ECMS Stethoscope Newsletter December 2020

the Stethoscope the Stethoscope

September 2019 Issue

Quarterly Newsletter of the Erie County Medical Society

Quarterly Newsletter of the Erie County Medical Society • December 2020

A Message From Your President

To strive, to seek, to find, and not to yield

by Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS

Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS Rebecca Doctrow Association Executive rdoctrow@pamedsoc.org Phone: 814-866-6820 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 777 East Park Drive Harrisburg, PA 17111 eriecountymedicalsociety.org

Having participated as a delegate in the Annual Pennsylvania Medical Society (PAMED) House of Delegates, I am comforted that even the mind-numbing isolation wrought by COVID-19 cannot keep isolated the physicians of the great state of Pennsylvania in carrying out not only their medicinal vocations but their administrative duties to their colleagues. This was the first virtual conference in the history of PAMED. Although there was an absence of live floor debates, delegates still responsibly addressed the merits of resolutions prior to the virtual meeting. Readers may recall the emotive song by the legendary Queen, “The Show Must Go On,” and applaud the courageous efforts of the Board, Speakers and PAMED staff in holding at least virtually an important activity for the benefit of all Pennsylvania physicians. Erie physicians also gained a seasoned physician as 8th District Trustee with the election of Dr. Timothy Pelkowski, who practices Family Medicine at St. Vincent Hospital. Congratulations Tim! Readers of an older vintage may recall another vinyl classic, this describing a surreal and mind-blowing period in our personal and professional lives. In 1977, The Grateful Dead released a two-set album entitled What a Long Strange Trip It’s Been, the title coming from the chorus of “Truckin’,” which ends with the stanza: Lately it occurs to me

The opinions expressed in this publication are for general information only and are not intended to provide specific medical, legal or other advice for any individuals. The placement of editorial content, opinions, and paid advertising does not imply endorsement by the Erie County Medical Society.

What a long strange trip it’s been Tossing aside any references to psychedelic substances it is indeed a long strange trip. From pandemic to politics we have feasted on a whirlwind buffet. I purposely penned this reflection before the official results of the November 3 election, lest I invite unnecessary criticism for sayings not intended or join unwittingly the ranks of the prognosticators of doom. History is littered with shocking and “most important” elections. In our own short history the Election of 1800 proved to be a new low in the young nation’s political tug-of-war for power. What has changed for physicians since that time besides cutting-edge technology, ongoing research and a pharmacopeia that is ever-growing?

Continued on page 2

To strive, to seek, to find, and not to yield?

We’re Moving!

Continued from page 1

Our office space at 1438 W 38th Street will be listed for sale and rent soon.

Frankly nothing. Our lives before and after election or pandemic will be the same in many concrete ways because our honored and ancient vocation (I daresay the oldest profession) calls upon each one of us to seek the benefit and solace of the sick. We will continue collectively to find new solutions to new problems and embrace with valor the new difficulties of a different pandemic at a different time. A long strange trip indeed but a trip we willingly travel because this is the arena in which we choose to stand our ground. Let us then as physicians be likened to the fabled Ulysses whom Alfred, Lord Tennyson quoted in 1833:

Listing for $159,000 or $1,660/month.

C-1 Zoning Let us know if you know someone looking for office space—we will share our listing when it is published.

We are not now that strength which in old days Moved earth and heaven, that which we are, we are;

Questions? eriecms@pamedsoc.org

One equal temper of heroic hearts, Made weak by time and fate, but strong in will To strive, to seek, to find, and not to yield.

Stay well!

