Lehigh Health & Medicine Spring 2024

Kenneth Brislin, M.D.

Knee, Shoulder

Gregor Hawk, M.D.

Hip, Knee, Shoulder

Paul Pollice, M.D.

Hip, Knee

Carol C. Dorey Real Estate, Inc.

Specialists in High-Value Property

Bucks County / Lehigh Valley, PA

www.doreyrealestate.com / (610) 346-8800

Holmquist Farm

The winding country roads of Solebury Township are an idyllic backdrop for this elegant rural estate. Surrounded by 12 acres of rolling meadows and verdant woodlands, this bucolic property offers a serene and secluded retreat like no other. Every aspect of the property has been renewed or improved in recent years, including a detached garage with guest suite, infinity pool, and pickleball court.

Offered for $6,400,000

White Acre Manor

An exceptional residence located in the heart of Saucon Valley in the private community of White Acre. The fine materials and craftsmanship are enhanced with the drama, technology, and conveniences of modern construction. Multiple terraces, decks and porches overlook lush lawn and a pond with stone waterfall, wooden footbridge, and a small dock for rowboats.

Offered for $2,950,000

Melrose Lane

Custom home builder Myron R. Haydt will work with homeowners who will settle for nothing less than extraordinary quality, location, and design to create their dream home with materials gifted by nature and honed by fine craftsmen. Protective covenants, including a 4,500 square foot minimum, have been developed to establish enduring value.

Starting at $2,889,500

Sycamore Hollow

Exposed beams, deep silled windows and random width wood floors mingle with modern amenities for the ultimate in luxury country living. This updated home is surrounded by more than 14 acres of wooded and cleared land, boasting a spring fed pond and access to Ontelaunee Creek. 4 bedrooms, 2.5 Baths, 2,608 SqFt, 14.267 Acres.

Offered for $724,000

LEHIGH COUNTY MEDICAL SOCIETY

P.O. Box 8, East Texas, PA 18046

610-437-2288

2023-24 LCMS BOARD OF DIRECTORS

Chaminie Wheeler, DO President

Kimberly Fugok, DO President Elect

Mary Stock, MD Vice President

Oscar A. Morffi, MD Treasurer

Charles J. Scagliotti, MD, FACS Secretary

Rajender S. Totlani, MD

Immediate Past President

CENSORS

Howard E. Hudson, Jr., MD

Edward F. Guarino, MD

TRUSTEES

Wayne E. Dubov, MD

Alissa Romano, DO

Kenneth J. Toff, DO

EDITOR

David Griffiths Executive Officer

*effective February 1, 2024 - for two-year terms

The

15 MATERNAL SEPSIS

An Update on Puerperal Fever

By Patricia Maran, MD, FACOG, and Christine Peng, MS2

17 PREPARE FOR EMERGENCIES. STAY INFORMED.

By Maryellen Shiels

19 PAMED LEGISLATIVE UPDATES

22 LEGISLATIVE PRIORITIES 'REPRODUCTIVE RIGHTS' STATEMENT

23 LCMS NEWS

As I look around my yard, I see definite signs that spring is here, as is the spring edition of Lehigh County Health & Medicine. We hope you have found prior issues educational. We look forward to hearing your responses, ideas, and contributions.

This spring we have articles on colorectal cancer, women’s health, and what you need to know about CodeRED.

Surely you are aware of emergency alert systems, but are you familiar with CodeRED?

Please read our article to learn more about this and subscribe to CodeRED in the City of Allentown and Lehigh County.

We have an illuminating article on colorectal cancer. The author leads with the number of patients who will be diagnosed with colorectal cancer in 2024 and goes on to describe the signs and symptoms, various screening techniques and concerns over the disparities in patient outcomes among different races.

Another article discusses maternal sepsis and speaks to how it presents along racial and economic lines. Also on the women’s health front we offer an article on the medical ethical debate around salpingectomy, which is the surgical procedure to remove one or both fallopian tubes.

If you are interested in how legislative activities regarding healthcare are moving in Harrisburg, we have added a legislative update as well.

Hopefully, you enjoy this magazine and find it both educational and relevant to your interests. If you wish to see past issues, they can be found at https://lcmedsoc.org/ our-publication. Thank you for reading.

Colorectal Cancer

Improving Patient Outcomes and Closing the Racial Gap

DAVID ADAMS, MSIII USF MORSANI COLLEGE OF MEDICINE

JOSEPH STIRPARO, MD FACULTY CONTENT ADVISOR

THE BASICS

Colorectal cancer (CRC) remains the third most common cancer in both men and women outside of skin cancers. It is also the third most deadly cancer in men and the fourth most deadly in women. It is estimated that there will be upwards of 150,000 cases of CRC diagnosed in 2024 and around 53,000 people will lose their lives from this disease.1 CRC is a slow-growing malignancy which makes screening an effective method of preventing adverse outcomes. Familial clustering and inherited syndromes can give patients an indication to seek out screening for CRC, but they make up just 20% and 10% of cases respectively.2 The vast majority of cases arise sporadically, with patients often unaware of the roughly 1 in 24 lifetime risk of developing CRC.1,2 This makes the role of the healthcare provider crucial in educating patients about how to notice the signs of CRC, providing screening methods that will work for each unique patient, and combatting existing racial disparities in CRC outcomes.

