The Message, September 2011

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LEARN MORE AT: www.gonzaga.edu/MBAhcm September SCMS The Message Open2

2011 Board of Trustees Brad Pope, MD President Terri Oskin, MD President-Elect Anne Oakley, MD Vice President David Bare, MD Secretary-Treasurer Gary Knox, MD Immediate Past President Trustees: Fredric Shepard, MD Michael Cunningham, MD Paul Lin, MD Randi Hart, MD Gary Newkirk, MD Carla Smith, MD Rob Benedetti, MD Audrey Brantz, MD Louis Koncz, Jr. PAC David McClellan, MD

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

How Will You Respond to the Market-driven Changes in Your Practice? . . . . . . . . . . . . . .

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L. Gordon Moore, MD Speaking at Upcoming SCMS General Membership Meeting . . . . . . . . 2 Spokane County Medical Society Pursues Network Collaboration on Quality . . . . . . . . . . . . 2 Quality Defined by Patient Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 EHR and the Solo Doc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Two Percent Less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Internal Medicine Residency Spokane Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Group Health Physicians: Our Perspective on Patient-centered Care . . . . . . . . . . . . . . . . . 9 ACO Reading List Now Available . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Collaboration to Improve Patient Care and Control Costs . . . . . . . . . . . . . . . . . . . . . . 11 WWAMI Celebrates 40 Years of Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . 13 Your ACO is Delighted to Make Your Acquaintance . . . . . . . . . . . . . . . . . . . . . . . . . 14 SCMS Social Event - Scenic River Cruise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Part-time Doctors Shaking Up Small Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Membership Recognition for September 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 CME Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Meetings, Conferences and Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Spokane County Medical Society Message Terri Oskin, MD, Editor A monthly newsletter published by the Spokane County Medical Society.

The annual subscription rate is $21.74 (this includes the 8.7% tax rate).

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

In the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Top 10 Sectors That Will Benefit From Health Insurance Exchanges . . . . . . . . . . . . . . . .

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"Our lives begin to end the day we become silent about things that matter."

Martin Luther King, Jr.

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

How Will You Respond to the Market-driven Changes in Your Practice?

By Brad Pope, MD SCMS President Changes are brewing across the country and in Spokane right now as medical groups react to the changing health care climate.

With health care organizations beginning to make structural changes in preparation for new payment methodologies, several large health care systems are organizing into versions of integrated delivery systems intending to become accountable for health care outcomes and cost. As a result, many Spokane-area physicians are being courted to join various health care systems.

Many of my colleagues tell me they feel pressure to make a decision. Will they join a large integrated practice or health system, or will they continue to care for patients in an independent practice? These are crucial decisions with no single right answer.

So to help you better understand some of the options, this month we’re publishing articles about several local medical practice models, their goals, and their implications for your practices. Our responsibility as medical leaders is to understand these changes.

While there’s plenty of gray area, I’d like to remind you of some facts.

Fact #1. The health care climate is changing. How we practice and the structure of our practices as businesses will change in a few fundamental ways. The most significant change is that payers will place greater emphasis on paying for the value of the health care we provide, rather than the volume and intensity.

Historically, the relative value unit (RVU) has been the currency that most doctors used for negotiating contracts and managing the business of medical practice. For many years practices applied cost-plus pricing to set their fees, simply determining their costs for providing care and adding a margin. The insurance companies paid. But we’re way past this now.

organizations in Spokane is in direct response to this desired future.

Fact #2. Because paying for volume is no longer sustainable, physicians must be prepared to report their value and costeffectiveness. This is the new reality for physicians in practices large and small. Patients and payers will begin choosing and compensating physicians based on their quality, their coordination of care, and related cost performance.

Large systems may have an initial edge implementing the necessary reporting systems, but tools exist for smaller practices as well. In this month’s Message, Dr. Gordon Moore discusses some interesting ideas on how primary care practitioners can collect data to measure patient satisfaction, care coordination, and implied costs. We’re also inviting Dr. Moore to lead an educational session for our members in the near future.

What’s your next step?

Depending on our individual goals and values, we will react to the option of joining a larger, integrated system differently. Some will welcome the opportunity and resources that accompany a larger organization. Many new physicians wouldn’t dream of joining a practice where they don’t use an electronic medical record.

Other physicians are committed to staying in an independent practice. Some may even chose to retire early.

Regardless of where you end up practicing, all physicians must prepare to demonstrate to patients and payers the value of the care they provide, not just the volume and intensity.

If you are facing such a decision, I encourage you to attend the Washington State Medical Association’s conference Medical Practice Transformation: Charting your Course on September 9 from 12:30 to 5 p.m. at the Davenport Hotel. If you are unable to attend in person, the conference will be available in bite-sized webinar format for viewing at a later date at your convenience.

The conference precedes the WSMA Annual Meeting and will guide you in assessing your options for maintaining independent practice and making informed decisions about practice settings.

WSMA has assembled a program of experts to assist you in your deliberations.

These are dramatic times. As always I welcome your feedback at pope.b@ghc.

As we witnessed in Congress’s controversial debt-ceiling debate, resources have truly come to a limit, nationally and in health care.

Cost-plus pricing is not going to work. Payers and physicians recognize that the better alternative is to pay for health care that is appropriate, effective and timely. Policy makers and provider institutions are attempting to redesign payment methods and incentivize for value of care, not just volume and intensity of care. The care delivery process is being redesigned to align all participants toward the single goal of providing only the right care at the right time by the right person in the right place to the right outcome. The current merging and alliances of health care September SCMS The Message 1

IMPORTANT - PLEASE READ! L. Gordon Moore, MD Speaking at Upcoming SCMS General Membership Meeting The title of Brad Pope’s President’s Letter in the September issue of The Message asks, “How will you respond to the market-driven changes in your practice?” Rather than a one-size-fits-all response, the reality is that each physician must find the best structure and governance, including systems and workflow methods that work best for their practice. Consider this comment from Dr. Jeff O’Connor’s article, “The only really meaningful use of a computerized medical record system is this: “Thanks for taking good care of me doc! I appreciate it." Give it a go.

The message from Dr. O’Connor is that the patient and their care is really the most important goal for any physician and their practice.

And, shouldn’t that be what matters to regulators, payers and the rest of the healthcare team? Then it would make sense that Dr. Moore’s comments below not only ring true for solo and small practice settings, they should be pursued by physicians who want to adopt practice methods that benefit patients.

Read the article below and then keep in mind that we have invited Dr. Moore (and he has accepted our invitation) to speak at the SCMS General Membership meeting on October 18, 2011. Watch for more information regarding meeting location and details.

Spokane County Medical Society Pursues Network Collaboration on Quality

each month and used a health assessment tool that patients fill out on line. The assessment unmasked issues that hinder patient management of their condition(s). In my practice we identified patients who might benefit from more in depth education and help. Another practice used key responses to test the effectiveness of their education. When the patient understanding and confidence improved, so did the percent of patients with hypertension, treated to goal. 3 In addition to unmasking patient issues, Lynn Ho MD, a family physician in Providence Rhode Island, used the tool to understand the effect of improving front office efficiencies. She worried that her patients might not be happy going through an answering machine during the day, but her rapid responses and other improvements made her patients very happy – 99% of her patients said her office was well organized and seldom wasted their time.4 This online assessment tool required nothing more than an internet connection and printer, so was easy for practices and patients to use. A common quality and measurement tool like that could make it possible for a group of physicians to work together in a payfor-performance program or explore other payment models that reward better outcomes.

1.

2.

3.

By L. Gordon Moore, M.D.

4.

Current payment policies create a difficult practice environment, especially for primary care.1Yet there is some possibility that those in the front lines of care could maintain their independence yet work together in ways that benefits patients, their own practice, and society at large.

