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A MON T HLY NE WS M AG A ZINE OF S P O K A N E C O U N T Y M E D I C A L S O C I E T Y – M A Y 2011

BRINGING SERVICE TO LIFE By Brad Pope, MD SCMS President

Mobius Science Center: A New Vision for Spokane Spokane Scholars Foundation: Recognizing the Best of the Best


May SCMS The Message Open2


2011 Board of Trustees Brad Pope, MD President Terri Oskin, MD President-Elect Anne Oakley, MD Vice President David Bare, MD Secretary-Treasurer Gary Knox, MD Immediate Past President Trustees: Keith Kadel, MD Michael Cunningham, MD Paul Lin, MD Randi Hart, MD Gary Newkirk, MD Carla Smith, MD Rob Benedetti, MD Audrey Brantz, MD Louis Koncz, Jr. PAC David McClellan, MD

TA B L E O F C O N T E N T S

Bringing Service to Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Spokane Scholars Foundation Recognizing the Best of the Best . . . . . . . . . . . . . . . . . . . 2 Spokefest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Angel Flight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Mobius Science Center: A New Vision for Spokane . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Tracking Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Project Access Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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62nd Annual SSIM Meetings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 UWSOM Curricular Changes and Potential Opportunities . . . . . . . . . . . . . . . . . . . . . . 11 Can we change the culture? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Successfully Surviving a RAC Audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Membership Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CME Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Meetings Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Spokane County Medical Society Message Terri Oskin, MD, Editor A monthly newsletter published by the Spokane County Medical Society. The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

"Act as if what you do makes a difference. It does." William James

Advertising Correspondence Quisenberry Marketing & Design Attn: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@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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Bringing Service to Life

you will enjoy reading how you are making a difference in the following articles. I hope even more of you will consider how you can make a difference.

By Brad Pope, MD SCMS President

Now let me give a brief update on our activities during the past month.

This month’s The Message recognizes the lively spirit of service in our medical community. We’ve got a lot to celebrate. If I asked how many among you are leading youth activities and coaching sporting events, many of us would raise our hands. If I counted how many of you serve on a non-profit board or lend your voice for political action, there would be many more. From mission work to providing care through free clinics, you give your time and that’s important. Community service changes lives, and not just those of the people you are directly helping. It’s personally fulfilling as well. Through our interactions, we are exposed to different people and ideas and we broaden our horizons. This, in turn, helps us become a better father, wife, doctor, or citizen. We’ve all worked hard to get our medical degrees and credentialing, and most of us would agree it’s a privilege and a gift to practice medicine. Helping others is a way for us to give back. From a practical standpoint, our involvement strengthens the medical profession. While we are out in the community, serving on a board, coaching our kids, and even raising money for good causes, our leadership reflects well and presents our human side. To our neighbors, we become someone more than the person in the white coat, asking personal questions and sending them bills. Interacting with our communities creates openings for the public to ask questions plays a vital role in and get our perspective on serving our communities. the health care issues of today. I am proud that our It can improve our bedside manner and our care. My own medical community works direct experience is tied to many collaboratively to find years volunteering with the Boy solutions and improve Scouts. Besides the treasure of spending quality time with my care for our neighbors. family, it opened a window on how other families deal with issues including hyperactivity. I could observe and understand how social, psychological and health issues played out in the lives of boys and I discovered that I related better to patients and families in my own practice.

As you can see, SCMS

Similarly, I’ve found that serving on a variety of boards has deeply expanded my knowledge in finance, organizational skills, and of course—people skills.

Chronic Opioid Task Force: The task force continues taking concrete steps to improve care for Spokane-area patients with chronic, non-malignant pain. A subcommittee has formed to research a common Pain Management Agreement and determine the essential elements of agreements, which could be used on the bulletin page of MEDITECH PCI in hospital emergency departments. Once those data elements are defined, the goal is for professionals in emergency departments, pharmacies and medical groups to be able to pull the information from MEDITECH or other community-based cloud platforms. Dr. Lynda Williamson is leading a subgroup of the task force to define key elements of opioid use agreements. SCMS CEO Keith Baldwin is providing support to that group. The SCMS also co-signed a letter with the Spokane Regional Health District to encourage local physicians to participate in a University of Washington survey of opioid prescriptive behavior. We hope to gain a better understanding of current practice in our community for managing opioids and identify areas for improvement. Use of PETC-CT: SCMS also convened a meeting of medical oncologists and radiologists with Dr. Jeffery Thompson, Medical Director, Department of Social and Human Services, to discuss the use of PET-CT with Medicaid patients as well as the use of the Dossier process for defining use and reimbursement.  Dr. Arvind Chaudhry and others gave input about this process and the impact for physicians and hospitals. The same group will follow through with Dr. Thompson on the Dossier process. Governance at INHS: At our March Board of Trustees meeting, Dr. Brian Seppi, our representative serving on the board of Inland Northwest Health Services (INHS), reported on recent changes to INHS’s governance structure.  The Empire Health Foundation will now appoint an SCMS member to participate as one of its three members on the INHS board, each with a single vote. Providence will be represented on the board with five votes.  Dr. Seppi remains as our SCMS representative for one more year. Four-Year Medical School: At the same board meeting, Rich Hadley of Greater Spokane Inc. and WSU Spokane Chancellor Brian Pitcher reported progress toward the four-year medical school, highlighting needs for capital and operational funding as well as physician participation as faculty.  We will schedule a meeting in mid-May for physicians to give input to the medical school development work plan. As you can see, SCMS plays a vital role in serving our communities. I am proud that our medical community works collaboratively to find solutions and improve care for our neighbors. I thank each of you for leading and for serving.

So thank you for volunteering in our community and world. I hope May SCMS The Message 1


Spokane Scholars Foundation Recognizing the Best of the Best

Unanticipated, even untoward events can occur during efforts to do good work. Yet, the most common response from a volunteer is, “I got more out of it than I gave”.

By Eric Johnson, MD The concept of Spokane Scholars Foundation (SSF) originated 20 years ago when Spokane attorney Lou Rukavina shared with me a news story that United States high school students ranked below Bulgaria in standardized test scores in History and Math. Neither Lou nor I had anything personal against Bulgaria, but it seemed to us our country could do better than that. Lou and I had coached football together at Cataldo Middle School for several years. We enjoyed sports. We realized that the Spokane sports template of publicly highlighting high school athletic performances seemed to be effective in encouraging and promoting athletics among junior high and grade school kids, who dreamed of someday being that “star athlete”. The annual sports banquet with its famous sports keynote speaker always resulted in full-page newspaper articles and lengthy features on every Spokane television station. Since adults spent so much time glorifying high school athletic achievements and so little effort (usually zero) publicly recognizing academic excellence, it was easy to see why some students might think their community didn’t value scholarly work. We sought to change that perception

Volunteerism exists in varying forms: high profile, low profile; individual or group driven; hometown or overseas; medical or non-medical; short or long term; helping one person or many people. The common characteristic is doing something for someone else for free. What do you get back from giving? Gratification, fulfillment, new friendships, personal development and a different way of looking at life.

