Contents
2015 BOARD OF DIRECTORS
SUMMER 2015
OFFICERS James M. Kelly, MD President
Lincoln Family Medicine
David J. Simons, DO President Elect
Community Anesthesia Associates
Robert K. Aichele, DO Vice President
Aichele & Frey Family Practice Associates
COVER STORY
What a Challenge! What a Team! Physicians, Physician Assistants, & Nurse Practitioners Work Together To Deliver Comprehensive Care (p. 30)
Paul N. Casale, MD Immediate Past President
The Heart Group of Lancaster General Health
Laura H. Fisher, MD Secretary
Lancaster Family Allergy
Stephen T. Olin, MD
Best Practices
Treasurer
6 Idiopathic Intracranial Hypertension (IIH)
DIRECTORS
10 From Volume to Value
Lancaster General Hospital
In Every Issue 4 President’s Message 21 Healthy Communities
Charles A. Castle, MD Stacey Denlinger, DO Robin Hicks, DO John A. King, MD
14 Latest Technologies at Lancaster General Health Improve Quality of Life for Patients
Venkatchalam Mangeshkumar, MD Kathryn McKenna, MD Ashley Morrison, MD
16 WellSpan Ephrata Community Hospital Expansion Announced
Karen A. Rizzo, MD, FACS
Interim Editor:
18 Life-Saving Technologies For Burn & Stroke Patients
35 Patient Advocacy 38 Regulatory Updates 42 Medical Society Updates 46 Restaurant Review 47 News & Announcements
Dawn Mentzer
Editors: Laura Fisher, MD Lancaster Family Allergy James Kelly, MD Lincoln Family Medicine
Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment.
PAMED Brings Clarity to the Medical Marijuana Debate… But Now What? (p. 42)
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President’s Message
PAMED Annual Meeting 2015: A Call for Resolutions
T James Kelly, M.D. President
his October, delegates from our local medical society will represent Lancaster County at PAMED’s 2015 House of Delegates and Annual Education Conference in Hershey, PA. This meeting is designed to bring representatives from all counties together to discuss concerns specific to Pennsylvania physicians. Employed and private physicians from all specialties will be present. Residents, medical students, and young physicians (under age 40 or with less than 5 years in practice) are represented with voting blocks separate from the county delegations. We unite at this meeting with a common goal: To improve the health care landscape for patients and providers in PA. Prior to the annual meeting, each county appoints delegates with numbers based on the size of the physician population represented. Philadelphia has the largest representation with a total of 36 delegates. Lancaster County is assigned a delegation of seven members. Lancaster is then paired with Dauphin, York, Berks, Cumberland, Perry, Adams, Franklin, Fulton, and Lebanon counties in a group designated as the 5th district. The idea is that geographically we would have similar interests should the need arise to form a voting block regarding a controversial topic. Heath Mackley, MD, from Dauphin County (see article on page 42 ) is our district representative at the state level. Lancaster delegates typically meet several months prior to October to review items specific to our county that could be recognized at the state level. Practice specific, specialty specific, or more global concerns (insurance reimbursement, access to care, public health) are up for discussion. If relevant topics are offered, PAMED assists with drafting resolutions to present at the state level. Depending on the topic, a resolution is vetted through district, specialty, resident, or the young physicians section to garner support prior to formal presentation at the annual meeting in October. If recommended for adoption at the state level, the resolution is next reviewed by the PAMED Board and ultimately taken nationally to the American Medical Association. Examples of resolutions passed in October of 2014 include: 1 A petition for CMS to include tetanus and TDAP as a covered service at Medicare wellness visits. 2 A call to establish standard policies for delivery and payment of telemedicine services in PA. 3
Opposition to the current Maintenance of Certification process, with suggestions to eliminate practice performance modules, reduce costs of recertification, and develop a more evidence-based and accurate assessment of physician clinical skills.
4 A call for regulations regarding E-Cigarette advertising and paid product placement. 5 Regulations asking for prompt communication of medical information from retail and urgent Visit lancastermedicalsociety.org
care clinics to primary care and specialty clinicians.
As a county medical society, one of our functions is to transcend barriers between hospital systems, private and employed physicians, and across specialties with a goal of uniting us to improve health care in Lancaster County. I am thus writing this month not only to review the process, but also to ask for suggestions, ideas, or concerns that we as your county board can bring to the state delegation this October. I invite anyone with a resolution idea or suggestion to contact me through the county medical society office by phone at (717) 393-9588 or by email at jxkelly@lgheatlh.org.
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pr ctices Idiopathic Intracranial Hypertension (IIH) From Volume to Value Latest Technologies at LGH Wellspan Ephrata Community Hospital Expansion Announced
Idiopathic Intracranial Hypertension (IIH) Symptoms, Diagnosis, & Treatment
Life-Saving Technologies For Burn & Stroke Patients
HELENA WU-CHEN, MD Neurology & Stroke Associates, PC
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diopathic Intracranial Hypertension (IIH)—also known as Benign Intracranial Hypertension or Pseudo Tumor Cerebri (PTC) or Idiopathic Intra Cranial Hypertension (IICH)—is a neurological condition characterized by elevated intracranial CSF (cerebrospinal fluid) pressure without the evidence of a tumor, infection, or other primary central nervous system disorders. If left untreated, this is not a benign condition. Many patients with IIH may suffer from intractable or
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disabling headaches and visual impairment that are sometimes persistent. The main symptoms of IIH are headache, visual disturbances, and sometimes ringing in the ears and pulsatile tinnitus. Most patients describe the headaches as a pounding pain in the head and not uncommonly in the back of the neck. The pain can worsen with bending or stooping. Headache pain can vary in severity, as well as the location, and could be accompanied by nausea and vomiting. Common visual disturbances associated with IIH include problems with peripheral vision, transient dimming, and blurring of the vision (often referred to as transient visual obscurations). Occasionally, patients experience double vision.
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Idiopathic Intracranial Hypertension
Triggers of the Disorder
The brain and spinal cord are bathed in a clear fluid called cerebrospinal fluid (CSF), produced by the choroid plexus located within the ventricles. It forms one of the three intracranial/spinal compartments. With many functions for it to perform, our brain produces about 300 to 450 cc of cerebrospinal fluid daily, and an average adult would contain 100 to 150 cc of CSF at any given time. CFS is thought to be absorbed by the arachnoid villi of the deep venous sinuses. Other mechanisms of absorption may also exist. What exactly triggers IIH is not clearly understood. It may be excessive production of CSF or poor absorption at the outflow. Both lead to high CSF pressure inside the brain. This high pressure can be transmitted to the back of the eye causing bilateral optic nerve swelling (path of least resistance) also known as papilledema (Figure 1). The high pressure may also cause damage to the nerves involved in eye movements, resulting in double vision.
Diagnosis of IIH
The diagnostic investigations of IIH include brain imaging and spinal tap. With the help of MRIs of the brain, we are able to rule out secondary causes of increased intracranial pressure such as tumors, inflammation, and blood clots in the venous sinuses. MRV (magnetic resonance venogram), CTV (CT venogram), and digital subtraction venogram may at times be crucial to the diagnosis. MRI brain scans may show some cardinal signs that can clue us in to the diagnosis of primary IIH. Those signs include: partial or full empty sella turcica (Figure 2), flattening of the globe, prominent subarachnoid space around the optic nerves, inversion or enhancement of the optic nerve head, tortuous optic nerves, and meningocele at the petrous apex. Advanced techniques can identify sinus venous stenosis.
pressure falling between 20-25 cm of H2O is considered equivocal. Some studies have shown that obese patients have higher opening pressure, approaching the normal limit of 25 cm of H2O. Other considerations to take into account include the positioning of the patient for the spinal tap. The ideal position would be in lateral decubitus with the legs straight. Some approaches like prone position can affect the opening pressure measurement. The cerebrospinal fluid sample collected should be normal. Findings of abnormal cells, inflammatory cells, or elevated protein may indicate prior infection, inflammation, or neoplasm that can lead to elevated intracranial pressure.
FIGURES LEGEND 1-A: Shows the appearance of a normal optic nerve. 1-B: Shows the appearance of a swollen optic nerve. 2: For the diagnosis of IIH, brain imaging like MRI should be performed to rule out any intracranial cause for the increased pressure around the brain.
Who Does IIH Affect?
IIH may occur in all age groups, but is most common amongst obese women aged 20-40. However, it may also be found in children, men, and patients who are not overweight. The cause for this disorder is unknown, but some medications (including long-term use of antibiotics, particularly minocycline or doxycycline, high doses of vitamin A derived products and hormonal contraceptives) may raise intracranial pressure. Other possible causes include obstructive sleep apnea, chronic kidney disease, systemic lupus erythematosus, and Behcet’s disease.
Figure 1-A
Continued on page 8 Figure 1-B
The lumbar puncture or spinal tap is essential in the diagnosis. The normal opening pressure is below 15-20 cm of H2O; any opening pressure above 25 cm of H2O is considered high open pressure. An opening Figure 2
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Best Practices
Idiopathic Intracranial Hypertension
Treatment
methazolamide (Neptazane—which can be used in patients intolerant to acetazolamide), and furosemide. Although corticosteroids have been used in the past for severe IIH, we currently do not recommend them because of rebound intracranial hypertension after discontinuation and other possible undesirable side effects.
Aim of the treatment in IIH patients is to prevent visual loss and blindness, as well as to control headaches. Treatment centers on reducing intracranial pressure. If the patient’s BMI is abnormal, weight loss is highly recommended. The clinical course can be self-limiting, with spontaneous remission with and without initial treatment; however, relapses can still happen later, or may continue chronically.
Surgical approaches are used for treatment of severe IIH or IIH refractory to medical therapy. Optic nerve sheath fenestration (a procedure performed by orbital surgeons, involving slitting the nerve sheath in several sites just behind the eye to allow drainage of the CSF) is indicated in patients who are at risk of severe visual loss due to papilledema.
