The Message, July 2012 by Spokane County Medical Society

message THE

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

2012

Planning for Today’s and Tomorrow’s Needs By Terri Oskin, MD SCMS President

What do Physicians Say about Today’s Healthcare?

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July SCMS The Message Open2

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

2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect Bradley Pope, MD Immediate Past President 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

Planning for Today’s and Tomorrow’s Needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Spokane County Medical Society Priorities 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SCMS Executive Committee and Board of Trustees Discuss NEW Strategic Plan . . . . . . . . . . . 5 An Assessment of SCMS’ Medical Education Priorities . . . . . . . . . . . . . . . . . . . . . . . . 6 What Do Physicians Say about Today’s Healthcare? . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Spokane Medical Students Take on Summer Research Projects . . . . . . . . . . . . . . . . . . . . 9 Membership – Who is keeping track? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 AMA Advocacy Activities: Spring 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 After the Supreme Court Ruling, Then What? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Physician Governance in the Evolving Healthcare Environment . . . . . . . . . . . . . . . . . . . 13 SCMS 2011/2012 Legislative Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 What is a Health Benefit Exchange? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 The Community Value of Project Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 In The News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Super Senior Docs Rock at Retired Physicians Golf Tourney . . . . . . . . . . . . . . . . . . . . . 21 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

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

Physician Leadership Resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Membership Recognition for July 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Healthcare Professionals Volunteering Abroad Evening a Success! . . . . . . . . . . . . . . . . . 23 New Physicians/Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

"Strategic Planning is a process by which we can envision the future and develop the necessary procedures and operations to influence and achieve that future." Clark Crouch

July SCMS The Message Open3

Planning for Today’s and Tomorrow’s Needs

Strategic planning leads to shift in focus

By Terri Oskin, MD SCMS President The focus of this month’s The Message is to take a look back and into the future. Are we accomplishing this year’s goals and where are we heading? You received a survey back in late 2011 asking you to identify what is important to you, including in your practice, in healthcare and in the role of the SCMS. Based on your results we set the following priorities as the focus of the SCMS for 2012: »» Patient Access to Care »» Expand Spokane-based UW Curriculum to Four years »» Physician Reimbursement/Payment Reform/SGR »» Collegiality/Professionalism/Leadership Development »» Physician-Hospital Relations/Medical Staff Issues/ Physician Employment and Contracting Based on the overwhelming number of responses from a survey sent by the Informatics Committee this spring, it is clear that sharing of patient information between physicians and the hospital systems is on a lot of your minds as well as the Informatics Committee’s. We also have been doing several strategic planning sessions to evaluate our short-term needs and focus on the future needs of our members. Patient Access to Care continues to be a significant topic of concern and will be until primary care shortages and payment reform are resolved. However, through our combined efforts and presence with the Washington State Medical Association, we successfully advocated to the state legislature to avoid passing the Zero Tolerance Policy for Medicaid patients presenting to the emergency departments as well as to preserve funding for the medical interpreter services, the Volunteer Retired Physicians Program (VRP) and the Basic Health Plan.

Recently the SCMS underwent an intense strategic planning evaluation. We have been a strong and respected organization in this community for over 100 years. How will we thrive another 100 years and what shall our role be as community leaders? One of the first things you may notice is a change in our mission and vision statements. As the number of employed physicians increases we all think it is important to emphasize our role as advocates, facilitators and collaborators to ensure the best community health possible for our local citizens. This is not intended to exclude the ever-smaller percentage of private practice providers, but to be inclusive to our entire physician/physician assistant population. Our goal is to become an organization that is vibrant and relevant to the medical community while also serving the needs of the local community. As we discussed in our planning sessions, one of the SCMS’s roles may be to serve as a neutral party, “the Switzerland where physicians can jointly address the business of medicine. We will protect our mission “to fairly and objectively serve as guardian of community health and wellness while leading and promoting the professional practice of medicine in our region.” As we look to the future for the SCMS, our goal is for the SCMS to be an organization with which physicians and physician assistants want to be involved. We hope that our new mission will bring recognition to the SCMS as the voice for quality healthcare in the region. We will continue to support regional healthcare initiatives, partnering with major organizations in our region that provide financial backing and support, so that Spokane will be recognized as a community where its citizens’ health is improving and access has become more available. The SCMS will be the organization that new physicians want to join. We are all reluctant to embrace change but may I ask that you take this challenge? Get involved, come to a meeting, join a committee or simply stay tuned to further updates by reading your monthly The Message. Share it with a friend who may not be a member, and then ask yourself, shouldn’t they be?

Project Access, under the leadership of Lee Taylor, continues to provide millions of dollars of free medical care to our community. This program would not be a success if it were not for those of you who donate your time and services. In 2011, Project Access served 651 uninsured individuals in Spokane County totaling over $7 million in donated medical services.

July SCMS The Message 1

Spokane County Medical Society Priorities 2012 Who’s keeping track? A mid-year update

four hospitals to implement the Best Practices negotiated

By Keith Baldwin, SCMS CEO

by Medicaid).” The group created Consistent Care WA,

with the legislature by Washington State Hospital Association (WSHA), Washington State Medical Association (WSMA) and the American College of Emergency Physicians (ACEP) in exchange for the Health Care Authority (HCA) to not implement their Medicaid policy of not paying for “unnecessary emergency department visits (as defined an entity that provided proposals to Rockwood Health’s

For 2012, a comprehensive set of priorities was developed to respond to the needs of the membership. That process started in the late spring of 2011 with a survey of the membership. Starting early allowed us to test the responses with the Executive Committee (EC), Board of Trustees (BOT) and additional members, before developing the seven priorities and assigning tactics. The priorities also reflected our ability to apply resources and measure the results. We tried to consistently apply those principles and were successful in most cases, although the proof of that will be in the results. This update is intended to provide you, the members, with a snapshot in time of how far we have come and to allow for adjustments as the environment or other activities change our thinking. We welcome your comments. For example, we are progressing fairly quickly on a much more robust Strategic Planning process with the help of Bob Colvin of Strategic PlanningMD. Bob has done a great job of individual interviews and group sessions to prepare a draft strategic scenario for EC and BOT discussion. The results of that work will be communicated broadly to the membership; if it hasn’t already happened prior to this publication. That process could change some of our priorities and tactics. Don’t forget that we start out with the statement, “STRIVE to keep the PATIENT first as we pursue the 2012 Priorities to promote the health of populations and engage individual patients in a shared decision-making care model.” This is a challenging statement and is intended to be kept in mind as we carry out the priorities. The first priority, “To improve the Spokane County Medical Society (SCMS) efforts to provide PATIENT ACCESS TO CARE (Physician Workforce/Uncompensated Care),” has four components with results to date as follows: »» Project Access has not only increased the number of providers volunteering care, they have dramatically reduced the time between the application and a provider visit. This is with more patients being taken care of, for an increase of 16.5 % from the first of the year until now; for a total of 412 active patients. Seven new providers were enrolled including Neurology, Urology and General Surgery. »» The Emergency Department (ED)Medical Director Group has organized, on a community-wide basis, to respond to the 2012 budget proviso for Medicaid Patient Requiring

Deaconess and Valley Hospitals. »» The Informatics Committee surveyed the membership and received 295 responses to date relating to a communitywide health information exchange (HIE) or sharing of patient information across the community. We are visiting all the systems with significant Information Technology platforms to advocate for a community-wide HIE policy to meet the needs of physicians and their patients. »» Patients continue to call SCMS for referrals to physicians so the SCMS is in the process of organizing all the links to existing referral sources in the community to include WSMA, Rockwood Health, Providence Health System and others for easy patient access. The second priority is to “Provide physician leadership to support the EXPANSION OF WWAMI/UWSOM CURRICULUM TO FOUR YEARS IN SPOKANE.” This has been an important issue for several years and we have seen tremendous progress this year. Here are the current accomplishments: »» Starting with legislator dinners last fall, physicians advocated in Olympia (several times) and in WA, D.C. this spring and subsequently the Biomedical Health Sciences building has been fully funded through the legislative capital budget. »» Dr. Gary Knox and I have served on a steering committee that led the planning process resulting in website development http://morethanamedicalschool.com/ - and private fundraising for the first two years of operation for the second year of medical education that is nearing its goal of $1.45 million. »» SCMS has sponsored and supported faculty development events in collaboration with WWAMI. A number of physicians attended the University of Washington School of Medicine Graduate Medical Education (GME) Summit at Washington State University Spokane this year as well as to discuss the latest developments in the enhancement of current GME and expansion into new residency programs. The third priority is to “Update and educate SCMS members on PHYSICIAN REIMBURSEMENT, PAYMENT REFORM and the Sustainable Growth Rate (SGR) FORMULA changes occurring at the Federal/State/local levels.” The progress to date includes:

Coordination (PRC) patients and is actively working with all July SCMS The Message 2

Continued on page 3

Leadership Resources, WSMA resources and an Opinion Page.

Continued from page 2 »» Advocacy in Olympia during the legislative session has focused on programs and services funded by the state and were threatened in the budget negotiations. All were ultimately saved including the Medicaid payment for interpreter services, Basic Health enrollment, volunteer physician medical liability coverage, the disability lifeline program and the HCA zero tolerance policy for unnecessary ED visits. »» SCMS solicited and published several excellent articles on payment reform in the February issue of the newsletter. Current payment reform information is placed on the SCMS Facebook account on an ongoing basis. »» The ED Medical Directors Group (involving the four Spokane hospitals) has committed to working together to implement the legislative budget proviso in lieu of the HCA zero tolerance policy. This requires the application of seven best practices in the ED to secure $30 million in savings for Medicaid by July 1, 2013. They are also working with several insurers on incentive based programs for ED utilization improvements. A resource page was added on Medicor for this activity.

