The Message, August 2011

message THE

A MON T HLY NE WS M AG A ZINE OF S P O K A N E C O U N T Y M E D I C A L S O C I E T Y – A U G U S T 2011

An Opinion about the Future of Medical Care

Your Opinions on Reform and Regulation - Are you reading this yet?

By Brad Pope, MD SCMS President

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2011 Board of Trustees Brad Pope, MD President Terri Oskin, MD President-Elect Anne Oakley, MD Vice President David Bare, MD Secretary-Treasurer Gary Knox, MD Immediate Past President Trustees: Fredric Shepard, MD Michael Cunningham, MD Paul Lin, MD Randi Hart, MD Gary Newkirk, MD Carla Smith, MD Rob Benedetti, MD Audrey Brantz, MD Louis Koncz, Jr. PAC David McClellan, MD

T a b l e o f C o n t e n ts

Your Opinions on Reform and Regulation - Are You Reading This Yet? . . . . . . . . . . . . . .

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The AMA and You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Washington AMA Delegation 2011 Annual Meeting Report . . . . . . . . . . . . . . . . . . . . . 2 An Opinion about the Future of Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Small Practices: Adapting to Survive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Staying in Private Practice Offers its Own Rewards . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Cost Effective Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 UWSOM GME Expansion Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Project Access Provider Outreach Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 CME Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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2011 Senior Physicians Golf Tournament…and Save the Date for Upcoming Dinner . . . . . . . . 16 SCMS Night at the Spokane Indians Game . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Membership Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Meetings, Conferences, and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Spokane County Medical Society Message Terri Oskin, MD, Editor A monthly newsletter published by the Spokane County Medical Society.

The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

"Our lives begin to end the day we become silent about things that matter."

Martin Luther King, Jr.

Advertising Correspondence Quisenberry Marketing & Design Attn: Jordan Quisenberry 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jordan@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

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Your Opinions on Reform and Regulation - Are You Reading This Yet?

Five sub-committees will be created to carry out the business plan. Dr. Harper is co-chair with Dr. Pitcher on the health workforce sub-committee.

Also during the budget cycle, we met with state legislators to curb cuts that would jeopardize our citizens’ access to health care. For example, our involvement contributed to the preservation of state Medicaid funding for interpreter services.

By Brad Pope, MD SCMS President Health Care Reform. Medical liability, Payment reform, Accountable care organizations. Do these topics pique your interest? Or perhaps they confuse you or raise your blood pressure?

It’s the hazy days of summer and we wanted to capture your attention. So this month we intended to focus on the political and regulatory environment, priorities you’ve asked us to keep tabs on. We invited you to submit your personal opinions about a variety of industry issues. To our surprise, we received very few responses. This issue of “The MESSAGE” includes the contributions we received. Our intention in this issue of The Message was to provide a forum where a sampling of your contributed articles would reflect a balance of the wide range of opinions expressed. Even though only a handful of our members shared their views, I believe that many of you hold a variety of opinions on a wide range of issues that we still have not heard. We really would like to hear more from you. So rather than asking you to submit an article, I would like to revise the opportunity and invite you to provide your comments and/or opinions to me. It is very important that the SCMS Board hears the range of opinions of its membership so that we can most accurately represent and take action on your behalf.

Because of the diverse range of opinions within our membership, developing a set of specific SCMS advocacy points is a balancing act. Still one thing is clear: our organization has influence. Therefore we are very intentional about getting input from as many of you as possible to help us best understand and reflect out to the community what the medical society should focus on. Although our efforts frequently occur behind-thescenes or over time; we do shape the political and regulatory arena. We carry significant influence at the state level. SCMS has one of the largest groups of representatives at WSMA’s annual meeting.

Just this spring we presented the case in Olympia for the four-year medical school, which helped result in a $35-million allocation from the state legislature. With that money, we’ll finally turn some dirt on the new medical school. On June 22, we met with Chancellor Brian Pitcher and Vice Chancellor Dennis Dyck at WSU to discuss the planning process for a multidisciplinary clinic providing interprofessional student training on the WSU Health Sciences Campus. Gary Knox, M.D., attended a steering committee meeting and community physician meeting where the business plan for the medical school was approved.

Recently we also influenced the language and content of the Washington that the SCMS Board Administrative Code hears the range (WAC) related to chronic of opinions of its non-cancer opioid use, a membership so that persistent problem in our we can most accurately community. Our involvement has been to recommend represent and take a consistent approach to action on your behalf. coordinating care. The SCMS facilitated the request by the Spokane Prescription Opioid Task Force for the SCMS board to approve a standard pain agreement. This will help to incorporate additional patients into the ED based Consistent Care program, with their pain management agreement posted on the Bulletin page of MEDITECH. Following up on this work, we are continuing discussions with Jeffery Thompson, M.D. at DSHS to determine how the SCMS might work with the DOH to influence physician narcotic prescribing behavior.

It is very important

The SCMS co-sponsored a successful Payment Reform Conference with BCIN, June 10, 2011, with presenters from CMS, ONC, and Ideal Medical Practices, Inc. Since then, Keith Baldwin and I had a conference call with L. Gordon Moore, M.D., of Ideal Medical Practices to explore opportunities to support primary care physicians in Spokane. There will be more to come on that in the next few months.

We don’t expect everybody to agree with every opinion published here this month, but it’s important to air a range of perspectives so that we can all be better informed. When we open our minds to other viewpoints, we can be better leaders and practice better medicine. I hope you learn something from these articles, and if you disagree with something you read—I invite you to make a rebuttal. I know you will keep it civil. Send it to me at pope.b@ghc.org in 750 words or less. It is not necessary to compose an “article”. Short comments are welcome. We promise to publish a balanced sampling of your comments to keep the conversation going.

You are also welcome to post your comments on our website at http://scmsblog.blogspot.com/2011/07/cost-effective-medicalcare.html.

August SCMS The Message 1

The AMA and You

By Rodney L. Trytko, MD, MBA Changes in health care are occurring at an unprecedented rate and the path forward is a dismal one. Medical homes and acute care will be controlled by large corporations. The corporate practice of medicine will likely fail to achieve the two primary stated objectives of healthcare reform legislation – access to care and reduced costs. Those that support single payer approach will claim that now is the time for true reform.

By my count, only two or three of these guiding principles were included in the final bill. Despite this and with no notice to the AMA House of Delegates, the AMA Board decided to endorse that bill. This created a real and possibly insurmountable division in the AMA. So the AMA has an outstanding organization and a national scope. With so many important issues at the national level, what other entity can effectively replace the AMA? At the present time, the answer is none.

More than ever before, all physicians need an organization that will protect our interest and those of our patients.

Who are the AMA’s primary constituents? Many of us are not real sure. I sincerely hope that the AMA will be able to resolve the current divisions for the benefit of all physicians.

The ability of any entity to effectively advocate is based on its organizational strength, scope, and primary constituents. All three attributes are necessary. Let’s consider each attribute as it pertains to the AMA.

Washington AMA Delegation 2011 Annual Meeting Report

Organizational strength requires effective management and non-dues financing. The AMA clearly has the largest and most experienced staff of any physician society. AMA products and database supply vast revenue. Its lobbying staff, history, name recognition, marketing, and relationships cannot be rivaled by any other medical society. Coordination efforts with national specialty and state medical associations leverage the strength of all medical organizations. If an issue is at the national level, the AMA needs to be involved.

