The Message March 2011

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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 – M A R C H 2011

2011 PRIORITIES

SCMS IS OFF AND RUNNING

By Brad Pope, MD SCMS President The Health System is Troubled An Interview with Glen Stream, MD

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March SCMS Message Open2

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: Keith Kadel, 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

TA B L E O F C O N T E N T S

SCMS is off and running . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Visits to Olympia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 AMA 2011 National Advocacy Conference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 The Health System is Troubled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Main Points of WSMA response to CMS request for comments . . . . . . . . . . . . . . . . . . . . 7 An Interview with Glen Stream, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Medical School Steering Committee Report to the Membership . . . . . . . . . . . . . . . . . .

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The Growth in Residency Training Conundrum . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Washington State's Medical Home Pilot Encourages Patient-Centered Primary Care . . . . . . . 15 Care Coordination Model for Adult Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . 16 The Importance of Medical Informatics to Preserve Community . . . . . . . . . . . . . . . . . . . 18 An Introduction to the New Project Access Director . . . . . . . . . . . . . . . . . . . . . . . . . 19 Community of Professionals Program - New Name, New Program! . . . . . . . . . . . . . . . .

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Spokane Scholars Foundation 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Physician Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Spokane County Medical Society Message Terry 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).

Advertising Correspondence Quisenberry Marketing & Design Attn: Jeff Akiyama 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jeff@quisenberry.net

Other Meetings and Conferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Member Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 CME Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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“You are the same today that you are going to be in five years from now except for two things: the people with whom you associate and the books you read.”

Charles Jones

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.

"Correction to the February issue of The Message - The article "Growing Medical Education in Spokane" was written by Derek Paul, M1.

The article was credited to another author. We apologzie for the error."

March SCMS Message Open3

President’s Message: SCMS is off and running

By Brad Pope, MD Back in January our trustees gave their seal of approval to our 2011 priorities which were based on your input to our member survey. Since then we’ve jumped in with both feet. Let me tell you what is moving forward at this time.

Access to Primary Care

Another key issue is the health insurance “exchange,” or marketplace, that the state will set up to give consumers the opportunity to shop for health insurance at competitive rates.

We’re advocating that a state exchange should include private insurers, as an alternative to what could become a purely staterun insurance system.

WSMA is also supporting legislation to license medical assistants to do specific basic services under the direction of a physician.

This will assist physicians to organize office workflows more efficiently and cost effectively.

As you can see, SCMS is lobbying on issues important to our members and WSMA that will allow patients more access to more affordable care. We are strongly promoting policies for citizens to have access to primary care through the Basic Health Plan and Medicaid and to emergency services when they need them.

In January, SCMS CEO Keith Baldwin and I travelled to Olympia to attend the Washington State Medical Association (WSMA) Legislative Summit and met with state legislators from our districts.

SCMS Priorities for 2011

We were there among the two busloads of WSMA members, including the WSMA Board of Trustees and contingents from county societies. You were well represented by Nick Fairchild, Dean Martz, Deb Harper and Brian Seppi, who is newly appointed to the WSMA Executive Committee. At the summit, Keith and I talked about the priorities of WSMA and how they aligned with our own.

1. Increase access to primary care

Our job was to stress to legislators how important it will be to minimize any cuts to the Basic Health Plan and Medicaid. We explained how the cuts would affect public health and also recommended that the state protect funding for interpreter services.

3. Create bridges on common issues to

SCMS is working closely with WSMA to make sure our priorities are aligned and to advocate together. We also touched on other issues that are in play, largely due to health reform.

One hot topic is balanced billing for emergency medical services.

Some state representatives are now promoting policies for pressing for legislation that would citizens to have access forbid balance billing by physicians to primary care through when providing emergency services.

Balance billing is the approach that the Basic Health Plan enables physicians to bill patients for and Medicaid and to the balance of their fee, when they emergency services don’t have a negotiated contract when they need them. with the insurer and are reimbursed at a rate below their retail fee. Since a fee hasn’t been negotiated in advance, physicians are frequently undercompensated. WSMA is concerned that regulation could eventually lead to the state setting prices for specialty physician services. If that occurs, patients would find it more difficult to get access to properly staffed emergency service because EDs would have a harder time finding proper staffing, especially in rural communities.

2. Expand to a four-year medical school in Spokane and increase GME capacity in Spokane

Improve hospital relationships 4. Strengthen legislative relationships for advocacy 5. Enhance professionalism through leadership in medicine

We are strongly

Expanding to a four-year, Spokane medical school Spokane’s medical school plans are progressing as well. Past SCMS President Gary Knox and Keith Baldwin recently attended a steering committee meeting that involved Greater Spokane, Inc. (the business community), Washington State University and the University of Washington to plan for its development.

Planners are beginning to think about the school’s curriculum.

Susan Allen, UW regional dean, and Deb Harper, MD, recently organized focus groups to discuss how medical school education should be provided for today’s world. In general, medical school curriculum hasn’t changed for 100 years as presented in the 1910 Flexner report. Students study two years of science followed by two years of clinical rotations.

March SCMS Message 1

Now educators are asking, “How should we adjust the curriculum to teach today’s students, especially for delivering primary care?” In addition to the basic sciences, medical students and postgraduates must learn other skills—such as the art and science of population-based care management, patient outreach and chronic disease management. Students should be prepared to use informatics and tools to systematically care for populations of patients.

performing; encouraging collaboration between these systems to provide the best care in our community. We will keep you posted.

• MD Training: Through WSMA, we are hosting a seminar to improve our members’ clinical performance. Following our March 30 Board of Trustees meeting, you are invited to attend the presentation by the Clinical Performance Improvement Network (CPIN) on Strategies for Chronic Pain Management in Primary Care. The seminar is designed especially for primary care physicians and will offer very practical advice on how to manage care for those patients in your office. All attendees will receive one hour of free CAT 1 CME credit. For further information or to register please contact Michelle Caird at (509) 325-5010 or michelle@spcms.org .

I also participated in the GSI Legislative Olympia Fly-In. Among several issues of importance to the GSI is legislative support for the Medical School in Spokane. I discussed this personally with our respective legislators. Also, Rich Hadley, the GSI Chief Executive Officer, and I had the opportunity to speak at a hearing of the House Committee on Capital Budget in support of the medical school in Spokane.

• Beacon Community of the Inland Northwest Project: SCMS is proud to support the Beacon Care Coordination Project, coordinated by Inland Northwest Health Services. Over the next three years, the project aims to increase the meaningful use of health information technology for all medical conditions and save costs by reducing ED and hospital admissions for diabetes-related complications. The project also seeks to improve care by boosting patients’ compliance with diabetes preventive health services and improving preventive measures for patients with diabetes. If you would like to become involved in the project, please visit www.inhs.org or call Jac Davies, MPH, MS, at (509) 232-8148.

Spokane’s medical school will have a real and vital role, teaching tomorrow’s doctors how to take care of populations of patients.

This is tremendously exciting.

Create bridges on common issues to Improve Hospital Systems Relationships One of the best ways SCMS can improve hospital systems relationships is by focusing on the common issues that matter to all physicians, regardless of where we practice. We have many platforms from which to begin collaborating, such as improving community health, sharing patient data among providers and promoting care coordination. Here are just a few new developments:

As you can see, 2011 is off and running. Now that our priorities are set and formalized, we will be building our action and evaluation plans. Watch for those in an upcoming the Message, along with more details on how we’ll perform on our other priorities.

• Payment reform: SCMS is closely following the State Multi-payer Reimbursement Project to support physician demonstrations of payment reform. The WA State Health Care Authority (HCA) and Department of Social and Health Services

If you would like to serve on a project or simply want to make a suggestion, please write or call me at pope.b@ghc.org or (509) 241-7370. We have much to offer each other and our community.

(DSHS), in conjunction with the Puget Sound Health Alliance (PSHA), lead the project to develop, implement and evaluate a pilot of one or more medical home provider reimbursement models, pursuant to ESSB 5491 of 2009.

• Project Access: Through Project Access we continue to bring doctors together and secure funding for safety-net providers and the programs that support our uninsured. I am delighted

The Christ Clinic / Christ Kitchen 20th Anniversary Celebration

to welcome Lee Taylor, our new full-time director to Project Access. You can learn more about him in this month’s the Message. SCMS will continue to seek funding to support Project Access’s administration and our community’s safety

April 28 6:30 – 8:30 p.m.

The Lincoln Center

net.

• Shared informatics: Our Informatics Committee has requested meetings with Providence Health and Community

For more information call (509) 325-0393

Health Systems to learn how they are making decisions about their electronic medical records, what lessons can be learned for the benefit of all physicians and how the systems are

March SCMS Message 2

Visits to Olympia

The key issues we stressed to attendees for their discussions with legislators included:

This week over 85 individuals from Spokane and the region came to Olympia for Greater Spokane Incorporated’s annual Olympia trip. Senator Lisa Brown addressed the large contingent of business and civic leaders and had an opportunity to discuss important items on their agenda. The number one priority, as always with this group, was the economic growth of our region.

• Funding for Medical Assistance, the BHP, interpreter services and other key services.

• Not losing the opportunity for capturing EHR Incentive Funds that will make available to our state a large pool of federal funds (upwards of $200-300 million) available for Medicaid payment enhancements for Washington state practices that meet “meaningful use” criteria for Electronic Health Records.