We continue to support the need for timely news, regulatory notifications and updates on the SCMS Facebook page. »» With the support of several SCMS Community of Professionals partners, the Bank of America lobby was made available for SCMS members and their families to use before and after Bloomsday. A number of women physicians met on several occasions to plan future events including a retreat in March 2013. A cruise on Lake Coeur d’Alene is planned for July 12, 2012, again with significant sponsorship by the Community of Professionals partners. »» There is now a monthly posting in the newsletter, with complementary menu item on the website, of physician leadership educational materials. »» I am currently using the membership database to evaluate the characteristics that could be used to enhance the use of SCMS/WSMA resources to improve the value of membership, especially in light of the potential for de-unification of counties during the 2012 WSMA House of Delegates (HOD) meeting in Tacoma September 15 – 16. »» Dr. Bare presented to Deaconess Hospital and Providence

The fourth priority involves, “Enhancing the COLLEGIALITY, PROFESSIONALISM and LEADERSHIP DEVELOPMENT of SCMS members.” We have made the following progress:

Holy Family Hospital medical staffs on best practices for opioid prescribing. I also met with Dr. Jeffery Liles at Providence Sacred Heart Medical Center about the development of standards and protocols related to the use of opioids. In

»» Medicor is enhancing the use of evidence-based information

addition, the ED Medical Director Group has advocated for

by agreeing to provide diabetes care information to physicians

the Washington State Prescription Monitoring Program (PMP)

and patients in the Beacon Community of the Inland Northwest

to communicate directly with the Emergency department

(BCIN). Medicor will also be developing a separate portal

Information Exchange (EDIE) system to improve access to

as a regional source of disaster and emergency response

patient information for ED physicians. The OneHealthPort HIE

information for providers in Spokane County. In-house guest

now also facilitates the use of the EDIE system based on the

access to Medicor was enabled for all Rockwood Clinics.

same advocacy efforts of the ED Medical Director Group with

»» We developed and continue to enhance folders in Medicor and

Project Access Director Lee Taylor’s support.

on the SCMS Website Menu for Pain Resources,

July SCMS The Message 3

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»» Spokane Prescription Opioid Task Force (SPOTF) meetings with medical staff officers related to the prescriptive behaviors

»» SCMS provided a pain management Continuing Medical Education (CME) as a pre-conference event of the Primary Care Update in early May. In addition, Jennifer Anderson,

physicians in the acute setting. »» Informatics Committee meetings of the Chair and SCMS CEO with health system CEOs and others about “sharing of patient

SCMS CME Coordinator, organized a planning committee for a daylong CME in the fall that will be preceded by the annual conscious sedation CME. In addition, Jennifer completed an

information.” »» Grievance Committee information about opioid prescribing behaviors of physicians related to Medicaid and the

application for re-accreditation with WSMA for Category 1 CME with an on-site survey in May 2012. »»

Finally, to enhance the leadership success of SCMS in the future, a strategic planning process was discussed and a consultant was hired to carry out individual interviews and

Department of Health (DOH) PMP. »» Fundraising activities of Project Access with support of physician leaders in meetings and development of prospects. »» The ED Medical Directors Group and their efforts to implement the seven best practices to reduce unnecessary

group discussions. From that input, a Strengths/Weaknesses/ Opportunities/Threats (SWOT) analysis and draft strategic scenario for the future of SCMS has been drafted and discussed at the EC and BOT meetings. The next step is to broadly communicate the new Strategic Scenario to the membership. The Strategic Scenario includes a new Mission/ Vision statement, strategic activities, five-year benchmarks and implications for organizational funding (involving the SCMS budget and dues structure) and governance. The strategic activities will involve enhancing current community-wide initiatives and evaluating and pursuing new initiatives. The fifth priority is to “Strive to enhance and elevate PHYSICIAN – HOSPITAL RELATIONS AND RESOLUTION OF MEDICAL STAFF ISSUES INCLUDING PHYSICIAN EMPLOYMENT AND CONTRACTING to secure fair and equitable interactions between all parties.” We have been pursuing the following activities:

visits by Medicaid PRC patients in the ED. »» Development of a planning committee for a fall SCMS one day CME offering. »»

The EC effort to guide the Strategic Planning process.

The seventh priority was added early in the year to address the significant changes occurring in the healthcare environment and delivery system. Current steps to address this priority which is to “Provide leadership for all physicians to become knowledgeable in the Triple Aim: Care, Health and Cost; improving the experience of care, improving the health of populations and reducing per capita costs of health care,” include the following; »» Several meetings were arranged between SCMS and the Puget Sound Health Alliance to better understand their quality measurement activities. Additional meetings and calls have been made to clarify the disease registry and data storage systems of CINA, a Critical Access Hospital Network

»» SCMS has been communicating with hospitals on several

(CAHN) project and the Orion care coordination program in

initiatives including the Informatics Committee’s “sharing

development by the BCIN. All of those projects support areas of

of patient information initiative” and have spoken with chief

the Triple Aim and our understanding of the how physicians can

executive, information, medical informatics and medical

incorporate tools in their practices that work toward those goals.

officers in the process to improve the dialogue on this issue. »» Project Access, through the SCMS Consistent Care WA entity, has made proposals to chief financial officers and others at Rockwood Health’s Deaconess and Valley Hospitals to implement the seven best practices to reduce unnecessary visits by Medicaid PRC patients. The Consistent Care WA program is engaged with the Providence Medical Group to evaluate care coordination for the uninsured and measure the

Thank You! The School Health Care Association of Spokane County sent a special thank you to the Spokane County Medical Society Foundation for its generous support of the Sunset School Health Center. To learn more about the project visit www.schoolhealthcaresc.org.

effectiveness of their efforts. »» Leadership at all the hospitals was included in the interview process by Bob Colvin for the SCMS strategic planning process and received valuable feedback. The sixth priority involves support for SCMS leadership in a number of initiatives and reads “Maintain and support an ONGOING EMPHASIS in the following activities.” Staff has provided significant support in the listed. July SCMS The Message 4

SCMS Executive Committee and Board of Trustees Discuss NEW Strategic Plan By Keith Baldwin, SCMS CEO & Bob Colvin, Strategic PlanningMD Major changes in our working environment always bring higher risk for success and failure. I have heard many people talk about this concept. Physicians and Physician Assistants are in the midst of a sea change in the way that medicine is delivered and paid for. Patient centered medical homes were but a blip on anyone’s screen just five years ago and until the Patient Protection and Affordable Care Act (PPACA), payment reform was just another pushing of the Sustainable Growth Rate (SGR) down the road for a few months. Now the CMS Triple Aim goals of improving the patient experience, improving the health of populations and reducing the per capita costs of health care, are front and center. This has forced significant discussions about the use of information technology, the formation of Accountable Care Organizations (ACOs) and Integrated delivery Networks (IDNs), shortages of primary care amidst a backdrop of significant employment of physicians and the cost to business to provide health coverage for employees (a benefit now provided by only 39% of businesses according to several recent sources). So, what is a medical society to do? Will they age in place and go the way of many service organizations who can’t find younger members to take on leadership positions (such as the recent “For Sale” sign on the Sons of Norway)? Or will they simply cut their expenses every year to stay within a shrinking budget; fewer members paying dues as they see less value (or simply vote to pay fewer dues as the WA Lawyers Association did in 2012)? Are there other scenarios? The SCMS Executive Committee (EC), in 2011, thought that the issue needed to be addressed. It was decided that a “strategic planning process” needed to be evaluated and professional facilitation was needed to move that process forward. Bob Colvin, the principal of Strategic PlanningMD, was chosen to provide consulting services from a number of qualified firms. Bob initially carried out individual interviews and group discussions to get feedback from the membership and other local healthcare and hospital leaders. The input from the interviews and a Strengths/Weaknesses/ Opportunities/Threats (SWOT) analysis were reviewed with the SCMS EC. Bob then introduced the “most likely” scenario based on the SWOT analysis discussion. »» The scenario begins with a Summary page »» A new Mission and Vision »» Strategic Activities in four categories: »» Communication, »» Facilitator/Convener/Broker/Partner, »» Regional Advocacy, and »» Medical Practice Support.

The new scenario and activities would be measured by benchmarks over a five- year period. So what makes this scenario different? It strives to create value for younger members who tend to join employee relationships while still serving independent members who strive for advocacy related to the profession. The Mission and Vision begin the change process by creating a statement about the “community’s’ health rather than a focus on the interests of individual physicians. It gets to the heart of or focus of medicine for the whole community. It also reenforces the position of the SCMS as a representative of the whole community on issues related to medicine, health and wellness.

Mission “The Spokane County Medical Society’s Mission is to fairly and objectively serve as a guardian of community health and wellness while leading and promoting the professional practice of medicine in our region.”

Vision “The Spokane County Medical Society uses its resources and expertise, through collaboration and strategic partnerships, to facilitate the best community health possible for citizens of our region. SCMS is also well respected for its role in supporting the practice of medicine and stimulating teamwork across the regional health care continuum.” The Strategic Activities start out with the category of “Communication.” Branding the society in the broader community and messaging everything important about the society’s activities which must be prominent and repeated often. SCMS would be taking on community wide health initiatives through leadership roles which use competent staff to convene, facilitate, broker and partner with other collaborators. The initiatives would need to be vetted by the society’s governance process. Think about this the way you would think any successful business would need to respond to a significantly changing environment; using its resources to the best advantage while governance leads with policy discussions and decisions. Finally, regional advocacy still remains an important activity along with practice support functions such as credentialing, authoritative information resources for physicians and other related groups and Continuing Medical Education. A set of benchmarks will be developed and finalized to make the strategy accountable to not only the members but to the community. The goal of the strategic scenario is to provide value for all the members. Governance should be streamlined and responsive to the membership as it continues to evolve into an ever-changing future with confidence. Do you want to be a part of this strategic scenario? YOU decide. PLEASE give the SCMS leadership and staff your comments, ideas and input. Every response helps to create a more robust strategy for the future of medicine.