SpokeFest

By William Bender, MD In 2007, I served on the volunteer Bicycle Advisory Board for the City of Spokane. Our goals included making bicycling safer, as well as finding ways to encourage people to use a bicycle for transportation and fitness. I was intrigued with the model of a number of other large cities who held mass community bicycle rides as a major municipal event. I have also been enthralled by Bloomsday, which has encouraged a wide range of people to get out and partake of a level of physical activity to which they might not have otherwise aspired.

We wanted kids in our town to “dream of being a star scholar”. We assembled a group of people who shared that goal. This all-volunteer board has been together for 20 years -- fund-raising, banquet planning, securing speakers and coordinating with Spokane’s 25 public and private high schools. We have to date had the privilege of individually introducing to the banquet attendees over 2500 incredible high school “scholar stars” and of providing nearly $500,000 in grants to the best of the best. Spokane students and schools now vie for the title of Spokane Scholar, and our keynote speakers are internationally recognized scholars themselves who generously appear without charge. Of note is that Spokane physicians and their families contribute each year over half of our $80,000 budget. Three retired physicians (hugely appreciated, not named here) give at a level that allows us to remain solvent. A successful volunteer effort requires people who share a vision, are passionate and committed, are immune to pessimism, understand the concept of teamwork and are willing to take risks. Not every volunteer effort results in the successes envisioned, whether it is changing a community attitude towards academics or providing medical care to children in third world countries.

With those thoughts in mind, I was fortunate enough to gather together a group of talented people, including Dr. Jude Martin, to form a non-profit corporation called “The SpokeFest Association” with the initial goal of putting on a large-scale community bicycle ride for all ages and abilities. The first SpokeFest took place the Sunday after Labor Day, 2008, witnessing 1255 riders. It included a 21-mile course highlighting the beauty of the Spokane River, and a 1-mile course in Riverfront Park, targeted for children. As we approach our 4th Annual SpokeFest on September 11, 2011, we do so with much joy and satisfaction. Last year’s event drew almost 2,000 people, who rode courses of 1, 2, 9, 21 and 47

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Continued from page 2 miles. We heard many wonderful stories from people who were inspired to develop new health habits, such as stopping smoking, losing weight, exercising and enjoying the outdoors more. We smiled at the enthusiasm of the kids who also stretched themselves to a new level of activity, and will hopefully develop a health-positive orientation that will last throughout their lives. The SpokeFest Association also continues to grow in a number of exciting ways. We are the parent organization for the Bike to Work Week event that is expanding under the name of “Spokane Bikes,” encouraging us all to consider biking to work, shopping, worship and social visits. Last year, in conjunction with the Mayor’s office and kind sponsorship from the SCMS Foundation, we put on two days of Summer Parkways. At the event, three miles of streets were closed to traffic and served as a venue for everyone to come out and enjoy some form of physical activity, including bicycling, walking, running, skateboarding, rollerblading, dance/exercising, hula hooping and many other offered activities. This year, the Mayor has asked the SpokeFest Association to put on three runnings of Summer Parkways, which will be held on June 22 from 6-9PM in the Manito/Comstock area, from 10 AM-2 PM on July 24 in the North Hill/Franklin Park area and August 14 in the Audubon/Northwest area. SpokeFest 2011, scheduled for 9/11/11, will include a commemorative for the tenth anniversary of the tragic events of this date. In keeping with our mission of education, in 2010, SpokeFest provided 30 bicycles and teacher training to East Valley School District to implement a bicycle curriculum for their 4th-6th grade students. The project teaches students the basic skills necessary to be safe while bicycling. Spokane’s East Kiwanis is a SpokeFest 2011 grant recipient for the Paint a Helmet children’s bicycle helmet program. The program was started in 1997 with youths receiving, at no cost, a white, Department of Transportationapproved, bike helmet they can paint and decorate. Volunteers fit helmets for the children and show parents how to maintain the proper fit. Both parents and children are encouraged to wear helmets every time they ride their bikes. Many, many volunteer hours have been put in by hundreds of people to make these events happen, along with generous sponsorship by a wide range of business and organizations. All of this has been richly rewarded in the joy of influencing the health of our community in a way well beyond what I can do in my medical office on a one-to-one basis. The community partnerships that continuously blossom around this take our original efforts toward public health and municipal enrichment well beyond anything I could have imagined. I give thanks to all who have given their time, resources and creativity.

Angel Flight By Terry Judge, MD I want to thank the staff of SCMS for giving me the opportunity to write this column. Next to my family, my life passions have been medicine and aviation. I have been a pilot and flight instructor for many years and it was therefore a wonderful and welcome coincidence that Angel Flight came to eastern Washington the same summer that I retired from Spokane Cardiology. I volunteered to fly missions and do medical outreach in eastern Washington and northern Idaho. Angel Flight’s core mission is to provide DONATED air transportation for financially needy and medically stable patients to and from their medical appointments. We also fly missions for Hospice, agencies of domestic violence many other compassionate needs and it’s great fun flying kids to their summer camps for cancer, heart disease, diabetes and kidney disease. The pilots use their own or rented aircraft and pay for ALL fuel and other expenses. There is no reimbursement. Angel Flight started in 1983 in California with three pilots and fifteen flights. It has enjoyed remarkable growth and is now in 13 western states, including Alaska and Hawaii. The current 2,500 pilots fly around 4,000 missions per year. Flights in Washington account for about 10% of all Angel Flight missions. We are very proud that we are now approaching 50,000 total flights without a single accident.

It has been a genuine privilege to fly missions, many times giving persons their very first ride in an airplane, and to serve patients that would not otherwise be able to make their medical appointments. I recall a very cute 8 year old girl with Candlelighters (partner with the American Childhood Cancer Organization) who wanted to fly, but was very anxious. I did my best to reassure her. I got some seat pads so she could see and adjusted the seat so she could reach the yoke. After takeoff I taught her to gently turn and climb and descend. Her shining smile grew, as you can see from the picture taken after the flight. She was thrilled and I’m confident she won’t forget the fun we had. I sure won’t!

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Continued from page 3 The medical outreach has also been very rewarding and we have brought the Angel Flight message to many medical facilities and hospitals. We have a display and I attend more conventions than I did during practice. I have also been a member of the state board for ten years and the national board for eight years. During this time I have met many very amazing and dedicated individuals that have become close friends. I have many local friends in Angel Flight who generously help with our outreach activities and two within the medical community, Dr. Tom Rulon and Evelyn Torkelson who have been especially helpful. Thanks to all you wonderful people.

I cherish the thought that this activity has continued to be helpful to our patients. It has certainly made my retirement more satisfying and meaningful. It has become apparent to me that the people who derive the most benefit from this program are the pilots. It’s why we do it. For more information visit www.angelflightwest.com or contact me at tjjudge@comcast.net or 509 624- 8512.