Initial lumbar puncture as a diagnostic procedure can sometimes be curative. This is necessary for headache relief and prevention of visual loss. Further pharmacological treatments are necessary for maintenance therapy to control headaches and facilitate resorption of the optic nerve swelling. Common drugs used in treating IIH include acetazolamide (brand name Diamox), which inhibits the enzyme carbonic anhydrase and reduces cerebrospinal fluid production. Common side effects include low potassium blood levels that can cause muscle weakness and tingling in the fingers. To help prevent them, physicians may advise patients to eat a diet rich in potassium or to take potassium supplements.
For patients who are not responding to medical therapy, a ventriculo-peritoneal shunt or a lumbo-peritoneal shunt can be placed by the neurosurgeon to help continuous drainage of the CSF. Potential complications of this procedure include local back pain, infection, and obstruction of the shunt itself requiring further intervention or replacement.
Other medications that might be effective include topiramate (which has a weak carbonic anhydrase inhibitor effect),
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Best Practices
Make Sure You’re Prepared RACHEL DAMRAUER, MPA
Associate Director of Communications, PAMED
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any physicians—regardless of practice type, setting, specialty, or geographic location—are filled with uncertainty with a multitude of changes to the health care delivery system. One of the new buzz phrases physicians and other health care providers have been hearing more of lately is “volume to value.”
successful. Value-based reimbursement also requires sophisticated, data-driven business decision making, with an emphasis on improving quality and the cost effectiveness of care. “A practice moving from volume to value needs people with many skill sets—someone focused on data interpretations; someone to predict financials; a clinical, quality-focused individual; and someone who is good at project management—to move forward,” said Tracey Glenn, director of practice management consulting for PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society (PAMED).
Since the inception of the Affordable Care Act, we have seen an evolution in health care delivery models involving value-based reimbursement. The transition from volume to value means many things, but in short, it means the methodology behind physician reimbursement is changing. For the first time in the history of the Medicare program, in January 2015, the U.S. Department of Health and Human Services announced goals and a timeline to shift Medicare reimbursement toward paying providers based on the quality of care they give their patients, rather than quantity (fee-for-service).
Glenn says the key strategies for success in moving from volume to value include: Choosing a leader or leadership team who can clearly identify goals and move the organization toward achieving them
Bottom-line: The transition from volume to value is coming and faster than many anticipated, and it will take investments of your time, energy, money, and the learning of new skill sets to be
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Communicating clearly and regularly with the entire health care team
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From Volume to Value
Developing a dashboard or using your EHR’s dashboard functions to share data with everyone
Innovating in operational processes, business models, products, services, and organizational culture
Creating a positive culture focused on continuous quality improvement in patient care and outcomes
Optimizing operational efficiencies in both administrative and clinical processes
Offering professional development and training to assist in achieving goals
Enabling information technology in order to achieve high-value care, efficient operations, and effective management and governance
Including staff in redesigning the processes needed to achieve goals Celebrating successes and revisiting areas that need work
To implement new care delivery models successfully, providers also need to develop a set of core strategic competencies. According to IBM Global Business Services, these include: Empowering and activating patients to assume more accountability and make better, more informed health and lifestyle decisions
“Of course, implementing these core strategies also takes money, time, and the acquisition of new skills for physicians, while simultaneously placing constraints on the payment rates dictated by current law,” said Dennis Olmstead, chief strategy officer and medical economist at PAMED. “All alternative payment models and payment reforms that seek to deliver better care at lower cost share a common pathway for success. Providers must make fundamental changes in their dayto-day operations that improve the quality and reduce the cost of health care. Skills will be needed by all providers to navigate these new delivery systems and payment strategies.”
Collaborating to integrate health care delivery across traditional and non-traditional care venues
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Best Practices
From Volume to Value
So, how can you prepare yourself and be ahead of the curve? A new innovative educational series of online, on-demand courses and live workshops from PAMED can help ensure you have the skills necessary to succeed in the transition from volume to value. Learn more, including the curriculum, and register at www. pamedsoc.org/valuebasedcare. Earn up to 1 hour of CME for each online course and up to 5 hours of CME for each live workshop. This series is facilitated by PAMED member Ray Fabius, MD, a nationally respected expert in quality and population health. What sprung Dr. Fabius into action? It was several years ago when, as a practicing pediatrician in Philadelphia, he was visited by a local medical director. “I was stunned when I learned that this medical director knew more about my practice that I did,” said Dr. Fabius. “He had information that compared my performance on quality, on utilization, and even information on my patient satisfaction. I never again wanted to have someone else know more about my practice than I did.” Learn more at www.pamedsoc.org/Fabius. This series is designed to help prepare health care providers for the future when reimbursement is based on outcomes, data and analysis are paramount, and population health is the focus. “As we move toward value-based delivery systems, the focus shifts from volume to cost and quality,” said Keith Kanel, MD, MHCM, FACP, Chief Medical Officer at Pittsburgh Regional Health Initiative. “Physicians must outfit themselves with new skills for modern challenges, and the PAMED program will provide the toolkit.”
What’s leadership got to do with it and where can I hone my leadership skills? “What’s needed [to be successful in the transition from volume to value] to tie all of these team members and skill sets together is a strong leader,” said Glenn. In addition to the volume to value educational series, PAMED also offers many leadership resources to Pennsylvania physicians through its Leadership Skills Academy. The Leadership Skills Academy includes a year-round leadership academy; online, on-demand courses; onsite training; and discounts on national seminars and conferences. Learn more at www.pamedsoc.org/leadershipacademy. “If we [physicians] don’t lead or at least participate in change, it will occur without us, and I’ll wager to our detriment,” said Gus Geraci, MD, consulting chief medical officer at PAMED.
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Best Practices
Latest Technologies at Lancaster General Health Improve Quality of Life for Patients MARY BETH SCHWEIGERT
Physician Communications Specialist, Lancaster General Health
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hree recent medical innovations implemented at Lancaster General Health have the potential to reach remote areas of the lung for earlier diagnosis and treatment, decrease heart failure-related hospitalizations, and expand the number and complexity of cases performed by surgeons.
GPS-Like Technology Detects Lung Diseases Early
LungGPS technology is guiding a three-physician team at LG Health to find lesions in the lung’s peripheral branches, areas that can be difficult to reach with traditional bronchoscopy.
Thoracic surgeon Dr. Jennifer Worth and pulmonologists Dr. Shakeel Amanullah and Dr. Keith Beaulieu began using the Covidien superDimension system’s LungGPS technology to perform LG Health’s first minimally invasive Electromagnetic Navigational Bronchoscopy (ENB) procedure on April 1. “If we can diagnose lung cancer at an earlier stage—1 or 2 vs. 3 or 4—it will lead to expedited treatment and hopefully improved outcomes,” Dr. Worth said. “ENB is a valuable tool in our belts.” ENB, which generally takes one to two hours in the operating room or endoscopy suite, has a lower rate of complications that can be associated with biopsy, she said. The
superDimension system uses a CT scan to create a three-dimensional map of the patient’s lungs. The LungGPS technology follows that roadmap to guide the physician precisely to the lesion. Earlier diagnosis offers more options for minimally invasive, less toxic treatment, Dr. Worth said. During the ENB procedure, physicians also can place a marker to use for radiation treatment or tattoo the lesion to assist in future biopsies or robotic procedures. “The potential for this GPS technology for treatment of lung cancer at the same time of diagnosis is also very exciting,” said Dr. Amanullah. “Once the biopsy of the lesion has confirmed the diagnosis of cancer, at the same time, radiation catheters can be directed into the lesion and radiation delivered directly to the lesion, thereby potentially reducing/avoiding radiation to nearby structures, including the lungs. Radiation to the adjacent lung can cause lung damage and is a concern for those with advanced lung diseases.” As technology continues to advance, pulmonary lesions are increasingly common incidental findings on CTs and MRIs, Dr. Worth said. New lung-cancer screening protocols will also likely lead to more demand
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for ENB. Anyone with a concerning lung lesion can be a good candidate for the procedure, but it is especially appropriate for medically frail patients with severe emphysema, heart problems or other comorbidities that make a needle biopsy or surgery too risky, she added.
The Next Generation Of Da Vinci Arrives
On March 19, Lancaster General Hospital became the first hospital in central Pennsylvania to perform surgery using the latest generation of the da Vinci robot.
The da® Vinci Xi™ Surgical System is expanding the number and complexity of cases surgeons can perform, according to
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Latest Technologies at LGH
Dr. Paul Newman, Division Chief of General Surgery for LGH. “The da Vinci Xi further advances minimally invasive surgery and maximizes access to all parts of the abdominal and pelvis to allow surgeons to perform complicated cases, including colorectal and combination surgeries with multiple specialties,” Dr. Newman said, noting the da Vinci Xi is more user-friendly than earlier models. “Robotic technology continues to improve minimally invasive surgery to give patients the benefit of smaller incisions and hope for less pain and quicker recovery.”
Heart Group. “Clinical trials have shown positive outcomes in terms of decreased hospitalizations, as well as improved longevity and quality of life.” The dime-size CardioMEMs, by St. Jude Medical, has no batteries or wires and is designed to last a patient’s lifetime. The device is placed in the pulmonary artery during a minimally invasive, catheter-based procedure in Lancaster General Hospital’s cath lab. “Previously, to measure pressures in the heart and lungs directly, we would have had to do an invasive procedure,” Dr. Roberts said. “With CardioMEMS, patients can go home the same day.”
The da Vinci Xi System, developed by Intuitive Surgical, can be used across a spectrum of minimally invasive surgical procedures and has been optimized for multi-quadrant surgeries in the areas of gynecology, urology, thoracic, cardiac and general surgery. By enabling efficient access throughout the abdomen or chest, the da Vinci Xi System expands upon core da Vinci System features, including: wristed instruments for more precise movements of tiny instruments inside the patient’s body; 3D-HD visualization that provides surgeons a highly magnified view, virtually extending their eyes and hands into the patient; intuitive motion; and an ergonomic design.