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Member News New

Reinstated

Timothy Baptist, MD Durga Sindhuri Dandu, MD Frederick J. Dudenhoefer, MD Daniel Stuart Gloekler, MD David Kenneth Israel, MD Thomas Meadows, MD Margaret Eileen Nawrockyj , DO Christopher W. Rial, DO John T. Schaaf, MD Matthew TerBush, MD

Hisham Y. Abusamhadana, MD Hobart John Carr, DO James Albert Dematteis, MD David W. Dexter, MD Amy Jo Farris, DO Robert M. Fine, MD Frederick C. Havko, MD, FACEP Shadab Kalim, MD Nishant I. Koradia, MD Lawrence M. Kuklinski, MD James Y. Lin, DO Brian Thomas McQuone, DO Justin P. Puller, MD Klara Anna Roman, MD Charles E. Romero, MD Nirali Shah Lee S. Spain, DO Conrad J. Stachelek, MD Timothy C. Trageser, MD Navalkishor R. Udgiri, MD Karen Marie Willenbring, MD Thomas A. Wittmann, MD Pararajasingham Yoges-Waran, MD

The Quote

CORNER

“ Wherever the art of Medicine is loved, there is also a love of Humanity.” ― Hippocrates 3

Legislative Update Pennsylvania Medical Society 2019-2020 Regular Legislative Session Summary December 2020 / Executive Summary: The Pennsylvania General Assembly completed its 204th legislative session on November 30, 2020, a date set forth in the state’s constitution. This ends two years of legislative deliberation and law making. At the conclusion of the session, there were 4,200 bills filed in both the House and Senate with only a small portion (290) making it to the Governor’s desk for signature into law. Additionally, another 312 bills were vetoed by the Governor. Legislation not approved by the General Assembly during the session expired.

When the 2019 session commenced, much of PAMED’s focus was on the Supreme Court of Pennsylvania’s proposed change to the venue rule related to the medical professional liability claims. In addition to venue, PAMED anticipated engaging in other “priority” areas such as scope of practice, restrictive covenants, surprise billing, telemedicine, and prior authorization reform. However, as the Covid-19 pandemic surged to the forefront in early 2020, attention rapidly shifted to protecting our front line health care providers and ensuring that they had the necessary tools and support to remain treating patients and keeping themselves and those around them safe. Other legislative initiatives were placed on the back burner.

From the beginning of the pandemic, PAMED, working with several stakeholders, repeatedly pressed Governor Wolf to provide immunity protection to physicians and other healthcare providers who were treating COVID-19 patients. The entire business community was also pressing the Governor to protect businesses that began manufacturing COVID-19 related materials from unnecessary litigation. The Pennsylvania Coalition for Civil Justice Reform (PCCJR), of which PAMED was a founding member, continues to urge Governor Wolf and lawmakers to provide broad immunity protections to those directly affected by the pandemic. While the business community was unsuccessful in securing protections for businesses, Governor Wolf did issue an executive order (EO) that served to protect healthcare providers who provided care within a hospital or ambulatory surgery center. While PAMED applauded these protections, the EO order failed to provide needed immunity for thousands of other providers caring for COVID-19 patients. PAMED will continue to seek broad protections for all physicians and other care givers engaged in the care and treatment of this patient population.

Scope of practice again dominated our legislative activities whether it involved pharmacists, physician assistants, genetic counselors, optometrists, or CRNPs. PAMED, part of a broader physician coalition, led a historic effort to negotiate a compromise with certified registered nurse practitioners (CRNPs) seeking independent practice authority. Although the coalition saw the pilot program approved by the State House, the legislation stalled in the Senate Consumer Protection & Professional Licensure Committee. As of this writing, the organization representing CRNP’s have announced they no longer support the agreement and will again be seeking universal independent practice authority.

PAMED also spent considerable time engaged in discussions with physician assistants who are seeking to change the process by which their supervisory agreements are structured and approved. Dialogue between our two groups did produce a better understanding of how current requirements disadvantage PAs over other providers such as CRNPs. Efforts to address concerns expressed will continue next session as we work to find a resolution that will appropriately reflect contemporary practice while at the same time ensuring patient safety.

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Legislative Update We were happy to see that Pennsylvania’s ophthalmologists resolved a decades long battle with optometrists through the adoption of an agreement that provides optometrists with limited expansion in the treatment of glaucoma while at the same time expressly prohibiting “surgical” procedures including laser surgery. With the exception of the ophthalmology issue, we anticipate the remaining scope issues to be reintroduced early next session.

