The Stethoscope, Quarterly Newsletter of the Erie County Medical Society, September 2021

the Stethoscope the Stethoscope

September 2019 Issue

Quarterly Newsletter of the Erie County Medical Society

Quarterly Newsletter of the Erie County Medical Society • September 2021

A Message From Your President

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

“You know, George, that’s what I’m going to do; I am going right up to Potter and spit in his eye.”

—Uncle Billy conversing with George Bailey from It’s a Wonderful Life (1946) Jeffrey McGovern, MD, FCCP, FAASM, President, ECMS Rebecca Doctrow Association Executive rdoctrow@pamedsoc.org Phone: 833-770-1542 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 400 Winding Creek Blvd.

Mechanicsburg, PA 17050 eriecountymedicalsociety.org

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.

In my last, official President’s message for the Stethoscope, I will thankfully avoid the customary and tired term “legacy.” In addition, other than the quote above (a reference to what we as physicians did to the dreaded COVID-19), my last comment on the travesties and heroics of 2020-2021 will be one of gratitude to the members of the Erie County Medical Society (ECMS) who selflessly and courageously treated their patients in a most humanistic and compassionate way. As I said in an earlier submission, every generation of physicians has their “COVID experience.” Although the particular diseases differ in kind, the indefatigability and ingenuity of the physician is a constant.

Like the colorful Uncle Billy, we may have stumbled through the challenges—but we knew that fighting back by any means possible was the ultimate answer.

From an administrative perspective, that meant that your president and his able Board of Directors (BOD) had to pivot from the usual activities and meetings to ones accommodating the strange times.

That meant that an ambitious agenda proposed at the outset in 2019 had to be tabled as well as changed for safer times. I am grateful that the BOD supported the “Do No Harm” series and am equally grateful that St. Vincent Hospital, UPMC Hamot Hospital and LECOM provided monetary and physical help for this vital program. While the series had to be delayed during the pandemic, it is certainly not cancelled. I continue to reach out to the respective parties to stoke their interest. It is indeed crucial to enjoin upon the community the reality of physician suicide. The caretaker needs care—especially now. I am grateful too that the BOD supported reengagement with the area attorneys to find common ground. An earlier association forged with then presidents Drs. Clark and Falasca opened the door of communication between these professionals. The Coalition of Attorneys and Physicians of Erie, or CAPE II, will hopefully keep our common interests in the forefront.

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President’s Message Continued from page 1

arrangement in the same building to rent space for our historical items and our future business meetings. Gone are the high monthly expenses.

We now have “dry powder in our store” for future events and activities. I could not be prouder to serve with a BOD which has the future interests of its members in mind.

We contributed out of the office and hospital too. Our service projects in Erie through Second Harvest Food Bank and ServErie showed the community that we could apply our healing touch through supplying basic and material needs. In addition, while communities extolled the work of health care workers of all stripes, we chose not to remain in the limelight alone. This year we inaugurated an annual award recognizing a valued partner in the community which shares our healthcare values. The award presented to the Erie County Department of Health (ECDH) was a welcome and cherished recognition in the midst of thankless and exhausting work. Surely, the standards Docs on Call, Annual Health Fair, and Annual Meeting will resume in person thanks to successful and far-reaching vaccinations. It is a good thing when we can meet one another and see that the light in our wearied eyes still shines brightly for our vocation caring for patients. Thankfully, we were able to meet in person at the ECMS-sponsored Financial Wellness Seminar for early career physicians this Spring. Members Dr. Harrington, Dr. Pelkowski (former president ECMS and current Trustee), Dr. Lim and special guest Dr. Jung provided financial insights from years of experience and different viewpoints. We hope to make this an annual activity.

Before I close, I want to thank my family for permitting me additional time away from them.

We spend so many hours serving the needs of patients; they allowed those additional hours to serve my colleagues in Erie. I am grateful for the assistance of our PAMED staff, Rebecca and Lauren, for pivoting and turning in the choppy waters of the past two years. I look forward, as should you, to the next administration of Dr. Kelli DeSanctis, who will be sworn in at the Annual Meeting in November. Please make every effort to attend this in-person meeting. The ECMS will continue, I am assured, to serve physicians both employed and in private practice. After all is said and done we both serve the ill and injured. As the healthy body needs two lungs to breathe properly, so do we need each other to keep this community thriving. Thank you for allowing me the opportunity to serve you.

