MCMS Physician | Fall 2015 by Hoffmann Publishing Group

Your Community Resource for What’s Happening in Healthcare

MCMS

Fall 2015

Top Doc Has A Heart for Organized Medicine

Help Your Patients Ward Off Type 2 Diabetes

A Physician’s Diary 1827: Dr. Hiram Corson

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Contents FALL 2015

2014-2016 MCMS BOARD OF DIRECTORS

Stanley Askin, MD Frederic Becker, MD Charles Cutler, MD Madeline Danny, DO

Immediate Past President

Walter I. Hofman, MD Secretary

James A. Goodyear, MD George R. Green, MD Chairman, Membership Services & Benefits Committee

Walter Klein, MD William W. Lander, MD Mark Lopatin, MD Chairman

Robert M. McNamara, MD Rudolph J. Panaro, MD Mark F. Pyfer, MD Jay Rothkopf, MD President-Elect and Treasurer

Scott E. Shapiro, MD Immediate Past Chairman

James Thomas, MD President

Martin D. Trichtinger, MD Chairman, Political Committee

MCMS Staff Toyca Williams Executive Director

montmedsoc@verizon.net

Editorial Board Jay E. Rothkopf, MD, Editor George Green, MD Mark F. Pyfer, MD Scott E. Shapiro, MD Toyca D. Williams, Deputy Editor

MCMS Physician is a publication of the Montgomery County Medical Society of Pennsylvania (MCMS). The Montgomery County Medical Society’s mission has evolved to represent and serve all physicians of Montgomery County and their patients in order to preserve the doctor-patient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and healthcare within the community, Montgomery County and Pennsylvania.

Doc has a Heart for 8 Top Organized Medicine 18 Laughter is Good Medicine 2015 PAMED Annual Business Meeting and Educational Conference 20

Features 12 Quick Consult: Asked to Join An ACO? 14 Frontline Groups 15 Meet Your County Medical Society Leaders 16 PHP Addresses Modern Physician Burnout 17 Opioid-related Overdoses in Montgomery County: A Call to Action 18 Laughter is Good Medicine 19 Highlights from the PAMED-ABM 22 A Physician’s Diary: Dr. Hiram Corson 26 Legislative Update 30 PCCY: PA Should Cover All Children 32 Living History: American Diabetes Association Celebrates 75 33 Help Your Patients Ward Off Type 2 Diabetes

In Every Issue 4 Chairman’s Remarks 6 Editor’s Comments 37 News & Announcements

34 36 37

Understand Proposed 2016 Medicare Fee Schedule & Transition to ICD-10 MCMS Happenings Welcome New Members

Pictured in Cover Photo (L-R): James Goodyear MD, Charles Cutler MD, Jay Rothkopf MD, George Green MD, Walter Klein MD, Scott Shapiro MD (PAMED President), Mark Lopatin MD, Nicole Davis MD, Mark Pyfer MD, Toyca Williams and James W. Thomas MD MCMS Physician is published by Hoffmann Publishing Group, Inc. I Reading, PA HoffmannPublishing.com I 610.685.0914 I for advertising information: audrey@hoffpubs.com or karen@hoffpubs.com

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Chairman’s Remarks

Communication is Key to Effective Patient Care Mark Lopatin, MD Chairman, MCMS Board of Directors

7-year-old boy asks his father, “Daddy, where did I come from?” The father begins to sweat and realizes that he must have the sex talk with his son. So he sits the son down and tells him the whole story —the birds and the bees, the sperm and the egg, etc. He finishes after an hour, turns to his son and says, “So does that answer your question?” The son replies, “Not really. Johnny came from Cincinnati. Where did I come from?”

Posing the Right Questions to Patients The question I pose is, do we really understand the questions our patients ask us? Do we really understand what they want? It has been drilled into us since medical school to elicit a “chief complaint.” We ask, “Why are you here?” But when the patient replies, “I am here for my headaches,” does that really tell us all we need to know? After all, “I have headaches, make them go away” is a lot different than “I have headaches, do I have a brain tumor?” But how many times do we really get to the core of what our patients want from us? To this end, I have instructed my medical students and residents to elicit a chief request rather than a chief complaint. This is precipitated by having the patient complete the sentence, “I came to you today doctor because I want you to ………..”

This forces the patient to tell me what they want rather than what their symptom is. Likewise, how sure are we that our patients understand what we say? We ask our patients at the end of their visit, “Do you have any questions?” Or “Do you understand everything?” But, patients are often reluctant to admit that they do not understand. I will typically put the onus on myself, by asking them instead, “Is there anything I can do a better job of explaining to you?” I will also ask them, “When your family asks you, ‘what did the doctor say’, what will you tell them?” These questions help to ensure that patients do in fact grasp what we are telling them. We should also write instructions down, but even that is not a guarantee that our patients will get it right.

Posing the Right Questions to Physicians There are also problems with physician/physician communication. How often when we ask for a consult, do we ask specifically for what we want? I get consults for rheumatoid arthritis, but that does not tell me what the other doctor is looking for. Does he want me to confirm the diagnosis of RA, or does he want to know whether to maintain the current treatment, or does he want me to initiate or change treatment right now, etc? It is presumed that when we list a diagnosis, the consulting doctor knows what we want him or her to do, but in practice this is rarely true. I was taught that like the television show Jeopardy, every consult should be framed in the form of a question even if it is the general, “I have no idea what is going

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Communication is Key to Effective Patient Care

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on. Could this patient have a rheumatologic illness?” Having a question posed to me, helps me to focus on the specific problem that the other physician wants me to address and provides for a better consult and therefore better patient care. After all, isn’t that what this is all about—patient care? At some point in my career, when I get a consult for “patient known to you,” I want to have the courage to write on the consult sheet, “No, this patient is not known to me,” and simply sign my name. I feel that “patient known to you” is never a valid reason to call a consult. Frankly, my opinion is that if there is not a specific question to be answered, there is no need to ask for the consult.

Communication Improves Patient Care These communication issues sound minor, but how many dollars are wasted and how much time is spent needlessly because we do not really understand what is being asked of us by our patients and by other doctors? With all the talk about the Affordable Care Act, MOC, reimbursements, medical legal issues, etc., the biggest barrier to good patient care is our own inability to communicate well. Good communication is a teachable skill that can and should be taught and can be improved upon if we put the conscious effort into it. Think of this the next time you ask your patient, “What is it that brings you here?” or the next time you ask another doctor to see your patient in consult.

CMY

Mark Lopatin, MD

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Editor’s Comments

A Passing or Failing Grade for Health Care?

A Passing or Failing Grade for Health Care? Depends on Who You Ask

t’s been a good year for health care. Or has it? As 2015 begins to wind down, physicians across the nation have reason to be hopeful. SGR is gone, MOC is on the ropes, and momentum for change has returned to our side. Or has it? There’s an old saying, “Complacency is the enemy of success.” No matter where you look, the world always seems to be in motion. One problem gets solved (at least in the eyes of some), and another rears its head. So yes, while there have been a few “feel good” moments in 2015, many challenges still lie ahead, and staying engaged remains no less vital. MCMS Physician Now PAMED Leader With that in mind, there’s a lot to talk about this fall. We begin with our cover story, a feature article on Scott E. Shapiro, MD, newly-inaugurated president of the Pennsylvania Medical Society (PAMED). Dr. Shapiro, the immediate past chairman of the Montgomery County Medical Society (MCMS) Board of Directors, is a practicing cardiologist with Abington Medical Specialists and resident of Lower Gwynedd. He has been a leader in organized medicine since his days as a medical student. We look forward to the energy, vision, and contribution he will undoubtedly bring to physicians across the state. MCMS Founder Shares Good Old Days of Medicine Keeping with the spirit of personal narrative, we then take a look at the diaries of the late Dr. Hiram Corson. Archived in the Medical Heritage library, his writings shed light on a man who was not only the founder of MCMS and a past president of PAMED, but also a strong supporter of lifting the ban on women practicing medicine. His words take us back to a different time, and we hope you’ll find it a worthwhile read. Next, Montgomery County Commissioner Dr. Val Arkoosh takes a look at a crisis sweeping through our county: overdosing on opioids. In the second edition of a newly-added column, Dr. Arkoosh shares her thoughts on what the medical community can do to respond to this troubling trend. We then follow with a column on another major issue—insuring the state’s

undocumented youth. In an original article, Colleen McCauley, Health Policy Director of Public Citizens for Children and Youth, makes the case for expanding coverage through CHIP to those who have fallen through the cracks. PAMED Hosted Annual House of Delegates in Hershey With October comes not only cooler days, Halloween, and pumpkin spice lattes, but also PAMED’s annual House of Delegates. Held from Oct. 23-25 at Hershey Lodge, it was a weekend filled with opportunities for education, networking, and a chance to have a voice in the future of organized medicine. ACOs. Like ’em or not, they are here to stay, and many physicians find themselves under pressure to join. As works-inprogress that continue to evolve, you may not be sure of what questions to ask when deciding whether or not they are a good fit for your practice. Dennis Olmstead, PAMED’s chief economist, offers his insight on how to navigate the waters of these new healthcare entities. Next, we profile Dr. Stanley Askin, a member of the MCMS Board of Directors. An orthopedic surgeon in Elkins Park, Dr. Askin is also the board’s resident attorney. We finish with a political update and a few tips from our county health department on combatting diabetes. Keep the Comments, Letters and Articles Coming Lastly, I would like to take a moment to thank you, our readers. Each issue, I put out a call to physicians across the county, asking you to send us your thoughts and ideas. We have not only received a robust response, but many of you have expressed a desire to contribute articles of your own. It has been a real pleasure receiving your feedback, and I ask you to please stay involved. This magazine, indeed our organization, is only as strong as the sum of its members. You have carried us far, and I am grateful for that. But the road continues, and much work remains. Let’s get to it. Together. Jay Rothkopf, MD Editor

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Feature

COVER STORY

The Shapiro Family (pictured L-R) – Brooke, Marci, Noa, Emma, Dr. Shapiro, and Harriet and Richard Shapiro (his parents)

H Top Doc Has A Heart for Organized Medicine BY TOYCA WILLIAMS, DEPUTY EDITOR

is voice crackled, almost unable to speak, and tears welled up in his eyes as he looked at his family and thanked them for the part they played in this professional milestone. “Marci, I cannot thank you enough for all of your love, support, and understanding of my at times crazy schedule. You are a wonderful mother and my very best friend,” said Scott E. Shapiro, MD, during his inauguration dinner as newly sworn in president of the Pennsylvania Medical Society (PAMED). His daughters Brooke, Noa and Emma also stood lovingly by his side as he shared the stage during one of his greatest professional achievements. “My biggest thank you of the night goes to the four of you. I love all of you more than I could ever put into words.” In that very moment, the 166th president of PAMED was reminded why he continues to work in the trenches of organized medicine as an advocate for physicians and their patients. “When you become a dad, patient advocacy becomes that much deeper. When I see the difficulties or challenges that my patients encounter that go beyond the exam room, I really appreciate the medical society even more,” said Dr. Shapiro between meetings at the American Medical Association Interim Meeting held mid-November in Atlanta. Dr. Shapiro is a member of PAMED’s AMA delegation. “Because of my involvement, I understand the healthcare system at a higher level and know how to direct my patients to various resources. I’ve worked at all levels of organized medicine, and no one advocates more effectively for physicians and patients than PAMED.”