Clinicians might collaborate on improved patient care by using simple common tools that measure aspects of quality. As an example, the Ideal Medical Practices project worked with independent solo practitioners from all over the U.S. We were able to demonstrate that by using a low-threshold approach, even solo independent practices were able to participate and demonstrate improvement.2

Bodenheimer, T. High and Rising Health Care Costs: Part I Seeking an Explanation. Ann Intern Med. 2005; 142:847-854.

Moore LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the DoctorPatient Relationship. Family Practice Management September 2007 pp. 20-24.

Wasson JH, Anders SG, Moore LG, Ho L, et al. Clinical Microsystems, Part 2: Learning from Micro Practices about Providing Patients the Care they Want and Need. Joint Commission Journal on Quality and Patient Safety, August 2008, 34(8) pp. 445-452.

Ho, Lynn. Seven Strategies for Creating a More Efficient Practice. Fam Pract Manag. 2007 Sep;14(8):2730

SAVE THE DATE!

Participants in the project joined a couple of conference calls September SCMS The Message 2

Quality Defined by Patient Experience Reprinted by permission Hospital Impact August 2nd, 2011

By Anthony Cirillo Did you catch the Duke University's Fuqua School of Business study that compared patient satisfaction surveys with clinical performance measures to see which is a better gauge of clinical quality?

Researchers measured 30-day readmission rates at roughly 2,500 hospitals and found that patient satisfaction scores were more closely linked with fewer 30-day readmissions than clinical performance measures.

"If you want to figure out if a hospital is providing high-quality care, asking patients if they were satisfied with their care is a better indicator than whether the staff competently performs a battery of tests," co-author Richard Staelin, professor of business administration at Fuqua, said in a release.

What struck me was that hospitals that scored highly on patient satisfaction with discharge planning also tended to have the lowest number of patients return within a month. The authors recommended hospitals that wish to improve their clinical performance focus on improving the interactions between patients and hospital staff.

To me, a great last impression is not only good for HCAHPS scores.

That last impression usually involves discharge planning, and when you get it right through education and communication, patients will follow the instructions and not end up back in the hospital.

That is why companies like GetWell Network and Emmi Solutions that offer innovative patient education are great adjuncts to clinical care at hospitals.

More evidence: A recent HealthGrades report showed modest gains in patient satisfaction based on data from 3,800 hospitals measured between April 2009 and March 2010. It noted that 81 percent of patients said they were most satisfied at the time of

hospital discharge because they received instructions.

So then add this wrinkle: A study in the Journal of General Internal Medicine found that 41 percent of inpatients desired a discussion of religion/spirituality (R/S) concerns while hospitalized, but only half of those reported having such a discussion. Overall, 32 percent of inpatients reported having a discussion of their R/S concerns. Religious patients and those experiencing more severe pain were both more likely to desire and to have discussions of spiritual concerns.

What's more, patients who had discussions of R/S concerns were more likely to rate their care at the highest level on four different measures of patient satisfaction, regardless of whether or not they had desired such a discussion. These data suggest that many more inpatients desire conversations about R/S than have them. Healthcare professionals might improve patients' overall experience with being hospitalized, as well as patient satisfaction, by addressing this unmet patient need.

Yet, pastoral care is sometimes the first to get "booted" should there be budget cuts. That's why we have a Director of Healing Solutions on our team.

So there you have it. That's more evidence that it really is the total hospital experience that matters. So why do we continue to ignore that there are financial implications for poor patient experience?

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He is also the expert guide in Assisted Living for About.com.

Hospital Impact is a blog written by and for hospital executives, physicians and other healthcare thought leaders.

FierceMarkets, which sponsors this blog, is a leader in B2B e-media. It produces email newsletters, websites, webinars and live events across five vertical markets: Telecommunications, Life Sciences, Healthcare, IT, and Finance. Every business day, FierceMarkets'' publications reach more than 1,000,000 executives in over 100 countries. For more information regarding Hospital Impact visit www.hospitalimpact.org.

September SCMS The Message 3

Travis Hunt, PA-C Northeast Washington Medical Group Colville, WA “As a new PA, working with an experienced group like Physicians Insurance enables me to better focus on patients and to spend time rounding out my knowledge base.”

Every physician needs a good foundation.®

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September SCMS The Message 4

EHR and the Solo Doc

than with a poorly programmed EHR.

By Jeffrey O’Connor, MD Once upon a time, there was a family practice doctor in Spokane who just knew he needed to have one of those newfangled “computerized medical records” he was reading about. After all, it was 1994 and about time he moved beyond the pinnacle of 80’s technology – dictation and transcription - to having computers help him do his job better.

Like Goldilocks, he looked at many different programs. Some were just too unaware of how doctors work. Some were too big and too expensive. Some thought they were boss and not him.

Others were too complex and some were just plain stupid. How he despaired at ever finding just the right program!

After wandering through the Desert of Erroneous Computer Programming and Misleading Marketing, he saw two programs that might be “THE ONE.” He took them home to his office staff (and wife), fired them up and said “Here, see how you like this.”

One they loved: “How soon can we get this?” they said.

The other they hated.

And so it was, that in April of 1996, a new helper moved in to work with the doctor and the rest of his staff. It was named Practice Partner, and even though it came with DOS, a dizzying array of heavy monitors, whirring printers, noisy computer workstations, reams and reams and reams of paper and yes, even its own server, it came to help!

At first, while he saw his patients with their paper charts, he dictated in their problem lists, he dictated in their medication and allergy lists, he dictated in the progress notes and physicals.

He dictated just like he always had (and still does to this day) and slowly his new helper became what he needed it to be. Lab results were flowing in as were x-ray reports. Hospital notes and consultant letters and ER notes were ready every day. He could order medications, x-rays and lab tests in a jiffy. And his Practice Partner kept close eye out for human frailty when it came to drug interactions and allergy goofs.

And then – no paper charts were needed! Oh Happy Day!! What once was lost now was found. There was jubilation and dancing in the halls.

And he knew he had done the right thing.

Over the years, while the names and acronyms have changed and multiplied - a CMR (computerized medical record) became an EMR (Electronic Medical Record) and now is an EHR (Electronic Health Record). Regardless, the foundational principle of using medical records software remains the same: it is there to help you be a better, safer doctor. No matter what, if it does not do that, it is a dangerous mirage of safety. You are better off with paper

Before jumping on any bandwagon promising to lead you to medical records Nirvana, first ask if converting your medical records is something you want to do. Despite all the new programs (and there are some really good ones now) and all the incentives, if your heart is not in it, you may not do the real work necessary to allow the program to help. It really is a two-way street.

Obviously, I would argue you should use an EHR to help you practice medicine. I would never see patients without one by my side. I would just point out that if you have the IQ and perseverance to make it through medical school and residency, you can do this!

If you have decided to take the plunge, don’t go to the CMS website and review the Meaningful Use criteria as a first step.

You’ll fold your tent in a hurry! Just like you’d buy a car, ask around and see what other docs - especially those in your specialty - are using, how they like it and if they’d get the same product again. Go to their offices and watch the programs work.

Take some of your staff. Ask their staff if they like it. Some offices are very happy with the help the program has offered. Other offices feel like they must be in purgatory the program (or its implementation) is so bad.

Once you have done your homework and decided on a few potential candidates, get on the web and review the products.

Like Lake Wobegon, all the vendor websites tell you their product is well above average, will make you more productive, get you home sooner and enable you to leap tall buildings in a single bound! See if your specialty website has user reviews of different programs. Always snoop around the internet and try to find users who DON’T like the programs you thought you liked. They are sometimes flat out rude, but nothing is perfect; you need both sides of the story to get the best product for you.

Finally, contact the vendors of interest. Some have local sales staff.

Always see the program in use in your setting. Never take a sales person’s word for anything. They are not doctors and even if they are, they are not you! The good sales person is there to help you see for yourself and meet your needs, not their quota. Take your time. This is a big investment so just let things percolate. Granted there are incentive programs that expire over the next several years but missing out on some government money is far better than saddling the wrong horse because you were in a hurry!