Mobius Science Center: A New Vision for Spokane By David Gruber, MD and Neil Worrall, MD Consider a single line in Article 1, Section 8 of the U.S. Constitution that speaks to the powers and responsibilities of Congress: “To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.” Think about that line: Patent and copyright law was included as a basic right for a new nation’s citizens in 1787—an era during which inventors like Benjamin Franklin and Thomas Jefferson struggled to understand electricity and design more efficient plows. The Continental Congress was drawn from the best and brightest of the colonies, so it’s not surprising that our founding fathers saw fit to support scientists, writers, and artists—those who observe, report and offer better ways to see, comprehend and solve problems. It is this element that Mobius Science Center’s leadership staff and Board of Directors are committed to: providing an opportunity for learners of all ages and circumstances to have their curiosity sparked, ask questions and experiment with solutions. Through this, we will encourage the development of the next generations of researchers, doctors, software engineers, inventors and innovators of all varieties. Mobius Science Center will be a 25,000 square-foot exploration destination designed to provide the youth and adults of the Inland Northwest with a unique blend of dynamic experiences, education and entertainment. Continued on page 6

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Continued from page 5 The Science Center is part of Mobius Spokane, and includes Mobius Kids, a children’s museum located in River Park Square that has welcomed 350K visitors in its first five years. The Center will feature 80+ interactive exhibits and numerous facilitated programs showcasing the most current and engaging scientific principles and findings from our region and around the world. Through an immersive, hands-on learning approach, visitors will have the opportunity to see and experience the wonders of science and technology, understand its relevance in their daily lives and have fun in the process. The mantra for the Science Center is “Sparking curiosity, Igniting imagination.” Its mission is “To stimulate minds, inspire careers and instill wonder across the Inland Northwest with thought-provoking, entertaining and experimental science programs and exhibits.” To achieve our goals, the Mobius Science Center staff and board members are working with educators and students in public, private, parochial and home schooling communities to facilitate synergistic partnerships. Through scholarships and outreach programming, we intend to reach students from our urban, rural and tribal communities and foster an opportunity to see how science and engineering can captivate imaginations and lead to fulfilling careers.

Tracking Medicine A Lecture by John E. “Jack” Wennberg, MD Group Health Innovation Conference, March 25, 2011 Summarized by Keith Baldwin, CEO, SCMS I was privileged to listen to Dr. Wennberg’s presentation with Brad Pope, MD, as part of a larger conference, which focused on quality of care and performance improvement techniques. His comments were in part from his book, “Tracking Medicine, a Researcher’s Quest to Understand Health Care,” where he pursues the topics related to understanding variations in the way that medicine is practiced. He has stories from Vermont and Maine which showed early (From “Science,” December 14, 1973) variation in practices followed by work at the Dartmouth Atlas Project. A significant outlier as variations go showed up and drew a reaction Dr. Wennberg refers to as the “stages of facing reality;” • Stage 1. “The data are wrong.” • Stage 2. “The data are right, but it’s not a problem.” • Stage 3. “The data are right; it is a problem; but it is not my problem.” • Stage 4. “I accept the burden of improvement.” He comments on the fact that variation was reduced in the Vermont and Maine cases because the outliers took it upon themselves to view a change in their practice as an opportunity to improve patient care. And, he notes that there are three categories of unwarranted variation (Variation that can’t be explained by illness or patient preferences) in health care delivery: • Effective Care: variation in the provision of care known to be effective • Preference-Sensitive Care • Supply-Sensitive Care: variation determined by available

Just as the Constitution is the backbone of our beliefs as a nation, Mobius Science Center will do its part to engage students, individuals, and families with informative, immersive experiences designed to spark the curiosity and imagination of each visitor and outreach program participant throughout our region. Construction for the Center will begin in May 2011; the facility will open in late 2012. The Center will be located at 809 West Main Avenue adjoining River Park Square and the Mobius Kids site. To realize our vision, Mobius has received considerable support from the State of Washington and private donors. If you are interested in helping to support this legacy project or in making a donation, please contact Anna Marlis Burgard, Director of Advancement, at 509-443-5669. David and Laura Gruber are the current co-chairs and Neil Worrall is the immediate past chair.

resources (Ex: ICU beds) Preference-sensitive care: Involves tradeoffs -- more than one treatment exists and the outcomes are different. Decisions should be based on the patient’s own preferences. But provider opinion often determines which treatment is used. He says, "Bottom line implication: Clinical appropriateness should be based on sound evaluation of treatment options (outcomes research), and to avoid wrong patient surgery, medical necessity should be based on informed patient choice among clinically appropriate options.” Shared decision making strategies, including the use of decision aids, can be an effective means to elicit patient preferences during a decision making process.

Continued on page 7

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Continued from page 6 Examples are:

Condition

Treatment Options

• Silent Gallstones

Surgery versus watchful waiting

• Chronic Stable Angina

PCI vs. surgery vs. other methods

• Hip and Knee Arthritis

Joint replacement vs. pain meds

• Carotid Artery Stenosis

Surgery vs. aspirin

• Herniated Disc

Back surgery vs. other strategies

• Early Prostate Cancer

Surgery vs. radiation vs. waiting

• Enlarged Prostate

Surgery vs. other strategies

• Early Stage Breast Cancer

Lumpectomy vs. mastectomy

Supply-sensitive care has the following attributes according to Dr. Wennberg: • The frequency of use is governed by the assumption that resources should be fully utilized, i.e. that more is better • Specific medical theories and medical evidence play little role in governing frequency of use • In the absence of evidence, and under the assumption that more is better, available supply governs frequency of use

That last bullet point is supported by a number of additional comments by Dr. Wennberg, but you will need to consider them for yourself by taking a look at his book. It is worth the read if you want to better understand the work that has been done on variation in the way that medicine is practiced. Note: www. Dartmouthatlas.org.

of free medical services to uninsured low-income residents of Spokane County. In Spokane, since 2003, Project Access has become a network of more than 800 physicians, pharmacists, allied healthcare providers, and hospitals serving people with no other access to health care. $30 million of free care has helped 5,000 patients in Spokane County. Services include primary and specialty care, hospitalization, outpatient treatment, rehabilitation, medications, lab work, imaging, medical equipment, transportation, and interpreter services. Project Access is affiliated with the Spokane County Medical Society and is a program of the Spokane County Medical Society Foundation, which is governed by a board of physicians elected by the SCMS members. Major institutional partners providing services are Providence Health Care, including Sacred Heart Medical Center, Holy Family Hospital, PAML, and Providence Physician Services; Deaconess Medical Center and Valley Hospital and Medical Center; Rockwood Clinic; Group Health; Inland Imaging Services; and Community Health Association of Spokane.

What Does Project Access Do? These are the key activities and principals of Project Access (PA): • Educate community clinics, social service agencies, and other referrers in the PA application and enrollment processes • Assist some applicants with the application process • Accept patients who cannot qualify for any other healthcare insurance or assistance program • Accept patients with acute, not chronic, conditions • Recruit, organize, and orient a network of volunteer providers • Match patients with a participating Primary Care Physicians (PCP’s), with which they establish a “medical home” • Facilitate patient care coordination between PCP’s, specialists, and hospitals • Track patient results, improve efficiency, and report outcomes

Why is Project Access Valuable to our Community?

Project Access Update

In 2010, 571 patients were enrolled. Patient care claims data, plus an estimated 26% in services not reported by providers, totaled $6,315,708 in donated care in 2010. That’s $12.36 of medical services value for each dollar spent by PA.

By Lee Taylor Director, Project Access Spokane Among the many things I learned in this past month is . . . some individuals in our medical community may not be as aware of what Project Access is or does, as I would hope. Since one of the key things that I would like to do to financially support Project Access is concisely explain our value in the community, I would like to share that with The Message readers. (If you think you already know this, please read it anyway. What Project Access is, and does, is important to all providers in our community.)