New Device Detects Heart Failure
In February, physicians at The Heart Group of LG Health were the first in the region to implant a device that detects pressure changes within the pulmonary artery, considered an early indication of worsening heart failure. “Using this new device, CardioMEMS, allows us to aggressively monitor and treat heart-failure patients,” said Dr. Justin D. Roberts, a heart-failure cardiologist with The
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Candidates for CardioMEMS have heart-failure symptoms with usual activities and have been hospitalized with heart failure in the past 12 months. For a few minutes each day, patients lie on a specially designed pillow, which transmits CardioMEMS’ pressure readings to a secure website. Providers review the readings and adjust the patient’s care plan accordingly. Symptoms of worsening heart failure, such as fatigue, swelling, and weight changes, frequently begin days before patients require hospitalization. CardioMEMS may detect changes weeks prior to worsening symptoms. If pressure changes are detected, the clinician may order an office visit, or medication or lifestyle changes.
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Best Practices
WellSpan Ephrata Community Hospital Expansion Announced
“This project is really a perfect example of the significant benefits our affiliation with WellSpan will bring to our patients and the communities of northern and eastern Lancaster County,” said John M. Porter Jr., executive vice president and chief operating officer of WellSpan Health, and president of WellSpan Ephrata Community Hospital.
Nearly $47 Million Project To Include Enhanced Surgical Facilities, Physician Offices
“It exemplifies WellSpan’s mission to improve the health of patients and the communities it serves,” he added.
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ellSpan Health is investing nearly $47 million to expand and renovate WellSpan Ephrata Community Hospital—the latest in the regional health system’s ongoing efforts to improve the local system of care in northern and eastern Lancaster County. The project will include newly expanded and centralized surgical facilities and additional physician office space, providing improved access to advanced specialty care for the region—including the future addition of robotic-assisted surgery and new, dedicated orthopedic operating rooms.
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Wellspan Ephrata Community Hospital Expansion Announced
The total project costs include about $28.4 million in estimated construction and renovation costs and nearly $18.4 million to purchase the Ephrata Health Pavilion building, which the hospital had been leasing since it opened in 2002. Construction on the project began in June and continues through late 2016. The project will increase the size of the Ephrata Health Pavilion by more than 40 percent—from nearly 69,000 square feet to more than 98,000 square feet. The expansion and renovation will occur on all three floors of the building.
Expanding Access to Advanced Specialty Care
As the communities served by WellSpan Ephrata Community Hospital have grown, the health care needs have grown with it, Porter said, adding that the expansion and renovation project will enable the hospital to better serve the region’s surgical needs. The project will relocate the inpatient operating rooms to the health pavilion, centralizing all of the hospital’s surgical facilities in one location on the second floor of the pavilion. “The overall design of the surgical suite is expected to improve efficiency and provide more private and comfortable facilities for patients and visitors,” said Marcia Hansen, Vice President of Operations and Chief Nursing Officer, WellSpan Ephrata Community Hospital. The hospital will expand its total number of operating rooms from nine to 10, with space available for future growth. All oper- WellSpan’s recent initiatives in Lancaster County include: ating rooms will also be larger in size, allowing the hospital to • introducing the patient-centered medical home accommodate robotics and other high-tech capabilities. model in its primary care practices in the county; The surgical suite will include two dedicated operating rooms for orthopedic surgeries, increasing the hospital’s capacity and improving patient access to these high-demand procedures.
• opening a new family medicine practice in Manheim; • adding new women’s specialty care services in Brownstown;
The construction project also expands facilities for storing, ster• developing a new neurology practice in Ephrata; ilizing and processing surgical supplies. “Through all of these changes and additions, our goal is to provide exceptional care to our patients through a more modern and more efficient facility,” Hansen said.
Building a Stronger Local System of Care
• initiating a new genetic counseling service at the Ephrata Cancer Center; and • launching the MyWellSpan online patient portal.
The expansion and renovation of WellSpan Ephrata Community Hospital underscores WellSpan’s mission to improve the health of patients and the communities it serves, Porter said.
The hospital expansion signals a new era of community-based, advanced specialty care for northern and eastern Lancaster County, according to Porter.
“Since Ephrata Community Hospital joined WellSpan in October 2013, we have made significant investments to improve and enhance the health care resources in northern and eastern Lancaster County,” Porter said.
“With WellSpan’s resources and its firm commitment to improving our local system of care here in Lancaster County, we can offer new, state-of-the-art health care facilities for our community,” Porter said.
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LIFE-SAVING TECHNOLOGIES For Burn & Stroke Patients
At Lancaster Regional & Heart of Lancaster Medical Centers
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hen people face an emergency room visit and/or hospital stay, the last things on their minds are how the treatment will be rendered and what technology will help coordinate their care. For patients potentially suffering a stroke or serious burn, minutes count. Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center are fully equipped with technologies to help save lives when immediate treatment is of the utmost importance.
to provide immediate, appropriate treatment by consulting with burn surgeons and specialists, even if those specialists are not on-site at Lancaster Regional Medical Center and/or Heart of Lancaster Regional Medical Center. TeleBurn allows them to transmit photo images (through a HIPPA compliant secured website) of a patient’s burns directly to the Regional Burn Center for evaluation. Burn surgeons can then make the determination whether the burn can be treated locally or if it is severe enough to require transport to Lehigh Valley Health Both hospitals are affiliates of the Network’s Regional Burn Center for more TeleBurn program of Lehigh Valley extensive, specialized treatment. This service Health Network’s Regional Burn Center. is offered at no cost to the patient or referral TeleBurn technology enables the hospi- hospital. It is also available 24 hours a day, 7 tal’s emergency department physicians days a week. TeleBurn is currently operating
in Pennsylvania, New Jersey, New York, and Delaware. There are over eighty TeleBurn locations or hospitals with TeleBurn services. The Lehigh Valley Hospital Burn Center is an ABA (American Burn Association) Verified Burn Center, treating over 10,000 outpatient and inpatient burns a year. It is one of the busiest burn centers on the East Coast. The hospitals are also affiliates of LionNet— the Penn State Hershey TeleStroke program housed within the only comprehensive stroke center in the region. LionNet technology provides real-time remote audio-visual access to a neurological consult with a stroke neurologist or neurosurgeon at Penn State Hershey. When a suspected stroke patient arrives in the emergency department at either hospital, they can connect to a stroke expert at Penn State Hershey, using a sophisticated computer system and a webcam. Physicians there can provide consultation, examine the patient, review scans, and speak to the patient and family in real time. A treatment recommendation is made and doctors can determine the best course of action. Patients benefit because faster treatment improves recovery. Treatment may be provided locally, reducing the need for travel to another hospital. With greater access to the stroke population, the use of IV-tPA, the standard of care for acute ischemic stroke, has increased, saving lives. Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center are directly or indirectly owned by a partnership that proudly includes physician owners, including certain members of the hospitals’ medical staffs.
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Healthy Communities
Using Cleaning Chemicals in Health Care Facilities How To Attack Contaminants While Protecting Health & The Environment
strippers, and disinfectants present a variety of human health and environmental concerns.
Risks
SCOTT WERKHEISER, PE
President, Green Commercial Cleaning, Inc.
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leaning, to limit the spread of infection and for aesthetic considerations, is particularly important in health care facilities. To ensure the job is done effectively, most facilities rely on a wide variety of potent chemicals to attack and remove contaminants. Cleaning chemicals commonly used in health care facilities fall into several product categories including: • Air fresheners • Bathroom and tile cleaners • Dusting aids • Fabric protectants • Floor polishes/waxes • Furniture maintenance products (aerosols) • General purpose cleaners • Glass cleaners While everyone might expect health care facilities to clean using these types of products, many traditional cleaning products, floor
Cleaning chemicals can cause damage via direct contact with skin, eyes, or other sensitive tissue, or through inhalation of vapors. The use of these traditional cleaning chemicals contributes to poor indoor air quality and has been implicated in the increase of worker respiratory ailments such as asthma and Reactive Airway Dysfunction Syndrome (RADS). Exposure to and contact with cleaning chemicals can also cause throat irritation, skin rashes, headaches, dizziness, and nausea. According to the Massachusetts Department of Public Health, the most commonly reported occupational asthma-causing agent is poor indoor air quality. Nursing, teaching, and office workers are the occupations most likely to report problems with indoor air quality. Hospitals use a variety of methods to disinfect and sterilize surfaces and equipment. Some of the most commonly used chemicals, however, such as glutaraldehyde and ethylene oxide, have been shown to cause serious health effects. Conversely, good air quality creates an environment where employees feel healthy and comfortable and, as a result, are more productive. This decreases both costs and liabilities. Adequate ventilation in relation to cleaning products and processes is a major factor in maintaining good indoor air quality.
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By carefully choosing environmentally sound cleaning chemicals, cleaning methods, and cleaning equipment, businesses could realize a 0.5% to 5% increase in worker performance.
Alternatives
By looking for products that are certified to meet certain environmental and health and safety criteria, health care facilities can avoid exposing staff and patients to harmful cleaning compounds. There are several accrediting bodies that make determinations about whether or not cleaning chemicals have met environmental criteria. • Green Seal • Canada’s Environmental Choice Program • New American Dream • State Programs
Alternative cleaning products approved by these organizations offer effective disinfection without creating adverse effects on health care workers and the environment. By researching the options and moving away from using cleaning products with harsh chemicals, health care facilities can further demonstrate their dedication to promoting wellness in all aspects of their businesses.
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Healthy Communities
Wearable Fitness Devices:
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recent study by the University of Scranton shows that only approximately eight percent of people who make New Year’s resolutions successfully achieve their goals. But could a growing trend help some stay on track? Wearable fitness devices seem to be picking up pace in the fitness and medical worlds, alike.
and even sleep patterns. Newer devices can also send the data to the users’ smartphones or computers for future reference. With the appeal of new and updated technology, it comes as no surprise that many doctors expect the use of wearable fitness devices to increase in popularity not only for personal use but for medical use as well.
Today, wearable fitness devices are more functional than the old pedometer—they do more for users than just count steps. With the consistent growth of technology, modern devices now possess the ability to track steps taken, heartrate, calories burned,
Society is attracted to new technology that promises to simplify daily tasks and help users stay organized. When individuals invest in technology to aid in improving their health, they often feel more inspired to fulfill their goals. Wearable fitness devices allow
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users to statistically visualize how their daily exercise impacts their current lifestyles and how that progress correlates to the general fitness goals these devices track. That can entice users to increase their daily physical activity and lead them to make healthier choices in other areas of their lives. “Patients who are wearing fitness devices are consistently more eager to engage in healthy eating habits,” Medical Director James Ku, MD, FACS, FASMBS, of Lancaster General Health Physicians Healthy Weight Management & Bariatric Surgery observes.
