The Message, November 2012

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

THE PERKS AND POWER OF YOUR SCMS MEMBERSHIP

By Terri Oskin, MD SCMS President

The Importance of Leadership in “The New Reality” The Value Proposition for SCMS Membership

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T a b l e o f C ont e nts

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

The Perks and Power of Your SCMS Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 The Importance of Leadership in “The New Reality” . . . . . . . . . . . . . . . . . . . . . . . . . 2 The Value Proposition for SCMS Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Regional Strategic Initiatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Moving Toward the Future: Increasing Access to Care . . . . . . . . . . . . . . . . . . . . . . . . 5 SCMS Informatics Committee Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Spokane Physicians at Center of Success of the Spokane Scholars Foundation . . . . . . . . . . . 7 Medical Education Building…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 For Your Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Leadership Spokane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Wilderness Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Meetings/Conferences/Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Physician Citizen of the Year Award . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Senior Physicians – Retired but still very active! . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Physician Leadership Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

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: Lisa Poole 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 Lisa@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.

Credentialing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Membership Recognition for November 2012 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2013 Events for Women Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 In The News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 New Physicians and Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Classifieds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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November SCMS The Message Open3

The Perks and Power of Your SCMS Membership

Community Health Improvement

By Terri Oskin, MD SCMS President In this month’s issue of The Message we focus on you, the members. Our goal is to inform you of the many programs the SCMS offers and leadership opportunities available. I’ll also brief you on the ways your local medical society is supporting your patients and practice.

Start With the Basics Your membership includes a monthly newsletter, The Message, as well as the pictorial directory of your fellow members. The directory is also available electronically on our website. This directory lists area specialty societies, pharmacies and urgent care centers plus contact information for all surrounding hospitals, low-income and charity clinics and other useful organizations. SCMS also provides a central service to make your credentialing easier upon arrival in Spokane.

Continuing Medical Education We continue to offer CME programs including the very popular Conscious Sedation program. This fall we also sponsored Medicine 2012, an update in primary care. We have an active CME committee that is committed to bringing you outstanding CME courses. Over time we’ve decreased the amount of in-person CME offered as our medical community has evolved in the way it accesses ongoing training. Besides these courses, we promote other CME and online opportunities in The Message and on our website.

Advocacy The SCMS also supports advocacy at the local, state and federal levels to ensure the health and wellbeing of our patients and our profession. Throughout the year we speak with legislators regarding the issues that impact our ability to provide care to our patients and communities. Besides meeting with local leaders, each year SCMS sends physician representatives to both Olympia and Washington, D.C. to meet and discuss the pertinent issues, including local issues. This year we emphasized the need to correct the Medicare Sustainable Growth Rate tie to physician reimbursement as well as delaying implementation of new ICD-10 coding requirements.

Closer to home, we successfully campaigned to save funding for the Basic Health Plan and the funding to provide malpractice insurance for our retired physicians who donate their time in low-cost and charity clinics. Last year alone these volunteers provided more than $15 million of free medical care in our state for a cost of $360,000!

To learn more about our successes and the ways we’ve affected legislation, follow the link on our website to the Washington State Medical Association (WSMA).

The SCMS also played a pivotal role in the Spokane Prescription Opioid Task Force and continues to post updates on our website.

Links include downloads for the Spokane County Uniform Pain Management Agreement and instructions for safe medication disposal. Many CME courses are available to those seeking more education or needing to fulfill the CME requirement under the new rules for management of chronic non-cancer pain.

Access to Care The SCMS continues to provide critical access to medical care with Project Access under the directorship of Lee Taylor. Last year 651 people received free care totaling $7.2 million in donated medical services. Currently, more than 600 volunteer physicians, pharmacists, allied healthcare providers and hospitals graciously donate their time to provide these services each year. The SCMS is also involved in the Emergency Department Collaboration Project, a collaborative effort between all the EDs in the area to manage emergency department utilization while maintaining high-quality patient care. More information is available on our website and look for updates periodically in The Message.

Informatics and More With our ever-increasing electronic world we also have an active and progressive Medical Informatics Committee that meets regularly with our medical leaders to provide an effective health information exchange for our community. Other SCMS committees include the Peer Review Committee, Grievance Committee, Senior Physicians Task Force, Continuing Medical Education Planning Committee and the Executive Committee.

Leadership Opportunities For those seeking more leadership experience, check out the opportunities listed on the website. Each month we review and recommend new books and you can also find out about several excellent courses offered through the WSMA. Also, please don’t forget about the wonderful opportunities available with SCMS by becoming a member of one of the committees or the Board of Trustees.

Get Social In addition to all of those serious topics, the SCMS promotes and organizes social gatherings as a way for us to foster collegiality within our organization. We are now in the infant stages of organizing a women’s social group. If you would like more information, please contact Michelle Caird at michelle@spcms.org. Last year we participated in the Susan Komen Walk for the Cure and hosted several potlucks at fellow physicians’ homes. Presently, we are organizing a women’s pajama party (one of the committee members does not like the term ‘retreat’) for March 15-16, 2013 at the Bozarth Mansion. Sorry, no boys allowed.

As you can see, the SCMS has a lot to offer. I encourage you to attend a Board of Trustees meeting, become a committee member, join us for a pot luck dinner or enjoy a river cruise. The more we share our opinions and ideas, the greater our growth and success.

November SCMS The Message 1

The Importance of Leadership in “The New Reality”

Government budgets are hitting the wall, no longer able to leverage resources from the future for the perceived needs of today. »» Our national policy is unclear on how to finance and design

By Brad Pope, MD

healthcare delivery. We are beginning to see a transition from the

It’s been seven years since I first joined the SCMS Board of Trustees and five years that I’ve served on the Executive Committee. I will leave the board at the end of 2012, making room for a new trustee.

This person will join during a period that I hope becomes a new age for the SCMS. (No, not because I am leaving the board.) This new age reflects several emerging realities for the medical profession and for our community in Spokane and the Inland Northwest. Among those realities: »» Americans are graying, leading to more demand for services. At the same time, access to primary care has become more difficult for Medicare beneficiaries and just about everyone else. »» Fewer small, single-specialty group practices exist today and most physicians and physician assistants (PAs) are now employed by someone else. Most practice in integrated delivery systems that often include ambulatory, inpatient and long-term care settings. »» The ratio of PAs and nurse practitioners is also increasing compared to physicians on healthcare teams. Patients are encountering many team players along the continuum of care (primary care providers, hospitalists, specialists, pharmacists,

Relative Value Unit (RVU) as the near sole determiner of physician and PA performance and reimbursement. Payers and practices are shifting their emphasis away from payment for volume of care to payment for value of care. Healthcare business planners have begun a shift toward managing themselves as collections of cost centers rather than profit centers. Payers and medical groups are developing novel reimbursement models. »» The emergence of multiple electronic medical records and IT platforms holds great promise to save money and improve quality; however, it also comes with its own set of information management problems.

Impact on SCMS Amidst these new realities, membership in SCMS has declined, as has nearly all county medical society membership across the country.

Medical societies used to play a chamber of commerce-type role, supporting small, private practices. With more physicians and PAs now employed by larger systems, medical societies need to change.

Fewer of us also have our dues paid for by the group or institution we for whom we work.

mid-levels, case managers, health coaches, etc.) »» Health systems are starting to design themselves to appeal to physicians and PAs who expect better-defined work hours and who often want to work less than full-time. At the same time, physicians and PAs are being asked to be more accountable for resource stewardship, clinical quality and patient satisfaction, based on performance data. »» Across the healthcare industry the available resources are less than

Despite these challenges, SCMS has a role to play. It is increasingly recognized as the neutral “Switzerland” in the Spokane area that can speak to and act on issues in a way that is impartial to the interests of any other existing healthcare entity in the area. The value that the SCMS brings to the individual physician and PA is evolving.

As these new realities further evolve, our patients will benefit if physicians and PAs take leadership roles in the process.

what consumers expect and their perceived healthcare needs.

November SCMS The Message 2

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Continued from page 2 These realities hold the potential for a better future and—at the same time—the risk of a worse future. Clinicians must step up as key leaders to ensure that we produce a healthcare delivery system of which we can be proud and that best serves our patients.

The new board member who takes my place will help create the future SCMS as an organization that fosters and delivers clinician leadership with these new realities. We are now setting up the framework to transition to a new structure that provides more value to members in the future.