July SCMS The Message 5

An Assessment of SCMS’ Medical Education Priorities By John McCarthy, MD Assistant Dean for Regional Affairs University of Washington School of Medicine The Spokane County Medical Society (SCMS) has continued to do an excellent job with respect to working with the 2012 priority of “providing physician leadership to support the EXPANSION OF WWAMI/UWSOM CURRICULUM TO FOUR YEARS IN SPOKANE.” There was a three-commitment process to which SCMS committed. First was a commitment to “advocate with local/state/ federal legislators for capital and operational financial support.” This continues to be a long-term commitment and goal. The community will be starting with four years of medical education in Spokane in one year, but this is a two- year pilot which is supported by community generated funds rather than the state. We need to continue to work towards the state valuing this enterprise as it has had a myriad of benefits for our Spokane community and will inevitably have benefit for all state residents as well. The second commitment was to: “provide physician leadership at the Steering Committee and sub-committee level for the Academic Health Sciences Center and specifically medical school development.” SCMS has continued to be engaged in this process and has been able to assist in convening meetings and providing representation as we plan for the future of medical education in this community. SCMS has been able to help broker the engagement of UWSOM, WSU, Greater Spokane Incorporated (GSI), the physicians, and the hospitals in developing more undergraduate training as well as residency opportunities. The third commitment has been to: “engage physicians as faculty and mentors to all medical students in the community at the medical school and graduate medical education levels”. At this time, there has been excellent involvement by physicians as faculty, preceptors, attendings and mentors for our residents and students. As we have all appreciated, the “asks” by learners of all types has increased and fortunately the “word on the street” is that Spokane is a great place to do medical education. Students are markedly appreciative of the teaching they receive here. This is likely not as evident to most SCMS members as it is to me. Students really enjoy their experiences in Spokane and although we are not a huge academic entity like the UW in Seattle, students realize they are getting excellent teaching, a constellation of intriguing clinical presentations, and wonderful precepting and mentoring. As I look at SCMS’s commitment to the growth of medical education in the community, I would suggest it maintain its commitment to supporting growth in medical education growth and maintain this as a priority. Unfortunately, this is not a time to sit back and enjoy our successes; there is more work to be done. Because we have done a good job, students are looking

to Spokane for more and more training opportunities. They are highly interested in more residency options and we know that need is profound. With that in mind, we need to continue our “long term plan and vision” as we grow education for physician assistants and physicians in this community.

What Do Physicians Say about Today’s Healthcare? Based on the theme of this Newsletter, “Who is keeping track?”, a number of physician leaders were asked to respond to the survey based on a number of questions about the healthcare industry, the physicians role in the healthcare system and the physicians’ relationship with other providers. (See Comments Below) You can respond to this article and the responses and your comments will be placed on the opinion page of the SCMS website. Thank you for your contributions to this discourse.

INDUSTRY SURVEY HEALTHLEADERSMEDIA2012 Physician Leaders Report About This Survey The HealthLeaders Media Industry Survey 2012 was conducted by the HealthLeaders Media Intelligence Unit. In October 2011, an online survey was sent to the HealthLeaders Media Council and select members of the HealthLeaders Media audience. The study is based on four concurrent surveys: Senior Leaders, Finance Leaders, Physician Leaders and Nurse Leaders. The surveys included some common questions for all respondents and some questions directed at leaders in specific segments. A total of 1,070 completed surveys are included in the overall survey analysis. The margin of error for a sample size of 1,070 is +/- 3.0 percentage points at the 95% confidence interval. A detailed breakout of completed surveys by report is listed below. Percentage totals do not always add up to 100% due to rounding. Of Physician Leaders Surveyed: 53 percent - Say the healthcare industry is on the wrong track 63 percent - Say their organization will be part of an ACO within five years 18 percent - Rate both their physician staff and nursing staff as very strong 58 percent - Say they have ordered a test or procedure for primarily defensive medicine reasons

July SCMS The Message 6

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says Douglas Garland, MD, medical director of the MemorialCare Joint replacement Center, part of 1,006-bed MemorialCare Health System in Long Beach, CA.

In Search of the Team Player “Often seen as self-styled Lone Rangers out to save healthcare with their clinical know-how, physicians must do a better job becoming involved in partnerships to overcome turf wars and egodriven barriers to coordinate care and improve patient outcomes. Improving relationships within hospital systems is critical, with the need clearly reflected in the HealthLeaders Media Industry Survey 2012,” says Michael J. Dacey, MD, FACP, senior vice president for medical affairs and chief medical officer for the 359-bed Kent Hospital in Warwick, RI. “Many hospitals now have millions of dollars each year at stake on quality and patient satisfaction measures,” he says. “In many cases, a hospital’s entire profit margin and then some will be accounted for by successful performance on these measures. In order to succeed with these, hospitals and doctors must work together.” It may not be easy. The industry survey reveals that 10% of physicians blame themselves for the “healthcare industry mess,” although three times that number—30%—see physicians as the ones who will save healthcare. And 13% say that physician disrespect and abuse of nurses is prevalent at their organization. “It has become increasingly apparent that doctors have to work with other people and share the care of patients with other professions, whether they are nutritionists, pharmacists, or nurse practitioners,” Dacey says. “You’ve got to be more collaborative, work as a team. There’s a different mind-set.” Of physician leaders in healthcare organizations nationwide, 36% said the government was “most to blame for the healthcare industry mess.” Another 23% blamed health plans, and 10% blamed physicians themselves. Physicians should be blaming themselves for a big part of the healthcare morass. “We order too much, [practice] too much defensive medicine, keep patients in hospitals too long,”

“We truly care about people and good outcomes, but not in rationing care, which doctors must learn to do. We made our bed and now we must sleep in it.” Patients need to learn, too, Garland says. “They want their own doc, not a doc in the box; they want the latest and the best,” says Garland, also co-chair of the orthopedics, neuroscience, and rehabilitation program for the 420-bed Long Beach Memorial Medical Center. And who’s going to save the healthcare industry? Well, the doctors say the doctor, that’s who. In the survey, 30% said that physicians would save healthcare, far outdistancing the other stakeholders, such as the government (13%) and hospitals (13%). “So much for humility,” Dacey comments. “The real answer, of course, is all of the above working together,” he says. “Most doctors believe that very few administrators understand physicians and the problems they face,” Dacey says. “And most administrators at both hospitals and insurance companies would say the same thing about doctors. And both groups are correct.” Relations between physicians and nurses are particularly important as systems move toward multidisciplinary approaches and use of nurse navigators with physicians for specialized care within service lines. The survey results indicated mixed attitudes about physicians related to their nursing colleagues. While 48% said increasing scope of care for nurses would improve the quality of care, 26% said it would worsen. When asked how pervasive physician abuse or disrespect of nurses is at individual organizations, 13% said it was common, while 88% said it was uncommon. Continued on page 8

July SCMS The Message 7

Continued from page 7 Physician and nurse relations are often dependent on where they work in the hospital, Dacey says. While ICUs or emergency departments may generate team concepts, a physician working on a medical floor “may feel that I’m going to be there for 20 minutes, and I don’t have to take the heat” and start being abusive, Dacey says. “Of course,” he adds, “any disrespect should not be tolerated. Nurses are our partners.” “It has become increasingly apparent that doctors have to work with other people and share the care of patients with other professions, whether they are nutritionists, pharmacists, or nurse practitioners. You’ve got to be more collaborative, work as a team. There’s a different mind-set.” Comments from SCMS Members As we move away from fee for service, physician leadership will become increasingly more important in order to improve care coordination. Physician leaders will not only create value for themselves and their organization, but also for every physician who is associated with that organization. The delivery of healthcare is rapidly changing and so must we. Rod Trytko, MD, MBA Defensive medicine is far understated. When a simple human mistake in problem synthesis or a rare condition that could have been handled better in hindsight can lead to a credentials action or lawsuit, it will never be tamed. David S. McClellan, MD, FACEP Wow! Shocked at the low percentage of responders that rank their physician and nursing staff as very strong. I am in the camp with the physicians that responded it is up to the physicians to fix the system however without strong leaders we will continue to sacrifice excellent healthcare for bureaucracy. Terri Oskin, MD Like the cliché says, Change is a Process. This survey shows that physicians need to continue the process of change to becoming better participants in the team approach to patient care and in making the transition to a pay for value rather than a pay for volume business model. We are in the midst of a very significant cultural and business model sea change for physicians. The change is underway regardless of national policy or personal preferences. The powerful forces driving this change all derive from the fact that resources available for healthcare are finite. It does not matter what we think we need or want. The fact is we can't afford it all. Let's lead by doing the best we can with what we have with a focus on teamwork and evidence based resource utilization. Embrace the change. Brad Pope, MD “I fear that the ship may have sailed for physicians taking a leadership role in transforming our health care system. The failure of Don Berwick to be confirmed as head of CMS seems to signal that. Though many individual physicians have joined this effort, organized medicine has not supported their work. As evidenced

