SCMS Newsletter Fall 2022

C E L E B R AT I N G 1 5 6 Y E A R S !

Stark County Medical Society A Message from our President

Fall 2022

2022 BOARD

We continue to work with our colleagues from Summit County and Mahoning County and invite them to join us for upcoming activities.

We are pleased to report that new members have joined SCMS. We will continue to work building our Membership.

The Member’s Benefit Committee has been busy throughout the year to arrange services for the members.

Raza Khan, MD

News

We hope you are enjoying a wonderful and glorious Fall. Here is the latest news We wish you a happy and joyous holiday season! from the Stark County Medical Society.

Members and their families had a great time at our Annual Summer Picnic on Sunday, Aug. 21 at Oakwood Country Club.

September 21 was our 21st Annual Golf Outing at Arrowhead Golf Club benefiting the Akron Canton Regional Foodbank.

This event was well attended and raised money for the Foodbank.

On October 14, we participated in Health Fair by The Stark County Medical Auxiliary. Free Covid and Flu vaccinations were available.

Officers

Raza Khan, MD President Roger Musa, MD President Elect JoAnn Krivetzky, MD Secretary | Treasurer Stacey Hollaway, MD Past President

Trustees

Jason Bertram, MD Anthony Degenhard, DO Matthew LiCause, MD Frank Luckino, MD Arup Maitra, MD Luis Martino, MD Seth Maurer, DO Charles Smith, MD Emmanuel Otomewo, MD Mark Stachel, MD David Utlak, MD SCMS Board Emeritus Kevin Metz Executive Director Taylor Kring Administrative Assistant Gail Myers Administrative Assistant

In this Issue...

President’s Message | Disability and Long-Term Insurance for Members | Financial Focus: Recession Survival | "Putting" An End To Hunger Akron-Canton Regional Foodbank | Desk of Charles Smith: Disovery of Insulin | Stark Public Health: Season Respiratory Illnesses Managing Patient Accounts | SureShred: Reducing Paper | In The Know | Calendar

The Stark County Medical Society (SCMS) has access to politicians and the state medical association. Together, we are strong with a voice that will be heard! Contact us at 330.492.3333 or www.starkmedical.org. We look forward to hearing from you.

Opinions expressed by the authors are their own, and not necessarily those of the Stark County Medical Society, Trustees or individual members. SCMS News reserves the right to edit all contributions for clarity and length, as well as, to reject any material submitted.

StarkMedical.org | (330) 492-3333

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Disability Income Insurance For association members Planning for the unexpected

We understand what is important to you

The decision to build a comprehensive financial plan is a smart strategy to help you through times of uncertainty and it should include disability income insurance. Disability income insurance helps you plan for the unexpected by replacing a portion of your income, if you’re unable to work due to a sickness or injury.

DInamic Foundation from Ameritas is disability income insurance and it helps protect your financial foundation. It’ll be there when you need it most, going to work for you when you can’t.

Life can never be free from uncertainty. But when uncertainty is minimized, life can be maximized. Our diversified products and services help individuals, families and businesses protect what matters most.

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We understand what is important to you which is why DInamic Foundation offers cost savings and design flexibility, so you can design coverage specific to your individual income protection needs.

Premium savings As a member of an approved association, you are entitled to a 15% discount from standard rates when you purchase individual DI and/or Business Overhead Expense insurance.

Plan design flexibility Options are essential to building disability protection based on your unique needs. With DInamic Foundation, you have choices.

• Plan options 1. Noncancelable and Guaranteed Renewable offers a rate guarantee to age 65.

2. Guaranteed Renewable helps you save on the cost of insurance, but premiums are subject to change prior to age 65 (on a class basis with state approval).

• Definition of disability 1. Own Occupation: benefits are paid if you’re unable to work in your own occupation due to sickness or injury, even if you choose to work in another occupation.

2. Own Occupation and Not Working: benefits are paid if you’re unable to work in your occupation due to a sickness or injury and if you’re not working in another occupation.

GDK & Company is not an affiliate of Ameritas or its subsidiaries.

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FINANCIAL FOCUS: Here's Your 'Recession Survival' Checklist

by Edward Jones It's unfortunate, but recessions are a fairly normal part of the economic land­scape. When a recession occurs, how might you be affected? The answer de­pends on your individual situation, but regardless of your circumstances, you might want to consider the items in this recession survival checklist: Assess your income stability. If your employment remains steady, you may not have to do anything different during a recession. But if you think your income could be threatened or disrupted, you might want to consider joining the "gig economy" or looking for freelance or con­sulting opportunities.

