The Message, February 2012

message THE

A MON T HLY NE WS M AG A ZINE OF SPOKANE COUNTY MEDICAL SOCIETY – FEBRUARY 2012

The Testy Climate in Neurology and Radiology

By Terri Oskin, MD SCMS President

The Challenges of Delivering Quality Imaging and Interpretations in a Climate of Reform The Preapproval Process in Oncology: Practice within the box…

February SCMS The Message Open2

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

2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect

The Testy Climate in Neurology and Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Bradley Pope, MD Immediate Past President

The Challenges of Delivering Quality Imaging and Interpretations in a Climate of Reform . . . . 1

David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD

The Preapproval Process in Oncology: Practice within the box… . . . . . . . . . . . . . . . . . 2 Advanced Imaging Plays Important Role in Eliminating Unnecessary Utilization . . . . . . . . . 4 Looking to Evidence When Making Radiology and Pharmacy Decisions . . . . . . . . . . . . . 5 Innovation or Just Disruption? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 State Stroke Program Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Imaging – One of the Most Important Services for Project Access Clients . . . . . . . . . . . 10 Graduate Medical Education – An Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 FYI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Membership Recognition for February 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

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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.

February SCMS The Message Open3

The Testy Climate in Neurology and Radiology

By Terri Oskin, MD SCMS President Wow, can you believe it’s already February? I hope 2012 is getting off to a smooth start for everyone.

This year will continue to bring many challenges to the medical community regarding reimbursement and restrictions to our autonomy to practice medicine. In this month’s The Message, we are focusing on the technical, clinical and payment issues facing Radiology and Neurology where: 1) significant reductions in payment are expected for many procedures, 2) State and other payers are expected to refuse to approve or pay for new, experimental or emerging techniques in treatment of our patients and 3) Medicaid and others indicate they will rely on evidence-based, outcome-oriented and expert opinion tools before approving new technology use.

No one will argue that making healthcare decisions based on the best evidence available is a bad idea. But is it really that simple? Consider these definitions by Dr. David Sackett, a pioneer in EBP:

“Evidence-based practice (EBP) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett, D,1996)

“EBP is the integration of clinical expertise, patient values, and the best research evidence into the decisionmaking process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and

Now mind you, EBP has been very effective for treating populations. Hospitals and clinical groups have developed many protocols that decrease morbidity and mortality.

Examples include the protocols used for sepsis, pneumonia and stroke in place at both hospital systems in Spokane (Providence Health Care and Community Health Systems) as well as mammogram screening and protocols for diabetes (used by medical groups such as Group Health and Rockwood Clinic). The protocols were developed by physicians and they can be individualized based on the clinician’s expertise and the individual patient, and they aren’t necessarily tied to reimbursement or payer approval.

One closing thought: Remember, we don’t want to give up our autonomy by becoming complacent in the payer-physician process. Physicians need to play an active role and be part of the conversations with payers when determining standards of care and they need to be mindful of the ever rising costs of providing this care.

Also included in this issue is an update on the Washington State Emergency and Cardiac Stroke System. Similar to Washington’s statewide trauma system, patients will be transported directly to hospitals that meet certain requirements. This assures that patients have the expertise and technologies available for prompt treatment. The intent of this law is to save more lives and reduce disability. As of November 2011, six counties in Washington had gone live, including Spokane with all four of our local hospitals participating. For more information visit the Washington Department of Health’s Web site at doh.wa.gov.

February’s publication is a meaty one. I welcome your feedback at TOskin@columbiamedicalassociates.com.

The Challenges of Delivering Quality Imaging and Interpretations in a Climate of Reform

clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.” (Sackett, D, 2002)

The concern of some physicians is that payers using an evidencebased model to determine benefits for their whole population may not be considering the individual patient’s needs or the physician’s individual clinical expertise and education to determine the value of a particular procedure. Some physicians worry that payers’ decisions about care will be based on large cohort studies reflecting a population rather the individual.

By Jayson S. Brower, MD As the lens of healthcare reform continues its unrelenting course of scrutiny, seemingly peering into every dark corner of healthcare delivery, I find myself alternating between optimism and anger. The anger is easy to understand: It is equal parts frustration that the career in which I am so heavily invested is being called out for being less than perfect, in combination with the dread of the unknown. So how could I possibly find hope in the swirling chaos that threatens to sweep away the current foundation of medicine? The simple answer is opportunity.

Continued on page 2 February SCMS The Message 1

Continued from page 1 With this challenge now being laid at our feet, we will all be compelled to act. The question is how to provide unparalleled access to medical care, both for our providers and our patients, while being responsible financial stewards of a system that is not sustainable in its current form.

Naturally the primary mandate, when we hear talk of healthcare reform, is to cut costs. In radiology, we are actively working to contain costs through the appropriate use of imaging. Data from various studies, including one performed in 2010 at UW Harborview, has shown that potentially up to 25% of advanced imaging studies (MRI, CT and PET) may be unnecessary. Further data suggests that nearly $35 billion in savings could be gained through more appropriate utilization of imaging. Inland Imaging is on the verge of introducing an electronic decision support system into our ordering workflow that we plan on piloting with several of our major referring provider groups. We know that electronic decision support can reduce costs for the healthcare system by showing clinicians the most appropriate use of advanced imaging thereby decreasing the number of unnecessary examinations being performed. Our goals for the pilot are straightforward: First, we want to show that the system is simple to use and fits easily into current ordering processes. Second, we want to prove to our referring providers that this is in fact an enhancement to the clinical care of their patients by ensuring the most appropriate imaging study is utilized at the proper time during the continuum of care.

Like all providers, I want to safeguard continued delivery of the absolute highest quality of medical care. What Inland Imaging provides are the images and interpretations that help our medical colleagues provide exceptional care for their patients.