How can you be a clinical leader? Support the SCMS in its activities.

During my time on the board the SCMS has promoted the necessity of integrated health IT systems in the Spokane area, developed a common approach and tools for chronic opiate therapy, promoted awareness and education about professional ethics and professional boundaries, effectively promoted healthcare undergraduate and graduate education in the Spokane area, and provided effective clinical advocacy at the state and federal levels on healthcare topics important to physicians and PAs and our patients. It has also managed Project Access to better serve a large number of distinctly underserved patients.

The SCMS Executive Committee and Board of Trustees took considerable time to evaluate the current environment and studied national and local trends along with how other medical societies were addressing the current environment. They developed a new Strategic Plan including a new Mission, Vision and Strategic Activities.

The Mission, Vision and Strategic Activities have been published in the SCMS Newsletter on several occasions. How does the plan then translate into activity on the part of the leadership and staff?

Let me list the major categories of activity from the much longer Value Proposition list of activities which we will be sending to you this fall as well. The Value Proposition is also on the SCMS website. The activities fall into the following major categories: • Political and regulatory advocacy • Leading and managing the Strategic Activities of Communication, Community-wide Population Health Initiatives, Regional Advocacy with strategic partners and Medical Practice support • Staffing SCMS Committees, representing SCMS at community organizations, supporting the SCMS Executive Committee and Board meetings and activities • Promoting the Professional practice of medicine and stimulating teamwork • Producing the SCMS Newsletter, website, and topic specific

Our new mission statement states,

meetings for members

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.

The SCMS is uniquely positioned to provide a place for physicians and PAs to co-create the most beneficial future with these new realities, without catering to the special interests of our individual professional societies, employers, hospital affiliations and payer affiliations. This work is important and exciting when you realize that we can help assure a better future for our patients and for ourselves.

I heartily invite you to become active with the Spokane County Medical Society. If you do, you will enhance your professional wellbeing and help your patients get the best care possible in “the new reality.”

The Value Proposition for SCMS Membership The Path to a Successful 2013

By Keith Baldwin, CEO, SCMS I have had numerous conversations about what the SCMS leadership and staff do to provide value to you, the members of SCMS, and everyone, has been very supportive. The trouble is how do we have that conversation with every member or non-member for that matter?

It isn’t an easy task. So, let me talk about that effort with the hope that you, the member, will take time to read this and to offer your comments or ideas to your colleagues, other members and also non-members.

• Providing CME opportunities locally • Credentialing for all physicians in collaboration with all the hospitals in Spokane • Publishing a Pictorial Directory, providing member announcements through email/fax, and a single security ID badge for multiple hospital access • Strategic Initiatives SCMS leads or participates in include the Spokane Prescription Opioid Task Force, Project Access, Consistent Care WA, ED Medical Director Collaborative and the Regional Health Improvement Collaborative and the Academic Health Sciences Center (four years of medical education in Spokane) for instance.

This is such a short list of all the activities carried out on your behalf at the SCMS. We also collaborate with the WSMA and others to elevate the effectiveness of those activities and tasks. It takes a lot of resources, sometimes over an extended period of time, to affect the outcome of any of these activities. But, that is the job of the SCMS leadership and staff. We are working hard on your behalf!

Members also need to be engaged in those activities and you need to encourage non-members to become supporters to advance the Mission and Vision of the SCMS. I will leave you with this quote, “I see my path, but I don't know where it leads. Not knowing where I'm going is what inspires me to travel it." Rosalia de Castro, Galician writer.”

November SCMS The Message 3

Regional Strategic Initiatives A Major Component of the New Mission of SCMS

By Lee Taylor Project Access and Consistent Care Washington Director The community health and wellness regional strategic initiatives are programs of the Spokane County Medical Society Foundation, which is governed by the executive committee of the Spokane County Medical Society. The initiatives are carried out in two programs: Project Access (PA) and Consistent Care Washington (CCW).

Project Access Project Access is a network of over 600 physicians, pharmacists, allied healthcare providers and hospitals serving people with no other access to healthcare. $44 million of free care has helped 5,500 residents of Spokane County since 2003.

Major institutional partners providing services are Providence Health and Services, including Sacred Heart Medical Center, Holy Family Hospital, and Providence Physician Services; Rockwood Health System, including Rockwood Clinics, Deaconess Hospital and Valley Hospital; PAML and Inland Imaging Services. »» Services provided include primary and specialty care, hospitalization, outpatient treatment, rehabilitation, medications, lab work, imaging, medical equipment, transportation and interpreter services. The key practices of PA are: »» Train community clinics, social service agencies and other referrers in PA requirements and enrollment processes

»» Accept only patients unqualified for any other healthcare insurance or assistance program »» Accept only patients with acute, not chronic, conditions »» Recruit, organize and orient a network of volunteer providers »» Match patients with participating Primary Care Physicians (PCPs), with which they establish a “medical home” »» Facilitate patient care coordination between PCPs, specialists and hospitals »» Track patient results, improve efficiency and report outcomes.

In 2011, PA served 651 clients. The value of donated medical services totaled $7,214,394, up from $6,315,708 in 2010. So far in 2012, PA has served 721 clients.

Consistent Care Washington (CCW) Consistent Care Washington, (CCW) is a new entity created to carry forward the work of the Emergency Department (ED) Collaboration. The collaboration with the ED medical directors of the four Spokane hospitals is working to develop new protocols and treatment pathways for ED patients across our community.

Over the past year, the work of this group has created strong connections and cooperation with providers of medical and behavioral health services. Those connections have created the opportunity to focus our community services on improving the health of high utilizers of medical services and lowering the cost of their care.

The ED Collaboration identified three phases of work defined by patient groups that visit the ED and would be better served by other providers in our community:

»» Assist applicants in public medical benefits applications when they are qualified

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November SCMS The Message 4

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The results of this work will be:

• Phase I - Frequent users of the ED that are assigned to the Medicaid Patient Review and Coordination (PRC) program.

• Phase II - ED patients who will benefit from a stabilization program with a PCP

• Clarity across all four EDs and within each ED regarding the resources available for referrals of mentally ill patients.

• Clearly defined pathways for those patients, with ample details to know the different pathways and protocols for various condition

• Phase III - ED patients with complex behavioral health conditions

complexities of patients.

• New communication and collaboration protocols that enable ED staff to get the answers they need about providing the best

CCW is managing the following initiatives to focus on the patient groups identified in the three phases above. The initiatives leverage the collaborative community efforts to better serve complex patient groups that are high utilizers of our hospital EDs and other community healthcare services.

ED to Primary Care Program The ED to Primary Care Program will provide access to primary care medical services from providers willing to donate their services for low-income, uninsured people residing in Spokane County.

Participating providers are Group Health and Providence Internal Medicine Residency. They will provide no cost care for up to six months for 50 patients per year referred by all four Spokane EDs. The role of CCW will be to provide support for establishing ED protocols, enrollment screening, care coordination, health coaching and outcome measurement.

Support for establishing ED protocols – Work with ED medical directors and case managers at all four EDs to clearly communicate the objectives of the program, patient profile requirements, and referral protocols.

Enrollment screening – Accept patient referrals from the EDs and confirm eligibility in the program using the existing PA process.

Care coordination – Complete patient orientation and expectation review, arrange appointments with PCP, coordinate ongoing communication with provider and perform patient follow-up to ensure continued participation.

treatment possible for these patients.

• Improved patient care, reduced cost of care and elimination of the inefficiency and inequity of moving patients inappropriately to other ED facilities due to lack of clarity of community resources.

This work will continue with an all-day facilitated meeting attended

by ED medical directors, providers, case managers, social workers, psychiatric staff and community behavioral health providers. The meeting will be facilitated by a Lean Practices Black Belt facilitator on staff at Providence Health and Services.

Prescription for Housing Community Care Coordination CCW received a grant from the City of Spokane called the Health Homeless Housing Systems Integration Pilot Project. The community name for this project is Prescription for Housing because the clients who will benefit from the services provided need healthcare services to “turn the ship” in the right direction for successful transition away from homelessness. The pilot project will serve approximately 40 homeless persons with complex medical conditions.

The expected outcomes of the pilot project are to create a collaborative system of care by engaging community partners in development and implementation of an effective system of providing medical care and social services for homeless clients with high risk medical conditions that will continue after the grant ends.