by the AMA continuing to champion “the unfettered” practice of medicine, there is stubborn reluctance to recognize that maintaining the status quo simply costs too much and is not an option. To be sure, the physician voice is essential for designing an optimal healthcare system. However, if that voice continues to sound self-serving, no one is going to listen and we will get more of what infuriates us, policies and regulations designed not by those who understand healthcare on a personal level, but by administrators and politicians.” Anonymous Until patients take some responsibility for their own health, no amount or kind of health care will be enough. Patients will always be able to outpace our advancements in providing care by eating, smoking, shooting each other, drinking alcohol, driving irresponsibly, using harmful drugs and reproducing at alarming rates. We (providers, insurance companies, government agencies, hospitals) need to create incentives to change how people care for themselves and each other. No one has yet figured out how to do this successfully. A Nobel Prize is due the person who solves this puzzle. Jon Keeve, MD Coming from the perspective of a safety net organization, I have a unique perspective. We see an at risk population, 34% without insurance, who, for fear of running up a bill, wait until something simple becomes something critical. Fred had an abscess on his left leg, but delayed treatment for lack of insurance. His infection became blood born, requiring hospitalization and surgery. Alice, a diabetic, was stable 12 months ago but because of a “spin down” Medicare requires, hasn’t had payment for her medications for the last two months and I have her on the way to the hospital in early ketoacidosis. Lack of affordable health insurance is a huge burden. Community Health Centers are already working in teams and have a 2:1 non physician provider to physician provider ratio. Our Care teams include pharmacists, nurses, dentists and support staff. But because we work in a Fee for Service environment (75% of our patients) we can’t get paid for care team work we do. Payment reform is another huge issue. We do ambulatory care with both hospital systems accepting our patients through hospitalist coverage. But the disconnect comes in that cost savings are made mainly at the ER and hospital level, but are modulated in ambulatory clinics like ours. There is separation of where work occurs and where savings occur. We need to further consolidate care to vertically integrated systems (ACOs) to align work with savings. Great opportunities are available in vertically integrated care systems to render safer, more timely, effective efficient equitable care that is patient centered. Islands of excellence currently exist in our nation (e.g. Kaiser and Group Health) who provide the insurance product and all lines of service both in and out patient, preventive health and healthcare. We as a nation need to promote and emulate those systems to reach access, quality and cost goals.

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Continued on page 9

Continued from page 8 Allow for a mixed private public system of care but mandate nonprofit insurance companies or public insurance like Medicaid and Medicare as a means of coverage. Finally make our healthcare system (like all industrialized nations whose systems are better than ours, which would be all of them) a primary care based system that does 85% of the care, with specialty care for consultation and procedures. All citizens would have their primary care provider know them and live in their community and great specialty care in accessible regional centers to have diagnostic workups and surgical procedures accomplished. Put all specialists on salary by the government and all primary care providers can be private providers in the communities where they live. David Bare, MD

a month working in a rural hospital in the Northwest (Rural and Underserved Opportunities Program) or 10 weeks in a developing nation as part of the Global Health Immersion Program. Kenny is pursuing a hypothesis-driven research option that is typically accomplished over 10 weeks. Some of these projects are supported by the Medical Student Research Training Program. “The idea behind students doing original research is a good one,” said Ken Roberts, the director of the WWAMI (Washington Wyoming Alaska Montana Idaho) first-year medical education program in Spokane. “We’ve encouraged students here to take a look around at the faculty who are teaching them – almost all of them have research programs – and as they build relationships with them, learn about what they do and potentially do a summer project with them.” Three students, including Kenny, are teaming up with an interprofessional group of faculty collaborators led by Daratha. The other two students are working on projects related to kidney disease. Daratha, Roberts and Spokane nephrologist Kathy Tuttle are each mentoring one student.

Spokane Medical Students Take on Summer Research Projects By Doug Nadvornick, WSU Spokane Tara Kenny has just completed a solid first year of medical school. Her hard work was rewarded with a Spokane County Medical Society scholarship and a class leadership award from the Shikany Foundation. This summer the Portland, OR native is staying in Spokane to fulfill a research requirement. She’s working with nursing assistant professor Kenn Daratha to study if expectant mothers with mental disorders and drug problems are more likely to suffer adverse events related to birthing than women who don’t have those conditions. “We’re looking at whether substance abuse and mental disorder affect things such as length of stay in the hospital,” said Kenny. “In the literature we found there’s a possible link between substance abuse and placental insult that could cause the baby to be born prematurely.”

“These are projects initiated by the students. They decide the topics. They’re the ones who write the proposals,” said Daratha. He says they work together through the process of getting support from institutional review boards. The students comb through databases that include de-identified hospital patient information to find and analyze relevant data. He says they combine that knowledge with evidence from other sources of medical information and pull it all together into papers they write for publication. The other two students are working with WSU sleep and addictions researchers. One is comparing the physiological effects of e-cigarettes and regular cigarettes in people who use them. The other is examining the sleep patterns of people who are dependent on opioids. Roberts says some students may be invited to present their research papers at the Western Student Medical Research Forum next January in Carmel, CA.

On-campus research options becoming more popular Kenny’s decision to stay and work in Spokane before going to Seattle in August for her second-year of studies is part of a trend. She and three of her classmates have paired up with WSU and local clinical researchers for summer projects, an increase from two students last summer and one during the summer of 2010. In addition, a fifth student – from Spokane’s first-year class of 2010 – is returning to continue a research collaboration he began last summer. The University of Washington School of Medicine requires a research project during the first and second years. It gives students five options. Many build their research around a clinical assignment, either

Medical Student Tara Kenny at Sheridan Elementary School teaching 6th graders about the heart,exercise and healthy lifestyles

July SCMS The Message 9

Membership – Who is keeping track?

are Family Physicians in an employed relationship. Thirty of your colleagues, who dropped their membership this year, had been members since before 1999.

By Keith Baldwin, SCMS CEO It seems that a lot of people are interested in membership demographics in today’s environment of health reform. In medicine, specialty societies such as the American Academy of Family Physicians (AAFP) or American College of Emergency Physicians (ACEP), state societies such as the Washington State Medical Association (WSMA), county societies such as the Spokane County Medical Society (SCMS) and national organizations such as the American Medical Association (AMA), are all strategically thinking about whether they are continuing to provide value to their members. In order to better serve members, most organizations are looking at who are current members. As part of the Strategic Planning process for SCMS, information was gleaned from our member data base to look for trends. Here is what we found. SCMS members are made up of 60 and 62% of the licensed men and women physicians respectively in Spokane County. That continues to be a large percentage as compared to many other county societies in Washington State. Still, the new goal would be for 80% of licensed physicians to want to be members in SCMS. Even though more than 50% of students entering medical schools today are women, only 25% of the SCMS members are women. Maybe Spokane hasn’t caught up with the national trend or the incoming classes haven’t matriculated through their residencies to become practicing physicians yet. I am not sure of the specific reasons for that demographic. Age categories seem to follow national figures as 54% of SCMS members are 50 years of age or older. I don’t think that is surprising. There also aren’t any surprises in the specialties, with 50% of members in primary care (includes FP, IM, GP, OB/ GYN), Internal Medicine subspecialties, Pediatrics and Pediatric subspecialties. All the surgical and other specialties make up the other 50%. More members are also now part of a group; more now than ever before. What is different is the number of employed members. We estimate that at least 44% of the membership is now in an employment relationship. Several sources have quoted the number of employed physicians in the state at 60% and climbing. And many physicians who have traditionally been in contracted positions (12% of members), are now moving to employment relationships which will again increase the percentage of employee physicians in Spokane County. That leaves a number of large and many small independent groups accounting for 44% of the membership total. What else do we know right now? You may not remember, but last year through a survey we noted some of the reasons physicians dropped membership; most commonly they mentioned the cost and then not enough value to support the cost. This year the majority of physicians who are no longer members (45 to be exact)

Is membership just a decision about cost? Would a choice between county and state membership reduce this barrier? Are employee physicians less likely to join local or state societies in the future for lack of perceived value? Is “joining” a professional or service organization just not relevant anymore; currently a significant problem for fraternal and service organizations? If you have any insight into why physicians decide about becoming members, it would be very helpful to the SCMS leadership. Please let them know if there are characteristics or trends you believe are important to the membership issue.

AMA Advocacy Activities: Spring 2012 By Rod Trytko, MD, MBA AMA Delegate We are in a very challenging environment for physicians. Healthcare reform and budgetary limitations provide for a very unstable environment for healthcare. Rapid provider consolidation, the shift toward the corporate practice of medicine, new freedoms for mid-level practitioners and the move away from a fee for service payment system are some of the more important changes. Physicians need a national organization that represents all physicians now more than ever before. The AMA is hard at work in a number of areas. I will describe some of those areas below. The Accountable Care Act (ACA), while far from perfect, has some beneficial provisions that the AMA supports including: • Increasing health insurance coverage to 32 million more Americans. • Making health insurance more affordable through the creation of state health insurance exchanges and the provision of slidingscale premium tax credits and cost-sharing subsidies. • Health insurance market reforms to address abuses of the health insurance industry. • Preventing denials of care and coverage, including those for preexisting conditions. • Stronger patient protections. • Administrative simplification. • Medicare bonus payments for primary care physicians and general surgeons. • Increasing Medicaid payments for primary care physicians. • Increasing geographic adjustments for Medicare physician payments. • Expanding and improving coverage of preventive services in the public and private sectors.

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Continued on page 11

• Implement a five-year period of stable Medicare physician payments.