Through the ongoing expansion of our regional PACS system, we have knitted together not only Spokane, but our outlying referring communities, into an electronic network that provides nearly seamless access to our patients’ imaging studies. We will continue to enhance the system we first introduced in 1999 and in the months ahead, launch our new “mobility platform” allowing providers to access their patients’ images and reports from nearly anywhere on the mobile device of their choice. In this fashion, any provider should be able to instantly know what imaging study his/her patient has had, reducing costly and unnecessary duplicate imaging while expediting clinical care.

We will continue to refine our reports and strive to offer the most clinically relevant interpretations and evidence-based recommendations possible. I envision a time in the not too distant future when our reports will be an interactive tool with embedded electronic links to the most current literature to aid in prompt and appropriate medical treatment. With the rapid approach of system-wide electronic health records, I also anticipate the opportunity for radiologists to quickly and easily mine relevant clinical data from the electronic chart so that interpretations are grounded in the reality of the patient’s medical history.

Finally, we must always ask how we ensure that our patients have the best possible experience when under our care. This goes beyond clean waiting rooms with prompt, efficient and courteous service: this is a given. We need to be transparent, both in terms of cost and communication. We increasingly hear that our patients want access to their reports concurrently with their referring clinicians. We must not ignore this but rather learn to manage their expectations while respecting the needs of our medical colleagues. We must take measures to protect our patients from excess radiation and to that end we have begun a comprehensive program to actively record and minimize radiation exposure throughout Spokane and the Inland Northwest communities we serve.

These are but several examples of actual change that enhances care while containing costs. In the end, it will be through collaboration whereby we make our greatest strides. Leveraging partnerships to implement system-based transformations that offer durable, cost-effective alternatives to what currently exists will be the key to true, sustainable, healthcare reform.

The Preapproval Process in Oncology: Practice within the box…

By Arvind Chaudhry, MD, PhD There is broad consensus that there have been major advances in diagnosis and treatment of cancer in the last decade.

However cancer care costs have skyrocketed and it is obvious that these costs are not sustainable in any system. Reining in cancer care costs, without compromising the quality of cancer care, has become a topic of extensive discussion in the cancer care community. This has raised questions about defining quality of cancer care and its costs to society in the last few years of our lives.

The Preapproval process has emerged as a significant factor, championed by payers and poorly understood by patients and treating providers. Payers have identified significant variability in cancer care across various spectrums. This variability is identified as a reduced quality of care. Several national guidelines, such as National Comprehensive Cancer Network and American Society of Clinical Oncologists, have been developed to reduce variability and increase consistency and predictability of cancer care in the nation. The introduction of pathways to treat cancer has also been championed by several payers and national organizations in an attempt to reduce variability and rein in costs. I will try to pen down my thoughts about the perspective of the patient, the payer and of the treating physicians.

February SCMS The Message 2

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The Oncologist perspective:

Patient’s perspective:

Most oncologists dream of practicing oncology unhindered.

Physicians are already being told how to practice medicine by the government, by hospitals and now by payers. For this precise reason, several oncologists seek “refuge” in hospital employment or university setting. We all realize, however, that there is significant variability amongst our own colleagues and the desire to provide hope for treatment for our cancer patients is now being confronted by increasing costs and need to justify costs for minimal benefits. As leaders of the cancer care team, we need to embrace the challenges of providing the best cancer care at the lowest cost. We are the most qualified to recommend those choices to our patients. By subjecting ourselves to the preapproval process and not running away from it or complaining about it, is the need of the day.

Patients diagnosed with cancer have enough on their minds already. The preapproval process has the potential of adding to stress and anxiety of diagnosis and certainly perceived by most patients as an irritant. All patients have the right to the best cancer care and one of the most important factors is time to diagnosis, staging and treatment. This has become a major factor defining quality of cancer care. The approval process of MRI or PET/CT or other expensive and essential modalities in cancer care can prolong this major quality factor. The time it takes for approval is also quite variable and ranges from 24 hours to 3 weeks, depending on payer. Most patients are not aware of this process when they are signing up with payers, private or government. Patients perceive the preapproval process as restrictive and as a scheme to save cost or to deny payment for a procedure or treatment. Patients want their oncologist or treating physician to be innovative and to think “out of the box” for their particular case. The appeal process for a denial of payment is more disconcerting and time consuming.

The Payers’ perspective:

In conclusion, the preapproval process is here to stay. I believe the process needs to be refined to meet the needs of the patient, the provider and the payer. The conversation for achieving quality cancer care at the most affordable price has just begun.

Arvind Chaudhry, MD, PhD is a Medical Oncologist with Medical Oncology Associates, PS.

Payers these days are being bombarded with new advances in cancer care. Surgery, radiation and chemotherapy are no longer the major cost drivers. Biologicals, antibodies, oral chemotherapy, immunotherapy, gene therapy, radio immunotherapy and bone marrow transplant are now in the range of more than $100K per patient per year. Off label use is also indentified as the major cost driver of therapy. Payers, rightfully so, desire more consistency and predictability in the cost of cancer care and it is not unreasonable to seek some semblance of control of cancer care costs. How else can we, as a society, rein in cancer care costs? This has become a “me too” phenomenon amongst payers.

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Advanced Imaging Plays Important Role in Eliminating Unnecessary Utilization

By Donald Storey, MD and Jayson Brower, MD As we continue to navigate healthcare reform the number one issue we face collectively is rising medical costs. With countless ideas circulating about how to do things differently, or better, it is important that we also address how to help stabilize rising costs while improving outcomes for patients.

One area of growing importance is utilization management.

Premera and Inland Imaging believe that appropriate evidence based utilization of expensive advanced imaging tools such as MRI, CT and PET will help physicians provide the best care for their patients. Health plans across the country have implemented a number of programs that not only focus on eliminating unnecessary or overuse of healthcare services, but specifically on enhancing patient safety.

One key area in recent years that needed to be reevaluated was advanced imaging. Continued trends in increased utilization in recent years were problematic for they had reached double digits and did not show any sign of slowing down. Both Premera and Inland Imaging believed that something needed to be done.

