The Message September 2010

THE

message A MON T HLY N E WS M AG A Z IN E OF SCMS – SEP T E M BER 2010

How Physicians Govern and Organize Their Practices

By Gary Knox, MD SCMS President

The Patient Centered Medical Home Ethics and Professionalism at the AMA GME Growth

SPOKANE COUNTY M EDICAL SOCIETY

2010 Board of Trustees Gary Knox, MD President Brad Pope, MD President-Elect Terri Oskin, MD Vice President Anne Oakley, MD Secretary-Treasurer J. Courtney Clyde, MD Immediate Past President Louis Koncz, PA-C Position 1 Keith Kadel, MD Position 2 Michael Cunningham, MD Position 3 David McClellan, MD Position 4 Paul Lin, MD Position 5 Michael Metcalf, MD Position 6 Gary Newkirk, MD Position 7 Carla Smith, MD Position 8 Vacant Position 9 David Bare, MD Position 10 Keith Baldwin, MHA Chief Executive Officer

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

President’s Message: How Physicians Govern And Organize Their Practices . . . . . . . . . . . 1 CME 2010 Program Schedule. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Patient Centered Medical Home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 In The News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Healthcare Reform And Project Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Public Medicaid Option. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Graduate Medical Education Summit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Ethics And Professionalism At The AMA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Meaningful Use Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Medical Education Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Medical Referral Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Physician Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Inland Northwest Medical Group Management Association . . . . . . . . . . . . . . . . . . . 16 GME Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Meetings & Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 New Physicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Membership Recognition For September 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Classified Ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Spokane County Medical Society Message Brad Pope, 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: Jeff Akiyama 518 S. Maple Spokane, WA 99204 509-325-0701 Fax 509-325-3889 jeff@quisenberry.net

"Whosoever desires constant success must change his conduct with the times."

NICCOLO MACHIAVELLI

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.

November SCMS Message Open3

President’s Message: How Physicians Govern and Organize Their Practices With all this talk recently about Accountable Care

The Patient Centered Medical Home (PCMH) has been written about and discussed extensively. Simply put, it is an enhancement of primary care that puts an emphasis on access to a personal provider who works in a team environment to coordinate care for the patient through the use of an electronic record, quality measurement and disease registries, health coaching, enhanced communications with patients such as secure email and interactive patient web portals, and use of evidence based

Organizations (ACOs) in the Message, WSMA publications, trade

clinical guidelines. Essentially, its focus is on improved service

publications and emails, one would be tempted to assume that

and along the way there is better quality and coordination of

we all understand what we are talking about when we mention

care. The PCMH differs from an ACP on that in the PCMH there

ACOs. But I find that many physicians who are busy every day

is no accountability for performance in a risk-based payment

caring for their patients need some explanation when it comes to

system. Medical homes have been shown to reduce ER and

understanding the concept of the ACO. Although there is not a

hospitalization costs, but those are not integral components of

unified definition yet for an ACO, it is starting to take shape.

the PCMH. The Medical Home is a very important, and some

This month I will attempt to give some framework and reference

would say necessary, component to have at the center of the

for understanding the basic concept behind the ACO idea, and

ACO, but it is not sufficient by itself to qualify as an ACO without

put it into perspective in contrast to our current fee for service

that commitment and focus on managing the cost of care as well

system. I will do so by asking and attempting to answer briefly

as the quality of service and care.

three questions: What is an Accountable Care Organization?

What is the difference between an ACO and a Patient Centered Medical Home? And, How will ACOs reduce health care spending?

Much of my information comes from a publication by the Center for Healthcare Quality and Payment Reform (1), along with the excellent review by Bob Perna, Director of the WSMA Practice Resource Center, which is available on the WSMA website.

An Accountable Care Organization is an organization that is built around effective primary care, is able to manage and coordinate patient care, manages financial risk associated with the costs of patient care and is able to measure and manage cost and quality in a valid way. Medicare defines an ACO as “an organization of health care providers that agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it.” This requires a culture of teamwork, coordinated relationships with specialists and a system of accountability for operations and attention to quality.

Leadership must be committed to improving value as a top priority. It is not necessary to have a hospital as part of an ACO, but it is advantageous to have a hospital associated with it if the hospital is committed to the same goals as the ACO, since one of the goals is a reduction in ER visits and avoidable hospitalizations.

Integrated deliver systems made up of hospitals, primary care, specialists (non-primary care), and possibly health plans, may be the ideal ACO if they are truly integrated clinically and not just corporately. It is probably not necessary for there to be corporate integration between primary care and other specialists. However, it is necessary to have coordinated relationships between the groups and with the hospitals. It’s easier said than done if there is not some shared risk.