What Is Project Access? Project Access is the only volunteer network of physicians, hospitals, and allied healthcare providers offering a full range

Traditionally, care for the uninsured and under-insured has been haphazard, fragmented and inefficient—frustrating both patients and physicians. Project Access coordinates the care of these patients, reducing the use of the specialty medical service providers’ resources to check insurance eligibility, contact patients for appointments, secure outside medical records, and ensure follow-up.

What is the Therapeutics Committee? Project Access care coordination includes medical screening by the Project Access nursing staff and volunteer physicians

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Cancer evolves at a rapid speed. So do our physicians. They have chosen the fields of oncology and hematology to specialize in and are the region’s leading board certified, fellowship-trained cancer experts. Pushing the limits, they conduct hundreds of clinical trials every year, publish articles for world-recognized scientific journals and customize treatment plans for every patient. Because no two cancers – or patients – are exactly alike.

Meet the physicians of Cancer Care Northwest. View their full profiles at: cancercarenorthwest.com/doctor-profiles

»

cancercarenorthwest.com

» 509.228.1000

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comprehensive innovative compassionate integrated


Continued from page 8 participating on the Therapeutics Committee. The Therapeutics Committee is a group physicians who volunteer their time to provide medical review and authorization services for patients referred to specialty physicians. A key to making the match of a PA patient with a specialist as efficient and successful as possible, is the medical screening process that ensures that each patient sees the right specialist, at the right time, with the required protocol of examinations and tests completed prior to the specialist visit. Here are the volunteer physicians and clinic representatives participating on the Therapeutics Committee:  hairperson/PA Medical Director C Valerie Logsdon, MD Family Medicine Brad Pope, MD David Bare, MD Family Medicine/Geriatric Jeff O’Connor, MD Radiology Don Cubberley, MD Dermatology Michael Ryan, MD General Surgery Courtney Clyde, MD Orthopedic Surgery Robert Rutherford, MD OB/GYN Robert Milligan, MD Neurology Steven Pugh, MD

In Memoriam

ROBERT WILLIAM MATTHIES, M.D. Robert William Matthies, M.D. died at age 75 on March 22, 2011, in Prescott, AZ. He was diagnosed in May with cancer. Born in Hammond, IN, on October 28, 1935 to Robert and Irene Matthies, Bob grew up in Lansing, IL. He chose a career in medicine and received his medical degree from the University of Illinois College of Medicine in 1961. He served in the U.S. Public Health Service Indian Health Division in Keams Canyon, AZ from 1962-1964 and was a medical missionary in Haiti in 1964-1965. He attended Garrett Theological Seminary in 1965-1966. From 19671971 he was in private practice in Wheaton, IL. He served as the Director of the Student Health Services at Boise State University from 1971-1976 and was the Medical Director of the Family Practice Residency in Boise, ID from 1976-1981; during which time he was honored as a "distinguished citizen" of the state. He was in private practice in Spokane, WA from 1981-1995 where he was a member of the Spokane County Medical Society and President of the Societ in 1993. He moved to Prescott, AZ and was in private practice there from 1995-2008. He was on the Postgraduate Medicine editorial board and in 2009 he was chosen as Arizona Family Physician of the Year. He went on numerous medical mission trips to Albania, Haiti, the Gulf Coast and other places. Bob and Marcie, his wife of 52 years, met in the Methodist Student Foundation at Northwestern University. Always committed to integrity in relationships, Bob early on asked for complete honesty. "Well then," she gently replied, "that tie doesn't go with that jacket.” Bob loved that story and had Marcie select his tie, shirt and cardigan sweater every morning. He made house calls, hugged patients, family and caregivers, and truly listened to people. Bob specialized in Geriatrics and was known as the physician who helped Alzheimer patients and their families. He taught physicians end of life care and learned from various specialists how to better care for his patients in his own office, thus avoiding unnecessary referrals. Dr. Matthies is survived by his loving wife Marcia, daughter Sharon, son Steve and his wife Karie, their daughters Amanda, Samantha, Hannah, Christina, Kathryn, and SaraGrace, his brother Richard and family, and his sister Buena (Copsey) and family.

Urology (Thomas) Nick Fairchild, MD Gastroenterology Dave Maccini, MD Otolaryngology Dave Malone, MD Clinic Representatives Carolyn Hendrikson, ARNP, SFFC Venetta McPherson, ARNP, Native Project Well, that’s the update for this month. Next month I’ll share some other areas where Project Access is collaborating with medical community partners to improve efficiency and effectiveness in our healthcare system. Please call me at (509) 220-2651 or email me at lee@spcms.org with any ideas that you would like to share. May SCMS The Message 9


Providence Inland Orthopaedics is located at 820 S. McClellan, Suite 300. The clinic offers a comprehensive approach to treatment of orthopaedic conditions and performs cutting-edge procedures by surgeons recognized for their expertise in advanced orthopaedic techniques:

Providence proudly welcomes Inland Orthopaedics to our team.

Eric Bowton, MD Erica Burns, MD Russell Oakley, MD

Arnold Peterson, MD D. Scott Redman, MD Leonard Atkinson, PA-C

Accepting new patients

PROVIDENCE INLAND ORTHOPAEDICS

Providence Inland Orthopaedics 820 S McClellan • Suite 300 Spokane, WA 99204 For an appointment call 509.838.7100

phc.org

May SCMS The Message 10


62nd Annual SSIM Meetings By Jeremy Graham, MD The Spokane Society for Internal Medicine held its 62nd Annual Scientific Meeting at the Spokane Convention Center in February 2011. This regional CME conference was accredited and co-sponsored by the Spokane County Medical Society. The Scientific Meeting, with approximately 200 attendees, received valued support from the following major sponsors: Deaconess Medical Center and Valley Hospital, Group Health Cooperative, Inland Imaging, Inland Northwest Health Services (INHS), PAML, Physicians Insurance, Providence Holy Family Hospital and Providence Sacred Heart Medical Center and Children’s Hospital as well as Premera Blue Cross. Notably, the 62nd Scientific Meeting was staged free of support from the pharmaceutical industry. Important developments for this year’s meeting included AAFP-approval of the CME hours, in addition to AMA Category 1 credentialing, thus expanding the utility of the scientific updates to a wider clinical community. Regional assessment of CME needs demonstrated community demand for updates in numerous aspects of chronic pain management. This year’s meetings included sessions on the legal implications of Washington’s development of chronicpain care regulations, on the management of chronic noncancer pain, and on new directions and resources to care for patients with chronic myofascial pain syndromes. Generous support from the Stier Foundation enabled a special address from physician-poet Jack Coulehan MD, founder of the SUNY Stonybrook medical humanities program. Further support from the Sam Shikany Foundation enabled the Spokane Medical Humanities Committee to present its first award for the residents’ pursuit of literature and humanism in medicine (published in the March issue of The Message). The Shikany Foundation also supported two much-requested lectures from Dr David Spach on primary care of the HIV patient and on the care of soft tissue and skin infections. Matt Hollon, MD, MPH, will serve the SSIM as program chairman for the 63rd Annual Meeting to be held in February 2012. The Society encourages SCMS members to communicate their recommendations and clinical needs for this meeting as we focus on continuing to provide top notch regional CME across primary care and the subspecialties of internal medicine.