SPOT THE SIGNS

Healthcare providers are responsible for taking care of their patients, and a big part of this entails empowering their patients by giving them the knowledge to advocate for themselves. Patients should be educated on some concerning symptoms that may indicate CRC3:

PROCEDURES

• CHANGES IN BOWEL MOVEMENTS, SUCH AS MORE FREQUENT CONSTIPATION OR DIARRHEA

• BLOOD IN THE STOOL OR STOOL THAT APPEARS DARKER THAN USUAL

• UNUSUAL AND UNEXPLAINED ABDOMINAL PAIN FEELING AS THOUGH A BOWEL MOVEMENT WAS NOT COMPLETE

• SIGNS OF ANEMIA, SUCH AS WEAKNESS OR FATIGUE

• UNINTENTIONAL WEIGHT LOSS

MEET YOUR PATIENTS WHERE THEY’RE COMFORTABLE

Colonoscopies are the gold standard when it comes to CRC surveillance. They provide the best visualization of relevant anatomy and allow for simultaneous biopsy. Unfortunately, patients are often hesitant to undergo what is perceived to be such an invasive procedure with an uncomfortable preparation process. Healthcare providers should emphasize the benefits of colonoscopies with their patients

Method Frequency Pros Cons

· Most sensitive test

· Bowel prep required

Colonoscopy Every 10 years

Sigmoidoscopy

Every 5 years

· Biopsies can be taken and polyps removed

· Can visualize entire colon and rectum

· Equally sensitive to colonoscopy for visualized parts of colon

· Biopsies can be taken and polyps removed

· Faster than colonoscopy

· No sedation required

CT colonography Every 5 years

· Faster than colonoscopy and sigmoidoscopy

· Less invasive

· Diet and medication changes may be needed prior to test

· Sedation required

· Injury to colon can occur

· Bowel prep required

· Diet and medication changes may be needed prior to test

· Sedation required

· Injury to colon can occur

· Does not visualize right side of colon

· Bowel prep required

· Diet and medication changes may be needed prior to test

· Less sensitive than colonoscopy

· Cannot take biopsies

· Radiation exposure

Stool Tests

Method Frequency Pros

· No sedation

Fecal occult blood test (FOBT)

Fecal immunochemical test (FIT)

Once each year

· No bowel prep

· Sample collected at home

· No sedation

· No bowel prep

Once each year

Stool DNA test

Every 3 years

whenever possible. However, a discussion of a patient’s values and what they are willing to do is important. Healthcare providers need to be able to have these discussions and inform patients of the many other options for CRC screening that are available, while making clear that their efficacy is decreased relative to colonoscopies. The tables shown will give an overview of various screening options, including important pros and cons for each method.4,5

CLOSE THE GAP

As with many health conditions, there are often disparities in patient outcomes across different races, and CRC is no different. Black patients have been shown to be 20% more likely to receive a CRC diagnosis and 40% more likely to die as a result of this when compared to other races. American Indians have also been shown to be at an increased risk of adverse outcomes. Various reasons for this have been posited including lower insurance rates, lack of inclusion in research/clinical trials, longer wait times for treatment, and decreased rates of receiving surgery, chemotherapy, and radiation therapy. Another interesting potential cause is the higher frequency of right-sided colon cancer in Black patients, which tends to have worse outcomes and will not be seen via sigmoidoscopy.6

· Sample collected at home

· More accurate than FOBT

· No sedation

· No bowel prep

· Sample collected at home

· Normal diet and medications prior to test

Cons

· Less sensitive than colonoscopy

· Positive results require additional testing

· Diet and medication changes may be needed prior to test

· Frequent false positives

· Less sensitive than colonoscopy

· Positive results require additional testing

· Diet and medication changes may be needed prior to test

· Frequent false positives

· Less sensitive than colonoscopy

· Positive results require additional testing

· Frequent false positives

Fortunately, work has been done to address an overall lack of CRC screening with an emphasis on closing the racial gap. A study was done analyzing members of the Kaiser Permanente Northern California (KPNC) health plan. Initial data showed that in 2000, 42% of Black members and 40% of White members were up to date with screening. There was a significant mortality gap with 54/100,000 for Black members and 33/100,000 for White members. During the period of 2006-2008, KPNC decided to implement system-wide changes to address these shortcomings. They changed from a model that offered on-demand sigmoidoscopy and FOBTs to offering on-demand colonoscopy and FITs. FITs were mailed yearly to all members. Along with this, a centralized tracking system was created to monitor rates of surveillance and assist with patient education and compliance. Effective follow-up with patients regarding surveillance or concerning results improved the amount of time elapsed until treatment began. After implementing these changes, CRC screening and mortality metrics improved across the members of KPNC. In the period of 20152019, 80% of Black members and 83% of White members were now up to date with screening. Mortality dropped in both groups to 21/100,000 for Black members and 20/100,000 for White members.7 The model set forth by KPNC effectively closed the racial gap in CRC screening and mortality

while improving overall outcomes for patients. This model is an exciting look into the results that can be achieved when evidence-based approaches are applied across an entire health system, and it serves as a framework for what we can achieve in Lehigh County.