The key outcomes of the pilot project are: • Reduce number of ED visits • Reduce ambulance transports

Health coaching – Counsel patients to understand their health and wellness needs. Establish connections with other providers of behavioral health or substance abuse services and other community services that will improve wellness.

Outcome measurement – Gather data about the patients’ healthcare history 12 months prior to the connection with PCP through this program and compare that to the healthcare experience during the six months during the program and six months after the program.

• Reduce hospital admissions / readmissions • Lower cost of healthcare services preprogram vs. post program • Improve medical vulnerability index score • Homeless stability for six months or more • Improved housing vulnerability index score • Increase transitions to permanent housing • Increase length of stay in permanent housing • Reduce individual client length of stay in homelessness • Lower cost per client / household preprogram vs. post program

Behavioral Health Workgroup This workgroup brings together the ED providers, case management staff, hospital Psych staff and providers of behavioral health services to establish community-wide protocols and pathways for discharging acute mentally ill patients from the local hospital emergency departments in Spokane.

November SCMS The Message 5

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Continued from page 5

PRC Client Community Care Coordination – (Pending funding) The PRC Client Community Care Coordination project focuses on the group of ED patients that are enrolled in the Medicaid Patient Review and Coordination (PRC) program. PRC patients are high utilizers of healthcare services and frequent users of the EDs. They are assigned to one primary care provider, one hospital and one pharmacist. They are the focus of the Washington Health Care Authority Seven Best Practices that are mandated by House Bill 2127.

The ED Collaboration Work Group brought the community together to collaborate about ways to more effectively provide health services for frequent users of the four Spokane EDs. PRC Client Community Care Coordination project will provide the following: • Dramatic reduction of non-emergent ED visits by uninsured and underinsured patients • Intensive care coordination focused on connecting patients to all the services they need for stabilization, including behavioral health, substance abuse and other community services • Creation of community care guidelines and convening community

CCW intends to utilize this model for the care coordination services required by the current initiatives and to play a leadership role in expanding the use of the Pathways Community HUB model to improve health and reduce the cost of healthcare in our community.

Please call me if you have questions or if you have ideas that you would like to share, at (509) 220-2651 or email me at lee@spcms.org.

SCMS Informatics Committee Update The Search for Information Sharing Consensus

By Jeff O’Connor, M.D., Informatics Committee Chair After a successful survey on May 15, 2012 of the SCMS membership, and with 295 individual and unique responses, it is clear that the “sharing of patient information” across all the providers of patient care in our community is a vital policy and quality patient care issue for physicians. The survey pointed out the need for near universal sharing of a minimum patient data set so physicians can provide point of care diagnosis and treatment in a timely manner. The March 2012 SCMS newsletter noted numerous reasons for the need to share data “freely” with personal stories from a number of contributors.

providers for clinical review of PRC clients and other frequent users of EDs. • Collaboration with community partners to create new clinical pathways and protocols that will improve care and reduce the cost of care for PRC patients and other frequent users of EDs. • Ongoing and proactive communication with the primary care providers as well as providers of behavioral health and substance abuse services to increase capacity and improve care.

• Outcome measurement including gathering data about the patients’ healthcare history 12 months prior to the connection with primary care provider through this program and comparing that to the healthcare experience during the six months and 12 months after participation in the program.

Continued work on this initiative is dependent upon funding from hospitals and Managed Care Medicaid Health Plans.

Pathways Community HUB Development A common thread in the initiatives outlined above is robust and intelligent care coordination. CCW is developing community care coordination capabilities based on the Pathways Community HUB model that is being used successfully by many communities across the United States.

The Community HUB model is designed to improve the system by which at-risk individuals within a community are identified and connected to appropriate healthcare and social services. The Community HUB and accompanying pathways represent effective vehicles for achieving the goals of healthcare reform legislation creating financial accountability for the delivery of high-value health and social services, and improving health outcomes.

Now might be a good time to recap some of the Informatics Committee’s activities for the past year. The committee most notably scheduled individual meetings with all of the health systems who have made or are in the process of making decisions about one or a number of information systems within their networks of providers. This included acute hospital information, individual and group physician electronic medical records and other tools such as Health Information Exchange (HIE) capabilities, data repositories, readmission prediction software and disease registries, just to name a few. Those dialogues clearly clarified the barriers confronting the systems in their efforts to “share patient information.”

Foremost was the fact that all health and hospital systems are consumed by the decision-making and implementation of information systems to meet meaningful use, address readmissions and impact population health issues, among many other initiatives intended to move the healthcare system from a fee for service environment to one rewarded for improved outcomes. A close second was the cost of purchasing and implementing the technology to support the information needs of the organizations both in capital and people costs, especially for training and ongoing challenges of implementing significant changes at such a rapid pace. Finally, the sheer volume of decisions that need analysis, evaluation and discussion around health information system design and coordination, have been overwhelming. Significant coordination has been necessary on the local level, at corporate offices and with a multitude of vendors making the strategic planning and goal setting process a mammoth task.

November SCMS The Message 6

Continued on page 7

Continued from page 6 With that information in mind, it was still also clear that all the systems support the need to have shared information available to providers at the point of care. What is also evident is that to share information, you need to be able to TRUST the partners involved in the process. Our current environment of heightened market share competition, threatened and real reductions in reimbursement for not implementing specific information system requirements from some payers such as Medicare, and the realization that the public is ill informed on many of the challenges facing the healthcare systems (and some would say non-compliance by patients), leads to a difficult environment for a COMMUNITY-WIDE consensus on “sharing of patient information.”

The SCMS Informatics Committee will continue to pursue a dialogue that educates, enlightens and brings the community closer to the goal of bringing the benefits of shared information to providers and their patients to improve the experience of care, improve the health of populations and reduce the per capita costs of healthcare to our community. The Informatics Committee challenges all physicians to be engaged in this dialogue.

Spokane Physicians at Center of Success of the Spokane Scholars Foundation

By Eric Johnson, MD In 1993 a small group of business and professional people observed that academic success and excellence among the region’s high school seniors were insufficiently acknowledged in comparison to the public accolades afforded their athletic counterparts. As a result, the Spokane Scholars Foundation (SSF) was created. For the past 20 years, the SFF, in concert with all 24 of the local private and public high schools and with the support of generous donors, has held a high profile banquet honoring the best senior high school students in the region, with significant grants to the best of the best. The banquet receives widespread news coverage. Internationally known keynote speakers, including William Gates, Sr.; Ambassador Ryan Crocker and the Directors of NASA, the Smithsonian Institute and National Portrait Gallery always appear gratis.

The concept of rewarding academic excellence solely on objective criteria seems to resonate with physicians, as evidenced by the unmatched involvement and support to the SSF by members of the Spokane County Medical Society (SCMS). In the 20 years of its existence, the SSF has raised and distributed nearly a million dollars to the students in the form of grants, Scholar Medallions and banquet expenses. According to Dr. Eric Johnson, co-founder and current President of the SSF, over half of the funds raised have come from individual physicians, their families and physician groups. Every year over 100 physicians

respond to a request signed jointly by Dr. Johnson and the SCMS President. Three individual physicians are recipients of the SSF’s highest honor, “Summa Cum Laude” – Dr. Elizabeth Welty, Dr. Jonathan Holloway, and Dr. Hampton Irwin (see photo).

Spokane physicians and families contribute in other ways as well, serving as judges of grant recipients, banquet presenters, keynote speaker recruiters and faithful banquet attendees. Dawn Shuster, wife of a Spokane physician, contributes as a member of the Board of Directors.

When asked why so many physicians are involved with the SSF, Dr. Johnson responded, “They appreciate academic excellence and the idea of rewarding excellence on a purely objective basis.

They know their contribution goes to the students (SSF is totally volunteer), and physicians are inherently generous. Plus I think a significant number of physicians can identify with students whose scholastic accomplishments were seemingly ignored in comparison to the athletes in their schools.”

Last year the SSF Board, in an effort to assess the impact of the foundation, sought feedback from prior scholars. A 2003 scholar wrote, “I would like to thank Spokane Scholar donors for believing in people like me, and assisting me in attaining my educational dreams.” A 1999 scholar, now a pediatric cardiologist, stated, “Selection as a Spokane Scholar is the highest academic distinction for local students. The Foundation has an outstanding goal – finally an organization that applauds students for excellent academic effort!”