Condensed by Keith Baldwin, SCMS CEO from a WSMA report (Includes Spokane delegates Drs. Rod Trytko and Beth Peterson)

Scope is the second factor. The AMA has been providing effective advocacy for physicians on a national level for decades.

Never has that been more important than now. National legislative efforts, regulatory issues, and a host of legal actions necessitate an AMA response and anticipatory actions.

The final attribute is primary constituents. The AMA House of Delegates had many spirited debates on health care reform.

Support for Obama Care was clearly led by primary care, and was hotly opposed by southern states and surgical specialists.

After controversially supporting the original House Bill which included an SGR fix (worth about $300b), the AMA House decided upon seven guiding principles that the association would base further support of a health care reform bill. They were: 1.

Cover all Americans

2.

Expand choice, eliminate denials

3.

Protect the patient-physician relationship

4.

Repeal Medicare SGR

5.

Reduce defensive medicine

6.

Streamline administration

7.

Promote quality, prevention, wellness

This was the turning point meeting for our delegation in terms of its internal workings. In response to requests for information and help from WSMA BOT members the AMA delegation restructured itself to use a set of guidelines in its actions. There are an adequate number of interested parties so that the delegation has a full complement. The delegation will be making a significant effort to be accessible to members at the WSMA annual meeting in Spokane, September 10 and 11, 2011.

Our caucus work in the Western Mountain State Conference brought us into discussions related to issues ranging from patient navigator programs, the study of X-ray back scatter at airports, and finally to internal AMA governance and structure.

The students and residents sections are more active than ever and have a number of ideas on the HOD work represented

by Dr. Alik Widge, our resident rep on the WSMA delegation.

Please take time to discuss these issues with him at the WSMA Annual meeting.

August SCMS The Message 2

Continued on page 3

Continued from page 2 Reference Committee B Report from AMA Delegate and WSMA President elect Doug Meyers Resolution 201 was submitted by the American Academy of Pediatrics in response to Florida’s law prohibiting physicians from asking about firearms in patients’ homes. The resolution was broadened by amendment to state that the AMA will actively defend the physician-patient relationship and actively oppose state or federal efforts to interfere in the content of communication in clinical care.

Resolution 211 was one of three submitted supporting the repeal of federal restrictions, imposed in the Patient Protection and Affordable Care Act, on the use of health savings accounts to buy non-prescription medications. This would free up those of us who are being asked to make prescriptions for OTC meds.

Resolution 217 called for the repeal of objectionable elements of the Patient Protection and Affordable Care Act, including the Independent Payment Advisory Board and the Non-physician provider non-discrimination provision. The resolution called for comprehensive liability reform, the right for Medicare patients to privately contract for their care with physicians not participating in Medicare, enactment of antitrust reform to permit physicians to collectively negotiate with insurance companies and expanding the use of health savings accounts.

Reference Committee F concerned structure and organization, and it was monitored by Dr. Bruce Andison.

Resolution 610 was presented by the WSMA Delegation and supported by WMSC Resolution seeks to: 1. Restructure the current HOD with smaller policy-setting mechanisms that reflect three categories of organizational focus: (1) federal health policy and advocacy, (2) public health, patient safety, and education and quality and (3) practice support. This would be coupled with a reduction in the size of the current board along with its reorganization. Testimony concerning this major reorganization was quite favorable and seemed to be well accepted as a timely suggestion for reorganization. Considering the major changes it would bring to the AMA referral was expected and welcomed.

There will be further communication with the WSMA members in the membership memos as the year progresses. Your AMA delegation looks forward to discussing these and other issues with the HOD at the WSMA annual meeting on September 10 and 11, 2011.

An Opinion about the Future of Medical Care

By George H. Rice, MD (retired) On physician reimbursement, I think all physicians should be on salary. The salaries could be based on local factors such as the Rockwood Clinic or Group Health, statewide clinics such as the Everett Clinic and national clinics such as Kaiser, Mayo, etc. My friends in those settings seem to be happy with their salaries.

I think fee for service is a bit of a joke anyway, the insurance companies are going to pay you their set fee no matter what you charge. Also, setting a salary would do away with unnecessary visits and extra tests.

Electronic records are a must and record banks need to be organized where all of a patient’s information is collected and can be easily tapped into by providers at any time. In other words the medical data on an individual is obtainable almost immediately.

All provider visits are recorded, as are pharmaceuticals, lab tests, hospital visits, x-rays, CAT scan, MRIs, etc. The biggest hurdle is communication between the disparate entities and the ability o f a provider to tap into the system when approved by the patient.

A wonderful example of how the system would work is the Cancer Northwest network, where no matter what office you visit, they have all your current information readily available. Patients should also be allowed to tap into the record bank so they can be active participants in their own care and can read results or know what tests they have had or vaccinations they have received and when.

The way we provide care The biggest hurdle is needs changing. I think it communication between should be divided by age such as birth to 18, 18 to the disparate entities and 65 and 65 to death. The the ability of a provider to providers of care in those tap into the system when settings would be nurse practitioners/physicians approved by the patient. assistants. The initial providers would receive backup by physicians in their respective fields, say pediatricians for birth to 18, internists and gynecologists for 18 to 65 and gerontologists for 65 and older. In addition other specialties would be available for consultations and some special cases such as obstetrics, cancer, heart care, etc. would have independent practices for that special treatment. You notice I have not included family practitioners. I think that is a bit of a misnomer. They should be incorporated into the mix of pediatricians, internists or gerontologists. I think, in today’s advanced medical care it would be extremely hard to be a “jack of all trades.” Many family physicians do not have hospital privileges and do not do obstetrics or surgery today.

Continued on page 5

August SCMS The Message 3

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Continued from page 3 As an adjunct, I would add that the medical home would fit into the above setting nicely with four to six nurse practitioners/ physician assistants in the home with one or two physician backups. Also, it would work in the rural setting with the home being in the local town and the possibility of home visits a reality.

I think this would meet the need of the baby boomer population that is looming and also would be cheaper way to provide care for all our citizens. I realize we need more gerontologists and that should be the focus of our “new medical school.�

Small Practices: Adapting to Survive With more physicians choosing to join or sell to hospitals and larger practices, many wonder if the traditional physician practice is dying.

By Victoria Stagg Elliott, amednews staff. Posted June 27, 2011.

When she began medical school, Delicia Haynes, MD, a family physician in Daytona Beach, Fla., envisioned a practice of her own where she could care for those with and without insurance.

Dr. Haynes opened Family First Health Center in early 2009. Most days are devoted to primary care, although she provides some aesthetic procedures. The financial model is basic fee for service, but she is looking at setting up some form of hybrid concierge care.

"My peers think I'm brave," she said. "It's not for everybody. If someone needs the safety of a guaranteed paycheck, then it's not for you. It's a lot of headaches, but they are all mine."

Just about any expert watching practice trends will say the numbers of physicians in hospitals and large practices only has gone up since these numbers were released. Management consulting firm Accenture on June 13 released a report that based on its read of MGMA and AMA numbers, health system hiring of independent physicians will increase 5% each year for the next three years, leaving only 33% of doctors self-employed.

Why practices are getting larger Most surveys suggest that the current generation of physicians coming out of residency is more interested in work-life balance than previous generations, and has more of a need for stable incomes to pay off student loans. That usually means taking a staff job.

Students who graduated medical school in 2010 left with an average of $157,944 in loans, an increase of 1% from 2009, according to the Assn. of American Medical Colleges. About 13% carried debt of more than $250,000.