REFERENCES

1. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html#:~:text=Overall%2C%20 the%20lifetime%20risk%20of,risk%20factors%20 for%20colorectal%20cancer

2. https://www.ncbi.nlm.nih.gov/books/NBK470380/ 3. https://www.mayoclinic.org/diseases-conditions/ colon-cancer/symptoms-causes/syc-20353669

4. https://www.cdc.gov/cancer/colorectal/basic_info/ screening/tests.htm

5. https://www.mayoclinic.org/diseases-conditions/ colon-cancer/in-depth/colon-cancer-screening/ art-20046825

6. https://www.healthline.com/health/colorectal-cancer/ racial-disparities-in-colorectal-cancer

7. https://www.nejm.org/doi/full/10.1056/ NEJMc2112409

Remember, we signed up for these dilemmas when we took our oath.

to cure.” As I have practiced Obstetrics and Gynecology since 1975, I have also found the Principle of Double Effect to have guided my application of my oath.

The Stanford Encyclopedia of Philosophy has a very rigorous treatment of this doctrine for those who wish to read all of its formulations, applications, and misinterpretations. (1) Briefly the doctrine allows the permissibility of an action that can cause harm as a side effect of promoting some good. Specifically it is permissible to do something harmful as an unintended side effect of bringing about a good result. Hence a double effect. As we will see, a further refinement for traditional Catholic application of the principle is written in the New Catholic Encyclopedia providing four conditions for the application of the principle of double effect. (2) “A person must licitly perform an action that he foresees

will produce a good effect and a bad effect provided that the four conditions are verified at one and the same time.”

I am sure you are wondering where we are going with this preface. In 2019 I was the faculty mentor for a thesis submitted in requirement for the Degree of Doctor of Medicine at the University of Arizona College of Medicine–Phoenix. We examined the safety and cost of risk-reducing salpingectomies in women at low to moderate risk of ovarian cancer. This research stimulated the search for further understanding of the medical facts and ethical and theological considerations of opportunistic and/or preventive salpingectomy. Opportunistic means salpingectomy performed during an abdominal operation for another indication. Preventive salpingectomy is done solely for the indication of ovarian cancer prevention.

Most ovarian cancers originate in the fimbriated end of the fallopian tube. This led to the hypothesis that surgical resection of the tubes may prevent the development of epithilial ovarian cancer for women with average risk of developing the disease. (3) Further data have shown a reduction in ovarian cancers of approximately 80% in this population and the potential to reduce ovarian cancer mortality in an estimated 15%. Wow, this is good stuff, eh!

Yes and no is the answer just as with most medical treatments. Remember, we signed up for these dilemmas when we took our oath.

The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 774, 2019;133:279-84 recommends that salingectomy for the primary prevention of ovarian cancer is safe and ovarian function does not appear to be affected. This is

“Facilities, ethicists and ethics committee must presume the good will and right intent of physicians and patients requesting these procedures.”

further reviewed and recommended in JAMA Surg 2023 Nov 1:158 (11):1204-1211.

Now for the principle of double effect part that I am sure you have been eager to pursue. Traditional Catholic doctrine has proscribed tubal sterilization.

I went to several sources including The National Catholic Bioethics Quarterly, Spring 2016. There are three experiences that seem to be interminable: assisting a neurosurgical procedure, reading a consultation from our internal medicine colleagues, and reading theologic philosophy. To spare us several hours of research, I will now summarize.

“Facilities, ethicists and ethics committee must presume the good will and right intent of physicians and patients requesting these procedures.” Salpingectomy is justified in treating ectopic pregnancy and tubal cancer. “An agent’s intent in performing it (salpingectomy) is not to induce sterilization but to reduce the risk of death from a very deadly form of cancer.”

I do not presume to posit an exhaustive review of all bioethics on this topic. Merely, I serve the reader with my distillation of information on this important topic for women and families. Now is probably a good time to partake in other distillations.

1.

Jefferson Health Merger

with

Lehigh Valley Health Network

WOULD MAKE IT PHILLY’S LARGEST EMPLOYER, WITH A 30-HOSPITAL NETWORK

The proposed deal between Jefferson Health and Lehigh Valley Health Network could close by the end of 2024, according to a joint announcement from the hospital systems.