Review your spending. Look for ways to trim your spending, such as canceling subscription services you don't use, eating out less often, and so on.

Pay down your debts. Try to reduce your debts, especially those with high interest rates.

Plan your emergency fund. If you haven't already built one, try to create an emergency fund containing three to six months' worth of living expenses, with the money kept in a liquid account.

Review your protection plan. If your health or life insurance is tied to your work, a change in your employment status could jeopardize this coverage. Review all your options for replacing these types of protection. Also, look for ways to lower premi umsonhomeorautoinsurance,with­out significantly sacrificing coverage, to free up money that could be used for health/ life insurance.

Keep your long-term goals in mind. Even if you adjust your portfolio during times of volatility, don't lose sight of your longterm goals. Trying to "outsmart" the market with short-term strategies can often lead to missteps and missed opportunities.

Don't stop investing. If you can af­ford it, try to continue investing. Coming out of a recession, stock prices tend to bottom out and then rebound, so if you had headed to the investment "sidelines," you would have missed the opportunity to benefit from a market rally.

Revisit your performance expecta­ tions. During a bear market, you will constantly be reminded of the decline of a particular market index, such as the S&P 500 or the Dow Jones Industrial Average. But instead of focusing on these short-term numbers, look instead at the long-term performance of your portfolio to deter­mine if you 're still on track toward meeting your goals.

Assess your risk tolerance. If you find yourself worrying excessively about declines in your investment statements, you may want to reevaluate your tolerance for risk. One's risk tolerance can change over time - and it's important you feel comfortable with the amount of risk you take when investing.

Keep diversifying. Diversification is always important for investors - by hav­ing a mix of stocks, mutual funds and bonds, you can reduce the impact of mar­ket volatility on your portfolio. [Continued page 13 ]

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“Putting” An End to Hunger 2022

SCMS’s 21st Annual Golf Outing Raises $10,000 For the Akron-Canton Regional Foodbank Given the growing need for hunger relief, food banks and restaurant operators across the country are rethinking their existing systems and trying to find a better way to redirect more excess prepared food to hungry children, families and seniors rather than landfills. The Foodbank’s Community Harvest program has led this charge since 1989 as one of the first nonprofits to engage the restaurant industry in the fight against hunger.

As the Community Harvest program continues to provide food for our neighbors experiencing hardships due to COVID-19, the demand for food from the Foodbank is at an all-time high. Food distribution is 42 percent higher than this time last year. As local restaurants continue to close and drive-thru restaurants experience a tremendous increase in business, the Community Harvest program has responded with innovative food rescue and delivery models to help meet the needs in our local community.

The Community Harvest food rescue program relies heavily on the dedication and tireless effort of volunteers, board members and community supporters. Fundraisers like Celebrity Cuisine, the Harvest Moon Run and the Annual SCMS Golf Outing account for approximately 70% of their operating income, which is necessary to help feed families, children and seniors facing hunger in our community. The lost revenue from some fundraising events due to COVID-19 have created many challenges for the Community Harvest program to execute its mission.

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The 21st Annual SCMS golf outing benefiting Community Harvest was scheduled on the perfect day! With sunny skies and a sell-out crowd of 126 golfers, the event helped Community Harvest provide 40,000 meals for neighbors facing hunger in our community!

Special thank you to the auxiliary, the generous sponsors, supporters and all the golfers who participated in this event and made it a success.

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From the Desk of Charles Smith, M.D. THE DISCOVERY OF INSULIN

This year marks the 100th anniversary of the most significant advancement in the history of medicine: the discovery of insulin – which was not really a discovery at all. It is a story of human passion and human progress. Progress that involves years of indirect collaboration of many and the final genius of one. The discovery of insulin has all the ingredients of a fairy tail or novel.

Frederick Grant Banting grew up on a farm outside of London, Onterio and entered the University of Toronto to study for the ministry but switched to medical school after one year. He was at best an average student, but with dogged determination he graduated and was inducted into the army for WWI. There he gained experience treating war wounds and was seriously wounded himself. On returning to Toronto, he began a surgical residency with emphasis in orthopedics at the Sick Children’s Hospital. On completion, unable to secure a staff position there, he followed his fiancé back to London setting up a private practice in July 1920.

As his practice was a total failure, and as he was going deeper in debt, he became an assistant at Western University in London. One assignment he was given was to prepare a lecture to the physiology students on carbohydrate metabolism – a subject in which he had no interest. He had never even seen a diabetic patient.

That night, exhausted from the lecture and despondent over his finances, he could not sleep. He picked up the latest journal of Surgery, Gynecology, and Obstetrics to try to read himself to sleep.