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Wearable Fitness Devices
Ku is currently leading a team of medical professionals in the Fitbit/Healthy Weight Management Study, funded by Von Hess. This study is designed to observe activity tracking through the use of Fitbit devices by bariatric patients. It focuses on how the data gathered by wearable fitness devices can be communicated with and used by medical professionals to benefit patients and whether fitness tracking leads to better health in patients, as well. Although both are important, Dr. Christopher Wenger, preventative cardiologist at The Heart Group of Lancaster General Health, notes patients need to realize that the concepts of exercise and healthy eating are not synonymous. “I would argue that eating healthy promotes good health going forward, while exercising mitigates the bad. It washes away your nutritional sins of the past, so to speak. If you really want to reverse chronic disease, it comes with exercise. If you want to promote good health going forward, you have to eat healthy.” Which concept the patient needs to focus on depends on his or her personal goal. Wenger explains that by exercising, users are “increasing resting metabolism, which accounts for 65 percent of one’s daily expenditure. Overall, you burn the most energy when you’re doing nothing—when you’re watching TV, reading the paper, or sitting at a desk—rather than when you’re working out. The key with exercise is to build and tone muscle, increasing your resting metabolic rate.” Wenger suggests individuals who use wearable fitness devices may get bored with the devices due to lack of personalization or live encouragement, such as feedback they would receive from a trainer. “Some people start out with good intentions but they get bored with it, much like people with the traditional treadmill in the basement that collects dust.” People feel a stronger sense of motivation to achieve their goals when they are working alongside others with similar goals. Ku encourages those looking to improve their health to find a workout buddy and create a
plan. Without a plan or specific goal, people are much less likely to be concerned about whether they achieve their recommended daily exercise.
As wearable fitness devices continue to increase in popularity in today’s society, doctors are becoming eager to utilize the collected data to provide patients with more accurate care.
Some wearable fitness devices allow users to compare their data with others using those same devices, providing a sort of competition among friends or coworkers. This grants users a sense of personal satisfaction when sharing their progress with those who possess similar goals. Being part of a social support network increases a user’s likelihood of reaching his or her goal, because it forms a strengthened sense of accountability among members of the network.
“We are seeing many of our bariatric patients are using wearable technology as they prioritize fitness in their lives,” Ku explains. “The folks at LGH Mobile and Virtual Health approached us to partner with Fitbit, whose server is able to transmit fitness data with our electronic medical record (EMR) system. The study emerged from subsequent brainstorming between LGH Bariatrics and Virtual Health.”
Hundreds of employees in large businesses across the country are participating in workplace wellness programs that implement wearable fitness devices. Through these programs, employers help keep their employees active and healthy while reducing the cost of health insurance premiums. Many employers who offer these wellness plans also offer monetary or free product incentives to participants in order to boost their probability of reaching weekly or monthly wellness goals.
Dr. Lawrence Wieger, medical bariatrician, also of Lancaster General Health Physicians Healthy Weight Management & Bariatric Surgery, has been working with patients who use wearable fitness devices for three years and is one of five medical professionals participating in the Fitbit/Healthy Weight Management Study with Ku. Wieger says he has found that some users become discouraged by their results when the devices display low levels of improvement. They give up because they feel overwhelmed by
“Patients who are wearing fitness devices are consistently more eager to engage in healthy eating habits.” Continued on page 24
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the amount of time and effort it would take for them to reach their goals at their current rate. In contrast, however, he notes that other patients who also use wearable fitness devices seem more motivated to increase their physical activity, proving those patients are using their feedback in a beneficial manner.
Wenger says he expects more people to join this trend and invest in wearable fitness devices as the technology is refined in order to record personalized statistics rather than using the same basic formula for each individual and producing generalized results.
“[Wearable fitness devices] are monitoring more information, but the question is…what do we do with that information?” Wieger suggests that as time progresses, medical professionals will possess the ability to collaborate with patients in order to help them set realistic and beneficial goals that apply directly to the individual patient. With attainable goals, patients will likely see improved progress, influencing even more people to make positive changes in other areas of their lives also, such as altering their diets.
With all the benefits wearable fitness devices have to offer, the future looks bright for medical professionals and their patients as well as those who choose to pursue getting fit without seeking professional assistance. More practical methods of improving people’s health and well-being may be only a few steps away.
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MINOR EMERGENCY CARE FACILITIES in Lancaster County
SUSAN SHELLY
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inor emergency care is one of the fastest-growing segments of health care in America, with more than 9,000 centers spread across the country, according to the Urgent Care Association of America.
“I can say that, as an insider, if urgent care is done well, it can be a boon to the medical community,” Hurst said. “It fills a little niche that can lighten the load on emergency rooms and get patients treated faster.”
And, while these facilities have been viewed with skepticism by some within the medical community, they are gaining in respect —and growing in reach.
Lancaster County has about ten minor emergency care facilities offering various levels of services and care. Six of those facilities are owned either by Lancaster General Health or WellSpan Health, and three (Patient First, Med Express Urgent Care and Concentra Urgent Care) are part of minor emergency care groups. Minute Clinic is the walk-in retail model clinic of the CVS drug store chain.
Generally, minor emergency care centers provide walk-in care for patients with injuries or illnesses that require immediate attention, but do not qualify as a true emergency. The centers often offer care during hours when offices of primary care providers are closed, providing added convenience for consumers.
“It fills a little niche that can lighten the load on emergency rooms and get patients treated faster.”
There are different models for minor emergency care, and they can be owned and administered by hospitals, insurance companies, corporations, or groups of physicians. While some health care providers push back against minor emergency care centers, saying they disrupt coordination and continuity of patient care, advocates claim they improve access and reduce expensive visits to emergency departments. Dr. Kenneth Hurst, a family physician who retired from office practice in December 2014, now treats patients at Lancaster’s Patient First Urgent Care.
Lancaster Regional Medical Center & Heart of Lancaster Regional Medical Center do not operate any minor emergency care centers, but Danielle Gilmore, Director of Marketing, said they are looking at community need and assessing the feasibility of such facilities.
A longtime member of the Lancaster City and County Medical Society, he believes that, instead of competition, minor emergency care should be viewed as complementary to other components of the medical community.
The point of hospital-owned minor emergency care centers, said Dr. Paul Conslato, Director of Clinical Affairs for Lancaster General Health, is to provide quality health care in convenient and accessible settings.
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Minor Emergency Care Facilities in Lancaster County
Lancaster General Health runs three minor emergency care facilities, located in Lancaster, Ephrata, and Parkesburg. They also operate a Lancaster General Health Express, located within the Giant food store in the Lancaster Shopping Center.
WellSpan runs Quick Care centers in Ephrata and New Holland, and has other minor emergency care facilities in York and Adams counties. “Patients tend to use our services due to convenience,” McGill said.
The minor emergency care centers are staffed by physicians and offer X-rays and lab services as necessary for urgent care, treating non-life threatening conditions such as burns and cuts, fractures and sprains, skin conditions, flu and sinus infections, and so forth. The Giant food store location is staffed by nurse practitioners and treats conditions such as ear infections, bronchitis, seasonal allergies, and stomach ailments.
In addition to extended hours, patients like the option of being able to access treatment close to home, McGill said.
The care facilities are popular with patients, who increasingly demand immediate care for illnesses and injuries. “We’ve heard from our patients that when an acute issue arises at an odd hour, they don’t want to wait for care,” Conslato said. The centers give patients an alternative to waiting to see their primary care provider, who may not be able to offer same-day service. Kyle McGill, Administrative Director of Retail Services for WellSpan, agreed that convenience is a big factor in the popularity of minor emergency care centers.
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And, she said, the Ephrata minor emergency care center, which opened in November 2013, helps with overcrowding in the emergency department of WellSpan Ephrata Community Hospital. “We needed a solution in the Ephrata area to take some of the pressure off of the emergency department,” McGill explained. “We opened that site to provide both relief for the ED and convenience for patients.” Cost is another factor in the popularity of urgent and quick care centers. Helen Dohm, a nurse practitioner who serves as district clinic practice manager for CVS’s Minute Clinic, said services provided at Minute Clinic locations cost less than the same services when provided in an emergency room, doctor’s office or physician-staffed minor emergency care center. Continued on page 28
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Minute Clinics in Pennsylvania are staffed by family nurse practitioners and treat relatively mild conditions, along with providing vaccines and physical exams. Common medications are prescribed at the time of the visit and can be filled in the store, when appropriate.
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“We are a retail health care model,” Dohm said. “We’re set up to treat a limited number of common illnesses.”
Locations in Lancaster County
Dohm’s claim regarding cost is backed up by research that appeared in a 2009 issue of the American College of Physicians’ Annals of Internal Medicine. A study compared costs and outcomes for patients suffering from three common illnesses (urinary tract infection, otitis media and pharyngitis) who first received care at a retail clinic, as opposed to a doctor’s office, urgent care center or emergency room. The average cost of care at the retail clinic was approximately thirty percent less than at a physician’s office or minor emergency care facility and approximately eighty percent less than at a hospital emergency department.
LANCASTER GENERAL EXPRESS (in the Giant Food Store) 1605 Lancaster Pike, Lancaster LANCASTER GENERAL HEALTH URGENT CARE (Three locations) 1605 Lititz Pike, Lancaster Intersection of Routes 322 and 222, Ephrata Intersection of Routes 30 and 10, Parkesburg WELLSPAN QUICK CARE (Two locations) 446 N. Reading Road, Ephrata 435 S. Kinzer Avenue, New Holland PATIENT FIRST 1624 Oregon Pike, Lancaster CONCENTRA 113 Butler Avenue, Lancaster MED EXPRESS 4 Rohrerstown Road, Lancaster CVS MINUTE CLINIC 1507 Lititz Pike, Lancaster
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Minor Emergency Care Facilities in Lancaster County
There are many reasons for such varying costs of services, including the fact that, unlike minor emergency care centers, hospital emergency departments are required by federal law to provide care to all patients, regardless of their ability to pay. Conslato said that Lancaster General is very conscious about keeping fees down in its minor emergency care centers, as patients have made it clear that cost is a big factor. “We’ve got to be very mindful of cost,” Conslato said. “We work hard to have value-based fees.” Some minor emergency care centers provide prices for services on their websites or in the office, enabling patients to know ahead of time what their visits will cost. Centers accept some, but not all insurance plans, and uninsured patients who pay out of pocket often are offered discounted rates for services.