My hope in starting with a silly – but true – fairy tale is that solo docs out there will realize that computerizing your office is doable and allows you to be a better doctor. Notice I did NOT talk about Meaningful Use, INHS, PHRs, documentation, interfaces, data, server farms, standards of care, best practices, workflow, CMS etc. etc. ad nauseam. These are all distractions - important in their place but distractions nonetheless.

September SCMS The Message 5

Continued on page 6

Continued from page 5 The only really meaningful use of a computerized medical records system is this: “Thanks for taking good care of me doc! I appreciate it.” Give it a go.

There are many things I have not touched on. I hope this has at least whetted your appetite. I am happy to talk to anyone about computerizing their office. You can contact me at 220-1846 or jo@ofmed.com.

Two Percent Less

By David M. Henzler, M.D. I am a neurologist and have been in solo practice in Spokane with Dr. Bill Britt for 12 years. We have a simple office expense- and call-sharing arrangement and a lean practice setting consisting of one secretary for each physician, a shared billing clerk, two exam rooms, an EEG lab and my EMG lab. We have no nurses or medical assistants.

I expected the first change to my practice would come with the Health Information Portability and Accountability Act (HIPAA) confidentiality rules. I thought that as a covered entity a new set of policies and procedures to comply would be needed. But I qualified as a non-covered entity since I only used the Center for Medicare and Medicaid Services (CMS) Health Insurance Claim (paper form) to bill patient charges. Surprisingly, I learned about this option from a little known medical association, the Association of American Physicians and Surgeons, and not from our regional Medicare administrator, the AMA, or my specialty association. I verified that option on the CMS website, answering “no” to the question, “Does a person, business or agency transmit (send) any covered transactions electronically?”1 I ultimately became a covered entity at no expense by borrowing the word processing templates and manual from another practice and adapting them to mine. I saved a lot of time and money and

have contemplated how much money might have been spent just in this community on HIPAA compliance matters.

In preparation for embarking on the Electronic Health Record trail, I wanted to break down gross receipts by payer to calculate the 2% Medicare payment reduction. I used my billing software, a widely used program by medical practices in Spokane, to perform the analysis. However, the report was separated by account types (cash, private insurance, Medicare, Medicaid, etc.). I found payment types of “cash, insurers, Medicare and Medicaid” for each of the account types. Digging further into the insurance carrier set-up screens, I discovered that none of the 261 insurance carriers was listed with an account type. Instead, on a separate screen, each carrier had a “carrier type” selected, which turned out to be a descriptor with no meaning in the database. It is not clear how the data on the practice analysis reports is extracted when sorted by account types, and I cannot make reasonable business decisions if I cannot analyze accurate payer data.

My current billing and scheduling software is complex, opaque and not adaptable to certain business practices. I have had to adapt the way the software does things instead of the software fitting already established office procedures. If this is the way our two solo practitioner office communicates non-electronically with payers in the healthcare industry, how many orders of magnitude of complexity will there be when my computer system has to connect to other very complex computer systems.

CMS requires “meaningful use of certified electronic health record technology every year they participate in the program.”2 Obviously, that will be exceedingly complicated and certainly will be fraught with unanticipated problems and errors that will go undetected for extended periods of time. I have decided to allow those with the time and money to go that route. I will happily accept a couple of percentage points off my Medicare payments.

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https://www.cms.gov/HIPAAGenInfo/06_ AreYouaCoveredEntity.asp; accessed 8/4/2011. http://www.cms.gov/EHRIncentivePrograms/30_ Meaningful_Use.asp#BOOKMARK2; accessed 8/4/2011.

September SCMS The Message 6

Internal Medicine Residency Spokane Clinic

By Mary Noble, MD IMRS Faculty The appearance of an Internal Medicine practice has changed over the past decade and will likely continue to evolve along with so many other aspects of medicine. I was asked to write about how the Internal Medicine Residency Spokane Clinic is addressing some of those changes.

It is important to first emphasize what has not changed is the prime importance of the physician-patient relationship. Several years ago I came to be the Clinic Director after having practiced Internal Medicine in Spokane for almost three decades. I had made the personal decision not to become a hospitalist and instead to maintain my long-term relationships with my patients, so hoped that I had worthwhile experience to draw upon.

One of my goals was to share the many positive aspects of outpatient medicine with future generations of physicians, i.e. internal medicine residents. Although I am not immune to the frustrations of outpatient medicine, I truly believe that the positives outweigh the negatives. The challenge would be to convey this to residents who are part of a program where intense training also occurs in the hospital.

Our residents follow patients who they took care of in the hospital, patients who seek our care because we gladly accept Medicare, patients referred by friends and family and patients referred from the Emergency Departments. Many of our patients proudly remind their "new doctor" that they have 'graduated many doctors' after being clinic patients for many, many years. A few of our patients have 'good insurance', most have Medicare or Medicaid coverage, some are homeless or transient. Many are extremely challenging medically, socially, financially and culturally. We try to create realistic expectations for the number of patients a resident can manage well and expect their efficiency and productivity to increase with experience, acknowledging that precepting with faculty is required and beneficial but slows them down.

care physicians. Funding is the limiting factor at the present time.

Our goals in the clinic are multiple: to provide high quality, compassionate, evidence based, economical care to our patients; to provide an opportunity for our residents to learn to manage health care needs of a diverse population of patients; to give the residents opportunities to develop meaningful relationships with their patients over the three years of their training; to create a clinic environment which helps prepare the residents to make career decisions and to ensure that regardless of what they do after they complete their residency training, they have a solid understanding of the role of the primary care physician in a patient's life and health.

In recognizing that patients with HIV/AIDS can live long full lives, we created The HIV Clinic at IMRS. Residents are able to follow people living with HIV/AIDS, in conjunction with our HIV Specialist, to help manage this chronic disease.

We believe it is important that our resident physicians appreciate the essential role of other members of the healthcare team. Our nurses provide great support to our residents and our patients, our HIV specialist is a PA-C, several wonderful community subspecialists come to our clinic and see patients with the residents and they interface with a nurse practitioner based at the nursing home where residents follow patients.

We are part of the larger medical community. IMRS is involved with two projects of the Beacon Community of the Inland Northwest (BCIN), our faculty work with WWAMI medical students in the hospital, and in our IMRS clinic, just as we hope increasing numbers of community physicians will do. We deal with the challenges of managing patients with chronic pain and work closely with Sacred Heart ED's Consistent Care program when needed.

The result of all these efforts and activities is that some of our IMRS graduates do indeed begin careers in ambulatory medicine. Others have pursued fellowship training, and some become hospitalists – who have a much better understanding of the importance of communication with their ambulatory colleagues who care for the hospital patients before AND after they are in the hospital.

We use an electronic medical record. Before the residents begin their first clinic experience, they spend time doing EMR training, but more importantly, work on skills of patient-centered interviewing WHILE getting used to using the computer. They recognize how important it is to remember that the computer is a tool that must not interfere with the physician-patient relationship. We strive to be our patients’ medical home, with a goal to have patients see their own doctors whenever feasible.

We anticipate that in the future we will participate in ACOs and are just beginning to be “educated” and provide education to residents about this concept. Residency training is currently largely funded by Medicare with a much smaller reimbursement provided from Medicaid. Our sponsoring institution also provides additional financial support. Currently, government funding is on shaky ground so it is incumbent on all programs to develop other resources to assist with training expenses. Our need is to expand the IMRS program to meet educational needs in light of increasing undergraduate presence as well as community needs for primary September SCMS The Message 7

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Group Health Physicians: Our Perspective on Patient-centered Care

These systems weren’t developed in a vacuum. Our physicians endorsed the need to put patients first and they designed them with frontline staff. So our physicians are medical leaders too—demonstrating new approaches in a very active learning organization.

