The Message, September 2012

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

SPOKANE’S CHANGING MEDICAL-PRACTICE MODELS

By Terri Oskin, MD SCMS President

CHANGING BUSINESS MODEL: PARTNER TO EMPLOYEE IT’S A BEAUTIFUL DAY IN THE NEIGHBORHOOD

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September SCMS The Message Open2

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

2012 Officers and Board of Trustees Terri Oskin, MD President Anne Oakley, MD President-Elect Bradley Pope, MD Immediate Past President David Bare, MD Vice President William Keyes, MD Secretary-Treasurer Trustees: Robert Benedetti, MD Audrey Brantz, MD Michael Cunningham, MD Karian Dierks, MD Randi Hart, MD Louis Koncz, PA-C Shane McNevin, MD Gary Newkirk, MD Fredric Shepard, MD Carla Smith, MD Newsletter editor – Anne Oakley, MD

Spokane’s Changing Medical-Practice Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 It’s a Beautiful Day in the Neighborhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Changing Business Model: Partner to Employee . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Economics and the Future of Physician Practice Models . . . . . . . . . . . . . . . . . . . . . . . . 3 Northwest Physicians Network Current Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Retaining Independence While Embracing Accountability: . . . . . . . . . . . . . . . . . . . . . . 5 Dear House of Charity Preceptors, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Your Role in Promoting Health Equity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Interprofessional Education: Preparing Students for Collaborative Practice . . . . . . . . . . . . . 11 In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Physician Leadership Resource . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 New Physicians and Physician Assistants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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"In the past a leader was a boss. Today ’s leaders must be partners with their people.. they no longer can lead solely based on positional power."

Ken Blanchard

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.

September SCMS The Message Open3

Spokane’s Changing Medical-Practice Models

I am hoping that this new collaborative effort between GHC and PHS will bring more of the same. The medical community in Spokane is definitely changing. As we make these moves forward, I am concerned about individual practices still trying to survive.

Will the providers burn out, give up and simply shut their doors or become part of one of the larger systems?

By Terri Oskin, MD SCMS President As you’ll read in this month’s The Message, many groups are developing new systems of care, including my Rockwood/CHS friends and colleagues. I just wanted to share some insights from my own personal experience in the past year. I hope you will find the updates informative and useful.

This month we write about changing physician practice models from traditional private practice to new models that include Integrated Delivery Networks, Accountable Care Organizations (ACO) and Patient-Centered Medical Homes, to name a few. Whether we like it or not, our physician practices are indeed morphing. I do not know what our health care system will look like in 50 years, however I am almost certain that the 21st century will produce transformative changes that will shape how we practice medicine and the role of our health care system—just as the Industrial Revolution transformed the way people worked and lived. All right, maybe not as momentous, but change is coming and we need to be prepared.

Just three short years ago I found myself part of a struggling traditional practice model. I am now employed by Group Health Physicians, one of the largest physician groups in the Northwest.

On August 1, 2012 Group Health Cooperative (GHC) and Providence Health Care (PHC) formed a limited liability corporation that includes health care providers from Group Heath Physicians (GHP), Providence Medical Group (PMG) and Columbia Medical Associates (CMA). The new organization is governed by physicians and administrators from both Group Health and Providence. The organization, as defined by the Center for Medicare and Medicaid Services (CMS), is not an ACO. It is a collaboration between both organizations to work together and find innovative ways to improve the delivery of health care to our community. This collaborative approach between physicians in different care settings is a new approach in our present day of medicine. It may take time, patience and a long learning curve to convince physicians that the present way may not be the only or best way to provide care.

I have always been leery that when an organization gets too large it loses some of its original scope. However, my first year as a Group Health Physician employee has been quite positive. I believe that my small office is better managed and patient communications have improved. With a larger organization come more meetings, which we all know is the last thing on our minds at the end of a long busy day. However, the light at the end of the tunnel has been an opportunity to meet fellow physicians from other offices and discuss practice ideas and solutions to difficult problems. GHP has been very supportive of its growing “family” and eager to listen to the experiences we bring to the table.

It’s a Beautiful Day in the Neighborhood

By Tom Schaaf, MD, Group Health Cooperative Five years ago Group Health piloted its medical home model and we’ve been using it at our Spokane-area medical centers since 2009. The heart of the medical home is health care managed and coordinated by personal physicians — the quarterbacks, as it were — and their teams, which can include nurses, pharmacists, physician assistants, and medical assistants.

The medical home has yielded some remarkable benefits.

Patients reported having better experiences and clinicians less burnout. Patients had fewer visits to the emergency room and fewer hospitalizations. Those with chronic conditions managed them better and followed medical orders better with the aid of the medical home team. And for every dollar Group Health invested, it recouped $1.50.

The Group Health Research Institute is now evaluating the model that was rolled out to all 25 Group Health medical centers. Results aren’t published yet, however, we are already preparing for the next evolution.

Medical home 2.0 Both at Group Health and nationally, health care is still too expensive. We aren’t as efficient as we can be and we recognize this. At the same time, health care reform is expected to drive hundreds of thousands of new patients into primary care, but most likely with lower reimbursements. Complicating things even further, the nation doesn’t have a large enough supply of primary care physicians to care for so many new patients.

In the next two years, Group Health will embark on reconfiguring our primary care teams to provide high-quality care for more patients, using a team approach. Doctors and nurses will practice at the top of their licensure, avoiding unnecessary clerical work.

We will design care that assures satisfying and exciting careers for family medicine, internal medicine, and pediatric physicians.

Growing the medical neighborhood We are also serious about expanding to a “medical neighborhood” model that includes a comprehensive range of specialists across the continuum. We’ve taken the next step by creating a new limited

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Continued from page 1 liability corporation (LLC) with Providence Health Care to become the region’s most comprehensive physician organization. Through the LLC, 132 primary care providers will act as the medical home for patients served by both medical groups. Providence has its own medical home model, and we will learn from each other how to apply the best concepts consistently across both organizations.

Each will keep its own distinct culture but apply the same principles and infrastructure to achieve coordinated, evidence-based, patient-centered care. We also will begin developing payment incentives that pay for this type of care in lieu of incentives that work against each other.

We’re also building the neighborhood by collaborating with Providence on urgent care, where both organizations’ physicians will be able to practice side by side. Today our primary care system doesn’t accommodate walk-in patients very well. Many patients— especially the working poor—don’t have medical leave to receive care during daytime hours, so instead they appear in urgent care with primary care needs. Together with Providence we are identifying how to get these patients the primary care they require and optimize urgent care for higher-acuity needs, helping prevent unnecessary emergency room visits.

As we look back on the medical home’s evolution, most Group Health doctors and staff would agree that they are giving care that’s better and more comprehensive. Nobody would go back to the old ways. As we strengthen the medical home and neighborhood, primary care providers and specialists will collaborate in more integrated, creative ways to care to their patients at the right time and place. It’s an exciting future.

Tom Schaaf, MD, is the assistant medical director for Group Health Cooperative’s Eastern Washington/North Idaho District.

