benefits. Providence Medical Group (PMG) – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence. org or 509-474-6605 for more information. PROVIDENCE MEDICAL GROUP (PMG) - Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in this scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, stateof-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive benefits. Providence Medical Group – Eastern Washington is our physician-led network of more than 200 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence.org or 509-474-6605 for more information.

PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care. Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly. We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@ partneringforprogress.org.

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March SCMS The Message 25


Continuing Medical Education

Meetings/Conferences/Events

Obesity Update 2013: This 2.75 hour AMA Category I CME seminar is sponsored by the Spokane County Medical Society. This activity has also been reviewed and is acceptable for up to 2.5 Prescribed credits by the American Academy of Family Physicians. This conference is one of the evening workshops for the 2013 Primary Care Update and will be held on May 2, 2013 5:30 – 9:00 p.m. at the Red Lion Inn at the Park. The 2013 course will present the latest material on the pathophysiology, the medical management and surgical treatment of obesity. This program will provide attendees with take-home strategies for improved treatment for this patient population. Contact Karen Hagensen at (509) 325-5010 or email Karen@spcms.org for more information. Rockwood Health Systems Breast and General Tumor Boards: These tumor boards are jointly sponsored by Rockwood Health Systems and the Spokane County Medical Society. Tumor Boards will be held weekly January – June 2013. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@ rockwoodclinic.com. STD Update – Join the Seattle STD/HIV Prevention Training Center and the Spokane Regional Health District March 21 and 22 at St. Luke’s Rehabilitation Institute in Spokane for this two-day STD Update. This course provides participants with training in the most recent advancements in the epidemiology, diagnosis and management of viral and bacterial STDs, and was designed for clinicians in the Spokane area who diagnose and treat patients with sexually transmitted infections. CMEs and CNEs are available. The cost to register is $100. Lunch and a continental breakfast will be provided each day. Seating is limited and pre-enrollment is required by March 14. CME: The University of Washington School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Washington School of Medicine designates this educational activity for a maximum of 13.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. Please visit www.seattlestdhivptc.org for online registration and payment information. Any additional questions can be directed to Anna Halloran, Health Program Specialist at the Spokane Regional Health District at 509-3241635 or ahalloran@srhd.org. Promoting Healthy Families (Practice Management Alerts from the American Medical Association) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at 509.358.7631. Spokane Guild of the Catholic Medical Association- Meets second Wednesday of each month at 6 p.m. at Providence Sacred Heart Medical Center Administrative Board Room in Administration on the Main Floor. All are welcome. For inquiries contact Phil Delich, MD at (509) 465-1554 or e-mail at delichphil@gmail.com. Upcoming Aging and Mental Health Conference, Thursday, March 7, 2013 8:00 a.m. to 5:00 p.m. The purpose of this conference is to raise awareness of the issues involved with mental health and older adults, as well as provide concrete tools for assessment and intervention. Mark your calendars now. More details to follow. For more information contact Jamie McIntyre, MSW Aging and Long Term Care of Eastern Washington Assistant Planner/ Title V Coordinator (509) 458-2509 x211. Medical Reserve Corps of Eastern Washington General Membership Meeting – Spokane Regional Health District Auditorium, 1101 West College Avenue, 6:00 – 8:00 p.m. Wednesday, 13 March 2013. Everyone is welcome to attend. Meeting topics include a briefing on the Hazardous Materials Team, an update on training, exercise, equipment, recruitment and communication and a Coordinator’s report. Established date for next month’s meeting, 10 April 2013. Disaster response and preparedness involves all of us at home or at work. For more information contact David Byrnes at DByrnes@srhd.org. HITECH - HIPAA Updates: Changes to the Regulations, New Enforcement Initiatives and Audits – WSMA Practice Management Seminar Thursday, March 28, 2013 12:30 – 4:30 p.m. Valley Hospital 12606 E. Mission Ave. The new HITECH Act has dramatically increased HIPAA compliance requirements. This seminar will explain the new rules as well as new requirements related to electronic health records that will require changes to policies, procedures, and even notices of privacy practices. Participants will receive practical legal guidance on drafting policies and procedures, as well as information on free Washington statespecific policies and procedures. For more information contact Jenelle Dalit at 1-800-552-0612 or jcd@wsma.org. Free Bloomsday Training Programs – Are you doing Bloomsday this year? Check out www.stepupandgo.org for free 8 to 16-week training programs to help you meet your walking or running goals for the 2013 run and for life. You will find the training programs under the Challenges tab at the top left corner of the website, next click on the View Available Challenges link to find the Bloomsday Tracker. What are you waiting for!

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Cl assified Ads REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com. Comfortable Three-Bedroom Home in quiet neighborhood for rent. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962.

MEDICAL OFFICES/BUILDINGS South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease. Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net. Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com. Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.

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Endocrinology – Physician

Spokane, Washington Columbia Medical Associates, a subsidiary of Group Health Physicians, is currently seeking a BC/ BE Endocrinologist to join our Medical Group in Spokane, Washington. The position offers the following: • Competitive Salary and Generous Benefit Package. • Full-time opportunity joining two established providers. • Opportunity to become a shareholder. Our physicians are committed to maintaining the health and well -being of their patients through preventative -care measures and working closely with community specialists. Our new partnership with Group Health and collaborative care models ensure patients have access to the best care in Spokane. For additional information or to submit your CV, please contact: Cayley Crotty, Crotty.c@ghc.org GHP Recruiting Dept. | 1-800-543-9323 | Or visit Grouphealthphysicians.org

NO SERVICE? NO PROBLEM— WE’VE GOT YOU COVERED. Every patient you refer to us will have their end-of-life care needs met, 24/7. To refer, call 509-456-0438. Northeast Washington’s only nonprofit hospice

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SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

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Rockwood Multiple Sclerosis Clinic ACCEPTING NEW PATIENTS! » Under the direction of Dr. Yashma Patel, a fellowship-trained MS neurologist caring for all aspects of MS treatment

» Central nervous system neuroimmunology » Evaluations for MRI concerning for MS » Treats patients of all ages

Yashma Patel, M.D., joined the Rockwood Neurology Center in August 2012. She received her medical degree from J.J.M. Medical College, Rajiv Gandhi University in Davangere, India. Dr. Patel completed an internship in internal medicine at Flushing Hospital Medical Center in New York. She also completed a residency in neurology at SUNY in Stony Brook, as well as fellowships in adult and pediatric Multiple Sclerosis and neuroimmunology, also at SUNY in Stony Brook, NY. Dr. Patel is board eligible with the American Board of Neurology, and is a member of the American Academy of Neurology, American Medical Association, National Multiple Sclerosis Society, Spokane County Medical Society, The International Association of HealthCare Professionals, and the Consortium of Multiple Sclerosis Centers.

To schedule an appointment or refer a patient, please call (509) 342-3200.


The Message, March 2013