Working with a provider coalition that included pathologists, emergency physicians, anesthesiologists, and others, PAMED played an active role in helping to prevent the passage of surprise billing legislation that would have been detrimental to both patients and physicians. We expect a more palatable proposal to be introduced early next year. PAMED also continued to push for prior authorization reform, an issue that continues to take shape and evolve into what we hope will be a successful effort in the coming legislative session.

It is fair to say that absent the public health crisis, this session likely would have looked a lot differently from a legislative outcome perspective. As we begin a new legislative session in January 2021, we will continue to engage and actively work to advance PAMED’s key legislative priorities. With that being said, the pandemic still persists, and we will continue to work to protect our heroes serving in the trenches.

Legislative Outcomes—204th Legislative Session: The following section provides a list of key bills either directly related or ancillary to PAMED policy and legislative priorities. The commentary details a brief description of the legislation and final outcomes as of the close of the session.

Enacted Legislation: House Bill 943 – (Gaydos) – Gag clause for pharmacists-extends the prohibition against price transparency to insurance programs not covered previously by the Federal legislation. Passed the House (197-0) and the Senate (50-0). This bill was signed into law by the Governor as Act 67 of 2020.

Senate Bill 572 – (Aument) – mandating opioid treatment agreements and urine testing-passed the Senate and House and the Senate concurred. This bill has been signed into law as ACT 112 of 2019 by the Governor. PAMED opposed based on mandating guidelines; Orthopedic society supports. There are still concerns being voiced over the passage of this legislation, most recently in the Senate.

Senate Bill 314 – (Baker) – rural health program-Passed both the Senate and House with no opposition and was signed into law as ACT 108 of 2019. PAMED was asked by the Governor’s office to weigh in during the process.

House Bill 1662 – (DiGirolamo) – Death and Incident Review Act-Amends the Methadone Death and Incident Review Act to include deaths and incidents attributable to the use and misuse of suboxone. Passed the House (199-0) and the Senate (48-0). It was signed into law as Act 126 of 2020.

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Legislative Update Senate Bill 473 – (Scavello) – Tobacco 21. Increases Pennsylvania’s minimum legal sales age for tobacco products from 18 to 21 years of age. PAMED supports this initiative. It has passed both chambers and was signed into law as ACT 111 of 2019.

Senate Bill 842 – (Phillips-Hill) – Photo identification tag regulations-Both of these bills remove the requirement for surnames to be displayed on health care employees’ identification badges.

SB842 passed the Senate (49-0) and House (201-0). It was signed into law as Act 54 of 2020.

House Bill 1880 – (Gillespie) – Photo id. This bill passed the House (188-0) and has been referred to Senate Health and Human Services. Not sure which one will get final movement/ traction.

Senate Bill 432 – (Phillips-Hill) – Allows MCOs to have access to the information in the Prescription Drug Monitoring Program (PDMP). Of note, we oppose this bill as expanding access to the PDMP and are monitoring amendments, specifically Rep. Grove’s, which would prohibit municipalities from creating duplicative PDMPs (direct response to Philly City Council intending to create their own). Passed the Senate and House and was signed into law by the Governor as ACT 8 of 2020.

Senate Bill 391 – (Gordner) – Seeks to amend the Optometric Practice and Licensure Act to revise the therapeutic drug approval process, clarify the definition of the practice of optometry, permit the treatment of anaphylaxis, and clarify insurance procedure. Voted favorably out of the Senate Consumer Protection & Professional Licensure committee and stalled in Senate Appropriations after receiving second consideration from the full Senate, as House Bill 2561 (companion) received traction.

House Bill 2561 – (Culver) – Amends the Optometric Practice and Licensure Act to revise the therapeutic drug approval process and to allow optometrists to order and interpret specific noninvasive imaging tests appropriate for diagnosis of a condition of vision. Passed the House (202-0) and the Senate (48-0). It was signed into law as Act 99 of 2020.

Senate Bill 983 – (DiSanto) – Legislation seeks to establish a standard newborn screening fee and merges the mandatory and supplemental disorder lists in Pennsylvania’s Newborn Child Screening and Follow-up Program. This legislation passed the Senate (50-0) and the House (202-0). It was signed into law as Act 133 of 2020.