Changing Business Model: Partner to Employee

By Brian Seppi, MD Adapt: To make suitable to requirements or conditions; adjust or modify fittingly. The current healthcare environment requires we all adapt or risk being left behind. The decision of my group, Physicians Clinic of Spokane, to join Providence Health Services was made after much thought and deliberation. We asked ourselves the question: Given the changes in healthcare delivery how can we adapt to those changes and provide better care to our patients? The answer to that question was to join an integrated delivery system and Providence was the system that aligned with our group’s culture, values and vision for the future.

There is little argument that our current healthcare system is unsustainable. The cost of healthcare in the United States has increased dramatically. Spending on healthcare in the US has

increased from 5.1% of GDP in 1960 to 17.4% in 2009. While the cost has increased, we have fallen behind in several measurements of healthcare quality. According to the Organization of Economic Co-operation and Development the US was in the middle of the pack in terms of life expectancy compared to other industrialized nations in 1960 but has fallen to the bottom quartile compared to those same nations in 2009. The US life expectancy was 69.8 years in 1960 and increased by 8.3 years by 2009. This compares to Japan, who had a similar life expectancy in 1960, but saw its life expectancy increase by 15.2 years by 2009.

The government’s response to the rising cost of healthcare was the passage of The Protection and Accountable Care Act of 2010 (Obamacare). The law’s main focus is to decrease the number of uninsured, but it also starts us down the path of healthcare delivery redesign. Even without that law, the healthcare landscape is changing due to demands from employers to reduce costs and demands from patients to improve the quality and the value of healthcare. The pressure to improve quality and lower costs is moving us from our current volume based payment system to a value based payment system. Our group saw the pressure of increasing costs and lagging quality in our healthcare system and knew that we needed to adapt if we wanted to survive.

We decided that the best way to prepare for those changes was to be part of a coordinated, integrated healthcare system. We sought out a partner with the same vision of the future that we have and that shares our goal of delivering high quality, affordable care to our patients. We explored several options and three of our physicians joined Columbia Medical Associates, becoming part of the Group Health system. The remaining 17 physicians in our group made the decision to join Providence.

Life is always about tradeoffs. Working for Providence gives us the security of having a large organization with the resources needed to take us into an uncertain future. The cost of security is giving up the autonomy that we had when we were a group of 20 physician/ owners of a practice. In the past if we wanted to purchase a new lab machine, we would pencil it out and if it made sense from a budget and patient care standpoint we would make the purchase.

Decisions are not that simple when you belong to an organization that employees 1,700 physicians and owns 27 hospitals. We understand that there will be challenges working for such a large organization but this is a tradeoff we are willing to make if the end result is better and more coordinated care for our patients.

It was not an easy decision to sell our practice to Providence but our group is confident it was the right decision. We chose Providence because it shares our values and vision for the future.

Rahm Emanuel is famous for stating “never let a serious crisis go to waste”. Our group saw the “crisis” in healthcare as an opportunity to transform our practice. There will be challenges along the way but when we overcome those challenges the end result will be providing better care to our patients by working in a system that provides patient centered, coordinated healthcare with the support of an integrated delivery team.

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Economics and the Future of Physician Practice Models

By Robert Colvin The Colvin Group

The bottom-line to all of this is that payments for all healthcare components must and will go down. Physicians and health systems will be forced to do more with significantly less. The most efficient systems with the greatest economies of scale will be most successful. There will be no looking back.

ACA, ACOs and New Payment Models

Today’s Economics 101 Two related economic factors will force the rapid transformation of healthcare in America with everlasting impact on the practice of medicine. The first is America’s “healthcare cost bubble”.

We all know the statistics indicating we, as a country, are now spending 18 percent of our economy (GDP) on healthcare.

That compares to the next most expensive developed country, Germany, at 11.5 percent. The average of all developed countries is around 10 percent. So, what really does this mean?

Compared to the rest of the developed world, we are “overspending” for healthcare more than $1.2 trillion a year. We pay much more for drugs, for hospital services, for administrative overhead and for nearly every major input of care. For reference, the $1.2 trillion overspending is as much as we spend on ALL public education in our country and is nearly double the entire U.S. defense budget. In a truly global economy can America afford to spend that much money on healthcare at the expense of other vital components of our society?

Combine that with the fact that the nation finally understands that the federal deficit must be reduced. However, with little likelihood of a comprehensive, bipartisan Congressional resolution, Medicare and Medicaid (particularly Medicaid) will likely be victims of isolated reductions. Hospitals and health systems are already facing significant reimbursement cuts over the next three years, negotiated as part of the Affordable Care Act (ACA), and additional cuts could be very painful for many.

The new models of healthcare presented in the Affordable Care Act – accountable care organizations (ACOs), bundled payments and medical homes, all overlaid with electronic health records, are an attempt to instill some “system” efficiencies and incentives in our non-system of healthcare. Certainly organizations that have already developed continuums of patient care with aligned incentives for providers and support infrastructure will likely do very well with those models. The early participants in the Medicare Pioneer ACO program are nearly all organizations that had already been on a path to a patient centered care continuum.

However, many other organizations will attempt to jump in with monetary or market share objectives but lack shared vision, aligned incentives, patient focus or adequate support infrastructure, such as I.T. All of those will be necessary for success, as will greatly enhanced efficiencies. There will be numerous organizations that attempt to build the complete ACO continuum and fail. They will be absorbed by other successful and expanding organizations.

It also must be remembered that even the most currently successful health systems will take a major financial hit with the implementation of ACA.

Implications for Physician Practices While more U.S. citizens will have insurance coverage in the future, we are predicting that reimbursements per Medicare and Medicaid patient will go down significantly over the next five years.

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Continued from page 3 Many health systems already lose money on both of those patient groups – with more cuts their “fiscal cliff” just got significantly worse. Physicians who have entered into employment contracts with those health systems must be aware that new financial pressures on health systems may force them into contract renegotiations in the not too distant future.

If lower reimbursements and market aggregation into ACOs does take place, are there real opportunities for physicians to remain independent? Let’s be realistic. Without significant new efficiencies or economies of scale independent physicians will see incomes decline. However, there are three independent practice models we believe can be successful. They are: • Large multi-specialty practices with convenient location(s) that negotiate proactively with ACOs and managed care to be a cornerstone of both.

• Medium to large single specialty groups that can demonstrate high quality, superior service and convenience and the most cost-effective business model. An example is a comprehensive orthopedic group, in good locations with low cost and full services.

• Medium to large primary care groups with highly streamlined and leveraged midlevel provider model. This also requires refined I.T. support for medical decision process and supervision.

It is expected that effective health systems and ACOs will do “make versus buy” decisions and can be convinced through proactive negotiation that there is merit in contracting with a high quality, cost-effective, independent group who will work positively with the system or ACO as a key part of the care continuum.

Northwest Physicians Network Current Status

By Leonard B Alenick, MD Northwest Physicians Network (NPN) was formed in 1995 by the merger of seven Independent Practice Associations (IPAs). We are now one of the few IPAs still active and the largest in the state. We comprise about 150 primary care and 345 specialist physicians in an area spanning Pierce and South King counties with a smaller presence in Renton and the east side of Lake Washington. We are all in private practice.