By Paul Sherman, MD

Physicians lead the medical home

Why do we choose to practice medicine where we do? Is it because of our patients, the people with whom we work or perhaps the compensation? For most of us, it’s probably a combination of these things.

It was a physician who convinced Group Health that it needed to pilot a medical-home approach. Our medical director, Michael Soman, MD, and several other doctors spent vast personal amounts of reputational capital and will to convince the organization to reorganize itself around the patient.

Group Health Physicians (GHP) is comprised of nearly 1,300 physicians, physician assistants, and other clinicians. Known for our preventive approach to primary care, we practice in 26 specialties and dozens of subspecialties. As a for-profit corporation governed and owned by practicing clinicians, we contract exclusively with Group Health Cooperative to provide integrated care for 425,000 people in 26 Group Health Medical Center locations across Washington and northern Idaho.

Our medical group formed its own corporation in 1997, after more than 50 years as part of Group Health Cooperative. Eligible staff pay a nominal buy-in to become shareholders, but the company’s priority isn’t to build equity. Instead it’s to build a supportive and rewarding practice life so our doctors can focus on career-long learning and clinical mastery for the benefit of their patients and clinical colleagues. Our clinicians are salaried and receive nominal incentives tied to patient satisfaction scores. This removes the financial incentive to create volumes of procedures, and returns the focus to what’s best for the patient.

If you asked our doctors why they join GHP, they’d say that they are part of an unparalleled system that allows them to provide better care for their patients. This includes integrated medical records so we don’t waste patients’ time or practice duplicative care. We cultivate a culture of safety, where error reporting is a transparent part of continuous improvement. We have reminder systems and outreach to patients so we can proactively keep them in better health, or catch problems earlier.

Teamwork creates smooth patient transitions through care settings. We’ve received state recognition for our work to reconcile patients’ medications at multiple touch points in both primary and specialty care. And we’re carefully managing the discharge from hospitals so patient follow-up is coordinated and prompt.

All of these elements add up to patient-centered care, where Group Health Physicians doctors can perform at their best with each patient, knowing the healthcare team around them is supporting them.

Group Health’s patient-centered medical home model emphasizes a greater investment in primary care, smaller panel sizes for primary doctors, longer visit lengths, use of virtual medicine to broaden access, chronic care management, proactive outreach to patients and advance visit preparation.

It’s paid off. A two-year study (Health Affairs 2010) that compared our medical home to our previous model reported that: • The quality of care was higher, patients reported having better experiences, and clinicians said they felt less “burned out.”

• Patients had 29 percent fewer emergency visits and 6 percent fewer hospitalizations, resulting in a net savings of $10 per patient per month.

• For every dollar Group Health invested—mostly to boost staffing—it recouped $1.50.

We’ve since spread the medical home to all Group Health Medical Centers and been accredited at the highest possible level by National Committee for Quality Assurance (NQCA).

Integrating care in Spokane Spokane faces a unique opportunity to improve community outcomes and lower costs due to its collaborative medical community and forward-thinking innovations such as health information exchange. We believe that by coordinating care across the continuum and allowing clinicians to do what they do best with common tools and support systems, the community will benefit in lower healthcare costs and higher quality. We have proven this approach works and seek to join the Spokane physician community to bring that same accountable care and integrated care system to a larger number of patients.

We're just beginning. As I round and meet with Spokane-area doctors, many are hungry to share resources and information.

They've seen the gaps that can occur when we practice in silos.

Continued on page 11

September SCMS The Message 9

Riverpoint Rx.pdf

1/20/10

10:55:21 AM

A Personalized Approach to Your Health Riverpoint Pharmacy is one of the few remaining pharmacies that can still offer customized medications through pharmaceutical compounding.

We can provide: • Individualized strengths, combinations and flavorings • Specialized dosage forms such as topical gells and slow release capsules • Sterile compounds such as preservative-free eye drops, injectibles and custom nebulizer solutions • Veterinary compounding Our specially trained pharmacists also offer personalized consultations in: • Nutrition evaluation and planning for improved health • Bioidentical Hormone Replacement Therapy for men and women • Review of medications and supplements • Pain management options for chronic pain and special needs

R iverpoint P

H

A

R

M

A

C

Y

Your treatment. Custom designed.

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

September SCMS The Message 10

Continued from page 9 In August GHP finalized the acquisition of Columbia Medical Associates (CMA), a group of more than 50 primary care providers with 75,000 patients in the Spokane region. CMA will continue employing its non-physician staff, and its doctors will continue seeing patients who have insurance other than Group Health at their current locations. Our new relationship will allow both organizations to bring the best of our strengths and clinical interests together on behalf of our patients.

Group Health and Providence Health Care have also agreed to collaborate to integrate care in our communities. Future steps include working toward shared electronic medical records.

The goal is to partner more closely with clinicians to form a more consistent and seamless care experience for all patients. Together we can drive toward these goals with an approach of continuous learning from one another, agreeing to care outcome measures, and joining around a common clinical model that’s supported by technology and financial incentives to provide the right care to patients. We’ll need to work together in a post-reform world.

Please feel free to contact me or Tom Schaaf, MD, our associate medical director in Spokane (Schaaf.m@ghc.org or 509-241-2125). _____________________________________________________ Paul Sherman, MD, is a pediatrician and the associate medical director for strategy development at Group Health Physicians.

Contact him at Sherman.p@ghc.org or 206-448-2785.

ACO Reading List Now Available

Collaboration to Improve Patient Care and Control Costs Medical Directors from the four Spokane EDs Created Joint Objectives

By Lee Taylor Director, Project Access Spokane Representatives from all four Spokane emergency departments met in July to begin working collaboratively on the challenges of providing excellent treatment for patients that visit their emergency rooms, while at the same time managing the cost of treating those patients. The intent of this work is to provide the best and most efficient patient care for the population presenting at the Spokane EDs. One of the major cost management challenges is a change to emergency room benefits for Medicaid clients. The change will mean no payment for visits from any client who has used more than three “non-emergent” emergency room visits during the year. The Legislature directed the Washington State Health Care Authority to save $72 million through this initiative. The Authority plans on implementing this benefit limit on October 1, 2011.

This initiative and the ongoing challenge of an increasing number of people using the EDs for their healthcare needs creates lots of motivation to work on a community solution for this longstanding problem.

The goals of the group focus on ensuring that patients receive the best possible care from the appropriate medical care provider.

Four major goals were established by the group:

Accountable Care Organizations (ACOs) take a variety of complex forms, but in essence, are affiliations of healthcare providers that are held jointly responsible for trimming or controlling the growth of healthcare costs while maintaining or improving the quality of care that patients receive. As part of the Patient Protection and Affordable Care Act, the ACO model seeks to accomplish these goals through a number of approaches, including prevention and early diagnosis, reducing unnecessary tests and referrals, decreasing preventable emergency room visits and hospitalizations, lessening in-hospital adverse events and preventable readmissions, and utilizing cost-effective treatments, infrastructures and care providers. For more information on ACOs, please see our ever-growing reading list located at http:// tinyurl.com/3pdw9sg

1.

2.

3.

4.

Ensure continued sharing of patient information in all Spokane EDs Create citywide standards for clinical evaluation in the Spokane EDs Developing an integrated delivery system for medical services to Medicaid insured visitors to the ED Create a test for a gainsharing compensation program

Accomplishing these goals will require collaboration with other providers in the community, and building capacity for referring patients who present in the ED to appropriate primary and specialty care providers, and urgent care facilities, depending on the patient’s needs. Project Access is involved in this collaboration to help coordinate the efforts of the group with other providers and to help build a network of providers who are willing and ready to create a community solution to this problem. A staff member from Empire Health Foundation also attended our meeting and we discussed possible involvement of their organization.

Continued on page 13

September SCMS The Message 11

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September SCMS The Message 12

Continued from page 11 There are many examples of ED utilization projects in other communities that demonstrate excellent results in both patient care and cost control. In addition, this project will benefit from the guidance and support of Medicaid.