KRISTEN MOSBRUCKER-GARZA WHYY.ORG

If a proposed deal between Jefferson Health and Lehigh Valley Health Network is finalized, the combined entity — not yet formally named but referred to as the “Jefferson Enterprise” — would become the largest employer in the Philadelphia region.

The nonprofit hospital systems signed a non-binding letter of intent to “create a leading integrated care delivery [health] system,” according to a joint announcement released earlier.

Philadelphia-based Jefferson Health, which includes Thomas Jefferson University and 17 hospitals, already has 42,000 employees across the region and is the second largest employer, which includes Jefferson Health Plans.

Allentown-based Lehigh Valley Health Network, which includes 13 hospital campuses, has 20,000 employees across the region.

If the two health care providers combine, the integrated health care system would control 30 hospitals and employ 62,000 workers.

That would outpace the University of Pennsylvania Health System as the current largest employer, with roughly 51,300 workers in the Philadelphia region.

The proposed Jefferson Health combined entity would include: Thomas Jefferson University Hospital in Center City, Philadelphia, Abington-Jefferson Health, Jefferson Health Northeast, Jefferson Health New Jersey, the Einstein Healthcare Network, and Magee Rehabilitation Hospital. Additionally, it would have four campuses in Allentown, two more in Bethlehem and Pottsville, and span to Easton, East Stroudsburg, Hazleton, Dickson City, and Lehighton.

Jefferson Health already generated about $9.7 billion of revenue during its fiscal year in 2023

that ended June 30 – albeit with an operating loss of $78.5 million.

Lehigh Valley Health Network produced about $4.1 billion in revenue during its fiscal year in 2023 that ended June 30 — with about $10.4 million in the black.

If the two entities were combined during the last fiscal year, it would generate about $13.8 billion in revenue but still be in the red in terms of an operating loss.

But it’s not a done deal – yet. Officials said in a news release that a final deal is expected to be signed by the end of 2024. The potential deal is still subject to internal negotiation and any required regulatory approvals.

Jefferson Health officials said in a news release that the move creates a nonprofit health system and research university with national recognition.

Continued on page 14

PHOTO CREDIT ©THOMAS JEFFERSON UNIVERSITY PHOTOGRAPHY SERVICES

FEATURE

The future board of trustees, which oversees the executives, would include both Lehigh Valley and Jefferson Health board members.

After the proposed deal closes, Jefferson Health’s CEO, Dr. Joseph Cacchione, would remain the top brass of Jefferson Enterprise.

“With our combined network of resources and sites of care, managed care expertise, education, and research capabilities — we will have the ability to make significant improvements to health outcomes and address health disparities in this region,” Dr. Cacchione said in a news release.

Lehigh Valley Health Network’s CEO Brian Nester is expected to become executive vice president and chief operating officer and president — and report directly to Jefferson Health’s CEO.

“In Jefferson, we have found an ideal partner that shares our culture and commitment to excellence in clinical care and a learning environment, and that has done a fabulous job in establishing a highly successful health plan with a sharp focus on the well-being of Medicaid and Medicare beneficiaries,” Nester said in a news release.

The health care systems touted that the combination would reduce the cost of health care, and offer a massive health care network with more than 700 sites across eastern Pennsylvania and South Jersey, which includes many primary care doctors. Thomas Jefferson University’s academic programs would have access to more clinical training as well.

The deal would enable the combined health system “sustainable cash flow and improved financial stability,” which would allow the organization to invest in more treatments through research and development.

In the meantime, both institutions will operate as independent organizations.

“The parties are committed to ensuring the patients and communities they serve continue to have access to exceptional care from their providers during completion of this process,” according to a statement.

If the two health care providers combine, the integrated health care system would control 30 hospitals and employ 62,000 workers.

The Hospital and Healthsystem Association of Pennsylvania, an advocacy organization for health care institutions statewide, commissioned some research released about a year ago detailing challenges in the market in terms of profitability.

The first two years of the COVID-19 pandemic were not as financially draining as 2022, because providers were tackling staffing shortages, higher labor costs, supply chain issues, inflation, rising interest rates on debt, and global markets in flux, according to the Analysis of the Current Challenges on Pennsylvania Hospitals report.

“This sentiment was overwhelmingly conveyed in interviews with leaders representing 10 hospitals and health systems across Pennsylvania. Many of these challenges are not merely transitory but likely represent a new normal,” according to the report.

Jefferson Health saw a $78.5 million loss from operations for the fiscal year ending June 30, according to financial documents shared with bondholders. That’s an improvement from $125.8 million in the red in June 2022.

By Sept. 30, Jefferson Health was $48 million dollars in the red for the quarter, which shows a narrowing loss. That’s compared to $84 million dollars in losses during the quarter ending September 2022.

Operating revenue was up nearly 6%, but expenses were also nearly 4% higher at Jefferson Health — or roughly $125 million and about $90 million, respectively — as of Sept. 30.