Physicians in Spokane County have been by far the major players in supporting the Spokane Scholars Foundation. If the more than 2200 scholars could convey a single message to the physicians of the SCMS, it would be, “Thank you for creating that one night in our lives when we were honored for our academic accomplishments. You helped us realize our community really does care. ”

Drs. Jonathan Holloway, Bradley Pope (SCMS President 2011), Elizabeth Welty, Hamton Irwin and Eric Johnson

November SCMS The Message 7

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at InCyte Pathology, where accurate, timely

• Established relationship with local hospitalist group for admitting, rounding, and discharge

results are everyone’s responsibility. A full lab process management suite carefully

Our physicians are committed to maintaining the health and well being

tracks each histology specimen from receipt

of all their patients through preventive

to final report. This process enhances

care measures and working closely with

overall laboratory operations, improves

community specialists. Our new partnership with Group Health and collaborative care models ensure patients have access to the

patient safety, and delivers the highest quality diagnosis for each and every patient.

best care in Spokane.

To apply or inquire for further information please contact:

Learn more about InCyte Pathology by visiting www.incytepathology.com or calling 509.892.2700

Nancy Longcoy, Physician Recruiter Longcoy.n@ghc.org; Ph: 206-448-6132

Proudly serving the greater Spokane healthcare community since 1957

November SCMS The Message 8

Medical Education Building….

By John McCarthy, MD Assistant Dean for Regional Affairs UWSOM I am reminded regularly that there is movement forward on the medical education front. Daily, I see changes in the new Biomedical and Health Sciences building rising out of the turf on the Riverpoint Campus. This will have the capability of holding an expanded medical class. The building is getting fleshed out, and as I understand it, is ahead of schedule. It is a regular reminder to me that change and growth are manifesting. This is a tangible manifestation of what this community is doing in preparation for growth in medical education. It is large and imposing, it changes the skyline, and it changes people’s lives as they detour around the construction. Physical manifestations of change are hard to ignore.

There are less tangible manifestations of the change that are coming to this community as well. Less evident is the growth of medical faculty who are creating a unique method of delivering the curriculum that a medical student needs. Less evident is the work that has included the identification of the 1000+ objectives that go into creating a student who graduates from the University of Washington School of Medicine (UWSOM). Less evident are the discussions about delivery models for medical education in the distributive WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) system which we heard recently is 40 years old.

The roll out of a distributed second year has created challenges and opportunities both for the Seattle and Spokane sides. The other states involved in WWAMI are watching closely as they have investment in bringing the second year of medical education to their states. We are the pilot project for those states as well.

Creating a medical student in today’s information rich society is, of course, about a lot more than new bricks and mortar. It is about developing an education delivery system which imparts far more information than I had delivered to me when I began my medical career. It is about doing things in a creative fashion in an environment that is steeped in tradition, success and regulation that can be seen as stifling innovation.

Those less visible components of developing more medical education in Spokane take a lot of planning, time, money and creativity. The transition to producing a product are in some ways more difficult than creating a building as the engineering and construction components for a building are well established ahead of time. There are days that I envy those putting the bricks and mortar together. They walk away at the end of the project with a fix immutable entity that is visible, appreciated and functional.

innovation. Invariably, it will change the lives across the Eastern part of the state and potentially across the WWAMI region for years to come. Ultimately we need the development of both the tangible and the intangible components that go into creating the growth which this community needs

For Your Information Do your part to reduce health care costs and increase automation by getting and using your organization’s new, free Health Plan or Other Entity Identifier!

Remember the benefits your organization received from the National Physician Identifier (NPI)? Now you can help the rest of the health care industry by obtaining a similar national, standard identifier for your organization. Health plans and all their business partners (third-party administrators [TPAs], benefit and disease management companies, preferred provider network PPNs, etc.) can now apply for a standard identifier for their organizations which will eliminate the uncertainty as to trading partner identities that currently plagues the health care industry and is undermining automation efforts.

The AMA encourages your organization and your business partners to: Access the Health Plan and Other Entity Enumeration System (HPOES) at www.insuranceoversight.hhs.gov. While your organization will not be able to sign up for a health plan identifier (HPID) or other entity identifier (OEID) until first quarter of 2013, you can sign up for e-mail updates. These updates will provide more information regarding when and how to submit your organization’s application for an HPID or OEID that best meets your organization’s needs.

Use the HPID in the Health Insurance Portability and Accountability Act (HIPAA) electronic standard health care transactions no later than November 7, 2016. OEID can be used in the HIPAA electronic standard health care transactions at any time.

Health plans must secure their HPID by November 5, 2014 (small health plans by November 5, 2015). The Department of Health and Human Services (HHS) will be providing more information regarding the application process through its Health Insurance Oversight System (HIOS).

The Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier (CMS-0040-P) final rule by the Centers for Medicare & Medicaid Services was published in the Federal Register on September 5, 2012. This final rule adopts the standard for a national unique HPID and establishes requirements for the implementation of the HPID.

At the same time, the development of a second year of medical education in Spokane will bring a lot more in the generations to come than will one more building in this community. It will bring research, a workforce, better health, greater education, and November SCMS The Message 9

Continued on page 11

Leadership Spokane

You have an answer to someone’s question. This doesn’t always happen in the context of the workplace.

By Linda Finney Executive Director

On the other hand, participants teach as much as they learn. If there are no physicians or pharmacists in the class, important questions go unaddressed or issues are not raised. I do my best as facilitator and bringing critical presenters to our daily discussions, but I have very little input on conversations that occur over coffee breaks and before and after class. Bankers and manufacturers need to hear from physicians about what’s going on in their world. No one else can tell that story.

A few weeks ago, I got a call from Keith Baldwin’s office, requesting that I write an article for the November newsletter.

“Each year, as you know, we send our upcoming president to Leadership Spokane. We would like an article from you about Leadership Spokane and the positive aspects of involving physicians.” It seemed eminently do-able in the context of everything else that demanded bits of me, yet here I find myself completing the article on vacation in early October on the north rim of the Grand Canyon. We spent the day on the road from Salt Lake City and then walked the path along the edge of the Canyon at sunset, looking at what” nature hath wrought” these past six million years. Our work as humans seems pretty unremarkable, in this context. But along with the wind and the water, we all have our missions to fulfill.

You in the medical community touch lives in ways that I never will, but I have my own job to do, helping to prepare the next generation of leaders for our region. I remember my second year of recruiting students for Leadership Spokane in the spring of 2002, and my surprise at the numbers of candidates from the medical community. As always, in interviews, we ask candidates, “Why are you applying for Leadership Spokane and what do you hope to gain from the program? Universally, they answered, “Our industry is changing, and we need to be connected to the community if we’re going to be successful.”

I think that is the key to the Leadership Spokane program. We are doing good work in leadership training and educating people about the Spokane region’s infrastructure, but I think the most important job of Leadership Spokane is getting people out of their work silos and connecting them with each other. It’s about forming relationships in addition to those you routinely work with, live next to, worship with, shop with—or the parents of your kids’ soccer buddies.

When we know one another, even though we don’t initially understand or agree, we begin to create a more viable community. When you physicians rub elbows with bankers, college deans, CEO’s of manufacturing companies, executive directors of arts and human services organizations, small business owners, leaders in government, energy companies, insurance execs and others, you form a much more complex and healthy understanding of how the community works---and how it doesn’t. You learn to fine tune your work in the face of regulation, constantly changing requirements and fiscal constraints. You create partnerships and relationships that lead to a new vision for Spokane, around a Health Sciences Center and medical school.

Someone has a resource you need.

“Leadership Spokane gives you a wonderful opportunity to explore and grow your leadership skills. It is focused on encouraging leadership within all walks of our community. It is a great opportunity to become involved in our community, learn the history of Spokane and become immersed in the numerous activities and agencies available in our community,” said Terri Oskin, MD, 2012 SCMS President.

Leadership Spokane was founded in 1982 by the Spokane Area Chamber of Commerce and a group of business and community leaders. The goal was to ensure that the momentum and energy of the 1974 environmental Expo was carried forward and that new leaders would be nurtured and trained to serve the community.

Leadership Spokane offers a civic leadership training program in which the voices of both the business and human communities are balanced, with the clear understanding that the health of both is vital to a healthy Spokane. 45 to 50 individuals from a variety of professions, races, backgrounds and neighborhoods from all over the county compose the class each year. Participants attend sessions from September through June and explore topics of relevance to the Spokane area. They examine current issues and meet with a broad spectrum of decision-makers. They enhance or learn new leadership skills. Participants grow professionally and personally. “I wish I could do it again, “commented Jeff O'Connor, MD,2008 SCMS President.