"I did harbor fantasies of my own practice when I started medical school, but then I realized that I didn't have an appetite for risk," said John Schumann, MD, an internist and assistant professor of medicine at the University of Chicago. He finished residency more than a decade ago; few of his peers are in private practice.

"I'm very pleased with my decision not to go into private practice.

It just seems harder and harder. I don't have a lot of control over my practice, but my malpractice is paid. I have young children, and I very much like having a work-life balance," Dr. Schumann said.

In addition to a generational shift, there are economic pressures that make it more likely physicians who are more established will sell. Small practices are faced with declining reimbursements as well as the challenge of complying with a growing list of regulatory requirements and installing EMRs.

A few decades ago, the majority of physicians were hanging out a shingle or working in a small practice with some sort of ownership stake. Today, more doctors are choosing to work in large groups or those owned by hospitals.

Many small practices are having problems recruiting new doctors.

"Obviously, small practices are diminishing," said Paul Settle, MD, a family physician who recently sold his two-physician practice, Piedmont PrimeCare in Danville, Va., to Centra Medical Group, a regional health care system in Lynchburg, Va. "I'm not sure medicine is going to be a cottage industry going forward."

"I have been my own boss for 25 years, but physicians have become more difficult to find. I obviously have mixed emotions, but [joining Centra Medical Group] is a good way to ensure longevity of the practice. I'm 58 years old. At some point, you have to figure out how to keep things going," Dr. Settle said.

According to data released June 3, 2010, by the Medical Group Management Assn., 65% of established physicians hired, and 49% of those finishing residencies, landed positions in hospitalbased practices in 2009. The most recent American Medical Association figures show that 25% of physicians were in solo practice from 2007-08. An additional 21.4% were in groups of two to four. Previous AMA data are not directly comparable, because different survey methods were used. But they do indicate that the number of physicians in small practices is declining. Slightly more than 37% of self-employed physicians were in solo practice in 2001, and nearly 26% worked in groups of two to four.

13% of medical student graduates in 2010 carried debt of more than $250,000.

Before Family Medicine Clinic in Sibley, Iowa, was sold to Avera McKennan & University Health Center, based in Sioux Falls, S.D., the practice had two physician-owners and one employed physician, but it used to be a group of five doctors.

August SCMS The Message 5

Continued on page 6

Continued from page 5 The owners, family physicians Douglas Miedema, DO, and Gregory Kosters, DO, sold the practice primarily to recruit and retain physicians after attempting to do so unsuccessfully for a year. From the hospital, they have received help integrating an EMR system and securing locum tenens coverage.

"We were not particularly interested in selling, but, with physicians leaving, we really had a difficult time recruiting. We needed to do it," Dr. Miedema said.

The ownership change has been in place for half a year, but Dr. Miedema said Avera has allowed the practice to continue doing what it does.

"A lot of our concerns were probably, in the end, more perceived than real. There's been some loss of independence, but little change in the patient-physician relationship."

In his GlassHospital blog on April 25, Dr. Schumann compared the demise of the solo and small practice to the easing out of the "yeoman farmer" in favor of large agribusiness.

"Also being relegated to mythic status is the yeoman doctor. ... The same kinds of issues are in play as with agribusiness: Consolidation brings leverage in negotiating contract prices; working for a large organization means economies of scale.

The corporate entity takes care of overhead like malpractice, computer systems, even paying the nurses and medical assistants.

"The health care reform legislation ... passed by Congress in 2010 will only accelerate this process. Organizations that integrate care to provide high quality mean that the little guy will be left out in the cold. The sheer bureaucracy of the new changes (e.g. building 'accountable care organizations' and 'gainsharing risk') will make it harder and harder for solo practitioners and even small groups to survive on their own."

A study in the March 30 New England Journal of Medicine suggested that the recent wave of consolidation most likely would not be reversed, as happened in the 1990s, when there was a spate of hospitals buying practices and physician practice management companies forming as managed care took off.

"Because of all the changes in reimbursement, it will be harder to go back into practice exactly as they did it before," said coauthor Robert Kocher, MD, director of the McKinsey Center for Health Reform and a nonresident senior fellow at the Brookings Institution. "It will be a different business than the one you would have left."

Many experts suspect that reimbursement pressures will become only stronger, especially in the wake of the 2010 health system reform law and other federal legislation that may reward or penalize physicians for integrating potentially expensive information technology and integrating practices for quality bonuses through accountable care organizations.

How small practices will keep going Despite the pressures on small practices, no expert believes they will go extinct. However, if they are to survive and thrive, they aren't going to look like the small practices of even five or 10 years ago -- and they probably will have a strong relationship with a larger organization.

"It's really incumbent on each individual practice and each individual doctor to decide how they are going to adapt. Health care is adapting, and there's no question that we have to make adjustments," Dr. Miedema said.

Most experts believe that a small practice able to maintain independence will need stronger connections to other small practices or a large health system through some sort of physician organization, a common EMR or other affiliation arrangement.

Continued on page 7

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Continued from page 6 "In a sense, it's the end of the small fragmented physician practice," said Paul Ginsburg, PhD, president of the Center for Studying Health System Change.

Brett Hickman, a partner who works on health care system integration issues in the Chicago office of PwC, said: "We're moving away from fragmented models of care to affiliated models. There are models by which practices can maintain some level of independence and still integrate in a way that is strategically and financially going to make sense for both parties."

A small practice may need to fill a specific marketing niche, such as Dr. Haynes' branching out into aesthetic and, possibly, concierge care. Small practices may operate in rural areas that can't support larger operations, or take advantage of a models that focus on keeping overhead to a minimum. Experts say profitable small practices most likely will incorporate the latest technology and hire nurse practitioners or physician assistants to provide some care.

"I'm sure there will be some successful small practices," Dr. Kocher said. "Small practices that are exceptional at caring for certain types of patients or certain types of diseases will do very, very well. The small practices that are going away are those that don't have some certain clear value for a group of patients."

No matter what the level of consolidation, most experts expect that there always will be some physicians who attempt to make independent practice work. Other industries have been through similar periods of consolidation, but there always are some who remain independent.

For example, the independent pharmacy used to be a staple of a community. Large chains bought many small pharmacies in the 1980s and 1990s, and three chains -- CVS, Walgreen Co. and Rite Aid -- tend to dominate in most metropolitan areas, with nearly 20,000 stores combined nationwide, according to the National Community Pharmacists Assn.

Staying in Private Practice Offers its Own Rewards Practice Management. By Karen Caffarini, amednews contributor.

Posted July 18, 2011.

The number of small, privately owned practices continues to shrink as economic pressures and long hours take their toll on the owner-physician.

Sixty-five percent of established physicians and 49% of physicians hired out of residency or fellowship in a recent 12-month period were placed in hospital-owned practices, according to a Medical Group Management Assn. physician placement report issued in June 2010.

But private practice doesn't need to go the way of the dinosaur, experts say. There are many reasons -- both financial and personal -- why physicians should not sell their practices.

One reason is having more autonomy. If you have your own practice, you are the boss and you run your own ship, said family physician Sanford J. Brown, MD, who has had a solo practice in Fort Bragg, Calif., for more than 30 years.

You set your own work hours, implement your own philosophy of care, spend as much time as you want with a patient and are not strangled by policy like you could be when working for some larger medical groups, said Nina Grant, vice president, managing agency director, with Practice Builders, an Irvine, Calif.-based marketing agency for private physician practices.