UWSOM Curricular Changes and Potential Opportunities By John McCarthy, MD Assistant Dean for Regional Affairs & WWAMI Clinical Coordinator for Eastern & Central Washington Paul Ramsey, MD, Dean of the University of Washington School of Medicine charged a pre-curriculum review advisory committee last fall. Michael Ryan, MD, Associate Dean for Curriculum, Suzanne Allen, MD, MPH, Vice Dean for Regional Affairs and Ramoncita Maestas, MD, Associate Professor, Department of Family Medicine were in Spokane in January meeting with students, faculty, and community members to obtain input on the current curriculum from a Spokane perspective. This is a creative and exciting time to be looking at medical education in Spokane. It is anticipated this committee will have their final report completed later this summer with a full curriculum review to start during the 2011-2012 academic year. Currently, a subcommittee of the pre-curriculum review advisory committee is discussing opportunities for offering the second year of medical education in the WWAMI region. The second year traditionally has been completed in Seattle. One of the exciting possibilities for the WWAMI Spokane campus would be to pilot a second year outside of Seattle. If funding can be secured for a pilot, Spokane can potentially begin seeing second year medical students as early as 2013! This means students applying for entry into medical school for summer 2012 could complete the majority of their four years of medical education in Spokane. All of the first, third, and fourth years of medical education can currently be completed in Spokane. This is another step toward creating more medical education in Spokane and this community is eager to rise to this challenge. As many of you know, the Biomedical and Health Sciences Building on the Riverpoint campus was not in the Governor’s budget for this next biennium. However, it is in the House’s budget, and as of this writing the reconciliation process between the Senate, House & Governor’s budgets has not yet occurred. This building is something the community has been seeking to facilitate the full transition of the School of Pharmacy to Spokane and, at some future date, to accommodate growth (increased class size and a potential second year) in the WWAMI Medical Education program in Spokane. The medical community has always played a critical role in the medical education offered in Spokane and your engagement and support will play a key role in moving forward. The potential for a pilot of second year of WWAMI medical education in Spokane, when funding can be secured, necessitates creative engagement and growth. Ken Roberts, PhD, Director, WWAMI Medical Education Program, WSU-Spokane & Assistant Dean, UWSOM is exploring how best to continue to advance an excellent education for our Spokane students with this proposed second year pilot. As always, he will need support from the medical community. Please contact him, Deb Harper, MD or John McCarthy, MD with any questions.

May SCMS The Message 11


Can We Change the Culture? Project aims to improve communication to prevent and respond to adverse events

By Rhenda Meiser for Physicians Insurance When a patient is injured or experiences an unanticipated outcome following medical treatment, patients need to know what happened and why. Where appropriate, patients should receive an apology, reassurance the problem has been fixed, and potentially financial compensation. Regrettably, few physicians and healthcare professionals are trained how to communicate after an unanticipated outcome. It’s recognized that failed communication between healthcare professionals is a leading cause of medical errors. Yet, many physicians and healthcare professionals aren’t trained in the team communication skills than can prevent these errors. Physicians Insurance is partnering with the University of Washington (UW) on a three-year project to improve team communication to prevent medical errors and aid in response when adverse events occur. Thomas Gallagher, MD, UW associate professor of medicine is the principal investigator. Providence Sacred Heart Medical Center will participate as a demonstration site. “Communication is the missing link to improving safety and the quality of health care,” says Dr. Gallagher. “We can prevent injuries by improving communication among health care workers. And we can also improve collaboration between providers, institutions and patients when something does go wrong.”

The training can also play a preventive role. Health care teams will be coached on how to talk amongst each other—such as the surgeon, scrub nurse, and the surgical tech. “We train staff to be comfortable in speaking up if they have a safety concern—anyone can stop the line,” says McCotter. E-learning content will be published on Health-PACT’s website for physicians and risk managers planning their own programs or seeking just-in-time advice.

A disclosure and resolution program: Five of the 10 hospitals and clinics will also participate in a pilot Disclosure and Resolution Program (DRP). The goal is to respond collaboratively and promptly when an adverse outcome occurs. A response might include 1) a joint investigation in an effort to share information with the patient, family or legal representative and 2) exploring an agreement for compensation. PI-insured physicians will have the opportunity to consent to this process or to decline. “Physicians Insurance already enjoys the reputation of being incredibly responsive—among our insureds, defense and plaintiff attorneys,” says Kym Shepherd, Physicians Insurances’ director of complex litigation. “What’s new is the opportunity to work in a collaborative manner and get all the providers talking to each other.” Researchers will study how the training and DRP interventions impact claims, litigation and settlement results over three years.

Providence Sacred Heart steps up At Providence Sacred Heart Medical Center, patient safety has long been a strategic initiative and priority. “For several years Providence Health & Services has been proactive in early disclosure of unanticipated events, transparency and negotiating early settlements,” says Bill Tately, complex

Patricia McCotter, RN, JD, CPHRM, CPC, is a senior healthcare risk management consultant at Physicians Insurance: “We know that communication error is a root cause in nearly 70 percent of serious adverse events. In a culture that supports transparency and disclosure after an adverse event, staff are willing to come forward to evaluate what happened and why, and how to prevent recurrences through safety improvements.”

The demonstration has three components: Health-PACT: Planners will create a statewide collaborative of clinicians, health care institutions, medical associations, patient safety advocates, and representatives from state government. Known as Health-PACT (Patient Advocacy through Communication and Transparency), the collaborative will officially launch this summer. Communication training for physicians and teams: Ten hospitals and clinics have agreed to participate in training to help their staff prevent and respond to adverse events. “This training will help physicians gain the skills to have difficult conversations with their patients when there is an adverse event. When there’s been a problem, it reduces their risk of guilt and enhances the patient provider relationship,” says Dr. Gallagher. May SCMS The Message 12

Continued on page 17


Providence Family Medicine is open at 212 East Central, Suite 440. The clinic is a multi-specialty medical office providing patients convenient coordinated care, imaging services in the building and an on-site lab. The following have joined the clinic:

Providence proudly welcomes a new northside clinic location.

William R. Brown, MD Janet R. Deegan, MD R. Kim Hartwig, MD Frank E. Otto, MD Magdaline W. Ndirangu, MD

PROVIDENCE FAMILY MEDICINE

Providence Family Medicine 212 East Central • Suite 440 (On the Holy Family Hospital Campus)

For an appointment call 509.252.9602

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10:55:21 AM

A Personalized Approach to Your Health Riverpoint Pharmacy is one of the few remaining pharmacies that can still offer customized medications through pharmaceutical compounding. We can provide: • Individualized strengths, combinations and flavorings • Specialized dosage forms such as topical gells and slow release capsules • Sterile compounds such as preservative-free eye drops, injectibles and custom nebulizer solutions • Veterinary compounding Our specially trained pharmacists also offer personalized consultations in: • Nutrition evaluation and planning for improved health • Bioidentical Hormone Replacement Therapy for men and women • Review of medications and supplements • Pain management options for chronic pain and special needs

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May SCMS The Message 13


Successfully Surviving a RAC Audit By: Tom Rehwald, CFO, InCyte Pathology In the Tax Relief and Health Care Act of 2006, Congress approved the national healthcare Recovery Audit Contractor (RAC) program. The goal of the program is to identify improper payments made on claims of health care services provided to Medicare beneficiaries.  Health care providers that might be reviewed include hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers and any other provider or supplier that bills Medicare Parts A and B. CMS contracts with four regional RACs as part of this program. Health Data Insights, Inc. is the RAC assigned to the western region, which includes the State of Washington where InCyte Pathology is based. The RACs are paid on a contingency fee basis for any overpayments that are collected from their audits. InCyte Pathology is a privately owned regional anatomic pathology laboratory located in Spokane Valley, Washington. Our service area covers Washington, Idaho, Montana and Alaska. InCyte has 140 employees, including 24 pathologists. 1.