Certainly the biggest administrative challenge the BOD faced was the disposition of the ECMS building. Purchased over a decade ago, the building provided a place to meet and conduct activities. Over the years with dwindling membership rolls, there was no longer a need to have a staff member on site. The building became a place only for business meetings. In 2020, like everyone, we met virtually. Looking carefully at the expenses and the planned departure of a loyal tenant, we concluded through difficult and mature conversations that it would be best to sell the building and rent space for our business use. We made this decision fully aware of the sensitivity of this issue to generations of physicians. In June, we closed on the sale and made an equitable

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Member News New Joins Robert Patrick Burns, MD Andrew Forrestel, MD Ali Mansour, MD Julia Leonardi Rodi, MD

Erie County Medical Society COVID-19 Vaccination Statement Employers around the country are weighing the importance of vaccine mandates as employees return to their place of work. We at the Erie County Medical Society want to address this issue as it pertains to our members.

Generally speaking, vaccination is especially important from a public health perspective.

Primum non nocere, or the Hippocratic maxim first do no harm, is a core ethic for those caring for the sick and injured. Getting vaccinated for preventable diseases such as COVID-19 is a palpable means of recognizing this core ethic. COVID 19 vaccines have prevented nearly 280,000 deaths and 1.25 million hospitalizations in the US according to recent estimates from the Yale School of Public Health. Increased vaccinations among health care personnel will not only reduce the spread of COVID 19 but also reduce the harmful toll this virus is taking within the health care workforce and on those we are obliged to serve. As individual weigh their options, physicians and health care systems should continue to spread the message that COVID-19 vaccines save lives.

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Women Physicians Section The Pennsylvania Medical Society is the place physicians in the Commonwealth can go to find support, advocacy and engage in leadership. Important missions include being a resource for physicians on upcoming legislation, providing education and sharing public health concerns. In October 2018 the House of Delegates created the Women Physicians Section (WPS), which was the intended space for female physicians to connect, provide support and allow for discussion of factors that uniquely applied to women practicing medicine. After its inception WPS created leadership roles, including a governing council and district delegates for the 13 districts. The representative for District 8, which includes Erie, Warren, Forest, Mercer, McKean and Crawford counties, is Dr. Ingrid Renberg. The leadership group meets quarterly to discuss regional concerns and brainstorm ideas. It works to support female physicians in pursuing leadership roles. WPS has become vocal in addressing issues such as discrimination and pay disparity. The members bring forward personal experiences of balancing medical practices while raising children. They share stories of both triumphs and frustrations in professional advancement. It has become a place where female physicians can find camaraderie and understanding. It is a place where our unique perspective and experiences can be shared through our presence in the House of Delegates.

And above all, it is a place where the female physicians of Pennsylvania can have a voice in advocating on policy issues affecting women and provide advisement.

For all female physicians in northwest Pennsylvania, please consider becoming active in WPS and sharing your stories and experiences! WPS offers educational webinars as well as live presentations addressing concerns. We are always open to proposed topics and work to find appropriate speakers.

In addition to dynamic female physician speakers, we have had lawyers, businesswomen and healthcare managers give presentations. Due to COVID we have had to hold meetings virtually, but we are hoping in the near future to hold more in-person events and make our section one of the most effective and utilized at PAMED. If there are any questions about WPS, please contact your delegate, Dr. Ingrid Renberg, at Connect with the Women Physician Section Representatives (jotform.com).

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Quarterly Legislative Update July 1, 2021 Legislature Recesses Early for the Summer Pennsylvania lawmakers have historically waited until the very last minute to approve the state budget. This year, the General Assembly exceeded all expectations by approving a nearly $40.8 billion dollar budget on June 25…five days before the constitutional deadline. The frenzy of legislative activity, immediately prior to the budget deadline, often results in “legislative surprises” where bills that had otherwise languished for one reason or another suddenly make it across the finish line. This year was no exception.

For the Pennsylvania Medical Society (PAMED), legislation to address the process by which physicians obtain informed consent from patients passed both chambers and was signed by the Governor on June 30, 2021, as Act 61. The measure, formerly Senate Bill 425, had originally been introduced several sessions ago after a state Supreme Court ruling materially changed the informed consent process, no longer allowing physicians to delegate that authority. The change significantly disrupted patient flow in hospitals often leading to surgical delays. Physicians will once again have the authority to delegate informed consent to another colleague or other qualified individual.