"You can design your own office the way you want it," said family physician Roland A. Goertz, MD, president of the American Academy of Family Physicians. "If you can't be happy in that environment, I'm not sure what environment you could be happy in."

Maintaining a strong sense of personality is another reason to keep your practice.

However, the NCPA survey found that 23,117 independent pharmacies were in operation in 2009, a modest increase from the 22,728 in 2008. Most offer services that the large chains do not. Likewise, there will be some doctors who will chose to stay independent and be able to do so.

"This is what people went into medicine for. Plus, doctors tend to be Renaissance people -- they can do a lot very well," said Dr. Goertz, whose practice is in Waco, Texas. He said many doctors are fascinated by the business side of the practice as well as the medicine aspect and have the ability and skills to succeed in both.

"Thirty years ago, when I first went into practice, they said solo practice was going to be extinct," said Doug Iliff, MD, a family physician who has been in solo practice in Topeka, Kan., since 1986. "It hasn't happened obviously. It may go down to 2 or 3% of physicians, but it will never go away completely. There will always be people like me."

In addition, a practice can match a physician's values. Dr. Goertz lives in a church-aligned area where some doctors instill their spiritualism in their practices. "These physicians will more easily attract patients with similar beliefs. Patients feel very comfortable with them," he said.

You can create a legacy. When a doctor builds a practice, he or she develops trust between themselves and patients that Continued on page 9

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Continued from page 7 continues to grow and becomes bigger than just the doctor, Grant said. It also includes paraprofessionals and other staff in the practice Other reasons why a physician should not sell his or her practice: • You despise politics: Grant said large conglomerate-owned or hospital-owned practices are big businesses that often have the same hierarchies and politics that can be found in the business world.

• You have a loyal staff: You're paying your staff's salary so they're loyal to you when you have your own office, Dr. Brown said. Irene Doti, a spokeswoman for Practice Builders, said doctors like to keep their own staffs and some doctors have a difficult time relating to hospital staffs. Plus, Doti said some

supplements and an on-site pharmacy. "Should someone's weight loss be managed by franchise owners or by doctors?"

Grant asked. She added, however, that not all these ancillaries are allowed in all states. Doctors can't do pharmaceuticals in New York, for instance, she said.

It makes you happy: Last, but not least, is the personal satisfaction factor. Experts say many established physicians and new residents went into medicine to be in their own practice, and that is what makes them happy. A heavy college debt load and other economic factors cause them to look for a set income and other perks of being an employee. But Dr. Goertz advised, "Doctors shouldn't look at just the monetary gain they could get from selling their practice. They need to look inside themselves and ask will they be happy."

Cost Effective Medical Care

physicians hire family members, including spouses, to help run their private practices. "The reality is, if the doctor works for someone else, the family member probably won't be able to come, too," she said.

• You have guaranteed income: Once you sell your practice, you have no guarantee of an ongoing income, Grant said. Dr. Brown said the only real job security in today's medical marketplace is the patients. If one mismatched patient leaves your practice,

By Rod Trytko, MBA MD Affordability is a primary factor affecting health care insurance access. A primary driver of medical cost is utilization, and utilization is growing very rapidly. New technology and medical inflation magnify the cost effects of increased utilization. The result is insurance premiums with double digit annual increases, thus pricing many out of the market every year.

there still are plenty of others. However, if there is a mismatch between a doctor and his or her employer, it could leave the doctor without a job.

• Your practice is filling a need: Dr. Goertz said there are certain areas in the country that will need independent small practices because their location doesn't attract a large number of physicians or large groups.

• You don't have to work around the clock: Dr. Brown said most areas have hospitalists, who free solo practice physicians from making those rounds. "That really freed up my time in the last 10 years," he said. Dr. Goertz said physicians can retain their independent practices, but share after-hours calls with other independent practices.

• Your practice can make a good income: "The biggest fear of some doctors is they won't be able to make it financially. I believe that is an irrational fear," Dr. Brown said. He said small physician practices like his can survive, provided doctors know the nuts and bolts of business. For instance, he said practices tend to be too heavy on the payroll side. "My rule of thumb is one employee per doctor," said Dr. Brown, who offers tutorials at his office to show doctors how they can successfully operate on their own. You can cut costs by not buying expensive décor and sharing overhead with other practices, Dr. Goertz said.

Grant said small practices can grow their income by bringing in additional cash revenue through ancillary products like weight management, hormone balance, allergy management, nutrition

We can no longer afford to provide all the care that everyone wants. We must develop a strategy for rationing care and reducing costs in a generally acceptable manner.

One strategy to decrease utilization is to eliminate care that provides no benefit or may be harmful. Nobody can argue with the fact that unnecessary care should be totally eliminated from the system. Another strategy is to manage the value proposition of various medical interventions. We must make medical care more cost effective and of higher quality.

In a recent article in the Annals of Internal Medicine, Owens and Qaseem describe such a strategy for reducing utilization while preserving high value care.1 Their strategy involves the application of the following three steps.

Step one: assess the benefits, harms and costs of interventions.

The benefit of an intervention can be estimated by multiplying the number of additional years of life gained by the quality of each year. Quality of life is a crude measure that can be estimated in a number of ways. A generally accepted way is the Quality Adjusted Life Year (QALY) model.

QALY assumes that the quality of an each additional year of life is as important as the year itself. Each year that an individual lives in perfect health is a QALY of 1.0. If the individual is in less than perfect health, the QALY is between 0 and 1.0. The scoring of the

August SCMS The Message 9

Continued on page 11

Cancer evolves at a rapid speed.

So do our physicians.

They have chosen the fields of oncology and hematology to specialize in and are the region’s leading board certified, fellowship-trained cancer experts. Pushing the limits, they conduct hundreds of clinical trials every year, publish articles for world-recognized scientific journals and customize treatment plans for every patient. Because no two cancers – or patients – are exactly alike.

Meet the physicians of Cancer Care Northwest.

View their full profiles at: cancercarenorthwest.com/doctor-profiles

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» 509.228.1000

August SCMS The Message 10

comprehensive innovative compassionate integrated

Continued from page 9 quality of an individual’s life is based on five equal dimensions: mobility, pain level, self-care, level of depression or anxiety and ability to conduct usual activities.2 Many current medical interventions are associated with harms.

Harms can be short term or long term, and iatrogenic or random.

They always are associated with costs and reduced quality of life therefore; they must be factored into any cost benefit analysis.

Those interventions that only result in harms (Appendix, right of A) must be identified and aggressively eliminated.

Step two: assess the downstream net costs of an intervention.

These costs should be included because they are real and would not have occurred if the intervention did not occur. Downstream savings are possible and should be included as well. Any subsequent costs or savings are a direct consequence of the intervention and must be included in the analysis.

Step three: assess the incremental cost effectiveness ratio of an intervention. Some interventions are more effective and cheaper than others, and some are less effective and more expensive. In general, choosing between those is fairly straight forward. The problem arises when an intervention is both more costly and effective. It is the incremental cost effectiveness ratio that must be assessed in order to determine the relative value of the more expensive intervention.

The authors finally group interventions into two broad categories: those that provide minimal or no health benefit and those that provide net benefit. While certainly effective in reducing medical waste, such categorization severely limits the ability to manage the various types of marginally effective care. I believe the primary reason why this was done was to avoid the complicated proposition of recommending a value of a QALY. Placing a value on QALY would permit a third and extremely valuable category of interventions where the marginal costs are less than the marginal value.

about $40,000.3 Not surprisingly, in the US the value is often quoted at $100,000 or more. No wonder the US spends much more on healthcare than others - we value each QALY more than anyone else in the world.