We have extensive experience and positive results in cost and quality improvements with a dedicated staff of nurse care managers. We have ongoing communication with the Puget Sound Health Alliance with Rick MacCornack PhD, our Systems Integration Officer, who was on the Board for three years and is now on their Quality Committee. Scott Kronlund MD, our CMO, is also on the Puget Sound Health Alliance Quality Committee.

Scott Kronlund was invited to be a member of the Institute of Medicine’s Advisory Committee on Care Coordination and attends all their meetings in person. The IOM wanted him because of our pioneering implementation and beta testing of the Clarity referral system. Clarity has implemented multiple ideas from our docs to improve utility and ease of use into the system. It is a webbased system that can deliver information by email or fax.

Clarity inexpensively solves the problem of the difficulty and high cost of creating communications between different EMR’s. It has cut the workload for referral coordinators in many practices and given feedback at all stages of the process including delivering relevant clinical information with the referral, checking that the insurance is operational at the date of the scheduled visit, giving feedback to the referring provider when the appointment is set and returning clinical results to the referring provider. It is a time and money saver for the practices using it. It also provides a data warehouse for any patient that has been referred through the system where a provider can see the data available for any patient they are seeing that is in the Clarity database.

These contacts and activities help us keep up with the state of the art in accountable care.

NPN has been doing managed care with both Medicaid and Medicare C since inception. Previously we were unable to approach private insurers about contracting and payment issues because we are a group of independent physicians with multiple tax IDs which would be a violation of federal antitrust laws.

However, recent developments in the health care marketplace have opened the opportunity to extend our expertise into the commercial insurance market.

Commercial insurers now understand that we all need to be more efficient in utilizing the health care dollar and they want to collaborate with organizations they believe have the expertise to further this goal. Since these companies coming to us are single tax IDs, there is no antitrust exposure.

We now have contracts with Premera which started May 1, 2012 and Aetna which started July 1, 2012 for their commercial patients. These contracts are for the patients our primary care docs are currently seeing plus new patients that come to our primary care docs under commercial contracts with that insurer.

Providers will be paid our usual commercial reimbursement and the insurer will pay NPN for management. The insurers have data on cost of care for all of their patients in the year prior to the beginning of these management contracts. The insurer has collaborated with us in defining reasonable goals for the first year of these contracts. If the first year shows measurable improvements in areas such as unnecessary ER visits; increased use of generic medication; shifting outpatient surgical, diagnostic or radiology procedures to free standing facilities when possible and decreasing inpatient readmissions for same or related conditions then we will share the savings with the plan.

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Continued from page 4 We are in negotiation with three other major insurers for similar contracts.

We are also in the early stages of forming an ACO with other partners to participate in the Medicare Shared Savings Program for non-managed Medicare patients.

I personally believe this opportunity to work in collaboration with private insurers is a breath of fresh air in getting free from the overbearing frustration of dealing with government programs.

The opinions expressed here are my own and don’t necessarily express the view of NPN.

Retaining Independence While Embracing Accountability: Care Coordination and Integration Strategies for Small Physician Practices (Part I) Physicians throughout the country are trying to figure out how to best achieve their professional goals in the changing health care delivery environment. Physician payments are increasingly being structured in a way that incentivizes quality and cost effectiveness over volume, and many place physicians at financial risk. In addition, public reporting of physicians' performance will now be the norm, rather than the exception, with Medicare's expansion of its Physician Compare website in 2013. Will physicians need to be employed by a hospital or a large medical group or health system in order to provide the quality and manage the costs that these payment and reporting systems require and take advantage of the emerging opportunities resulting from health system reform?

Not necessarily. While some physicians may ultimately decide that formal alignment with a large medical group or hospital system is their best option, others are actively working to integrate new care coordination and accountability capabilities into their smaller practices. Indeed, there are a number of avenues that physicians in smaller practices can take that will allow them to retain their independence while also achieving the new capabilities they will need to succeed in this new environment.

Developing new capabilities to coordinate care and improve results AMA has published a new resource to assist physicians in small and solo practice in taking advantage of the opportunities presented by the changing health care delivery environment, entitled “Retaining independence while embracing accountability: care coordination and integration strategies for small physician practices,” available at www.ama-assn.org/go/

ACO. This resource identifies the core capabilities physician practices will likely need to enhance to be successful in the future and describes how small physician practices can attain these capabilities, which are summarized briefly below. The resource also discusses options small practices may have to collaborate with other physicians and to obtain financing for practice enhancement, which will be covered in a subsequent article.

Three steps to improve quality There are at least three things that even the smallest of practices can do to improve care: • Standardize care through the use of accepted guidelines, policies and procedures; • Facilitate better coordination and interaction among all the parties involved with the care, including the patient; • Develop and analyze data to change behavior, produce better outcomes, and provide care more efficiently.

One practice’s success story For example, in "Achieving Clinical Integration with Highly Engaged Physicians,"1 the authors point to Consultants in Medical Oncology and Hematology (CMOH), a ten-physician independent hematology practice in Delaware County outside of Philadelphia.

These physicians were dissatisfied with their inability to contract on acceptable terms with managed care plans, and therefore began collecting their own data that would demonstrate the practice's value by measuring performance on issues such as keeping their patients out of the hospital, and producing high satisfaction scores. They implemented an electronic health record to track their patients' utilization of services and provided standardized approaches to care. With collaboration among its clinical support teams, the practice adhered to evidencebased guidelines, provided enhanced patient access to care through same day/next day visits, and educated patients to improve medication, evaluation, and treatment compliance, etc. According to the study, the results of these efforts were impressive, as the practice: »» Increased its financial margin by lowering its full-time employee staffing requirements by 10%; »» Lowered the number of emergency room referrals for its patients; »» Reduced hospital admissions for its patients; »» Increased the number of patients seen within 24 hours of a telephone call five-fold.

By 2010, the group's clinical integration program resulted in it receiving the first oncology patient-centered medical home designation by the National Committee for Quality Assurance.

(Id. at 10-11.)

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go to the AMA's website at www.ama-assn.org/go/HIT.

Tools for small practices

Claims data. Another potentially valuable source of

Tools are available for physicians to help them make changes to their practices and manage patient referrals and transitions necessary to support coordinated care. For example, the Institute for Healthcare Innovation, funded by the Commonwealth Fund, has provided a toolkit entitled "Reducing Care Fragmentation" that introduces four key concepts for enabling change, and offers activities, model documents, and other tools to support their implementation. This toolkit is available at www. improvingchroniccare.org.

Similarly, there are a number of tools that small physician practices can use to aggregate and evaluate their data efficiently:

information is claims data. AMA has published a toolkit to help physicians use these data for practice improvement activities, whether they are received from health insurers associated with their physician profiling reports or directly from a physician’s practice management system or clearinghouse. This helpful resource, “Taking Charge of your Data,” is available at www.ama-assn.org/go/physiciandata.