The participants in the collaboration are: Dr. Mike Wymore, Providence Sacred Heart Medical Center ED, Medical Director Dr. Darin Neven, Providence Sacred Heart Medical Center ED, Consistent Care Director Dr. Scott French, Deaconess Medical Center ED, Medical Director Dr. Mike Sicelia, Providence Holy Family Hospital ED, Medical Director Dr. Wayne Tilson, Valley Hospital and Medical Center, Medical Director Dr. Mark Mueller, Valley Hospital and Medical Center, ED representative Lee Taylor, Project Access/Spokane County Medical Society Foundation Brian Myers, Empire Health Foundation, Capacity Building Grants Program I look forward to sharing more information about this important community collaboration as it develops. If you would like to learn more about this project please call me at (509) 220-2651 or email me at lee@spcms.org.

WWAMI Celebrates 40 Years of Medical Education

By Deb Harper, MD Assistant Dean for Regional Affairs and Rural Health WWAMI Clinical Medical Education – Eastern & Central WA This 2011/2012 academic year marks the fortieth anniversary of the WWAMI program. In the late 60's, creative medical educators at the University of Washington and in Alaska, Montana and Idaho came together to find a way to educate the future physician workforce for our region. They called it WAMI (Washington, Alaska, Montana, Idaho).

In the WAMI model, students spent their first year of basic science medical education in their home state. At the beginning, Washington students could spend their first year at the UW, Seattle or at WSU, Pullman. Then everyone went to Seattle for their second year and could spend their third and fourth years of clinical education anywhere in the four states.

In 1997, Wyoming joined and the program became WWAMI. We have a rivalry with our Wyoming colleagues as to which of us is the first “W”. Our school now covers 28% of the land mass of the USA (Okay, gotta admit, having Alaska helps!). In 2008 the Washington class size was increased by 20 students and the firstyear program was expanded to include the Spokane Riverpoint campus. Those first Spokane students will graduate the summer of 2012.

The experiment took a lot of work. The accreditation body,

September SCMS The Message 13

Continued on page 14

Continued from page 13 Liaison Committee on Medical Education (LCME), took a lot of convincing. Forty years later we can say this has been a success.

The UW School of Medicine WWAMI program has been ranked #1 in creating primary care physicians and is the #2 public school in research funding.

We are cost-effective. The average cost to educate a medical student per year is over $100,000. Our cost is under $70,000.

Our current challenges? Both Idaho and Washington have very low numbers of medical student slots available compared to their population. We need to find ways to educate and fund more medical student positions. We need to find ways to increase the clinical clerkship opportunities for our students. We need to increase residency positions to accommodate our new graduates.

We need to integrate our education with other health professionals and integrate our basic science and clinical curricula.

How can you help? Your ideas about medical education are welcome. Email, call or write to my office. I read all of the suggestions and pass them along to UWSoM leadership. Come to our next Faculty Development CME Workshop, the evening of October 6. Attend our next GME Summit on March 23. Volunteer as a preceptor for first years or a clerkship teacher for clinical year students, residents or PAs. And, keep your eyes open for more celebrations of our 40 years of medical education in the region.

The Patient Centered Medical Home Team at St. Jude the Obscure ACO Yes, Morrison got a big laugh. But clearly these are serious times in patient care.

SCMS Social Event Scenic River Cruise Spokane County Medical Society members and their significant others along with SCMS staff and representatives from the Community of Professionals enjoyed a perfect summer’s evening cruise down the Spokane River to Lake Coeur d’Alene aboard the 92’ boat, The Serendipity. Starting at Templin’s Marina in Post Falls, the boat meandered down the Spokane River as the guests on board enjoyed meeting new colleagues, viewing the wildlife, listening to guitar music by Steven King and reminiscing about the Seahawks with Paul Moyer.

Thank you to our Community of Professionals partners, Fruci & Associates, Sterling Savings Bank, Witherspoon – Kelley, UBS – The Prewitt Group and US Bank, for sponsoring the second SCMS social event of 2011.

Your ACO is Delighted to Make Your Acquaintance Ian Morrison, futurist, author and blogger, perhaps got the best laugh of a recent summit during his keynote when he described a letter Medicare beneficiaries might receive to explain an ACO. Dear [Name Withheld to be HIPAA Complaint]: Dr. Oskin, SCMS President Elect, welcoming everyone to our first cruise.

Congratulations.

It's now official. While we have seen quite a bit of each other this past year, we just heard from the good folks at Medicare that we are now officially responsible for the quality and costs of the medical care you got this past year. It was as much of a surprise to us as it must be to you. Nevertheless, we are delighted to have you.

However, the relationship has gotten off to a bit of a rocky start.

We see from your records that you had a heart attack in Florida when you were visiting cousin Mildred. To make matters worse, they did not give you an aspirin on discharge and now we won't get our bonus.

We really hope you take much better care of yourself in the coming year and don't travel so much.

Warmest regards,

Drs. Jon Kalisvaart and Monica Zherebstov, both pediatric specialists new to Spokane

September SCMS The Message 14

When it comes to your special delivery, we’ve got you covered.

We believe new moms and babies should be surrounded with comfort and care. That’s why we bring you:

• Suites designed so mom and baby can remain in the same room throughout their stay • Spacious suites with cozy amenities, a private bath and accommodations for an overnight guest • Trained OB nurses plus a Special Care Nursery for infants with more complex medical needs • Support for all types of birth plans, from natural to planned C-sections • A waiting room exclusively for families of OB patients

To schedule a tour of The Birthing Center and Special Care Nursery at Valley Hospital, call (509) 473-5475.

To find an OB physician based in the Valley, visit www.spokanevalleyhospital.com/physicians.

12606 East Mission • Spokane Valley

P e r s o n a l i z e d OB C a r e . R i g h t H e r e .

September SCMS The Message 15 53203_VHMC_OB_7_5x10c.indd 1

1/14/11 5:01 PM

Part-time Doctors Shaking Up Small Practices

the week or hours of the day. • Having part-timers do specialized work, such as pediatrics or geriatrics, in a family medicine practice. • Having part-time physicians take same-day or urgent care calls.

Practice Management. By Karen Caffarini, amednews contributor.

Posted July 11, 2011.

Increasing numbers of physicians are seeking part-time positions with flexible hours, resulting in higher turnover rates for some small practices that do not adjust to the trend and challenges for those that do.

A 2010 Physician Retention Study released in April by Cejka Search and the American Medical Group Assn. found that turnover rates are increasing slightly despite the poor economy. The trend has been fueled largely by young female and pre-retirement male physicians, including many who are seeking part-time positions.

The survey found that 13% of male physicians and 36% of female doctors practiced part time in 2010, compared with 7% and 29%, respectively, in 2005.

"Given the high demand we're seeing, the notion of a part-time physician is one small practices will need to look at," said Kenneth Hertz, principal consultant at the Medical Group Management Assn.

But it isn't always an easy adjustment for small practices to make. Fulltime physicians, especially if they are partner-owners, could feel they are taking the brunt of the workload without sufficient compensation.

The hours the physician wants to work may not correspond with patient flow. The doctor may want part-time hours but full-time compensation. And other full-time physicians in the office may believe a precedent has been set and expect the same privilege, experts say.

So how does a small practice adjust to this growing trend and make the part-time physician work for the practice and the patient?

First, practices need to set up a plan that is appropriate for the physician and the practice, one that keeps in mind the continuity of care for patients.

"The practice needs to look at the practice's cost structure and the physician's expectations, and it needs to come up with a system that incentivizes the physician to remain productive," Hertz said. "The plan needs to reward the part-time physicians yet fairly compensate the practice so its overhead costs and expenses are covered."

Creativity is important, added Mary Barber, vice president of Cejka Search.

Barber said one way to use part-time physicians without disrupting an office's patient load is to have them visit patients in the hospital while full-time doctors see patients in the office.