“Your first stop, in most cases, should be your primary care provider, if you can’t get in there, an urgent care might be a good solution. But, if it’s a real emergency, you always get right to the emergency department.”
Patient First doctors send out reports to primary care physicians describing a patient’s condition and treatment. “Most of us who work at Patient First are family doctors or interns who understand and appreciate the value of continuity of care,” Hurst said. While minor emergency and quick care centers are increasing in popularity, everyone agrees that they are not substitutes for primary care providers or emergency departments. McGill said that WellSpan is starting a campaign to educate residents about who to call or where to go under certain circumstances. “Your first stop, in most cases, should be your primary care provider,” McGill said. “If you can’t get in there, an urgent care might be a good solution. But, if it’s a real emergency, you always get right to the emergency department.” Anyone who suspects they are having a stroke, heart attack, or other life-threatening condition should not consider an urgent care center, Hurst said. “In those cases, time is of the essence and the emergency room is the appropriate place to be to minimize damage,” Hurst said.
If someone is unable to pay the entire amount for urgent care, Lancaster General will help the patient work out an installment plan. “We learn from our patients as we go,” Conslato said. “I’ve had patients who have educated me about health care payments.” While some minor emergency care centers can be used as primary care for patients who don’t have a regular doctor, the great majority of people who use Lancaster County minor emergency care facilities are under the care of a primary physician. “Fortunately, the Patient First model allows for primary care, but the vast majority of our patients have other primary care providers,” Hurst said. “Most of our patients come to us because they can’t get an appointment with their primary care provider, or they need treatment at a time when their primary care provider’s office isn’t open.”
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From their somewhat dubious beginnings in the 1980s, minor emergency care centers and retail clinics are increasingly trusted and popular among patients. The Urgent Care Association of America estimates that between 71 and 160 million patients visit urgent care centers each year. And, while care and services vary from center to center, meaning that patients should do their homework before choosing a facility, minor emergency care is a valuable component of medical care. “It’s an alternative access point for care that has really taken off,” Conslato said. “I’ll bet you down the road that these urgent care sites will be open 24/7.” Information about the American College of Physicians’ Annals of Internal Medicine study can be found at: http://annals.org/article.aspx?articleid=744702
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What a Challenge! Physicians, Physician Assistants, & Nurse Practitioners Work Together To Deliver Comprehensive Care
PAUL M. CONSLATO, MD
T
he inter-related concepts of health care access, cost, and quality are central to ongoing health care transformation in the United States. Concurrent challenges include the decreased number of primary care physicians, escalating costs for chronic disease management, and the concept of population health where physicians are being asked to better manage the health of individuals even outside of the traditional fee for service visit. The physicians of Lancaster County have been up to the challenge!
Physicians are now being asked to oversee all care but to prioritize and focus on those with complex or poorly controlled chronic diseases or acute illness that may require escalating levels of care and resources. With this evolving role of driving outcomes to new levels and managing expenditures for those complex and acutely ill patients, there is inherently less time available for facilitating wellness and tending to patients with stable chronic diseases and minor acute illnesses. Continued on page 32
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As we look through the population health lens, the population health team’s responsibility and accountability lies with the physician to manage the more highly complex patients and delegate activities to those with less acute, less intense care needs to the talents of his/her team members. Over the last two decades, several new health care professions have been created to work on physician led teams to keep up with the need for a heightened commitment to superior patient outcomes across diverse populations of patients. Two such health care professions are that of a certified physician assistant (PA-C) and a nurse practitioner (NP). Both of these professions are somewhat similar, with only subtle differences
NPs and PAs are now the fastest-grow- a national certifying exam and subsequently ing group of primary care providers, with pass a recertification exam every 10 years, students who plan to enter primary care mirroring that of physicians. In addition, graduating at three times the rate of their 100 hours of continuing medical education medical student counterparts. Physicians is required every two years. can wait to see how this plays out or be Physician assistants are generalist trained proactive and create relationships with these professionals. Identifying clinical roles and with a focus on primary care but with the responsibilities could help manage popula- flexibility to work in essentially any field of tions and create a satisfying environment medicine. About half of PAs are currently employed in specialty fields. They may work to practice. in a variety of settings and specialties in Physician assistants are medically trained Lancaster County, including family mediprofessionals who practice medicine and pro- cine, pediatrics, obstetrics and gynecology, vide high quality patient care. PAs examine, internal medicine, emergency medicine, diagnose, order, and interpret laboratory radiology, orthopedics, and medical and studies and imaging; develop and execute surgical specialties as well as geriatrics. treatment plans; and prescribe medications. A nurse practitioner is a registered nurse (RN) who also has a master’s degree and clinical experience. He or she helps to educate patients, with a focus on health maintenance, counseling, and disease prevention. An NP must choose a particular specialty during his or her training. A nurse practitioner has a collaborative agreement and relationship with a physician. NPs do practice independently in some states but not in Pennsylvania. They work in a variety of settings and specialties, including family medicine, neonatal, pediatrics, geriatrics, obstetrics and gynecology, acute care, occupational health, or as certified nurse midwives and certified registered nurse anesthetists.
between them. This close similarity in job They believe in team-based care and work descriptions often leads to misunderstanding, alongside physicians to broaden the impact as many people find it difficult to differen- and services of the team. tiate between the two specialties. However, physician leaders haven’t become caught Physician assistant training is extensive in the confusion but rather have partnered with nearly all PAs holding master’s degrees, with NP and PA-Cs across the county to something all programs will require by 2020. use these talented professionals, together Training is based on the medical school referred to as “advanced practice providers” model and consists of a continuous 24-27 (APPs), to deliver better outcomes and create month program with over 1,000 hours of an environment with better professional classroom education and over 2,000 hours of well-being in this time of change. clinical rotations. All PAs are required to pass
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Both physician assistants and nurse practitioners complement the physician-led teams across Lancaster County. While at first glance they may appear to be similar, there are some subtle differences between the two professions, which mainly relate to the type of education that each profession requires. A nurse practitioner is essentially a more academically advanced and experienced registered nurse. A registered nurse acquires a nurse practitioner certification when he or she advances from a bachelor’s degree (BN) to
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What a Challenge! What a Team!
a master’s and qualifies through a national exam. NP programs typically call for approximately 40 credits of academic work toward one’s master’s degree and at least 600 supervised clinical hours in a variety of settings. Nurse practitioners must follow through with continued education as well. While physician assistants qualify through a more general medical examination, nurse practitioners generally qualify through an exam more specific to population of focus, such as pediatrics or geriatrics. Also, they have practical experience as BNs before qualifying. Another difference between the practice of physician assistants and nurse practitioners is that a physician assistant must practice under the supervision of a physician. Although PAs may be able to perform certain duties on their own, they do this under the authority of their supervising physician. PAs are medical professionals and their scope
of practice is according to their agreement with the physician. They mainly perform tasks such as collecting medical information from patients, performing examinations and tests, diagnosing illnesses, prescribing medications, referring patients to specialists, and assisting in surgery. PA-Cs do generally have expertise regarding minor surgical procedures as well. As both professions are state regulated, the scope of practice varies in different states. The duties typically overlap and include conducting physical examinations, obtaining medical histories, prescribing physical therapy, performing diagnostic tests, prescribing drugs, providing prenatal care, as well as counseling and educating patients. As the health care landscape continues to change with more patients entering the health care system and a shift in
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reimbursement away from fee for service and more to a value-based model, APPs will see their roles continue to expand and become even more important to physician leaders. The reality is that nurse practitioners and physician assistants are here to stay in our nation. Some areas of the country have gotten bogged down in trying to clarify all the nuances between the groups. More progressive physicians, however, have integrated NPs and PA-Cs on their teams to deliver better outcomes through better access. And they’re discovering more professional satisfaction as teachers and population health managers as a result. Many physician leaders in the county have acknowledged this team approach and appreciate the value-adds of powerful partnerships and collaboration that these professionals bring to this environment of added accountabilities.
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Patient Advocacy
LANCASTER CITY & COUNTY MEDICAL SOCIETY
Honors Outstanding Community Members & Organization
T
he Lancaster City & County Medical Society used the occasion of its 171st Annual Dinner and Meeting on June 16, 2015 to honor a community organization and two outstanding community individuals. The Benjamin Rush Award is given in recognition of organizations and individuals (non-physicians) who have made outstanding contributions to the health and welfare of the people of Lancaster County. Dr. Benjamin Rush was a native of Pennsylvania, and a prominent physician in the 1700s. He served on the committee of the Continental Congress and was the only physician to sign the Declaration of Independence. Dr. Rush founded the first medical clinic for the poor, championed prison reform, public education, and higher education for women and has been called the “Father of American Psychiatry.� He was a founder of Dickinson College, Franklin and Marshall College, and the College of Physicians of Philadelphia.
Benjamin Rush Award to An Outstanding Organization The A Week Away is a non-profit organization whose mission is to finance and coordinate respite weeks for individuals and their loved ones who are dealing with life-threatening illness in order to help them to find the peace and energy needed to continue fighting the disease.
Dr. Kelly with Joe Fittipaldi, President of the A Week Away Foundation.
Several years ago, Caleb Walker was diagnosed with Stage III Anaplastic Ependymoma, a rare and aggressive form of cancer that attacks the brain and spine. Because of this, he knew firsthand the toll that fighting disease takes on the individual and his support team. He saw what life threatening illnesses can do to families and recognized that the battle with a life altering diagnosis is fought not only by the patient but also by caregivers and loved ones as well. In starting A Week Away, he hoped to give immediate family members and/or primary caregivers a week of peace in the midst of their chaotic
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world. He believed that by giving families even just one week of peace together, they could return home with the hope they need to continue the fight. Caleb Walker lost his battle with cancer last year, but through the A Week Away Foundation his dream of giving hope and peace lives on. Joe Fittipaldi, President of the A Week Away Foundation was on hand to accept the award on behalf of the organization. Continued on page 36
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LCCMS Honors Outstanding Community Members & Organization
Masters Degree from the Wharton School at the University of Pennsylvania. He has earned a certificate from the Health and Human Service Management Executive Program from the Harvard Business School.