Continued from page 10

• Transition to an array of new payment models designed to enhance The ACA also had a number of negative provisions that the AMA has already successfully revised, including: • Repealing the expanded Form 1099 information reporting requirement. This would have required most businesses, including physician offices, to file a Form 1099-MISC with the IRS for certain transactions valuing $600 or more. • Eliminating a budget neutrality adjustment for primary care and rural surgery bonuses. • Eliminating a tax on elective cosmetic surgery and medical procedures. • Eliminating a Medicare/Medicaid enrollment fee for physicians. • Eliminating a five percent Medicare payment cut for “outlier” physicians. • Postponing penalties related to quality reporting data for two years (from 2013 to 2015) and will continue to advocate opposition to penalties.

care coordination, quality, appropriateness and costs. Fee for service may not survive. A recent victory occurred when the AMA successfully lobbied for legislation that eliminated the Medicare 3% withhold. The billed was signed by the president late last year. This represents an additional step forward in stabilizing the Medicare system. The additional burden of a 3% tax-withhold would have been untenable in the current Medicare payment environment. In another recent victory, the AMA along with other physician organizations successfully lobbied CMS to reverse its proposed revisions to the hospital conditions of participation (CMS 3244P) that would allow hospital CEOs to grant clinical privileges to any provider up to the limit of state law. It also revised its proposal that would allow hospital corporations with multiple hospitals to have a single board only if members of the medical staff from each hospital are on the board.

Much more work on the ACA remains to be done. The areas where the AMA is actively engaged include:

The AMA continues to work on many other national advocacy issues, including:

• Independent Payment Advisory Board (IPAB) which the AMA

• Medical liability reforms at the federal and state levels.

opposes and will continue to actively advocate for it its repeal prior to implementation of the first IPAB recommendations in 2015. • Supporting graduate medical education (GME) initiatives necessary to ensure an adequate physician workforce, including preserving Medicare GME funding and lifting the cap on Medicare supported GME training positions to address physician shortages. • The ACA includes a provision stating that health plans may not discriminate against any health care provider— acting within its state scope-of-practice laws—that wants to participate in the plan. The AMA will seek clarification that this provision does not allow expansion of the scope of practice for non-physician allied health practitioners. • The ACA includes provisions that restrict physician ownership of hospitals. The AMA actively and successfully blocked previous attempts to restrict ownership going back to 2003. The AMA opposes this provision and has supported legislation to repeal it. Perhaps the most serious acute national problem for physicians is the current physician payment system and the flawed sustainable growth rate (SGR) formula. For years now, Congress has elected to kick the can down the road rather than directly address the issue in a credible manner. Now the SGR problem has grown to such a magnitude that effective reform may be out of reach. The SGR problem may simply be too big to fix in the current budgetary environment. The AMA has recommended to Congress a three-pronged approach to reforming the physician payment system: • Complete repeal of the SGR.

• Legislation that will allow health care professionals to jointly negotiate with health plans regarding terms that affect patient care. • Stopping the required implementation of ICD-10 scheduled for October 1, 2013. • Legislation that will allow Medicare patients and their physicians to enter into private contracts without penalty to either party. • Efforts to ensure that patients have accurate information regarding the education, training and qualifications of individuals providing their health care services. The AMA has also been very active in its advocacy activities this year in Washington State, where it is a solid partner of the Washington State Medical Association (WSMA). The AMA provided support this year to the WSMA to oppose the Medicaid Fraud Bill and the Emergency Department visit limitation. In addition, the AMA litigation center supported the WSMA in the Washington Chapter of the American College of Emergency Physicians v. State of Washington lawsuit. The AMA provided financial support, and has continued to provide additional legal support as the debate on this issue continues with the Health Care Authority and in the Washington State Legislature. In so many ways, the AMA is hard at work. No other physician organization has the scope, reach and resources to effectively advocate for all physicians. Never has the AMA been more important to all of us. Dr. Trytko is an AMA Delegate from Washington State and a Regional Medical Officer for Team Health Anesthesia.

July SCMS The Message 11

Adult Psychiatry, Spokane Riverfront Medical Center Group Health Physicians, the Northwest’s premier multi specialty group, is currently seeking a BE/BC Adult Psychiatrist to join our Riverfront Medical Center team in Spokane. Group Health is dedicated to providing comprehensive, innovative

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July SCMS The Message 12

After the Supreme Court Ruling, Then What?

These are all new collaborative approaches and we will continue to evolve and work with partners in the community, because regardless of whether the ACA is overturned, the reality of spiraling costs will still be with us. If our strategies in Spokane prove successful, Group Health may replicate them elsewhere in the state.

By Tom Schaaf, MD By the time you read this, we will know the Supreme Court’s ruling on the Affordable Care Act (ACA). Several people have asked me if the health care act were to be turned over, would Group Health do anything different in its quality and affordability strategies. The answer is no. We believe health care is too expensive and fragmented in its current state, and so regardless of the outcome of the ACA, we will stay the course. Staying the course means continuing to organize and evolve our care to be high-quality, affordable and appropriate, while also meeting and exceeding our patient’s expectations. Some key areas we’ve focused on are redesigning primary care, improving our costs and services, and better coordinating care with other medical groups. For example, Group Health is now working with Columbia Medical Associates, Providence Health Care and other physician partners to improve care coordination in different specialties. We are collaborating with Providence to design a new Urgent Care facility that is intended to better serve patients who need prompt medical attention but don’t really need an emergency room. Our shared vision is to deliver care with better services and lower costs. Doors to the Urgent Care center will open this December. Group Health is also developing new contractual arrangements with partners participating in our integrated delivery system that will allow us to manage patients more like an accountable care organization. Providers would get paid based on population and quality standards instead of on a per-procedure basis. We will be trialing a fee-for-value financing model rather than the traditional fee-for-volume. Electronic medical records (EMR) are another opportunity for collaboration, and Group Health is working with the Spokane County Medical Society (SCMS) to stay in front of the changing environment. Providence is beginning to implement Epic, the same EMR that our clinicians use, so we are figuring out how our two systems can leverage the platform. Another challenge is getting Group Health’s records in Epic to communicate with other EMRs in town. Finally, we’re exploring how to use electronic tools to support care, for example, through virtual consultations. In the future, a physician might send a question to a neurologist without having an in-person visit—and the results of that consult would be clearly documented so that all physicians can see the care plan and discussion, rather than repeat them. We are also talking with Inland Northwest Health Services, which uses a different platform, and with Columbia Medical Associates, which uses Allscripts and already has a system for communication between primary care and specialty called HealthBook.

On a different note, I’d like to welcome five new physicians who have joined Columbia Medical Associates and therefore Group Health’s care delivery system: two new neurologists—Drs. John Wurst and Bill Bender—and the physicians of Spokane Valley Internists, Dr. Rita Snow, Dr. Victoria Weaver, and Dr. Diane Lefcort. Dr. Bender was just honored by the SCMS as Physician/ Citizen of the Year for his outstanding contributions to the medical profession and community. We welcome them and are excited to be working with such talented physicians.

Physician Governance in the Evolving Healthcare Environment By Rob Benedetti, MD and Craig Whiting, MD Rockwood Health Services One-hundred-and-four years ago, Dr. William Mayo addressing a graduating medical class in Chicago said, “the best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, a union of forces is necessary.” In 2006 at a strategic planning retreat, the Rockwood Clinic Board of Directors came to a similar conclusion with a vision to be the region’s most comprehensive provider of health-related services focused on improving the health of patients and the health of our community. This vision could be alternatively seen as providing accountable care and has been the cornerstone of all multispecialty medical practices long before the term Accountable Care Organization was put into use. A key facet of Dr. Mayo’s emphasis on patient-centeredness, and a contemporary understanding of accountable care, is coordination of care across healthcare settings, providers and suppliers in an environment where clinicians collaborate in order to furnish higher quality care than if they worked independently. The union of forces of Deaconess and Valley Hospitals, Rockwood Clinic, and Community Health System has created the ability and power to deliver on that vision. In 2006 our Board recognized that without a hospital partner our vision was unattainable. Furthermore, we believed that without mutual financial interdependency, the collaborative efforts that are needed would be held hostage to narrower, self-serving interests. Fundamental to our agreement with Community Health System was maintaining the historical governance structure of Rockwood Clinic, whereby all governance decisions are made by a Board of Directors comprised of and elected by Rockwood providers.

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HEIRLOOMS TO LIVE IN THOUGHTFUL SITE INSPIRED ARCHITECTURAL DESIGN

What I remember the most about the design experience was how our vague ideas would be rendered into several potential and elegant solutions by Sam. When I look at my home I can’t tell what came from me or my wife or from Sam. It doesn’t matter of course, we just love the results. Sam was honest and ethical in every aspect of our work together. He worked diligently to understand what we really wanted. Such questions as “what does quality mean to you” were taken up with all seriousness to find the subtle differences that make a custom home custom. We recommend Sam to anyone who wants a thoughtful, intelligent, honest partner in the design of a unique and personalized dwelling. - Don George

SAM RODELL

W W W. R O D E L L . C O

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ARCHITECT AIA 509.939.7007

Continued from page 13

• HB 2246 the False Claims Act passed with a qui tam provision

As emphasized by Dr. Mayo, we champion the critical role that clinicians play in leading the collaborative efforts that are required to be a high performing healthcare system. In addition, our partnership was founded on and maintains a primary focus on quality and service. We embrace the need for accountability in the delivery of healthcare. This includes accountability to the patients we serve through efforts to measure and continuously improve both the quality of the clinical care that they receive and their perceptions of the service that we provide, and to the payers of that healthcare so that they know they are achieving maximum value when patients are cared for in our integrated delivery system.

which may encourage frivolous claims. A NEGATIVE • The Basic Health, Disability Lifeline and Apple Health program funding was preserved in the budget. A POSITIVE • Mental Health funding for RSNs and a specific Spokane County program were preserved with no loss of beds at Eastern State Hospital. A POSITIVE • Medicaid Emergency Department issues had the following results: A POSITIVE oo The “No – payment” policy was delayed oo A new budget proviso was enacted to obtain the delay and involve »» A set of best practices required for hospitals and EDs and

The entities which have come together as Rockwood Health System are now two and a-half years into design and construction of a healthcare system that will be part of the answer rather than an ongoing part of the problem that besets the current state of health care in our country. We remain committed to our promise of “working together for a healthier life”.