Potential benefits Finally, this resource outlines the benefits which accrue from engaging in quality measurement programs and using practice data to monitor, report, and improve:

Flow sheets. The American Medical Association-convened

Increased quality. Measurement drives behavior.3

Physician Consortium for Performance Improvement (PCPI) has developed prospective data collection flow sheets for a number of clinical conditions that incorporate evidencebased performance measures. See www.ama-assn.org/ama/ pub/physician-resources/clinical-practice-improvement/ clinical-quality.page. These prospective data sheets can serve as a reminder checklist to ensure that all care team members know what needs to be done when the patient is in the office.

Measurement can result in both improved outcomes for patients and lower health care costs generally due to the avoidance of duplicative and/or unnecessary health care services. For example, in 2000, "U.S. patients were much more likely—three or four times the benchmark rate—than patients in other countries to report having had duplicate tests or that medical records or test results were not available at the time of their appointment."4

Registries. The ability to generate and use registries, that is, lists of patients with specific conditions, medications, or test results, is also considered a proxy for high quality health care.2 Such registries help office staff identify patients who are overdue for recommended services and facilitate contacting them and arranging for office visits, lab monitoring, referrals and other needed care. Some registries can even be developed using free software. The AMA has provided guidance on patient registries, including information on how to create them. See "Optimizing Outcomes and Pay for Performance: Can Patient Registries Help?" a copy of which can be found at www.ama-assn.org/ama1/x-ama/upload/ mm/368/pt_registries_102005.pdf. In addition, the California Health Care Foundation’s resource "Chronic Disease Registries: A Product Review," available at www.chcf.org may also be helpful.

Electronic Health Records. Electronic health records (EHR) can also assist with care coordination. Physicians in smaller practices may be particularly interested in investigating some of the newer, cheaper cloud-based EHR systems. “Cloud computing” refers to a number of technology solutions that: (1) operate over the Internet; (2) use shared resources such as storage, processing, memory and network bandwidth with other users; and (3) are "ondemand," meaning capabilities such as network storage can be adjusted virtually, eliminating the need for on-site IT staff.

For more information on health information technology, including the Medicare/Medicaid EHR incentive programs,

Improved “profiles” (and more patients). Private thirdparty payers have ranked physicians for years. And now, Medicare has gone into the "quality reporting" business by launching a Medicare Physician Compare site which, starting in 2013, will include Physician Quality Reporting System (PQRS) results based first on the 2012 reporting year.5 Increasingly, anyone who has access to a website can find out information about his or her physician, and how that physician "compares" to other physicians.

While many physicians have been concerned about such public ranking, physicians who are acknowledged as recognized providers in these programs have gotten more patients to treat than non-recognized physicians and often get the opportunity to participate in more networks.6 Consequently, despite their drawbacks, performance measures can mean that those who score well will be in a better position to obtain: (1) higher payment; (2) increased consumer attention, and (3) better branding opportunities.

Increased financial benefits. The National Priority Partnership, convened by the National Quality Forum, has identified four activities which require physician involvement that reduce costs substantially and improve quality. The opportunity for estimated savings can be summarized as follows:

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1 See Alice G. Gosfield, JD, and James L. Reinertsen, MD, "Achieving Clinical

Integration with Highly Engaged Physicians," a copy of which can be found at http://www.

OPPORTUNITY SAVINGS Preventing hospital readmissions

$25 billion

wsma.org/files/Downloads/PracticeResourceCenter/Achieving_Clinical_Integration_ GR.pdf.

Improving patient medication adherence

$100 billion

2 See Fleurant, et al., "Massachusetts e-Health Project Increased Physicians' Ability

to Use Registries, and Signals Progress Towards Better Care," Health Affairs, July 2011, 30:7.

Reducing emergency department overuse

$38 billion

Preventing medication errors

$21 billion

3 Asch, McGlynn, et al., "Comparison of Quality of Care in the Veterans' Health

Administration and Patients in a National Sample," Ann.of Int.Med. Vol. 141, No. 12, December 21, 2004, pp. 938-345.

See www.nationalprioritiespartnership.org.

Thus, not only is performance measurement likely to improve patient care, it may also serve as a foundation for financial incentive and reward programs in value-based purchasing strategies. In California alone, since 2004 approximately $400 million dollars have been distributed to physicians by certain health plans participating in a pay for performance initiative.7 See Results of Integrated Healthcare Association Pay for Performance Program, at www.iha.org.

In the end, physician practices that enhance their competency with respect to the three core areas outlined above, (1) standardization, (2) care coordination, and (3) data evaluation, will likely perform better, both clinically and financially.

4 The Commonwealth Fund Commission on a High Performance Health System, Why

Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008, The Commonwealth Fund, July 2008. http://www.commonwealthfund.org/ Publications/Fund-Reports/2008/Jul/Why-Not-the-Best--Results-from-the-NationalScorecard-on-U-S--Health-System-Performance--2008.aspx.

5 See 42 U.S.C. §280j-2. Further, although the PQRS was once voluntary, if

eligible professionals do not satisfactorily submit data on quality measures for covered professional services for the quality reporting year beginning in 2015, the Medicare Fee Schedule amount for such services will be reduced. (42 U.S.C. §1395w-4.)

6 See Berry, Emily, "Narrow Networks: Will You Be In or Out?" AMedNews, Oct. 4,

2010.

7 The AMA Private Sector Advocacy Unit created "A Physician's Guide to Evaluating

Incentive Plans" that physicians can use to evaluate such plans for their financial and patient care implications http://www.ama-assn.org/resources/doc/psa/x-ama/pfp_

Access AMA resources online

brochure.pdf.

“Retaining independence while embracing accountability: care coordination and integration strategies for small physician practices,” is available as part of the AMA resource, ACOs, CO-OPs and other options: A how-to manual for physician’s navigating a post-health reform world, at www.ama-assn.org/go/ ACO. Stay up to date with all of the new resources from the AMA, by signing up to receive the free AMA Practice Management Alerts emails at www.ama-assn.org/go/pmalerts.

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COLUMBIA MEDICAL ASSOCIATES is currently seeking a BC/BE Internist to join our Northside Internal Medicine Group in Spokane, Washington to meet our increased service utilization. We are a group of over 40 physicians providing comprehensive medical care to families and

InCyte Pathology Delivers Answers

individuals of all ages within the Spokane

InCyte Pathology

region. The position offers the following:

Welcomes Alden Webb, D.O.

• Flexible schedules and outstanding teams make this opportunity worth exploring.

• Competitive Salary and Generous Benefit Packages • Conveniently located only two blocks from Holy Family Hospital • Established relationship with local hospitalist group for admitting, rounding, and discharge Our physicians are committed to maintaining the health and well being of all their patients through preventive

InCyte Pathology welcomes Alden R. Webb, D.O., to its growing Dermatopathology Services Department. InCyte Pathology’s dermatopathologists work closely with area dermatologists to provide the best treatment for patients with skin conditions and diseases.