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Top Doc Has a Heart for Organized Medicine

Youthful, Yet Experienced Although he is the youngest physician to serve as PAMED’s leader, his involvement in organized medicine doesn’t lack experience. Almost 18 years ago, he became a PAMED member as a medical student at Temple University School of Medicine. He served on PAMED’s board of trustees from 1999 to 2012 in several positions including medical student trustee, resident and fellow trustee, and young physician trustee. He also served as president of the Montgomery County Medical Society (MCMS) from 2007-2008 and relinquished his role as chairman of the board of directors to focus on his leadership role as a PAMED officer. In addition to being a member of MCMS and PAMED, he is a member of the AMA and is a Fellow in The American College of Cardiology. “At a young age, I knew I wanted to be a physician,” said Shapiro, a practicing cardiologist in a group of 17 at Abington Medical Specialists in Abington, PA. He speaks fondly of the days visiting his grandfather, Nathan B. Shapiro, MD, a family physician in northeast Philadelphia. He later followed in the footsteps of his inspiration by attending the same medical school. The elder Shapiro, who passed away when Dr. Shapiro was a young boy, graduated from Temple’s medical school in 1936. “I was enamored with what my grandfather did. I remember playing with his stethoscope or sitting in his desk chair. It was a kind of a naïve admiration that grew later into a love and appreciation for the process of taking care of patients.” He shared that his affinity for internal medicine was an obvious choice, more of a natural fit that promotes an ongoing doctor-patient relationship.

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No More Sitting on the Sidelines As the practice of medicine continues to evolve, Dr. Shapiro said PAMED must use an aggressive approach, with a laser focus, on shaping this dynamic and challenging landscape of medicine now and in the future. The future of medicine involves the patient at the center of a “cutting edge” team that is led by a physician. Additionally, PAMED must continue to address issues of vital importance to both employed and private practice physicians, including but not limited to the medical liability climate and fair reimbursement by the state’s payers. “Our PAMED has and must continue to aggressively be the voice of our patients. Our PAMED Continued on page 10

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Feature

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Getting to Know Dr. Shapiro 10 Fun Facts: Interesting childhood fact: While in high school, he played the trumpet in a live concert with great American jazz trumpeter Dizzy Gillespie. He played the trumpet through grade school and college. cannot allow the Commonwealth’s patients care to ever be second best,” Shapiro said to more than 200 colleagues at the October 24 PAMED Annual Business Meeting in Hershey. In addition to patient advocacy, Dr. Shapiro points out that PAMED must continue to address regulations and legislation that widens the practice gaps between the doctor and patient, changes in population health, community health crises like current opioid abuses and the maintenance of certification (MOC). He emphasized that physicians are lifelong learners; however, if a process like MOC hampers a physician’s ability to effectively take care of patients, then PAMED must engage and “hold their feet to the fire.” For example, PAMED’s stand against the Commonwealth’s unjust raiding of the Mcare Fund to balance the state budget is a prime example of why PAMED needs to continue to aggressively advocate for the profession. Five years later and several years of litigation, an agreement has called for the Commonwealth to return $200 million in overpayments retained by the Mcare Fund to physicians and others and provide protections that a transfer of Mcare funds will not happen again. Physicians pay into this fund for professional liability coverage. “We learned a valuable lesson from the Mcare litigation. Because of a gutsy move to challenge the state in the court of law and in the media, every physician regardless of PAMED membership benefitted from our work to settle the case.” The avid Philadelphia Flyers fan cited a quote by hockey great Wayne Gretzky to further sum up his point, “You miss 100 percent of the shots you don’t take.”

Entrepreneur at heart: In addition to practicing medicine, he is also a co-founder of OnCall Physician Staffing, with locations in hospitals and health systems throughout New Jersey, Philadelphia, and the surrounding suburbs. It is one of the few staffing companies that is run by physicians and employs physicians.

Favorite hobby or hobbies? Loves to play golf, ski and watch the Philadelphia Flyers. The kids enjoy skiing, too.

. .

Last book read? Memorial Day by Vince Flynn.

Favorite piece of technology? Smartphone. Unfortunately, it serves as favorite and least favorite.

Facebook or Twitter? Just started using Twitter a month ago and likes it a lot.

If I could be something other than a physician? A professional golfer with a much lower handicap.

If you could get away right now, where would it be? A trip to a nice warm beach with my girls — Marci, Brooke, Noa and Emma.

One thing you may not know – Enjoys collecting wines. A good Burgundy or Pinot noir can complement most holiday meals.

Favorite music genre? Really enjoys a variety of music from classical to Top 40.

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Top Doc Has a Heart for Organized Medicine

Leaders are Groomed, Not Born Just like physicians, leadership skills are learned through mentors, training and experience. Organized medicine has been the ideal lab for Shapiro to hone his leadership skills. He said he is thankful the medical society and physicians mentors gave him a front row seat to lessons on advocacy. “Most physicians aren’t necessarily born to know how to lead. I am fortunate to have several mentors within Montgomery County and I’ve learned a lot from watching them and talking to them,” said Dr. Shapiro, the fourth physician from Montgomery County to serve as PAMED president. MCMS Chairman Mark Lopatin, MD, has witnessed his growth over the years and admires that he is genuinely passionate about effecting change and making a difference for physicians. “Probably the best definition of a leader is someone whom others are willing to follow. His enthusiasm simply shines through,” Dr. Lopatin said. “He is not afraid to speak his mind, but he is fair in his assessments and is able to listen to opposing points of view.” Dr. Lopatin further agrees with Dr. Shapiro’s emphasis on political advocacy. His leadership on MOC at the state level, as well as nationally, has been effective and assuring. “It is time that we are vocal in our objections to the mandates being placed upon us. Our message to the powers that be needs to be united and loud.”

Outside of Medicine, Family is Focus As the notable voice speaking for the profession, the conversations about the challenges faced by physicians can be intense at times. To take the edge off, ask about his children. “My free time is spent with my wife and daughters. The girls are huge sports fans like me. Flyers games are number one on our list and spending time at the beach is priceless.” Family and home are purposefully nearby. Even after going to undergraduate school at the University of Miami, he returned to this place of familiarity and settled in Lower Gwynedd, a little more than a halfhour drive from his childhood home of Richboro. “The reason I was successful in realizing this dream were two other very special people who I love very much,” said Dr. Shapiro of his parents, Richard and Harriet. “It was their tremendous love, support, motivation and guidance that truly enabled and inspired me to realize my dream of becoming a physician.” Ms. Williams is the executive director of the Montgomery County Medical Society of PA. If you need further information about MCMS and its programs, do not hesitate to call, (610) 878-9530 or e-mail, montmedsoc@verizon.net .

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The Business of Medicine

Questions for Pennsylvania Physicians to Consider When Asked to Join an Accountable Care Organization BY DENNIS OLMSTEAD, PAMED CHIEF STRATEGY OFFICER & MEDICAL ECONOMIST

any Pennsylvania physician practices are being asked to consider joining an Accountable Care Organization (ACO) or multiple ACOs operating in a physician’s delivery market. According to Avalere Health, as of January 2015 there were 24 Medicare Shared Savings Program and Pioneer ACOs operating in Pennsylvania. Additionally, as of May 2015 there were 12 commercial ACOs operating in Pennsylvania. The movement toward ACO creation is here and expanding in Pennsylvania. Before committing to a request to join an ACO, what do you need to know to make an informed decision? The Pennsylvania Medical Society (PAMED) recommends the following questions to consider. To obtain more information about services and educational products that PAMED has available to you, please contact 855-PAMED4U (855-726-3348). Personal • Do I believe in the concept? • Does the culture of my practice fit with the goals and mission of the ACO? • How much time must be committed to participating in the ACO? Structure, Governance, and Finance • Who owns the ACO? • Is it for-profit or not-for-profit? • How would I be represented on the organization’s governing body? • Who sits on the board? • What are the operational committees through which the ACO program operates? • Does the ACO provide a process and contact person for questions, concerns, and/or issues that might arise? • If I decide to leave the ACO at any point in the future, what is the process for doing so? • What are the requirements related to exclusivity in the ACO, and what are the expectations/requirements for any existing relationships with other providers not participating in the ACO? • What would the ACO require of my practice as far as administrative and organizational tasks? What data would need to be shared? • What are the costs associated with participation in the ACO? • What is the financial viability of the ACO? How have financial

and clinical performance been to date? • Does the system have risk sharing analytics in place to support the financial analysis of risk-based contracts (shared savings, cost sharing algorithms)? • Does the potential exist for losses to accrue that I would have to pay back? What maximum risk would I face? • Would I be adequately protected from penalties related to federal and state laws? • Does the ACO monitor provider and staff satisfaction? • What level of support does the ACO provide in terms of onboarding physician practices that are joining the ACO? • Will joining the ACO provide additional data or information to help better care for my patients? • How will the ACO share data with providers? • To what extent does the ACO provide direct and indirect support to primary care practices that are committed to transforming to a patient- and family-centered medical home? • Will the ACO provide a care coordinator or other clinical support staff in my office? • Has the ACO developed linkages to key community resources to support care coordination? • Are there membership fees associated with joining? • Does the ACO have any contracts already? • Can you get copies of or access to all policies with which you would be expected to comply? • If my practice joins an ACO, what are the implications to my professional liability and malpractice coverage? In an ACO arrangement, what are the malpractice, professional liability and disability insurance and related risks, exposures, and costs? • What is the size and make-up of the provider network? How many primary care physicians are there in relation to specialty physicians? What is the ratio of employed physicians and independent physician practices? • Does the ACO require medical home recognition/certification? Health Information Technology • What kind of practice transformation would the organization expect regarding EMR system implementation, case management, access, etc.? Will the ACO offer any financial or in-kind assistance in this transformation? • Will I be obligated to change EHR systems if I join this ACO? If so, will the ACO support the transition to a new EHR

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Quick Consult, PAMED Practive of Medicine Series financially? Does the new EHR have functionality for my specialty? • How is data collected and integrated from multiple clinical, financial, and patient specific sources? • What measures are being implemented by the ACO to ensure the privacy and security of the data? • Does the system permit the transmission of data during transitions in care? • What are the details of the data reporting timeline?

improvement initiatives? • What criteria are used in determining medical necessity? • What are the means by which this ACO will identify at-risk patients?