2.

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7. 8.

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In 2010, InCyte challenged over 400 cases with our RAC. The following is a recap of the major timelines and steps associated with defending your practice in case of a RAC audit. Receive ‘Demand Letter’ and supporting ‘Audit Detail’ (claim specific information including an ‘Audit Message indicating the alleged infraction) The ‘Demand Letter’ will outline your appeal rights Develop an inventory listing of all Demand Letters received and pertinent dates of actions taken Call the RAC immediately if it is unclear what their issue is with your claims You may submit a ‘Rebuttal statement’ within 15 days of receipt of your Demand letter to Noridian (our Medicare carrier) indicating why you feel the asserted claims should be dismissed (we did not do this) Noridian has 15 days to respond to your Rebuttal Statement Your first formal appeal step is to submit a request for ‘Redetermination’ to Noridian with a cover letter, the Medicare Redetermination Request Form, and copies of supporting documentation such as remittance advices, claims, medical record documentation; include any regulatory citations (billing regulations or guidelines) that supports your billings Submit the ‘Redetermination’ within 30 days to prevent payment offset or recoupment, but recognize you have up to 120 days to submit to protect your appeal rights

his undergraduate education at the University of Washington, followed by his medical school training at the University of Oregon School of Medicine, and his general internship at the University of Wisconsin. Choosing to specialize in Neurology, Dr. Jones completed his residency at the University of Oregon and at San Francisco Veterans Hospital. In addition, Dr. Jones completed one year of additional training in Internal Medicine at Portland's Good Samaritan Hospital. During World War II, Dr. Jones enlisted in the US Army Air Corps and was stationed in Bangor, MN, where he served as medical officer and honorary consultant. In 1952, Dr. Jones and his family moved to Spokane where he joined Dr. Howard Lander and Dr. Joseph Lynch in establishing a neurology practice. Over the years, as Spokane's medical community evolved, Dr. Jones was affiliated with Neurology and Neurosurgery Associates as well as Neurology Associates of Spokane. Dr. Jones retired in January 2000. Dr. Jones was preceded in death by his wife Nancy; son, Gregory; and brother, William E. Jones, MD. He is survived by his two nieces, Betsy Brown and Siri Tobey of Snohomish, WA; and his dear friend and "honorary daughter" Cynthia (Cindy) McCall. Bud and Nancy shared a love of music and travel. They enjoyed memories of attending the New Year's Eve performance of the Salzburg Johann Strauss Orchestra in Austria. On cruises they explored South America, China, Australia, Scandinavia, Spain and Greece. They loved travelling by motor car around Europe, a highlight being Scotland where they golfed at St. Andrews course. In Sun Valley, Idaho they hiked the Sawtooths, and enjoyed golfing and cross-country skiing. Dr. Jones was a member of Manito Presbyterian Church. A memorial service will be held in the Rockwood South Main Lounge, 2903 E. 25th Ave. on Friday, April 8, 2011 at 1:30 pm. The family would like to extend a very special thanks to Cindy McCall for her faithful commitment to Bud and Nancy, to the many close friends who were part of their lives, and to the staff at Rockwood Atrium. Donations can be made in Dr. Jones' memory to the charity of your choice. Arrangements entrusted to Hazen & Jaeger Funeral Home, 1306 N. Monroe St.

Continued on page 16ortland, OR on March 24, 1922. He completed May SCMS The Message 14


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Angioplastyƒ(mechanicalƒwideningƒofƒtheƒbloodƒvessel) Atherectomyƒ(removingƒplaqueƒfromƒtheƒartery) Placingƒstentsƒorƒaƒballoonƒinflationƒinƒtheƒartery Implantingƒpacemakersƒtoƒimproveƒtheƒheartƒfunction Implantingƒdefibrillatorsƒtoƒnormalizeƒheartƒrhythms Electrophysiologyƒ(mapping,ƒablation,ƒpacers,ƒAICDƒdevices)

May SCMS The Message 15

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Peripheralƒvascularƒissues Congestiveƒheartƒfailure Interventionalƒandƒnuclearƒcardiology Thrombolysis


Continued from page 14 10. 11.

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Regardless of the steps you take, interest will accrue at +10% after 30 days Noridian should respond with a ‘Medicare Redetermination Notice’ (MRN) within 60 days of receipt of your Redetermination Request If your MRN response is unfavorable, your second formal appeal step is to initiate a ‘Reconsideration’ request to the Qualified Independent Contractor (QIC) within 180 of receiving your MRN (we didn’t do this as we were able to satisfactorily resolve our appealed cases) Your third, fourth and fifth appeal rights are through an Administrative Law Judge, Medicare Appeals Council Review and Federal District Court, respectively.

If you are successful, you will receive a letter from both the RAC and Noridian! From our experience, we suggest healthcare providers facing RAC audits consider the following: • Be proactive and be vigilant • Consider contacting either a healthcare attorney or billing/ coding expert (if necessary) • Be respectful in all phone conversations and written correspondence, and be an attentive listener • If it appears the person you are speaking with doesn’t understand the points you are making, try to reach out to someone else and make sure you have a meeting of the mind on the perspectives shared (remember you are the expert in your field, the RACs have to know a little bit about a wide range of healthcare reimbursement regulations and methodologies) • Bird dog reversals of recoupments • Re-evaluate your internal procedures to help prevent the issue from recurring (if appropriate)

In Memoriam

MILLARD E. JONES, MD Millard E. “Bud" Jones, MD passed away peacefully on April 1, 2011 at the Atrium of Rockwood South. Dr. Jones, a neurologist, was born in Portland, OR on March 24, 1922. He completed his undergraduate education at the University of Washington, followed by his medical school training at the University of Oregon School of Medicine, and his general internship at the University of Wisconsin. Choosing to specialize in Neurology, Dr. Jones completed his residency at the University of Oregon and at San Francisco Veterans Hospital. In addition, Dr. Jones completed one year of additional training in Internal Medicine at Portland's Good Samaritan Hospital. During World War II, Dr. Jones enlisted in the US Army Air Corps and was stationed in Bangor, MN, where he served as medical officer and honorary consultant. In 1952, Dr. Jones and his family moved to Spokane where he joined Dr. Howard Lander and Dr. Joseph Lynch in establishing a neurology practice. Over the years, as Spokane's medical community evolved, Dr. Jones was affiliated with Neurology and Neurosurgery Associates as well as Neurology Associates of Spokane. Dr. Jones retired in January 2000. Dr. Jones was preceded in death by his wife Nancy; son, Gregory; and brother, William E. Jones, MD. He is survived by his two nieces, Betsy Brown and Siri Tobey of Snohomish, WA; and his dear friend and "honorary daughter" Cynthia (Cindy) McCall. Bud and Nancy shared a love of music and travel. They enjoyed memories of attending the New Year's Eve performance of the Salzburg Johann Strauss Orchestra in Austria. On cruises they explored South America, China, Australia, Scandinavia, Spain and Greece. They loved travelling by motorcar around Europe, a highlight being Scotland where they golfed at St. Andrews course. In Sun Valley, Idaho they hiked the Sawtooth Mountains, and enjoyed golfing and cross-country skiing.