Members can learn more in PAMED’s Quick Consult on Act 61 at www.pamedsoc.org/QuickConsult.

Other PAMED supported bills were advanced in the legislative process prior to the summer recess. These included: nS enate Bill 225 (PAMED supports) – Legislation to reform the prior authorization process.

Approved by the Senate Banking and Insurance Committee. nS enate Bill 705 (PAMED supports) – A telemedicine measure that will, among other things, mandate insurers to pay for telemedicine. The bill was approved by the Senate Banking and Insurance Committee. nH ouse Bill 681 (PAMED supports) – A measure to limit restricted covenants in physician contracts was approved by the House Health Committee and awaits final consideration by the full House. nH ouse Bill 1280 (PAMED supports) – Legislation changing the process by which patients are informed about the results of imaging studies. The bill was recently approved by the House Health Committee. nS enate Bill 416 (PAMED supports) – This legislation officially recognizes certified registered nurse anesthetists (CRNAs) in the Commonwealth of Pennsylvania as well outlining requirements for certification of CRNAs. PAMED followed the anesthesiologists lead in supporting this effort.

The bill was signed into law by the Governor on June 30 as Act 60. nH ouse Bill 1420 (PAMED supports) –The Health Care Heroes Act will establish a public awareness campaign to provide information regarding the programs and services available for first responders, health care workers, and other workers suffering from mental health issues related to COVID-19. nH ouse Bills 1700-1701 (PAMED supports) – Newly Introduced – Disclosure of disingenuous physician complaints. This bill would no longer require physicians to acknowledge the existence of a complaint filed against their medical or osteopathic license if the case were closed without any formal action. PAMED supports this effort and will advocate to advance these bills.

This legislation has been referred to the House Professional Licensure Committee.

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Quarterly Legislative Update Continued from page 5

While the advancement of legislation listed above positively reflects PAMED’s legislative efforts and the efforts of engaged physicians, there are several bills that we continue to oppose and actively monitor.

It is important for legislators to hear from their physician constituents on all of these pieces of legislation to either thank them or explain why specific legislation is not in the best interest of patient care.

PAMED is closely monitoring and engaging in the following: nS enate Bill 25 (PAMED opposes) –The bill, introduced in this same form since 2015, would grant CRNPs independent practice authority. PAMED has long opposed these efforts and will continue to do so. This bill was recently voted out of the Senate Consumer Protection and Professional Licensure Committee. nS enate Bills 397-398 (PAMED opposes in current form) – Since late 2019, PAMED has been working with representatives of physician assistants (PAs) to reach an agreement on several changes to the existing rules governing the physician supervision. Legislation introduced this session, Senate Bills 397-398, were approved by the full Senate before the summer recess. PAMED, working with our physician coalition, is seeking critical changes to the bill that would ensure appropriate oversight of newly graduated PAs in addition to those who are changing from one specialty to another. PAMED is seeking to improve physician workflow related to PAs, while at the same time ensuring appropriate supervision and state oversight of the process.

Over the summer recess, PAMED encourages physicians to set aside time to reach out to their local legislators and begin to develop a personal relationship. For those who already know their representative or senator, it is a good time to simply touch base. The first lesson in effective advocacy is to avoid your first meeting with lawmakers to be the one where you are asking for help. Physicians interested in engaging in the issues above, or on any legislative proposal, are encouraged to reach out to PAMED’s Governmental Relations staff for assistance at 800-228-7823.

Stay up to date on PAMED’s legislative priorities at www.pamedsoc.org/Advocacy.

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Pre-Diabetes: You Can Change the Future In metered but unsteady steps, the human race is collectively recovering from a historic yet relatively short-lived global pandemic. In sharp contrast, however, the United States has been drowning for decades in the wake of a raging national epidemic: preventable Type 2 Diabetes. Thirty-four million of us are diabetic. Even more shockingly, 88 million American adults have Pre-Diabetes…and 84% don’t know they have it. We now know that if these Pre-Diabetics continue on their current trajectories, they will fall into the diagnosis of Type 2 within just a few years. The saving grace is that we also know that Pre-Diabetes is the “sweet spot” where we can reach those at risk, because it is a highly reversible condition through adjustments to lifestyle.