Once we decide on a reasonable QALY value, we then can expand our analysis to three categories of interventions in order to manage each very differently. First, interventions where the marginal benefit is more than the marginal cost (Appendix, left of B) should be fully covered and fully paid. Most public health interventions: vaccinations, prevention and wellness programs are in this category. Any management of those interventions reduces utilization and therefore overall health.4 Second, interventions where the marginal benefit is less than the marginal cost (Appendix, between A and B) should be covered and managed. This is the area where managed care must be permitted to creatively effect allocation and overall utilization.

Third, interventions where the marginal benefit is not positive (Appendix, right of A) should not be covered and aggressively eliminated. Non-beneficial care causes harm and crowds out scarce resources for beneficial interventions.

Finally, once a cost curve is defined for each specific disease, we can actively bend the cost curve downward. Medical waste is rampant and medical profits are excessive.5 Even worse, those problems are very difficult to fix because each healthcare dollar saved is a dollar lost by someone else. Medical waste and profits have politically active constituents who do not care about access.

Our healthcare resources are scarce and must be utilized wisely in order to ensure access. Getting rid of interventions that are of no benefit, managing interventions of marginal benefit, encouraging interventions of high benefit and increasing the efficiency of all interventions will dramatically improve the access of healthcare to everyone.

Appendix

The determination of the value of a QALY is extremely complicated. Factors such as age, income, wealth, race and national origin are extremely important. Poor countries with limited resources value individuals who are productive members Video taken of the accessioning process at InCyte Pathology.

Accessioning is where all of our specimens are received from couriers and checked in. of society. In those countries, the young and the old are worth less than middle aged working individuals. Some countries simply value life less than others or choose to limit resources globally allocated to healthcare. Finally, some individuals choose to spend much more on the margin for an additional QALY. The range of values for a QALY is huge. The World Health Organization places the value of a QALY at three times Gross Domestic Product (GDP) per capita, or about $22,000. The British National Institute for Health and Clinical Excellence places it at August SCMS The Message 11

Continued on page 12

References 1.

2.

3.

4.

5.

2.

Owens, D.K., Qaseem, A. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical intervention. Ann Intern Med. 2011;154: 174-180.

Parkin, D., Rice, N. Statistical analysis of EQ-5D profiles: does the use of value sets bias interference? Med Decis Making 30:556-565.

National Institute of Health and Clinical Excellence.

Guide to methods of technology appraisal. Accessed may 27, 2011. http://www.nice.org.uk/media/B52/A7/ TAMethodsGuideUpdatedJune2008.pdf Buntin, M.B., Haviland, A.M. Healthcare spending and preventative care in high-deductible and consumerdirected health plans. Am J. Manag Care.17(3): 222-230.

Fuchs, V.R. Eliminating “waste” in health care. JAMA 302(22): 2481-2481.

UWSOM GME Expansion Committee

By John McCarthy, MD Assistant Dean, UWSOM Regional Affairs A little over a year ago, Suzanne Allen, MD, MPH, Vice Dean for Regional Affairs and Larry Robinson, MD, Vice Dean, Clinical Affairs and Graduate Medical Education asked me to lead a committee with the following charge: 1.

Refine and update physician supply and workforce needs for Central/Eastern Washington;

Initiate planning for graduate medical education programs to meet the physician workforce needs for Central/Eastern Washington. This planning may include: • exploring models for the structure and content of potential programs both in primary care and specialty care; • exploring affiliation of potential programs among regional academic partners, hospital partners and networks; • assessing local potential for GME development, including support from hospitals and physicians, availability of potential faculty and program directors, and community interest; • determining optimal sites for placing GME

programs in Central/Eastern Washington; and Develop recommendations for business plans and financing of graduate medical education programs in Central/Eastern Washington.

In response to this request, residency directors, hospital leaders, community leaders, medical society leaders, and leaders of GME administration at the University of Washington School of Medicine (UWSOM) have gathered and explored how to best expand Graduate Medical Education (GME) in a distributive model which reflects and matches the development of Undergraduate Medical Education (UME) in the WWAMI region. Paul Ramsey, MD, Dean of UWSOM joined us in Spokane last September as we began this journey with a summit on regional GME. There was palpable enthusiasm at this gathering for creating GME throughout the region and states aside from Washington were excited to get on board with this opportunity as well.

3.

Continued on page 17

Visit our updated website • View "The Message" Online

• Legislative updates

-Full current and past issues available

-Connect with SCMS on Facebook and stay informed

• Membership information

• Connect to Medicor

-Information about credentialing, committees, bylaws, etc.

-The online medical library is a SCMS membership benefit.

• CME information -Topic and dates for upcoming CME courses

August SCMS The Message 12

Riverpoint Rx.pdf

1/20/10

10:55:21 AM

A Personalized Approach to Your Health Riverpoint Pharmacy is one of the few remaining pharmacies that can still offer customized medications through pharmaceutical compounding.

We can provide: • Individualized strengths, combinations and flavorings • Specialized dosage forms such as topical gells and slow release capsules • Sterile compounds such as preservative-free eye drops, injectibles and custom nebulizer solutions • Veterinary compounding Our specially trained pharmacists also offer personalized consultations in: • Nutrition evaluation and planning for improved health • Bioidentical Hormone Replacement Therapy for men and women • Review of medications and supplements • Pain management options for chronic pain and special needs

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August SCMS The Message 13

Project Access Provider Outreach Activities

By Lee Taylor Director, Project Access Spokane Two of our major operational goals for Project Access are: 1.

2.

Increasing the number of volunteer providers by 10% Increasing the number of patients we serve by 10%

As you can probably imagine, when we can accomplish goal number one, goal number two gets a whole lot easier.

We believe that there will continue to be an overabundance of uninsured people in Spokane needing specialty medical services. The estimated number of uninsured adults in Spokane County today is 82,000. We don’t know yet how much better this situation will get when healthcare reform is fully implemented.

Some estimates suggest that about half of the currently uninsured will still not be covered by insurance. We believe that there will still be a large group of people who need help accessing needed medical services.

We are working with our specialty medical services providers to increase the capacity of the provider network. This will enable us to meet the continuing community need. Our outreach activities strive to build partnerships with our providers based on a clear understanding of Project Access goals and guidelines and combined with the willingness of the providers to help uninsured residents of Spokane.

Over the past few months Project Access staff has met with 20 providers to review program details and confirm commitments to provide donated services. We plan to meet with all of the approximately 100 provider organizations.

In June we met with two of our orthopaedics specialty providers, Orthopaedics Specialty Clinic of Spokane and Northwest Orthopaedic Specialists. Key staff members from those organizations met with Project Access staff for a lunch meeting.

We appreciate the time we spent together and are confident that this meeting and all of our outreach activities will help improve our partnerships with our invaluable providers of donated medical services.

If you would like Project Access staff to visit with you or your organization’s staff, please call me at (509) 220-2651 or email me at lee@spcms.org.