One major project in the works is a $762 million dollar Honickman Center at 11th and Chestnut Streets in Center City — about $66 million has been spent during the third quarter this year.

The next bond report, which would have more information about Jefferson Health’s financials, is expected to be released by the end of the year.

Here we were in Allentown, PA, rounding on a woman who despite being very ill, didn’t seem to want any of our medical recommendations. The woman looked up; it was the first time in a week I had seen her face light up. In retrospect, this is the first time I realized rounding could be more than a list of numbers. Both subjectively and objectively this woman was not improving and continued to decline the care we had to offer for her florid sepsis. Pain medicine, iron supplementation, antibiotics, anything we offered for her infected uterus, she declined.

We couldn’t give back her lost child. But I realized my attending, who had 30 years of experience on me, was trying another tactic. Faith, hope, belief, a world I hadn’t studied, a world to which I had nothing to contribute.

An hour later, when he emerged, he said something to the effect of: “That’s what puerperal fever is. That’s why birthing babies is a dangerous, sometimes deadly business. Order her some iron and Tylenol. She agreed to that.”

The medical term is sepsis. Maternal sepsis. And when it comes to childbirth, women have multiple risks for infections gone awry. Besides massive hemorrhage, and hypertensive crisis, maternal sepsis is one of the leading killers surrounding reproduction.

Sepsis occurs when an infection triggers a dysregulated, extreme immune response. It is a dangerous condition that can lead to organ failure and death. In pregnant women, infections that become septic are usually caused by a microbial mixture of the common and commensal bugs of our skin, and reproductive and GI tracts. The myriad stresses our bodies go through to grow an infant leave us more vulnerable to these bacteria. Any infection has the possibility to cause sepsis. Despite the amazing capacity for the womb to protect the unborn baby, it can be a nidus for a rapidly progressive infection. Pregnant people are also particularly vulnerable to pneumonia (due to decreased lung capacity) and mastitis (infection of the milk ducts). Of course, trauma from birth or miscarriage is a risk as well.

Maternal morbidity and mortality in the United States is staggering, especially when compared with global countries with similar socioeconomic luxuries. There are known racial and economic maternal disparities in our country. A low income means worse health outcomes but regardless of income or insurance status, well-educated black women have worse maternal morbidity than white women lacking a high school education. One need only watch the documentary of famed tennis star Serena Williams, or documentation of former Olympic athlete Tori Bowie, to realize all women are vulnerable. Tragically, Black women and their children do die in the United States at a higher rate from sepsis than Hispanic or non-Hispanic White women.

As many counties across the nation become medical deserts, and small rural hospitals close under economic stressors, the trend in maternal deaths is rising. When time to treatment is the single best way to avoid the escalation of sepsis and subsequent organ failure, families are driving even further to receive care. As a nation, prenatal visits have become sparse and waiting lists are months long. Maternity wards are closing. Especially in the poorest parts of our country, there is a concerning trend of OBGYNs moving out of states that makes reproductive health a dangerous business.

Not a day goes by when we don’t see reports from Texas, Alabama, or Idaho, to name only a few, where the challenges of practicing medicine in the most tumultuous field of women’s health, where the most difficult of medical ethical decisions have become an enforceable criminal act. I am left to wonder if I won’t see more patients presenting too late to fix, too many women with their uteruses rotten, no longer salvageable.

“Birthing babies is dangerous business,” my attending said. Day after day he sat in the corner of that grieving mother’s room, trading scripture, gaining her trust, convincing her to take one more medical intervention.

As I reminisce, I realize that on that day I was witnessing medicine as art, science, faith and compassion: faith that with all

the advanced science and premiere medical facilities we have, we may continue to care for all of our citizens with compassion, equity, and knowledge that poor outcomes are preventable, predictable, and modifiable.

RESOURCES

1. https://www.sciencedirect.com/science/article/abs/pii/ S0889854512001052

2. https://www.sciencedirect.com/science/article/abs/pii/ S0749070415000822

3. https://www.uptodate.com/contents/ critical-illness-during-pregnancy-and-the-peripartum-period?search=maternal%20 sepsis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H6

4. https://www.criticalcare.com/article/ S0749-0704(15)00082-2/fulltext

5. https://obgyn.onlinelibrary.wiley.com/doi/ abs/10.1111/1471-0528.12892

6. Racial disparities in maternal sepsis https://www.ncbi. nlm.nih.gov/pmc/articles/PMC5953763/ (neonatal sepsis)

7. https://www.thieme-connect.com/products/ejournals/ abstract/10.1055/s-0039-1696721

8. https://journals.lww.com/ anesthesia-analgesia/fulltext/2013/10000/Maternal_Sepsis_Mortality_and_Morbidity_During.24. aspx?casa_token=FNp_9LrPfqkAAAAA:BGvLJFVYBlpjzPrkRrVUB-v7FYSedZNgoxZ851CzWVfz_LJqRWjC-HL5hZkD_XE290pojcxh5Rrec9KKu6J5CFYm 9. https://journals.plos.org/plosone/article?id=10.1371/ journal.pone.0067175#s4

prepare for emergencies.

stay informed.