Dr. Webb recently completed his fellowship at Indiana University School of Medicine in Indianapolis and will join InCyte Pathology in early August. Dr. Webb is board certified in anatomic pathology and clinical pathology and is board eligible in dermatopathology.

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

You deliver quality healthcare.

InCyte Pathology delivers quality diagnostics.

best care in Spokane.

To apply or inquire for further information

Learn more by calling us at 509.892.2700 or visit www.incytepathology.com.

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

Proudly serving SCMS physicians and their patients since 1957

September SCMS The Message 9

Dear House of Charity Preceptors,

Your Role in Promoting Health Equity

We are writing this letter on behalf of the WWAMI Spokane medical students, UW MEDEX PA students and Spokane’s homeless to thank you for the hard work and time that you dedicated to precepting at the House of Charity clinic this year.

By Adrian Dominguez, MS, Epidemiologist Spokane Regional Health District

The House of Charity Saturday Clinic was established in January 2010 to provide the homeless population of Spokane weekend access to free healthcare, while also creating a unique and exciting clinical opportunity for students. With the invaluable support of our preceptors, we provided care for 282 patients during 47 clinic sessions. The total combined volunteer hours of both preceptors and students is 583.

Students benefit greatly from the opportunity to develop our clinical skills while gaining exposure to dedicated health professionals who share and emulate our values of wanting to work with an underserved population. Here is some of the feedback we received from student volunteers: »» I had a great experience with the preceptors at the House of Charity. They were my first exposure to the Spokane medical community and I was blown away by their investment in our »» The time at House of Charity is irreplaceable in our education first year. We get to apply everything we’re learning in Introduction to Clinical Medicine and feel like we’re actually becoming physicians. »» The preceptors’ knowledge and time dedicated to House of Charity is incredible. I really appreciated them being there.

You are true mentors for us and your dedication has been an important example of what we can do for our communities.

Spokane has been an excellent learning environment for a variety of reasons and the opportunity to work with you has been one of the most meaningful. Thank you once again for providing us with those opportunities.

Sincerely, Student Coordinator Student Coordinator

The following is a list of physicians who have donated their time this year: Stephen Anthony, DO Aaron Scott, MD Erin Church, MD

Paula Silha, MD

Darin Eckert, MD Nan Smith, MD, MPH Robert Golden, MD

For healthcare providers locally, a critical piece in this understanding—data collection—has been relatively limited… until now. A new report from Spokane Regional Health District's Community Health Assessment, Planning, & Evaluation program Odds Against Tomorrow: Health Inequities in Spokane County details how residents here who have limited education or income, or who live in poor neighborhoods, have worse health compared to those who are better educated or financially better off. Also, Spokane's racial and ethnic minorities have worse health than whites.

For instance, as detailed in the report:

learning as well as in the care of their patients.

Alyssa Zemanek, UWSOM MS1 Jacob Casey, UWSOM MS1

In the world of public health, the link between social determinants of health—including social, economic and environmental conditions—and health outcomes is widely recognized. It has been gratifying over the last decade to see a shift in understanding among those outside of public health, particularly among health care providers, that inequitable distribution of these conditions across various populations is a significant contributor to persistent and pervasive health inequities.1

Katherine Tuttle, MD

Jeremy Graham, DO

Karen Wildman, MD

Thomas Laselle, MD

Michael Wymore, MD

John McCarthy, MD

Daniel Yang, MD

in Spokane County, babies born to mothers who do not finish high school are 2.5 times more likely to die before their first birthday as babies born to mothers with a bachelor’s or advanced degree there is an 18-year gap in life expectancy between the neighborhood with the highest life expectancy, Southgate (84 years), and the neighborhood with the lowest life expectancy, downtown's Riverside neighborhood (66 years) American Indians/ Alaskan Natives have the highest mortality rate—1.4 times higher than that of white NonHispanics.

And health inequity is not only about extremes of wealth and poverty. There is a continuous gradient in health status throughout society—even among the middle classes.

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Continued on page 11

Continued from page 10 The higher an individual’s social status, the healthier they are and the longer they live.

“Inequalities in health status in the U.S. are large, persistent, and increasing. Research documents that poverty, income and wealth inequality, poor quality of life, racism, sex discrimination, and low socioeconomic conditions are the major risk factors for ill health and health inequalities… conditions such as polluted environments, inadequate housing, absence of mass transportation, lack of educational and employment opportunities, and unsafe working conditions are implicated in producing inequitable health outcomes. These systematic, avoidable disadvantages are interconnected, cumulative, intergenerational, and associated with lower capacity for full participation in society” - National Association of County and City Health Officials Health and Social Justice Committee.

Many people tend to attribute differences in health to variations in individual behaviors or genes that are ultimately inevitable: “That's just the way things are.” But that's not the way things have to be.

Current health policy is focused on treating the negative health outcomes born of inequity and reflects that most attention is on access to healthcare, while the U.S. Centers for Disease Control and Prevention estimates that only 10 percent of premature mortality is due to inadequate healthcare.

Communities have to rethink the way in which health differences are perceived by considering if those differences are equitable or just. There is a broader array of conditions affecting health that we now have an opportunity to address. It is time to focus on the root causes of negative health outcomes.

Many communities are developing multicomponent initiatives with the understanding that many factors affect health. To be successful, those approaches require community-, policy-, and system-level changes that combine social, organizational, environmental, economic, and policy strategies along with individual behavioral change and clinical services.

Each initiative brings new information about strategies that can be used to improve social determinants of health. Bolstered by data from its report, Spokane has a unique opportunity to join in nationwide efforts toward health equity.

It is essential to build partnerships to address the social determinants of health because no one group, be it healthcare providers, public health practitioners or community members can accomplish the many tasks required for changing social, economic, and environmental conditions that impact health.

The Spokane Regional Health District is leading an initiative to encourage and support the development of new, and the expansion of existing, initiatives and partnerships to address the social determinants of health inequities locally. Along with numerous partners, including City of Spokane, Empire Health Foundation,

NATIVE Project, Spokane Neighborhood Action Programs (SNAP) and United Way, we’ll be hosting a series of community dialogues starting in October. The dialogues will help us assess and engage the community in our efforts to develop, implement and evaluate interventions that address social determinants of health equity. The views and expertise of local healthcare providers will be critical to our efforts. Please plan on attending.

Access the health district’s report at: http://www.srhd.org/ documents/PublicHealthData/HealthInequities-2012.pdf

Interprofessional Education: Preparing Students for Collaborative Practice

By Barbara Richardson, PhD, RN Interprofessional Education Washington State University Division of Health Sciences Historically, education for most health care providers has been profession specific, with little influence from other programs.

However, as patients today seek care for increasingly complex health problems, an interprofesional (IP) team approach is necessary to ensure the highest quality patient care and safety.