Other possibilities include:

If the practice also does nursing home visits, the part-time physician can take that role, too, said Deborah Walker Keegan, PhD, author of "Innovative Staffing for the Medical Practice" and president of health care consulting firm Medical Practices Dimensions, near Asheville, N.C. The part-time physician who wants to spend more time at home with young children also could do e-consulting and e-visits and fill prescriptions from home, Keegan said.

One point that needs to be worked out from the beginning is call.

Some full-time physicians who are about to retire and want to lessen their workload will want to give up call, putting that responsibility on the remaining full-time physicians, said Jennifer Metivier, executive director of the Assn. of Staff Physician Recruiters in St. Paul, Minn.

Talking about pay Compensation is another point that needs to be discussed upfront.

Robert Wolfson, MD, president of Wolfson Consulting in Lakewood, Colo., said some part-time physicians will work on a purely contract basis, with no benefits or retirement plan, saving a small practice money. However, experts say pay is usually based on salary and some productivity formula.

"Some offices pro-rate based on the number of hours worked," said Patrice Streicher, president of the National Assn. of Physician Recruiters and associate director of VISTA Physician Search & Consulting "Some base pay on collections. The physician gets a percentage after a certain threshold."

Wolfson said the pay would be based on a percentage of the amount a physician brings in, minus overhead costs to run the practice.

Jenny Liebl, physician recruiter for Pacific Memorial Clinics near Seattle, said Pacific Memorial pays part-time physicians a guaranteed salary for the first two years, after which it goes to a production model.

And then there is the situation where the part-time physician is a partner in the practice, which Walker Keegan said opens up a whole new set of complications.

"Should the person continue to be a partner once they are part time? How long should they be a partner? Should it be forever? Who is taking call for them? Are they still paying their full share of the practice's costs? There are a lot of questions to ask," she said.

Family physician James Valek, MD, who formerly operated Vista Family Medicine in Chicago before selling the practice to Little Company of Mary Affiliated Services, discovered the challenges of

• Job sharing, in which two part-time doctors work different days of September SCMS The Message 16

Continued on page 19

A Multidisciplinary Approach to Improving Quality of Life.

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

Patricia Fernandez, PsyD

Fax: 888.316.1928 September SCMS The Message 17

Spokane, Washington

Membership Recognition for September 2011

Spokane County Medical Society Continuing Medical Education 2011 Program Schedule

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.

Moderate (Conscious) Sedation and Analgesia

60 Years William J. Sinclair, MD

9/20/1951

Monday, September 19, 5:30 – 9:15 pm Deaconess Health and Education Center

30 Years

(SCMS’ annual program to satisfy JCAHO requirements

David G. Grubb, MD

9/15/1981

Edwin R. Holmes III, MD

9/15/1981

Eugene B. Patterson, MD

SEPTEMBER

9/15/1981

and provide a refresher course to members of the medical community in order to increase patient safety.)

OCTOBER

20 Years

Endocrinology Update 2011

Bruce Abbotts, MD

9/25/1991

Thursday, October 06, 5:30 – 9:15 pm

Steven L. Dixon, MD

9/25/1991

Deaconess Health and Education Center

William D. Keyes, MD

9/25/1991

(Three one-hour topics will be presented)

Michael H. Kody, MD

9/25/1991

Mitchell F. Minana, MD

9/25/1991

NOVEMBER Orthopaedic Update 2011

10 Years Janice D. Christensen, MD

9/4/2001

Glen O. Baird, MD

9/19/2001

Nelson Chow, MD

9/19/2001

David M. Henzler, MD

9/19/2001

Rodney F. Hestdalen, MD

9/19/2001

John F. Hoffmann, MD, FACS

9/19/2001

Hakan Kaya, MD

9/19/2001

William S. Stovall, MD

9/19/2001

November 02, 5:30 – 9:15 pm Deaconess Health and Education Center (Three one-hour topics will be presented)

September SCMS The Message 18

Continued from page 16 hiring a part-time physician as an employee with the idea that the doctor eventually would become a partner.

He said the relationship lasted 1½ years before he decided to sell the practice.

"Were we wildly successful? I would say no," Dr. Valek said. "As the owner of the practice, I had more responsibilities forced on me. A partnership implies splitting, but when one is full time and one is part time, it is difficult to use that term."

He said he wouldn't have done anything differently. "But a doctor looking for a partnership, it is pretty hard to do unless everyone shares the same load," he said.

Dr. Valek said he decided to sell for a variety of reasons, but the biggest factor was the realization that the burden always would fall on him.

"Almost all the people I interviewed wanted to work part time with a full-time salary," he said. "No one wanted to be paid on productivity.

I found it extremely hard to grow a practice in that sense."

Continuing Medical Education •Moderate (Conscious) Sedation and Analgesia: 2.5 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. Conference held on September 19, 2011 at the Deaconess Health and Education Center. Contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org for more information.

•Reducing Hospital Readmissions by Engaging Community Physicians WSMA CPIN WEBINAR: Thursday, September 7, 2011 – 12:15 to 1:15 PM This free webinar will present practical advice to help community physicians become more involved with recently discharged patients, thereby reducing the likelihood of readmission.

This activity has been approved for AMA PRA Category 1 Credit; AAFP Preferred CME credit will be applied for and determination is pending. All sessions are free for medical groups, physicians and all other care providers. Register online at www.wsma.org/CPIN OR send the following information in an e-mail titled CPIN Sep 7 to kho@wsma.org: Name; Phone; Clinic/Group; and Number of Participants.

•Interactive Teaching Skills, a WWAMI Spokane Faculty Development Workshop presented by Judith L. Bowen, MD, FACP, professor of medicine at Oregon Health & Science University.

Approved for 2.5 CME Category 1 and sponsored by Providence Health. Registration is free and includes dinner. Save the date for October 6 from 5:30 p.m. to 9:00 p.m., venue in Spokane to be announced. For more information contact Marlene Maurer, 509-3587795 or mamaurer@uw.edu. This is the 2nd in an ongoing series.

Previous attendance not required. Grant funded by Empire Health Foundation.

•Alliance Community Check-up Results and Update WSMA CPIN

WEBINAR: Thursday, September 29 12:15 – 1:15 p.m. This onehour lunchtime webinar will summarize how well care is delivered at the medical group level on over twenty measures of quality and appropriateness. Free for medical groups, physicians or other care providers. This activity has been approved for AMA PRA Category 1 Credit; AAFP Preferred CME credit has been applied for and determination is pending. Registration at www.wsma.org/CPIN. For more information contact Kesley Howard at (800) 552-612 or jcd@ wsma.org.

Meetings, Conferences and Events Medical Practice Transformation: Charting Your Course - Jointly Sponsored Conference Physicians & Practices: Sustainability and Transformation Initiativesm Physicians are facing dramatic pressures to reevaluate their practice settings and business operational relationships. Market-based changes in payment methodologies and compensation, Medicare Shared Savings Program and Accountable Care Organizations, to name a few, are driving those reassessments. WSMA members or Physician Insurance insureds can attend for a special reduced rate of only $99 per person, and can sponsor their 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 $79 per person. Immediately precedes the WSMA Annual Meeting at The Davenport Hotel in Spokane.Friday, September 9 - 12:30 pm–5:30pm. The Davenport Hotel, 10 South Post Street, Spokane. Contact Jenelle Dalit at 1(800) 552-0612 or jcd@wsma.org.

WSMA Practice Management Webinar 2011 ICD-9 & ICD-10 Update – Thursday, September 22 Noon to 1:30 p.m. Information on the 2012 changes to ICD-9 codes. Guidance on approaching ICD-10 implementation. WSMA & WSMGMA members $89 per phone line.

Contact Jenelle Dalit at (800) 552-0612 or jcd@wsma.org.