Quality & Performance Measurement • How does the ACO communicate information concerning providers and provide support related to clinical, quality, and cost-based metrics? • How are quality and performance metrics developed and what systems are in place to collect and assess the data? Are they weighted based on their importance to influence either resource use or quality improvement goals? • What is the degree of input by physicians to the quality and performance metrics and data collection? • Does the ACO have any specific quality improvement initiatives? • Will the ACO provide opportunities to participate in quality improvement initiatives that would be meaningful for my practice? • What patient and family satisfaction measures are included as elements of the performance metric portfolio for the ACO? How active are family representatives in the organization’s quality

Payment • What is the anticipated revenue to the practice from participating in the ACO? • What shared savings can the ACO reasonably expect to earn, and how would those shared savings be distributed? • What is the payment methodology used by the ACO? • What payers are contracted with the ACO? How many patients comprise the ACO? • How am I eligible for enhanced payment (e.g. bonuses, shared savings, etc.)? • How are shared savings and pay-for-performance payments calculated? How will these be sustained in subsequent years, or will payments diminish over time? • Will I be obligated to accept different insurance products as a result of joining this ACO? • Will I be prohibited from accepting certain insurance products as a result of joining this ACO? • Will I be obligated to accept uninsured patients within the ACO catchment area as a result of joining? Reprinted with permission from the Pennsylvania Medical Society. You can find more analysis on business of medicine issues as part of PAMED’s Quick Consult series at www.pamedsoc.org/quickconsult.

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Frontline Groups

Feature

Frontline Groups Join an elite group of practices that are 100 percent committed to the Montgomery County Medical Society and the Pennsylvania Medical Society. Frontline Practice Groups — three or more physicians in a group — stand on the front line of the medical profession by making a commitment to 100 percent membership to the Montgomery County Medical Society and the Pennsylvania Medical Society (PAMED). Your support helps MCMS and PAMED to advocate on your behalf and provide a forum for physicians to work collectively for the profession, patients and practice. The Montgomery County Medical Society says thank you.

MCMS Frontline Groups as of September 2015 Abington Medical Specialists Abington Memorial Hospital-Division of Cardiothoracic Surgery Abington Neurological Associates Ltd Abington Perinatal Associates PC Abington Reproductive Medicine Academic Urology-Pottstown Annesley Flanagan Stefanyszyn & Penne Armstrong Colt George Ophthalmology Berger/Henry ENT Specialty Group Cardiology Consultants of Philadelphia-Blue Bell Cardiology Consultants of Philadelphia-Lansdale Cardiology Consultants of Philadelphia-Norristown East Norriton Women’s Health Care PC Endocrine Metabolic Associates PC ENT & Facial Plastic Associates of Montgomery County Gastrointestinal Specialists Inc. Green & Seidner Family Practice Hatboro Medical Associates Healthcare for Women Only Division

King of Prussia Medicine LMG Family Practice PC Lower Merion Rehabilitation Associates Main Line Gastroenterology Associates-Lankenau Marvin H Greenbaum MD PC Neurological Group of Bucks/Montgomery County North Penn Surgical Associates North Willow Grove Family Medicine Otolaryngology Associates Patient First-East Norriton Patient First-Montgomeryville Pediatric Associates of Plymouth Inc. Performance Spine and Sports Physicians PC Rheumatic Disease Associates The Philadelphia Hand Center PC Thorp Bailey Weber Eye Associates Inc. Total Woman Health & Wellness Ob/Gyn TriValley Primary Care/Lower Salford Office TriValley Primary Care/Upper Perkiomen William J Lewis MD PC

Through your membership, MCMS Frontline members and practices receive special recognition and benefits that include: • A 5 percent discount on your county and state dues. • A certificate of recognition to hang in your office. • Regional meetings covering topics like risk management, employment law and payer and regulatory matters. These meetings are designed exclusively for member practice managers and office staff, free of charge. • Additional discounts and services from county and state endorsed vendors. • Quarterly recognition in MCMS Physician magazine. • Continual recognition on the MCMS web site, www.montmedsoc.com For more information on how your practice can become a Frontline practice, e-mail montmedsoc@verizon.net or call (610) 878-9530 or PAMED, (800) 228-7823 or (717) 558-7750. M C M S 14 P H Y S I C I A N

hia VIP recognizes Stanley R. Askin, MD, JD, of the Law Office of

his outstanding volunteer assistance to VIP clients. Please scroll Feature bout our September 2009 Volunteer of the Month. Congratulations,

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Meet Your County Medical Society Leaders

Meet Your County Medical Society Leaders Most interesting day in medicine: My most interesting day in medicine was re-attaching the thumb of a one-and-a-half-year-old child who was following her dad mowing the lawn with a rotary lawn mower. She had fallen into the mower. I have done other re-implantations but none as challenging or rewarding.

OUTSIDE THE OFFICE Interesting childhood fact: My first job

Dr. Stanley R. in Askin graduated s assisted VIP clients a variety of from matters. makes time to now defunct was Stan in newspaper delivery for the the Hahnemann University School

Philadelphia Bulletin. It was also my first

Medicine in 1973. He specializes amidst hisofdemanding schedule as a practicing hand surgeon. Stan experience working seven days a week. in orthopedic surgery and hand

How did I end up practicing in andpractice is affiliated with to ensure VIP tside of hissurgery general area clients achieve access Einstein Medical Center Elkins Park

Montgomery County? I ended up practicing in

and Lourdes Medical Center of

What interests me outside medicine:

demanding work schedule, Askin is

and ballroom dancing. I never danced a step

Montgomery County to be close to my relatives. istently takes VIP’s most difficult guardianship cases, supporting VIP’s campus, Holy Redeemer Hospital

Outside medicine, I enjoy g family stability. Through his involvement in civilofforfeiture andjogging, reading Burlington County. Aside from his

rs, Stan contributes to VIP’sattorney goal ofand preventing homelessness. his until I was 61 years old, and thenBy chose to a licensed, practicing is

undertake ballroom dancing as a bucket-list

a board member of the Montgomery clients in auto accident and consumer cases, labors toenough maintain item.Stan I am still not good for dancing County Medical Society.

with the stars, but it is a worthy diversion from

c stability for VIP clients. In one recent collection the stressesdefense of the day. case, Stan Name: Stanley R. Askin, M.D.

If I could be anything other than a d for his disabled client who was sued by a physician: bank for over $40,000. I never had any aspirations for a

m a car

Specialty: Orthopedic surgery and hand surgery note the client co-signed for her

career other than medicine although brother-in-law on which he I have since

attended law school and added a J.D. to my Currently Practices: Montgomery County and list of accomplishments. Even motion. as a lawyer, my helped theBurlington client County, by obtaining a favorable ruling on a non-suit NJ goal is to help people. I have served as a child Medical School:the Hahnemann advocateaand provide pro bono sale legal services el and intervention, client University/ could have faced lien or forced of Drexel University/Hospital of the University to indigent clients. I also enjoy interacting gment. Forofhis commitment and dedicationwith to medical VIP clients in many Pennsylvania (Fellowship) students and have participated in teaching bioethics to students at Drexel’s College Mayo Clinic elphia VIP Residency: offers our heartfelt appreciation to Dr. Stanley of Medicine and wouldAskin. not mind doing more Birthplace: Philadelphia, Pa teaching if my services were needed. Residence: Oreland, Pa My family: My greatest accomplishment has been raising eight children. Nothing I have done professionally or otherwise has been as PROFESSIONAL BACKGROUND worthwhile. Colin Powell, former U.S. Secretary Why I chose a career in medicine: I knew of State, observed that all we leave behind is our I was going to be an orthopedic surgeon as a good works and our children. It is difficult if child. My grandfather had a gait impediment not impossible to know how our efforts will be and my goal was to be able to help people judged, but hopefully we made some difference walk. However, after I entered the field, to our fellow man. I have tried hard to be a I found that hand surgery was where my good example to my children, not just a ‘do as aptitude lay and I have focused my professional I say’ and ‘not as I do’ parent. My children were efforts on the upper extremity. never left with a babysitter and all vacations were The role of the orthopedic surgeon: My with the children. It is interesting to watch my job is basically to help people and my first children with children behave with an echo of question to new patients is, “How can I help?” my parenting. Most rewarding elements of my career: I greatly admire: I greatly admire physicians The most rewarding elements of my career are who have taken up the challenges of the political to see patients from the onset of their concern arena and have made a difference such as Sen. through healing. Getting referrals from satisfied Tom Coburn. It is desirable for more physicians patients is professionally validating. to be involved politically as we bring a different

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sensibility and perspective to the issues of the day.