• Defeat of efforts to ban emergency care reimbursement and balance billing (passage of which would allow insurers to shift to physicians their obligations to their subscribers).

• Support of legislation to grant specific licensure to Medical Assistants.

• Support of a market based approach to an insurance exchange

Brad Pope, MD and participants of Greater Spokane Incorporated’s annual Olympia fly-in gather in the State Reception room to listen to Senator Brown’s address and engage in discussion.

WSMA Legislative Summit: Tough News Delivered Personally with a Request to Build on a Good Relationship.

The steepness of the budget hill we need to climb to save the BHP, and interpreter services (for example) was starkly outlined

by Governor Gregoire in her speech to the 140 plus physicians and practice managers who attended the legislative summit in Olympia. She also noted the need for legislators to slough along a tough learning curve she has already traversed. “For example, I’ve been forced to choose between services for children and adults. These are terrible choices to have to make,” she said, adding that painful decisions for legislators are in store over next 100 days: Reform of pensions, modernize state agencies, the ferry system, unemployment comp system and how to retrain employees. Her proposed budget eliminates 75 programs and services. Beyond the cuts, looking ahead to the state’s pending responsibilities in light of health reform she challenged, she said, “I want us to work together. The WSMA has been a great partner in such things as the Health Technology Assessment Program, and increased use of generic medications. We’re leading the way on reforms that work. I’ve asked the HHS Secretary Diane Sebelius to help us pilot healthcare reform in Washington State, not just for state programs,” she said. “We are moving forward; I want to work with you. If I can’t save the BHP, we need to implement healthcare reform sooner that the Feds.”

that includes such criteria administration simplification, ensure patients have access to local providers and promote the viability of providers.

Bills are being dropped into the legislative hopper en masse. For a copy of WSMA legislative agenda go to www.wsma.org – click on the Government Affairs tab.

WSMA President Dean Martz, MD addresses the attendees at the WSMA Legislative Summit.

March SCMS Message 3

AMA 2011 National Advocacy Conference Drs. Oskin and Oakley, SCMS, and Dr. Martz, WSMA, all from Spokane, advocated with a number of Federal Legislators in WA D.C. about the SGR fix, flexibility in Medicare for physicians and patients, and Medical Liability Reform (2 demonstration projects in WA.) in addition to a number of other issues. This joint effort by SCMS and WSMA also advocated for a number of improvements to the Accountable Care Act in addition to supporting the maximum physician input into the regulatory process. SCMS continues to support your issues at the State and Federal level.

Anne Oakley, MD, Representative Cathy McMorris Rodgers, Terri Oskin, MD and Dean Martz, MD

Dean Martz, MD, Jennifer Hanscom, Doug Myers, MD, Senator Adam Smith, Ray Hsiao, MD, Anne Oakley, MD, Tom Curry and Terri Oskin, MD

Terri Oskin MD and Anne Oakley, MD Jennifer Hanscom, Tom Curry, Anne Oakley, Representative Jay Inslee, Dean Martz, MD, Doug Myers, MD and Terri Oskin, MD

March SCMS Message 4

“The Health System is Troubled”

By Keith Baldwin, CEO, SCMS The phrase, “The health system is troubled” is how Donald M. Berwick, M.D., MPP, administrator for the Centers for Medicare & Medicaid Services (CMS), started his presentation to the 2011 National Advocacy Conference in WA. D.C. February 8, 2011.

You, a member of the SCMS, were well represented to hear Don’s comments. Drs. Dean Martz, WSMA President; Terri Oskin, SCMS President-Elect; and Anne Oakley, SCMS Vice President were all in attendance to advocate on your behalf for physician issues to benefit you and your patients.

There are themes that Dr. Berwick will repeat through his presentation and he begins by telling the story of Kevin. With a cohort of medical students, he asks a patient in the hospital, 15 years old, who had had many hospitalizations over time and was actually doing fairly well at this point in his disease process, “what could we do to improve your care?” At first, he says everyone is great and all is going well. Later Kevin admits to having thought about it for a while and he has three things he would like to mention.

1. “Tell me what you are going to do before you do it,” 2.

To the team of providers; “talk to each other, and

3. Ask me what I think!”

What Kevin is really saying is that there should be a plan, a team to carry out the plan, and that he should be the boss; a patient centered approach to care.

Kevin says that,”he needs a plan of care, a team to carry out the plan, and a patient centered approach.”

Dr. Berwick, a Pediatrician in clinical practice, has a message, “my real message is that all physicians will need to be involved in the solutions to the problems in the system to support sustainability.”

His role at CMS is to make health care better over time and he made it clear he can’t do that without the help and support of physicians from around the country. He boldly stated that, “we need better care, health and at lower cost, through improving the system.” He went on to talk about his support for the Accountable Care Act because it does bring solutions to some of these issues. There was no waver in his voice when he said that, “SGR is a defective threat – we need to provide a cure for this to stabilize the care system.”

“But, it is also difficult when people expect magic from medicine – sometimes true and sometimes not,” he said. He was referring to the “contextual changes in medicine over the years and how the publics’ expectations have increased dramatically.

“Teamwork is now necessary because of the wealth of knowledge and technology – no one individual can possibly manage or absorb it all,” was his way of stating the obvious.

Dr. Berwick reinforced again that, “It will take some time to come up with all the answers and the work will need to involve all the team members and leadership of physicians.” He feels that the ACA has many tools which will help the system and is an appropriate step toward the provision of quality care. He believes, “the root of the solution is in quality, improvement toward better care, better health and lower cost toward sustainability.”

Dr. Berwick now follows on his story about Kevin, “the come up with all the answers proposed rulemaking and the work will need to for ACO’s, which involve all the team members is coming soon, is important to and leadership of physicians.” meet the needs espoused by Kevin.”

“Physicians need to be engaged in this opportunity.” There is a consistent theme from Dr. Berwick about physicians taking leadership roles to impact the quality of care in the reformed system of care. He reiterates, “Physicians will have more control and their patients will have better journeys, not just episodic care.” If you aren’t buying into his line of reasoning yet, he has another set of themes to consider.

“It will take some time to

He feels that these themes, as part of the new system, are important to understand; 1. Simplicity – the steps of care should add value to improve care (no tolerance for fraud and abuse in the system), 2.

Modernization – EMR, patient registry, care coordination; an asset to improve systems to support patient care (not an easy investment but we can be better with these tools),

3.

Security – the ACA supports patients e.g. to be insured, not to be excluded for pre-existing conditions, etc.,

4.

Pro-activity – prevention is important, investments in primary care and patient safety are necessary to the new system.

He believes it is time to bring excellence to scale by using best practices in all the care that is provided.

There you have it. Will the ACA tool, as Dr. Berwick believes, bring a new system into place that has a plan, a team and is patient centered as Kevin suggests, or will there be some alternate future?

March SCMS Message 5

On March 30, we’re prescribing a healthy dose of Thanks.

March 30 is Doctors’ Day. Doctors’ Day means so much to us at Valley Hospital and Medical Center, because if it weren’t for physicians and their healing skills, all the other days of the year might be a little less special.

Please join us in congratulating the 2010 Physician Award Winners!

2010 Physician of the Year: Jonathan Keeve, M.D., Northwest Orthopaedic Specialists, P.S. 1st Quarter 2010: Physician of the Quarter: Douglas Brown, D.O., OB/GYN Golden Pen Award: Renu Sinha, M.D., Surgery 2nd Quarter 2010: Physician of the Quarter: Craig Hart, M.D., Internal Medicine Golden Pen Award: Sirisha Sesham, M.D., Internal Medicine 3rd Quarter 2010: Physician of the Quarter: Randi Hart, M.D., Radiology Golden Pen Award: Jonathan Keeve, M.D., Orthopaedic Surgery 4th Quarter 2010: Physician of the Quarter: Terese Kincaid, M.D., Family Medicine Golden Pen Award: Robert Laugen, M.D., Oncology

SpokaneValleyHospital.com Some of the medical staff represented are independent physicians and are neither employees nor agents of Valley Hospital and Medical Center.

March SCMS Message 6

Main Points of WSMA response to CMS request for comment on its proposal to implement the ACO and Medicare Shared Savings Program.

• Remove barriers preventing ACOs from successfully contracting with private payers to support shared services.

• Only establish requirements for ACOs that require large capital investments if it provides specific financing mechanisms to enable physician practices to make those investments or CMS arranges it such that the ACO can receive the essential service from another CMS sponsored program.

• Have a seamless attribution process to help ACOs focus their efforts to deliver better care and promote better health.

About half the physicians in our state practice in smaller practice settings (50 physicians or less). We are extremely pleased that CMS is pursuing policies to help these practices in the new payment environment being contemplated. Smaller practices will be an important aspect of improving health care delivery in the future.

• Maximize the extent to which an ACO is held accountable only for those patients who voluntarily choose its physicians to provide or manage their care, and minimize (and ideally eliminate) the use of statistical attribution methodologies, particularly retrospective attribution after care has already

CMS and other federal agencies should: • Create explicit policy that allows practicing physicians to help lead ACOs, ensure smaller practices can participate, set up explicit safe harbors from antitrust enforcement so small,

been delivered after the end of the reporting period.