Benjamin Rush Individual Award Risa Paskoff has been with Aaron’s Acres since its founding in 1998. She says that it was always her dream to create programs for children who have special needs and now she is living out that dream. Aaron’s Acres is a 501(c)3 non-profit organization which was founded in order to provide summer camp experiences for children with special needs. The summer camp program started in Lancaster County with 11 children and one week of camp. Since then, their philosophy of “embracing possibilities beyond disabilities” has resonated so much with the special needs community that the program has expanded to Berks and Dauphin Counties. Aaron’s Acres programs serve children and young adults ages 5–21 by offering therapeutically based, and age-appropriate recreational program directed by specially trained and certified staff in a supportive environment that enhances socialization and communication skills. Emotional, educational and recreational support is offered for the entire family as well. Due to the tremendous need expressed by families within all three counties, the number of camp weeks, as well as the number of participants has grown exponentially in recent years. Today, over 200 participants are served over eleven weeks of camp and there are various programs and activities available to connect the entire family throughout the year.
Distinguished Service Award The Distinguished Service Award is presented to a member of the Lancaster City and County Medical Society for outstanding service to the community and to the medical profession. The Lancaster City & County Medical Society was proud to present the Distinguished Service Award to Carl Manelius, MGA of Lancaster General Health. As Director of Physician Affairs he is responsible for Physician Leadership Education, including the Physician Leadership Academy and Continuing Medical Education forums. He also focuses his efforts on Physician Communication, Medical Staff Planning, and Physician Satisfaction and Engagement. Carl provides guidance and support to the Medical Staff leadership and serves as the liaison to the Lancaster City & County Medical Society and the Pennsylvania Medical Society. He has served on the Board of the Lancaster Medical Society Foundation and the Executive Committee of the Edward Hand Medical Heritage Foundation. Mr. Manelius received his Bachelors Degree from Millersville University and then went on to earn his
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Carl has also been very involved in the Lancaster County community, having worked as Vice President of Community Services with the United Way of Lancaster County for over a decade before his tenure at Lancaster General. He has served on the Hempfield Board of School Directors, the Hempfield Area Recreation Commission, was Chair of the Lancaster County Food and Shelter Advisory Commission, President of Hands on House Children’s Museum, Co-Chair of the Lancaster County Partners for Affordable Housing, and an Advisory Member of Lancaster County MH/MR. Article Photography by Ali & Paul Co.
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Regulatory Updates
Pennsylvania Medical Society Quarterly Legislative Update SCOT CHADWICK
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to fund a multi-payer payment and health delivery system transformation; and $100,000 for a new registry to compile health data from people living in Marcellus Shale drilling areas. PAMED supports the establishment of such a registry.
s is often the case at the start of a fresh two-year term of the General Assembly, there isn’t much to report in the form of newly enacted legislation. In fact, an April 2 search of the legislature’s website for statutes enacted so far this year reveals “no records found.” Don’t be fooled, though. There is a lot going on, and much of it is health care-related. Following are some key early developments in what promises to be an interesting year, as Pennsylvania’s new Democrat governor, Tom Wolf, interacts with conservative Republican majorities in the state House and Senate.
Importantly, the budget appropriates $2.147 million to the Achieving Better Care by Monitoring All Prescriptions (ABCMAP) program. That’s the official name for the newly enacted statewide controlled substance database. The database was supposed to be up and running by June 30 of this year, but that timetable has been jeopardized by a lack of funding in the current year state budget.
2015–2016 State Budget Pennsylvania’s annual budget process began with a proposed spending and revenue plan delivered by the governor in an address to a joint session of the General Assembly on March 3, and those expecting Gov. Wolf to offer an initiative very different from that of his Republican predecessor were not disappointed. Overall, Wolf ’s proposal would increase state spending by 2.7 percent (actually more than 8 percent if you include education spending), to be paid for with a variety of tax increases, including a raise in the state income tax from 3.07 percent to 3.7 percent, and a boost in the sales tax from 6 percent to 6.6 percent. The sales tax would also be expanded to include many services, though physician/patient office encounters are excluded. Wolf ’s proposal offers $8.5 million to expand the state’s loan forgiveness program for primary care physicians, more than doubling the current appropriation. He also recommends that the program be moved from the Department of Health to the Pennsylvania Higher Education Assistance Agency, commonly referred to as PHEAA. Other significant health care items include a $2.5 million increase for behavioral health services and a $5 million increase to the Department of Drug and Alcohol Programs (DDAP) to address heroin and opioid addiction. PAMED works closely with DDAP on drug abuse issues. The budget proposal also contains $3.8 million to reopen closed state health centers; $3 million for health care innovation,
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PA Medical Society Quarterly Legislative Update
Additionally, the budget contains $2.7 million to continue the operation of the Pennsylvania Health Care Cost Containment Council (HC4), which was unfunded in the current year budget but continues to operate under a gubernatorial executive order. While it is encouraging to see so many proposed health care-related spending increases, it must be noted that Pennsylvania’s state constitution requires revenues to match spending, and House and Senate Republican leaders have reacted negatively to Gov. Wolf ’s recommended tax increases. House and Senate budget hearings have now been completed, and work will soon begin on crafting the new revenue and spending plan, which is due by the end of the fiscal year on June 30.
Medical Marijuana Legislation on Center Stage Legislation to legalize medical marijuana didn’t make it to the governor’s desk last year, dying in the state House after receiving Senate approval. However, Sen. Mike Folmer (R-Lebanon County) has reintroduced the measure, now Senate Bill 3, and it has already been the subject of House and Senate public hearings this year. PAMED testified at the hearings, repeating our position that the FDA should relax marijuana’s status as a Schedule I drug to facilitate testing of a substance that seems to have some promise in treating children with epileptic seizure disorders, nausea in cancer patients, and other conditions. PAMED also believes the state should fund pilot studies that the Department of Health laid the groundwork for last year. However, until solid research results are in hand, the Society believes legalization would be premature. Looking at the bill’s specific provisions, there are a number of reasons for concern. The bill’s scope is very broad, and goes well beyond the legalization of cannabidiol, the non-psychoactive component of marijuana that seems to help some children with seizure disorders. SB 3 would also legalize THC, the psychoactive component of marijuana, to treat cancer, epilepsy and seizures, ALS, cachexia/wasting syndrome, Parkinson’s disease, traumatic brain injury and post-concussion syndrome, multiple sclerosis, Spinocerebellara Ataxia (SCA), post-traumatic stress disorder, severe fibromyalgia, and any other condition authorized by the Department of State. This is despite a review in the February Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics, stating that a growing
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body of evidence links cannabis to “long-term and potentially irreversible physical, neurocognitive, psychiatric, and psychosocial adverse outcomes.” The bill would permit the medical use of marijuana edibles, presumably including THC-laced brownies and candy bars, raising concern over the risk of diversion and unintended harm. This has been a problem in states that have legalized medical marijuana, as evidenced by a 2011 study in Colorado that concluded that “diversion of medical marijuana is common among adolescents in substance treatment.” The bill would authorize up to 65 growers and another 65 processors, far more than would seem necessary to provide marijuana-based products to a defined subset of patients with specifically enumerated conditions. Further, this creates more than 4,000 possible ways a specific medical marijuana product could get from grower to processor to dispenser, raising questions about product consistency. The bill would permit physicians, CRNPs, podiatrists, nurse midwives, and physician assistants to all “recommend” medical marijuana to patients, the antithesis of a go-slow, cautious approach warranted by legislation legalizing a Schedule I, nonFDA approved substance. Yet another problem relates to physician liability. The bill provides that the commonwealth can’t be held liable for any deleterious outcomes resulting from the medical use of cannabis Continued on page 40
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PA Medical Society Quarterly Legislative Update
by a registered patient, which makes sense given the paucity of scientific evidence supporting the safety and efficacy of medical marijuana. However, no similar protection is given to health care practitioners who will actually “recommend” non-FDA approved marijuana concoctions to their patients. Despite these concerns, Senate approval is again expected early this year. House action on the legislation is less certain.
Naturopathic Licensure Bill Advances House Bill 516, which would provide for the licensure of naturopaths and grant them a formal scope of practice, was recently approved by the House Professional Licensure Committee. The bill would permit licensed naturopaths to independently prevent, diagnose, and treat human health conditions, injuries, and diseases. They would be able to order and perform physical and laboratory examinations, and utilize invasive routes of administration for their tests and treatments that include “oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous, and intramuscular.”
PAMED opposes the bill for several reasons. The level of credibility that state licensure establishes could be misleading to the average Pennsylvanian by implying that naturopathy is equivalent to mainstream medicine. “Naturopathic medicine” is defined in HB 516 as “a system of primary health care.” Patients may see unproven and possibly unsafe treatments by “naturopathic doctors” as a substitute for conventional medical care. If there is doubt about whether the bill allows naturopaths to perform a particular test or treatment, the question would likely be resolved in their favor, as Section 102 (4) specifically calls for the act to be “liberally construed.” Additionally, there is no requirement in HB 516 that naturopaths collaborate with or refer complicated medical cases to a physician. The bill would also create logistical headaches for the state. Fewer than 100 naturopaths would qualify for licensure under this bill, requiring the State Board of Medicine to establish and maintain the necessary infrastructure for a mere handful of people. The vast majority of Pennsylvania naturopaths would remain unlicensed after the bill is enacted, adding confusion and providing little, if any, protection to the general public. The committee improved the bill slightly by deleting language that would have authorized licensed naturopaths to order diagnostic imaging studies, though that change is insufficient to warrant a change in PAMED’s opposition.
Scot Chadwick is legislative counsel, state legislative affairs for the Pennsylvania Medical Society.