September SCMS Message 1

Continued on page 5

SPOKANE COUNTY MEDICAL SOCIETY CONTINUING MEDICAL EDUCATION 2010 Program Schedule SEPTEMBER Moderate (Conscious) Sedation and Analgesia Thursday, September 30 Deaconess Health and Education Center 5:30 – 9:15 pm (SCMS’ annual program to satisfy JCAHO requirements and provide a refresher course to members of the medical community in order to increase patient safety.)

NOVEMBER Infectious Disease Update 2010 Wednesday, November 3 Deaconess Health and Education Center 5:30 – 9:15 pm (Three one-hour topics will be presented)

The Patient Centered Medical Home With a vision to improve patient access, care coordination and practice redesign, the Spokane Veterans Affairs Medical Center (VAMC) began our transformation to a Patient Centered Medical

medical appointments and in the near future secure messaging appointments with the primary care provider.

The second process being implemented is optimizing the

Home (PCMH) in April of 2010. This program will soon be VA-

workload for the teams. The goal is to reduce administrative

wide and Spokane was one of the first pilot sites and is leading

workload encounters for the primary care provider by shifting

the way on this new initiative. The simplified version of the

appropriate workload to other members of the care team who are

Spokane VA’s implementation plan involves two levels of changes:

working at the top of their licensure.

Several facility education sessions have been completed

behavior changes and process changes.

Behavior changes are targeted towards staff and Veterans

to raise awareness of this program to include Directors Staff

and include: Emphasis for behavior change directed towards

meetings, Quality Improvement Poster Fair, Primary Care and

staff includes values coaching to transform from a culture of

Community Based Outpatient Clinic Staff meetings and Medical

accountability to one of ownership and self-motivation and emphasis

Services Staff meetings.

for behavior change directed towards Veterans includes learning to

System redesign involving workflow processes is underway.

As a result, several processes will be changed to improve the

interact with a dedicated team and self-ownership of care.

Process changes are categorized under three pillars: access,

key elements of PCMH. For example, the completion of time

practice redesign and care coordination. It is estimated that

sensitive behavioral health screenings has improved since efforts

greater than 200 process changes will be implemented over the

at system redesign have been implemented.

next several years as we complete our rollout into this new model.

Leadership is working with Human Resources and Fiscal

The Spokane VAMC has already rolled out two teams under the

Services to ramp up Primary Care support staff to achieve a 3:1

new PCMH model. Support staff for each PCP will increase from

support-staffing ratio per teamlet for full implementation during

two to three additional staff members assuming a 1,200 patient

Fiscal Year 2011. Additionally, executive leadership has been in

panel. Next step involves expanding the PCMH culture to six

the forefront by transforming our culture along with us. Once

additional teams. Full implementation will involve rolling out a

this program is fully implemented, we hope to see continued

total of 18-20 teams.

improvements in access, quality and satisfaction with our veteran

The first process being implemented is shaping the demand

population and staff.

for traditional face-to-face appointments with the Primary Care Provider (PCP) by 30%. This is being accomplished via call

Sunil Wadhwani M.S., Pharm.D

center changes to triage demand for PCP appointments and

Acting Associate Director, Chief of Pharmacy

offering non-traditional options like phone appointments, shared

Spokane Veterans Affairs Medical Center

September SCMS Message 3

simply opposite. It will take time for these changes to take shape,

President's Message continued from page 1

and payment systems will vary from region to region, and from In order to save health care dollars through implementation

payer to payer. Each physician practice and organization will need

of ACOs there will need to be payment reform. This goes way

to weigh the impact of these changes and what they might mean

beyond the old capitation system which was strictly based on the

to their organization. Better definition of how best to collaborate

goal of reduced utilization of services. There was no meaningful

or join together will need to take place.

emphasis on evidence and quality in capitated systems. What is

Ultimately to whom are the Accountable Care Organizations

being discussed for payment to ACOs varies: global payment for

accountable? To a degree they will be accountable to payers

care of a population for a set period of time vs. shared savings

because if there are savings, the payer sill benefit. But, at the

if there is a reduction of costs while maintaining or improving

end of the day the ACOs are accountable to the individuals and

quality and patient satisfaction based on agreed upon metrics, vs.

businesses who purchase health insurance and to the patients

hybrid systems that break out outpatient and impatient costs and

who are cared for with more attention to value, as defined as the

pay for them in different ways and combinations of all of these. To

right service at the best quality for the lowest cost. I think we may

some degree I suspect there will be reduction of services, but I

be on the right track. Time will tell.

hope that will occur through better coordination of care resulting in reduced ER visits and avoidable hospitalizations, and through

“How to Create Accountable Care Organizations,”

accountable use of high tech imaging and medication prescribing

www.CHQPR.org

based on best practices and evidence. There will most likely be many different ways to do this, but one thing is pretty clear: it

Gary Knox, MD

won’t work under traditional fee for service. The incentives are

SCMS President

Online death filing starts early 2011...enroll now!