• Educate and encourage beneficiaries to take actions that will help make ACOs successful.

independent practices can work closely with each other and • Create policies that deal equitably with “problem” patients. If

collaborate with hospitals and other providers.

patients are non-compliant and physicians have explicitly taken • Permit ACOs to participate with no more than 5,000

the patient thru a non-compliance process, then the physician

beneficiaries, the minimum number required by law. Having

(and therefore the ACO) should be able to “de-select” the

only one ACO in many communities, reduces choice for

patient. Physicians should not be allowed to de-select a

patients and competition.

patient because the outcomes are poor.

• Limit requirements for the structure or internal systems of ACOs

• Make the kinds of changes to the fee-for-service system

to items where there is clear evidence that high-quality, affordable

-- or allow the ACO itself to set certain payment policies as

care cannot be provided without such structures or systems.

described in Section 7 -- so that physicians can be paid upfront

• Require that an ACO and/or CMS provide timely, detailed data to physician practices to enable them to identify opportunities to make improvements in cost and quality.

• Create payment models that enable ACOs to self-finance improvements, and do not impose unnecessary requirements that require significant upfront capital. Physician practices should not be forced to enter into partnerships with hospitals simply to obtain access to capital.

for currently unreimbursed and under-reimbursed services that will improve care for patients and save money for the Medicare program.

• Physicians should not be penalized for accepting sick patients into their care or customizing a patient’s care to meet their unique needs.

• Implement quality performance metrics using existing, validated measures and, over time, expand these measures as

• Create payment systems that enable physicians participating in ACOs to be paid immediately for key services that are not

the state of the art advances.

• At least in the initial years of the ACO program, avoid requiring

currently paid under Medicare, e.g., phone calls and email

ACOs to collect and report new or different quality measures

communications with patients and other physicians, and use of

beyond those that are already being required under other CMS

nurse care managers.

programs.

• Payment systems should enable ACOs to accurately project the

• Support the ability of multi-stakeholder organizations to work

savings they will be able to retain or the additional payments

with ACOs in the community to collect and report additional

they will be able to receive if they are successful in restructuring

quality measures tailored to the unique needs of individual

care delivery in specific ways.

communities.

March SCMS Message 7

• Any requirements for new measures applicable to all ACOs should be limited to measures of outcomes and patient experience, not measures of process or structure, • The initial standard of performance on any quality measures should be “no decrease in quality,” for the first year. Do not seek to force arbitrary improvements in quality measures on ACOs at the same time they are creating ACOs to seek ways to reduce costs.

• Assure patients that ACOs will not result in lower quality care, but not promise that any particular aspect of quality will improve immediately. Give ACOs the flexibility to choose the areas where they focus quality improvement and cost reduction efforts.

• There should be no arbitrary limits on the number of providers who can participate in a payment model that is structured to assure budget neutrality.

• Providers should be able to participate without regard to whether other CMS demonstrations are implemented in the same geographic area.

• Implement effective risk-adjustment methodologies and risk caps on the costs associated with individual patients so that ACOs are managing performance risk, not insurance risk. Stop loss and episode of illness carve outs must be included in the final rules.

• Limit the extent to which ACOs are accountable for the costs of certain services if they are delivered by only one provider in the community. This will avoid penalizing ACOs for the actions of an uncooperative monopoly provider or forcing the ACO into an imbalanced partnership with such a provider.

• Allow for experimentation with partial and global capitation, virtual partial capitation, an Accountable Medical Home payment, and condition specific capitation. Implement additional transitional payment models within traditional Medicare fee-for-service to make it more feasible for primary care practices and specialty practices to transition successfully to more accountable care delivery The complete comment letter is available on the WSMA website, www.wsma.org.

March SCMS Message 8

An Interview with Glen Stream, MD

That’s your “day job” so now tell us about your “extra curricula” activity you are involved in.

You mean the white water rafting and golf – that I don’t get to do anymore???? I’m not exactly sure how I got involved in organized medicine. Unlike a lot of people that I serve with in the American

By Keith Baldwin, CEO SCMS

Academy of Family Physicians they became very active as students

Please introduce yourself

and residents. I didn’t. I went into medical school planning to be

I am Glen Stream - family doctor. My primary identification as a

a family doctor. I never even remotely swayed in my thinking from

person is being a doctor. I am originally from Seattle, WA, born

that not being what I wanted to do. I think a lot of medical students

and raised there. I did all my medical training there. I went to the

that are active in our academy have that same perspective, but I

UofWA, undergraduate and medical school and did my residency

think some of them are also testing the waters – what’s it be like to

at Swedish Hospital in Seattle. At the time I was interested in rural

be in Family Medicine? What would my professional community be

practice, so when I finished my residency I practiced in Cashmere, a

like? So they interact with the Academy to see what that would be

little town between Wenatchee and Leavenworth. I practiced there

like for their professional future and that just wasn’t the case for me.

at a small practice for six years before I moved to Spokane and have

And I wasn’t involved as a Resident either. I was just busy trying to

been here almost 20 years with Rockwood Clinic.

learn medicine.

With Rockwood, I originally started in the Valley Satellite. When

I went to my first meeting right before I finished my residency

I started I didn’t have any particular computer training, but I was

program. When I started in practice and I was new to the

always interested in computer “stuff.” In February, it was 11

community, so I got involved. That was in Chelan County. I got

years that Rockwood created a position for Medical Director of

involved in the County Medical Society and the local chapter of the

Information Systems. It started out as a .1 FTE and grew from there.

Family Medicine Academy. I was president one year and at that

I’ve been doing that for 10 years now.

time our annual meeting for the state academy rotated around.

In 2007 I finished a Masters Degree in Bio Medical informatics. I look

I became involved in planning the annual meeting. We had a

at it that I can bridge the clinical world that I have a lot of experience

successful meeting so I was punished by then planning the next

in with the IT world. You hear a lot of complaints from physician users

eight meetings for the state.

about information systems - that it doesn’t flow or that it doesn’t

And that’s how you got more involved in the national level then

work like my brain works in medicine. What a physician informatician

was by working at the state level?

can do is take the best of what was the paper workflow and how information looked and make it work better in a computer system.

It’s very similar to what a state Medical Society would be compared to the American Medical Association. I never really intended to

I’ve heard that a number of times that when you go to an IT based

be that involved in the National Academy. Two things made that

system of any kind, you need to look at the functions that are

happen. One is someone asked me to run from the Nominating

related to that. Is that a part of the training?

Committee for alternate delegate from WA State to the American

The function, the workflow and then the information representation

Academy. When my Academy asks me to do stuff I usually say yes.

piece – for those of us who trained in a “paper world” time you are

I’m learning how to say no.

used to looking at a paper chart with tabs and things in a specific

I started attending those meetings. Even then I didn’t have any

place. The computer is organized differently, but it can represent

intention of running for the board or be an officer. Part of it is when

some of that information flow.

you are the “newbie” you see people who served and have done

And you have applied that at Rockwood in what way?

amazing things and I didn’t foresee myself as having the credentials

I persistently pestered our group until they agreed to implement

some ways and covert in others, but you are mentored along and

electronic medical records. We weren’t at the early wave of adoption like other people in the Medical Society effort where they did a RFP in 1998 or 1999 and the server farm was started at the Heart Institute, first groups went on line as the Physicians Clinic and Hearts NW I think were some of the earlier groups.

We at the time were wrestling with significant Y2K issues as far as our practice management system and had to replace that. There wasn’t as much experience in doing Electronic Medical Records in large medical groups so it was a bigger leap for a bigger group. In ’05 we made the commitment to go forward and went live in 2006.

in my own mind to do that. Though there’s a process. It’s overt in you do some formal leadership training. You learn from example of how other people lead an organization. I still was never really thinking about it until the leadership of the academy did something that really upset me.

You have two choices. Either you just accept it or you do something about it. I didn’t feel that my academy was representing me in a way that I thought was very important to me, so I decided to run.

So your current position now is President- elect of the American Academy of Family Physicians and your obligations right now are

So we’ve been live for about 4.5 years. Not as long as some but

that you are on an executive committee, a board?

we are ahead of the poor people trying to adopt next year to be

Meaningful Users on day one.

March SCMS Message 9

Continued on page 11

March SCMS Message 10

Continued from page 9

shortages to take care of people. We need those components

I just finished a three-year board term. There is a Board of Directors of 17 for the American Academy. Three at-large members elected every year for three-year terms, and then we have President-elect,

of legislation that promote medical student and postgraduate education that allow people to come out of training without quite so much debt that they have to choose a subspecialty that can pay off their debt. Hopefully this will encourage them to go into rural and

President, Immediate Past President, Speaker, Vice Speaker,

underserved areas. As we know in eastern WA we have vast areas

student, resident and new physician board members. Those are very important constituents for us. In Family Medicine we are really concerned about the pipeline of new physicians entering training,

where if one or two doctors retire there is nobody for a hundred miles in any direction. So it’s a challenge.

that are going to practice Family Medicine, especially those who

So based on those really important issues, if there were a couple of

are going to practice in rural and underserved areas. We as an

things you would tell your colleagues personally, what would those

academy make a very concerted effort to reach out our residents,

be?

students and new physician constituency to get their input about

It’s so challenging when people work so hard every day and they

what’s important to them for the specialty and for their specialty

don’t necessarily have time at the end of the day to plan their

society. In September I was elected President-elect. I serve on a board of directors that meets four or five times a year for four or five days at a time. We have a board agenda that is not uncommonly

One is the Meaningful Use requirement. There are a lot of people

Out of the 1000 pages what are two or three really important

still practicing and who say”I’m going to retire before I have to use

items you hope to accomplish this year?

a computer.” I would tell them that day is 2015, because starting in

We have four main strategic objectives –

2015 if you don’t have a certified electronic medical record and use it in a meaningful way you can’t get paid the same amount under

1. Advocacy for the specialty

3.