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Medical Society Updates
PAMED Brings Clarity to the Medical Marijuana Debate...
But Now What? HEATH MACKLEY, MD
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he Pennsylvania House Health and has endorsed the legalization of medical Judiciary Committees met on March marijuana. However, the Pennsylvania State 24, 2015, and PAMED was there to Nurses Association did so in 2014. The AMA provide much needed clarity to lawmakers believes physicians should be able to give and the public as they consider the legaliza- patients unfettered information about the tion of medical marijuana. The white paper therapeutic use of marijuana without the that presents PAMED’s policy position can fear of criminal sanctions, but does not go be accessed on the Society’s website at www. so far as to say that physicians should be pamedsoc.org/IsMarijuanaMedicine, and I allowed to prescribe marijuana under state encourage physicians and patients alike to law without fear of federal prosecution. read this well researched document. Like Although the Pennsylvania legislation, in its the AMA, PAMED believes the federal current form, describes that providers “recgovernment should facilitate the study of ommend” rather than “prescribe” marijuana, marijuana and its chemical components the risk that the federal DEA can sanction so its safety and efficacy can be evaluated a physician for prescribing marijuana in a with the same scientific vigor as any other state that legalizes it remains real. medication undergoing the FDA approval process. Additionally, PAMED believes the LIMITED STUDIES passing of medical marijuana legislation Marijuana has been studied in 27 double would be premature at this time. blind randomized trials subjected to peer review since 1990. Most are small and have The federal government’s position formally short follow-up, and 10 were negative trials. remains unchanged since the passage of Currently, the most promising conditions that the Controlled Substance Act of 1970, in merit further study based on positive trials response to the United States signing on are muscle spasticity for multiple sclerosis to the multi-national Single Convention and neuropathic pain. As with all potential on Narcotic Drugs in 1961. Marijuana interventions, there is a risk of harm. There is a Schedule 1 substance, meaning it have been no reported deaths from the use should not be studied because it has a high of medical marijuana, but marijuana has potential of abuse and has no recognized well-documented acute and late toxicity, medical use. Both the AMA and PAMED including the development of respiratory believe this should be reviewed, while other symptoms and diseases, adverse neurocognitive medical societies have officially endorsed development in adolescents, and psychiatric making marijuana Schedule 2 in order to disorders. Marijuana edibles run the risk of facilitate its study. No physician-led society diversion because of their attractiveness to
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children, and states with medical marijuana legislation have higher rates of recreational use and abuse in their populations. Furthermore, a type of “medical marijuana,” in the form of regulated prescription drugs, has existed since 1985. There are two FDA-approved THC derivatives: Marinol (dronabinol) and Cesamet (nabilone). Additionally, Epidiolex, a liquid form of CBD, is undergoing FDA-approved trials for intractable childhood seizures, and Sativex, an oral spray with THC and CBD, is being studied in the treatment of pain and ADHD. An Epidiolex trial is open at the Children’s Hospital of Philadelphia.
AN EMOTIONAL ARGUMENT Although PAMED’s stance for more research is medically sound and intellectually honest, the chief sponsors of the legislation are not relying on a scientific argument. Many patients suffer from ailments we do not have effective treatments for, perhaps the most tragic of which are children with intractable seizures from Dravet syndrome and Lennox-Gastaut syndrome. The argument is that to withhold from them a product that has helped some patients is inhumane. Given that heartbreaking reality, it is not surprising that 11 states have legalized CBD for medical use, and 23 others to some degree have approved CBD and THC. Clearly, momentum is building nationwide, and this is no different
SUMMER 2015
PAMED Brings Clarity to the Medical Marijuana Debate…
in Pennsylvania, where multiple polls have shown overwhelming support for medical marijuana legalization.
STAY ENGAGED Although the future remains uncertain, Pennsylvania physicians should seriously consider what their individual position will be in the event that PA allows them to prescribe marijuana. Furthermore, PAMED will need to consider what its role should be. Should PAMED offer marijuana guidelines similar to the opioid prescribing guidelines (www.pamedsoc.org/opioidguidelines)? Our
patients know we are concerned about their health, and they trust us to have informed opinions. Our patients and our legislators trust our organizations will have a similar concern for public health, and the ethical practice of medicine. In Pennsylvania, like many other states, if and when medical marijuana legislation passes, it will be a case of “the people have spoken.” But that will just lead us to a different conversation. So stay engaged, we’re going to need you!
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Dr. Mackley is a radiation oncologist in the Penn State Hershey Cancer Institute and serves as the 5th District Trustee on the PAMED Board, representing physicians of Lancaster. This article previously appeared in The Reporter (Dauphin County Medical Society’s newsletter)
L A N C A S T E R M E D I C A L S O C I E T Y.O R G
Medical Society Updates
LANCASTER C I T Y & C OUNT Y MEDICAL SOC IE T Y
171st ANNUAL Dinner & Business Meeting
Article Photography by Ali & Paul Co.
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he Lancaster City & County Medical Society held its 171st Annual Dinner and Business Meeting on June 16, 2015 at the Lancaster Country Club. An event for both members and non-members of the society, it is a time for socializing, honoring physician members, and honoring individuals and organizations that make an impact on the health and wellness of the Lancaster County community. It is also a time for meaningful discussion based on a timely topic presented by the keynote speaker, generally a nationally known expert in his or her field.
This year, the Lancaster City & County Medical Society (LCCMS) is thankful for the generous support of Lancaster General Health, Lancaster Regional Medical Center & Heart of Lancaster Regional Medical Center, and WellSpan Ephrata Community Hospital. After a time for conversation over cocktails and hors d’oeuvres, LCCMS President James Kelly, MD, invited participants to take their seats and called the meeting to order. He introduced the slate for the Board of Officers and Directors for the 2015–2016 year:
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Keynote Speaker:
David A. Asch, MD
SUMMER 2015
LCCMS 171st Annual Dinner & Business Meeting
The Directors are: Stacey Denlinger, DO
Lancaster County Business Group on Health Representative
Baron Family Practice
Charles A. Castle, MD
Elected Director Two Years
Lancaster General Health
Elected Director One Year
John A. King, MD General Internal Medicine of Lancaster
Resident Representatives
Kathryn McKenna, MD
The Officers are: PRESIDENT
James M. Kelly, MD Lincoln Family Medicine
Ashley Morrison, MD Robin Hicks, DO International Medical Graduate Representative
Venkatchalam Mangeshkumar, MD Neurology & Stroke Associates
Pennsylvania Medical Society Officer Liaison
Karen A. Rizzo, MD, FACS Lancaster Ear, Nose, & Throat
Delegates to the Pennsylvania Medical Society House of Delegates: Robert K. Aichele, DO Paul N. Casale, MD C. Anthony Castle, MD James M. Kelly, MD
IMMEDIATE PAST PRESIDENT
Stephen T. Olin, MD
Paul N. Casale, MD
David Simons, DO
The Heart Group of Lancaster General Health
PRESIDENT ELECT
David J. Simons, DO Community Anesthesia Associates
VICE PRESIDENT
Robert K. Aichele, DO Aichele & Frey Family Practice Associates
SECRETARY
Laura H. Fisher, MD Lancaster Family Allergy
TREASURER
Stephen T. Olin, MD Lancaster General Hospital
The evening was capped off with a keynote presentation, entitled “Using Behavioral Economics to Improve Individual and Population Health� by David A. Asch, MD, MBA. Dr. Asch is Executive Director of the Penn Medicine Center for Health Care Innovation, Professor of Medicine and Professor of Medical Ethics at the Perelman School of Medicine, Professor of Health Care Management and Professor of Operations and Information Management at the Wharton School. He is also Director of the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania. Through his research, Dr. Asch looks to understand how physicians and patients make medical choices in clinical, financial, and ethically charged settings, including the adoption of new pharmaceuticals or medical technologies, the purchase of insurance, and personal health behaviors. His research combines elements of economic analysis with psychological theory and marketing in the field now called behavioral economics.
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Restaurant Review
Shanks Tavern LAURA FISHER, MD Lancaster Family Allergy
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s the mother of two small children, I rarely get to eat with or to even see my husband. A night out to do both is a special treat. Several fine dining options have been reviewed already in this magazine, so I thought I’d review a more casual establishment. With the unexpected offer from a relative to babysit for the night, I recently had the opportunity to enjoy dinner with my husband in a relaxed atmosphere at one of our favorite restaurants in Marietta.
though. I ordered my favorite, Swiss & Shroom Big Fats. My husband ordered his favorite, the Spicy Conehead Chicken. As always, they were delicious that evening. We were too full for dessert, but they have an excellent selection. Another great thing about Shank’s is it’s very inexpensive—our entire bill, including several beers, nachos, and our burgers, was just $40. Shank’s is open Monday through Friday. You can actually rent out the whole bar for $225 for private parties on the weekend, a fact I will have to remember. For the younger and more energetic folks, twice every year there is a pub crawl in Marietta. Shank’s is among the sites that participate in that fun event. If you’re in the mood for a very quick and comfortable meal, we recommend Shank’s. Their food, service, and value keep us coming back again and again!
For those of you who have not been to Marietta, you are definitely missing out. About fifteen minutes from Lancaster City, Marietta has a combination of small town charm and smartly refurbished brick homes. There is the newly reopened Railroad House, which is more upscale, with an excellent bar and superb cocktail menu. McCleary’s Irish Pub down the street has traditional Irish fare and an outdoor dining area. However, an old favorite of ours is Shank’s Tavern, our destination for the night. Shank’s is the oldest, continuously operated tavern in Lancaster County. Although it’s always crowded (a testament to the excellent food), we have never been unable to find a table; that night was no exception. There is an outdoor area as well, but we chose to eat indoors. The service was prompt and personable. We had not been in for months, but our favorite waitress, Tina, remembered us. Bob Shank himself was, as usual, out circulating and greeting his patrons.