MARYELLEN SHIELS

EMERGENCY PREPAREDNESS MANAGER, ALLENTOWN HEALTH BUREAU

when emergencies strike, emergency management, public safety, and public health officials may have important information that can protect the health, safety and well-being of you and your loved ones. It’s important to stay informed.

There are national emergency alert systems including Wireless Emergency Alerts (WEAs) sent through mobile devices, Emergency Alert System (EAS) sent through TV and radio, and NOAA Weather Radio (NWR) that broadcasts continuous weather updates through the radio.

In addition to those systems, emergency management officials in both the City of Allentown and County of Lehigh also utilize CodeRED. CodeRED is an emergency notification system used to alert people when there’s an emergency such as weather events, chemical spills, gas leaks, missing persons alerts, emergency evacuations, shelter in place recommendations, and other related incidents. The CodeRED emergency alert systems are important and made available at no cost to you.

important considerations:

Create a username and password which enable you to make updates to your account, such as adding or removing cell phone numbers.

Register your email address and cell phone numbers associated with the address. Be sure to add your family members’ email addresses and cell phone numbers that should also receive the emergency alerts for that property address.

You may need to register with both Allentown’s and Lehigh County’s CodeRED systems if one of your addresses is within the City of Allentown and the other address is outside the City of Allentown limits.

The CodeRED App and website registration are NOT connected. You’ll need to complete a separate registration, but you can use the same username and password for both accounts.

Stay Informed. Emergencies and disasters can occur with little or no advance notice. We want you to be prepared. Do it today…Sign up to receive CodeRED Emergency Alerts and download the free CodeRED App.

As Sir Francis Bacon said, “Knowledge itself is power” (Meditationes Sacre. 1597). The knowledge you gain from emergency alerts, such as CodeRED, provides you the power and information needed to protect yourself and your loved ones when there’s an emergency.

If you have questions about CodeRED or need assistance creating a CodeRED account, please email EMA@allentownpa.gov or call the Allentown Health Bureau Public Health Emergency Preparedness Program (PHEP) at 610-437-7760 x3510.

download the codered app

Who?

Everyone who has a mobile phone. The free CodeRED App uses the GPS location of your mobile device to alert you of an emergency. The CodeRED App is available for both iOS and Android devices.

Why?

You’ll get notified if you and your mobile device are in an area that is affected by an emergency, the community uses the CodeRED system, and they send a CodeRED emergency alert.

How?

Search the App Store (iPhone) or Play Store (Android). Download the free CodeRED App and click on the “Register” button.

Sign up with CodeRED to get notified if the address where you live or work is affected by an emergency. Here are the directions:

City of Allentown CodeRED

Who?

Register if your home and/or work address is within the City of Allentown.

How?

• Go to: allentownpa.gov/ema

• Click on the top CodeRED Weather Warning icon or

• Text ALLENTOWNALERT to 99411

NOTE: You can receive Allentown’s CodeRED alerts in 7 languages (English, Spanish, Chinese, French, Japanese, Korean, Russian). Select your preferred language when you register for an Allentown CodeRED account.

Lehigh County CodeRED

Who?

If your home and/or work address is within Lehigh County (but outside the City limits).

How?

• Go to: lehighcounty.org

• Click on Departments

• Click on Emergency Management/9-1-1

• Click on CodeRED Keeping Citizens informed icon.

THE LEGISLATIVE YEAR IN REVIEW 2023

“Unpredictable” is probably the best word to describe the many changes that have taken place over the past year… both from a legislative perspective and a political one, although the two are often inextricably linked.

Shortly after the 2022 House of Delegates in October that year, the General Assembly approved Senate Bill 225, prior authorization reform legislation. This proposal was the result of nearly six years of stakeholder meetings, physician coalition discussions, meetings with PAMED

Continued on page 20

physician leaders, and grassroots physician advocacy. The new law made changes to the time-frames health insurers have to make prior auth decisions, refined the definition of medical necessity related to prior authorizations, streamlined the process of medication step therapy and enacted changes to the qualifications of peer-to-peer reviewers. Passage of Senate Bill 225 was applauded by physician organizations across the Commonwealth along with members of the legislature. Though more work needs to be done when it comes to the relationship between physicians, health insurers and patients.

November 2022 also brought the election of a new Governor, Josh Shapiro, and a historic shift of power in the state House of Representatives with democrats edging out a one-seat majority. These changes, coupled with the untimely death of Anthony DeLuca, a democratic member of the House, impacted the ability of the General Assembly to “hit the ground running” in early 2023. Adding to the political complexities of a new legislative session was the resignation of several democrat house members who had been elected to other offices, including Lt. Governor Austin Davis. As a result, the “business” of the House didn’t really get started in a serious way until April.