WORTH NOTING Most interesting moment in medicine: Interesting moments in my practice have been in diagnosing conditions that were not specifically orthopedic in patients who showed up at my practice. Memorable cases included one case of bacterial meningitis that presented with acute onset of neck pain, a teen with appendicitis who presented with right hip pain, an older person presenting with upper back pain due to a posterior wall myocardial infarction, a lady with multiple joint pains caused by hemochromatosis, a person with low back pain due to undiagnosed prostate cancer, and another with vague aches due to hypothyroidism. I was called to the ER for one patient whose presenting complaint was uncontrolled movement of a foot, the explanation for which turned out to be a brain metastatic lesion. When the AIDS epidemic was new, it was certainly hair-raising to perform surgical cases on infected patients. I would usually ask the surgical tech to stay far away from me to minimize mishandling of the sharp instruments used. You may not know: As an orthopedic surgeon, I have been fortunate in having had very few mortalities. Low points in my practice have been those times when I have had to break the news of death to a family. I must confess as well that other low points are the times I have been notified of a pending malpractice suit—certainly an occupational hazard as an orthopedic surgeon. I have been fortunate in my career to have never lost a malpractice case. Speaking of legal matters, since I also practice as a lawyer, I have found that clients are more overtly or demonstrably complimentary of my efforts than patients. Patients don’t jump for joy at the conclusion of treatment, but clients do when a case is successful. Why I stay involved in organized medicine: I stay involved in organized medicine as payback to the profession, which after all should mean that we profess certain ideals as a group. Advice to young physicians: My advice to medical students more so than young physicians is that medicine is a calling and not just a job. There are many frustrations, bureaucratic and otherwise, that would be intolerable if practicing were just a job.

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PHP Addresses Modern Physician Burnout BY JON SHAPIRO, MD, MEDICAL DIRECTOR, PHYSICIANS’ HEALTH PROGRAMS THE FOUNDATION OF THE PENNSYLVANIA MEDICAL SOCIETY Physicians’ Health Programs (PHP), a program of The Foundation of the Pennsylvania Medical Society, provides support and advocacy to physicians struggling with addiction, physical, or mental challenges. The program also offers information and support to families of impaired physicians and encourages their involvement in the physician recovery process. The PHP, embarking on its 30th anniversary, is funded by grants and contributions from physicians, hospitals, and others interested in physician health issues. PHP assists all physicians (MDs and DOs), physician assistants, medical students, dentists, dental hygienists, and expanded function dental assistants.

s we approach our 30th anniversary at the Pennsylvania PHP, it is natural for us to undergo a period of reflection and self examination. Our main mission has and will continue to be the “care and feeding” of the recovering doctor. We are expanding our focus as we view the condition of the modern physician. As medical director, I have been called upon to examine and lecture about some areas that affect the practice of medicine in the Commonwealth of Pennsylvania in the 21st century. Once I got over the initial terror of stage fright, I found that lecturing can be an educational experience. I only hope my audiences learn as much from me as I do from them. For the last year or so, I have spoken at several hospitals about physician burnout and stress. The increased attention to physician burnout reflects the multiplicity of stressors faced by modern health care professionals. Burnout is defined by the presence of overwhelming physical and emotional exhaustion, feelings of cynicism and detachment from the job and a sense of ineffectiveness and lack of accomplishment. Burnout seems to have increased in prevalence. For a complete discussion of physician burnout, I refer you to some excellent sources that are listed on the Pennsylvania Medical Society’s (PAMED) web site, including a blog and CME presentation produced by PAMED, www. pamedsoc.org/lifeofmedicine. I would like to share what some Pennsylvania doctors are saying. In Erie, doctors told me they feel in conflict with a large health system. Large health care systems provide economies of scale and bargaining power, but small hospital staffs are characterized by a warmth and camaraderie that may be lost in larger organizations. Local medical staff influence easily becomes diluted and ineffectual. One hospital in Philadelphia endured more than the usual pain of breaking in an electronic health record. When they found that they had purchased an inferior product they had to

MCMS

suffer the frustrations and lost productivity of learning a second EHR within a single year. Other common complaints include that EHRs don’t communicate with one another and that clinicians spend more time viewing screens than faces. A practitioner in central Pennsylvania sold his practice to his local hospital. When he began to work as an employed clinician, he found that his values and those of the health care facility were not in accord. His priorities had always involved the health of his patients and long-term relationships. The hospital system seemed to prize aggressive coding and billing. My ex-partner in a primary care practice wants to know why pharmacies and urgent care centers are allowed to skim off the easy cases when they aren’t responsible for continuity of care. Anyone can treat a sore throat, but only the family doctor will be there when hand holding is needed as much as pills. Physicians are drowning in the alphabet of regulation. It is hard to swallow so many abbreviations—PQRS, M.U., EMR, PCMH, OMG. Okay, the last one isn’t real but the point is clear. Every minute we spend on charting, reporting and regulations is a minute less that we spend with our patients. The subjective experience of being sued in a malpractice case is an earth-shattering event. It penetrates to the core, eroding confidence and inducing depression. It contributes to the waste of medical resources through the defensive practice of medicine. Our response to stress and burnout may be simple if not easy. Live the life you suggest for your patients. Eat right. Exercise regularly. Sleep a wholesome full night. Try generally to balance your profession with time spent with family and hobbies and community. Concentrate on the wonderful core of medicine: the doctorpatient relationship that called you to this illustrious career. We are privileged to be able to serve our patients in a therapeutic trusting relationship and study the fascinating sciences of life. For more information, visit www.foundationpamedsoc.org.

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Opioid-related Overdoses in Montgomery County: A Call to Action

Opioid-related Overdoses in Montgomery County: A Call to Action BY VALERIE ARKOOSH, MD, MPH, MONTGOMERY COUNTY COMMISSIONER

pioid-related overdoses have reached national epidemic levels and continue to climb rapidly. In 2010-2011, Pennsylvania ranked 14th in the nation for prescription and heroin fatalities, rising quickly to a 7th place ranking in 2012-2013. Montgomery County saw 83 drug related deaths in 2009 and 134 drug related deaths in 2013 – an increase of 61 percent in just four years. According to the Montgomery County Coroner’s office, the total opiate related deaths for the 1st Quarter of 2015 was 31, 20 of which included heroin. Industry professionals suggest the reason for such a dramatic surge may be attributed to the demand for prescription medications containing highly addictive synthetic opioids. In 2012, it is estimated that health care providers distributed close to 300 million prescriptions for opioid painkillers, the equivalent of one for every American adult. In many cases the patient becomes addicted to these legally prescribed opioids. Unable to obtain more of the prescribed medicine, they then turn to illicit narcotics, namely heroin, which is cheaper, easier to obtain, and far more likely to cause overdose and death. In response to this crisis, Montgomery County Commission Chairman, Josh Shapiro, launched the Montgomery County Overdose Task Force (MCOTF) in September 2014. Made up of substance abuse, medical and public health professionals, educators, law enforcement, and concerned citizens the MCOTF has issued a number of recommendations: (You can read the full report at www. montcopa.org/overdosereport) • Prevention strategies including public educational programs, public service announcements, and educational materials for schools.

• Reducing the availability of unneeded prescription drugs in the home by expanding the “Drug Take-Back Box” Program to more locations. • Urging municipal police officers and EMS professionals to carry naloxone. Between May 2015 when this program began, and mid-October, 2015, 16 lives were saved by first responders carrying naloxone. • Use the county’s Community Connections program to improve the ease with which residents can connect with treatment services. • Continue support of the Drug Treatment Court, a long term, evidence based, and highly structured Treatment Court program for non-violent offenders. In an effort to make life-saving naloxone easily available, in late October I issued a standing order for naloxone that covers every Montgomery County pharmacy that wishes to participate. Under this order, any individual can simply walk up to the pharmacy desk and ask for either the auto-inject or nasal mist forms of naloxone. The cost is covered by most insurers. (Pennsylvania’s Physician General Rachel Levine MD later followed by signing a statewide standing order for naloxone that allows all Pennsylvanians to access the drug without a prescription.) The Pennsylvania Medical Society, together with the PA Department of Health and Department of Drug and Alcohol Programs, has issued opioid prescribing guidelines for “Opioids to Treat Chronic Noncancer Pain,” “Emergency Department Pain Treatment Guidelines,” and “Opioids in Dental Practice.” These resources are freely available at www. pamedsoc.org/opioids.

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What Montgomery County physicians can do? • Encourage schools in your area to participate in evidence-based drug and alcohol prevention/intervention education programs offered by the County. • When prescribing an opioid consider yo the best practice guidelines and give your patient information on where to find a local Drug Take-Back Box in casey they do not finish the prescription. Encourage all patients with unused medication to properly dispose of that medication. A regularly updated list of locations can be found at www. r montcopa.org/meddrop. • Let concerned parents, spouses/ partners, and friends of opioid users know about the availability of life-saving naloxone at our County pharmacies. A regularly updated list of participating pharmacies can be found at www.montcopa.org/ overdoseprevention.

Working together we can combat the tragedy of opioid overdose deaths in Montgomery County. Please submit feedback and ideas for this column to val@montcopa.org.

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Laughter is Good Medicine MCMS Delegation Enjoyed Business and Humor at PAMEDâ&#x20AC;&#x2122;s Annual Business Meeting BY TOYCA WILLIAMS, DEPUTY EDITOR

leven physicians from your Montgomery County Medical Society (MCMS) represented your interests at the annual business meeting of the Pennsylvania Medical Society (PAMED). Held Oct. 24-25 in Hershey, the annual business meeting, also called the House of Delegates (HOD), provided a forum for 221 physicians from across the state to discuss and vote on several important issues such as the medical use of cannabis, legislative/regulatory action to end the practice of exclusive contracts by hospitals and hospital networks and the creation of a task force to examine the feasibility of forming larger regional medical societies in an effort to control cost and improve efficiencies. MCMS submitted five resolutions, including a memorial resolution recognizing the passing of Hitoshi Thomas Tamaki MD, a longtime MCMS member who served as cochairman of MCMS Foundation for 47 years. In addition to the business of medicine, attendees were able to support a good cause and enjoy many moments of laughter during the Inauguration Dinner and Awards Ceremony. Montgomery County Cardiologist Scott E. Shapiro, MD, was sworn in as PAMED president as his wife, Marci, and their three daughters, Brooke, Noa and Emma, looked on. Dr. Shapiro is a member of the MCMS Board of Directors and is the immediate past chairman. The celebration continued with the annual silent auction to benefit the Alliance Medical Education Scholarship (AMES) Fund. Eight scholarships were awarded to second- and third-year medical

students enrolled in accredited Pennsylvania medical schools â&#x20AC;&#x201C; one for $3,000 and seven at $2,500 each. Since 2003, the Fund has provided 125 scholarships amounting to $303,500. At the end of the evening, guests were entertained by the comedy stylings of Will Durst, a political satirist. Several delegates said the humor was a welcomed ending to a day filled with reference committees and educational seminars. During the dinner, it was announced that there would be a runoff election for vice speaker of the HOD. Congratulations to our former PAMED 2nd District Trustee, Dr. John Pagan, for being elected as vice speaker. In a three-way race and then runoff, Dr. Pagan was victor. He and Dr. John Spurlock, plan to run for speaker of the house next October. Dr. Martin Trichtinger, current speaker for the last seven years, was re-elected to serve another year; however, he has announced he will not seek re-election in 2016. Many thanks to the following physicians for diligently serving as members of the delegation and effectively representing your colleagues at the PAMED-HOD: Frederic Becker, MD; William Bothwell, MD; Arvind Cavale, MD; Madeline Danny, DO; Nicole Davis, MD; James Goodyear, MD; George Green, MD; Joseph Grisafi, MD; Mark Lopatin, MD; Carl Manstein, MD; Mark Pyfer, MD; and James Thomas, MD