Today, more than 1000 program alumni serve throughout the region. You all know a graduate or two or three and what has been accomplished the last 30 years. There’s always more to do.

But it has been a privilege and a pleasure to work with Spokane County Medical Society’s Leadership Spokane candidates these past few years: Jan Monaco, past CEO; W. Philip Werschler, MD; Robert G. Hartman, MD; Donald A. Cubberley, MD; Douglas G. Norquist, MD; Thomas N. Fairchild, MD; Brian J. Seppi, MD; Jeffrey R. O'Connor, MD; J. Courtney Clyde, MD; Gary M. Knox, MD; Bradley W. Pope, MD; Terri Oskin, MD and Anne Oakley, MD.

November SCMS The Message 10

Continued from page 9 In addition, it adopts a voluntary data element that will serve as an OEID for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions, including preferred provider networks and third party administrators.

Consider how best to enumerate your organization.

While health plans and their trading partners make decisions based on their business needs, the AMA strongly encourages all health plans and their trading partners to obtain HPIDs and OEIDs for each separate company. While the rule allows health plans to enumerate themselves at a much higher level of generality, and does not require health plan trading partners to enumerate themselves at all, the value of the HPID/OEID will be greatly reduced if health plans and their trading partners do only the bare minimum. It is only through identification of each separate company that the HPID/OEID will enable physicians and other health care providers to enjoy the benefits of enumeration that the rest of the industry has enjoyed as a result of the NPI. Access the Health Plan and Other Entity Enumeration System (HPOES) at www.insuranceoversight.hhs.gov to sign up for e-mail updates that will provide more information. See the attachment and access the final rule at https://federalregister. gov/a/2012-21238 for specific guidance regarding enumeration opportunities.

Share this message with your peers and business associates!

Please encourage your peers and business associates to obtain a specific HPID/OEID for each of their companies as appropriate.

The reduction of administrative costs, such as phone calls and appeals, that the HPID/OEID promises will only occur if each of your peers and business associations also obtain an appropriate identifier and prepare to utilize these IDs in the HIPAA electronic health care transactions no later than November 7, 2016.

Consider machine-readable patient health insurance identification cards or smart technology.

Streamline and save. By issuing machine-readable cards or smart technology, you'll save money and reduce hassle for patients and practices. Visit MGMA’s SWIPE IT initiative for more information.

The HPID/OEID’s ISO 7812 standard ID format is conducive to machine-readable cards, since it consists of a 10-digit, all-numeric identifier with a Luhn check-digit as the 10th digit. The ID format is an intelligence-free identifier, except that the start digit of the identifier signals whether the identifier is assigned to a health plan, an “other entity” or a health care provider, which each have a different start digit.

Reduce administrative costs (e.g. phone calls) through increased transparency.

require that all relevant information concerning the payer, the payer’s agents and the fee schedule amount be transmitted on all relevant electronic health care transactions in unambiguous terms.

Given the plethora of potential claims billing and payment scenarios—including the added complexity of numerous organizations performing health plan roles (payer, administrator, network contractor, etc.)—payment transparency and accuracy can only occur if the following information is clearly identified on each of the HIPAA mandated electronic health care transactions, such as the ASC X12 5010 271 eligibility and 835 electronic remittance advice: 1. The entity financially responsible for payment; 2. The entity responsible for administering the claim; 3. The entity that owns the contract with the physician applicable to the claim; 4. The fee schedule that applies to the claim; 5. The specific plan/product type; 6. The location where the claim is to be sent; and 7. Any applicable secondary or tertiary payers who may have financial responsibility for all or part of the claim.

Currently, patients, physicians and other health care providers must either contact the health plan directly and request the information before patient treatment is delivered and/or be forced to contact the health plan after payment is received to ascertain if the contractual agreement was fulfilled. Ambiguity and manual intervention contribute to higher costs for everyone.

Clear identification of each organization, plan/product type and the specific fee schedule involved in the determination of the ultimate patient benefit and claim payment will result in transparency gains that will benefit patients, payers, and physicians and other health care providers, as well as contribute to a decrease in health care costs for the entire industry.

Automating coordination of benefits The HPID/OEID will also enable automation of the coordination of benefits (COB) process by ensuring that physicians and other health care providers always have access to all relevant payer IDs, whether they are primary, secondary or tertiary. COB is the process of coordinating the adjudication of a claim between two or more payers that both have financial responsibility for health services being rendered. The adoption of an HPID and OEID to include provider networks, third-party administrators (TPAs) and other entities involved in a claim transaction would facilitate identification of the various payers. This will lead toward the automatic identification of secondary payers, thus facilitating the automated generation of claims to secondary payers or a Medicare supplemental plan, reducing the burden on the patient or beneficiary, and eliminating the need for physicians and other health care providers to generate paper claims which contribute to higher transaction costs and increased risk of error.

The HPID/OEID is the first step toward achieving a fully automated claims payment and reconciliation cycle, which will November SCMS The Message 11

Continued on page 12

Continued from page 11 Access www.ama-assn.org/go/simplify for white papers and additional information regarding AMA’s administrative simplification initiatives.

Questions or concerns about practice management issues?

AMA members and their practice staff may e-mail the AMA Practice Management Center at practicemanagementcenter@ama-assn.org for assistance.

For additional information and resources, there are three easy ways to contact the AMA Practice Management Center: Call (800) 621-8335 and ask for the AMA Practice Management Center.

Fax information to (312) 464-5541.

Visit www.ama-assn.org/go/pmcto access the AMA Practice Management Center website.

Physicians and their practice staff can also visit www.ama-assn.org/ go/pmalerts to sign up for free Practice Management Alerts from the AMA Practice Management Center.

The Practice Management Center is a resource of the AMA Private Sector Advocacy unit.

Wilderness Medicine

By Jacob C. Deakins, MD Here in the great Northwest we are surrounded by a vast array of outdoor activities and with four seasons those opportunities are available year round. Those activities take many forms for people, from skiing, rafting, hiking, climbing, biking and snowmobiling to a host of others. We tend to like to play outdoors here in our great region and with good reason! Despite the differences in these pursuits, there is a similarity. Distance from definitive medical care. Whether it is a quick mountain bike ride on a trail close to home or an extended backpacking trip into the mountain, we may find ourselves more than an hour from any type of medical care. This is where a rapidly growing segment of medicine, called wilderness medicine, is emerging. The concept of wilderness medicine is not entirely new, as organizations that spend time outdoors have been teaching first-aid skills for decades. How does this differ and what defines something as being “wilderness medicine”? The general answer is when care may be more than one hour away with other variables factoring in. These include, but are not limited to, moving an injured patient over difficult terrain, the weather, wound management and many other considerations. This may need to be accomplished in an austere environment or, at the very least, one that does not provide us with elaborate diagnostic or treatment options.

Most of us are limited on what we can realistically carry with us into the field, even with vehicle supported pursuits. This leaves us to our training and any materials/equipment that we may already have on hand.

Several professional societies have been fundamental in the development of standards, curriculum and guidelines for this type of care. Among them are the Wilderness Medical Society (WMS)

and the Wilderness Medical Institute (WMI). WMS was founded in the 1980s “to encourage, foster, support, and conduct activities or programs concerned with life sciences which may improve the scientific knowledge of the membership and the general public in matters related to wilderness environments and human activities in these environments.”

And the Wilderness Medical Institute of National Outdoor Leadership School (NOLS) whose philosophy is as follows: “The WMI community values an educational approach that prepares our graduates with the judgment and skills to act with confidence and competence. Our evidence-informed wilderness medicine curriculum emphasizes skills and information that are practical, accurate and relevant. The curriculum is delivered with passion and skill through a balance of scenarios, skills practice and focused lectures.” Both entities provide valuable resources in expanding wilderness medicine and improving the caliber of training available for healthcare providers from first responders to physicians.

The spectrum of settings, from the heights of the mountains to the depths of the ocean and everything in between, and ailments is as varied as the participants. The core topics as listed by WMS include the following areas of medicine: Diving And Hyperbaric Medicine; Tropical And Travel Medicine; High Altitude and Mountaineering Medicine; Expedition Medicine; Survival, Field Craft and Equipment; Safety, Rescue and Evacuation; Sports Medicine and Physiology; Preventative Medicine, Field Sanitation and Hygiene; General Environmental Medicine; Improvised and Alternative Medicine; Disaster and Humanitarian Assistance and Wilderness Emergencies and Trauma Management. With such an extensive offering, there is an area for everyone to further their particular interest, while expanding on lesser known areas.