4.

struggling to get by and so in order to be able to see the future and prepare for it is challenging. I think there are three big areas.

1000 pages. You learn to read fast and have a lot of email.

2.

future. If you’re in a one or two or three doctor office, you are just

Medicare as other people. Certainly private insurances are going to

Education

follow that.

Practice enhancement which is practice transformation

-

My personal prediction is that it’s probably 10 years and you won’t be

Medical Home, Meaningful Use, Accountable Care and

able to practice medicine without an electronic medical record and

quality initiatives.

be able to bill insurance companies. It’s just going to be an assumed

Health of the public, as family physicians we are very

infrastructure. I may be right or wrong, but I think I’m right; it just

concerned about tobacco abuse and obesity, safety things like seat belts and bicycle helmet use those sort of public health advocacy efforts.

Primarily if you ask what the biggest thing for the coming year is, I think it is implementation of the Health Care Reform Legislation.

It’s pretty high on everyone’s agenda - understanding it or changing it or trying to implement it? What seems to be the direction?

may be a matter of time line. I think it’s really important to not see that as something onerous just being imposed on people but there is an important overlap between the practice transformation that I think family medicine as a specialty sees as important to its future and that’s pretty much the medical home transformation.

That is not just relying on people to come in when they are sick and treat whatever it is they come in for or they come in for a physical and you treat certain things, but to really take responsibility and accountability for a population of people that your practice serves.

All of the above! In 2700 pages I don’t know of anybody who

If your 50+ year old patient has never had a colonoscopy, you make

understands it completely. It has many small parts that were

some outreach to them. You try to get them colon screening to

“smooshed” together in the typical legislative sausage making

reduce their risk of colon cancer. Preventative screening for women

process. So there are parts of it that are clearly good for our

is probably the area people have done the best in the past (pap

healthcare system and family medicine. There are parts that could

smears and mammograms), but for other things we don’t do very

be better. There are major gaps in what people thought should

well for reminders.

have been there, our academy feels that way. Particularly, there was no long-term fix to the SGR that is a critical issue to all of medicine, not just family physicians.

The biggest burden on our healthcare system is from chronic diseases such as hypertension, hyperlipidemia, diabetes and asthma. If you could get people with those diseases to get better

There was no really meaningful medical liability reform. There are

healthcare and better management of their chronic diseases, you

some pilot projects but no one knows what those will do, but those

enable them to get better health and you have enormous impact on

are two really important issues for physicians. I think preserving

the cost of healthcare.

those parts that we find to be beneficial for primary care particularly around workforce. Granted there are loan forgiveness programs that encourage people to enter primary care specialties so not just family medicine but general internal medicine, pediatrics, general surgery are the areas where there are impending critical manpower March SCMS Message 11

Continued on page 22

March SCMS Message 12

Medical School Steering Committee Report to the Membership

However, the vision of this project is becoming better defined, and extends far beyond providing more doctors for our region.

The vision for what is now being called an “Academic Health Sciences Center”, all on the Riverpoint campus, includes the following: • A four-year medical school expanding the University of

By Gary Knox, MD

Washington/Washington State University medical education

For the last year we have focused much attention on the audacious goal of developing a four year medical school in Spokane on the Riverpoint Campus. This article will update you on the progress of the steering committee.

Keith Baldwin and I were asked to represent the Spokane Medical Society on this committee, which is co-chaired by Dr. Elson Floyd, president of Washington State University, and Scott Morris, CEO of Avista Corporation. Other members of the committee are Drs. Deb Harper, John McCarthy and Suzanne Allen of WWAMI/U W School of Medicine, Bill Gilbert, CEO of Deaconess Medical Center, Dr. Andy Agwunobi of Providence, Drs. Brian Pitcher and Brian Slinker of WSU, and several local business leaders including Rich Hadley of Greater Spokane Incorporated.

The committee recently received an interim report from the consulting firm of Tripp Umbach that is developing a white paper that will guide the business plan and activities of the committee over the next two years or so. Tripp Umbach has already delivered its report of the projected financial impact on the region of developing a medical school here, and was received with great excitement by the business community. But, the committee also continues to focus on the clear benefit to the region of an academic and research center that will provide doctors to our region for many years to come. The need to develop a steadier pipeline of health care professionals for our region has been clearly outlined by several studies of the manpower shortage in health care.

partnership, and expanded residency programs • Dentistry programs • A four-year pharmacy college • Nursing programs (bachelors’ through doctoral degrees) • Public health programs • Allied health programs, such as exercise and nutrition • Partnership among a number of higher education institutions and the health care and biomedical sectors.

The business plan for the Academic Health Sciences Center will be fully developed by the end of February. But, our “best laid plans” depend entirely on the obtaining the necessary funding for a new building and maintenance support. We have strong verbal support from all of our local legislators, who nearly universally tell us this project is their “top priority”. Still, the steering committee, the SCMS, and Greater Spokane Incorporated will all continue to advocate for more than just verbal support.

The committee continues to move forward with a sense of guarded optimism, buoyed by the excitement of being part of a project that, when completed, will have a huge positive impact on our whole region for many years to come.

March SCMS Message 13

The Growth in Residency Training Conundrum

By John McCarthy, MD UW School of Medicine Assistant Dean for Regional Affairs & WWAMI Clinical Coordinator for Eastern & Central Washington For some time, I have known that Graduate Medical Education development (residencies/fellowships) was complex and intricate.

Since chairing the University of Washington’s Regional GME Expansion Committee for Eastern and Central Washington, I have been especially impressed with the ever increasing complexity and difficulty in creating our future physicians in this current climate. Not only is it expensive for a community, hospital, or university to create physicians, it is incredibly complicated to maintain the quality of education that we demand in having physicians who will take care of ourselves and our families.

In order to advance a quality residency (and “quality” is a very important descriptor here), there is a significant amount of infrastructure involved. The residency directors in this community work diligently to maintain excellence in training. It entails gathering committed, mostly volunteer faculty who appreciate the value of teaching tomorrow’s physicians. This is a difficult process as issues of finances become tighter and the margins even thinner. I encourage you to be thankful for the work they do to enhance the physician that comes out at the end of the educational process.

The cost of moving residents through the system is profound and born on the back of the sponsoring institutions, e.g. the hospitals. Residents do not make money for a system, even with the governmental subsidies (the monies for Indirect Medical Education/Direct Medical Education reimbursement through “the caps”). Residents tend to cost institutions (very roughly) in the neighborhood of $150,000/resident/year! You can do the math for a 6/6/6 program and appreciate the commitment that our hospitals have to the future physicians in this community.

Obviously, there is some benefit to the institutions in the ability to have more patients taken care of, night hours covered, prestige of working with cutting edge training and education, and ease of recruiting. But as the fiscal realities hit our hospitals, it hits our training programs and it impacts our abilities to develop more resident positions.

I believe that within the current economic state, the Federal government will be slow to come to the rescue. Deaconess and Sacred Heart hospitals will not be able to increase amounts received from government subsidies even with the re-allocation of “caps” that we have all heard about. So any growth in these hospitals will need to occur without any government subsidies unless some unknown changes occur. It is a tough environment for conceptualizing quality growth, and yet we are looking at attempting to grow both Undergraduate Medical Education (medical students/school) and GME. The GME Expansion Committee has had the benefit of working with Huron Consulting Group for the last three months and has had support from the University of Washington, Washington State University, Providence Sacred Heart, CHS Deaconess, Greater Spokane Incorporated, Spokane County Medical Society, all of the local residencies as well as physician leaders in Wenatchee, Yakima, and Kadlec Hospital in Tri-Cities. The need for growth is a region-wide issue which needs a region-wide solution. I encourage you to maintain connection with this process and continually ask these questions: • “How can I help make sure my patients and their children will have excellent quality care in the future?”

• “How can I help make sure that deserving students in our communities can get into our medical school and residencies as opposed to having to leave the community for their education?”

We continue to work hard to educate our future physicians and ask you to be ready to support teaching, medical schools, and residencies when the inevitable ask comes. Our students and residents deserve the highest quality education that we can bring forward and we appreciate your investment in this process.

To further complicate this issue, the above cost per resident training is IF there is “cap” support from the federal government.

At a simplistic level, this community has funding for about 72 residents, enough to produce about 24 new doctors a year. If we add in the Yakima and Colville programs, the number increases to around 30 new physicians being produced in Eastern Washington.

Let me assure you, that is not enough to maintain our current needs much less plan for a future that includes a baby boomer population that will have high medical demands. Our needs are real, becoming more immediate, and more profound.

March SCMS Message 14

Washington State’s Medical Home Pilot Encourages PatientCentered Primary Care

system in a five-county region. All eight major health plans in the state are participating, including Aetna, CIGNA, Community Health Plan of Washington, Group Health, Molina, Premera Blue Cross, Regence BlueShield, and United Healthcare.