In 2008, Premera launched its Advanced Imaging Quality Initiative. The initiative was designed to protect patients’ safety and to make sure there was collaboration between ordering providers and imaging service providers when it came to ordering advanced imaging tests. The goal was to streamline the delivery of care, while eliminating needless imaging (lowering costs) and ultimately improving patient care. Such programs have proven fruitful in improving patient safety by eliminating radiation (CT) from unnecessary tests, reducing the overall increase in medical costs and still providing good patient care.

A Necessary Review Today, when a provider orders an advanced imaging service for a patient, the provider’s request is put through a “medical necessity review.” To ensure the review process is valuable and delivered in a timely fashion, Premera has partnered with American Imaging Management (AIM) to conduct each review. This review serves as an added layer of protection for the patient. It evaluates whether the service is medically necessary and if the patient’s health plan covers the service.

When this program was originally implemented, some providers expressed concerns that the additional review process may cause a delay in care delivery. However, the average wait time for authorization from AIM is less than four minutes and the feedback Premera has received from providers is that the review process is “easy to use.”

If a provider’s request is denied by AIM, the ordering provider has the opportunity to consult with AIM to determine whether there is a more appropriate test available. Since the review process was implemented, Inland Imaging has diligently worked with AIM to find alternative tests for patients when a request has been denied. Inland Imaging believes this is a critical component to providing appropriate, quality care to patients.

Subsequent results prove that advanced imaging management is working as the utilization trend continues to drop. In the three years since the program was implemented, Premera has recorded the following results:

• Before the review program was implemented, the utilization trend was increasing at 1.2% per year. After implementation, the utilization trend dropped to -3.4% in Year 1, to -6% in Year 2 and –7.3% in Year 3.* • The program achieved $8.5 million savings in Year 1, $11.9 million savings in Year 2 and $16.3 million in cost improvement in Year 3.* Such savings in medical costs can help control premiums over time for Premera’s customers.

They also often mean cost-sharing savings for patients in the short-term while still providing good patient care.

*Year 1: July 2008 – June 2009; Year 2: July 2009 – June 2010; Year 3: July 2010 – June 2011

Reducing Radiation Exposure While reducing unnecessary medical costs is valuable, even more important may be addressing concern associated with the radiation to which patients are exposed with each CT study. There is an ongoing debate in the medical world about radiation exposure and how much is harmful to patients.

Through Premera’s partnership with AIM, Premera offers its providers online access to Ask AIMee, an interactive model that tracks cumulative radiation dosage for CT studies. Ask AIMee provides up-to-date estimates of radiation dosage for commonly-ordered CT studies, allowing providers to review common uses, alternative exams and radiation exposure levels associated with various imaging studies. Since Premera implemented the Advanced Imaging Quality Initiative, approximately 2,000 members have avoided unnecessary radiation exposure based on provider access to this tool.

Where to from here Advanced imaging review programs are one step in the right direction to help control rising medical costs and improve patient safety. The data proves that such programs have lowered the utilization trend and have also enhanced patient safety while maintaining good patient care.

February SCMS The Message 4

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Continued from page 4 It is important that we continue to look for ways together to improve the health of patients through appropriate utilization of advanced imaging, an important tool in patient care, without driving medical costs inappropriately higher.

With healthcare reform upon us and everyone being asked to do more with less, it is important that we all do our part, big or small, to help create a high quality sustainable healthcare system.

Donald Storey, MD is a Medical Director at Premera Blue Cross Jayson Brower, MD is President of Inland Imaging

Looking to Evidence When Making Radiology and Pharmacy Decisions

By Matthew Handley, MD Medicaid and Medicare are proposing to limit the number of tests that will be reimbursed in radiology and for neurological care. The question shouldn’t be whether this is good or bad.

The question should be when extra testing is likely to prove beneficial to patients and when it may cause harm.

At Group Health Cooperative, we practice medicine based on research and best practices. We invest in pharmacy and emerging technology committees that inform our care decisions. The teams consist of medical librarians, epidemiologists and clinicians who use a systematic search of the literature and appraise studies to ensure they are welldesigned and executed without bias. We also look for evidence of patient outcomes that matter—for example, whether a patient returns to work sooner, lives longer or has an improved quality of life—not interim measures that do not necessarily predict a good outcome.

for complications. So if a scan (whether a CT, MRI, PET or any other scan) is done for the wrong reason it can lead to net harm for the patient.

Nationwide about one person in five had a CT scan last year.

While remaining lower than the community rate, Group Health’s own scan rate had doubled the past decade and order rates varied dramatically by provider, clinic and geography. We reached out to our providers with the goal of reducing tests by 20 percent over two years. We’ve succeeded.

We added clinical decision support to our Electronic Medical Record (EMR) that prompts doctors to consider some questions and evidence whenever they order a CT or MRI. We also became more visible with our data, sharing ordering rates with our providers. Several doctors were surprised by their rates—even some who believe they practice conservative medicine. A few primary physicians believed that specialists required them to order a test prior to referring, but discussions with specialists proved the assumption false— routine imaging prior to consultation wasn’t necessary, except in a few specialties and conditions.

Family physician Fredric Shepard, MD, at Group Health’s South Hill Medical Center, was one doctor surprised by his own rate of ordering. He put together a sampling of his cases and together we reviewed the appropriateness of the orders, leading him to change his approach from “defensible” to “what is the likelihood that this test will lead to a meaningful change in outcome for my patient.”

Dr. Shepard has encouraged his colleagues to think more critically about their ordering practices. He often tells them that it’s more appropriate to refer a patient to a specialist than to get an MRI, saying, “My advice is to pay for a brain, not for a scanner.” At South Hill, ordering rates dropped by more than 50 percent and they’ve stayed down, and yet patient outcomes have remained as good or have even improved. Doctors need to ask themselves if the result of the test they are about to order will change how they manage the patient. If the answer is no, then thetest should not be ordered.

“My philosophy is that everyone can improve. As a doctor with 28 years of experience, it comes down to relying on my own clinical judgment more and also leveraging time for those conditions that can heal with time,” says Dr. Shepard. “There’s no point in doing a test for curiosity.”