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Highlights from the PAMED-ABM:

agreeing that PAMED and its Board of Trustees has been fully engaged in efforts to improve the MOC process for Pennsylvania physicians. In lieu of this resolution, delegates adopted recommendations that call on PAMED to:

LEGISLATION/REGULATION • Medical marijuana — Delegates voted that PAMED (MCMS resolution): o Call for further adequate and well-controlled studies of marijuana and related cannabinoids in patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy o Urge that marijuana’s status as a federal Schedule I controlled substance be reviewed with the goal of facilitating clinical research and development of cannabinoid-based medicines and alternative delivery systems o Urge the National Institutes of Health to implement administrative procedures to facilitate grant applications and the conduct of well-designed clinical research into the utilization of marijuana o Support trials using cannabidiol oil to treat children with seizure disorders, funding for the trials, and a patient registry. • Protecting Pennsylvania physicians who wish to terminate futile medical care from civil and criminal prosecution — The delegates called on PAMED to conduct a thorough review of the existing law and newly enacted laws in other states to assure that Pennsylvania physicians are best equipped to handle difficult end of life treatment issues, and that appropriate protections are in place. • Legislative/regulatory action to end the practice of exclusive contracts by hospitals and hospital networks — Physicians continue to be concerned that highly qualified private practice physicians are being excluded from hospital medical staffs. Delegates reaffirmed last year’s HOD policies, which were virtually identical. PAMED staff has made progress in drafting legislation and is working to identify a potential bill sponsor to address this issue.

EDUCATION/SCIENCE & PUBLIC HEALTH • Reducing health care disparities for LGBT patients — Recognizing the unique health care needs of the LGBT community, delegates adopted policy calling on PAMED to advocate for expanded access and elimination of health care disparities for LGBT Pennsylvanians. PAMED was also directed to support further research efforts investigating LGBT health issues and to make information on these health issues available to Pennsylvania physicians. • Recognizing National Board of Physicians and Surgeons (NBPAS) as an equal alternative to the American Board of Medical Specialties (ABMS) MOC and recertification process (MCMS resolution) — Delegates did not adopt this resolution,

o Draft a resolution to be presented at the AMA November meeting calling on the AMA to only support recertification processes that meet the 20 existing AMA MOC principles and oppose those that don’t; o Explore reaching out to the Liaison Committee for Specialty Boards, an organization sponsored by ABMS and AMA/ CME; and o Explore non-ABMS alternatives to board certification, such as the NBPAS. • Parity for International Medical Graduates (IMGs) with U.S. Medical Graduates (USMGs) in years of Graduate Medical Education (GME) required for licensure — PAMED was called on to support and aggressively pursue parity in the number of years of GME training required for IMGs and USMGs to obtain state medical licensure. The adopted resolution also calls on a progress report back to the HOD in two years.

MANAGED CARE & OTHER THIRD PARTY REIMBURSEMENT • Improve delivery of peripheral arterial disease (PAD) care to Medicare patients at a lower cost to the state (MCMS resolution) — Delegates voted that PAMED urge the Pennsylvania Department of Human Services to cover and reimburse in-office percutaneous PAD therapies. • Informing public of hospital revenue per inpatient day of care — The resolution as submitted called on PAMED to work with the Pennsylvania Department of Health and the Pennsylvania Health Care Cost Containment Council (PHC4) on this issue. Delegates referred this issue to the PAMED Board of Trustees for study, noting that, though there is strong support for transparency in health care costs, information must be clear and useful to both patients and physicians, and it would be irresponsible to embark on this path without first collaborating with other interested stakeholders.

MEMBERSHIP/LEADERSHIP • The education of Pennsylvania physicians to the legalities of contracts — Delegates voted in favor of PAMED creating a readily available presentation, educating physicians and physiciansin-training on the proper method of analyzing, questioning, and entering into contracts. • Regional local medical societies (MCMS resolution) — In an effort to control cost and improve efficiencies, the delegates voted for PAMED to create a taskforce to examine the feasibility of forming larger regional medical societies.

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2015 PAMED Annual Business Meeting and Educational Conference

MCMS

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2015 PAMED Annual Business Meeting and Educational Conference

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A Physician’s Diary: Dr. Hiram Corson D

r. Hiram Corson, an 1828 graduate of the University of Pennsylvania, made his first diary entry March 31, 1827, while he was still a medical student. His last entry was dated Jan. 31, 1896. He died March 4, 1896. He was well-known nationally and was highly respected by such illuminati as Sir William Osler. The diaries of Dr. Hiram Corson give many insights into the man, the society and times in which he lived, the Civil War, and most especially into medical education and the medical profession of the 19th century. More than any other man in America, Dr. Corson was responsible for women physicians gaining recognition and being accepted into the medical profession. Undaunted by reprisals or scorn, he was an outspoken abolitionist. His sense of justice caused him to respond to many issues. His public awareness throughout his long life is reflected in his diaries, which contain a treasure of information. For more than 30 years he worked for better care for the mentally ill. In 1877, Pennsylvania Gov. John F. Hartranft appointed Dr. Corson to the Board of Trustees of the State Lunatic Asylum at Harrisburg “in recognition of his life-long interest and zealous efforts in behalf of the insane.” Dr. Louis Meier transcribed, edited and annotated Dr. Corson’s diaries and shared them with the Medical Heritage Library earlier this year. The library holds three volumes of Dr. Corson’s diaries that you can view at www.medicalheritage.org.

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1827

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A Physicianâ&#x20AC;&#x2122;s Diary

Reprinted with permission granted by Centers for History of Medicine, the Medical Heritage Library. MCMS Physician will continue to share the words of Dr. Corson in future issues of the publication. Until then, you can learn more about 19th century medicine, www.www.medicalheritage.org.

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Legislative Update BY J. SCOT CHADWICK LEGISLATIVE COUNSEL, PAMED

ennsylvania’s state budget for the 2015-2016 fiscal year is nearly five months overdue. In the meantime, school districts and social service agencies are feeling the pain that comes with the lack of their annual state funding. However, the state budget stalemate has not prevented legislative and regulatory action on other issues, many of which are health care-related. Following is an update on some of those actions that have occurred.

Expunging Minor Violations from a Practitioner’s Disciplinary Record SB 538, legislation that would expand the obligation of professional licensees to notify their licensing board when they run afoul of the criminal law or another state’s licensing body, is just one step away from the governor’s desk, needing only Senate approval of amendments added by the House, which could occur in the near future. One of the House amendments could benefit physicians and other licensees who have a minor transgression on their disciplinary record. Should the bill become law, certain violations could be expunged (erased) from a licensee’s record, provided that certain conditions have been met. The types of violations that would be eligible for erasure fall into one of two categories: • failure to complete continuing education requirements or practicing for six months or less on a lapsed license, registration, certificate or permit. At least four years must have elapsed since the final disposition of the disciplinary record at the time of application for expungement; and • any violation, except those which resulted in license suspension or revocation, in which at least 10 years have elapsed since the final disposition of the disciplinary record at the time of application for expungement. Thus, only minor violations would be eligible for expungement, and some time needs to have gone by since

the problem was resolved. Anything serious enough to have warranted a license suspension or revocation would stay on a licensee’s disciplinary record permanently. Other conditions would also have to be met in order for a licensee to apply to have a disciplinary black mark removed. Specifically: • the licensee must make written application for expungement not earlier than four years from the final disposition of the disciplinary record; • the disciplinary record must be the only disciplinary record that the licensee has with either the commissioner or a licensing board or commission under the commissioner’s jurisdiction; • the licensee must not be the subject of an active investigation related to professional or occupational conduct; • the licensee must not be in a current disciplinary status, and any fees or fines assessed must be paid in full; and • the licensee must not have had a disciplinary record previously expunged by the commissioner. You only get one bite at this apple. As indicated, the bill may be enacted soon, and if so PAMED will provide all the information physicians need to initiate the process of requesting expungement of old, minor violations from their disciplinary record.

Gov. Wolf’s 2015 Regulatory Agenda On July 25, the Governor’s Office released its Regulatory Agenda for calendar year 2015. The purpose of the Governor’s Regulatory Agenda is to provide advance notice of upcoming regulatory activity. The publication represents the Administration’s intentions regarding future regulations. Following is a brief summary of the regulations proposed for action:

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Legislative Update Achieving Better Care by Monitoring All Prescriptions Programs: The Department of Health plans to release proposed regulations to support the implementation of the forthcoming prescription drug monitoring program—Achieving Better Care by Monitoring All Prescriptions Programs (ABC-MAP)—in Spring 2016. The Department anticipates that these regulations will (1) improve the quality of patient care in Pennsylvania by providing prescribers and dispensers access to information about all controlled substances dispensed to a patient, and (2) aid regulatory and law enforcement in the detection and prevention of fraud, drug abuse, and criminal diversion of controlled drugs. Anesthesia Regulations: The State Board of Dentistry plans to issue proposed regulations updating the standards for administration of general anesthesia, deep sedation, moderate sedation, minimal sedation, and nitrous oxide/oxygen analgesia in dental offices to conform to and adopt the current standards used by the dental profession. Child Abuse Reporting Requirements: This winter, the State Board of Medicine and the Osteopathic Board of Medicine plan to issue regulations to update the Board’s existing rules regarding the mandatory reporting of suspected child abuse pursuant to the recent amendments to the Child Protective Services Law (CPSL). Compounding Regulations: This fall, the State Board of Pharmacy will issue, as proposed, updated regulations to improve the profession’s safe, sterile practices and procedures for the compounding of pharmaceutical products for patients. Health Care Worker Identification Badge Regulations: Specific provisions of the 2011 Photo Identification Tag Regulations law went into effect on June 1, 2015. Even though the law related to the use of titles (e.g., Doctor, Nurse, etc.) and their precise placement on the badge, it did not go into effect until June 2015. Many of those affected by the law (particularly physicians) have been in compliance with all components of the law since it was passed in 2011. This fall, the Department of Health plans to release proposed regulations for this law. Injectable Medications, Biologicals, and Immunizations: The Board of Pharmacy plans to issue proposed regulations to implement the 2015 amendments to the Pharmacy Act this winter. These amendments allow a pharmacist to administer influenza vaccine to patients beginning at age nine and allow pharmacy interns to administer injectable medications, biologicals, and immunizations.

or dispensing controlled substances or one specific additional drug which shares serious potential for addiction and abuse (butalbital). According to the Board, butalbital is a barbiturate that is known to have addictive and abuse potential and is prone to overuse by the consumer.