Left to right – Marsha Pinat CMPE – Orthopaedic Specialty Clinic of Spokane Robert Rutherford, MD - Project Access Therapeutics Committee Member Margie Locher, Project Access Patient Care Coordinator Lee Taylor, Project Access Director Debbie Crogan, Practice Coordinator/Supervisor - Northwest Orthopaedic Specialists Rachae Windham, Practice Coordinator and New Patient Referrals - Northwest Orthopaedic Specialists Leanne Mason, COO– Northwest Orthopaedic Specialists Cathy Kirsner, LPN, Project Access Program Manager

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2011 Program Schedule SEPTEMBER Moderate (Conscious) Sedation and Analgesia Monday, September 19, 5:30 – 9:15 pm Deaconess Health and Education Center (SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety.)

OCTOBER Endocrinology Update 2011 Thursday, October 06, 5:30 – 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented) NOVEMBER Orthopaedic Update 2011 Wednesday, November 2, 5:30 – 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

August SCMS The Message 14

When it comes to your special delivery, we’ve got you covered.

We believe new moms and babies should be surrounded with comfort and care. That’s why we bring you:

• Suites designed so mom and baby can remain in the same room throughout their stay • Spacious suites with cozy amenities, a private bath and accommodations for an overnight guest • Trained OB nurses plus a Special Care Nursery for infants with more complex medical needs • Support for all types of birth plans, from natural to planned C-sections • A waiting room exclusively for families of OB patients

To schedule a tour of The Birthing Center and Special Care Nursery at Valley Hospital, call (509) 473-5475.

To find an OB physician based in the Valley, visit www.spokanevalleyhospital.com/physicians.

12606 East Mission • Spokane Valley

P e r s o n a l i z e d OB C a r e . R i g h t H e r e .

August SCMS The Message 15 53203_VHMC_OB_7_5x10c.indd 1

1/14/11 5:01 PM

2011 Senior Physicians Golf Tournament…and Save the Date for Upcoming Thursday, October 20 Dinner!

Twenty-four game but chilly docs lined up at 8:00 AM, Friday, May 13 to compete (?) in the umpteenth Mature Docs Golf Tourney at Manito Country Club. Some of the participants had to suspend personal rules such as “I don’t play unless it’s 50 degrees or over” and some competitors were noted to be wearing gloves on BOTH hands. The generosity of NIKE Golf made sure everyone started the tournament with plenty of balls.

Drs. Bob Notske, Franklin Browne, and Bob Kendall

Needless to say at the end of the day there were no holes-inone nor eagles, and surely there were many more birds in the trees than on the scorecards. At the “Victory Lunch” the group was joined by one or two non-golfer Senior Docs who came just because it’s fun to have lunch together. And it really is fun.

Franklin Browne is an outstanding golfer, and to the surprise of only a few, had the lowest net score of the day for those with a handicap of 15 or under at 68. He was promptly elected chairman of the event for next year after he gave an inspiring very brief speech on comradeship and collegiality in our Spokane medical community, as he received his award.

Drs. Joe Rush, Tom Miller, Neil Okeefe, and Bob Notkse

Bob Notske, a former chairman, cinched the prize for lowest net for those with a handicap of 16 or above. Bob had the lowest net score of the day at 67. Bob Kendall won the “Really Really Senior” lowest net score which is defined by the age of 80 and over, not the score of 80! His score was 72.

Congratulatory handshakes completed, thanks were given to Sandy Greer and Bob Parker who formed the supportive committee. Actually, Michelle Caird at the SCMS office does virtually all the work and makes it all happen.

Drs. Mike Eaton, Dick Stacey, and Ford Cashion

We look forward to seeing you at the 25th Annual Senior Physicians Dinner at Manito Country Club, 5:00 PM on Thursday, October 20. Please save the date.

Cheers, Richard Stacey

Drs. Richard Kleaveland, Bob Kendall, Dick Stacey, and Sandy Greer

August SCMS The Message 16

Continued from page 12 As the GME Expansion committee moved through their discussions, the conclusion was reached that there is a significant need to advance GME training in Eastern & Central Washington. It was noted that there are 1550 GME positions west of the Cascades and 97 east of the Cascades. The GME expansion committee held its last meeting earlier this year and it recommended that there be attempts to grow Eastern Washington GME by 144 slots over the next ten years. It was felt that this was a relatively conservative number in terms of needs but a huge number with respect to the financial commitment that will be required. It is an exciting and markedly challenging time to be thinking of this type of growth. The challenges of finding funding for resident education are immense but the committee members representing Spokane and communities in Eastern Washington feel these challenges need to be addressed in order to continue to provide the quality physicians that are needed for the future. This will take a concerted effort by the physician

SCMS Night at the Spokane Indians Game The weather was perfect for the first SCMS social event of the year – an evening at the Spokane Indians Ballpark. And although the Spokane Indians got off to a slow start, they rallied in the ninth inning to win the game.

A special thank you to our sponsors Witherspoon - Kelley, Fruci & Associates, UBS The Prewitt Group, US Bank, Office Team (A Robert Half Company) and Fidelity Associates for an outing enjoyed by all!

community to allow for this growth. The UWSOM is committed to assisting with this endeavor but our community will need to take a lead in making this happen. GME is expensive, labor intensive and with our local graduating students hitting the residency circuit this year, we have a responsibility to help them complete their training locally so they can join us as future partners.

Your medical education leaders in the community will continue to work closely with the UWSOM and their Graduate Medical Education office. At the same time, it is clear that leadership for development of new GME opportunities will need to be developed locally. Progress has been made at the Undergraduate Medical Education (UME) level with plans for the new medical education building coming to fruition. Furthermore, efforts are being made to pilot a 2nd year of medical education in our region. It is imperative that we grow our GME opportunities in order to meet the workforce needs, keep qualified, welleducated physicians in our communities, and continue to be a health care leader for the state.

Membership Recognition for August 2011

Otto with SCMS President Brad Pope

Dr. Chaudry and family with Doris Spokanasaurus

Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

10 Years Patrick T. Miller, MD

8/1/2001

Tycho E. Kersten, MD

8/4/2001

Renu Sinha, MD

8/15/2001

SCMS members enjoying the game.

August SCMS The Message 17

Meetings, Conferences and Events

illness, addictions, work-related stress, life transitions, and relationship difficulties. The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees. Contact Bob or Carol at 509-624-7320 for more information.

Continuing Medical Education • Moderate (Conscious) Sedation and Analgesia: 2.5 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. Conference held on September 19, 2011 at the Deaconess Health and Education Center. Contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org for more information.

Medical Practice Transformation: Charting Your Course - Jointly Sponsored Conference Physicians & Practices: Sustainability and Transformation Initiativesm Physicians are facing dramatic pressures to reevaluate their practice settings and business operational relationships. Market-based changes in payment methodologies and compensation, Medicare Shared Savings Program and Accountable Care Organizations, to name a few, are driving those reassessments. WSMA members or Physician Insurance insureds can attend for a special reduced rate of only $99 per person, and can sponsor their staff in the same practice for the member rate. Three or more members or sponsored staff from the same practice may register for a group discount of $79 per person. Immediately precedes the WSMA Annual Meeting at The Davenport Hotel in Spokane.Friday, September 9 - 12:30 pm–5:30pm. The Davenport Hotel, 10 South Post Street, Spokane. Questions? Contact Jenelle Dalit by phone at 1(800) 552-0612 or jcd@wsma.org.

WSMA Clinical Performance Improvement Network (CPIN) events: Registration and details regarding the CPIN events are available at www.wsma.org. For more information contact Lance Heineccius at (206) 956-3657 or Lance@wsma.org.

