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When to Consider
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WHEN TO CONSIDER PALLIATIVE CARE for Your Patient
By DAVID R. WENNER, DO, FAAFP, FAAHPM Assistant Medical Director, Homeland Hospice
Community-based palliative care is a growing specialty, as the need for palliative care is increasing locally in Central Pennsylvania and in communities throughout the United States.
According to a report by the Center to Advance Palliative Care and the National Palliative Care Research Center, 94 percent of our nation’s hospitals with more than 300 beds now have a palliative care team. Even among smaller hospitals, with 50-299 beds, 62 percent have palliative care programs.
As the cost of health care continues to rise, that same report also shows that palliative care reduces direct hospital costs by as much as $3,000 per admission. For patients with four or more diagnoses, costs are lowered even more – by upwards of $4,800 per admission.
Physicians and their patients typically seek out palliative care to assist with symptom management, communication regarding goals-of-care discussions and decision-making, and end-of-life or hospice care. Inpatient palliative care is usually managed by either a hospital team or a single palliative care practitioner.
Palliative care focuses on relief of physical, emotional and spiritual symptoms related to chronic and/or serious illness. Symptoms such
as pain, anxiety, insomnia, shortness of breath, fatigue, nausea, and appetite loss can often significantly impact a patient’s quality of life. Palliative medicine specialists aim to reduce the burden of these symptoms by focusing on individualized treatment strategies, addressing the “whole patient” and not just the disease process.
When palliative care is provided using a team approach, a variety of specialists is involved including physicians, nurses, social workers and chaplains. The team works collaboratively alongside the patient, family and other professionals who are providing the patient’s care. Palliative care specialists see patients in hospitals, in their offices, in long-term care facilities and even in patients’ homes.
Sometimes palliative care is confused with hospice care; however, palliative care is not the same as hospice care. Whereas hospice care is provided at end-of-life, palliative care may be provided at any time during a person’s illness. It is often offered to patients at the same time they are receiving potentially life prolonging or curative treatments. Receiving palliative care does not prevent patients from pursuing other services, treatments or procedures.
Palliative care also is designed to help patients and families better understand an illness and to assist with complex medical decision-making. Paramount to palliative care is that a patient’s values and goals are fully understood and appreciated, so they are able to make the best decisions possible for their care.
A referral to a Palliative Medicine physician does not mean a patient or their medical provider is “giving up hope.” On the contrary, patients who receive palliative care early on in their disease process often benefit from improved symptom management, greater emotional support and overall improved quality of life.
Homeland at Home provides quality care and support to patients in 14 counties throughout Central Pennsylvania, either in their home or wherever they reside including nursing facilities. Services include compassionate end-of-life hospice care; daily non-medical assistance and companionship; and at-home physician-ordered medical treatment. Homeland at Home’s proud tradition of exceptional care began 150 years ago, when Homeland Center opened its doors in Harrisburg. Today, Homeland Center is a licensed Continuing Care Retirement Community offering exceptional personal and skilled nursing care. For more information, visit homelandathome. org or call 717-857-7400.
LAPU LAPU
FILIPINO FUSION
By ROBERT ETTLINGER, MD
Our world has over a hundred nations. Since we can’t get anywhere close to visiting them all, it can be fun to at least experience them by trying their foods. Lemoyne can add the Philippines to the list with the newly opened Lapu Lapu Filipino Fusion.
Filipino cuisine is a fusion unlike any other in Asia, reflecting their history of colonialism. The Magellan-led Spanish, who ruled the Philippines from much of the 16th through 20th centuries, introduced Iberian ingredients and styles. Chinese migrated there in the 16th century, and the United States also shaped their food habits after the arrival of shipping and military following the Spanish-American War of 1898. All of them combined with the indigenous use of tamarind, mango, coconut, plantain, banana, and abundant seafood to shape a unique vibe for our palates. Vinegar is often used to help preserve food in their hot climate. While the flavors are bold, heat is not a defining characteristic.
Brightly adorned by artwork, furniture, and a food counter all created by its owner, Lapu Lapu is a nice place to share dishes with friends and family, as customary in the Philippines and many other Asian nations. And it’s BYOB. We started with the entire list of appetizers, including Lumpia (a national dish, like spring rolls), Lapu Lapu Rolls (lumpia with a mild cheese), marinated skewers, Asian Zing Wings (with a sweet and tangy tamarind dipping sauce), and a plate of Sisig Fries topped with pork belly, onions, cilantro, and a mildly acidic house sauce.