This approach has served Group Health patients well, particularly in high-end imaging and pharmacy.

To scan or not to scan?

We have recently implemented a program to improve the value of high-end imaging. CT scans are used for everything but they come with a cost, and not just a financial cost—with every test, patients are exposed to a significant dose of radiation.

Studies show that one to two percent of all cancers are caused by high-end imaging, especially CT scan. The risk is especially high for children. Data suggests that a single pelvic CT in a teenage girl can significantly increase her lifetime incidence of cancer. Unwarranted testing also leads to the discovery of benign anomalies that can frighten patients and additionally lead to unnecessary surgery, opening the door

Pharmacy and other clinical decisions Group Health’s pharmacological care is evidence-based, and we have the most cost-effective prescribing practices in the state.

This doesn’t mean that we are slow to innovate—in fact, when a medical treatment is proven to work, we implement it quickly.

February SCMS The Message 5

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Innovation or Just Disruption?

Continued from page 5 This was the case in 2001, after the Heart Outcomes Prevention Evaluation (HOPE) clinical trial determined that angiotensinconverting enzyme (ACE) inhibitors significantly lowered the risk of heart attack, stroke and death in patients with diabetes and heart disease. Within six months of the trial, 80 percent of the patients in our group practice who might benefit (20,000 people) were successfully prescribed ACE-Is. Conversely, it’s our same commitment to evidence that keeps harmful medications away from patients. Vioxx, for example, was introduced to the market in 1999 but never dispensed through our formulary. Worldwide, 80 million people were prescribed the drug. Here in the Northwest, our patients complained that Group Health would not prescribe it in order to save money. In fact, our rationale was that we found no reliable evidence that it benefited patients and significant concerns that it might cause harm. The drug was pulled off the market in 2004 because of associated risks of heart attack and stroke.

Sometimes patients have more than one viable option for their care. For cases of spinal stenosis or radiculopathy and several other conditions, our physicians use video decision aids that are evidence-based so that patients are well informed when they decide whether to pursue invasive treatment.

Putting it all together Group Health takes many steps to ensure that our care is safe and high-quality, and we continually evaluate our results. We also engage our medical community to look at variations in practice so that we provide value to our patients.

As Dr. Shepard says, “We can all improve.” It’s vitally important that doctors work together and adapt to provide the right care at the right time. If we don’t, we can expect payers to come in with cruder tools—as they are now—and force physicians to change patterns of care that aren’t delivering real value.

By Jeff O’Connor, M.D. Several years ago, I was in Seattle attending a meeting regarding the use of computers in medicine. One of the doctors in the audience stood up and in a very frustrated tone asked this question: “Why can't I just go into the hospital in the morning, get a list of all my patients in the hospital, all their vital signs, lab work, medications and images, before I make rounds? All this information is available but in different places. It makes it difficult to do good medical care. Why can't we do better?”

I wanted to tell him "You can do better. Just move to Spokane."

I doubted anybody on the west side of the state would believe that those of us in Spokane could do those things, so I just kept my mouth shut.

It has been over a decade since we in eastern Washington have had to get patient information "the old-fashioned way."

Through the auspices of Inland Northwest Health Services (INHS) and supported by the local hospitals, we've had a wonderful system of retrieving and receiving electronic patient data. Our ability to access images and imaging reports, emergency room reports, admitting and discharge notes, hospital lab results, and outpatient lab results on this electronic basis has become second nature to us. For many years, we were one of the few regions in the country that had this capability (even if those on the west side never believed that it was true).

The Spokane County Medical Society has had an Informatics Committee since before we really knew what informatics meant.

We have had MEDITECH almost as long. There are many of us in this community who have been working hard to make sure that we are adequately capitalizing on all the electronic tools available to provide better care to our patients.

Matthew Handley, MD, is the medical director for quality and informatics at Group Health Cooperative.

February SCMS The Message 6

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February SCMS The Message 7

Continued from page 6 MEDITECH would not have been possible were it not for the somewhat risky and farsighted political decision on the part of both Empire Health and Providence Health. They used their resources and mutual need to establish, fund and nurture the underlying data system that we now use. Likewise, Inland Imaging took a chance and invested in what we now know as Stentor and PAML established our current electronic lab system. Like our household utilities, we have come to assume that these tools will always be available to us. MEDITECH is clunky but far better than nothing. Just click the mouse and we have what we need to take care of our patients.

Alas, "Progress" has struck River City. The three regional hospital systems encompassing northern Idaho and eastern Washington are in the process of upgrading their electronic health systems.

There are many legitimate reasons for doing so. However, they will be on three different systems. For the present, the systems won't talk to each other. While it appears each hospital system would be a distinct improvement on what they currently have, our individual patients aren't divided into a northern Idaho part, a Rockwood Health part and a Providence Health part.

Without a conscious effort on the part of the different hospital and health systems, in collaboration with regional physicians, the business community and INHS, we will have more disruption than innovation. It will take financial resources and political will to ensure that we maintain a central repository or system of exchange for data for each of our patients.

The days of MEDITECH being that central repository are numbered. It has run out of gas and needs to be replaced.

Fortunately, the tool to replace it is ready. Through the Beacon Community of the Inland Northwest (BCIN) Grant, INHS has been able to develop what is known as a Health Information Exchange (HIE) using the Orion product. While the BCIN Grant is focused on Type II diabetes care, the INHS HIE is fully capable of handling all patient data generated in eastern Washington and northern Idaho and making it available to all those who should have access to it.

That means that instead of logging on to MEDITECH, we will log on to the INHS HIE. In a sense it will be "the new MEDITECH." There is a catch. All three health systems have to provide the data to the exchange. Technically it's doable. Making it real will require political muscle, interfaces, tech time and financial resources. The costs are unknown, but in this day of Accountable Care Organizations, having access to pre-existing data regarding a patient is much less costly and safer than repeating a test.