The lead article concerned a case with a stone totally obstructing the pancreatic duct. At autopsy there was complete destruction of the acini with total sparing of the islets of Langerhans. Instead of inducing sleep this made his mind race all night. At 2 AM he got up and wrote down a note about a possible experiment: “Ligate pancreatic duct of dog. Keep dog alive till acinidegenerate leaving Islets.

Try to isolate the internal secretion of these to relieve ‘glycosuria’” He presented his idea to the professor of physiology who referred him to Dr. JJR Macleod in Toronto. Macleod was very skeptical but agreed to allow him to use his lab during the summer while he was home in Scotland on vacation. Banting returned to London to consider this. After failing to land a job as a physician for an oil exploration company in the Arctic, he closed his practice and returned to Toronto on May 17, 1921. .Dr. Macleod offered him the assistance of

two physiology students Charles Best and Clark Noble for the summer. The students decided to split the summer. Charles Best won the coin toss and started the first shift. He immediately started to clean the dirty, dingy little room they were given for the surgeries. This complimented the storage closet they were given for lab work. Macleod found the pair very inexperienced, so remained there for another month to help with procedures and protocols.

They worked vigorously through the hot summer, having many setbacks and having to go onto the streets to procure more dogs, but by the summers end they had successfully ligated the pancreatic duct of dogs, isolated an extract from the endocrine pancreas and repeatedly demonstrated glucose lowering in diabetic dogs. They were able to keep Marjorie, a severely diabetic dog, alive for 70 days. When Macleod returned in September, he became more interested and involved in the experiments which upset Banting. In late November they wrote their first paper on their work. On Dec 20, 1921 they first tried the extract on a diabetic patient. Afraid to inject it, they gave it orally with no response. Dr. Macleod asked Dr. Collip a biochemist to join the group to help with the isolation and purification of the extract. On December 30,1921 they presented their findings to the American Physiological Society. Dr. Banting was so nervous he entirely botched the presentation and had to be rescued by Dr. Macleod. This further kindled the animosity between the two.

Anxious to try the extract on humans, Banting obtained permission to inject the extract he and Best had prepared on a dying welfare 14 year old diabetic boy named Leonard Thompson. On January 11, 1922 he was given an injection with no clinical response. This was a humiliating defeat, but Collip continued to tinker with his own extraction methods. In late January he announced he had produced a purified extract that contained the active material and was free of other protein contaminants. After threatening to patent it himself, and a physical altercation with Banting, they all agreed to continue working together. On January 23, 1922 this extract was tested on Leonard Thompson with spectacular results.

Leonard was essentially brought back to life, maintained on these injections, and lived a long and productive life.

Collip had trouble duplicating his initial success and they had trouble producing enough extract to continue testing. Connaught Laboratories joined

them using whole beef pancreases, but couldn’t produce enough either and the few patients then under treatment all deteriorated and one died. Banting became despondent and turned to alcohol.

With the help of Best he came around and continued working. Eventually they accepted the offer of the Eli Lilly company to help. Lilly had experience producing Secretin and developed a process for extracting what was now called insulin from pork pancreases. Eventually a process of iso electric precipitation of the active substance was discovered. This allowed the production of large quantities of pure extract.

In May 1922 at the meeting of the Association of American Physicians Dr. Macleod announced to the world their discovery of insulin. By then Dr. Banting was deluged with referrals from physicians around North America. He was finally granted privileges in the university hospital. So just one year after his first experiments, he was finally recognized by the academic community in Toronto and the commercial production of insulin was begun. Not until October 1923, after an extensive educational program for physicians by Lilly, was the sale of insulin released to the public.

Many scientists over the years had produced extracts containing insulin, but none had been able to purify their extracts to eliminate the toxic effects, or to demonstrate such positive results as Banting and Best.

Because of their academic arrogance, it took the Europeans at least two years to recognize the importance of this work and to attempt to produce insulin themselves.

The British Medical Journal wrote in December 1922 “The production of insulin originated in a wrongly conceived, wrongly conducted, and wrongly interpreted series of experiments.” They asked why was insulin discovered by 2 inexperienced researchers in a city with no status in the world of research?

Yet it happened. Banting and Best kept on working where others had stopped.

Banting became a hero of the lay press.

A farm boy who did what the elite researchers could not. He received honor after honor and finally in October 1923 Stockholm announced the awarding of the Nobel prize in medicine to Drs. Banting and Macleod. Banting had a fit stating Macleod had done none of the work. He initially refused the award, but eventually acquiesced and divided it with Charles Best. Dr. Macleod then announced he would share his with Dr. Collip.