Controlled Substances Database Progress Update It now appears certain that the long-awaited statewide controlled substances database will not be operational until sometime in 2016. That word comes from the Department of Health, which is charged with housing the program. The law creating the database, Act 191 of 2014, set June 30 as the date it was supposed to be operational, but that didn’t happen, for a number of reasons. First, creating a robust, interactive system that will be used daily by thousands of health care practitioners is no small task. And while it’s disappointing that Pennsylvania is the only state besides Missouri that doesn’t have an operational database, we do benefit from the opportunity to look at what other states have done and identify best practices. The Department is doing that now, and it takes some time. The second problem is money. The $2.1 million earmarked to build and operate the system for the next year is tied up in the ongoing state budget stalemate. How long it will take to resolve that impasse is anyone’s guess. Fortunately, the state recently received a $900,000 grant that can be used to get the ball rolling financially. The board that is to run the database, made up primarily of Gov. Wolf’s cabinet members, held a public meeting on Sept. 15, and revealed that the process of selecting a vendor to build the system is now under way. That process should be complete before the end of the year, but then comes the task of actually creating the database. Hence, the likelihood that the program won’t be operational until 2016.

Allowing Traveling Team Physicians to Treat Players without a Pennsylvania License Most sports fans are aware that college and professional teams often bring their team physicians with them when they travel to another state to compete. This makes sense, because the team physician would be most familiar with the players, along with any Continued on page 28

Laser Regulations: This fall, the State Board of Medicine will issue proposed regulations to clarify the requirements for the use and delegation of the use of medical lasers. The proposed rule will bring the Board’s regulations in line with the majority of other states with regulations related to these devices. Osteopathic Prescribing Regulations: This fall, the State Board of Osteopathic Medicine anticipates its release of regulations to outline the minimum acceptable standards of practice that an osteopathic physician or physician assistant licensed by the Board must follow when prescribing, administering,

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Legislative Update

Feature injuries or other medical conditions they may be dealing with. This seemingly straightforward situation becomes complicated if the out-of-state team physician actually treats a player while they are competing in Pennsylvania, because our state law requires physicians to be licensed in Pennsylvania in order to practice here. Thus, under the letter of the law a duly licensed out-of-state team physician who has an established physician/ patient relationship with the team’s players, and who may be treating them for anything from asthma to post-concussion follow-up to a sore knee, technically must stand aside and allow a Pennsylvania-licensed physician, who likely doesn’t know the players at all, to treat them when the team is playing in Pennsylvania. In order to address this situation, 21 states currently allow for visiting team physicians to practice in their state without meeting home state licensing requirements. As indicated above, Pennsylvania is not among them. However, Sen. Jake Corman (R-Centre County), whose district includes Penn State’s main campus in State College, has introduced legislation that would ease our physician licensing requirements in those circumstances. SB 685 and 686 (one for MDs and one for DOs) provide that any visiting team physician who is licensed in his or her home state and has an agreement with a sports team to provide care for the team while traveling, may treat the team’s players while they compete in the Commonwealth without a Pennsylvania license. Specifically, under the bills a physician who is licensed in good standing to practice in another state is exempt from the

licensure requirements of Pennsylvania’s Medical Practice Act and Osteopathic Medical Practice Act while practicing in the Commonwealth if either of the following apply: (1) The physician has a written or oral agreement with a sports team to provide care to the team members and coaching staff traveling with the team for a specific sporting event to take place in the Commonwealth, or (2) The physician has been invited by a national sport governing body to provide services to team members and coaching staff at a national sport training center in this Commonwealth or to provide services at an event or competition in this Commonwealth which is sanctioned by the national sport governing body (think Little League World Series) so long as: (i) The physician’s practice is limited to that required by the national sport governing body, and (ii) The services provided by the physician must be within the area of the physician’s competence. A physician who is exempt from Pennsylvania licensure under the bills would not be permitted to provide care or consultation to any Commonwealth resident other than those specifically allowed by the legislation, or practice at a health care clinic or health care facility, including an acute care facility. The Senate passed the bills unanimously on Sept. 30, and they have been referred to the House Professional Licensure Committee.

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ARE YOU

LOSING REVENUE OR ARE YOU AT

RISK FOR AN AUDIT?

BECOME AUDIT READY AND REVENUE HEALTHY! STEPS TO AN EFFECTIVE DOCUMENTATION AND CODING AUDIT PROCESS 1| COMPARE*

Compare practice and/or individual physician data with Medicare statistics. Utilize PMSCO’s FREE Coding Benchmarking Tool for this comparison. Your results, displayed in a colorful bell-curve graph, will indicate your areas of possible lost revenue or risk. *Log on to www.consultPMSCO.com to access PMSCO’s FREE Coding Benchmarking Tool (by clicking on the Resources link under Inside PMSCO) as a first step in your auditing process.

2| AUDIT

An audit is the only way to know for certain if the correct level of code is being chosen based on the documentation in the chart. An audit will also look at other risk areas such as legibility, signature, diagnosis code use, etc. PMSCO offers targeted, focused audits in areas such as:    

ICD coding (crosswalked to greatest level of specificity) CPT and diagnosis level of service EHR-use (cloning issues) Payor audit verification (pre-payment/post-payment/frequency)

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Feature

PCCY: PA Should Cover All Children

Pennsylvania is the birthplace of CHIP; however, lags in providing coverage to undocumented children who are uninsured. BY COLLEEN MCCAULEY, RN, BSN, MPH HEALTH POLICY DIRECTOR, PUBLIC CITIZENS FOR CHILDREN + YOUTH

ictor, a 15-year-old from suburban Philadelphia, had the misfortune of being born a few months prior to his mother emigrating here from Mexico to find work. She has since given birth to three additional children who have the advantage of being born American citizens. While all the siblings share the deprivations of poverty – Victor alone suffers from the deprivation of not having health insurance. Consequently, his medical care all too often consists of an aspirin and what the family can manage as a nutritious meal. “I never know when he’s sick enough to see a doctor or maybe he’ll just get better on his own,” said his mother. But the aspirin is not enough to handle the pain of a tooth he broke in a sports accident or the constant knee pain that has plagued him since he tripped and fell off a treadmill at school. Not to mention the several unfilled cavities a dentist found at a visit over six years ago. “Whenever Victor is sick or hurt he wants to go to the doctor,” said his crying mother. He asks, ‘Why can’t I go to the nice places you take my sister and brother?’ All I can tell him is that, ‘You wouldn’t understand.’ How can you explain this kind of unfairness to your child?” Have you cared for a child like Victor or tried to help a child without insurance secure critical follow-up care without success? It’s a plight that unfortunately many have faced.

24,000 Children Uninsured in PA There are an estimated 1,500 Montgomery County children who are undocumented and uninsured and an estimated 24,000 children statewide. They do not qualify for CHIP

(Children’s Health Insurance Program) or Medicaid (with limited exceptions for Emergency Medicaid) or Affordable Care Act (ACA) Marketplace coverage. As a nurse working in a federally qualified health center for nearly a decade, I had the good fortune of being able to provide care to every child and adult who walked through our doors regardless of their citizenship status. But if a child who was undocumented and uninsured needed an x-ray, physical therapy or a dermatologist, I had no place to refer her for affordable care. We can’t afford not to cover all children. At the Children’s Hospital of Philadelphia (CHOP) alone, they spend $4,600 per child in uncompensated care, yet CHIP coverage costs just half of that amount – about $2,500. Pennsylvania is losing its national standing for children. While we are the birthplace of CHIP, we are still not among the five states and District of Columbia that cover all kids. But we have the ability to change that. Because of an ACA requirement, starting in October, the federal government is paying 89 percent of the state’s CHIP costs – up from 66 percent previously. This provides an extra $591 per child per year or a total of $92 million more available for the 150,000 kids Pennsylvania anticipates enrolling in CHIP this year. Federal funds cannot be used to pay for undocumented kids’ coverage, so the state could use a portion of the savings and expand CHIP to cover all kids. Based on other states’ experience, Public Citizens for Children and Youth (PCCY) estimates that about 25 percent of the newly eligible children would enroll in year one at a cost of about $15.4 million for the first year – amounting to little more than a rounding error in Harrisburg.

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PCCY: PA Should Cover All Children

In Montgomery County, 9 out of 10 Children Receive Delayed Care PCCY interviewed 53 parents across southeastern Pennsylvania, 11 of them Montgomery County parents, to better understand the health and financial impact of having a child who is undocumented and uninsured. Here are its findings:

It’s important to remember that these families contribute to public coffers. In fact, undocumented immigrants pay sales, wage and other taxes, contributing to revenues that back public health care programs. A 2007 Congressional Budget Office study found that 75 percent of undocumented immigrants had taxes withheld from their paychecks, filed individual tax returns or both. In Pennsylvania, undocumented immigrants paid an estimated $135 million in combined income, property and sales taxes in 2010. Support is building for this effort to help cover those children who cannot receive the health care that they so badly need and deserve. Montgomery County Medical Society (MCMS) supports PCCY’s Dream Care initiative. MCMS is among more than 35 groups who want to see every Pennsylvania child receive health insurance coverage. PCCY serves as the leading child advocacy organization working to improve the lives and life chances of children in the region. Through thoughtful and informed advocacy, community education, targeted service projects and budget analysis, PCCY watches out and speaks out for children and families. If you would like to become a supporter or want more information, contact Colleen McCauley, RN, BSN, MPH, Health Policy Director, (215) 563-5848 x33 or (215) 298-2027. To learn more or to read PCCY’s report, “Fulfilling Pennsylvania’s Promise to Cover All Kids – Closing the Health Insurance Gap for Children,” visit www.pccy.org.