The current fee-for-service payment system, which compensates providers each time they provide a service or see a patient, is ineffective in rewarding quality and value. The kinds of changes that would improve the quality of care for patients take time and resources that are not fully provided for within the current reimbursement system.

such as care coordination, increasing flexible access to care, tracking and monitoring chronic conditions and doing preventive outreach or follow up planning. Primary care practices that participate in the pilot will share savings if they can reduce preventable ER and hospital admissions while maintaining or improving quality care in a number of areas such as care for chronic conditions like diabetes, heart disease and depression.

In this pilot, primary care practices may receive an additional monthly fee per patient to support work that normally does not get reimbursed in a fee-for-service payment model,

The Washington State Multi-Payer Medical Home Reimbursement Pilot is testing alternative reimbursement approaches that compensate providers more if they achieve specific, targeted outcomes. It is designed to give patients more timely, coordinated care through advanced primary care. The pilot will last three years and is expected to launch this spring.

The pilot program is being led by the Washington State Health Care Authority and is co-sponsored by the State Medicaid program and Puget Sound Health Alliance, a nonprofit organization where the people who get, provide and pay for health care come together to help drive change in the health care

Fourteen practices have been selected preliminarily, and they are expected to serve patients covered by any of the eight health plans participating in the pilot. In the coming months, the roster of clinics will be finalized, contracts with participating plans will be completed, and preparations made by all entities to implement the program.

For more information about the medical home pilot, please contact Reena Koshy, MD, project coordinator for the pilot, at reenakoshy@gmail.com.

Physician Health is Important.

Eastern Washington Physician Health Committee We are available to assist you in the following areas: • • • • • • • • •

Marital and Family Issues Death of Spouse or Family Member Drug/Alcohol Misuse Lawsuit Education and Support MQAC/OSTEO Board Issues Boundary Issues Disruptive Behavior Elder Care Practice Management

This committee, a fusion of the former SCMS committee and one including members of medical staffs of Community Health Services and Providence Health Care Hospitals, meets quarterly to educate ourselves about physician health issues, review utilization and satisfaction with the Wellspring Early Assistance Program (EAP), and plan activities, programs and resources to address needs in these areas. Some of the guiding principles of this committee are: The medical profession and healthcare community should foster physician well-being A sense of community with one’s peers is vital to personal well-being Changes in the healthcare environment and contributing to personal and professional challenges and new stressors for physicians Physicians should have resources available to them to anticipate and manage episodic personal issues

COMMITTEE MEMBERS Jim Shaw, MD, Chair 474-3097 Steve Brisbois 927-2272 Michael Metcalf 928-4102 Paul Russell 928-8585 Phil Delich 624-1563 Michael Moore 747-5141

Robert Sexton 624-7320 Jim Frazier 880-0025 Mira Narkiewicz 889-5599 Patrick Shannon 509-684-7717 Deb Harper 443-9420 March SCMS Message 15

Sam Palpant 467-4258 Alexandra Wardzala 448-9555 Mike Henneberry 448-2258 Tad Patterson 939-7563 Hershel Zellman 747-2234

Care Coordination Model for Adult Type 2 Diabetes

center around three groups of care coordination triggers: clinical, care coordination and care transition. See Table 1.

Beacon Community of the Inland Northwest

By Daniel Hansen and Jennifer Polello The Beacon Community of the Inland Northwest (BCIN)1, a chronic disease management project focusing on adults with type 2 diabetes, is utilizing a health information technology foundation to enhance clinical patient outcomes. The project utilizes various technologies including Health Information Exchange (HIE) and disease management applications accessible through interfaces with ambulatory care and hospital electronic health records systems (EHR). The BCIN work groups are comprised of various key stakeholders from across the region and have assisted in defining use-cases of data exchange involving diabetes clinical encounters from multiple health care providers across the patient care team. The disease management application operates on data from various members of the care team, whether the data is from ambulatory care, specialty care, hospital, laboratory, pharmacy or the diabetes care coordination team.

The functionality of the BCIN care coordination model is based on the Patient-Centered Medical Home (PCMH), which has gained momentum in recent years for disease management issues. Key members of a primary care or specialty care practice are identified to receive BCIN care coordination training through a three-stage training program using proven PCMH change concepts, including quality improvement and performance measurement. The methods and structure of training is provided through the Washington State Department of Health, Medical Home Collaborative.

Care coordination is supported with Clinical Decision Support (CDS) elements within the BCIN chronic disease module.

Reminders, tasks and alerts are activated based on the triggers listed above. The CDS elements are designed consistent with prevailing national standards through the National Quality Forum.

Office-based case managers and care coordinators that don’t already rely on clinical decision support will be able to utilize this solution with patients with diabetes that are part of the BCIN program. Offices that do not currently provide case management and care coordination services can receive BCIN diabetes care coordination resources offered by the INHS CHER Diabetes Center. (See Table 2) The BCIN project can assist physicians in the primary care, specialty care and hospital settings by providing workflow integration that is vital for optimizing care for their adult patients with type 2 diabetes. The enhanced value for those same practice settings is the interfacing of the facility’s EHR/EMR into a health information exchange that facilitates timely clinical decision support, meets emerging “meaningful use” requirements and prepares the practice for the future of health care.

For more information and how to get involved with the Beacon Community of the Inland Northwest, please contact Diane Lenier at (509) 590-6611 or lenierd@inhs.org or visit www.bcin.inhs.org.

Daniel Hansen, DC, and Jennifer Polello, MHPA, CHES, are coteam leads for the BCIN Care Coordination Team.

BCIN care coordination for adult patients with type 2 diabetes will

Table 1: Sample Triggers for Ambulatory Care Workflow in Adults with Type 2 Diabetes Clinical Triggers • Adult T2 DM with most recent HbA1c value ≥ 9.0

Care Coordination Triggers

(poorly controlled)

• Patient non-compliance with treatment plan • Consultant reports not otherwise available

>100mg/dL

•

• Adult T2 DM with most recent LDL-C level is • Adult T2 DM with most recent blood pressure reading > 140/90 mm Hg • Adult T2 DM who had an eye screening for diabetic retinal disease • Adult T2 DM with most recent foot exam abnormal

• • •

through HIE Changes in medical management by self-report or pharmacy Notice of recent ER visit or in-patient hospitalization Out-of-range clinical laboratory or other diagnostic test Risk factors not otherwise noted, e.g., tobacco use

Transition of Care Triggers • Accountable provider identified at all points of care transition

• Care planning (including advanced directives) • Medication reconciliation (including patient & family)

• Test tracking (laboratory, radiology, & other diagnostic procedures)

• Tracking referrals to other providers or settings of care

• Admission and discharge planning • Care team process: Tracking follow-up

appointment with Primary Care Provider

Table 2 : Sample Set of Case Management and Care Coordination Work Flow Tasks for Adults with Type 2 Diabetes Case Management Tasks

Advanced Care Coordination / Education Tasks

• Identify any clinical standards out of range (e.g., NCQA, ADA, NDEP) • Adjust diabetes related medications as needed to meet clinical goals • Adjust other co-morbid medications as directed • Patient Individual Needs Assessment including: clinical , socioeconomic, environmental, and patient level of compliance, cooperation and accountability

• Care Coordination Assessment and Plan • Diabetes Self Management Education • Weight Management & Medical Nutrition Therapy • Medication Reconciliation • Behavior Modification, Lifestyle Coach/Motivation • Transition of Care and Post-discharge Coordination

1

The Beacon Community of the Inland Northwest is funded by a Cooperative Agreement from the Office of the National Coordinator, Award No: 90BC0011/01, CFDA:93.727.

1

National Quality Forum (NQF), Driving Quality – A Health IT Assessment Framework for Measurement: A Consensus Report, Washington, DC: NQF; 2010.

March SCMS Message 16

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

R iverpoint P

H

A

R

M

A

C

Y

Your treatment. Custom designed.

(509) 343-6252 | 528 E. Spokane Falls Blvd. #110 www.riverpointrx.com

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

»

cancercarenorthwest.com

» 509.228.1000 March SCMS Message 17

comprehensive innovative compassionate integrated

The Importance of Medical Informatics to Preserve Community-Wide Cooperation

By Deb Wiser, MD Medical Informatics Committee Chair Picture a swirling economic downturn of cyclonic proportions converging on a rapidly growing patient population that lives longer and struggles to manage chronic disease. The forecast is for more strain to an already weakened, poorly organized healthcare system. It’s truly a healthcare quality “chasm” as the Institute of Medicine coined it, promising more inefficiency and even greater risk of harm unless there are significant improvements to community-wide care coordination and information sharing.

Last week, I met "Mr. Smith" for the first time in my clinic. He is a 60ish male with that classic metabolic history of diabetes, hypertension and hyperlipidemia. The clinical questions stack up even as he walks in the door, such as "why glimepiride instead of metformin?," or "what was his last A1C", and "last colonoscopy?...I had that camera thing on my backside maybe 4 or 5 years ago.. with some doc up the hill". Only in the last week, we have seen several Mr.Smiths. The reasons for changing providers are mostly economy related, such as losing and regaining insurance, changing jobs and subsequently insurance, or losing access to a prior physician for payment defaults. In every case, we do not have access to the vital patient data that will best help us care for our patients, such as prior medications, allergic reactions, lab values, and prior testing. This can cost the system much more in testing and evaluation, in return visits to follow-up labs, and in staff time to find the information.