SCMS 2011/2012 Legislative Advocacy

»» Hospitals must demonstrate savings (e.g. reduce unnecessary visits). • Interpreter services funding for Medicaid was preserved in the budget. A POSITIVE • Physician Volunteer Services and the malpractice insurance for those volunteer retired providers was preserved. A POSITIVE • The UWSOM/WSU Biomedical Sciences building received the additional capital funding to complete the building and assure a home for 4 years of medical education in Spokane. A POSITIVE

By Keith Baldwin SCMS CEO This was a long legislative session where the SCMS was able to work with and support the Washington State Medical Association (WSMA) advocacy resources and successfully fought to preserve programs important to physicians in eastern Washington and promote legislation that would benefit patients, including access to quality care and patient safety. SCMS physician leaders provided strong advocacy on your behalf in meetings with legislators in Spokane, Olympia and WA D.C. this year as we know that legislative visits and advocacy are a valued member benefit. SCMS tracks issues and legislation during session with the WSMA Legislative team who also help to draft bills that are important for your practices, testify before legislative committees and meet regularly with legislators and officials in the executive branch.

All in all, very good results for medicine and hospitals considering the significant budget difficulties faced by the state. Fighting: for Physicians, for Patients, for Access to Quality Care, a summary of the 2012 legislative session from WSMA can be downloaded as an electronic version [PDF] through at: http://tinyurl.com/83hvwhq . We should thank all of our legislators for their hard work to come up with the difficult budget solutions.

SAVE THE DATE Pierce County Medical Society Leadership Conference Hotel Murano, Tacoma

Below is a recap of the 2012 session that included policy and budget issues that affect medicine. • SB 6237 Scope of Practice for Medical Assistants passed

Friday September 14 For more information contact Sue Asher at

creating a standard/role definition. A POSITIVE • HB 2308 Awarding of attorney fees favorable to physicians when challenging peer review decisions was passed. A POSITIVE

July SCMS The Message 15

sue@pcmswa.org or 253.572.3667

What is a Health Benefit Exchange?

The Community Value of Project Access

An Exchange is a key provision of national health reform that creates a new marketplace for each state to offer health benefits to individuals and small businesses. Under national health reform, states must have an Exchange in place by January 1, 2014. Exchanges can be developed and implemented by the state or by the federal Department of Health and Human Services. In May, 2011, the Washington State legislature passed the Health Benefit Exchange Enabling Legislation (Substitute Senate Bill 5445) which designated the Health Care Authority as the lead organization to build Washington State's Exchange.

By Lee Taylor Director, Project Access Spokane

What is the Health Care Authority doing to plan for an Exchange in Washington State? The Health Care Authority applied for and received a $23 million federal establishment grant to: »» Develop options and recommendations on policy decisions, »» Begin public education efforts and stakeholder coordination by holding public meetings around the state, »» Create operational plans, and »» Develop IT systems that build new features while leveraging existing state systems.

Project Access is the Right Thing to Do In many other developed countries healthcare systems provide affordable medical care to most citizens. In our country the healthcare system has lots of gaps, leaving millions of people struggling to get the medical care they need. Even if the current healthcare reform laws are fully implemented there will still be an estimated 20 to 30 thousand people in Spokane who are uninsured. Because of those gaps, most people would agree that in our community, Project Access is “the right thing to do”.

You Can’t Go to the Bank on “It’s the Right Thing to Do” There are about 90 Project Access type organizations across the US. There are six in Washington State. We meet on a quarterly basis with the Washington Project Access organizations. Based on the information exchange with those “local” organizations, I think it is fair to say that money for operating expenses doesn’t come easily. It doesn’t just flow in because Project Access is “the right thing to do”. All of those Project Access organizations are continuously working to quantify the value of Project Access in their community. The community value is what will make the money for operating expenses “flow in”.

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We Have the Numbers

How do You Determine Community Value?

We have been able to calculate the community value of Project Access services based on the difference in charges of treating common conditions before they are urgent, through Project Access, versus treating them emergently in the emergency department (ED). Intuitively, we all know the difference is huge and we all know that difference in charges, (and costs), is one of the main reasons we have Project Access. We can’t go to the bank on just intuition either, however, now we can share the real numbers.

There are lots of ways to think about the community value of Project Access. For example: »»

Project Access patient no-show rate is just below 4%, compared to the average no-show rate for uninsured and underinsured patients of approximately 20% to 30%.

»»

Project Access’ referral review service ensures patients have all of the appropriate tests completed and follow proper protocols for referrals for each area of specialty – ready for a medically effective and cost-efficient appointment.

Does anyone have an estimate for value of those services for your practice? We are working on ways to determine the value of those services in our community. Our preliminary data indicate that those services save at least tens of thousands of dollars in an average size practice.

Project Access Treatment versus Emergency

The Community Value of Project Access We used hernia repair and gallbladder surgery for the comparison of charges. Those are two of the most common conditions for Project Access clients. We compared the charges for clinic visits and ED visits, the charges for the specialist’s diagnosis and treatment and the charges for hospitals and surgery centers. On average, the difference in charges for treating patients through Project Access, non-emergently for those conditions, and treating patients who delayed treatment and presented in our emergency departments, is $20,575 per patient. (See the accompanying chart for details.)

Department Treatment –

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CHART

July SCMS The Message 17

Continued from page 17 Now we need to get from the difference in estimated charges to real costs. Data gathered by the Washington State Department of Health shows that for Washington State hospitals the average cost of services is 35% of the amount charged. Based on this information the cost difference between patients being treated through Project Access versus being treated in the emergency department is an average of $7,200 per patient, (35% of $20,575). Project Access served 44 clients over the past 12 months with hernia and gallbladder conditions, for a total community savings of $316,800, ($7,200 x 44). This is the community savings associated with just the 44 Project Access clients with hernia and gallbladder conditions. What about the community savings associated with the rest of the 650 clients served by Project Access?

Project Access Community Value = Community Cost Savings We’re going to approach the estimation of total community value and total community savings in a different way because we don’t have the necessary data to analyze all clients’ services the way we analyzed the clients with hernia and gallbladder conditions. One of the questions about using the data from the hernia and gallbladder study is whether it is reasonable to use those numbers to estimate the total community value for the mix of services provided for Project Access clients. The average value of services for all Project Access clients is $11,000. We know that the average value of treatment for the hernia and gallbladder conditions is $16,352, 67% higher because of the surgical procedures required. Those two conditions, while they are common for Project Access clients, are not representative of all patient conditions and service charges. We think it is a fair and conservative estimate of cost savings when we reduce the 55% savings from the hernia and gallbladder data to 30% savings for all services provided through Project Access compared to services provided for the same conditions through the emergency department. Using the numbers above, the estimated annual community cost savings resulting from Project Access services is $1,080,000. Here is the calculation based on services provided in 2011:

In addition, Project Access creates community value and cost savings in other ways that are more difficult to quantify: »» Helps manage providers’ and institutions’ charity care in turn freeing and reducing administration expenses. »» Increases overall community health by providing access to quality acute healthcare. »» Increases productivity in the community by reducing missed days of work.

Who Pays the Added Costs of Poor Access to Healthcare? It probably is not a surprise that based on our data, the bulk of the charges and costs for emergency healthcare services are hospital facility charges for the emergency department, surgery centers and applicable staff for those facilities. Hospitals rightfully consider the federally mandated treatment of everyone coming through the ED, including people with no insurance, a cost of doing business. The cost of treating uninsured people, which increases the cost of doing business, is then covered by increased payments from insurance companies who charge higher insurance rates to individuals who do have healthcare insurance. Those uninsured people who do not utilize Project Access services and receive treatment in our emergency departments are among the many reasons that health insurance rates are accelerating at unsustainable rates. Who should be motivated to reduce those costs? The candidates are hospitals, healthcare insurance companies, community businesses (especially those that do not provide health insurance to their employees) and individuals who want to pay less for health insurance premiums. We plan to ask all of the above to help support Project Access services. With the results of the recent study we can demonstrate the community value of Project Access and make the case for reducing the cost of providing medical care for low-income uninsured people in the community by keeping Project Access alive and well. Please call me if you have questions or if you have ideas that you would like to share, at 220.2651 or email me at lee@spcms.org.

»» Billable charges that were donated to Project Access clients = $7,200,000 »» Based on the conservative 30% estimate for savings we can calculate the estimated savings as follows: • Project Access cost of $2,520,000 / 70% = ED cost of $3,600,000 • Community savings = ED cost of $3,600,000 – Project Access cost of $2,520,000 = $1,080,000

July SCMS The Message 18

In the News

WSMA Finance Committee Nomination

John McCarthy, MD Named Washington Family Physician of the Year The Washington Academy of Family Physicians (WAFP) has named Spokane physician, John McCarthy, MD as Family Physician of the Year for 2012 and welcomes him as Washington Academy of Family Physicians Foundation President. The prestigious award is given annually by WAFP to a family physician who exemplifies a compassionate commitment to improving the health and wellbeing of people and communities throughout Washington. Dr. McCarthy has been described as “a doctor’s doctor” who demonstrates a remarkable blend of clinical excellence, community service, and professional leadership. He has also been described as “the quintessential teacher of family medicine,” as he clearly relishes his role as a teacher, in particular introducing students to the challenges and rewards of being a rural practice doctor. Indeed generations of UW medical students chose family medicine and entered a rural practice as a direct result of working with him. Dr. McCarthy grew up in Tacoma. He received his BS in Biology at Santa Clara, and later received his MA in Counseling from Gonzaga in 1985, followed by counseling work in Alaska. He completed his MD at the University of Washington School of Medicine in 1990, followed by residency at Tacoma Family Medicine, a program focused on care for rural and underserved patients. For the next 14 years Dr. McCarthy practiced full spectrum rural family medicine with a small group in the Okanogan community of Tonasket, and provided service to outreach clinics in the tiny community of Oroville as well. Dr. McCarthy received the award at the WAFP’s annual meeting on May 11, 2012 at the Suncadia Lodge in Cle Elum, WA. With over 3000 members the WAFP is the largest medical specialty professional organization in Washington. It is comprised of physicians, residents and students who specialize in Family Medicine. The organization works to influence the development of health care policy that will provide optimal healthcare for all citizens of Washington State.