We were also happy to see the election of Arvind Venkat, MD, to the State House of Representatives, the first physician to do so since 1961. Since his swearing in, Dr. Venkat has made a positive impression with members of his caucus and has, more than once, influenced or helped shape health care legislation in Harrisburg. We anticipate that Dr. Venkat will continue to be a driving force, and trusted source of clinical knowledge, to many members of the legislature. It should be noted that PAMED’s political action committee, PAMPAC, was an early supporter of Dr. Venkat’s candidacy.

Politics aside, we have seen several proposals put forth this legislative session that have PAMED very much engaged. We saw the reintroduction of Senate Bill 25, legislation that would grant CRNPs with independent practice authority and expect to see a companion bill introduced in the House before the end of the

year. Legislation was also introduced to allow pharmacists to prescribe medications. A public hearing on this measure, House Bill 1000, was held in September with future stakeholder meetings expected. Staying with the theme of scope of practice expansion, PAMED has been engaged with the PA Chapter of the American College of Obstetricians/Gynecologists in considering a legislative proposal that would no longer require nurse midwives to maintain a collaborative agreement with an OB/GYN. As of early December, consideration of these proposals is not expected in the near term.

While PAMED spends considerable resources on scope of practice issues, there are a number of bills, unrelated to scope, on which we are actively engaged. These include, but are not necessarily limited to, the following in no particular order:

Pennsylvania Orders for Life Sustaining Treatment (POLST) —PAMED continues to work on moving proposals in both the Senate and House to address the issue of POLST. Sen. Gene Yaw (R-Lycoming) has introduced Senate Bill 631 and Rep. Tarik Kahn (D-Philadelphia) has introduced the companion bill in the House as House Bill 1212. Committee consideration of House Bill 1212 could come in early 2024.

Insurer Credentialing—PAMED has identified Sen. Ryan Aument (R-Lancaster) as a possible sponsor in the Senate for legislation to shorten the time it takes to credential providers with health insurers. PAMED is working on several fronts to gather documented information on the delays in the credentialing process. It should be noted that Rep. Steve Mentzer (R-Lancaster) has introduced a version of our credentialing bill in the House as House Bill 1510.

Non-Compete Agreements—As mandated by the PAMED House of Delegates, we continue to discuss the issue of non-compete agreements in physician contracts with many legislators. Interest in this area seems to be growing as lawmakers learn more about how these contractual agreements negatively impact patient access and continuity of care. Sen. Michele Brooks (R-Venango) has

re-introduced a proposal, Senate Bill 521, that would require a patient to be notified if their physician changes practices. Under the legislation, patients would receive the appropriate contact information for their physician should they choose to continue seeing their provider in another location. The bill would also void non-compete agreements when a physician is terminated “without cause.” The Hospital and Healthsystem Association of Pennsylvania opposes this legislation. In the House, Rep. Dan Frankel (D-Allegheny) has introduced House Bill 1633, a proposal that would outright ban the use of non-compete agreements in all physician employment contracts. PAMED will be working with Rep. Frankel, and other policy makers in the House, to move this proposal forward. While PAMED supports House Bill 1633, our support is contingent upon adding a provision that would permit the use of non-compete agreements by private physician practices.

Bio-markers—Legislation introduced by Sen. Devlin Robinson (R- Allegheny), Senate Bill 1754, would mandate that health insurers cover the costs associated with diagnostic tests to determine a given patient’s bio-markers related to a specific illness. Rep. Kyle Mullins (D-Lackawanna) has joined with Rep. Bryan Cutler (R-Lancaster) in introducing House Bill 954, another bio-marker proposal as well and a companion to the Senate version. PAMED, along with a broad coalition of provider organizations and patient advocacy groups, supports both legislative initiatives.

Telemedicine—PAMED is hopeful that a telemedicine bill may finally get to the Governor’s desk this legislative session. Sen. Elder Vogel (D-Beaver) has once again introduced Senate Bill 739 of which PAMED is supportive.

ED Overcrowding —PAMED has asked Governor Josh Shapiro to establish a task force on the issue of ED overcrowding. While no legislative remedy to this crisis has been introduced, PAMED hopes to work handin-hand with the Shapiro administration in identifying a solution and following through with its implementation.

Mental Health Access—PAMED, along with the Pennsylvania Psychiatric Society (PSA), has embraced the collaborative care model between psychiatrists and primary care physicians as a way of expanding mental healthcare services to patients in need. House Bill 849, authored by Rep. Mike Schlossberg (D-Lehigh), provides funding to establish coordinated care models in primary care offices. The language also includes a model that utilizes psychologists in care models as well.