In The News

The Washington State Department of Health is releasing a new

Hospice of Spokane announces new board member Hospice of Spokane is proud to announce the election of its newest member to the Board of Trustees, James Bingham, MD. Dr. Bingham has more than twenty years of experience in healthcare. He joined Group Health Permanente Medical Group in 1984 and specializes in family medicine at Group Health’s Riverfront Medical Center.

“Dr. Bingham is a wonderful addition to our Board of Trustees,” said Gina Drummond, RN, MSN, Hospice of Spokane’s CEO. “He is a respected leader and treasured family doctor whose skill and experience will greatly benefit Hospice of Spokane and the community.”

Dr. Bingham graduated from the University of Washington’s Medical School in 1981. He completed his family medicine internship and residency at Providence Medical Center in Seattle, WA in 1984.

online Electronic Death Registration System (EDRS) to Pierce, Thurston, Mason, Benton, Franklin and Spokane counties in early 2011, with a statewide release to follow. EDRS is an internetbased death filing system for those who file death records in Washington State. EDRS streamlines the death registration process, improves the quality of the death data collected, improves communication among those who file, and uses the internet to make filing faster.

To enroll or request more information, contact Field Services at 800-525-0127 or EDRS@doh.wa.gov.

August 2010 edition of the Washington Healthcare News available at www.wahcnews.com Articles include, "Accountable Care Organizations and the Future of Healthcare," written by Chris Rivard and Chris Pritchard of the Moss Adams Health Care Group and the summary financial results for the largest 40 Washington hospitals 2009 and 2008.

Among the highlights of the summary: UÊ 39 of the 40 hospitals increased operating revenues in 2009 UÊ 37 of the 40 hospitals reported positive operating margins in 2009 UÊ 36 of the 40 hospitals reported positive total margins in 2009

Continued on page 22

September SCMS Message 5

good alternative to low income workers, was scaled back because

Healthcare Reform and Project Access

the State could no longer afford to subsidize the plan for lowincome workers. In the near term in Washington State, access to healthcare has diminished. In the long run, there will be less

We are asked frequently how the Federal Healthcare Reform will affect

people without health insurance, but still many people will still “fall through the cracks.”

Project Access programs. The quick

Because of this, there will always be a part of the practice of

answer is providing better access to

medicine that involves charity care. Physician volunteerism has

healthcare to more uninsured people is

gone on forever, and will go on well into the future. As to the

still years away. The pathway to achieve

future of Project Access, each community based Project Access

the goal of covering 32 million more

program will continue to evolve to meet the current healthcare

people is yet to be defined. At this time,

access needs of their community. As an example in Spokane, the

the biggest issues we are facing are

SCMS Project Access is assisting regional dentists in forming a

working people and small employers who struggle to afford the

dental Project Access delivery model. Our overarching goal is to

cost of health insurance. This issue has been greatly exacerbated

eliminate health disparities in medically underserved populations

as a result of the global economic meltdown. The US is unique

due to lack of access to healthcare services. Therefore, there will

in that, with health insurance typically tied to employment, the

always be a need in our community for the services our volunteer

consequence of job lose is also loss of healthcare. With a 10%

physicians and hospitals donate to low income individuals. Thank

unemployment rate, more people are without coverage, and

you for supporting Project Access patients – you are helping build

seeking medical services. Project Access is seeing a large influx of

a healthy productive community.

newly unemployed or self-employed people out of work, applying for services. Demand is up just at a time when public resources

John Driscoll

are down. The Washington State Basic Health Plan, which was a

Project Access Executive Director

September SCMS Message 6

Public Medicaid Option The news after the Patient Protection and Affordable Care Act (PPACA) passed was that the PPACA would eliminate the problem of the uninsured and there would be no public option. I believe the news was wrong on both accounts.

The Congressional Budget Office projects a huge increase in state plans starting in 2014. As we get closer to 2014, these projections will surely be revised to show much more extensive increases in enrollment into the state plans. Here is why.