In 2003, the Institute of Medicine’s (IOM) seminal publication, Health Professions Education: a Bridge to Quality, called for a dramatic restructuring of health professions education to ensure all students gain the competencies necessary to deliver patient-centered care, work in IP teams, use informatics to inform decision making and employ best practices, and use quality improvement principles to increase patient safety and satisfaction. The American Association of Medical Colleges, along with the American Association of Colleges of Nursing, American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of Schools of Public Health, and the American Association of Colleges of Osteopathic Medicine (IPEC, 2011) have endorsed interprofessional education (IPE) and encouraged the integration of four core competency areas within health professions curricula including: (1) values and ethics, (2) roles and responsibilities, (3) collaborative communication, and (4) teams and teamwork. The World Health Organization (2010) recommends inter-professional collaboration in education and practice as innovative strategies that will play an important role in mitigating the global health workforce crisis, noting that interprofessional education is necessary to prepare a “collaborative practice-ready” health care work force that is better prepared to respond to local and global health care needs. Additionally, The Lancet (Frenk, et al., 2010) commissioned a report, “Health professionals for a new century: transforming education to strengthen health systems in an interdependent world” calling for redesign of professional health education with a focus on coordinated care across time and space that will demand unprecedented teamwork.

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Continued on page 12

Continued from page 11 Clearly, numerous government and professional organizations are calling for radical reform, yet most health science programs have been slow to develop and require interprofessional learning opportunities for all students. Significant barriers exist for implementing innovative IPE programs. Timing of course content across programs, unwillingness of educators to change teaching and learning strategies that have worked well for years, a lack of institutional support, and a scarcity of successful model programs are just a few of the challenges facing faculty that embrace the concept of IPE. In practice settings, questions remain unanswered as to whether a team approach to patient-centered care truly produces improved outcomes and contains costs. Challenges to the team-based model of care include having appropriate payment systems that recognize the value of collaborative care, clearly defining professional roles and responsibilities of team members, and developing an ethic of shared responsibility and collective concern for patients. Practitioners must also recognize and value patients as important members of the health care team.

Changing health delivery systems to successful team-based practices will require the testing of numerous innovative models in order to determine those that have a positive impact on improving patient safety, health outcomes, and cost containment.

So too, graduating health professions students who demonstrate interprofessional core competencies and function well in teams will require more than a few optional interprofessional programs in which students can voluntarily participate. The Spokane health care community and the Riverpoint campus are in a unique position to become national leaders in IPE, health education, and practice reform. Medical practices, hospitals, and universities across the country are looking for successful models that can be replicated. The Riverpoint programs (WSU -WWAMI medicine, nursing, pharmacy, speech and hearing, nutrition and exercise physiology, and health policy administration; EWU - PT, OT, RIDE

dental, dental hygiene, and communication disorders; and the UW – physician assistant) are relatively small in size, new enough to be flexible and innovative, and have a sufficient number of faculty “IPE champions” willing to lead the changes necessary to overcome the major obstacles keeping other university programs from implementing collaborative programs. As we strive to create a robust academic health center in our community, a coordinated effort to integrate interprofessional education into all of the Riverpoint health science programs could place WSU, EWU, and the UW among the nation’s leaders for developing sustainable IPE programs. In a time of severely constrained resources, collaborative efforts are one way to build excitement around opportunities that benefit students, faculty, and our community partners. We are open to your novel ideas, and welcome the prospect of developing interprofessional education, practice, and research opportunities with our community partners. Developing collaborative partnerships can be a spark for innovative change for health education and clinical practice in our community.

For more information on interprofessional programs contact Barb Richardson, Director of Riverpoint Interprofessional Education & Research at barichardson@wsu.edu.

References: Greiner, A., and Knebel, E. (Eds). (2003). Health professions education: A bridge to quality. Institute of Medicine. Washington, D.C., National Academies Press.

World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. http://www.who.int/en/ Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

Frenk, J., et al., Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet. Published online November 29, 2010. DOI:10.1016/50140-6736(10)61854-5.

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September SCMS The Message 13

In The News

Physician Leadership Resource

Southwest Airlines Rehabilitation Therapy Module Takes

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

Flight in St. Luke’s Community Innovative Airplane at St. Luke’s Rehabilitation Institute Helps Patients Experience and Prepare for Real-Life Travel After Injury or Illness Southwest Airlines has landed at St. Luke’s Community, a 2,200 square foot real-life therapy area at St. Luke’s Rehabilitation Institute dedicated to helping people recover after an injury or illness. A portion of a fuselage was retrofitted to be part of St. Luke’s therapy program, the region’s only level I trauma rehabilitation hospital.

St. Luke’s Community is designed with the everyday in mind – from the grocery store, bank, office and restaurant to the bus, car and airplane. With the guidance of physical, occupational and recreational therapists, patients practice getting in a car and putting on their seatbelt; cross the street, navigate the curb and different surfaces and board a bus and now an airplane.

Book

Prescription for Lasting Success Leadership Strategies to Diagnose Problems and Transform Your Organization In a method similar to the way a doctor reads a chart and runs tests to diagnose an illness, Prescription for Lasting Success offers a practical system for solving problems in any organization.

Author Susan Reynolds, MD, PhD, presents a unique approach to leadership development and organizational transformation based on four levels of assessment and focused change. The 4 Ps models of strategic transformation, focusing on Purpose, Passion, Planning and People, enables leaders to improve their effectiveness and allows organizations to succeed during periods of significant transformation.

“Southwest Airlines’ contribution to St. Luke’s Community is helping patients regain confidence in their abilities to travel after an illness or injury,” said Nancy Webster, St. Luke’s therapy director. “Southwest is known for their commitment to the communities they serve and we are grateful for their support.”

“Southwest Airlines is proud to partner with St. Luke’s on this unique opportunity to create an airplane therapy module that will help patients return to their daily lives faster,” Southwest Airlines’ Spokane Station Manager J Evans said. “This is the first time Southwest has partnered with a hospital in this manner, and we look forward to learning how we can best serve our customers and continue offering our Legendary Customer Service.”

September SCMS The Message 14

The Spokane County MEDICAL SOCIETY Strategic Plan

»» Regional Health Care Quality, Performance Measurement and Benchmarking »» BCIN – SCMS Informatics Committee, »» CAHN Regional Collaboration – CINA point of care decision tool (WWAMI tool), disease registry, standards development and quality indicator

MISSION

comparisons.

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.

Regional Advocacy in Collaboration with Strategic Partners »» EHF - ED Medical Director Group (4 hospitals) - 7 ED Best Practices to address Medicaid patients requiring coordination (PRC)

VISION The Spokane County Medical Society uses its resources and expertise, through collaboration and strategic partnerships, to facilitate the best community health possible for citizens of our region. SCMS is also well respected for its role in supporting the practice of medicine and stimulating teamwork across the regional healthcare continuum.