Next came the big plates and bowls. From the Spanish influence, Adobos came in pork or chicken, roasted in a soy sauce/garlic/bay leaf/onion/vinegar baste, spicy but not overwhelmingly so. Sisig Tacos had crunchy and melt-in-your-mouth fillings, with avocado, cabbage, and lime, served with a ramekin of Spanish rice. The Birria Tacos were cheesier, with a consommé dip. Lechon Kawali was a nicely presented loin of pork belly with balanced seasoning. Chicken Bicol Express had mild heat from a shrimp paste, tempered with coconut milk and ginger. Garlic lover that I am, Topsilog was my favorite...pork marinated with tocino (Filipino bacon), garlicky rice, crowned with a fried egg.
If in the mood for meatless, veggie sides to choose from are rice, fries, Tortang Talong (roasted eggplant and egg) and main plates such as Pancit (noodles, cabbage, snow peas, and carrots in a soy/lime dressing) and Ginatang Kale (with coconut milk, ginger, and onion).
Desserts to cleanse your palate after the savory dinner include mango, strawberry, or cantaloupe smoothies, and tall glasses of Halo-Halo, with layers of jellied fruit and mung beans, shaved ice with condensed milk, and a purple yam ice cream. Funky and fabulous.
For a fun and tasty experience from the South China Sea by way of Spain, Lapu Lapu can be found across the street from the Lemoyne Post Office, minutes from the river.
LAPU LAPU FILIPINO FUSION
324 Market Street | Lemoyne, PA | 717-571-5223
LEGISLATIVE UPDATES
PENNSYLVANIA MEDICAL SOCIETY
Quarterly Legislative Update
RETURN TO HARRISBURG
The 3rd quarter is typically the “quietest” time of the legislative year as there is a long break in session during the months of July and August, followed by a shortened September session scheduled post the Labor Day Holiday. Both chambers of the Pennsylvania General Assembly returned to Harrisburg to continue work in the 2021 Regular Session. The legislature is currently in year one of the two-year legislative session and will now have another condensed schedule as they have a short window before the upcoming election cycle taking place on Tuesday, November 2, 2021.
Despite the limited number of session days, the Pennsylvania Medical Society (PAMED) still saw a few priority issues get some attention and advance in the legislative process. Most notably, legislation to streamline the process through which physicians must navigate on behalf of their physician assistants (PAs) received final passage and was signed into law by the Governor. These were SB397-398 (Pittman – 41st Senate District) and were signed into law as Act 78 of 2021. The stakeholder process leading to the final passage of this legislation included the broader provider community across the Commonwealth and Hospital and Health System Association of Pennsylvania. Specifically, these bills significantly decrease the “start-up” time required to employ a PA by no longer requiring Medical or Osteopathic Board approval of PA agreements. However, the boards will be required each year to review 10% of agreements filed after the bill’s passage. The measure will also allow physicians to determine the degree of oversight they wish to employ over their PAs as it relates to medical chart reviews, though the legislation continues to require a 12-month 100% chart review for new PAs entering the workforce and for those who may be changing medical specialties. Neither bill expands a PA’s scope of practice, nor do they diminish a physician’s responsibility to appropriately supervise the care PAs are providing to patients.
While we often report on the legislation that is front and center and “moving” through the legislative process, PAMED’s advocacy goes beyond the bills that get voted. During much of the time leading up to the legislature’s return, PAMED’s advocacy team focused intensely on a proposed bill to allow expanded access to the Prescription Drug Monitoring Program (PDMP). Having conducted multiple district visits to meet legislators and having PAMED physician leaders directly engage, among other efforts, at this time we have yet to see this legislation advance through the legislative process.
Other bills that PAMED is following through the law-making process…
THESE INCLUDED:
• House Bill 245 (PAMED supports) – Legislation to modernize the process by which International Medical Graduates (IMGs) become licensed. (Passed out of Senate Consumer Protection & Prof. Licensure) • House Bill 1082 (PAMED supports) – An effort to establish an education program for providers on early diagnosis of dementia and incorporates information about the disease into existing public health outreach programs. (Passed out of Senate Aging and Youth; awaiting final consideration)
• House Bill 1774 (PAMED supports) – This was necessary legislation to extend the sunset date for the Achieving Better Care by Monitoring All Prescriptions Program. (Signed into law by the Governor as Act 72 of 2021)
While the legislation listed above 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 these pieces of legislation to either thank them or explain why specific legislation is not in the best interest of patient care.