The PPACA calls for extensive and burdensome new insurance regulations that will cause many people to lose their insurance.

These regulations include: No dollar lifetime maximum Restrictions on annual limits Preventative care with no cost sharing No pre-existing condition exclusions for enrollees under age 19 Medical loss ratios capped at 80% for individuals and 85% for group plans.

Premiums will rise 30-40%; causing many to be priced out of the market. Medical loss ratio caps will make individual and small group markets very unprofitable for health insurers. In addition, many small employers will discover that the fine for not insuring their employees is far less than paying inflated health insurance premiums; even with whatever subsidies are available.

Sadly, the state simply will not be able to afford the huge number of individuals that will be trying to enter the state plans.

Federal funds will never be sufficient. The state will be forced to ration enrollment, just as it does now with Basic Health.

We will have a public option. It will be a public Medicaid option and the problem of the uninsured will remain.

Rodney L. Trytko, MD, MBA Past President SCMS

High-risk pools and insurance exchanges will both be administered by the state. The OIC recently published the list of pre-existing conditions that is very extensive. Almost anyone can qualify. The exchanges, according to some, were modeled after the Washington Basic Health Plan. While Basic Health originally paid commercial rates, it rapidly transitioned to Medicaid rates.

So in 2014, the PPACA will likely move most of the currently uninsured (50 million), all current individual market participants, and many of those currently insured by their employer into state plans. Current Basic Health, high-risk pool and Medicaid participants will simply stay in the state plans. Physicians and hospitals will likely be paid Medicaid rates for all state plans.

SCMS is interested in assisting our members to participate more actively in key community leadership roles. If you become aware of an open board, a or advisory committee position please notify Michelle Caird at (509) 325-5010 or my email at michelle@spms.org.

September SCMS Message 7

Ethics and Professionalism at the AMA

GRADUATE MEDICAL EDUCATION SUMMIT Paul Ramsey, MD CEO, UW Medicine Dean, UW School of Medicine

WHAT DO PRACTICING PHYSICIANS THINK ABOUT “ENHANCEMENT”?

What role medicine should play in providing interventions for enhancement has been a question of considerable interest in recent years, but debate has been largely at the level of

Invites medical and community leaders to discuss key issues in expanding GME in the region.

theory and hasn’t given much attention to empirical data or the perspectives of practicing physicians. To understand physicians’ views and experience, the AMA’s Institute for Ethics deployed a survey asking doctors how often they felt their patients asked them to prescribe enhancements and how often they feel they’re

October 15, 2010 – Friday 8:00 a.m. – 4:30 p.m.

Spokane Riverpoint Campus

prescribing medicine for that purpose.

One thing survey responses suggest is that a majority of physicians think it’s possible to distinguish medicine used for enhancement from medicine used for therapy—but they don’t always agree on where to draw that line. More than threequarters of respondents agreed that interventions that give

For information email wwamigme@uw.edu or call (509) 358-7640

individuals a non-medical advantage should be thought of as enhancement. More than 80% agreed “medicine that makes Continued on page 18

September SCMS Message 9

David Blumenthal, M.D., M.P.P., the national coordinator for

Meaningful Use Update

health IT within HHS, has acknowledged the obstacles faced by

The American Recovery and Reinvestment Act of 2009, or ARRA, is intended to increase the adoption and use of health information technology. Swift changes and updates to rulings pose a challenge to physician practices and hospitals to stay informed and to take advantage of possible financial and technical support that may be available to implement health IT systems.

Included in the ARRA is Health Information Technology for Economic and Clinical Health (HITECH) which focuses on promoting the adoption of health IT among hospitals, physicians and other health care providers. HITECH authorized $2 billion for several programs to spur health IT use, including a Beacon Community program, a health IT workforce program and a health IT extension program.

HITECH also provides incentives under both Medicare and Medicaid for physicians and other health care providers who meet "meaningful use" criteria. On July 13, CMS issued a final rule defining the meaningful use objectives that must be met to qualify for the financial incentives. (http://www.cms.gov/ EHRIncentiveprograms/)

small physician practices and says that the regional extension centers are geared toward small physician practices.

It is important for providers to stay abreast of the swift changes. Several opportunities exist locally.

The upcoming Northwest Medical Informatics Symposium (NMIS) addresses opportunities and challenges for providers. It is a place for office managers and interested providers to hear from national experts about Meaningful Use and the Beacon Community of the Inland Northwest. The conference is on September 15 and 16 at the Davenport Hotel in Spokane and is sponsored by Inland Northwest Health Services (INHS) and the eHealth Iniative (eHI). Visit www.nmis.info to register on-line and to view the agenda.