• Thursday, September 7 – Managing Post-Discharge Transitions (Larry Schecter, MD, Carol Wagner, and others) – 12:15 PM • Wednesday, September 29 – Alliance Community Checkup Results (Peter McGough, MD, and Susie Dade) – 12:15 PM Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

Caduceus Al Anon Family Group – Meets every Thursday evening from 6:15 pm until 7:15 pm at 626 N. Mullan Road, Spokane, WA. Non-smoking meeting for spouses and significant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format.

No dues or fees. Contact 509-928-4102 for more information.

WSMA and UW Physician Leadership Course for physicians who want to know more about healthcare leadership. This is a 10-week course involving online and in-person learning in partnership with the University of Washington Graduate Programs in Health Administration and the UW Professional and Continuing Education. Dates for the next course start September 23 and go to November 18, 2011. If you are interested in the course or have a physician(s) in your organization you would like to nominate, please email Jennifer Hanscom. Applicants are asked to submit a cover letter outlining their interest in the course and the goals they hope to accomplish, a CV and a letter of reference from a supervising or mentor physician. Please send the documents to Jennifer before August 1, 2011. The course is limited to 30 individuals, and the tuition is $2,000. If you have any questions about the WSMA/UW Physician Leadership Course, please contact Jennifer Hanscom at the WSMA Seattle office (206) 4419762 or 1 (800) 552-0612 or jen@wsma.org.

In Memoriam

Robert J. Davis, MD On July 12, 2011 Robert J. Davis passed away. He was born on June 15, 1922, in Sioux City, Iowa, the younger of two sons of Roy and Fern Davis. He entered Williams College in 1940. Following Pearl Harbor, he accelerated his study to obtain his bachelor’s degree and enter the United States Marine Officer Candidate School in Quantico, Virginia. He was commissioned as a second lieutenant in 1943, entering the war as one of the youngest officers in the United States Marine Corps. He served at Guadalcanal, Okinawa and northern China. Following the war he completed his studies and surgical residency at Western Reserve Medical School in Cleveland, Ohio. He went on to complete his residency in ophthalmology at the University of Iowa Medical School. In 1958 he moved to Spokane and was one of the original partners in the Spokane Eye Clinic. In 1965, he spent a month in Algeria as a volunteer physician with C.A.R.E. In 1971 he served a tour with the hospital ship Hope. He retired from the practice of medicine in 1985, but remained dedicated to a wide range of activities, continuing to ski at Mt. Spokane until the age of 80 and fishing at Priest Lake until a few weeks before his passing at the age of 89. He will be remembered by his many friends and loved ones. He is survived by his son Clark (Diane), daughters Robin Davis, Gail Davis and Erin Davis (Steve Dunbar) and grandchildren Matthew, Mark, Sean, Vanessa, Ainsley and Charlotte.

Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental August SCMS The Message 18

The following physicians/physician assistants have applied for membership, and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS Baker, Tyler J., MD Family Medicine Med School: U of Washington (2008) Internship/Residency: Family Medicine Spokane (2011) Practicing with Providence Family Medicine Indian Trails beginning 8/2011 Hammil, Sarah L, MD Obstetrics and Gynecology Med School: Creighton U (2004) Internship/Residency: U of Utah Medical Center (2008) Fellowship: U of Utah Medical Center (2011) Practicing with Northwest OB/GYN beginning 8/2011 Heller, A. Chris, MD Neurological Surgery Med School: Oregon Health and Sciences U (2001) Internship/Residency: U of Southern California (2008) Fellowship: Epilepsy and Brain Mapping Program (2007) Practicing with Spokane Brain and Spine beginning 7/2011

DiCarlo, Jason M., MD Diagnostic Radiology Med School: Eastern Virginia Medical School (2005) Practicing with Radia, Inc., PS beginning 8/2011 Fahmy, Jana L., MD Diagnostic Radiology/Pediatric Radiology Med School: Loma Linda U (1987) Practicing with Radia, Inc., PS since 7/2011 Iverson, Julie M., MD Obstetrics and Gynecology Med School: Mayo Medical School: (1991) Practicing with Obstetrix Medical Group of WA, Inc., PS since 1/2009 Kelley, Michael B., MD Internal Medicine/Cardiovascular Disease Med School: U of Vermont (2004) Practicing with Inland Cardiology Associates beginning 8/2011 Lamuth, Delacy L, MD Diagnostic Radiology/Body Imaging Med School: New York Medical College (2004) Practicing with Inland Imaging Associates, PS since 7/2011 Loos, Mary E., MD Internal Medicine Med School: U of Missouri, Kansas City (1981) Practicing with Apogee Physicians since 10/2006

Feliciano, Brita M., MD Internal Medicine Med School: Creighton U (2005) Internship/Residency: Virginia Mason Medical Center (2008) Practicing with Rockwood North Clinic since 10/2011

Morrison, David S., MD Obstetrics and Gynecology Med School: Tulane U (1992) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011

Miller, Rebecca L, MD Pediatrics Med School: Creighton U (2008) Internship/Residency: U of Michigan (2011) Practicing with Providence Sacred Heart Medical Center, Pediatric Hospitalists beginning 8/2011

Ormazabal, Amaya, MD Diagnostic Radiology/Pediatric Radiology Med School: U of Texas Southwestern (2000) Practicing with Radia, Inc., PS since 7/2011

Nakayama, Ikue, MD Internal Medicine Med School: Tohoku U, Japan (2005) Internship/Residency: Pennsylvania Hospital (2011) Practicing with Apogee Physicians beginning 8/2011

O’Neil, Nancy A., MD Obstetrics and Gynecology Med School: Northwestern U-Feinberg (1978) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Reichard, Alexander K., MD Orthopaedic Surgery Med School: U of Louisville (2005) Practicing with Northwest Orthopaedic Specialists, PS beginning 8/2011

Ween, Jon E., MD Neurology Med School: U of California, Irvine (1988) Internship: St. Mary’s Medical Center (1989) Residency: Boston U (1992) Fellowship: Boston U (1993) Practicing with Rockwood Clinic, PS beginning 10/2011

PHYSICIANS PRESENTED A SECOND TIME

Reisner, Dale P., MD Obstetrics and Gynecology/Maternal-Fetal Medicine Med School: U of Washington (1982) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011

Agress, Richard L., MD Obstetrics and Gynecology Med School: U of North Carolina, Chapel Hill (1978) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 August SCMS The Message 19

Continued on page 20

Continued from page 19 Starley, James W., MD Obstetrics and Gynecology Med School: Creighton U (1972) Practicing with Obstetrix Medical Group of WA, Inc., PS beginning 8/2011 Upegui-Gomez, Jaime, MD Internal Medicine Med School: Univerisdad Pontificia Bolivariana (2003) Practicing with Apogee Physicians since 9/2010 Whitehead, George F., MD Ophthalmology/Pediatric Ophthalmology Med School: Ohio State U College (2006) Practicing with Northwest Pediatric Ophthalmology since 7/2011

PHYSICIAN ASSISTANTS Cooke, Ondi A., PA-C School: Idaho State U (2009) Practicing with Providence Health Services dba NW Heart and Lung Surgical Associates beginning 8/2011 Deubel, Angela L., PA-C School: Western U of Health Services (2010) Practicing with Women’s Health Connection since 11/2010 Diaz, Lindsey M., PA-C School: U of Florida (2008) Practicing with Rockwood Clinic, PS beginning 8/2011 Goyt, Amanda N., PA-C School: Drexel U College of Nursing-Health Professionals (2005) Practicing with Rockwood Clinic, PS since 7/2011

In The News Washington Physicians Health Program Welcomes Dr. Gary Carr as Medical Director The Board of Directors of the Washington Physician Health Program (WPHP) is pleased to announce the appointment of Gary D. Carr, MD as Medical Director, effective September 1, 2011. Dr. Carr brings a wealth of experience to this position, having worked with physicians and other healthcare professionals with potentially impairing illness since 1997. Dr. Carr developed the Mississippi Professionals Health Program (MPHP) in its present form and led it for a decade. MPHP became nationally recognized under Dr. Carr’s capable leadership, and he has become a go-to professional throughout the addictions community.