Shank’s Tavern
They have great beers on tap. I always enjoy a Hefeweizen, and my husband had something from Victory. We like to start off with the Macho Nachos, drenched in chili with sour cream, but there is a wide array of appetizers to choose from. We suggest going on a Friday if you like seafood. The clams/mussel/shrimp steamers are the best. We were in the mood for burgers that night
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Front & Waterford Streets Marietta, PA 17547 717.426.1205 www.shankstavern.com
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SUMMER 2015
News & Announcements
FRONTLINE GROUP SPOTLIGHT
Lancaster Cancer Center, Ltd. L
ancaster Cancer Center (“LCC”) strives to provide patients and their families with a comprehensive, personalized treatment plan which includes a powerful combination of advanced conventional treatments combined with supportive complementary medicine therapies. By treating the whole person, they prepare patients to fight their disease and empower them to enjoy an optimal quality of life.
as though they are part of the LCC family. Embracing the challenges facing those touched by cancer, LCC understands and addresses the many ways cancer affects patients and everyone in their lives.
LCC’s entire staff dedicates itself to providing patients with not only the most appropriate hematology and oncology care, but also with a calming and friendly environment that allows patients to feel
At LCC, they understand the difficulties cancer patients face, and through their Healing Journey Foundation (a non-profit 501(c) (3) Penna. corporation) they have an array of cancer support programs and other services to help patients, their families, and friends cope with issues that may feel overwhelming.
The comprehensive approach at LCC provides a full range of diagnosis, treatment and follow-up care. The Center’s expert team has the qualifications to care for patients suffering from both common Patients come to LCC because of the center’s history of caring. and rare blood diseases, cancer and related tumors. LCC’s on-site It was founded by Dr. H. Peter DeGreen over 30 years ago, and lab, physician directed dispensing pharmacy, non-profit Healing the tradition of caring continues with his son, Dr. Hyatt P. “Tracy” Journey Foundation, and clinical trials program all support the Center’s caring mission. DeGreen, Dr. Lena Dumasia and Dr. Joanna Rodriguez.
The Lancaster Cancer Center continues to be recognized for its care and compassion as Lori Gerhart, nurse manager of Lancaster Cancer Center, was recently selected as one of six nurses across the nation honored by Avella Specialty Pharmacy to receive its second annual CARE award. “Lori has organized surprise sharing of gifts from our staff to families in need on multiple occasions which, among other things, has brought our entire staff to more greatly appreciate their individual importance in providing care to our patients,” said Dr. Peter DeGreen, who nominated Gerhart.
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L A N C A S T E R M E D I C A L S O C I E T Y.O R G
News & Announcements
Frontline Groups The Lancaster City & County Medical Society thanks these groups for 100% membership in the Medical Society for 2015.
Allergy & Asthma Center
Jeffrey H Chaby DO & Associates
Baron Family Practice
Justin L Cappiello, MD, PC
Brain Orthopedic Spine Specialists Campus Eye Center Cardiac Consultants PC
Lancaster Family Allergy
Conestoga Family Practice – Terre Hill Dermasurgery Center PC
Lancaster Retina Specialists Lancaster Skin Center PC
Eye Health Physicians of Lancaster
Leacock Family Practice
Eye Physicians of Lancaster PC
LGHP – Lincoln Family Medicine
Family Eye Group
LGHP – Manheim Family Medicine
Family Medicine of Ephrata
LGHP – New Holland Family Medicine
General & Vascular Surgery of Lancaster
LGHP – Susquehanna Family Medicine
Neurology & Stroke Associates PC
Glah Medical Group
Southeast Lancaster Health Services-Hershey Ave
Stephen G Diamantoni MD & Associates-Leola
The EMG Group at The Electrodiagnostic Center of Lancaster
The Heart Group of Lancaster General Health Trout Run Family Practice WellSpan General Surgery – Ephrata Welsh Mountain Health Center Westphal Orthopedics
MARK YOUR CALENDARS!
Orthopaedic Specialists of Central PA
Annual Holiday Social to Benefit the Lancaster Medical Society Foundation Scholarship Fund
Otolaryngology Physicians of Lancaster
Lancaster Country Club 6:00 pm
OBGYN of Lancaster
Highlands Family Practice Hospice & Community Care
LGHP – Women’s Internal Medicine
Georgetown Family Health
Hyperbaric & Wound Care
Southeast Lancaster Health Services-Arch St
Surgical Specialists Of Lancaster
Lancaster Radiology Associates Ltd
ENT Head and Neck Surgery of Lancaster
Lancaster HMA Physician Management
Lancaster Plastic Surgery
Electrodiagnostic Medicine Group Ltd
Southeast Lancaster Health Services Inc
Stuart H Goldberg MD PC
Lancaster Physicians For Women
Eden Family Medicine
Lancaster General Health Physicians
Lancaster Neuroscience & Spine Assoc
Eastbrook Family Health Center
Lancaster County Center for Plastic Surgery Lancaster Ear, Nose & Throat
Community Services Group
Rothsville Family Practice
Lancaster Cardiology Group LLC
Red Rose Cardiology
Lancaster Arthritis & Rheumatology Care Lancaster Cancer Center Ltd
Care Connections Clinic
Dermatology Associates of Lancaster Ltd
Pennsylvania Specialty Pathology
Keyser & O’Connor Surgical Associates Ltd
Cardiothoracic & Vascular Surgeons of Lancaster
Community Anesthesia Associates
Pennsylvania Counseling Services-Lancaster
Hypertension & Kidney Specialists
Pain Medicine & Rehab Specialists
Internal Medicine Specialists of Lancaster County
Patient First – Lancaster
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DEC
SUMMER 2015
News & Announcements
Welcome…New Members Diane Klauser Donnelly, MD SE Lancaster Health Services
David Doyle, Administrator Lancaster Cardiology Group LLC
Congratulations...Reinstated Members Lisa S. Allen, MD LGHP – Arthritis & Rheumatology Specialists
Hyasmine M. Charles, MD Stephen G. Diamantoni MD & Associates
Victor Altadonna, MD Lancaster Urology
Paul M. Conslato, MD LGHP – Internal Medicine
Shashi M. AriyanayagamBaksh, MD Pennsylvania Specialty Pathology
Denise Cope, MD LGHP – Abbeyville Family Medicine
Fabien K. Baksh, MD Pennsylvania Specialty Pathology Beverly Sue Bitner, Administrator Highlands Family Practice Debbie Buhay, Administrator Neurology & Stroke Associates, PC
Stacey Denlinger, DO Heart of Lancaster Regional Medical Center Joyce L. Ellison, Administrator Lancaster Retina Specialists Mona S. Engle, Administrator Doctors May-Grants Associates Diane Fletcher, Administrator Lancaster Physicians for Women
In Remembrance…DECEASED Members John H. Esbenshade II, MD John H. Esbenshade, Jr., 83, died in Naples, Florida on Sunday, March 16, 2014. John was a well known Cardiologist at Lancaster General Hospital and was Director of Medical Education at the hospital for over twenty-five years. He also maintained a long-standing private practice, which he merged with The Heart Group of Lancaster prior to his retirement.
David B. Raab, MD David B. Raab, MD, 85, of Lancaster, died at Hospice and Community Care, Mount Joy, on Tuesday, March 10, 2015. Dr. Raab graduated from Washington and Jefferson in Little Washington, PA and graduated from the University of Pittsburgh School of Medicine. He did his internship at McKeesport Hospital and served in the 82nd Airborne of the United States Army from 1957–1959 in Fort Bragg, North Carolina. After the military, he was a General Practitioner serving on the staff at Lancaster General Hospital from 1959–2000.
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L A N C A S T E R M E D I C A L S O C I E T Y.O R G
News & Announcements
David Simons, DO Q: Are you involved in any community, non-profit, or professional organizations? If so, please list the groups:
Q: Where do you practice and why did you settle in your present location or community? A: I currently practice at the Heart of Lancaster
A: • Board of Trustees – Heart of Lancaster Regional
Regional Medical Center in Lititz, PA and the Surgery Center of Lancaster in Lancaster, PA. My office is located at 1575 Highlands Drive, Lititz, PA. I initially came to the area because of the excellent reputation of the osteopathic teaching programs as well as the high caliber physicians in the community. The location was attractive to myself and my wife, as it was centrally located and close to our families. My personal experiences have made me realize that Lancaster County is distinctive because people here invest in the community and each other. This has been a great choice for my family and I feel fortunate to live here.
Medical Center • Physician Leadership Council – Heart of Lancaster and Lancaster Regional Medical Center • Heart of Lancaster Anesthesia Residency Program Director • Fellow – American Osteopathic College of Anesthesiologists • ACGME Anesthesia Residency Review Committee • Medical Staff President – Heart of Lancaster Regional Medical Center • International Spine Intervention Society • American Academy of Pain Management
Q: Hobbies and interests when not working:
• American Society of Anesthesiologists
A:
• American Osteopathic Association
I participate in triathlons and love bicycling. I have been accused of being “addicted” to exercise.
• Lancaster Sunrise Rotary • Masonic Lodge 476 • Philadelphia Union League
Q: Favorite part of practicing medicine: A: My specialty of anesthesiology allows me the privilege of providing safety and comfort to patients and their families during extremely stressful times as they undergo surgery or other invasive procedures. My pain management practice affords me the opportunity to care for patients suffering from a multitude of painful conditions and provide hope and pain relief. Working with my caring team of spirited medical professionals, together easing pain and changing lives for the better gives me a tremendous amount of personal and professional satisfaction. LANCASTER
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SUMMER 2015
Stacey Denlinger, DO Q: Where do you practice and why did you settle in your present location or community? A: I am finishing my Family Medicine Residency in June 2015 and joining Baron Family Practice, full-time, in July.
I chose Manheim because I enjoy the smallcommunity-feel that Manheim offers.
Q: Hobbies and interests when not working: A: I am married and we have a 6-year-old lab mix, Maya. I enjoy reading, cooking, listening and playing music, and being outdoors.
Q: Are you involved in any community, non-profit, or professional organizations? If so, please list the groups: A: Currently, I am active in the Graduate Medical Education Committee at HLRMC and The Osteopathic Health Foundation and hope to stay involved after Residency.
I am a member of the AOA, ACOFP and AAFP. I am hoping to become more involved in local organizations after graduation.
Q: Favorite part of practicing medicine: A: Getting the opportunity to be part of my patients’ lives and the challenge of “figuring out the problem.”
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