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Seasonal Respiratory Illnesses - Enterovirus and Respiratory Syncytial Virus Chelsea Sadinski, MPH, Epidemiologist - Stark County Health Department

Enterovirus and Respiratory Syncytial Virus (RSV) are common illnesses which can infect people all year round, but typically peak in the late summer and early fall. Seasonality of these illnesses often coincides with influenza season and can cause similar symptoms.

Enteroviruses cause about 10 to 15 million infections and tens of thousands of hospitalizations each year in the United States. Most enterovirus infections cause mild cold-like illness but some enterovirus infections can cause viral conjunctivitis, hand, foot and mouth disease, viral meningitis, viral encephalitis, myocarditis, pericarditis or acute flaccid myelitis.

Annually, RSV leads to about 2.1 million outpatient visits and 58,000 hospitalizations among children under age 5.

Among adults 65 years and older annually, there are 177,000 hospitalizations and 14,000 deaths due to RSV. RSV infection are typically seasonal with onset beginning around midSeptember, peaking during the winter months and tailing off around mid-April. Most RSV infections cause cold-like illness but can cause more severe infections such as bronchiolitis and pneumonia, especially in children younger than 1. Scientists are working to develop vaccines, monoclonal antibodies and antiviral therapies to help protect those at highest risk.

In September 2022 the Centers for Disease Control and Prevention released a health advisory alert due to increases in pediatric hospitalization among patients with severe respiratory illness who also tested positive for enterovirus.

After further typing of specimens, it was noted that specimens were resulting positive for enterovirus D68 (EV-D68), one of more than 100 enterovirus types. EV-D68 primarily causes acute respiratory illness but can also cause acute flaccid myelitis (AFM), a rare but serious neurologic condition which causes muscles and reflexes in the body to become weak.

Between August and November 2014, EV-D68 caused a nationwide outbreak of respiratory illness in the U.S. and has subsequently been detected in 2016, 2018, 2020 and 2022.

Recommendations for healthcare providers: •.Consider enterovirus and RSV as a possible cause of acute, severe respiratory illness in children Consider laboratory testing of respiratory specimens for •. enterovirus and RSV •.Provide supportive clinical management for enterovirus or --------------------------------------------------------------------------------------------------------------

fINANCIAL FOCUS

RSV, there are no available vaccines or antiviral treatment •Consider the use of prophylaxis for high-risk infants and young children during the RSV season based on gestational age and certain underlying medical conditions •Report clusters of severe respiratory illness to local and state health departments •.Consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever •.

Collect specimens from multiple sources (CSF, serum, stool, nasopharyngeal or oropharyngeal swab) from patients presenting with possible AFM as early as possible •.

Communicate with patients and families about how to protect themselves from getting ill by: •.Washing hands often with soap and water for 20 seconds •.Avoid touching eyes, nose and mouth with unwashed hands •.Avoid close contact with people who are sick and when you are sick •Cover coughs and sneezes •.Clean and disinfect frequently touched surfaces such as toys and doorknobs •.

Consider wearing a mask around others if experiencing respiratory symptoms Enteroviruses and RSV are always present in the community, and different types circulate each year with different types being common in different years. CDC is working with healthcare providers to encourage testing of respiratory specimens for enteroviruses and RSV to determine virus type, support identification and investigation of outbreaks, and monitor seasonal activity.

This article was written by: Chelsea Sadinski, MPH, Epidemiologist at the Stark County Health Department on behalf of the Stark County Reportable and Emerging Diseases (RED) Network. RED Network is a group of individuals involved with infection control focused on enhancing and coordinating the reportable disease network in Stark County.

[continued from page 4]

To cite one example: Higher-quality bonds, such as Treasuries, often move in the opposite direction of stocks, so the presence of these bonds in your portfolio, if appropriate for your goals, can be valuable when market conditions are worsening. (Keep in mind, though, that diversification cannot guaran­tee profits or protect against all losses in a declining market.)

A recession accompanied by a bear market is not pleasant. But by taking the appropriate steps, you can boost your chances of getting through a difficult period and staying on track toward your important financial goals.

This article was written by Edward Jones for use by your local Edward Jones Financial Advisor.

Edward Jones. Member Sf PC. 13

“Managing Patient Accounts” by Scott P. Sandrock and Jeana M. Singleton Brennan, Manna & Diamond, LLC

The practice of medicine is challenging. Additional challenges face practices dealing with patient billing, engaging in proactive collection activity, lost productivity because of patient cancellations and other business issues. There are strategies available for physicians to help, provided careful planning steps are taken in advance consistent with the policies of government and commercial payors and state and federal law.