Wilderness medicine provides a chance to combine a passion for the outdoors with the passion for medicine. There is a variety of ways to utilize one’s training in wilderness medicine other than for personal benefit, such as expedition doctor on international treks, ship doctor, adventure race support or as a physician who provides expertise and curriculum for others in this capacity. This can be both personally rewarding as well as fun! It serves the greater purpose of providing a standard of care to a population and promoting medicine and health in an outdoor setting. Many of those skills can come into play in disaster and relief medicine as well.

As a physician I have carried my passion for medicine into the outdoors and I am actively pursuing a fellowship in wilderness medicine offered through the Wilderness Medical Society. I have wanted to have a venue here in the Inland Northwest to meet with like-minded healthcare professionals. As such I would like to start an interest group to meet on a regular basis to discuss wilderness medicine topics, have a journal club and find others with similar interests. This of course is in its infancy and I am hoping that this article and the links provided will garner some interest. I would like to hear from anyone interested at inwmed@yahoo.com. The links for the Wilderness Medical Society and the Wilderness Medical Institute are Wilderness Medical Society: www.wms.org and Wilderness Medical Institute: www.nols.edu/wmi/.

November SCMS The Message 12

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

Medical and Therapeutic Management of Chronic Pain: This seminar is jointly sponsored by the St. Luke’s Rehabilitation and the Spokane County Medical Society. 4.5 AMA Category 1 Credits.

Conference will be held on November 9, 2012 from 8:00 AM – 3:30 PM at the Davenport Hotel. Additional information & online register available at www.cherspokane.org.

Rockwood Health Systems Breast and General Tumor Boards: These tumor boards are jointly sponsored by Rockwood Health Systems and the Spokane County Medical Society. Tumor Boards will be held weekly September – December 2012. Each Tumor Board is worth 1.0 Category I CME credits. For more information please contact Sharlynn M. Rima CME Coordinator at SRima@ rockwoodclinic.com.

Update in Internal Medicine 2013: This seminar is jointly sponsored by the Spokane Society of Internal Medicine and the Spokane County Medical Society. 9.25 AMA Category 1 Credits. Conference will be held on February 22, 2013 from 7:00 AM – 6:00 PM at the Spokane Convention Center. For additional information please contact Jennifer Anderson at (509) 448-9709 or email spokanesocietyim@gmail.com.

Meetings/Conferences/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.

WSMA & UW Physician Leadership Course Offered in Spokane Spring 2013 Terri Oskin, MD, SCMS President wrote in the August Newsletter, “Through Leadership Spokane I developed a new and deeper understanding and appreciation of Spokane, both its strengths as well as its weaknesses. The program stresses the role of the servant leader and active participation.” The SCMS has and continues to stress the importance of physician leadership through its publications and activities in the community. If you are in a position of leadership or are contemplating it, read the many physician authored articles in the August Newsletter and consider advancing your leadership skills. The following announcement outlines an excellent leadership program that you should consider.

Physicians who lead are in a remarkable position - they know the culture of patient care as well as the culture of business. Safe and costeffective care can only be achieved if more physicians take leadership

roles in health care or form strong partnerships with administrators.

Nevertheless, many physicians do not feel confident in their skills and need an opportunity to see what their future might be as leaders.

The WSMA/UW Physician Leadership course is a comprehensive leadership skills development program that offers 10 weeks of interactive hybrid distance learning specifically designed for physicians. The course is based on UW MHA and Certificate of Medical Management curriculum. The course offers 8 weeks of online assignments and group work bookended by two in-person weekend meetings, allowing physicians to develop and hone their leadership skills in a convenient manner without needing to take significant time away from their practice or personal lives. The 40-hour course (CME and AAFP credit apply) focuses on: leadership and conflict management, strategic planning and management, safety and quality management, finance and communication and advocacy.

Our next course will be offered spring 2013 in Spokane, Washington.

In-person dates are March 8 and 9 and May 10. Between March 9 and May 10 the course is conducted online. The course is limited to 30 individuals. Tuition for WSMA members is $2,000 and non-member tuition is $2550. To apply for the spring 2013 course, contact Jennifer Hanscom at 1.800.552.0612 or 206.441.9762 (jen@wsma.org).

The Second Annual James Mcclellan Lecture Humanity In Clinical Care The Marcus Whitman Hotel and Conference Center, 2nd and Rose Street, Walla Walla, WA. Parking is available on site. Friday, 9 November 2012 Welcome noon Lecture 12:30pm Luncheon 1:30pm: FREE, with Symposium (1:30-4:00 PM) CME II, 2 hours Cost: None.

The Lectureship is funded through donations from the medical community of Walla Walla as a loving memorial to Dr. James E. McClellan. Pre-registration is required. Space is limited: reservations will not be accepted after 4 November. Register by email: Carole Alexander at: cralexander@charter.net; include full name, occupation (physician, nurse, student, etc.), and mailing address.

ICD-10-CM Guidelines & Primer This workshop will provide much deeper and broader training in ICD-10-CM coding guidelines and protocols. Emphasis will be placed on understanding the differences between the old and the new coding systems, and specifically on the documentation requirements. Friday, November 16 at Valley Hospital from 12:30 to 4:30 p.m.

Attend this afternoon program and learn • ICD-10 guidelines/conventions; focus on primary differences between ICD-9 & ICD-10 • Implement chart auditing at your practice • General changes and differences between ICD-9 & ICD-10 • Specific chapters with case examples WSMA and WSMGMA members can attend for $189 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 $169 per person. For more information and to register go to the WSMA website at www.wsma.org.

November SCMS The Message 13

Physician Citizen of the Year Award

Senior Physicians – Retired but still very active!

Each year a member of the Spokane County Medical Society is chosen as the Physician Citizen of the Year. Recipients of the award are nominated by their peers who must give examples of the nominee’s dedication to the healthcare profession that are addressed in five areas:

There are more than 200 senior physician members of the Spokane County Medical Society. Those members are either completely retired or are currently working and have reached the age of 70.

• Contributed to public understanding and appreciation of the role of medicine and to an improved public image of our profession and its members.

• Demonstrated high standards of competence, ethics and professionalism.

• Showed outstanding ability in medicine.

• Worked for the advancement of the medical profession.

• Contributed to the betterment of our community and nation.

An independent entity reviews the nominations and chooses the award recipient. The award is usually presented in conjunction with a planned physician event or meeting.

Nomination forms are sent in early spring to all members as an insert in The Message monthly newsletter. Please watch for the form and nominate someone you believe should be the Physician Citizen of Year for 2013!

The senior physicians get together twice a year. The first event is in the spring when physicians interested in the game of golf sign up for a day of lunch and a round of golf. There are prizes, trophies and lots of camaraderie. In October, physicians get together with their spouses and guests to enjoy dinner and election of the chair for the coming year. For the past couple of years there have been presentations about volunteer opportunities, both locally and abroad, in which senior physicians are involved. A special thank you goes to all the physicians who generously give their time and experience to those less fortunate.

UPCOMING SCMS EVENT DECEMBER Board of Trustees’ Meeting – 5 oo Installation of officers

Medical Society Focuses On Community Health and Wellness New Program, Consistent Care Washington, Spearheads New Initiatives The Spokane County Medical Society’s new strategic plan will focus on Community Health and Wellness Initiatives that will improve health and reduce costs. A new program called Consistent Care Washington has been established to spearhead these initiatives.

Another Medical Society program, Project Access, has for the last nine years, organized a network of medical services providers who donate medical services to low-income uninsured people in the Spokane region.

Consistent Care Washington promotes and supports the “Triple Aim” for the Spokane Region. The Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It focuses new healthcare systems designs on simultaneously pursuing three dimensions, 1) Improving the patient experience of care (including quality and satisfaction); 2) Improving the health of populations; and 3) Reducing the per capita cost of healthcare. Over time, this approach will improve our health and stop the ever increasing costs of healthcare services and insurance.