David McClellan, MD has been recommended by the WSMA Nominating Committee for election to the WSMA Finance Committee for a three-year term. The slate of recommended candidates will be voted on at the House of Delegates in Tacoma on September 15 – 16.

Anne Montgomery, MD Assumes Office as President of the Washington Academy of Family Physicians On May 11, 2012, Anne Montgomery, MD, FAAFP was inaugurated as President of the Washington Academy of Family Physicians (WAFP) at the Academy’s annual meeting in Cle Elum, WA. As President, Dr. Montgomery is Chief Elected Officer of the Academy and will chair its board of directors. Dr. Montgomery received her Bachelor of Arts in 1981 from St. Olaf College in Northfield, MN, graduating cum laude with majors in Chemistry and Religion. She earned her medical degree from Mayo Medical School in 1986 and completed her residency at Saint John’s Unit, University of Minnesota in 1989. Her clinical background includes work at the Spokane Falls Family Clinic, Sacred Heart Medical Center Maternity Clinic, Group Health Cooperative in Olympia and the River Valley Clinic in Northfield, MN. She is currently a Residency Faculty Physician with Family Medicine Spokane.

Anne Montgomery, MD President WAFP and husband, Glen Stream, MD

PROPOSED BYLAWS CHANGE – Official vote in August 2012 (Suggested wording changes in underline and wording deletions in strikethrough)

Hakan Kaya, MD Promoted to Clinical Faculty Congratulations to Dr. Hakan Kaya who received a promotion in clinical faculty rank at the University of Washington School of Medicine. Dr. Kaya is an enthusiastic teacher of students and residents and very much deserves his promotion to Associate Clinical Professor. Thanks for your hard work and dedication Dr. Kaya!

Physician Assistant members shall consist of physician assistants who are licensed and in good standing by the State Board of Medical Examiners and who are employed and supervised by a Spokane County Medical Society physician member. They shall pay annual dues as established by the Board of Trustees, but such membership does not entitle the member to vote. One seat on the Board of Trustees may be filled by a physician assistant.

July SCMS The Message 19

July SCMS The Message 20

Super Senior Docs Rock at Retired Physicians Golf Tourney By Frank Browne, MD - Chair Sunshine and lightning fast greens greeted the 24 players in the annual Retired/Senior Physicians Golf Tournament at Manito Golf Club on Friday, May 18. Sponsored by SCMS, Nike Golf and Waterbrook Winery, the players each took home six golf balls and a bottle of wine with their memories of a great day on a beautifully manicured golf course. Waterbrook supplied some of its finest wine for the winners with the Super Seniors (read 80+) showing the rest of us that they can still play the game better than most. Of the three divisions they won the 16 & under with a 72 (Dick Steury), the 80+ year olds with a 75 (Roy Zimmer) and took 2nd and 3rd in the 17 & over division (Dick Kleaveland with a 78 and Bob Parker with a 77). Bob Notske rounded out the winners by taking home the 17 & over division trophy, for the third straight year, with a 74. Second and third places in the 16 & under division went to Frank Browne with a 74 and Mike Eaton with a 75. Congratulations to all the golfers! Thanks to Nike Golf and Waterbook Winery for their sponsorship and especially to SCMS and Michelle Caird for her organizational expertise. This golf outing is about fellowship and renewing old friendships among colleagues. If you are a retired/senior physician golfer and did not receive a flyer, please contact Michelle at SCMS (325-5010) with your information.

Super Senior Award winner Roy Zimmer with Frank Browne

It's Official! Bob Notske threepeats in the 17 and over division and Frank Browne

Retired physicians be sure to mark your calendars for our annual dinner get-together Thursday October 18th at Manito Golf & Country Club. More details will follow!

16 and under division winner Dick Streury with Frank Browne

Thank you to Dr. Frank Browne as the chair of the 2012 Senior Physiciansâ&#x20AC;&#x2122; Golf Tournament and Luncheon. And a special thank you to Dr. Browne for arranging the donation of Waterbrook Wine for all of the participants.

July SCMS The Message 21

Continuing Medical Education

Physician Leadership Resource

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 i nformation www.ama-assn.org.

A link for any of the resources listed can be found at the SCMS website (www.spcms.org) Leadership Resources tab.

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 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. 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. Documentation Improvement for Physician Practices – for Today and Tomorrow! Federal initiatives will drive increasing attention on documentation processes used by practices and health systems. Implementation of ICD-10-CM/PCS will require increased specificity in documentation, demanding greater accuracy in code selection. The ongoing formation of state, regional and private health information exchanges, accountable care organizations and medical homes will further require more attention and effort on documentation requirements. In addition, changes in reimbursement methods and ongoing audits will require continued attention to documentation and how it affects revenue cycle management. WSMA and WSMGMA members can attend for $149 per person, and may sponsor staff in the same practice for the member rate. Three or more members or sponsored staff from the same practice may register for a group discount of $129 per person. Register at www.wsma.org (Practice Resource Center) Spokane Valley Friday, July 13 12:30–4:30 p.m. Valley Hospital For more information Contact Jenelle Dalit by phone at 1 (800) 552-0612 or jcd@wsma.org

Book Healthcare Strategic Planning, Third Edition, by Alan M. Zuckerman, FACHE, FAAHC, provides practical guidance and expert insights for addressing near-term pressures, achieving long-term goals, and managing pitfalls that can derail effective planning. Descriptions, examples, and guidelines lead you step by step through a proven strategic planning process.

Article Channeling Change: Making Collective Impact Work, Standford Social Innovation Review by Fay Hanleybrown, John Kania and Mark Kramer An in-depth look at how organizations of all types, acting in diverse settings, are implementing a collective impact approach to solve large-scale social problems.

Membership Recognition for July 2012 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today.

10 Years C. Chris Anderson, MD

7/1/2002

Kerry L. Drain, MD

7/1/2002

Peter J. Schlegel, MD

7/1/2002

Christopher M. Zylak, MD

7/1/2002

David W. Egger, MD

7/15/2002

Krishna M. Malireddi, MD

7/15/2002

Paul C. Thorne, MD

7/15/2002

Mathew C. Rawlins, MD

7/22/2002

Keith A. Morton, MD

7/23/2002

July SCMS The Message 22

Healthcare Professionals Volunteering Abroad Evening a Success!

UPCOMING SCMS EVENTS JULY River Cruise - 12

Thank you to everyone who attended the May 22, 2012 evening panel presentation of “Healthcare Professionals Volunteering Abroad”. A special thank you to Jon Keeve, MD, for collaborating with SCMS and Providence to make the evening’s event a success. Dr. Keeve spoke on the role of volunteer providers and the challenges they face. He also discussed his medical missions in Vietnam, Bhutan, Cambodia, Myanmar, Germany and Haiti. The other evening presenters included Suzanne Bonacum, RN: Mission work with Mother Teresa in Calcutta, India and service on the floating hospital ship, Anastasis; Samuel Joseph, DO: Healing Hearts Northwest and opportunities in Rwanda; Elizabeth Peterson, MD: Bridging the Gap: Cleft Care in developing countries; Carla Smith, MD: Working with SIGN Fracture Care International and Healing the Children in Nepal, Rwanda and the Philippines and Stephen O. Woodard, DDS: Dental and oral surgery work in Zacapa, Guatemala.

SEPTEMBER Board of Trustees’ Meeting and Caucus – 12 House of Delegates (Tacoma) – 15 & 16 Moderate Conscious Sedation CME Program – 27 SCMS Presents Medicine 2012 – 28

OCTOBER Senior Physicians’ Dinner – 18

DECEMBER Board of Trustees’ Meeting – 12

Thank you again to the volunteer healthcare professionals who traveled abroad and donated their time and expertise to those less fortunate. Also, thank you to Providence for their generosity in providing the facilities and the refreshments. To view the presentations go to the SCMS website at www.spcms.org.

Carla Smith, MD, Stephen O. Woodard, DDS, Suzanne Bonacum, RN, Elizabeth Peterson, MD, Samuel Joseph, DO and Jon Keeve, MD

July SCMS The Message 23

The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicantâ&#x20AC;&#x2122;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.