House Bill 730 – (Cruz) – Voted out of House Human Services and received first consideration from the full House. The Senate version moved as nod to Senator DiSanto in an election year with a tough race.

House Bill 1457 – (Schroeder) – This legislation provides for insurance coverage of custom breast prosthetics post breast cancer reconstruction. PAMED supports coverage for this vulnerable population of patients. Passed the House (199-0) and the Senate (50-0). This bill was signed into law by the Governor as Act 44 of 2020.

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Legislative Update House Bill 770 – (DeLuca) – Granting pharmacists the ability to administer certain diagnostic tests such as “rapid strep tests.” After originally passing the House (163-25), the Senate sent it back over to the House amended (47-1) where it received concurrence (154-48). PAMED actively worked to stop this bill as it jeopardizes patient safety and will result in increased health care costs. The bill was signed into law as Act 140 of 2020.

Senate Bills/Resoltuions: Senate Bill 857 – (Vogel) – Telemedicine-Passed the Senate (47-1) and passed the House (111-77) with the abortion language (the FDA’s REMS list medication). The Senate concurred on the House amendments and passed the bill (29-21). However, the Governor vetoed this legislation (Veto 4 of 2020).

Senate Resolution 20 – (Baker) – This resolution directed the Legislative Budget and Finance Committee to conduct a study of the impact of venue for medical professional liability actions on access to medical care and maintenance of health care systems. PAMED strongly supported this effort to delay the Supreme Court’s proposed rule change on venue. The Senate passed this resolution (31-18) and the LBFC held hearings. The Senate Judiciary committee conducted hearings related to the LBFC’s findings and PAMED will be provided testimony.

Senate Bill 675 – (Brooks) – MAT, buprenorphine- This bill continues to be opposed by various entities including the Governor’s office. Although the bill passed the Senate (41-9), the House Human Services committee lacked the votes to advance this bill.

Senate Bill 761 – (Gordner) – Informed Consent remedy to Supreme Court decision.

No movement on this bill and priority level has been reduced as result of practitioners adapting to the change in law. Recently, PAMED gov’t relations received a request to advocate the inclusion of both radiology practitioner assistants (RPA) and Radiologist Assistants (RA) (Dr. Wildenhain-Interventional Radiologist/Washington, PA); Over the course of the current session PAMED heard of various attempts to include this bill in possible House deals/trade-offs, but it received no movement.

Senate Bill 340 – (Killion) – Bill seeking to allow genetic counselors to order genetic testing; we have participated in numerous stakeholder discussion to come to agreed upon language before the bill is ready for “prime time.” Introduced and referred the Senate Consumer Protection & Professional Licensure committee, where it remained.

Senate Bill 325 – (Gordner) – Recognizes Certified Registered Nurse Anesthetists (CRNAs) under Pennsylvania statute. Passed the Senate (49-0) and has been referred to the House Professional Licensure Committee, where no further action was taken.

Senate Bill 90 – (Killion) – Extreme Risk Protection Orders (ERPOs); temporarily restricts an individual’s access to firearms when they clearly present a danger to themselves and others.

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Legislative Update Senate Bill 870 – (Killion) – Physician Assistants (PAs); seeking to help physician assistants work and practice with increased efficiency. The bill allows for modernization for physician assistants to practice while maintaining their role under supervising physicians. These bills were voted favorably out the Senate Consumer Protection & Professional Licensure committee and then stalled.

Senate Bill 871 – (Killion) – companion bill amending the DO act.

Senate Bill 993 – (Brooks) – These bills seek to assist small businesses in providing health care benefits to their employees by the formation of group association health plans. It was likely that the Senate version would move as it contains additional language providing for elasticity pending the outcome of federal litigation around the issue, but it stalled in committee.

House Bill 2200 – (Gaydos) – House companion bill to SB993.

Senate Bill 181 – (Brooks) – Bill providing for mandatory CME in Lyme disease and related tick-borne diseases for health care professionals; PAMED opposes any mandatory CME and communicated this in recent stakeholder meeting with the Senator’s staff. The bill received no committee action.