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

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

Physician Family Support Group — Physicians, physician spouses or significant others, and their adult family members share their experience, strength, and hope concerning difficult physician family issues which may include medical illness, mental illness, addictions, work-related stress, life transitions, and relationship difficulties.

The meetings are on Tuesdays from 6:30 pm – 8 pm at Sacred Heart. Format: 12 Step principles for everyone, confidential and anonymous personal sharing; no dues or fees. Contact Bob or Carol at 509-624-7320 for more information.

September SCMS The Message 19

The following physicians/physician assistants have applied for membership, and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing 104 S Freya St., Orange Flag Bldg #114, Spokane, Washington, 99202.

PHYSICIANS

Zherebtsov, Monica, MD Pediatrics Med School: UMDNJ- Robert Wood Johnson Medical School (2004) Internship/Residency: U of Medicine and Dentistry, New Jersey (2008) Fellowship: U of California, San Diego (2011) Practicing with Pediatric Gastroenterology beginning 9/2011

PHYSICIANS PRESENTED A SECOND TIME

Eggers, John R., MD Obstetrics and Gynecology Med School: Loma Linda U (1985) Internship/Residency: San Joaquin General Hospital (1989) Practicing with Obstetrix Medical Group of Washington, Inc., PS beginning 10/2011 Hannon, Elena M., MD Obstetrics and Gynecology Med School: U of Colorado (1995) Internship/Residency: Virginia Commonwealth U (1999) Practicing with Obstetrix Medical Group of Washington, Inc., PS beginning 10/2011 Heller, Stephanie A., MD Pediatrics Med School: Oregon Health and Science U (2002) Internship/Residency: Children’s Hospital of Los Angeles (2006) Fellowship: Children’s Hospital of Los Angeles (2007) Practicing with Deaconess Medical Center beginning 9/2011 Jones, William B., MD Diagnostic Radiology Med School: U of Washington (1981) Internship: U of North Dakota (1982) Residency: U of Minnesota (1986) Practicing with Radia Inc., PS since 10/2009

Baker, Tyler J., MD Family Medicine Med School: U of Washington (2008) Practicing with Providence Family Medicine Indian Trails since 8/2011 Hammil, Sarah L., MD Obstetrics and Gynecology Med School: Creighton U (2004) Practicing with Northwest OB/GYN since 8/2011 Heller, A. Chris, MD Neurological Surgery Med School: Oregon Health and Sciences U (2001) Practicing with Spokane Brain and Spine since 7/2011 Feliciano, Brita M., MD Internal Medicine Med School: Creighton U (2005) Practicing with Rockwood North Clinic beginning 10/2011 Miller, Rebecca L, MD Pediatrics Med School: Creighton U (2008) Internship/Residency: U of Michigan (2011) Practicing with Providence Sacred Heart Medical Center, Pediatric Hospitalists since 8/2011

Karambay, James J., MD Emergency Medicine Med School: Albany Medical College (2008) Internship/Residency: Hennepin County Medical Center (2011) Practicing with Valley Hospital Emergency Dept. beginning 9/2011 McGree, Kathren E., DO Family Medicine Med School: Touro U College of Osteo (2008) Internship/Residency: Family Medicine Spokane (2011) OB Fellowship with Family Medicine Spokane beginning 9/2011 Olson, Soren L., MD Orthopaedic Surgery Med School: U of Washington (2004) Internship/Residency: U of Washington (2009) Fellowships: Toas Orthopedic Institute (2010), Harborview Medical Center (2011) Practicing with Northwest Orthopaedic Specialists beginning 9/2011 Rezvani, Laghaieh, MD Diagnostic Radiology Med School: Mashad U, Iran (1970) Internship/Residency: U of Missouri (1982) Fellowships: U of Missouri (1983) and U of Chicago (1984) Practicing with Radia Inc., PS since 10/2009

Nakayama, Ikue, MD Internal Medicine Med School: Tohoku U, Japan (2005) Internship/Residency: Pennsylvania Hospital (2011) Practicing with Apogee Physicians since 8/2011 Ween, Jon E., MD Neurology Med School: U of California, Irvine (1988) Internship: St. Mary’s Medical Center (1989) Residency: Boston U (1992) Fellowship: Boston U (1993) Practicing with Rockwood Clinic, PS beginning 10/2011

PHYSICIAN ASSISTANTS PRESENTED A SECOND TIME Cooke, Ondi A., PA-C School: Idaho State U (2009) Practicing with Providence Health Services dba NW Heart and Lung Surgical Associates since 8/2011

September SCMS The Message 20

Continued on page 21

Continued from page 20

Inland Imaging Business Associates Receives

Deubel, Angela L., PA-C School: Western U of Health Services (2010) Practicing with Women’s Health Connection since 11/2010 Diaz, Lindsey M., PA-C School: U of Florida (2008) Practicing with Rockwood Clinic, PS since 8/2011 Goyt, Amanda N., PA-C School: Drexel U College of Nursing-Health Professionals (2005) Practicing with Rockwood Clinic, PS since 7/2011

In the News Teaching Attending of the Year The Internal Medicine Residency Spokane and Transitional Residency Programs both elected Dr. Dan Coulston the Volunteer Teacher of 2011. This award is received after a vote by the residents and is quite an honor since they strive to pay tribute to the teacher who has helped them advance their knowledge and is a role model for excellent patient care.

Dan works with residents year round, averaging 26-30 residents plus medical students each year.

National Technology Innovation Award Radiology Business Journal Announces Top Five Medical Imaging IT Projects of 2010 Inland Imaging Business Associates received a technology innovation award in a competition conducted by the Radiology Business Journal and the Society for Imaging Informatics in Medicine (SIIM). The results of the competition were announced in the June/July 2011 issue of the Radiology Business Journal.

Inland Imaging received “Winning Entry #5” in the nationwide competition for its leading-edge work in developing a streamlined, Web-based workflow system that functions in multispecialty clinics, hospitals and imaging centers . As a result of the implemented workflow system, radiologist productivity has increased while improving quality in report turnaround meaning physicians and patients get their imaging results more quickly.

The comprehensive system includes a radiologist scheduling and credentialing component allowing patient exams to be routed to the best-suited radiologist based upon their subspecialties and across multiple locations. The system also has built in peer review and other quality improvement based functionality.

Criteria for the competition were innovation/ingenuity; meeting a critical, urgent or unmet need; validating/evaluating a tool; and having the potential to be generalized to other institutions.

Dr. Coulston has been the recipient of this award several times in the past.

Please congratulate him on this well-deserved honor.

Visit our updated website • View "The Message" Online

• Legislative updates

-Full current and past issues available

-Connect with SCMS on Facebook and stay informed

• Membership information

• Connect to Medicor

-Information about credentialing, committees, bylaws, etc.

-The online medical library is a SCMS membership benefit.

• CME information -Topic and dates for upcoming CME courses

September SCMS The Message 21

Top 10 Sectors That Will Benefit From Health Insurance Exchanges

much lower rates, which often barely cover the cost of services. As a result, private payers have been charged more for these services.

In the ensuing five years, through 2016, IBISWorld predicts especially strong revenue growth and operating profit for specialist doctors, primary care doctors, podiatrists, diagnostic and medical laboratories and emergency and other outpatient care centers.

Average growth in these areas is expected to be 5.7 percent annually, up from 4.5 percent in the previous five-year period.

By Chris Anderson, Senior Editor Healthcare Finance News July 12, 2011 LOS ANGELES – Industry research firm IBISWorld has forecast the top 10 sectors that will benefit from the creation of state health insurance exchanges under the new rules released this week by the U.S. Department of Health and Human Services.

With nearly 12 million people expected to buy insurance on the exchanges in 2014 and as many as 28 million by 2019 according to Congressional Budget Office estimates, the 10 sectors expected to benefit most are:

“Revenue is forecast to improve in these industries with the implementation of the exchanges. Moreover, operating profit margins are projected to rise since commercial insurance payments make up a larger source of operating profit than government programs, such as Medicare and Medicaid,” Snyder added.