Your Choice.
Our privilege.
We believe the care a person receives makes a difference in his or her quality of life.
717-857-7400 | HomelandatHome.org
Hospice volunteers are always welcome.
MAY 15, 2022 ~ HOMELAND 155TH ANNIVERSARY
CELEBRATION Honoring Betty Hungerford
Sherry Bolinger Regional Media Sales Executive sherry@hoffpubs.com 717-979-2858
Publishing Group
hoffpubs.com
LEGISLATIVE UPDATES
PAMED IS CLOSELY MONITORING AND ENGAGING IN THE FOLLOWING:
• Senate Bill 225 (PAMED supports) –This bill is a multi-session effort to reform prior authorization. Simply, this bill streamlines and standardizes the process of prior authorization of medical services in the Commonwealth. PAMED continues to engage with a broad provider coalition to advocate for the advancement of this legislation, after being introduced for the fourth consecutive legislative session. This bill has been voted favorably out of the Senate Banking and Insurance Committee and is awaiting further action by the full Senate. • House Bill 681 (PAMED supports) – Another long-discussed issue, restrictive covenants in physician employment contracts, this legislation aims to set parameters for when restrictive covenants are utilized and seeks to limit them in situations where they are deemed not appropriate. Having advanced overwhelming out of the House Health Committee with bi-partisan agreement on pursing a “middle ground approach” this legislation is awaiting final approval from the full House.
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 Government Relations staff for assistance at 800-228-7823.
Stay up to date on PAMED’s legislative priorities at www.pamedsoc.org/Advocacy.
FRONTLINE GROUPS
The Dauphin County Medical Society thanks the following for their 100 percent membership commitment and their unified support of our efforts in advocating on behalf of physicians and the patients they serve.
Allergy Asthma & Immunology Brownstone Dermatology Associates Central PA Surgical Associates Ltd Cummings Associates PC Elena R Farrell DO
Family Internal Medicine Family Practice Center PC-Lykens B Family Practice Center PC-Millersburg Forti & Consevage PC Gastroenterology Associates of Central PA PC George M Kosco III DO & Associates Harrisburg Gastroenterology Ltd Hershey Pediatric Center Hershey Pediatric Ophthalmology Associates PC Hershey Psychiatric Associates Houcks Road Family Practice James R Harty MD Jatto Internal Medicine & Wellness Center PC
John E Muscalus DO Morganstein De Falcis Rehabilitation Institute-Harrisburg Patient First-Harrisburg Penn State Health Medical Group-Hershey PinnacleHealth Express PinnacleHealth Radiation Oncology Premier Eye Care Group Saye Gette & Diamond Dermatology Assoc PC Schein Ernst Mishra Eye Stratis Gayner Plastic Surgery Tan & Garcia Pediatrics PC
UPMC Arlington Group UPMC Heart and Vascular Institute-LCV
UPMC Pinnacle Colon & Rectal Surgery UPMC Pinnacle Harrisburg Transplant Services Urology of Central PA-Harrisburg Woodward & Associates PC
NEW MEMBERS
REINSTATED MEMBERS
Alexandra Chahwala Angela Derobertis, MD Kathy Engle Chikezie Ikechukwu Eseonu, MD Jacquelyn Marie Kohler, MD Anish George Mammen, MD Christian Morris, MS Abdullah Osme, MD Lydia Smeltz Mara Trifoi
Min Yao, MD Eric Michael Zimmerman
Salim Baghli, MD Jeffrey J. Miller, MD Matthew Scott Redclift, MD Thomas Trieu, MD
Expanding urology expertise for your patients – right here, close to home.
Penn State Health Urology has expanded to a new location at Penn State Health Hampden Medical Center to better serve your patients on the West Shore.
Urologic oncologist Dr. Jaime Herrera-Caceres, urologist Dr. William Daiber, and certified registered nurse practitioners Stephanie Marencic and Sambina Roschella provide comprehensive urologic care.
As an academic medical center with the connection to the College of Medicine, patients also have access to clinical trials at Penn State Health Milton S. Hershey Medical Center – offering improved outcomes and new hope.
Penn State Health Urology on the West Shore
Penn State Health Hampden Medical Center
2200 Good Hope Road, Suite 1076 Enola, PA 17025 Refer a patient: 717-981-8160