Missed Appointment Charges Under Medicare, a fee is permitted to be charged to patients for missed appointments, but the fee is charged solely to the patient and not Medicare. In order to have such a charge, however, the practice must have a cancellation policy in writing, it must be provided to patients, confirmation of the patient’s receipt and limited to patients who do not cancel within 24 hours of the visit. Medicaid expressly prohibits such charges however. Commercial payors, generally, follow the Medicare guidelines in this area but the practice manager should carefully review or seek guidance from commercial payors regarding cancellation fees. Medicare refers to this as a “missed opportunity” charge which must be less than the professional fee had the services been performed.

Pre-Service Deposits Medicare permits a physician to request a deposit from a patient in advance of an appointment or a procedure. This makes sense, particularly in the circumstance of a significant cost that could potentially be incurred by the practice in order to provide the service to the patient, such as certain infusion therapies and the like. You should check individual commercial carrier plans to see if such deposits are permitted and if the deposits may be limited to the co-pays or deductible portions of the charges.

Credit Cards Most patients pay for their co-pays, deductibles or self-pays through credit cards. Some practices would like to keep patient credit card information on file and then simply charge the card as charges are incurred in the regular course.

This is permitted subject to specific rules. The practice may not charge the card until after confirmation of amounts due, after processing insurance claims, and provided that they take appropriate steps to comply with both federal and state law.

Healthcare information is subject to HIPAA and credit card information is likewise subject to HIPAA. In addition, it is subject to Ohio law and other industry standards, such as the payment card industry and data security standards. Under all of those rules, the practice, if they wish to keep credit card information on file, need to have written agreements with patients outlining the policies and procedures. Under Ohio law, you need to provide a written estimate for services prior to the services being charged (which could include a standard fee schedule) and other related policies. This would also satisfy the No Surprise Billing rules. The practice, however, would also be responsible for any data breaches or misuse of credit card information by outside hackers or potentially even employees gaining unauthorized access or use of such information.

Policies If your practice might be considering implementing any program involving cancellation fees, deposits, keeping credit card information or the like, your practice should develop a detailed, written policy that covers each and every aspect of your policies and procedures and meet the legal requirements for each part. This must be provided to the patient in advance, with confirmation by the practice that the patient has agreed to those terms and conditions. Failure of the practice to comply with any law may not only result in the practice not recovering payment for the services, but may well also expose the practice to financial obligations to the patients for violation of state and federal law. For example, in Ohio, failure to strictly comply with the regulations can result in a violation of the Ohio Consumer Sales Practices Act which can result in the recovery of damages, attorneys’ fees and even punitive fees against the practice. We encourage you to confer with experienced healthcare attorneys prior to implementing any programs in your office.

Should you have any questions, please contact Scott P. Sandrock at 330-253-4367, spsandrock@bmdllc.com, or Jeana M. Singleton at 330-253-2001, jmsingleton@bmdllc.com.

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In the Know...

tHe lateSt NewS & eVeNt iNForMatioN FroM ScMS CAll foR VolunteeRS Are you interested in strengthening organized medicine? Want to make a difference in your community? Network with professionals and make new friends? If so, we have opportunities for you. Reach out to a current board member about serving as a trustee, helping with fundraising, member recruitment, or organizing a meeting. Whatever your talent, we have a place for you.

MeDiCAl wASte DiSPoSAl DiSountS SCMS is pleased to announce a new partnership with Amer-Medical Waste Services. Ameri-Medical is a complete medical waste service which meets or exceeds all environmental regulatory requirements. We negotiated a guaranteed price structure for our members for period of five years. The fee includes container, liner, transportation, disposal and manifest tracking. There are no hidden charges. To schedule a no obligation quote, please contact Jim Parks at 1.800.604.5039.

Membership has its value. uPDAte YouR infoRMAtion Did you move or change practice location? If so, please let us know. We want to make sure you get all SCMS updates and correspondence. Contact Kevin at 330.492.3333 2023 DueS If you have already paid your 2023 dues, THANK YOU! If not, it’s not too late. Full-time dues are $325.00 (check) or $335.00 (credit card) and Part-time dues are $225.00 (check) or $235.00 (credit card).

2022-23 CALENDAR December

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SCMS Board Meeting Thursday

February

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SCMS Board Meeting Thursday

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More information coming soon. © 2022 Bayer. All rights reserved. BAYER, the Bayer Cross, and KERENDIA are registered trademarks of Bayer. All other trademarks are property of their respective owners. PP-KER-US-0219-1 01/22

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Looking back...

21st annual golf outing

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