Here is where you come in. Some of us are employed and some of us are independent, but all of us are community physicians. The only reason we're here is to take care of our patients. All else is secondary.

It is incumbent on us to develop and encourage whatever inclination the hospital systems have to share data with the HIE. Speaking with one voice and one expectation will help ensure that when we make that mouse click, we will still get what we need to take care of our patients.

Dr. O’Connor is the 2012 Chair of the SCMS Informatics Committee and a patient advocate using all the IT tools necessary to the delivery of quality patient care.

State Stroke Program Update

By James M. Nania MD, FACEP Medical Program Director Spokane County Emergency Medical Services (EMS) One of the most exciting developments in the last quarter of a century in emergency medicine has been the development of fibrinolytic therapy for acute ischemic stroke. Earlier in my practice there was nothing that could be done to reverse an ischemic stroke. Our protocols for emergency treatment were brief and primarily focused on preventing further injury and protecting the airway. Hospital care involved a limited search for treatable causes to prevent future events and rehabilitation.

Particularly in that stroke is one of the major causes of premature death and disability in our state it had been very frustrating to have so little to offer patients with significant strokes.

With the advent of the time critical use of ‘clot busting’ drugs for acute stroke our healthcare systems approach to this disease needed to evolve. Many of the principles that had been developed to best treat major trauma patients within the ‘golden hour’ now had relevance to the treatment of acute stroke patients. To most effectively organize the key medical resources that needed to be delivered in a timely manner a formal statewide system was designed in a lengthy committee process that was hosted by Washington State Department of Health.

The process included a survey of the current delivery of stroke care in our state as well as an assessment of the magnitude of stroke as a healthcare issue. The results identified many inconsistencies in the care we provided in addition to a very low rate of the administration of fibrinolytic therapy. Only 2.4% of patients with ischemic strokes in 2003-2005 were treated with tissue plasminogen activator (t-PA) and 57% of 95 hospitals within our state did not give a single dose of t-PA during that time.

We also had the benefit of other examples of regional stroke care systems in our nation as well as significant advocacy by organizations such as the American Heart Association. The motivation to create a stroke system was further fueled by our population demographics that clearly indicated that the aging of the baby boomer generation will put many more of our citizens at risk for premature death and disability from stroke.

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Continued from page 8 With the passage of SB 2396 in the spring of 2010 the legal framework for a statewide stroke system was established.

Statewide prehospital protocols were developed that incorporated the Cincinnati stroke scale and the phrase “Time last seen normal” as the easiest means of identifying the correct patients and their potential candidacy for rapid transport to an interventional facility.

A hierarchy of three levels of stroke centers was defined to best ensure that patients are taken to the facility most capable of providing the full spectrum of comprehensive stroke care that is associated with the best outcomes. Through a system of voluntary participation, most of our state’s hospitals have been categorized as a level I, II or III stroke center. The widespread participation is a strong endorsement, by our hospitals, of the importance of stroke care. That the system be inclusive is particularly important in that many stroke patients continue to present to the hospital outside of the Emergency Management system.

The implementation of our state’s stroke system began on a county by county basis starting July 1, 2011. Prior to ‘going live’ the EMS council of each county must identify to the department of health that all of the key elements are in place. As of the end of 2011, 12 of our 39 counties have implemented their systems with most of the other counties expected to complete implementation within the current calendar year. (Figures 1 and 2)

In general, implementation has gone extremely well. There has been some resistance in areas where the close proximity of facilities of different levels has probably resulted in more patients being triaged to the higher level stroke center. However, as Spokane’s own ‘stroke evangelist’, Dr. Madeleine Geraghty has pointed out “‘the benefit of a comprehensive stroke center goes far beyond the administration of t-PA or even the use of clot extraction devices”. Dedicated stroke units with specially trained staffs and evidence-based protocols are often equally important to patient outcomes.

The final element to be realized in our stroke system is the implementation of an effective, data driven quality improvement (Q/I) program. This is a particular challenge given the austere economics of our current healthcare environment. Data submission and participation in such a program was among the voluntary requirements for becoming a stroke center. Local and regional EMS councils are in the early stages of evolving existing trauma Q/I committees to reorganize so that appropriate providers will be assembled to reflect upon the performance of our stroke care system. Well established national benchmarks are available to facilitate the process.

Finally, I should identify that throughout the process there was widespread recognition of the importance of prevention and early identification of symptom onset with immediate access to the 911 system. Although our stroke hospitals will be formally involved in the public educational efforts, it is incumbent upon those of us providing primary care to do our best to prevent that which remains too often incurable. Our success in reducing premature death and disability from stroke will depend not just on the implementation of the Washington State Stroke system but, perhaps to an even greater degree, on the risk assessments and primary prevention provided in our offices.

February SCMS The Message 9

Imaging – One of the Most Important Services for Project Access Clients

By Lee Taylor Director, Project Access Spokane When we look at why the Project Access network works for our clients, it is clearly the collaboration with many different providers that defines the value of the Project Access model.

Physicians, medical services organizations and providers, and the medical community in general provide millions of dollars of free services to our community. It is the nature of people working in this industry to care for others, and they do this even though a large portion of that care will be provided without payment. The key to the Project Access model is to coordinate donated medical services and create a system of care that serves low-income uninsured people in our community.

Without Project Access, low-income uninsured people will find individuals and organizations that are willing to donate services. What they will not find is a group of individuals and organizations that work together to provide the combination of services they need to address their medical needs. That is the system of care and the coordination of services that is provided

by Project Access.

Imaging services is a major component of the treatment for many Project Access clients and those services are a great example of the value of the Project Access network. When donated services are provided outside the Project Access network, the patient needs to inquire about and/or apply for charity care with each provider. This often leads to roadblocks in getting the care they need. When a Project Access client needs imaging, or other services, it is part of the complete care they will receive while they are in the Project Access Program.

Clients receive a card, much like an insurance card, that identifies them as a qualified Project Access client, and they can access imaging services and all of the care they need from the providers and organizations participating in the Project Access network at no charge.