Good luck and remember that a recent MGMA survey indicated that 1/3 of appeals are successful.

May SCMS The Message 16


Continued from page 12 claims manager. It gets trickier though when an event occurs involving independent physicians and their own insurers. “This presents a great opportunity to bring the wider medical community together on the same page and build better rapport between the care provider and the patient and family,” says Tately. Mr. Tately and Providence Health Care Director of Risk Management, Cheryl Thomas, RN, MN, CPHRM, train physicians on how to have conversations with patients. “We’re excited and have high hopes that the program will have a positive effect on health care and patient safety, as well as patient satisfaction,” says Thomas.

MEMBERSHIP RECOGNITION FOR APRIL/MAY 2011 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. APRIL 50 Years William N. Dire, MD 40 Years Bruce A. Ellingsen, MD

Can we change the culture? We’re going to try Since 1999, with the Institute of Medicine’s landmark report “To Err is Human: Building a Safer Health System” many organizations have promoted new patient safety protocols that have led to better outcomes. “Still, in some areas we haven’t seen adverse events improve,” says Dr. Gallagher. He views one of the greatest challenges to be changing a medical culture where the doctor is expected to be perfect, where they aren’t supposed to admit they make a mistake and where team members are unwilling to speak up.

4/13/1961 4/27/1971

30 Years Nancy K. Crotty, MD

4/28/1981

James B. Elmer, MD

4/28/1981

R. Campbell McIntyre, MD 4/28/1981 10 Years John P. Everett, MD

4/23/2001

MAY 50 Years

“More open communication amongst team members goes hand in hand with better communication with the patient. Once teams learn conflict resolution skills and how to respond to emotion with each other, they’ll be able to use the same skills with their patients,” says Dr. Gallagher.

Walter D. Kelsch, MD

To learn more about the AHRQ program in the Spokane area, please contact Kim Anderson, Physicians Insurance Healthcare Risk Management Consultant and Claims Representative at (509) 456-5868.

Robert K. Fairbanks, MD 5/21/2001

5/11/1961

30 Years David C. Gilman, DO

5/26/1981

10 Years Mark E. Didier, MD

5/1/2001

Patrick J. Shannon, MD

5/21/2001

Ramon G. Canto, MD

5/29/2001

Visit our updated website • View "The Message" Online

• Legislative updates

-Full current and past issues available

-Connect with SCMS on Facebook and stay informed

• Membership information -Information about credentialing, committees, bylaws, etc.

• CME information

• Connect to Medicor -The online medical library is a SCMS membership benefit.

-Topic and dates for upcoming CME courses

May SCMS The Message 17


Meetings, Conferences and Events 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. Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery. Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8 p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous personal sharing; No dues or fees. Guided by Drs. Bob and Carol Sexton. The contact phone number is (509) 624-7320.

The presenters will be Scott Kronlund, MD, of the Northwest Physicians Network and Alan Glaseroff, MD, of the Humboldt (California) Independent Practice Association. Free for medical groups, physicians and all other care providers. $75 for all others. This activity has been approved for AMA PRA Category 1 Credit; AAFP Preferred CME credit has been applied for and determination is pending. Register online at www.wsma.org/CPIN OR send the following information in an e-mail titled CPIN May 31 to jcd@wsma.org: Name; Phone; Clinic/Group; and Number of Participants Questions about registration: call Jenelle Dalit at 1-800-552-0612 or jcd@wsma.org Questions about content or CPIN: call Lance Heineccius at (206) 956-3657 or Lance@wsma.org

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2011 Program Schedule

JUNE Topic to be determined Wednesday, June 22, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

Having Fun Teaching - The Joys of Teaching Medical Students, PA Students and Residents Saturday, May 21, 2011 7:30 a.m. to 12:30 p.m. Spokane Riverpoint Campus Health Sciences Building Rooms 110A & 110B Sponsored by a grant from The Empire Health Foundation Please register at : http://www. regonline.com/WWAMIFacultyDevelopment 60 Minute CPIN WEBINAR: Effective Referral Management Tuesday, May 31, 2011 – noon until 1:00 pm -- This free webinar will present an in-depth discussion of effective, bi-directional referral management, giving participants a practical framework for improving how care is coordinated among clinical partners. Focused on the patient-centered medical home model of care delivery, the framework begins with understanding why formal referral arrangements are now a necessity, and then describes how to develop and implement formal agreements that improve care coordination and outcomes while reducing costs.

SEPTEMBER Endocrinology Date to be determined, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented) OCTOBER Moderate (Conscious) Sedation and Analgesia Wednesday, October 5, 5:30 - 9:15 pm Deaconess Health and Education Center (SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety.)

Karry Home A Kindle Kontest! Tell us about this interesting piece of medical history and enter to win an Amazon Kindle! (Hint: this is an early piece of lab equipment originally patented in 1927). Winning a Kindle 6” 3G Wireless Reader is easy and fun! (a $189.00 value) Simply go to our website at http://spcms.org , find this picture on one of our web pages and follow the simple instructions to enter our contest. Are we being too obvious? Of course! We’re holding this contest to increase interest among our members in both our monthly newsletter, “The Message” and our newly redesigned website. May SCMS The Message 18


The following physicians/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 Bringhurst, Jade R., MD Emergency Medicine Med School: U of Utah (2008) Internship/Residency: Grand Rapids Medical Education Partners (2011) Practicing with Hospital Physician Partners (Valley) beginning 7/2011 Cedars, Leonard A., MD Obstetrics and Gynecology/Maternal-Fetal Medicine Med School: U of Texas, Southwestern Medical (1974) Internship: U of Washington (1975) Residency: Parkland Memorial Hospital (1978) Fellowship: Cedars-Sinai Medical Center (1995) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011 Cranny, Dean R., MD Family Medicine Med School: Ross U, West Indies (2001) Internship/Residency: Mercy Family Practice (2004) Practicing with Rockwood Clinic, PS beginning 7/2011 Gopalani, Sameer, MD Obstetrics and Gynecology/Maternal-Fetal Medicine Med School, Thomas Jefferson U 1997 Internship/Residency: Magee Women’s Hospital (2001) Fellowship: U of Washington (2004) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011 Hall, Dustin J., DO Obstetrics and Gynecology Med School: Michigan State U, College of Osteo Medicine (2007) Internship/Residency: Henry Ford Wyandotte Hospital (2011) Practicing Rockwood Clinic, PS beginning 9/2011 Harding, James A., MD Obstetrics and Gynecology/Maternal-Fetal Medicine/Family Medicine Med School: U of Vermont (1983) Internship/Residency: Eastern Maine Medical Center (1986) Residency: Oregon Health Sciences U (1989) Fellowship: U of California, Irvine (1991) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011 Humble, Byron I., DO Orthopedic Surgery Med School: Kirksville College of Osteo Medicine (1998) Internship: Naval Medical Center (1999) Residency: Naval Medical Center (2005) Practicing with Rockwood Clinic, PS beginning 6/2011