House Bills/Resolutions: House Bill 1862 – (Pickett) – OON/Surprise billing-This bill was originally fast tracked, but with 30+ entities voicing opposition it was put on hold. We continue to oppose it in the current form, while we support amendments proposed by Rep. Kaufer and Rep. Rothman dealing with the commercially reasonable standard and independent dispute resolution. Various meetings and discussions with House leadership continue to occur and have this legislation in “stalemate” of sorts where it will not go as is, but also will not go against the drafter’s (Chairman Pickett) original intent/language. No movement on this bill was a positive outcome for PAMED as it stalled before the full House.

House Bill 533 – (Owlett) – Credentialing-Passed the House (187-0). After various stakeholder meetings, it is likely that Senator Brooks will be introducing a new version of this bill, which will have to go back to the House at some point if it is to move. This bill received no action in the Senate Banking and Insurance committee.

House Bill 944 – (Fritz) – Allows the auditing of subcontractors to PBMs. Passed the House (197-0). No movement on this bill from Senate Health and Human Services.

House Bill 79 – (Isaacson) – lead testing for children- PAMED did not take a position other than to say that we are following the lead of the pediatricians. This bill came out of House Children and Youth and received first consideration from the full House, then stalled.

House Bill 137 – (Quinn) – Drug Overdose—Requires overdose victims to be taken to and receive evaluation by a certified recovery specialist. Passed the House (122-72) and stalled in the Senate Judiciary committee.

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Legislative Update House Bill 2103 – (Jozwiak) – Patient Test Result I.e. Act 112 remedy. Passed the House (202-0). PAMED worked to advance this bill but it died in the Senate Health and Human Services committee.

House Bill 1743 – (Sonney) – Disclosure of disingenuous physician complaints. This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical license if the case were closed without any formal action. Bill was referred to House Professional Licensure where it saw no action.

House Bill 1947 – (Kaufer) – IMG. Seeks to modernize the process by which graduates of international medical schools become licensed. Passed the House (202-0) and advanced to the Senate Consumer Protection & Professional Licensure committee, where it stalled.

House Bill 916 – (Stephens) – The bill deals with alcohol monitoring as a condition of bail for repeat DUI offenders. Our concern is not with this bill but the proposed amendment from Rep. Klunk which would require the use of MAT (and behavioral counseling) as a condition of ARD. Passed the House (142-51) and Senate (46-3) with amendments but failed to get concurrence in the House.

House Bill 1075 – (Stephens) – ERPOs; creates an alternative to the 302 process. PAMED has written in support and has policy to support. It was always unlikely that either of these bills moved in an election year by Republican majorities in both chambers as they are viewed by many as restrictions on the Second Amendment/gun rights. Neither of these bills received committee votes.

House Bill 891 – (Rothman) – Addressed patient access to experienced physicians; Dr. Kakaria bill introduced by Rep. Rothman after significant engagement; stakeholder meeting conducted with the Chairwoman of the House Insurance Committee. Bill was referred to the House Insurance Committee where it received no further action.

House Bill 1194 – (Mentzer) – Prior authorization reform bills. There is a large coalition with multiple provider entities and patient advocacy groups seeking to make wholesale changes to the prior authorization process in the Commonwealth. PAMED has played an integral role in developing this legislation and working to advance it. There was no committee action on either of these bills.

Senate Bill 920 – (Phillips-Hill) – Senate companion bill to HB1194.

House Bill 100 – (Topper) – These are two very familiar pieces of legislation as they seek to grant CRNPs independent practice authority. It is likely that any movement would be on HB100 due to political tension with the Senate sponsor. PAMED has long opposed these efforts but have recently agreed to listen/negotiate a pilot program where CRNPs would be granted independent practice with specific guidelines and restricts. Passed the House and stalled in committee in the Senate.

Senate Bill 25 – (Bartolotta) – Senate companion bill to HB100.