Now, back to imaging services and the huge part they play in providing care for low-income uninsured people in our community. Both of the major providers of imaging services, Inland Imaging and Radia, donate services to Project Access clients. Inland Imaging alone donates services valued at approximately $300,000 annually to our clients.

When conversations about Project Access began in 2003, Inland Imaging was at the table and ready to participate. “I don’t think any of us had an idea of what it would evolve into,” recalled Dr. Don Cubberley, who was on the board of the Spokane County Medical Society and president of Inland Imaging at the time. “Traditionally, care for the uninsured

and under-insured has been haphazard, fragmented and inefficient—frustrating both patients and physicians,” explains Dr. Cubberley. “Project Access coordinates the care of those patients, reducing the use of our own resources to check insurance eligibility, contact patients for appointments, secure outside medical records and ensure follow-up.” Inland Imaging sees value in community goodwill and avoiding the expense of billing patients who were “already in a tight spot.” Dr. Don Cubberley also reviews imaging services prescribed to ensure that they are necessary and appropriate for each patient. That makes the donation of the services from Inland Imaging more efficient and also reduces the time and resources spent on unnecessary imaging services. The medical screening alone saved over $55,000 in resources during 2010 that would have been expended unnecessarily without the Inland Imaging and Project Access partnership.

We truly appreciate the partnership with both Inland Imaging and Radia. We look forward to working with them to provide complete and coordinated care for Project Access clients.

“Project Access coordinates the care of low-income uninsured patients, reducing the use of our own resources to check insurance eligibility, contact patients for appointments, secure outside medical records, and ensure

And, as usual, please follow-up.” Dr. Don Cubberley call me if you have questions or if you have ideas that you would like to share, at 220-2651or email me at lee@spcms.org.

Graduate Medical Education – An Update

By John McCarthy, MD Assistant Dean for Regional Affairs, UWSOM As this community strives to develop more medical education locally (as witnessed by the excavation for a new health sciences building at Riverpoint Campus reaching its maximum depth), it is worth noting what progress is happening on the Residency/GME (Graduate Medical Education) front. One year ago, after a six month review with Huron Consulting Group, our GME Expansion Committee put forth the desire to grow the number of GME slots on the eastern side of the state by 144 slots within the next 10 years (now nine years). Even at achievement of this number of slots, we would still be below the national average in resident physicians per capita. It would, however, move us closer to the mid-range ratio for the nation.

February SCMS The Message 10

Continued on page 11

Continued from page 10 We remain interested in growing GME locally as our workforce projections demand attention to this. We are acutely aware that a critical component in growing a medical school includes creating residencies. To this end, the academic leaders have been working with our legislators, Greater Spokane Incorporated, the hospitals, the VA system, the existing residency leaders, and the UWSOM to explore ways to grow our training opportunities. With the reality of profound budget shortfalls at both the national and state levels, it is a terribly difficult economic environment to be exploring this growth. In fact, we have seen contraction of our GME programs with the phasing out of the Psychiatry residency.

We continue to need support and we continue to need those invested in medical education to be ready and “in the wings” as we work to free up funds for the needed investment in our future physicians.

The University of Washington, Washington State University, Spokane County Medical Society, Greater Spokane Incorporated, the residency programs and hospitals throughout the city want to develop ways to help create training for the upcoming medical student graduates. The University of Washington will be hosting a second GME Summit on March 23 at WSU’s Riverpoint campus. The day-long event is designed for the stakeholders in medical education from across the WWAMI region to come together to discuss how to effectively move toward models of GME that serve the needs of the WWAMI region with the support of the University of Washington and its medical school. The first GME summit was well appreciated as a step in the right direction and we look forward to making continued advancement in this realm. As usual, we look forward to creative approaches to advance excellent medical training for our up and coming practice partners.

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February SCMS The Message 11

Providence proudly opens a new northside primary care clinic.

Providence Medical Group opens a new convenient northside primary care clinic at 551 East Hawthorne. New patients are welcome – please call to schedule an appointment.

The following providers have joined the Hawthorne clinic: • Elizabeth O’Halloran, MD, family medicine • Kathleen Moudy, PA-C, pediatrics

Call now for an appointment 509.252.1900.

PROVIDENCE FAMILY MEDICINE PROVIDENCE PEDIATRICS For a complete listing of Providence Medical Group physicians and clinic locations, visit our website at phc.org. phc.org

February SCMS The Message 12

Providence Medical Group - Hawthorne 551 East Hawthorne • Spokane 99218

In the News

Membership Recognition for February 2012

Dr. Jeffery Snow retires The Spokane Eye Clinic is pleased to wish Dr. Jeffery Snow, M.D. (former SCMS President in 1990) a wonderful retirement that was effective January 1, 2012. After thirty-two years of private practice medicine at the Spokane Eye Clinic, Dr. Snow said his two strongest memories are; (1) The joy of serving many wonderful patients and (2) The pleasure of collegiality within the extraordinarily fine Spokane Medical Community of talented, dedicated MDs, DOs, PAs, and Nurses.

He is quoted as saying, “I will miss the daily challenges and intellectual stimulation, but new challenges await. Thank you all”.

Happy Travels, Doctor and Mrs. Snow.

FYI WSMA Coding Hotline – Protect Your Practice!

For better or worse, codes determine your reimbursement, and correct coding keeps the auditors away. Free guidance on CPT, ICD-9 and HCPCS coding is available from the WSMA's certified coders via our WSMA Coding Hotline. Contact Michelle M. Lott, CPC at (206)441.9762 or (800)552.0612 or e-mail mml@wsma.org.

This service is FREE to WSMA member physicians and WSMGMA member practice managers and staff.

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.