In 2010, Congress authorized the National Diabetes Prevention Program in an attempt to combat the explosion of Type 2 Diabetes within the United States. This program was the result of a 20-year study conducted by the National Institutes of Health. The study clearly demonstrated the effectiveness of moderate behavior change in the prevention or delay of the development of Diabetes. Over the course of the one-year program, participants are coached to gradually lose 5-7% of their body weight while working toward a minimum of 150 minutes of physical exercise each week. The program is effective because it is delivered in a slow and reinforced manner, with emphasis on food tracking, cognitive restructuring, and consideration of the individual background and needs of each participant.

In 2018, The Sight Center of Northwest PA began delivering the National Diabetes Prevention Program (NDPP) in an effort to reduce cases of Type 2 Diabetes and to prevent resulting blindness. The Sight Center is currently the only NDPP educator in the region that is fully-recognized by the Centers for Disease Control and Prevention for the efficacy of its program. Its Lifestyle Coaches recognize that when a physician takes the time and energy to refer a Pre-Diabetic patient to its program, they expect to see that patient make significant and lasting changes for the better. The Center’s task is to facilitate those changes and encourage healthier choices that endure for years to come.

“We are working hard to inform Erie County physicians about the availability and effectiveness of the Sight Center’s NDPP for their patients,” says Program Director, Lana Kunik. “We already have several local practitioners who refer often, but none that has embraced our program quite like our first Physician Champion, Dr. Joseph Carvelli.

In one of our current classes, 80% of the participants were referred directly by Dr. Carvelli; and at week 13, every one of his patients has made significant changes to their weight and level of physical activity. We absolutely love being able to report this information back to both the referring doctor and the CDC,” Kunik says.

So, what are we defining as Pre-Diabetes? Per NDPP guidelines, Pre-Diabetes is a condition in which blood sugar is high, but not high enough to be diagnosed as Type 2. Pre-Diabetes in lab results would be reflected as an HBA1C in the range of 5.7-6.4, a fasting plasma glucose range of 100-125, or a 2-hour plasma glucose range of 140-199. Other risk factors that put your patients at high risk of Pre-Diabetes include being overweight or obese, a family history of diabetes, a personal history of high blood pressure, a personal history of gestational diabetes, a history of delivering a baby over 9 pounds, being over the age of 45, and/or living a sedentary lifestyle. You may want to consider having your patients complete Pre-Diabetes Risk Assessments at each point of contact, in order to keep both you and them aware of their ongoing risk status.

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Pre-Diabetes: You Can Change the Future Continued from page 7

Although anyone can self-refer to the National Diabetes Prevention Program, we all understand that the directive to take action is exponentially more persuasive when it comes from our doctor. When you take the time to educate and inform your patients that they DO have a great deal of choice in the status of their future quality of life, please know that IT IS A VERY POWERFUL MESSAGE! Research tells us that Pre-Diabetes CAN be reversed through modest weight loss and increased physical activity. Statistics tell us that 1 in 3 of your non-diabetic patients IS Pre-Diabetic! That fact is chilling and cannot be ignored.

The Sight Center of Northwest PA will gladly provide a Lunch and Learn presentation to you and your office staff regarding the National Diabetes Prevention Program, the referral process, insurance coverage status, other payment options, and details about what you and your patients can expect from participation. This program is available to your patients NOW!

Simply contact Becca Swick at beccas@sightcenternwpa.org or 814-403-8583 at your convenience, she can also provide you with an updated program flyer and pre-diabetes risk assessment.

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Sponsor registration is now open for the 11th Annual Health Expo!

More information is available on the Health Expo registration portal.

More Information & Registration

Advertise With Us Erie County Medical Society has a variety of sponsorship opportunities available throughout the year.

To learn more about these opportunities, visit the “Advertise With Us” page of our website. http://www.eriecountymedicalsociety.org/advertise

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2020–2021 ECMS Board of Directors Jeffrey P. McGovern, MD, FCCP, FAASM President

Thomas Falasca, DO, FACA, FACPM At Large Member

Narendra Bhagwandien, MD Immediate Past President

Timothy D. Pelkowski, MD At Large Member

Kelli DeSanctis, DO President Elect

Paul Malaspina, MD At Large Member

Terence O. Lillis, MD Secretary/Treasurer

Kirk Steehler, DO At Large Member

Peter S. Lund, MD, FACS AMA Representative

Amanda Marie Wincik, DO At Large Member

Kathleen Anne Costanzo, DO At Large Member

Michael Furey Student Representative