Consistent Care Washington was created to carry forward the collaborative work of Dr. Darin Neven and the Emergency Department Medical Directors of the four Spokane hospitals Dr. Scott French, Dr. Mike Wymore, Dr. Wayne Tilson and Dr. Mike Sicilia. The work of this group over the past year has created strong collaboration with providers of medical and behavioral health services, focusing attention on improving the health of frequent utilizers of medical services and lowering the cost of their care.

Dr. Neven, is the Medical Director of Consistent Care Washington. He brings his experience and expertise as Medical Director of the successful Consistent Care emergency department care coordination program at Providence Sacred Heart Medical Center.

“Consistent Care Washington provides the perfect community-based foundation for this important work,” said Dr. Neven.

“We will be working on several initiatives to provide better care at lower costs, in collaboration with our community clinics, our major hospital systems, and health care insurance providers.”

November SCMS The Message 14

Physician Leadership Resources

SAVE THE DATE Spokane Society of Internal Medicine’s 64th ANNUAL MEETING The 64th annual Update in Internal Medicine will be held at the Spokane Convention Center on February 22, 2013. Mark your calendars!

This year’s meeting features internationally renowned back pain expert, Dr. Richard Deyo, as well as medical humanities leader, Dr. Robert A. Schwab. Other topics include updates in rheumatology, women’s health, palliative care and drug therapy, with focused sessions on COPD, GERD and anemia. For further details of the meeting and updates please see the SSIM website http://www.spokanesocietyim.org/.

If attending the SSIM meeting don’t miss the SSIM-ACP kickoff event on Thursday evening. We will provide an update on ACP activities regionally and nationally and offer a short session on advancing to fellowship in the College prior to hearing an entertaining talk from Dr. Schwab.

All in all, the SSIM meeting will be an amazing opportunity for both hospital-based and office-based internists, as well as other specialists and primary care providers, to hear updates on a broad range of areas relevant to the care of the adult patient. As this year’s meeting will be held on Friday only, for those traveling to Spokane, consider making an extended weekend out of it by visiting one of the five major ski areas (Schweitzer Mt., Silver Mt., 490 North, Mt. Spokane and Lookout Pass) within a two hour drive from downtown Spokane.

Be sure to check the SCMS website (www.spcms.org) Leadership Resources tab for suggested books and articles.

Credentialing The Spokane County Medical Society (SMCS), in collaboration with Spokane hospitals, provides physicians and physician assistants a centralized credentialing service for application of membership and hospital privileges. This service is simple and more efficient as medical professionals need only complete the Washington Practitioners’ Application once, reducing duplication and paperwork. This expedites the credentialing process for providers new to the community and joining SCMS membership.

As of October 2012 over 100 applications have been processed by the SCMS staff and reviewed by the Credentialing Committee members. The committee consists of seven members. Three are members of the SCMS at large (Judy Benson, MD – Chair; Daniel Dionne, MD and Sajid Ravasia, MD) and four represent the various Spokane hospital Credential Committees ( Jeff, Clode, MD; Tiffany Hanf, MD; Randi Hart, MD and David Ott, MD).

The duties of the committee include reviewing each applicant and investigating the moral and professional qualifications for membership in the Spokane County Medical Society. After careful investigation, the findings are reported at a regular meeting of the Board of Trustees along with recommendations regarding membership in the Spokane County Medical Society.

SCMS is happy to welcome Candace Mickiewicz as our Credentialing/Membership Coordinator. Candace comes to SCMS with four years of experience in the credentialing field and eight years with the medical insurance industry. Along with her credentialing duties she is responsible for maintaining our comprehensive member data base. She is currently studying to take the Certified Provider Credentialing Specialist (CPCS) exam in the spring of 2013. She is happily married and enjoys roller derby and remodeling her new home.

November SCMS The Message 15

Continuing Medical Education During 2012 the Continuing Medical Education Committee was busy working hard on providing Category 1 CME programs for our members and the Inland Northwest regional medical community.

The Committee mission statement states that “The scope of the Committee will be to initiate, evaluate and approve Category 1 CME programs suitable to the needs of the physicians in our region.”

This is accomplished in two ways. The first is by SCMS directly sponsoring programs that meet the educational requirements as determined by our annual needs assessment survey. Secondly, SCMS joint sponsors programs with local specialty societies or medical groups.

Drs. Mary Noble, Clint Hauxwell and Jeffrey Fox

It is the goal of the committee to initiate, evaluate and accredit high quality continuing medical educational programs that reflect our local and regional physicians’ educational needs both for primary care and specialty care and meet the stringent requirements of AMA PRA Category 1 CME credits.

Thank you to the CME Committee members, Clint Hauxwell, MD (committee chair); Bruce Becker, MD; Don Coerver, PA-C; N. Roger Cooke, MD; V. Patrick Hughes, MD; Guy Katz, MD; Melanie Lang, MD; Mary Noble, MD and Kim Thorburn, MD, who give their valuable time to ensure we have quality medical education in our community.

A special thank you goes to Jennifer Anderson who has served as the SCMS CME Coordinator since 2007. Jennifer’s exceptional performance will be greatly missed, and as one physician noted “she is just right persistent, kind, up-beat and sharp as a tack.”

Since the CME Committee is not allowed to plan programs a CME Planning Committee was established in 2011. The Committee members are Robert Benedetti, MD; Robert Bray, MD; Deb Harper, MD; Clint Hauxwell, MD; David McClellan, MD; Gary Newkirk, MD and Brian Seppi, MD. The committee was tasked with the planning, funding and implementation of our first all-day CME symposium – Medicine 2012 held on September 28, 2012.

Dr. Robert Bray

Dr. David Spach

Dr. Brian Seppi

Membership Recognition for November 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.

30 Years Daniel R. Coulston, MD

11/30/1982

Michael H. Cunningham, MD

11/30/1982

Eric S. Johnson, MD

11/30/1982

Thank you to the speakers, participants and vendors who helped make Medicine 2012 a success. Topics and speakers of the day included common GI malignancies (Jeffrey Fox, MD), patient motivation (Mary Noble, MD), screening recommendations (David Grossman, MD), bio identical hormone therapy (Linda Mihalov, MD), healthcare reform (Glen Stream, MD), IBS (Jeffrey Fox, MD), pharmaceutical advertising (Matthew Hollon, MD), immunization indications (David Spach, MD) and palliative care (Robert Bray, MD).

Planning for Medicine 2013 is underway. The program will be held on Friday, September 27, 2013, preceding the WSMA House of Delegates meeting.

Additionally in 2012 SCMS sponsored a Pain Management CME held in conjunction with the Primary Care Update in May and our annual Moderate (Conscious) Sedation and Analgesia CME program in September.

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VTEES SA E DA TH

2013 Events for Women Physicians February 27 Wednesday Mamm Party 5:30 to 8:00 p.m.

March 15 Friday 5:00 p.m. to March 16 Saturday noon at the Bozarth Center Watch for more details.

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In The News Congratulations to Bradley W. Pope, MD who received the Cooperative Spirit Award from Group Health Cooperative at their annual meeting. The award honors staff members who demonstrate Cooperative principles by creating or facilitating meaningful partnerships with members. Dr. Pope, East Cascades District Medical Director, was recognized for his work with the Spokane Prescription Opioid Task Force and for engaging with consumer members of the region’s appeals committee and for valuing their input.

Inland Northwest Health Services Awarded $931,815 to Help Create Healthier Communities in Eastern Washington Inland Northwest Health Services (INHS) was awarded a grant of $931,815 to address obesity challenges in six eastern Washington counties over the next two years.

This grant is a part of the U.S. Department of Health and Human Services’ (HHS’s) Community Transformation Grants (CTG) to support public health efforts to reduce chronic diseases, promote healthier lifestyles, reduce health disparities, and control health care spending in small communities.

By focusing on where people live, work, learn and play, the CTG program is expected to improve the health of more than four out of 10 U.S. citizens—about 130 million Americans.

Lead agency INHS is coordinating the efforts of five crosssector partners and 21 regional coalition members in the implementation of the “Start Healthy. Start Now.” initiative.

Collaborating partners include Community Minded Enterprises, Empire Health Foundation, Spokane Regional Health District, Step UP and Go and Washington State University’s Area Health Education Center (AHEC) of Eastern Washington.

The obesity prevention initiative Start Healthy. Start Now. will bring health promotion and child development training, technical assistance, educational resources and system and policy changes to a high-need population in Spokane, Stevens, Pend Oreille, Ferry, Whitman and Adams counties.