Dr. Carr received his undergraduate and medical degrees from the University of Mississippi. He trained in Family Practice in Anniston, Alabama (1987) with added qualifications in Addiction Medicine (2004). Dr. Carr has held leadership roles with state and national chapters of the American Medical Association, the American Society of Addiction Medicine, the American Academy of Family Practice and the Federation of State Physician Health Programs.

Dr. Carr is the author of several papers on professionals’ health and lectures internationally on issues related to physicians and other healthcare professionals with potentially impairing illness.

Dr. Carr is the Immediate Past President of the Federation of State Physician Health Programs (FSPHP) and has been a leader in many of its initiatives. He was a principal author of the FSPHP Guidelines and the FSPHP Public Policy on Illness vs. Impairment. Dr Carr co-chaired the FSPHP Steering Committee during the Project Blue Print national research project, which produced the most comprehensive study to date of physicians with addictive illness.

Dr. Carr co-authored one of the publications from this study.

Dr. Carr co-chaired the ASAM Public Policy Subcommittee that produced 11 public policies on professionals with potentially impairing illness adopted by the ASAM Board of Directors in 2011.

He also served on the Federation of State Medical Boards (FSMB) committees that modernized the FSMB Guidelines on Professional Sexual Misconduct (2005) and Physician Impairment (2011).

Regarding his selection as WPHP’s new Medical Director, Dr. Carr commented, “I am deeply appreciative and honored to be selected to carry WPHP into the future. Following in the footsteps of Drs. Lynn Hankes and Mick Oreskovich is humbling and I am aware I stand on the shoulders of giants in this field.”

The mission of the WPHP is to facilitate and monitor the rehabilitation of healthcare professionals who have medical conditions that could compromise public safety. WPHP is an independent organization governed by a dedicated and engaged Board of Directors, chaired by John Wynn, MD. The program is funded through a surcharge on licensing fees and has a staff of 11, including Addiction Psychiatrist Dr. Charles Meredith, who has served as the Interim Medical Director, and Scott Alberti, Clinical Director for the past 18 years. The program enjoys the strong support of organized medicine and participating regulatory entities. WPHP is proud of its reputation for excellence, with published recovery rates for its clients exceeding the national average. We are confident that Dr. Carr will continue WPHP’s tradition of service, innovation and leadership.

By John David Wynn, MD Chair, WPHP Board of Directors

Faculty Changes at Internal Medicine Residency Spokane Internal Medicine Residency Spokane is proud to announce that Dr. Audrey Routt Brantz, Dr. Darrol Hval, Dr. Dan Dionne, Dr. Esther Rawner and Dr. Christopher Vernon have all received clinical faculty appointments from the University of Washington School of Medicine. In addition, Dr. Rick Lambert has been promoted to Clinical Associate Professor of Medicine and Dr. John Naylor promoted to Clinical Assistant Professor of Medicine.

The medical education community is privileged to work with such fine, dedicated volunteer faculty. Please congratulate these physicians as you work with them.

By Judy Benson, MD Internal Medicine Residency Spokane

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REAL ESTATE

Luxury Condos for Rent/Purchase near Hospitals.

Two Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/ month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@inreach.com.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side. (Owners rarely in residence) This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor.

One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.

Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth College. Please call 954-8339 for details.

Also willing to rent "unfurnished.”

For Sale: 17718 E Linke Rd, Greenacres WA $649,900 Elegance redefined featuring a custom-built rancher and horse property situated on 5 breathtaking acres. For you over 3,800 sq feet, opulent master bedroom, formal dining, open floor plan & a gourmet kitchen. For your horses a 56’ x 48’ metal show barn, heated tack room, 12x12 wash area, 11 matted stalls, mechanical horse walker. Everything to accommodate you & your equestrian needs. Offered by John L Scott Real Estate – John Creighton at (509) 979-2535. For a virtual tour www.tourfactory.com/709316.

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $22 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers?

This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services.

For more information, call (509)

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting.

Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue.

The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include, pediatricians, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease. Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

OTHER

Closing OB/GYN practice – For sale 2 exam tables, 1 electric MEDICAL OFFICES/BUILDINGS

Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

exam table (like new), colposcope, non-stress test machine, speculums, metal filing cabinets, office supplies, waiting room chairs and bookcases. Call 747-6600 for more information.

Northpointe Medical Center Located on the North side of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community.

If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease. Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 1560 sq/ft *Suite 302 - 2190 sq/ft

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POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact Kelly McDonald at (509)444-8888 or kmcdonald@chas.org.

OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509)326-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/ BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs. Contact: Mark Rearrick, mark.rearrick@ providence.org, (509) 474-6605, www.providence.org/ physicianopportunities.

PEDIATRIC HOSPITALISTS OPPORTUNITIES - If you would like the opportunity to participate in the growth of our pediatric services at Deaconess and Valley Medical Centers, please consider joining our multi-disciplinary team. We need four to five Pediatric Hospitalists at either facility. You will be working with nurses with many years of pediatric expertise. You will be part of a team of hospitalists providing 24-hour coverage/365 days per year. Please contact Evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth.org for more details.

is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic. This affiliation provides exceptional administrative support, offers state of the art diagnostic services’ improving our ability to diagnose and treat, and a referral system that is unmatched. For more information contact Evelyn Torkleson, physician recruiter at (509)473-7374 or email at torkele@empirehealth.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family practice, Internal medicine and General medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Katrina Nudo at 1-800-260-1515 x2226 or email knudo@qtcm.com or visit our website www.qtcm. com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (PULLMAN) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential.

Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments. We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical!

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty.

Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@dshs.wa.gov. PO Box 800, Medical Lake, WA 990220800.

URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA. We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position. Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call. Please contact Evelyn Torkelson at torkele@empirehealth.org or (509)473-7374.

SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) has an opportunity for a physician. Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes of the injured worker and follows best practices as defined by Washington State L&I’s Center of Occupational Health and Education (COHE). SROM August SCMS The Message 23

services: clinic consultations and follow-up Holter monitoring Heart rhythm monitoring echocardiography Transesophageal echocardiography stress echocardiography Nuclear stress testing Echocardiography and nuclear stress testing will be available on a full time basis to any and all practices in the Coeur d’Alene/ Spokane Valley corridor in the Valley Hospital Outpatient department supervised by Rockwood Cardiologists.

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PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID

Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

Printed on GP Spectrum速 Paper: Certified by the Sustainable Forestry Initiative. Please recycle.

circling raven summer special

STAY AND PLAY

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take a tour @ circlingraven.com/video

*Includes 18 holes of golf and one night stay Sun-Thurs.

Based on deluxe room double occupancy. Expires October 2nd, 2011

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Worley, Idaho

August SCMS The Message 25

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