Early efforts to correct these gaps in patient health information centered on the software and hardware that made both electronic health records (EHRs) possible and vital medical data accessible to caregivers. This meant we could better exchange information within an organization. Now, the process of EHR exchange is receiving increased attention, so that we may exchange information as a medical community. The Informatics Committee was originated with similar goals, and the hospitalbased Meditech system and INHS came partly out of that leadership. That system was exemplary for the region's ability to share information among hospitals and disperse it to clinics. Now that we may lose some of this ease of information sharing with Providence changing to Epic, the information-sharing concept is vitally important in the Beacon project. Keeping the community focus is increasingly important as we discuss such imperative issues as accountable care organizations, medical home models, the “meaningful use” of health information and how data can best be shared and utilized across organizations, among providers, and throughout communities.

In this year’s whirlwind of change, the Spokane County Medical Society’s Medical Informatics Committee hopes to serve as a central clearinghouse for new developments in health information technology (HIT). But, as in years’ past, we also wish to assure that organizations with apparently diverse and often competing interests continue to exchange information to the improvement of health in our community. As a committee we recognize the importance of technology; but more importantly, the need to build and nurture relationships to preserve crucial access to patient care information. We welcome members of the community to the committee and any insights or suggestions you may want to contribute.

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

March SCMS Message 18

An Introduction to the New Project Access Director

to us by our volunteer physicians and hospital services. The better we manage and support our volunteers . . . the more patients we will serve . . . the more lives we will change . . . the more we will leverage our investment dollar.

By Lee Taylor PA Director

One thing is certain, there will be change. We will become more efficient and even better stewards of our donated investment dollars. I look forward to working with volunteer physicians and their offices, the clinics and doctors’ offices that refer our patients and Project Access staff to accomplish those positive changes.

We will keep our partners informed of changes that may impact our working relationships.

I am the “new guy” at Project Access. My goal is to combine many years of business experience and practices to this organization in a way that will maximize the efficiency of our service delivery.

I also have experience directing nonprofit organizations, so I am very sensitive to the need for Project Access to be prudent with the donations of time and talent of our volunteer physicians. My management experience taught me many lessons in fiscal responsibility that will be used to maximize the good work Project Access can do to help the patients that desperately need medical services.

It is an amazing opportunity to work with so many people who know so much about efficiently delivering healthcare services.

Remember, I am in the learning mode. I am learning how to help our staff, the volunteer physicians and their offices, and our patients. If you have good ideas that you would like to share to help make Project Access even more valuable in our community, please call me at 220 2651 or email me at lee@spcms.org.

I am in the mode of learning as much as I can about what we do well and what we can do better. I am very excited about the value we create for our community -- matching low-income uninsured patients who need specialty health care services, with specialty physicians who volunteer to help their fellow human beings. And, I am very optimistic about what we can do additionally to create more of those amazing matches and create even more value for our community.

It is clear to me that the key to ensuring that Project Access is a sustainable organization is in the degree to which we leverage our operating funds to deliver services to our most needy citizens. Over the past seven years Project Access has helped deliver $30 million of donated physician and hospital services to Project Access patients. Facilitating the donation and delivery of that vast amount of medical services that have changed the lives of thousands of people in our community is a wonderful accomplishment. Project Access accomplished this by leveraging donated dollars to engage and support our physician volunteers.

For every one dollar invested in Project Access, we delivered an average of $8.57 in medical services. That is HUGE! There are very few organizations that can create that much value for each dollar invested.

One of the primary ways of doing this is to be very focused on where Project Access truly adds value and provides services that are not available from other sources. Project Access will be totally focused on facilitating and organizing the linkage of patients with volunteer physicians. The success of Project Access is absolutely dependent upon how we manage the amazing resources donated

March SCMS Message 19

Community of Professionals Program - New Name, New Program!

By Keith Baldwin, SCMS CEO The Spokane County Medical Society Circle of Friends program is NOW the Community of Professionals. After some significant development work with our current Partners in the Community of Professionals program, and communication with our healthcare providers in town, including SCMS members, we have officially changed the name and functions of the program.

of the community to support recruitment and retention of medical and educational professionals by building community based relationships and supporting individuals with their professional expertise upon request. They have developed an inventory of personal and professional interests which allows SCMS members, hospital systems, higher education entities and others, to introduce recruited physicians, students or residents, to these Community of Professionals partners to help build relationships and/or provide access to their professional expertise based on interests or needs.

Our current Partners in the Community of Professionals program include Sterling Savings – Private Banking 111 N. Wall St. Spokane, WA 99201 (509) 363-2448 Fax: (509) 358-6152 Keith Kristin Nancy Hoke

The changes are occurring because the SCMS is committed to supporting the goal of a four-year medical school in Spokane, along with expanded and new graduate medical education (GME) programs in our community. The ultimate goal is to retain physicians after they have successfully completed their medical education in Spokane and the Inland Empire community to increase the number of physicians, especially in primary care (Family Practice, Internal Medicine and other specialties). The location of a physicians’ educational experience has shown to have a significant influence over where physicians choose to practice medicine after their training is completed.

US Bank Private Banking PD-WA-T12R 428 W. Riverside Ave., Ste. 700 Spokane, WA 99201 Dave Walker John Bumgarner

The goals of the Community of Professionals program are as follows:

Witherspoon Kelley 1100 US Bank Building 422 W Riverside Ave Spokane, WA 99201 (509) 624-5265 Fax: (509) 458-2728 Mary Giannini Greg Embry

• Make the SCMS members and their staff aware of competent and trusted professionals that they can call upon to support their practices and staff for operation and service functions.

• Enhance the recruitment and retention of medical and educational professionals in our community by entities such

UBS – The Prewitt Group 601 W. Riverside Ave, Ste. 1200 Spokane, WA 99201 (509) 622-0609 Fax (509) 623-1306 Travis Prewitt Brad Desormeau

as multi-specialty or single specialty group practices, hospital systems, research facilities, and faculty and students for graduate medical education and training programs.

• Significantly elevate the number of long-term relationships and opportunities for collaboration among Partners with the Community of Professionals program to benefit our entire

Fruci & Associates 218 N. Bernard St., Ste 200 Spokane, WA 99201 (509) 624-9223 Paul M. Fruci Paul R. Fruci

community.

Another significant factor that influences a physician’s decision is the relationships developed with other physicians and professionals in the community during their educational experience. Those relationships can be related to lifestyle and practice choices, e.g. recreational activities, proximity to extended family, children’s activities, spouses’ needs for career mobility, specialty, group size, system affiliation and research or faculty opportunities. To begin to support the development of professional relationships that enhance and support all of those choices, the SCMS has expanded the scope of the Community of Professionals program.

Please contact Keith Baldwin or Michelle Caird at (509) 325-5010 or email Keith at keith@spcms.org, or any of our Partners with questions or comments about the Community of Professionals Program and their partnership with the members of the SCMS.

The competent and trusted Community of Professionals, in partnership with the SCMS, has agreed to act in the best interests March SCMS Message 20

A Multidisciplinary Approach to Improving Quality of Life.

Physical Medicine & Rehabilitation Psychology Interventional Spine Pain Medicine EMG/NCS Jamie Lewis, MD Phone: 509.464.6208

Patricia Fernandez, PsyD

Fax: 888.316.1928 March SCMS Message 21

Spokane, Washington

Continued from page 11

looked to, to contribute to their greater world. I think that society invests in us. People talk about what it costs me in tuition to go to

And that doesn’t happen if you just wait for people to come in. The electronic record part of that allows you to have a registry function, with reminders and prompts to do things, pre-visit preparation

medical school, but often don’t have an understanding that that’s actually a small fraction of what the world invests in us to allow us to be physicians. It’s a privilege and I think we owe something back.

before someone is coming in and you can see that they haven’t

People can choose what forum or venue that is. Certainly not

had their mammogram and their pneumonia shot. You in advance

everyone needs to be a leader in their medical specialty society

know that those are agenda items for that visit, no matter what the

(although I’d like them to send in their dues so you and I could do

person is coming in for. I always tell patients, “we talked about

our work), but for them to find where they can make a contribution

your two things, now we get to talk about my two things.” These

and to put in the effort and not get discouraged. Change tends to

are the things I think are important. I think that part of that is

happen slower than we like. I think that is a frustration for physicians

engaging patients in their healthcare in a way they haven’t before.

– we’re used to seeing a boil and lancing it and the patient is better.

I think that for most of us the days of “whatever you think doc”

The boil, that is our healthcare system, is going to be a slow process

are long gone days. It’s that individual person’s health and they

and long hard work. You have to be in it for the long haul; you have

need to be an active participant and in making decisions about

to be able to see some positive in the incremental steps.

what they do or don’t want. The other big piece is the Accountable Care Organization transformation. I think for people who are in smaller practices – if you have one, two three, five doctors that have always been able to function independently and often are fiercely independent and proudly independent you need to respect them

Spokane Scholars Foundation 2011

for that but they need to realize the world is changing. It doesn’t necessarily mean they have to give up small practice but they have got to be willing in my opinion to collaborate and integrate with other practices to be able to function in the Accountable Care Organization world that most people think is coming. I think it’s really important that physicians are active in deciding how those organizations function. People are very apprehensive because they see it as a different acronym for HMOs. HMOs in a lot of people’s minds have a negative connotation, caring more about cost than quality of care.