Profit growth in emergency and other outpatient care centers is expected to lead the pack in increases based on the issued rules.

Operating profit in this sector is projected to be 9.6 percent of revenue by 2016 versus 8.6 percent in 2012.

“Several healthcare industries rely heavily on payments from private health insurance. Since much of the healthcare reform legislation is still being debated, the move to issue rules is at least one indication that these industries will ultimately gain from the legislation in regard to having a broader and more stable customer base,” said Sophie Snyder, healthcare analyst with IBISWorld.

According to the report, during the preceding five years, these sectors have become increasingly reliant on payment from private insurance. Government payers, such as Medicare, compensate at September SCMS The Message 22

FAMILY Now providing comprehensive HOME prosthetic and orthotic patient care for adults and children CARE VALLEY ORTHOPEDIC

Spokane Valley 509-922-5040 Coeur d’Alene 208-765-3080 Sandpoint 208-265-0100 Post Falls—Opening November 2011 For more information and practitioner profiles, go to www.kpoidaho.com

We’re with you and your patients

Every Step of the Way

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REAL ESTATE

Northpointe Medical Center Located on the North side

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.

All Costs Included--Upscale View Condo One of a kind, separate entrance condo built into an upscale home on the north side. (Owners rarely in residence) This home is located in a quiet, upscale-gated community, with panoramic views overlooking a small lake and golf course. It is totally turnkey furnished, dishes, linens, cleaning supplies etc. All new appliances, modern decor.

One bedroom (king size bed/rollway for guests) one bath, complete laundry room w/full size wash/dryer and one car garage with extra storage. ALL COSTS ARE INCLUDED! Heat/AC, Utilities/Water, Cable TV, Internet/Wi-Fi, Long Distance phone.

Golf and walking trails right out the door. Close to Holy Family Hospital and Whitworth College. Please call 954-8339 for details.

Also willing to rent "unfurnished.”

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

603 West Sumner Avenue – The Historic Crommelin Home Beautiful 1908 home marvelously and meticulously restored. High ceilings and lots of natural light. 6 bedrooms, 5 bathrooms, office, guest house, elegant kitchen, family room, formal dining, hardwood floors, lovely gardens and more – pristine neighborhood, walking distance to Sacred Heart and Deaconess. If interested before listed on the market, contact Cal Larson (callarson@aol.com tel. 455-3904) MEDICAL OFFICES/BUILDINGS

Good location and spacious suite available next to Valley Hospital on Vercler. 2,429 sq ft in building and less than 10 years old. Includes parking and maintenance of building. Please call Carolyn at Spokane Cardiology (509) 455-8820.

of Spokane, the Northpointe Medical Center offers modern, accessible space in the heart of a complete medical community.

If you are interested in locating your business here, please contact Tim Craig at (509) 688-6708. Basic info: $23 sq/ft annually. Full service lease. Starting lease length 5 years which includes an $8 sq/ft tenant improvement allowance. Available space: *Suite 210 - 2286 sq/ft *Suite 209 - 1650 sq/ft *Suite 205 - 1560 sq/ft *Suite 302 - 2190 sq/ft

For Lease 3700 sq ft of second floor space in a new 18,900 sq ft building available. It is located just a few blocks from the Valley Hospital at 1424 N. McDonald (just South of Mission). First floor tenant is Spokane Valley Ear Nose Throat & Facial Plastics. $22 NNN. Please call Geoff Julian for details (509) 939-1486 or email gjulian@spokanevalleyent.com.

Sublease: Furnished Medical Office Space ~ Need immediate space for one or more north Spokane care providers?

This shared suite is ready for occupancy; all furniture and exam room equipment included. Two exam rooms, one provider office, one nurse’s station and shared surgery suite, medical records storage area, reception and waiting area. 963 sq ft total, original lease $23/sq ft; will negotiate lower rate. Excellent location in a full-service medical building with lab and full radiology services.

For more information, call (509) 981-9298.

South Hill – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting.

Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

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

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

OTHER

Closing OB/GYN practice – For sale 2 exam tables, 1 electric exam table (like new), colposcope, non-stress test machine, speculums, metal filing cabinets, office supplies, waiting room chairs and bookcases. Call 747-6600 for more information.

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POSITIONS AVAILABLE OUTREACH CLINIC AT HOUSE OF CHARITY – This is an opportunity to volunteer and bring to the underserved in our community first line medical care. We need one or two more doctors to help us. We see the homeless, predominantly, two afternoons each week. Join four Board MDs and twelve RNs to rotate once or twice monthly in an excellent, well-equipped clinic with pharmacy. If you are completely retired, the state will pay for your medical license and malpractice. For more information and to sign up, call Dr. Arch Logan, Medical Director, at (509)326-0255 or Ed McCarron, Director of the House of Charity, at (509)624-7821.

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

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

PEDIATRIC HOSPITALISTS OPPORTUNITIES - If you would like the opportunity to participate in the growth of our pediatric services at Deaconess and Valley Medical Centers, please consider joining our multi-disciplinary team. We need two more pediatric hospitalists to complete our team and participate in a flexible schedule. You will be working with nurses with many years of pediatric expertise. You will be part of a team of hospitalists providing 24-hour coverage/365 days per year. Please contact Evelyn Torkelson Director, Physician Recruitment, at torkele@empirehealth.org for more details.

EASTERN STATE HOSPITAL PSYCHIATRIST - ESH is recruiting for a psychiatrist. Joint Commission accredited, CMS certified, state psychiatric hospital. 287 beds. Salary $161,472 annually with competitive benefits and opportunity for paid on-call duty. Join a stable Medical Staff of 30+ psychiatrists, physicians and physician assistants. Contact Shirley Maike, 509.565.4352, email maikeshi@ dshs.wa.gov. PO Box 800, Medical Lake, WA 99022-0800.

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

URGENT CARE POSITION – First Care Med Centers has four Urgent Care locations in Spokane, WA. We are seeking a Board Certified physician with comparable Urgent Care experience for a full-time position. Excellent salary and benefits package with flexible work schedule - 12-hour shifts and no call. Please contact Evelyn Torkelson at torkele@empirehealth.org or (509)473-7374.

SPOKANE REGIONAL OCCUPATIONAL MEDICINE (SROM) has an opportunity for a physician. Our treatment approach takes a comprehensive view that encompasses the medical, psychosocial and functional outcomes of the injured worker and follows best practices as defined by Washington State L&I’s Center of Occupational Health and Education (COHE). SROM is affiliated with Valley Hospital and Medical Center, Deaconess Medical Center and Rockwood Clinic. This affiliation provides exceptional administrative support, offers state of the art diagnostic

services’ improving our ability to diagnose and treat, and a referral system that is unmatched. For more information contact Evelyn Torkelson, physician recruiter at (509)473-7374 or email at torkele@ empirehealth.org.

QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Family Practice, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy.

The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Gia Melkus at 1-800-260-1515 x5366 or email gmelkus@ qtcm.com or visit our website www.qtcm.com to learn more about our company.

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

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

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

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

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

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

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St. Luke’s Rehabilitation Institute Information Resource Management (IRM) Northwest MedStar Northwest TeleHealth health@workTM Community Health Education & Resources (CHER) Center of Occupational Health & Education (COHE)

At INHS collaboration drives everything we do.

Through innovative health care technology, education and patient care solutions, INHS is reaching out to the region and creating tomorrow’s health care − today.

Health Training Network Northwest MedVan Spokane MedDirect Center of Philanthropy

Inland Northwest Health Services (INHS) is a non-profit corporation in Spokane, Washington providing collaboration in health care services on behalf of the community and its member organizations Providence Health Care and Empire Health Foundation.

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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

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Spokane, WA Permit No. 512

ADDRESS SERVICE REQUESTED

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