40 Years LeRoy J. Byrd, MD

2/22/1972

30 Years James A. Numata, MD

1/25/1982

William S. Coleman, MD

1/26/1982

Jan S. Connelly, MD

1/26/1982

Steven E. Goodell, MD

1/26/1982

Meredith A. Heick, MD

1/26/1982

Alexander R. MacKay, MD

1/26/1982

Stephen C. Maher, MD

1/26/1982

Michael M. McCarthy, MD

1/26/1982

Arnold G. Peterson, MD

1/26/1982

Pamela Gee Silverstein, MD

1/26/1982

20 Years Michael F. Kestell, MD

2/15/1992

Spokane Society for Internal Medicine & Providence SHMC Special opening session of the SSIM 2012 Scientific Meetings Dr. Steven Schroeder Distinguished Professor of Health and Health Care Department of Medicine University of California, San Francisco “Why does health reform come so hard?”

Free and Open to the Public Credentialed for AMA PRA Category II CME Thursday February 23, 2012 5:30-7:30 p.m.

Providence Sacred Heart Medical Center Providence Auditorium Join Dr Steven Schroeder, Distinguished Professor of Health and Healthcare, and the most recent past president of the Robert Wood Johnson Foundation. Author of the recent “Personal Reflections on the High Cost of American Medical Care,” Dr. Schroeder will explore perspectives on Health Reform and the attendant uncertainties for clinicians and patients. We look forward to seeing you there!

Please share this invitation with friends and colleagues.

February SCMS The Message 13

Continuing Medical Education Promoting Healthy Families (Practice Management Alerts from the American Medical Association ) is designed to help physicians successfully talk about healthy behaviors with their adult patients in a way that may spark—and help sustain—positive changes for the whole family. The continuing medical education activity includes a video module, a detailed monograph and patient handout. These activities have been certified for AMA PRA Category 1 CreditTM. For more information www.ama-assn.org.

Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental illness, addictions, work-related stress, life transitions, and relationship difficulties. The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees. Contact Bob or Carol at 509-624-7320 for more information.

E-prescribing Narcotics Webinar – Stay on top of the rules

Annual Winter Retreat and CME Conference February 3 (Noon to 7:00 p.m.) and 4 (7:30 a.m. to Noon), 2012 Red Lion Hotel at the Park. 7 Prescribed credits have been applied to American Academy of Family Physicians. Registration Fee $95 (INAFP members) $110 (nonmembers). Contact Camtu Thai, MD at (509) 710-9862 or email thai.c@ghc.org

and regulations of e prescribing and the future opportunities for eRx of narcotics. There will be implementation in 2012 of this topic, especially since Washington State has already adopted the DEA rules on the subject that were created in 2010, but there are many steps for providers, hospitals and pharmacies to make that happen. February 21, 2012 Noon – 1 p.m. SCMS Conference Room. Limited registration. Call (509) 325-5010 for more information.

Meetings, Conferences and Events

Health Information Exchange Panel: Regional Projects Aimed at Creating an Integrated Patient Medical Record

Inland Northwest Academy of Family Physicians – 13th

Institutional Review Board (IRB) – Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

Caduceus Al Anon Family Group – Meets every Thursday evening from 6:15 pm until 7:15 pm at 626 N. Mullan Road, Spokane, WA. Non-smoking meeting for spouses and significant others of Healthcare Providers who are in recovery or who may need help seeking recovery. Facilitated 12 Step Al Anon Format. No dues or fees. Contact 509-928-4102 for more information.

Monday, March 12, 5:30 to 7:30 p.m. – Red Lion Hotel at the Park (no cost, light refreshments served) As hospitals and providers begin to determine the type and functionality of patient information that they need to reduce the cost and provide better care for their populations; the panel will discuss specific and broad solutions for discussion among rural and urban providers. Each panelist will present for 10-15 minutes with an overview of their program then the moderator would ask several questions for each panel member to address with an open Q&A to follow. Content Questions Contact: Keith Baldwin, Spokane County Medical Society, 509.325.5010 x24 or keith@spcms.org Registration: http://www.regonline.com/ rhc2012 More Info: http://extension.wsu.edu/ahec/Pages/ conf2012.aspx

February SCMS The Message 14

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 Balasubramanian, Ambalauanan, MD Internal Medicine Med School: Tirunelvcli Medical College (2000) Internship/Residency Scranton Temple Residency Program (2006) Practicing with Apogee Physicians (Deaconess & Valley) beginning 2/2012 Bullard-Berent, Jeffrey H., MD Pediatrics Med School: Wayne State U (1987) Internship/Residency: U of Southern California (1990) Practicing with Spokane Emergency Medicine beginning 3/2012 Cackowski, Patricia M., MD Family Medicine Med School: Wayne State U (1978) Internship/Residency: Saginaw Cooperative Hospitals (1981) Practicing with Rockwood Clinic beginning 2/2012 Germino, Kevin W., MD Pediatrics/Pediatric Emergency Medicine Med School: Northwestern U (2006) Internship/Residency: Cardinal Glennon Children’s Medical Center (2009) Fellowship: Cardinal Gelnnon Children’s Medical Center (2012) Practicing with Spokane Emergency Medicine beginning 3/2012

Ruiz, James A., MD Obstetrics and Gynecology Med School: U of California, San Diego (1986) Internship/Residency: U of New Mexico (1988) Residency: Santa Clara Medical Center (1990) Practicing with Deaconess Perinatal Services beginning 2/2012

PHYSICIANS PRESENTED A SECOND TIME Krane, Bjorn B., MD Neurology Med School: Oregon Health and Science U (2000) Practicing with Deaconess Hospital beginning 3/2012 Primm, Jane C., MD Diagnostic Radiology Med School: U of Washington (1985) Practicing with Radia, PS since 1/2012 Shaw, Amie R., DO Family Medicine Med School: Touro U, College of Osteo Medicine (2008) Practicing with Group Health since 7/2011

PHYSICIAN ASSISTANT Jones, Christina L, PAC Physician Assistant School: U of Washington, Medex Northwest (2011) Practicing with Cancer Care Northwest since 12/2011