Reproductive Health —PAMED has met with Rep. Leanne Krueger (D-Philadelphia) regarding her proposal to expand access to contraceptives. Her proposal, House Bill 1140, would remove limitations on the duration of prescriptions for patients taking medications that not only prevent pregnancies but also treat ailments such as endometriosis and Polycystic ovary syndrome. PAMED is working cooperatively with Rep. Krueger to “tighten” aspects of the bill to ensure

that physicians ultimately have control of the prescription process.

Constitutional Amendment on Abortion—Rep. Danielle Friel Otten (D-Chester) introduced House Bill 1888, a constitutional amendment measure that would enshrine within the state constitution an individual’s right to exercise personal reproductive liberty related to pregnancy. A constitutional requirement to hold a public hearing on the proposal was satisfied on December 12, 2023. It is anticipated that the bill will be considered by the full House of Representatives in early 2024.

Although the current legislative session has been less than robust, a breast cancer-related proposal authored by Sen. Kim Ward (R-Westmoreland) made it to the finish line in record time in May of this year. Senate Bill 8, lauded as a “first-of-its-kind” in the country to improve breast cancer screening coverage of necessary BRCA testing and screening for high-risk Pennsylvanians, had the support of

PAMED and several patient advocacy groups. PAMED played an active role in helping to develop this legislation through several meetings between PAMED Board Chair and oncologist Ed Balaban, DO, and Sen. Ward’s legislative staff. The bill was signed into law by Governor Josh Shapiro as Act 1 of 2023.

As we begin the 2024 legislative calendar, PAMED is looking ahead strategically on many of the issues contained in this report. We anticipate a busy legislative agenda as lawmakers will be looking ahead to the state’s April primary election and, of course, the Presidential election in November of 2024. As always, PAMED members are encouraged to develop relationships with their local state representatives and state senators. These relationships will play a key role in helping PAMED to achieve our legislative goals.

2023/2024 PAMED

LEGISLATIVE PRIORITIES ‘REPRODUCTIVE RIGHTS’ STATEMENT

The Pennsylvania Medical Society (PAMED) believes in the sanctity of the physician/ patient relationship. PAMED acknowledges support of women’s reproductive health and the role of physicians in providing said care.

PAMED will support decision-making choice with respect to reproductive rights and education so that a woman fully understands both the physical and psychological effects of their decisions in their reproductive health.

PAMED opposes legislative measures which interfere with medical decision making or deny full reproductive choice, including abortion, based on a patient’s dependence on government funding.

KEY ITEMS:

• Decisions about reproduction and women’s health should be between the woman and her physicians.

• Legislation that interferes with a woman’s reproductive rights may interfere with appropriate, effective, and frequently used treatments for conditions such as rheumatoid arthritis and cancer. Treatments for these conditions could be limited because of the potential risk of impacting an unknown pregnancy. This could put a woman’s health and life at risk.

• Reproductive health restrictions will disproportionally affect communities that are already marginalized. PAMED works to advance the health of all Pennsylvania patients, especially those who need it most.

• Guttmacher Policy Review reported 75% of abortions are sought by low income patients.

• Physicians who are worried about prosecution for what is seen as basic treatment of their patients could leave the state to practice elsewhere.

Appropriate, effective, and frequently used treatments for conditions such as rheumatoid arthritis and cancer could be limited because of the potential risk of impacting an unknown pregnancy.

LCMS NEWS

NEW MEMBERS

Sohaib Alkowni, MD Resident, Hematology & Medical Oncology (Internal Medicine)

Marissa Lara Ambron, DO Internal Medicine

Emmanuel Annor, MD Resident

Veera Jayasree Latha Bommu, MD Resident, Internal Medicine

Nehali Gupta Medical Student

Christopher W. Guske Medical Student

Bilal Arshad Mannan, MD Internal Medicine

Neil C. Jikaria, MD General Surgery

Amir Loghmani, MD Psychiatry

Matthew D. McClure, MD Psychiatry

Zachary Simon Rothkopf, MD Resident

REINSTATED MEMBERS

Liang Chen, MD Physical Medicine And Rehabilitation

Clinton C. Holumzer, MD Internal Medicine

Kyle C. Klitsch, DO Physical Medicine And Rehabilitation

Kimberly S. Kuchinski, MD Pediatrics/Physical Medicine And Rehabilitation

Luke W. Riddell, DO Resident Emergency Medicine

Jennifer Christine Rovella, DO Pulmonary Disease

WOMEN & BABIES PAVILION NOW OPEN

In the Allentown community, we have been delivering babies since 1945. We are proud to continue to deliver the next generation of babies at our newly renovated, state-of-the-art, Women & Babies Pavilion at St. Luke’s Allentown Campus.

• Spacious private patient rooms with spa-like amenities

• Welcoming interior design with décor inspired by nature

• Personalized care team focused on your inpatient experience

• Level III Neonatal Intensive Care Unit (NICU) with private bays designed to allow mothers to remain close to their baby during their stay