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Feature

Living History: American Diabetes Association Celebrating 75 years of diabetes advances, innovation, and progress

Diabetes care has changed significantly since the American Diabetes Association was founded in 1940. New medicines, devices, and technologies have emerged practically every year. Here are some highlights in the progress of the care and treatment of diabetes over the past 75 years.

Living History: American Diabetes Association April 2, 1940: The American Diabetes Association is born: 12 delegates attend a meeting of the Committee for the establishment of a National Diabetes Association in Cleveland. 1941: Miles Laboratory launches Clinitest, a urine glucose–testing tablet. It’s an improvement over the existing standard, Benedict’s solution, which must be mixed with urine and heated over boiling water. 1947: The Association opens its first diabetes camp for children in Montgomery, Ala. 1955: A disposable plastic insulin syringe is released. 1963: The prototype of a wearable insulin pump, the size of a large backpack, is developed. It delivers both insulin and glucagon. 1966: The first successful pancreas transplant is performed at the University of Minnesota Hospital. Antirejection medications are required, but the surgery proves it’s possible for a person with type 1 diabetes to live without insulin injections. 1973: New, more highly purified beef and pork insulins reduce the chance of allergic reactions. 1977: The Centers for Disease Control and Prevention opens a division devoted to diabetes. In 1989, the name will change to its current Division of Diabetes Translation. 1981: After being available in doctors’ offices for the past 11 years, blood glucose meters are ready for home use. The first blood glucose meter designed specifically for use by people with diabetes, the Ames Glucometer I, is introduced. 1982: The Food and Drug Administration (FDA) approves the first synthetic human insulin, Eli Lilly and Co.’s Humulin. Synthesizing insulin in a lab rather than relying on pancreases left over from the meat industry helps ensure a virtually unlimited supply. 1986: The ADA launches the National Standards for Diabetes Patient Education program, the first of its kind to review, assess, and recognize quality diabetes education. At about the same time, the National Certification Board for Diabetes Educators is born, creating a system for accrediting diabetes educators. 1990: The Americans with Disabilities Act is signed into law, promoting equal opportunity and prohibiting discrimination against people with physical or mental disabilities, including diabetes. 1993: Results of the Diabetes Control and Complications Trial (DCCT) show that people with type 1 diabetes can significantly lower their risk of complications by keeping blood glucose levels as close to normal as possible. In 1998, the United Kingdom Prospective Diabetes

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Study (UKPDS) finds that tight blood glucose control can prevent complications in people with type 2 diabetes. 1994: Glucophage (metformin) is approved by the FDA. It goes on to become the first-choice medication for most people with type 2 diabetes. 1999: A flood of new diabetes medicines comes out around the turn of the century: type 2 drug rosiglitazone in 1999, long-acting insulin glargine (Lantus) in 2000, injectables pramlintide (Symlin) and exenatide (Byetta) in 2005, and type 2 med sitagliptin (Januvia) in 2006. 2002: The U.S. Diabetes Prevention Program results reinforce the Finnish Diabetes Prevention Program: Adults at risk for developing type 2 diabetes can lower their risk by losing weight (5 to 7 percent of body weight), eating a healthy diet, and being physically active. 2005: The FDA approves exenatide, the first drug in a new class of injectables for type 2 diabetes. It’s derived from a compound in the venom of the Gila monster and stimulates the body to produce insulin when blood glucose is too high. 2012: The Affordable Care Act is signed into law, significantly improving access to health insurance coverage for people with diabetes. 2013: The FDA approves Medtronic’s MiniMed 530G With Enlite pump. The pump—first of its kind to stop insulin delivery when glucose drops too low and alarms are ignored—comes one step closer toward an artificial pancreas. Thank you to the clinicians, researchers, volunteers, donors, people living with diabetes and their loved ones who have helped forge progress in diabetes care and treatment, advocacy, and education. The American Diabetes Association, the nearly 30 million Americans living with diabetes, and the 86 million people at risk for developing type 2 diabetes look forward to the day when there is a final entry on this timeline that says “cure.” For more moments in diabetes history, visit diabetes.org/ADA75 or call the ADA, (800)-DIABETES. The article is submitted by the American Diabetes Association. For information on it programs and services, contact Michelle Foster, Director, Mission-Delivery Programs, 150 Monument RdSuite 100, Bala Cynwyd, Pa. 19004. (888) 342-2383 ext. 4643 or (610) 828-5003 ext. 4643, mfoster@diabetes.org.

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Help Your Patients Ward Off Type 2 Diabetes

Help Your Patients Ward Off Type 2 Diabetes BY LEONARD OLU-WILLIAMS, MPH, CHES MONTGOMERY COUNTY HEALTH DEPARTMENT

ovember is Diabetes Awareness Month. According to The Nutrition Source—Simple Steps to Preventing Diabetes, if type 2 diabetes was an infectious disease that was passed from one person to another, public health officials would say we’re in the midst of an epidemic. “This difficult disease, once called adult-onset diabetes, is striking an ever-growing number of adults. Even more alarming, it’s now beginning to show up in teenagers and children.” In 2007, diabetes cost the U.S. an estimated $116 billion in excess medical spending, and an additional $58 billion in reduced productivity. If the spread of type 2 diabetes continues at its present rate, the number of people diagnosed with diabetes in the United States will increase from about 16 million in 2005 to 48 million in 2050. According to the Centers for Disease Prevention and Control (CDC), 8.7 percent of people in Pennsylvania have diabetes.

Obesity and Diabetes Obesity is causally related to type 2 diabetes and it raises risks for heart disease, stroke, kidney failure, blindness, and neurological problems. Rising rates of obesity and diabetes resulted from profound changes in society that began or accelerated during the last two decades. “These societal changes affected the structure of families, schools, neighborhoods, consumer demands, agricultural production, business practices, and technology. All promoted eating more food, more often, in more places, and in greater quantities—as well as promoting inactivity” (www.ncbi.nlm.nih.gov/).The good news is that type 2 diabetes is largely preventable. About 9 cases in 10 could be avoided by taking several simple steps which would be discussed. Making a few lifestyle changes can dramatically lower

the chances of developing type 2 diabetes. You may suggest simple Steps to help your patients lower their risk of developing type 2 diabetes: • Control Weight — Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes about seven fold and being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight. Losing weight can help if your weight is above the healthy-weight range. “Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half!”(Mason et Al, 2001) • Get Moving — Inactivity promotes type 2 diabetes. Exercising often makes your muscles more efficient in their ability to use insulin and absorb glucose. This puts less stress on insulinmaking cells. • Tune Up Diet • Choose whole grains and whole grain products over highly processed carbohydrates • Skip the sugary drinks, and choose water instead • Choose “good fats” instead of “bad fats”—The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds, can help ward off type 2 diabetes. Bad fats, such as trans fats, are found in margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label.

M C M S 33 P H Y S I C I A N

• Limit red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead. Swapping out red meat or processed red meat for a healthier protein source, such as nuts, low-fat dairy, poultry, or fish, or for whole grains, lowered diabetes risk by up to 35 percent. yo Smoking Altogether • Quit

The key to preventing type 2 diabetes can be boiled down to five words: Stay lean and stay y active.

Four things Your Patients Can Do for rDiabetes Awareness Month: 1. Learn and share information about diabetes and prediabetes 2. Learn the most recent diabetes and prediabetes statistics in the 2014 National Diabetes Statistics Report, www.cdc.gov/diabetes/data 3. Take the Diabetes Risk Quiz, www. cdc.gov/diabetes/home and learn more about preventing diabetes and its complications 4. Follow us on Twitter @ MontoHealth and share our tweets on diabetes. References: • The Nutrition Source. Simple Steps to Preventing Diabetes. Harvard School of Public Health • Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345:790-7. • Centers for Disease Control and Prevention. Data and Statistics.

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Feature

Updates and Tools to Help PA Physicians Understand Proposed 2016 Medicare Fee Schedule and Ease the Transition to ICD-10 on Oct. 1 BY JENNIFER SWINNICH, ASSOCIATE DIRECTOR PRACTICE SUPPORT OF PENNSYLVANIA MEDICAL SOCIETY

he Centers for Medicare and Medicaid Services (CMS) has been busy with the release of the 2016 Medicare Physician Fee Schedule (MPFS) Proposed Rule and clarification on the joint statement with the American Medical Association (AMA) on ICD-10 implementation. Here are a few highlights.

Advance Care Planning Services The MPFS Proposed Rule aims to enhance support for primary care practices through several different initiatives. This includes allowing payment for Advance Care Planning Services for Medicare beneficiaries. CMS defines advance care planning as a face-to-face meeting with the patient, family members, and/or surrogate for “the explanation and discussion of advance directives such as standard forms (with the completion of such forms, when performed), by the physician or other qualified health professional.” CPT code 99497 is used for the first 30 minutes, and then add-on CPT code 99498 for 30-minute increments thereafter. Although advance care planning was available in the past, it was only covered when included with the Initial Preventive Physical Exam (IPPE), also known as the “Welcome to Medicare” visit. Most beneficiaries were not likely to discuss advance care planning at the time of that visit. This enhancement will allow for greater flexibility for scheduling advance care planning services for both beneficiaries and providers.

Traditional Care Management In recent years, CMS has recognized the need for care management. As a result, CMS developed payment for Transitional Care Management (TCM) for patients recently discharged from inpatient hospitals, and Chronic Care Management (CCM) for patients with multiple chronic conditions. Although these codes were approved in rules from prior years, in the 2016 proposed rule CMS is looking for feedback to relieve some of the administrative burden when billing for care management services. The Pennsylvania Medical Society (PAMED) also offers resources to help providers understand TCM reimbursement at www.pamedsoc.org/TCM and CCM reimbursement at www.pamedsoc.org/CCM.