Hoehler, Amanda E., MD Pediatrics/Pediatric Emergency Medicine Med School: U of California, Irvine (2002) Internship/Residency: Seattle Children’s Hospital (2003) Fellowship: U of Utah (2009) Practicing with Spokane Emergency Medicine beginning 2/2012 Jasman, Lora L., MD Internal Medicine Med School: U of Washington (1985) Internship/Residency: St. Joseph’s Hospital (1989) Practicing with Rockwood Clinic since 1/2012 Keats, John R., MD Obstetrics and Gynecology Med School: Brown U (1978) Internship/Residency: UCLA Medical Center (1982) Practicing with Deaconess Perinatal Services beginning 2/2012 Le, Minh H., MD Family Medicine Med School: State U of New York (1999) Internship/Residency (2002) Residency: Cook County Providence Family Medicine Residency Program (2004) Fellowship: Austin Medical Educational Programs (2005) Practicing with Riverstone Family Health since 1/2012 February SCMS The Message 15

POSITIONS AVAILABLE PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Pediatricians to join us in Spokane, the urban center of spectacular eastern Washington. Excellent opportunity to join a collegial, physician-led medical group affiliated with the region’s most comprehensive and caring hospitals. Providence offers generous hiring incentives, competitive compensation, comprehensive benefits and flexible work arrangements to fit individual needs.

Contact: Mark Rearrick, mark.rearrick@providence.org, (509) 4746605, www.providence.org/physicianopportunities.

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 99022-0800.

PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/ work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more.

To learn more about physician employment opportunities, contact Toni Weatherwax at (509)444-8888 or hr@chas.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at 1-800-260-1515 x5366 or email gmelkus@qtcm.com or visit our website www.qtcm. com to learn more about our company.

PRIMARY CARE INTERNIST WANTED (Pullman) - Immediate opportunity for BE/BC primary care internist to join a privately owned, multi-specialty, physician practice. Palouse Medical offers a competitive employment package, guaranteed first year salary, comprehensive benefits and partnership potential. Dedicated to delivering quality care, we are proud to offer an extensive array of patient services and on-site laboratory and imaging departments.

We can’t wait to introduce you to the communities that we love and serve. Call Theresa Kwate at (509) 332-2517 ext. 20 or email tkwate@palousemedical.com. Contact us today and discuss your future at Palouse Medical!

CONTRACT BACK-UP PHYSICIAN 4 + HOURS/MONTH Octapharma Plasma is hiring a Contract Back-Up Physician in our Spokane, WA Donor Center! This position requires just 4 hours per month. GENERAL DESCRIPTION Provide independent medical judgment for issues relating to donor safety, health and suitability for plasmapheresis and immunization. Provide federal and international mandated training and supervision of donor center medical staff to assure compliance with applicable laws. We provide on-the-job training. WHO IS OCTAPHARMA PLASMA? Octapharma Plasma, Inc. is dedicated to improving the health and lives of people worldwide. OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally.

Learn more at www.OctapharmaPlasma.com! APPLY TODAY! Apply today by sending your resume/CV to Careers@ OctapharmaPlasma.com!

PREMIER CLINICAL RESEARCH, an independent dedicated research facility here in Spokane with 20 years of research experience is looking for a Pediatrician to be a part of our physician network for future studies. For more information please contact: April Gleason, Director of Business Development, (509) 390-6768, premierclincalresearch@gmail.com.

FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships.

This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at 509-459-0688 or e-mail at BorgwaD@fammedspokane.org.

PROVIDENCE SACRED HEART CHILDREN’S HOSPITAL (Spokane, WA) is seeking a BE/BC Pediatric Hospitalist to join our inpatient team. Be part of an exceptional care-team serving children from four inland Northwest states. Work closely with the Pediatric Trauma Center, general pediatric unit, PICU, NICU (level III), and Pediatric Surgery known for exemplary care. Strong crossspecialty support, state-of-the-art equipment and technology, and wonderful quality of life in sunny eastern Washington. Competitive compensation and excellent benefits package, including relocation.

Sacred Heart Medical Center and Children’s Hospital has 623 beds, a medical staff of more than 900 and a service area population of about 1.5 million. The children’s hospital alone includes more than 90 pediatric sub-specialists. Learn more: Mark Rearrick, Providence physician recruiter, (509) 474-6605, mark.rearric@providence.org, www.providence.org/physicianopportunities.

Continued on page 19

February SCMS The Message 16

February SCMS The Message 17

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   February SCMS The Message 18

Continued from page 16 PROVIDENCE HEALTH & SERVICES is building its Urgent Care presence in Spokane. We are recruiting for BE/BC Urgent/ Immediate Care physicians and advanced practice providers (nurse practitioners and physician assistants welcome to apply). This is a great opportunity to join a growing employed medical group in beautiful eastern Washington. The exceptional Providence care team is implementing a system-wide standardized EHR and providers benefit from shared best practices and robust clinical and business support. Providence already operates hospitals, residency programs and numerous primary care and specialty clinics in Spokane. Competitive compensation and excellent benefits package, including relocation. Learn more: Mark Rearrick, Providence physician recruiter, (509) 4746605, mark.rearrick@providence.org, www.providence.org/ physicianopportunities.

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

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.

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling.

Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

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

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

Clinical Space for Lease - Built in January 2011. 1128 sq ft, four exams rooms, two administrative offices, one office with a counter (electronic bar for laptops, etc.), restroom, reception area and waiting room. Rates are negotiable. Interested parties contact Sharon Stephens at Bates Drug Stores, Inc. 3704 N. Nevada, (509) 489-4500 Ext. 213 or Sam@batesrx.com.

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

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GONZAGA MBA In Healthcare Management

Because Better Business Means Better Care Gonzaga is committed to developing innovative and ethical leaders with the ability to think criticially about the current challenges facing the healthcare industry.

MBA & MACC PROGRAMS

Learn More At An Upcoming Information Meeting: Tuesday, March 6th 5:30 - 7 PM at Gonzaga’s Jepson Center

RSVP at www.gonzaga.edu/mbainfomtg February SCMS The Message 20

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

PRSRT STD U.S. Postage

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Spokane, WA Permit No. 512

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