Start Healthy. Start Now. is focused on more than 50,000 children, families, licensed child care staff and early childhood educators and the families of child care staff and early childhood educators in the six-county region.

The initiative is designed to affect measurable changes in three of the five Community Transformation Grant outcome measures (healthy nutrition, physical activity emotional well-being and mental health) with a research-based assumption that changes in these outcome measures will impact a fourth outcome measure (weight) over time.

Overall, HHS awarded approximately $70 million in prevention grants to 40 awardees focused on improving the health of small communities across the nation. Administered by the Centers for Disease Control and Prevention (CDC), the CTG Program is a comprehensive prevention and wellness initiative launched in 2011 and funded through the Affordable Care Act’s Prevention and Public Health Fund. These new funds will support areas with fewer than 500,000 people in neighborhoods, school districts, villages, towns, cities, and counties. Awardees represent organizations committed to improving health from a multitude of sectors.

The Prevention and Public Health Fund, as part of the Affordable Care Act, is supporting the CTG program and other initiatives designed to expand and sustain the necessary capacity to prevent chronic diseases, detect them early, manage conditions before they become severe and provide states and communities the resources they need to promote healthy living.

To learn more about the Community Transformation Grant Program, including a list of all awardees, visit www.cdc.gov/ communitytransformation.

Focus on Safety and Quality Earns Northwest MedStar AAMS “Program of the Year” Award Northwest MedStar was named 2012 Program of the Year by the Association of Air Medical Services (AAMS) for exemplifying the best of the air-medical and critical care transport programs internationally.

Awarded by the industry’s international association serving providers of air and ground medical transport systems, the AAMS 2012 Program of Year award recognized Northwest MedStar for demonstrating safety consciousness, patient care excellence, commitment to quality improvement, community service, strong leadership and visionary innovation. All AAMS air medical programs worldwide are eligible for the Program of the Year honor.

“The team is highly-trained with ICU and emergency department experience,” said Dr. James Nania, medical director with Northwest MedStar. “The cases that Northwest MedStar handles are at the high end of tough, and the care they provide is at the high-end of wonderful.”

Felix Martinez, Jr., M.D. has been awarded the College of American Pathologists’ (CAP) Ultrasound-Guided Fine Needle Aspiration Advanced Practical Pathology Program (USFNA AP3) Special Practice Certificate. The award recognizes successful completion of an educational program that requires rigorous study and on-site practical training in ultrasound-guided fine needle aspiration (FNA). Dr. Martinez is the Cytology Laboratory Director at InCyte Pathology.

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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 applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS Kwon, Jun-Beom, MD Internal Medicine Med School: George Washington U (2006) Internship/Residency: U of Rochester (2009) Practicing with Apogee Physicians 08/2009

PHYSICIANS PRESENTED A SECOND TIME Dunsmoor Su, Rebecca F., MD OBGYN Med School: U of Pennsylvania (2001) Practicing with Obstetrix Medical Group of Washington 09/2012 Laselle, Brooks T., MD Emergency Medicine Med School: Feinberg School of Medicine (2004) Practicing with Spokane Emergency Physicians 01/2013 Lowe, Gloria V., MD Family Medicine Med School: U of Washington (2008) Practicing with South Hill Family Medicine 09/2012

PHYSICIAN ASSISTANTS

Pakkianathan, Stephen J., MD OBGYN Med School: Loma Linda U (2007) Internship/Residency: Loma Linda U Med Ctr (2011) Practicing with Northwest OBGYN 10/2012

Houchin, Charles R., PA-C Physician Assistant School: MEDEX Northwest/U of Washington (2012) Practicing with Rockwood Clinic 10/2012

Parker, Pamela D., MD OBGYN Med School: Jefferson Medical College (1990) Internship/ Residency: Swedish Medical Center (1993) Residency: U of Missouri (2003) Fellowship: Family Medicine Spokane (1999) Fellowship: Maricopa Integrated Health Services (2012) Practicing with CHAS 01/2013

Lang, Gregory R., PA-C Physician Assistant School: U of Washington (2012) Practicing with Inland Cardiology Associates/Rockwood Clinic date pending

PHYSICIAN ASSISTANT PRESENTED A SECOND TIME

Wilson, Jonathan J., DO Family Medicine Med School: Des Moines U. (2008) Internship/Residency: Central Washington Family Medicine (2010) Residency: Mt Clemens Regional Medical Center (2012) Practicing with Deer Park Family Care Clinic 02/2012

Lipps, Deanna R., PA-C Physician Assistant School: U of Washington (2012) Practicing with Rockwood Clinic 10/2012

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

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

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

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

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

OPI owns and operates plasma collection centers critical to the development of life-saving patient therapies utilized by thousands of patients globally. Learn more at www.OctapharmaPlasma. com. Apply today by sending your resume/CV to Careers@ OctapharmaPlasma.com!

FAMILY MEDICINE SPOKANE Immediate opening with Family Medicine Spokane (FMS) for a full time BC/BE FP physician who has a passion for teaching. FMS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Diane Borgwardt, Administrative Director at (509) 459-0688 or e-mail at BorgwaD@ fammedspokane.org.

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.

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/ physicianopportunities.

SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PAC 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.

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.

MEDICAL DOCTOR (MD/DO) (PRN openings in Spokane, WA) Physicians needed to perform physicals and health screenings at a non-commercial medical facility. MD/DO must have a current active, license from any state, available 1 to 3 mornings a week.

Send CV to or call: Gil: (210) 424-4008 meps@thi-terra.com EOE

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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: 16909 N Triple Butte Court, Colbert, WA $789,000 Beautiful home, custom built in 1996 by Copeland Design and Construction. Situated on five wooded acres with two seasonal ponds and 220 feet of river frontage along the Little Spokane River.

Idyllic country living but only 5 minutes from the Wandermere Shopping Center and only 10 - 15 minutes from Holy Family Hospital.

There are 4 bedrooms, a library, a formal dining room, an open kitchen with eating area, great room, rec room, sun room, 2 full baths, a guest bath, mud room, laundry room, a 3-car attached garage and a greenhouse with fenced-in garden, covered front porch, large back deck with hot tub and a patio of cobblestones. Views from the back deck look over the Little Spokane River wetlands. Call Dr. Edward Petruzzello at (509) 879-3770. No realtors please.

MEDICAL OFFICES/BUILDINGS 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.

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 receptionistenclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.

OTHER Ten (10) adjustable rolling physician stools, teal - $35.00 each, all in great condition. For more information contact Colleen Kins at Internal Medicine Residency (509) 744-3965 or email Colleen.Kins@ Providence .org.

Went into partnership - no longer need the following items: CIRC BOARD & CLAMPS Circumstraint circumcision board $50. Gomco circumcision clamps (sizes 1.1, 1.3, 1.45) $20ea size. Everything like new. EKG & SPIROMETER - $200 WelchAllyn, Schiller AT-10 EKG and Spirometer. Low use. Maintained/inspected/serviced by Sacred Heart Engineering. Comes with 14 reams of additional paper, Spirometry calibration syringe and 50 disposable spirometry mouth pieces. Original manuals included. AUTOCLAVE - $2000 Midmark, M9 UltraClave, Steam Sterilizer/Autoclave. Low use, ideal condition.

Maintained/inspected/serviced by Sacred Heart Engineering. Comes with assortment of sterilization envelopes, sterilization wraps and confirmation tape along with 6 bottles of Speed-Clean, Autoclave cleaning solution. Original manual included. All equipment located in Spokane Valley. Email shellymanson@comcast.net for purchase, pictures and/or questions.

North Spokane Professional Building has several medical office suites for lease. This 60,000 sf professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various spaces available for lease from 635 to 6,306 usable square feet available. The building has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include pediatricians, dermatology, dentistry, pathology and pharmacy.

Floor plans and marketing materials can be emailed upon request. A Tenant Improvement Allowance is Available, subject to terms of lease.

Please contact Patrick O’Rourke, CCIM, with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720. Email: psrourke@comcast.net.

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

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Serving the Medical Community for over 30 years, Fery’s will gladly cater your next breakfast, lunch, or dinner meeting We can accommodate any size and budget!

To schedule, call: 509-458-5234 or e-mail: feryscatering@gmail.com 421 S. Cowley Spokane, WA 99202

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

PRSRT STD U.S. Postage

PAID

Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

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

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