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Updates and Tools to Help PA Physicians

Clarification on Incident To Requirements In an effort to clarify “incident to” requirements, CMS reiterates the supervising physician is the physician who bills for “incident to” services. In a recent conversation with CMS’ subject matter expert, PAMED was told, “The proposal is intended to clarify that the ordering physician or other practitioner and the supervising physician or other practitioner DO NOT need to be one in the same. Rather, the proposal is intended to clarify that the physician or other practitioner who bills for the “incident to” services must always be the supervising physician or other practitioner.”

ICD-10 Flexibility Lastly, CMS and AMA released a joint statement on the implementation of ICD-10 scheduled for Oct. 1, 2015 and later issued clarifications to their statement. The initial statement reiterated that there will be no delay for implementing ICD-10. Medicare will not accept any ICD-9 codes with a date of service on or after Oct. 1, 2015, and all claims must have a valid ICD-10 code. The statement also claimed that Medicare can be “flexible” with ICD-10 implementation. The clarification defines flexibility with ICD-10 codes to include the “family of codes.” A family of codes is the first three characters of the code within a category that are clinically related. One must report a valid code within the code family and not simply a category. In most instances, the code will have more than three characters – most valid codes will have a fourth, fifth, sixth, or seventh digit for greatest specificity. CMS will not deny claims based on the specificity of the ICD-10 diagnosis code alone. However, claims will be held to the same coverage standards under ICD-10 as they were under ICD-9. Therefore, national coverage determinations (NCDs) and local coverage determinations (LCDs) that required specific ICD-9 codes will continue to require specific diagnosis codes under ICD-10. PAMED has more information and resources on ICD-10 at www.pamedsoc.org/ICD10, including specialty-specific crosswalks, online documentation training for physicians, education, and coding scenarios. PAMED members who have questions can contact PAMED’s Practice Support Team at (717) DOC-HELP or (717) 362-4357.

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610.878.9530 Email: montmedsoc@verizon.net M C M S 35 P H Y S I C I A N

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Feature

MCMS

Full MCMS Delegation Participated at PAMED-ABM – Many thanks to the physicians who served on your behalf as delegates to the Pennsylvania Medical Society (PAMED) Annual Business Meeting, Oct. 23-25, Hershey. In addition to the business meeting, PAMED offered several educational opportunities for physicians to obtain CME. The delegates engaged in various discussions on issues affecting the profession, the practice and the patients. The MCMS delegation included Frederic Becker MD, William Bothwell MD, Arvind Cavale MD, Madeline Danny DO, Nicole Davis MD, James Goodyear MD, George Green MD, Joseph Grisafi MD, Mark Lopatin MD, Carl Manstein MD, Mark Pyfer MD and James Thomas MD. Montgomery County Cardiologist Sworn In as PAMED President – The PAMEDABM was also a celebratory event for MCMS. Immediate past chairman of the Montgomery County Medical Society (MCMS), Scott E. Shapiro MD was sworn in as the 166th president of the state medical society. Dr. Shapiro, representing more than 14,000 physicians and medical students in the state, advocates for the advancement of quality patient care, the ethical practice of medicine, and the patients all physicians serve. During the weekend, Dr. Shapiro encouraged his colleagues to aggressively engage in the issues that impact physicians and their patients. You can reach him at stat@pamedsoc.org or follow him on Twitter via @PAMEDPrez.

Happenings

MCMS Provides Top 10 Must-Haves for Dr. Gurman Survival Guide – Dr. Andy Gurman, president-elect of the American Medical Association, was given special recognition at the PAMED-ABM in October. Each county medical society was asked to contribute to a survival kit of sorts. The immediate past speaker of the PAMED-ABM was overwhelmed by the generosity. MCMS took a humorous approach to gift-giving. Such items shared were earplugs, to drown out the rhetoric; back scratcher, to soothe ruffled feathers; Neosporin, to treat the cuts and bruises while climbing “The Hill”; chewing gum, to help stick to the issues that matter most; a pocket flask, just because hydration is important. If you want a full list of the top 10 must-haves, contact MCMS staff, montmedsoc@verizon.net. Free CME Reimbursement up to $500 – Applications are being taken for the Howard F. Pyfer Fund. Through the fund, MCMS members under the age of 45 are awarded CME reimbursement up to $500 per year. Visit MCMS web site, www.montmedsoc. com for an application. Deadline to apply is Jan. 11.

MCMS Chairman Featured Speaker at Hospital Grand Rounds – Mark Lopatin, MD was the guest speaker at the Lankenau Medical Center Grand Rounds in Internal Medicine on Oct. 23. Dr. Lopatin addressed some of the challenges physicians face in medicine such as medical malpractice, maintenance of certification, issues related

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to scope of practice, the importance of team-based care and other relevant issues. He also shared what your county and state leadership have done to address some of these challenges. Dr. Lopatin would be delighted to share and further the conversation with other health systems in Montgomery County. Contact MCMS staff for more information, montmedsoc@verizon.net or call (610) 8789530. What Keeps You Up at Night? MCMS wants to help you navigate the evolving health care environment. If there is a particular issue you are interested in knowing more about, let your county medical society staff know. Send suggested topics to Toyca Williams, MCMS executive director, montmedsoc@verizon.net. MCMS would like to continue to host live or virtual meetings to address challenges that negatively affect your practice’s health. MCMS Secretary Received Lifetime Achievement Award – The Montgomery County Democratic Committee honored Montgomery County Coroner Walter I. Hofman MD with a Lifetime Achievement Award during its annual dinner on Oct. 25. Committee Chairman Marcel L. Groen hailed Dr. Hofman as a dedicated and distinguished public servant who has devoted his entire career to the betterment of our communities, state and nation. Mr. Groen further said that “he has modernized and professionalized that office, and has earned the respect of law enforcement, the courts and families.” Congresswoman Allyson Y. Schwartz was also honored at the dinner for her exemplary public service. Help MCMS Create Medical Experts Directory – MCMS needs your help in creating a directory of medical experts. MCMS physician members have been asked to share information about your area of expertise and contact information. The information provided will be compiled and used as a “directory” for staff to quickly identify the right physicians based on their specialty to write articles, provide quotes and give opinions on medical issues. The deadline to submit your information is Dec. 1.

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MCMS Happenings

Latest Medical Mystery – No two days are alike in any medical practice. Each day brings new patient challenges, some fairly simple to resolve and others not so. The Philadelphia Inquirer readers want to know more about the medical mysteries that physicians encounter. MCMS Chairman Dr. Mark Lopatin recently shared in the Nov. 8 issue of The Inquirer how a patient’s sore ankle addressed a larger issue on how third party payers have increasingly become more involved in the exam rooms. If you have a medical mystery to share, contact Charlotte Sutton, Inquirer Health and Science Editor, csutton@philly.com. Good News: Liability Insurance Limits Remain Status Quo – Physicians will not see a rise in primary limits for professional liability insurance, according to an Aug. 18 announcement from Pennsylvania Insurance Commissioner Teresa D. Miller. Every two years, the Department of Insurance is charged with examining the private insurance market capacity in the state and determining whether it is healthy enough to sustain an increase in primary limits in conjunction with an equal decrease in Mcare limits. PAMED’s policy, conveyed to the Wolf administration, is that raising the liability insurance limits should not impose an overall cost increase on physicians. The Commissioner’s decision aligns with PAMED policy to support the phase out of the Mcare Fund, but not when it would create a financial hardship to physicians. Share Your Passion Outside Medicine – The readers have missed hearing about your passions outside of medicine. We all have them, so open up and provide insight into your favorite pastime. You’ve read about our physician pilot who enjoys flying with his grandchildren, our ER doc who releases stress by coaching his dragon boat team in competitions all over the world or the determined young resident who scaled Mt. Everest and practiced medicine along the way. We want to hear more. MCMS Physician Editor Jay Rothkopf MD also encourages physicians to submit articles for the publication. For more information or to send articles or ideas, contact MCMS Executive Director Toyca Williams, at montmedsoc@ verizon.net.

MCMS Members Welcomed To Attend Board of Directors Meeting – The next board of directors meeting is Tuesday, Jan. 5, 6 p.m., MCMS office, 491 Allendale Road, Ste. 323, King of Prussia. If you are interested in attending a board meeting, contact Toyca Williams, MCMS executive director, montmedsoc@verizon.net or call (610) 878-9530. The MCMS Board of Directors represents you. For a list of board members, visit the MCMS web site, www.montmedsoc. com . Speakers Needed for MCMS Speakers Bureau – The MCMS Speakers Bureau is an effective way for you to give back to your community, engage with the public and promote a healthy way of living. Physician members will share valuable information about his or her area of specialty on healthrelated topics. You can also speak on the state of medicine and share the challenges physicians and patients face in this changing health care environment. Volunteer for the MCMS Speakers Bureau by completing the enrollment form found on the MCMS web site, www.montmedsoc.com. Like Us on Facebook – If social media is a favored hang out, then like MCMS on Facebook. Haven’t been on MCMS Facebook page lately, you’re missing out: • Real-time updates on the naxolone standing order. • Decisions made on medical marijuana. • The announcement on Scott E. Shapiro, MD, FACC, who was sworn in as the 166th president of the Pennsylvania Medical Society. • Updates on the CRNP Independent Practice Debate. • MCMS Chairman Dr. Mark Lopatin’s opinions on MOC.

News & Announcements

Welcome New Members MCMS is pleased to welcome the following individuals who joined the Society in 2015: August 2015 Burhan Hameed, MD

September 2015 Cheri L. Matthews, Practice Admin. Mark Heywood Ulbrecht, MD

October 2015 Abhishek Bhari Jayadevappa, MD Mary Kay Johnson, Practice Admin. Arati Sunil Karhadkar, MD Katherine Sprague Patil, DO Deeptej Singh, MD

July 2015 Johanna Lynn Beck, Student Kerry Ann Laughlin, Practice Admin.

To publish photos of new MCMS member physicians, please submit digital copies to montmedsoc@verizon.net

Necrology Report MCMS regrets the loss of these society members since June 2015. David A. Bevan, DO Henry S. Clair, MD Richard J. Minicozzi, MD

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