Medical Practice Support »» Credentialing – a hospital collaboration for primary verification, »» Medicor – Regional On-line Medical Information and Research Library and Information Services, »» Community-wide CME (selected Topics) »» Business contract and employment resources

STRATEGIC ACTIVITIES Member/Community Engagement/Communication »» Member and non-member engagement – Publications, Newsletter, Press Releases, Pictorial Directory, Broadcasts, Event Management, Membership messaging, Social Media »» Key issue communication »» Strategic Initiatives; strategy, plan and promotion »» SCMS Agenda; member and public engagement »» Mission/Vision; Proactive advocacy Convener/Facilitator/Manager of Community-wide Population Health Initiatives »» Cost Effective Health Care Access for uninsured and underinsured »» Project Access »» Pursuing Healthy Populations »» Spokane Prescription Opioid Task Force, »» Regional Health Information Sharing – SCMS Informatics Committee, »» Community Collaboration to Optimize ED Utilization - ED Collaboration Community Project, »» Community Care Coordination – Consistent Care WA, »» Bilateral Integration – re-designing primary care to enhance mental health evaluation and treatment

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September SCMS The Message 16

Membership Recognition for September 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.

UPCOMING SCMS EVENTS SEPTEMBER Board of Trustees’ Meeting and Caucus – 12 House of Delegates (Tacoma) – 15 & 16

30 Years A. Chris Olson, MD, MHPA

9/28/1982

Michael E. Ryan, MD

9/28/1982

Moderate Conscious Sedation CME Program – 27 SCMS Presents Medicine 2012 – 28

20 Years Duncan W. Lahtinen, DO

9/25/1992

OCTOBER Senior Physicians’ Dinner – 18

10 Years Melanie Bergman, MD

9/18/2002

DECEMBER

James D. Fischer, MD

9/18/2002

Board of Trustees’ Meeting – 12

Robin J. Gavelin, MD

9/18/2002

Diane W. Lefcort, MD

9/18/2002

Eric D. Stucky, MD

9/18/2002

September SCMS The Message 17

Continuing Medical Education Moderate (Conscious) Sedation and Analgesia: 3.0 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. Conference held on Thursday, September 27, 2012 at the Providence Sacred Heart Medical Center Auditorium. This is SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety. See the Spokane County Medical Society’s website for more information and to view the program brochure at www.spcms.org or contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org.

Spokane County Medical Society presents MEDICINE 2012: 8.0 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. We will be honored to hear from Dr. Glen Stream, president of AAFP, on Health Reform, Dr. Jeffrey Fox from Kaiser Permanente in California regarding Updates on Gastrointestinal issues and Dr. David Spach from the University of Washington regarding immunization updates to name a few. Conference will be held on Friday, September 28, 2012 at the CenterPlace Regional Event Center in Spokane Valley, WA. Visit the Spokane County Medical Society website for more information and to view the program brochure at www.spcms.org or contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org.

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.

Improving Patient Health Outcomes Through Research-Based Interventions for Falls September 19, 2012 5:30 - 9:00pm • Free to physicians 3.0 Category 1 CME Credits CenterPlace Fireside Lounge • 2426 N. Discovery Place, Spokane Valley, WA Space is limited. Physicians (primary care, specialty fields, emergency room) will have priority. Registration required by September 14, 2012.

Register at https://cc.srhd.org/register/default.asp?id=14 or by calling (509) 324-3613 or email mrlee@spokanecounty.org Dinner provided.

Sponsored by the Spokane Regional Health District & Fall Free Spokane Coalition partners.

Spokane Pain Conference Friday and Saturday September 28 and 29, 2012. Red Lion Hotel 303 W. North River Dr., Spokane, WA 15 AMA Category 1 Credits For more information contact Melissa at russocme@gmail.com or (509) 431-0718 or go to www.russocmecom.

Topics include Pain Patients w/ co-occurring Psychiatric Disorders, Comprehensive Medical Management of Chronic Pain, Alternative Approaches to Pain Management, Psychology & Chronic Pain and Opioid Hyperalgesia and Intrathecal Microdosing.

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.

Intensive Outpatient Care for Patients with Multiple Chronic Illnesses Webinar Wednesday, September 19, 2012 12:15 - 1:15pm Everyone talks about “patient engagement” and “bending the cost curve.” This webinar will present practical steps on how to actually achieve these goals in a way that significantly improves patient care outcomes by focusing intensive outpatient care on high-risk persons with multiple chronic conditions. While this is not a new concept, widespread adoption of these evidence-based approaches has been slow to catch on until very recently. This webinar will highlight programs underway in California, Oregon and Washington that have demonstrated their effectiveness in improving care and reducing costs. Physician members of WSMA may register online at www. wsma.org/foundation/CPIN/ All others can register by sending an e-mail titled CPIN Sep 19 to kho@wsma.org, with the following: Name, Phone, Clinic/Group Name and Number of Participants Free for all physicians, medical group staff or other care-givers. $75 for nonclinical participants. This activity has been approved for AMA PRA Category 1 Credit™; AAFP Prescribed credit is pending application.

Yin of Medicine - Past, Present and Future October 10-13, 2012 21.25 hours of Category 1 credit Brochure, Tuition & Registration http://cmetracker.net/GHC/Login?FormName=RegLoginLive&Event id=1572 For twenty years, Yin of Medicine has served as a consistent gathering place for women in health care. This year's program celebrates the past successes of women in health care, the current state of health care, and a look forward to the roles women will play in its future. Alongside this content, we will continue to explore hot clinical topics and how each of us can participate in shaping the future of health care through our contributions as practitioners, leaders, and team members. Location: Alderbrook Resort 7101 E State Highway 106 Union, WA 98592 (360) 898-2200 http://www. alderbrookresort.com/ All reservations must be made by the cut-off date of 9/11/2012. Contact Maria Cárdenas-Anson at (206) 326-2084 for more information or at cardenasanson.m@ghc.org.

Meetings, Conferences and Events Institutional Review Board (IRB) - Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at 509.358.7631.

Standing Together to Prevent Falls Thursday, September 20, 2012 • 9:00am–3:00pm • $40.00 CenterPlace Great Room • 2426 N. Discovery Place, Spokane Valley, WA Register by Friday, September 14, 2012 at https://cc.srhd.org/register/default.asp?id=15 or (509) 324-1530 Breakfast and lunch provided. Sponsored by the Spokane Regional Health District & Fall Free Spokane Coalition partners.

This conference will include Data on the prevalence of senior falls, Effective strategies for identifying and mitigating fall risks and Networking opportunities to discuss issues with falls and learn from colleagues and fellow professionals.