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Legislative Update House Bill 2212 – (Frankel) – This effort seeks to establish a prescription drug affordability abord, which would determine whether certain drugs pose affordability burdens and cap the amount that pharmaceutical companies can charge for necessary drugs. PAMED recently participated in a stakeholder meeting and is reviewing this legislation with the Legislative Advocacy Task Force. No committee action occurred.

House Bill 629 – (Rapp) – This bill requires health insurers to cover treatment plans of Lyme disease or related tick-borne illnesses as prescribed by a health care practitioner; issues over what type of treatments could be covered (experimental long-term antibiotic for example).

Passed the House (158-34) and referred to Senate Banking and Insurance committee, where it remained.

House Bill 990 – (O’Neal) – This legislation seeks to assist trained military medical personnel with transitioning into medical roles once in the civilian world by creating a military medic pilot program. It requires that military medical personnel be under the supervision of a physician or podiatrist and the supervising practitioner retains responsibility for the patient.

HAP supports, seeking to partner with PAMED. No committee vote took place.

House Bill 2636 – (Ecker) – Recently, Representative Ecker circulated a co-sponsor memo seeking support for his legislation that will aim to prevent the use of non-compete agreements in health care practitioners’ employment contracts. PAMED has long had policy to support this effort and will be working to ensure that any legislation that moves forward considers the impact on all of PAMED members. The session ended prior to any committee activity.

House Bill 2779 – (Quinn) – This legislation seeks to extend the easement of regulations and licensing requirements for various mid-level practitioners beyond what the Governor’s Executive Orders provide for concurrent with the COVID-19 Emergency Declaration. PAMED opposed this bill as it has the potential to negatively impact various scope of practice issues.

After advancing out of the House Health committee, the bill saw no further movement.

House Bill 2792 – (Thomas) – Providing for a long-term care medical directory registry; PAMED supported this effort. The bill passed the House 202-0 but received no movement out of the of the Senate Health and Human Services committee.

House Bill 1737 – (Gleim) – Bill seeking to provide certain civil liability protections for Covid-19 related lawsuits and claims. A top priority of PAMED during the Covid-19 pandemic, this was a critical effort that we undertook. While we were successful in getting this bill through the General Assembly, it was ultimately vetoed by the Governor. House passed the bill (192-0) and after significant Senate amendments (29-20), the House narrowly concurred (104-98).

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Legislative Update 2021 Regular Session Preview: When the 2021-22 legislative session begins on January 5th, and members of the General Assembly take the oath of office, attention will likely remain focused on pandemic related issues along with the most recent election results and processes. PAMED will be swiftly working to see key legislation reintroduced (some of which already has as of this writing) in the new session. We will continue to actively engage and advocate to see these critical issues get across the finish line. Additionally, we will be continuing our efforts to protect and provide support for our providers in the trenches during the on-going pandemic.

As a result of the November 2020 General Election, both chambers of the General Assembly saw republicans maintain their majorities with House republicans adding three members to their side of the aisle. In the Senate, the numbers will either be identical to the 2019 session or see republicans net one additional seat as the results of the Senate race in District 45 remaining undeclared and likely to be determined in federal court. The political breakdown of each chamber will likely look like this:

Senate: 29 Republicans – 20 Democrats –

1 Independent (note: caucuses with Republicans) House: 112 Republicans – 91 Democrats The PAMED government relations team will be working in the early days of the new session to develop relationships and rapport with newly elected legislators. Included in these efforts will be familiarizing new members with our key priorities and white papers on critical physician issues.

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2019–2021 ECMS Board of Directors Jeffrey P. McGovern, MD, FCCP, FAASM President

Timothy D. Pelkowski, MD At Large Member

Narendra Bhagwandien, MD Immediate Past President

Paul Malaspina, MD At Large Member

Kelli DeSanctis, DO President Elect

Kirk Steehler, DO At Large Member

Terence O. Lillis, MD Secretary/Treasurer

Amanda Marie Wincik, DO At Large Member

Peter S. Lund, MD, FACS AMA Representative

Justin Webber, MD Resident Representative

Kathleen Anne Costanzo, DO At Large Member

Michael Furey Student Representative

Thomas Falasca, DO, FACA, FACPM At Large Member