Jawed, Irfan, MD Internal Medicine/Pain Medicine/Medical Oncology/Hospice and Palliative Care Med School: Dow Medical College, Pakistan (1996) Internship: Long Island College Hospital (2005) Residency: Internal Medicine Residency Spokane (2007) Fellowships: Memorial Sloan-Kettering Cancer Center (2008), National Cancer Institute (2011) Practicing with Cancer Care Northwest beginning 7/2011 Madarang, Wilfred Alex O., MD Family Medicine Med School: St Luke’s College of Medicine, Philippines (2003) Internship/Residency: Penn State U (2011) Practicing with CHAS beginning 9/2011 Taha, Assad M., MD, PhD Surgery/Surgical Critical Care Med School: American U of Beirut, Lebanon (1980) Internship: Good Samaritan Hospital (1982) Residency: Medical College of Ohio (1985) Practicing with Surgical Specialists of Spokane beginning 8/2011 Peterson, Suzanne E., MD Obstetrics and Gynecology Med School: U of Washington (2003) Internship/Residency: Magee Women’s Hospital (2007) Fellowship: U of Washington (2010) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011 Rai, Pragya, MD Pediatrics Med School: U of Science and Technology, Bangladesh (1999) Internship/Residency: Brookdale Hospital (2008) Fellowship: U of Texas, Houston (2011) Practicing with Providence Pediatric Pulmonology beginning 8/2011 Sajnani, Nitin V., MD Internal Medicine Med School: NDMVP Samaj Medical College, India (2003) Internship: U of Missouri (2009) Practicing with Sound Physicians beginning 5/2011 Singh, Harnek, MD Internal Medicine Med School: Osmania U, India (1990) Internship/Residency: Michigan State U (2001) Practicing with Sound Physicians beginning 5/2011 Shen, Yu L., MD Pediatrics Med School: U of Washington (2008) Internship/Residency: Children’s Hospital of Los Angeles (2011) Practicing with Rockwood Valley Clinic beginning 8/2011 Sorensen, Tanya K., MD Obstetrics and Gynecology/Maternal-Fetal Medicine Med School: U of Washington (1985) Internship/Residency: U of Washington (1989) Fellowship: U of Washington (1991) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011

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Waller, Sarah A., MD Obstetrics and Gynecology Med School: Tulane U (2004) Internship/Residency: Stanford U Hospital (2008) Fellowship: U of Washington (2011) Practicing with Obstetrix Medical Group of Washington, Inc, PS beginning 7/2011 Ward, Joshua Q., MD Anesthesiology Med School: Medical College of Virginia (2007) Internship: North Carolina Baptist Hospital (2008) Residency: Wake Forest U (2011) Practicing with Anesthesia Associates, PS beginning 6/2011

PHYSICIANS PRESENTED A SECOND TIME Barber, Anna A., MD Pediatrics Med School: U of Washington (2004) Practicing with Providence Family Medicine North beginning 8/2011 Barber, Douglas R., MD Obstetrics & Gynecology Med School: U of Washington (2004) Practicing with Sacred Heart Center for Maternal Fetal Medicine beginning 8/2011 Brown, Anthony N., MD Orthopaedic Surgery Med School: U of Minnesota (1992) Practicing with Providence Orthopedic Specialties beginning 8/2011 Feliciano, Beejay A., MD Surgery/Vascular Surgery Med School: U of California, Davis (2004) Practicing with Rockwood Heart & Vascular Center beginning 8/2011 Grosse, Scott E., MD Physical Medicine & Rehabilitation Med School: U of Washington (1992) Practicing with Spine Team Spokane since 3/2011 Henkel, Amy E., MD Diagnostic Radiology Med School: Creighton U (2005) Practicing with Inland Imaging Associates, PS beginning 7/2011 Poulton, Thomas L., MD Urology Med School: Uniformed Services U of Health Sciences (1996) Practicing with Rockwood Kidney and Hypertension Center beginning 5/2011 Sandhu, Neelwant, MD Physical Medicine & Rehabilitation Med School: Oregon Health & Science U (2005) Practicing with Inland Neurosurgery and Spine Associates since 3/2011

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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.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side.  (Owners rarely in residence)  This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course.  It is totally turnkey furnished, dishes, linens, cleaning supplies etc.  All new appliances, modern decor.  One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.  Golf and walking trails right out the door.  Close to Holy Family Hospital and Whitworth College.  Please call 954-8339 for details.  Also willing to rent "unfurnished.”

For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres.  For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen.  For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker.  Everything to accommodate you & your equestrian needs. Offered by John L Scott Real Estate – John Creighton at (509) 979-2535. For a virtual tour www.tourfactory.com/709316. MEDICAL OFFICES/BUILDINGS

Good location and spacious suite available next to Valley Hospital on Vercler.  2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building.  Please call Carolyn at Spokane Cardiology (509) 455-8820.

ft building available. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $22 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services. For more information, call (509) 981-9298.

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.

HAVING FUN TEACHING The Joys of Teaching Medical Students, PA Students and Residents Saturday, May 21, 2011

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community. If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease. Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 - 2190 sq/ft

7:30 a.m. to 12:30 p.m. Spokane Riverpoint Campus Health Sciences Building Rooms 110A & 110B Sponsored by a grant from The Empire Health Foundation Please register at : http://www.regonline.com/ WWAMIFacultyDevelopment

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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 Kelly McDonald at (509)444-8888 or kmcdonald@chas.org. OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509)325-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821. PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatrician and BE/BC Family Practice Physicians. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements. Providence Physician Services (PPS) is our physician-led network of more than 100 primary and specialty care physicians in multiple clinic locations. Learn more at www. providence.org/physicianopportunities or contact Mark Rearrick mark.rearrick@providence.org or April Mayer april.mayer@ providence.org. PEDIATRIC HOSPITALISTS OPPORTUNITIES: If you would like the opportunity to participate in the growth of our pediatric services at Deaconess and Valley Medical Centers, please consider joining our multi-disciplinary team. We need four to five Pediatric Hospitalists at either facility. You will be working with nurses with many years of pediatric expertise. You will be part of a team of hospitalists providing 24-hour coverage/365 days per year. Please contact Evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth.org for more details.

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. URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA. We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position. Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call. Please contact Evelyn Torkelson at torkele@empirehealth.org or (509)473-7374. SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) has an opportunity for a physician. Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes of the injured worker and follows best practices as defined by Washington State L&I’s Center of Occupational Health and Education (COHE). SROM is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic. This affiliation provides exceptional administrative support, offers state of the art diagnostic services’ improving our ability to diagnose and treat, and a referral system that is unmatched. For more information contact Evelyn Torkleson, physician recruiter at (509)473-7374 or email at torkele@empirehealth.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 Katrina Nudo at 1-800260-1515 x2226 or email knudo@qtcm.com or visit our website www.qtcm.com to learn more about our company.

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

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The Message, May 2011