Le, Uyen (Michelle) T., MD Family Medicine Med School: Ross University, West Indies (2009) Internship/Residency: Phoenix Baptist (2012) Fellowship: University of Arizona (2012) Practicing with Spokane Falls Family Clinic 8/2012

PHYSICIANS

Liu, Eashen M., MD Gastroenterology Med School: George Washington U (2006) Internship/Residency: Georgetown University Hospital (2009) Fellowship: Georgetown University Hospital (2011) Practicing with Providence Adult Gastroenterology 8/2012

Aharon, Alan S., MD Cardiothoracic Surgery/General Surgery Med School: Tulane U (1990) Internship/Residency: UCLA Medical Center (1999) Fellowship: Vanderbilt U (2001) Practicing with Rockwood Heart & Vascular 6/2012

Macutay, Gerry B., MD Internal Medicine Med School: U of the Philippines (1998) Internship/Residency: St. Vincent Charity Medical Center (2012) Practicing with Apogee Physicians

Archibald, David J., MD Otolaryngology Med School: Mayo Clinic (2006) Internship/Residency: Mayo Clinic (2011) Fellowship: U of South Florida (2012) Practicing with Rockwood Main Clinic 8/2012 Biswas, Shaluk, MD Internal Medicine Med School: Mymensingh Medical College (2002) Internship/Residency: Brookdale University Hospital (2012) Practicing with Apogee Physicians 9/2012 Coan, Michael C., DO Rheumatology Med School: Des Moines U Internship/Residency: Plaza Medical Center (2010) Fellowship: Plaza Medical Center (2012) Practicing with Rockwood Main Clinic 9/2012 Cook, Jill A., MD Pediatrics Med School: St. Louis U (2006) Internship/Residency: Childrenâ&#x20AC;&#x2122;s Hospital (2009) Practicing with Washington-Spokane Primary Care, LLC 9/2012 Gerhardt, Christina M., MD Pediatric Endocrinology Med School: U of Birmingham (2003) Internship/Residency: Oregon Health Sciences U (2006) Fellowship: U of Colorado Health & Science (2009) Practicing with Providence Pediatric Endocrinology 6/2012 Harwood, Mark D., MD Cardiology Med School: Keck School of Medicine (2004) Internship/Residency: University of Utah (2007) Fellowship: Hospital of St. Raphael (2010) & Stanford University (2012) Practicing with Providence Spokane Cardiology 8/2012 Hubbell, Michael P., MD Otolaryngology Med School: Rush U (2007) Internship/Residency: Ohio State (2012) Practicing with Rockwood Main Clinic 8/2012

Marshall, Suzan E., DO General Surgery Med School: Philadelphia College of Osteopathic Medicine (2000) Internship: Pinnacle Health (2002) Residency: York Hospital (2005) Solo Practice Hakone Surgery & Wellness 11/2012 Rhee, Paul H., MD. Plastic & Reconstructive Surgery Med School: U of Colorado (1995) Internship/Residency: Temple University Hospital (1998) Residency: U of Colorado Health Sciences Center (2000) Practicing with Rockwood Main Clinic 8/2012 Sanborn, Adam M., MD Family Medicine Med School: Creighton U (2006) Internship/Residency: Naval Hospital, Jacksonville (2009) Practicing with Spokane Falls Family Clinic 10/2012 Sanborn, Melanie J., MD Pediatrics Med School: Creighton U (2006) Internship/Residency: U of Florida, Jacksonville (2010) Practicing with Washington-Spokane Primary Care, LLC 7/2012 Sebley, Caroline M., DO Internal Medicine Med School: Kansas City U of Medicine and Biosciences (2009) Internship/Residency Legacy Health Systems (2012) Practicing with Rockwood Main Clinic 8/2012 Spinning, Kristopher A., MD Diagnostic Radiology Med School: Oregon Health Science U (2006) Internship: Columbia U (2007) Residency: Yale New Haven Health (2011) Fellowship: Oregon Health Sciences U (2012) Practicing with Radia Inc., PS 7/2012

Continued on page 25

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Continued from page 24 Watterson, Kara A., MD Family Medicine Med School: Creighton U (2009) Internship/Residency: Providence Family Medicine Spokane (2012) Practicing with Group Health Permanente (Riverfront) 7/2012 Wilson, Jeffrey D., DO Internal Medicine Med School: A. T. Still U (2008) Internship/Residency: Providence Internal Medicine Residency Spokane (2011) Practicing with IPC Hospitalist Co. 7/2011 Zhuo, Ying, MD Hematology/Medical Oncology Med School: Hunan Medical U, China (1994) Internship/Residency: Tulane U (2009) Fellowship: Tulane U (2012) Practicing with Medical Oncology Associates, PS 7/2012

Basnett, Saneer, MD Psychiatry Med School: Government Medical College, India (2005) Practicing with Providence Sacred Heart Psychiatric Center 7/2012 Boyum, Jon D., MD Surgery/Thoracic Surgery Med School: U of Washington (2000) Practicing with Surgical Specialists of Spokane 8/2012 Consiglieri, Giac D., MD Neurological Surgery Med School: U of Southern California, Keck (2005) Practicing with Inland Neurosurgery and Spine Associates, PS 9/2012 Daly, Jennifer C., MD Diagnostic Radiology Med School: U of Vermont (2005) Practicing with Radia Inc., PS 8/2011

Kelly, Megan S., MD Obstetrics and Gynecology Med School: U of Michigan (1993) Practicing with Obstetrix Medical Group of Washington Inc., PS 7/2012

Lewis, Katrina, MD Anesthesiology/Pain Medicine Med School: U of Cape Town, South Africa (1987) Practicing with Spine Team Spokane 5/2012 McEvoy, Jennifer R., MD Diagnostic Radiology Med School: U of Colorado (2006) Practicing with Radia, Inc., PS 7/2012 Oâ&#x20AC;&#x2122;Riordan, Moira A., MD Diagnostic Radiology Med School: U of Chicago-Pritzker (2006) Practicing with Radia Inc., PS 7/2012 Palmer, Jr., Robert H., MD Obstetrics and Gynecology Med School: U Autonomous of Guadalajara, Mexico (1983) Practicing with Obstetrix Medical Group of Washington, Inc., PS 7/2012 Webb, Alden R., DO Pathology/Dermatopathology Med School: Midwestern U (2007) Practicing with InCyte Pathology 8/2012

Dong, Mei, MD, PhD Medical Oncology/Hematology Med School: Harbin Medical U, China (1997) Practicing with Cancer Care Northwest 8/2012

PHYSICIAN ASSISTANT

Germain, Rasha S., MD Neurological Surgery Med School: U of Southern California, Keck (2005) Practicing with Inland Neurosurgery and Spine Associates, PS 9/2012

Hayes Balmardrid, Melissa A., MD Diagnostic Radiology Med School: Tulane U (2006) Practicing with Radia Inc., PS 7/2012

Kamae, Kondon, MD Ophthalmology Med School: U of Hawaii (2006) Practicing with Spokane Eye Clinic 9/2012

Kicska, Gregory A., MD, PhD Diagnostic Radiology Med School: Albert Einstein College of Medicine (2003) Practicing with Radia Inc., PS 5/2012

PHYSICIANS PRESENTED A SECOND TIME

Hay, Arlene P., MD Pediatrics Med School: U of Santos Tomas, Philippines (1989) Practicing with Rockwood North Clinic 7/2012

Kadri, Abdulmajeed, MD Internal Medicine Med School: U of Texas, San Antonio (1999) Practicing with Apogee Physicians 7/2012

Stimpson, Debra A., PA-C Physician Assistant School: U of Washington, Medex Northwest (2005) Practicing with Providence Internal Medicine Residency 9/2008

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME Phillips, Joshua J., PA-C Physician Assistant School: U of Washington, Medex Northwest (2010) Practicing with Providence Medical Group â&#x20AC;&#x201C; Orthopedic Specialties 5/2012

July SCMS The Message 25

POSITIONS AVAILABLE PHYSICIAN OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact 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, oncall 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! 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. SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PA-C N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider. Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org. 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) 474-6605, mark.rearrick@providence.org, www.providence.org/ physicianopportunitiesexperience is a plus but not required. NEWHP offers competitive 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. PHYSICIANS NEEDED FOR WORKERS COMPENSATION EXAMS Let us help you get started in earning additional professional income! We are an established I.M.E. practice currently looking for Active Practice and Board Certified Orthopedic and Neurological Doctors, to perform Workers Compensation Exams. Located just minutes away from Rockwood Clinic in North Spokane, we offer a flexible schedule in a helpful, working environment. Previous experience performing Workers Compensation Exams is not required. Please contact Lorraine Stephens for further information at (509) 484-0380. 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. PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care. Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly. We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@partneringforprogress.org. PSYCHIATRIST, EASTERN STATE HOSPITAL, MEDICAL LAKE, WA ESH is recruiting for a psychiatrist. ESH is Joint Commission accredited and CMS certified. ESH is the 287 bed state psychiatric hospital in eastern WA 20 miles from Spokane. This position offers state employment with competitive benefits (including malpractice coverage) 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.

July SCMS The Message 26

Continued on page 27

Continued from page 26

MEDICAL OFFICES/BUILDINGS

EASTERN STATE HOSPITAL ESH, the 287 bed state psychiatric hospital in eastern WA, is recruiting for a family practice or internal medicine physician, physician assistant or ARNP to provide medical care with a caseload of 30 patients. The medical provider would be part of the treatment team, which includes the attending psychiatrist, medical provider, social worker, RN, and recreation therapist. The medical provider will treat common medical conditions and refer for consultation to providers in the community for care that cannot be provided at ESH. Twenty minutes southwest of Spokane, WA. Join a stable Medical Staff of 30 psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@ dshs.wa.gov. Eastern State Hospital, PO Box 800, Medical Lake, WA 99022-0800.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers? This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services. For more information, call (509) 981-9298.

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.

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.

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

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.

Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic. Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location. 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 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.

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Rest easy, little one. We’ve got you covered. Valley Hospital brings you the physicians, care and amenities that can put your mind at ease when you’re having a baby. Our spacious suites are designed so you and your little one can remain in the same room throughout your stay. We offer guidance on breastfeeding and newborn care, and are here to answer all your questions. And most important, our skilled nurses and OB physicians are dedicated to your care and comfort.

To c on n e c t w it h a n OB w ho de l i v er s at Va l l e y Hospita l , c a l l 5 0 9 -473 - 5 7 85 or v isit Spok a n eVa l l e yHospita l .c om.

“I believe that your time is as important as my time. I will always try to see you on time and give you my full attention.” 12606 East Mission • Spokane Valley

Nathan Meltzer, M.D., OB/GYN Independent Member of the Medical Staff

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5/31/12 10:35 AM

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

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To p 10 0 Go lf In st ru ct or s Golf Magazine 2004 to 2012

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