There was a New England Journal article about ACOs being either hospital dominated or physician dominated. I would like to think we could all play nicely together and focus on what’s in the best interest of the patient and their healthcare and not about who controls the system. But physician input is absolutely critical.

Last parting words, I liked your comments about what you do with AAFP, you feeling responsible – something needs to be changed, you need to get engaged and provide that leadership. Do you have a comment for the rest of the medical world out there or what would you tell them to help them be more engaged from a leadership standpoint? Why is that important?

I think physicians are natural leaders. When you are a physician you are leading a healthcare team – nurses, pharmacists, physical therapists, so there’s a leadership characteristic I think that is inherent in most, if not all physicians, but not everyone has to lead in a medical specialty society or elected office. I have friends who are physicians who have been on school boards or are leaders in their church or in their community association. I think that physicians are

The Board of the Spokane Scholars Foundation (SSF) has announced that its speaker for the 2011 Annual Spokane Scholars Banquet is Mr. Ryan Crocker, former United States Ambassador to Iraq, recipient of the Presidential Medal of Freedom, and current Dean of the Texas A. and M. University’s George Bush School of Government and Public Service.

Mr. Crocker, a Spokane native, will present the keynote address on Wednesday, April 20 at the Spokane Convention Center.

According to Dr. Eric Johnson, Vice-President and co-founder of SSF, “There were banquets galore for athletic achievement; we wanted to create at least one comparable venue for scholarly excellence. The support by Spokane physicians for all 18 years of the Foundation’s existence has made this possible. Without the physicians and their families on board, we would have been unable to properly honor these incredible high school seniors.”

The annual banquet showcases the best of the best high school seniors from all of Spokane’s area schools, both public and private, presents each a personalized medallion, and awards significant grants to the top student in each of the academic categories of English, Mathematics, World Languages, Fine Arts, Social Sciences, and Science.

Dr. Johnson added, “What separates the SSF from other organizations and seems to makes it so attractive to physicians in particular is the underlying principle that recognition of academic excellence should be based on objective criteria.”

SCMS members are encouraged to attend. Banquet tickets are available by telephoning ALSC Architects at (509) 838-8568.

The website address for SSF is www.spokanescholars.org

March SCMS Message 22

POSITIONS AVAILABLE EMERGENCY ROOM PHYSICIAN POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time ER physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane. NorthEast Washington Medical Group consists of 27 providers that serve a surrounding area of approximately 30,000 in the very rural tri-county area. We offer flexible hours for an ER physician or FP physician with Emergency Room experience. Our ER physicians enjoy working in the new emergency department at Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ed Johnson, MD, ER Medical Director, via phone at 509-685-7831 or e-mail at edjohnsonmd@hotmail.com or Ron Rehn, DHA, Chief Executive Officer, via phone at 509-684-7723 or e-mail at rrehn@newmg. org. Mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville, WA 99114. Visit our website at www. newmg.org for more information.

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.

PHYSICIAN OPPORTUNITIES AT CHAS – At Community Health Association of Spokane (CHAS), we believe doctors should practice what they are passionate about: serving patients and the community. We are looking for physicians to join our great team!

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. Experience pure patient care at CHAS. 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

INTERNAL MEDICINE POSITION OPENING NorthEast Washington Medical Group is currently recruiting for a full-time (Monday through Thursday) Internal Medicine physician to join us in beautiful Colville, a rural northeast Washington community located 75 miles north of Spokane.

NorthEast Washington Medical Group serves a surrounding area of approximately 30,000 in the very rural tri-county area. This is an outpatient based Internal Medicine position with call. There is supporting physician call in Family Practice, OB, surgery, and orthopedics. Our clinic physicians have privileges at Providence Mount Carmel Hospital, a 25-bed, full service critical access facility with 24/7 ER and ancillary service coverage. This is an outstanding practice community located in the middle of a wonderful recreation area with limitless opportunities for outdoor activities. Qualified individuals should contact Ramon Canto, MD, Internal Medicine Medical Director, by phone at 509-684-7706 or Ron Rehn, D.H.A., Chief Executive Officer at 509-684-7723 or e-mail at rrehn@newmg.org. The mailing address is NorthEast Washington Medical Group, 1200 E Columbia, Colville WA 99114.

Visit our website at www.newmg.org for more information about Colville Medical Center P.S. PHYSICIANS- Are you looking to expand your clinical horizons?

Here’s an opportunity to serve your community and our nation’s veterans. We are looking for physicians to provide night coverage, weekends and holidays to do admissions and hospital coverage. 12 to 16 hours shifts are available. For additional information, please contact VA Medical Center, Jim Erickson, Administrative Assistant to the Chief of Staff, 4815 N. Assembly, Spokane, WA 99205. 509-434-7211. An Equal Employment Opportunity.

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)325-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatrician and BE/BC Family Practice Physicians to join us in Spokane. 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. Providence Physician Services (PPS) is our physician-led network of more than 100 primary and specialty care physicians in multiple clinic locations in the greater Spokane area. PPS physicians offer exceptional patient-centered care as a reflection of our Providence values. PPS partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital and Providence Holy Family Hospital in Spokane, and Providence Mount Carmel Hospital in Colville and Providence St. Joseph’s Hospital in Chewelah. Providence Physician Services is part of Providence Health & Services, a not-for-profit network of hospitals, clinics and physician partners in Alaska, California, Montana, Oregon and Washington. Providence has a proud 150-year history in the West, and we continue to grow with the communities we serve. With more than 300 physician opportunities in virtually all specialties, we offer physicians diverse lifestyle choices, flexible work arrangements and robust practice support. Learn more at www. providence.org/physicianopportunities or contact Mark Rearrick mark. rearrick@providence.org or April Mayer april.mayer@providence.org.

March SCMS Message 23

Continuing Medical Education •

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•

•

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Rural Physician Training Opportunity: Substance AbuseRural health care providers are invited to attend training on reducing opiate addiction in Spokane on March 29, 2011. The training is hosted by the Rural Opiate Addiction Management (ROAM) project. Attendees will learn about the use of buprenorphine, a medication that removes the craving for opiates. The training includes a certified eight hours of category I CME credits in addition to access to a variety of additional resources. For more information and registration, visit the University of Washington website at http://depts.washington.edu/fammed/roam or contact Roger Rosenblatt at rosenb@u.washington.edu or (206) 685-1361.

2011 Yakima Valley Medical Conference: This seminar is to be held on March 4 and 5 at the Howard Johnson in Yakima. The conference has been approved for 15 AMA Category 1 credits with sixteen regional specialists speaking.

For more information visit www.russocme.com or email russocme@gmail.com.

60 Minute Webinar: Reducing Health Disparities – Collecting Standardized Data This webinar will present a hands-on, practical approach to collecting and using standardized patient data about race, ethnicity and language to measure and reduce disparities in your practice. Marcia Wilson, PhD, and Christina Rowland, MPH, of the Robert Wood Johnson Foundation’s Aligning Forces for Quality Project will be co-presenters. Tuesday, March 8, 2011 – noon - 1:00 PM Free for medical groups, physicians or other care providers. $75 for all others. One hour of AMA Category 1 CME credit is approved; AAFP Preferred CME credit has been applied for and determination is pending. Registration: call Jenelle Dalit at 1-800-552-0612 or jcd@wsma.org.

Content or CPIN: call Lance Heineccius at (206) 956-3657 or Lance@wsma.org Innovating Through Engagement- topics will include healthcare reform, medical home, transitions of care, shared decision making and provider feedback. March 25, 2011 8:30 a.m.-4:30 p.m. The Westin Seattle Hotel Grand Ballroom 1900 5th Avenue, Seattle $75/person (includes lunch) Group Health Cooperative designates this educational activity for a maximum of 6.25 AMA PRA Category 1 Credits ™. Registration is limited and the deadline is March 11.

Details can be found at http://ghc.org/solutions/.

Update on the Management of STDs & HIV 2011 - The Spokane Regional Health District and the Seattle STD/HIV Prevention Training Center - two-day STD Update course March 24 and 25 at the Valley Hospital Health and Education Center in Spokane. This course provides training in the recent advancements in the epidemiology, diagnosis and management of viral and bacterial STDs, and was designed for clinicians who diagnose and treat patients with sexually transmitted infections. The University of Washington School of Medicine designates this educational activity for a maximum of 13.25 AMA PRA Category 1 Credits™.

Presenters include Dr. Jeanne Marrazzo and Dr. Devika Singh. Cost - $100. Seating is limited and pre-enrollment

by March 16. Visit www.seattlestdhivptc.org for online registration. Additional questions contact Alexandra Hayes, Health Program Specialist, Spokane Regional Health District at 509-324-1635 or ahayes@spokanecounty.org.

•

2nd Annual Pain Management Symposium 2011 – College of Medical Education – Pierce County Medical Society, Friday March 25, 2011 at St. Joseph Medical Center , Tacoma WA. The goal of the symposium is to promote a better understanding of the pathophysiology of acute and chronic pain and to enhance the knowledge regarding various chronic neuropathic pain conditions as well as to critically review the novel state-of-the-art interventional and non-interventional techniques in diagnosis and management of chronic pain. The College of Medical Education designates this educational activity for a maximum of 6 AMA PRA Category 1 Credits™.

For information contact (253) 627-7137.

Other Meetings, Conferences and Events.

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 Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery.

Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8 p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous personal sharing; No dues or fees. Guided by Drs. Bob and Carol Sexton. The contact phone number is (509) 624-7320.

2011 Compliance Program Update & OIG Enforcement Issues - Reduce your risk to your practice! Bob Perna, FACMPE is the Director of the Practice Resource Center for the Washington State Medical Association (WSMA)-. Thursday, March 31, 12:001:30 pm WSMA and WSMGMA members can attend for $89 per person. One registration fee per phone line lets your entire staff listen in. Non-members: Call for pricing. Contact Jenelle Dalit at 1(800) 552-0612 or HYPERLINK "mailto:jcd@wsma.org" jcd@ wsma.org for more information.

Save The Date – Saturday morning, May 21. “How to have fun teaching medical students!" The morning will include a chance to interact with medical students, information on teaching without impacting productivity and an introduction to the UW online library services. More information to come.

March SCMS Message 24

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 Chappell, John S., MD Pediatric Surgery Med School: U of Witwatersrand, South Africa (1960) Internship: Johannesburg Group of Hospitals/ U of Witwatersrand (1967) Residencies: Johannesburg Group of Hospitals/U of Witwatersrand (1967), Hospital for Sick Children (1968), Alderhay Children’s Hospital (1970), U of Washington (1971) Practicing with Pediatric Surgery Center since 2/2011 Goswami, Sushanta K., MD Internal Medicine Med School: Sri Ramachandra U, India (1986) Internship/Residency: Woodhull Medical and Mental Health Center (1996) Practicing with Sound Physicians beginning 3/2011 Maixner, Andrew H., MD Anesthesiology Med School: U of Washington (2005) Internship/Residency: U of Wisconsin (2009) Practicing with Anesthesiology Associates, PS beginning 4/2011 Messick-Laeven, Petra M., MD Pediatrics Med School: U of Amsterdam, Netherlands (1995) Internship/Residency: U of Utah (2000) Practicing with Pediatric Surgery Center since 1/2011 Nievera, Jr., Conrad C., MD Neurology Med School: U of the Philippines (1991) Internships: Philippine General Hospital (1991), St Francis Hospital (1993) Residency: Medical College of Wisconsin (1996) Fellowships: Indiana U (1997), (1998) Practicing with Rockwood Clinic, PS beginning 8/2011 Pidgeon, John S., MD Neurology Med School: Upstate Medical U (2003) Internship/Residency: U Hospitals of Cleveland (2007) Fellowships: U of Hospitals of Cleveland (2008), Detroit Medical Center (2009) Practicing with Rockwood Clinic, PS beginning 3/2011 Saw, Eng C., MD Surgery/ Thoracic and Vascular Surgery Med School: Loma Linda U (1969) Internship: U of Southern California (1970)

Residencies: Kern County Medical Center (1974), U of Southern California (1976) Practicing with Department of Veterans Affairs Medical Center since 7/2010 Webb, Joel D., MD Obstetrics and Gynecology/ Gynecologic Oncology Med School: U of New Mexico (1992) Internship/Residency: William Beaumont Army Medical Center (1996) Fellowship: Walter Reed Army Medical Center (2005) Practicing with Rockwood Clinic, PS beginning 6/2011 Wyrick, Jared J., MD Internal Medicine Med School: Medical College of Wisconsin (2005) Internship/Residency: Oregon Health and Sciences U (2008) Fellowship: Oregon Health and Sciences U (2011) Practicing with Rockwood Clinic, PS beginning 8/11

PHYSICIANS PRESENTED A SECOND TIME Christ, Constance B., MD Internal Medicine/Nephrology Med School: U of Illinois (1996) Joining Rockwood Clinic, PS beginning 4/2011 Cole, Debra A., MD Internal Medicine Med School: U of Arkansas for Medical Sciences (1982) To begin practicing with Rockwood Clinic, PS Damsker, Keith E., MD Internal Medicine Med School: Hahnemann U (1997) Practicing with Rockwood Clinic, PS since 1/2011 Ionescu, Raluca M., MD Internal Medicine Med School: Carol Davila U, Romania (1991) Practicing with Rockwood Main Clinic since 1/2011 Ionescu, Serban I., MD Internal Medicine Med School: Carol Davila U, Romania (1991) Practicing with Rockwood Medical Lake Clinic since 1/2011 Kalisvaart, Jonathan F., MD Pediatrics Med School: Baylor college of Medicine (2004) Practicing with Providence Physician Services Co dba Pediatric Urology beginning 8/2011

PHYSICIAN ASSISTANT Quinlan, Linda A., PA-C Physician Assistant Med School: U of Washington, Medex Northwest (1999) Practicing with Inland Neurosurgery and Spinae Associates, PS since 6/2000

March SCMS Message 25

REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 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.

FOR SALE with Lease Option. MUST SEE!!! Beautiful custombuilt Lake home with attached “daughter house.” Main home has two bedrooms, two baths and complete office. Rock Garden, private driveway with security gate, two car garage, AC, wood floors, central VAC, fireplace, washer & dryer. “Daughter” house includes 2 bedrooms, 1 bath, office and separate carport. Lease option - $1,200 for main house; $800 for in-law suite or $2,000 for both. Country living but close to Cheney and Spokane. Contact Jerry Krause, jerrykrause3@aol.com or krausej@athletics.gonzaga. edu or cell #, 509-280-8179.

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 Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available December 2009. 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. $24 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 fullservice medical building with lab and full radiology services. For more information, call (509) 981-9298.

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.. Floorplans 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.

MEMBERSHIP RECOGNITION FOR MARCH 2011 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.

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.

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

60 Years Bert P. Jacobson, MD

3/8/1951

20 Years Guy E. Katz, MD

3/20/1991

Karen A. Wohlen, MD

3/20/1991

10 Years Charles D. Brickner, MD

3/14/2001

Pamela G. Burg, MD

3/28/2001

March SCMS Message 26

In The News Two Northwest MedStar Employees Appointed to the Governor’s Steering Committee on EMS and Trauma Services Annmarie Keck, clinical nurse educator, and James Nania, MD, medical director, of Northwest MedStar were recently appointed to the Steering Committee on EMS and Trauma Systems by Washington Governor Christine Gregoire.

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2011 Program Schedule

APRIL Update in Pain Management Thursday, April 28, 5:30 - 9:15 pm Evening Seminar for the Primary Care Update Conference Red Lion Inn at the Park (Two one and one-half hour topics will be presented) JUNE Endocrinology Update 2011 Wednesday, June 8, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

This governor-appointed, 30-member committee consists of healthcare representatives from across the state that provides guidance and direction to the Washington State Department of Health (DOH) in its development of the trauma system and EMS and trauma care needs throughout the state.

These appointments come in light of the passage of the Cardiac and Stroke System Bill (SSHB 2396), signed by Governor Gregoire on March 15, 2010, directing DOH to support an Emergency Cardiac and Stroke System similar to the Trauma System, effective

by June 2011. Because of their background in cardiac and stroke procedures, Keck, Nania and other health care professionals from around the state will be involved in the oversight of the new cardiac and stroke system statewide as members of the committee.

This is the first appointment for Keck, and second for Nania who previously served for 6 years. These appointments highlight the important role that Northwest MedStar continues to play in the continuum of critical care and transport to help meet the timeframes associated with the cardiac and stroke protocols.

WSMA Board Position Appointed; Nominating Committee Approved The WSMA Board approved appointment of Dr. Donna Smith (Seattle, Ped), to fill the board seat vacated by Dr. Brian Seppi (Spokane, IM,) who joined the WSMA Executive Committee last fall to fill an unanticipated vacancy. It also appointed the following physicians to the Nominating Committee: Drs. Harold Dash (Everett, CD); Stuart Freed (Wenatchee, FP), Thomas Fairchild (Spokane, U), Gregory Schroedl (Seattle, EM), and William Hirota (Tacoma, GE/IM). These members will serve two-year terms. The committee will be chaired by WSMA Past President Deb Harper (Spokane, PED).

Requests for suggested nominees for WSMA officers and trustees will be going to specialty societies, county societies and large medical groups in mid-March. The committee will meet in May and construct a roster of nominees for election at the WSMA Annual Meeting in September. For information on this process please contact our Director of Administration Shannon McGeoy at slm@wsma.org.

OCTOBER Moderate (Conscious) Sedation and Analgesia Wednesday, October 5, 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) NOVEMBER Topic TBD Tuesday, November 8, 5:30 - 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented) To sign up for a Continuing Medical Education class, please contact Jennifer Anderson, CME Coordinator (509) 325-5010 ext. 28 or Jennifer@spcms.org

Medical Referral Line Seeks Physicians One of the many benefits the Spokane County Medical Society offers to its physician-members is the Medical Referral Line. This service allows SCMS staff to support area medical practices by providing the names of physicians accepting new patients to community members searching for a physician. If you are currently a member of our Medical Referral Line, please accept our sincere thanks!

We are, however, in need of more physicians to whom we can refer patients. Is your practice able to accept new patients? Would you like to be part of this service, which assists both the physician and the patient? If so, please let us know by calling 325-5010 – and we'll fax you a Medical Referral Update form to complete and return.

Although physicians in all specialties are always welcomed to our service, our greatest need is for primary care physicians – especially those who accept Medicare and/or Medicaid!

March SCMS Message 27

March SCMS Message 28

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March SCMS Message 29

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