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September SCMS The Message 19

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 Jobe, Richard R., MD Internal Medicine Med School: Missouri U School of Medicine (1961) Internship: St Mary’s Hospital (1962) Residency: Missouri U Medical Center (1965) Fellowship: Ellis Fischel Cancer Ctr (1965) Practicing with Community Health Associates of Spokane 9/2012 Kilaru, Ravi K., MD Cardiovascular Disease/ Electrophysiology Med School: Guntur Medical College (1998) Internship: Government General Hospital (1998) Residency Westchester Medical Center (2004) Fellowship: Danbury Hospital (2009) Fellowship: U of California San Diego (2011) Practicing with Rockwood Clinic 8/2012

Cady, Francois M., MD Anatomic & Clinical Pathology Med School: Louisiana State U (2001) Practicing with Pathology Services (Deaconess) 8/2012 Clauser, Janelle M., MD Internal Medicine/Pediatrics Med School: Loma Linda U (2006) Practicing with Providence Medical Group-IM Hospitalists 7/2012 Doggett, Casey R., DO Family Medicine Med School: Kansas City U (2009) Sports Medicine Fellowship with Family Medicine Spokane 7/2012 Kelly, Alan J., MD Internal Medicine Med School: U of Nevada, Reno (1994) Practicing with Rockwood Main Clinic 8/2012 Mantei, Kristin M., MD Anatomic & Clinical Pathology/Hematology Med School: U of Washington (2001) Practicing with Pathology Services (Deaconess) 8/2012 Murphy, Cynthia R., MD Neurology/Vascular Neurology Med School: Louisiana State U (2002) Practicing with Providence Neuro Science Center 8/2012

Le, Steven K., MD Cardiovascular Disease Med School: UCLA School of Medicine (2006) Internship/Residency: UCLA Medical Center (2009) Fellowship: U.of Washington Medical Center (2012) Practicing with Providence Spokane Cardiology 9/2012

Ondersma, Ross M., MD Diagnostic Radiology/Nuclear Medicine Med School: Wayne State U (2006) Practicing with Radia, Inc. 9/2012

Reveron, Ivan J., MD Family Practice Med School: Eastern Central U (1984) Internship: Centro Medico Mayaquez (1987) Residency: Centro Medico San Pablo (1991) Practicing with Community Health Associates of Spokane 8/2012 Schomberg, Paula J., MD Radiation Oncology Med School: Medical College of Wisconsin (1979) Internship/Residency: Mayo Clinic (1983) Practicing with Cancer Care Northwest 11/2012

Tailor, Shamit D., MD Internal Medicine Med School: Saba U (2008) Practicing with Apogee Physicians 9/2012

PHYSICIAN ASSISTANT

Zimmerman, Colleen E., MD Family Medicine Med School: Sanford School of Medicine (2009) Internship/Residency: Family Medicine Residency of Idaho (2012) Practicing with Family Medicine Spokane 9/2012

Perius, Nicholas J., PA-C Physician Assistant School: U of North Dakota Practicing with Valley Hospital and Medical Center 6/2012

PHYSICIANS PRESENTED A SECOND TIME Baker, Ryan J., MD Pediatrics Med School: U of Cincinnati (2007) Practicing with Providence Medical Group-Pediatric Hospitalists 8/2012

Behne, Christopher M., DO Internal Medicine Med School: Western U of Health Sciences (2009) Practicing with Providence Medical Group-IM Hospitalists 7/2012 September SCMS The Message 20

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

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, oncall shifts, overhead and case file administration. Please contact Gia Melkus at (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!

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.

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.

SPRINGDALE COMMUNITY HEALTH CENTER ARNP or PA-C N.E. Washington Health Programs (NEWHP) has an immediate opportunity for an excellent Physician Assistant (certified) or Nurse Practitioner with Family Practice experience to join our Springdale Community Health Center located in rural Springdale, WA. This position is for Family Practice outpatient care; urgent care experience is a plus but not required. NEWHP offers competitive compensation, comprehensive benefits. . NHSC eligible site. EOE and provider.

Application Deadline: Until filled. Send resume to: N.E. Washington Health Programs Attn: Human Resources PO Box 808 Chewelah, WA. 99109 or electronically to desirees@newhp.org.

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

PROVIDENCE 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.

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.

PARTNERING FOR PROGRESS is a humanitarian Spokane-based nonprofit that is committed to ensuring that residents of the Kopanga, Kenya community have improved access to healthcare, clean water, sanitation and education. Through generous donors, P4P built a clinic for the Comprehensive Rural Health Project that is run by Alice Wasilwa RN with two other Kenyan nurses and provides primary care. Some of the common diseases include malaria, water borne illness as well as the diagnosis and treatment of HIV. There are approximately 12 deliveries per month and the clinic staff treats 900-1000 patients monthly.

We are in need of medical providers, optometrists and dentists to travel to Kopanga to provide primary care on Oct. 18 – 28, 2012. If you would like to volunteer please contact Stacey Mainer at info@ partneringforprogress.org.

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Continued from page 21 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 REAL ESTATE Luxury Condos for Rent/Purchase near Hospitals. 2 Bedroom Luxury Condos at the City View Terrace Condominiums are available for rent or purchase. These beautiful condos are literally within walking distance to the Spokane Hospitals (1/4 mile from Sacred Heart, 1 mile from Deaconess). Security gate, covered carports, very secure and quiet. Newly Remodeled. Full appliances, including full-sized washer and dryer. Wired for cable and phone. For Rent $ 850/month. For Sale: Seller Financing Available. Rent-to-Own Option Available: $400 of your monthly rent will credit towards your purchase price. Please Contact Dr. Taff (888) 930-3686 or dmist@ inreach.com.

FOR SALE: 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.

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.

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) 6246522 or cell (509) 999-2720. Email: psrourke@comcast.net.

Office space located at 1315 North Division. This location is two miles north of downtown Spokane and just west of Gonzaga and the university district. It consists of 902 sq. ft. and rents for $1015 per month plus 20% of the building Avista and City of Spokane bills. The rest of the building is occupied by a physiatry and pain management medical practice. The space would be ideal for an ancillary medical, chiropractic or therapeutic clinic.

Parking is ample and convenient. The space has a nice waiting area and receptionist-enclosed area, with several office, storage or exam rooms. Call (509) 321-2276 for more information or for a showing of your ideal location.

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.

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HEIRLOOMS TO LIVE IN THOUGHTFUL SITE INSPIRED ARCHITECTURAL DESIGN

What I remember the most about the design experience was how our vague ideas would be rendered into several potential and elegant solutions

by Sam. When I look at my home I can’t tell what came from me or my wife or from Sam. It doesn’t matter of course, we just love the results.

Sam was honest and ethical in every aspect of our work together. He worked diligently to understand what we really wanted. Such questions as “what does quality mean to you” were taken up with all seriousness to find the subtle differences that make a custom home custom. We recommend Sam to anyone who wants a thoughtful, intelligent, honest partner in the design of a unique and personalized dwelling.

- Don George

SAM RODELL

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

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ARCHITECT AIA 509.939.7007

PRSRT STD

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

U.S. Postage

PAID

Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

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

COBRA POLO CLASSIC 9th SEPT 2012 Date: Sunday, September 9th, 2012 Time: Noon - 4:00 pm Location: Spokane Polo Club Experience the event that combines the strength, elegance, speed, pride and love of fair play with tents, hats and champagne.

Limited seating. Make reservations now!

The price per ticket is: $2,500 for a sponsored table of 10 $175 per person / $350 per couple prior to August 12th. After August 12th the price per ticket is: $200 per person / $400 per couple Along with live polo action you’ll enjoy: Live Music, Champagne Divot Stomp, Hat Competition, Silent Auction, Gourmet Food & Wine and Whiskey Cigar Tent.

For more information: Dee Knight DuBey deek@rmhspokane.org Or Ami Kunz-Pfeiffer amik@rmhspokane.org rmhspokane.org / 509-624-0500

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