Prior to NMIS, there will be a Beacon Community of the Northwest (BCIN) meeting on September 14, 2010 at 4-5:30 p.m. in the Pennington A Ballroom at the Davenport Hotel. Topics include design of the BCIN program, based on decisions that have been made to date regarding care coordination and health information exchange and evaluation. To RSVP call 232-8148.

Jac Davies Director of Beacon Communities of the Inland Northwest

WE DEAL WITH INSURANCE COMPANIES... SO YOU DON’T HAVE TO

Payer Contracts . Fee Schedules . Audits . Claims Disputes . Revenue Recovery Denials Management . Credentialing . Compliance . Coding . Professional Discipline JEFF COOPERSMITH - jeff@coopersmithlaw.com Former Chief Counsel and Director of Enforcement, Office of the Insurance Commissioner

DWIGHT JOHNSON - dwight@coopersmithlaw.com Former Assistant Director of Provider Contracting, Regence BlueShield

September SCMS Message 10

(206) 343-1000 . www.coopersmithlaw.com

Medical Education Update Let me introduce myself and why I am writing about medical education - my name is Suzanne Allen. I’m a family physician in Boise, Idaho where I have been a faculty member at the Family Medicine Residency of Idaho (FMRI) for the last eleven years. I continue to see my patients and teach there as well as serving as the Designated Institutional Official for FMRI. I also am currently one of the members of the family medicine residency review committee. Prior to moving to Boise, I spent seven years on active duty in the Air Force; the last several of which I was faculty at the family medicine residency program at Andrews AFB and where I helped start the combined family medicine/psychiatry residency program in the National Capitol Area. Currently, I am the Vice Dean for Regional Affairs for the University of Washington School of Medicine. In that role, I work closely with Drs. Deb Harper, John McCarthy, Ken Roberts and Andrew Turner who oversee the WWAMI program in Spokane and eastern Washington.

Together, we are working to increase opportunities for medical education on the eastern side of the state recognizing that there is significant need and potential for growth.

These are interesting times in medical education at the national and local level. In 2005, the Association of American Medical Colleges recommended that all medical schools should expand by 15% to meet the physician workforce needs of the nation.

Washington expanded the number of medical student positions in the state by 17% by starting the WWAMI Spokane first year regional campus in 2008 with twenty students. WWAMI Spokane is currently preparing for the third entering class this year and as a result there will be more students in Spokane for their third year clerkships than ever before.

Expansion of undergraduate medical education alone does not produce more physicians. If graduate medical education (GME), commonly known as residency and fellowship training, does not

As an example, when the specialty of family medicine was founded in 1969, the requirements for a new program fit on three pages! The requirements now are thirty-nine pages and that doesn’t include the institutional requirements. The Accreditation Council on Graduate Medical Education (ACGME) oversees all residency and fellowship training. There are residency review committees as part of the ACGME which oversee the accreditation of residency programs in a given specialty.

Residency and/or fellowship must be completed to take the board certification for a given specialty. There are currently 24 different specialty boards which are part of the American Board of Medical Specialties. These specialty boards set the standards for initial board certification and maintenance of certification in a given specialty.

The financing of GME has also changed over the years.

Prior to the passage of the Medicare legislation in the 1960’s, individual hospitals paid a physician to be a resident and work at the hospital. Many of these physicians lived at the hospital (thus they were “interned” at the hospital). As medical schools were expanding in the 1960’s to meet the projected physician workforce needs, there was language included in the Medicare legislation to help hospitals finance the increased number of physicians training at a given hospital. This was accomplished by the federal government paying the hospital to cover the cost of salary and benefits for each resident as well as indirect costs of training a resident (such as longer patient stays at the hospital, teaching time, etc). With the balanced budget act of 1997, the number of resident physicians the federal government will help finance under the Medicare legislation was frozen. Since this happened, the number of GME positions has not expanded at the same rate as the number of undergraduate medical education positions. Producing more graduates of medical schools does not increase the number of practicing physicians unless those graduates also complete a residency program.

expand, the nation will still be producing the same number of practicing physicians as it was in 2005. With that in mind, GME in Spokane and eastern Washington needs to expand to help meet the local physician workforce needs.

The current structure for GME developed over the last sixty years with the drive for physicians to specialize starting at the completion of World War II. Since that time, there have been many new specialties and sub-specialties developed. There has also been more regulation and standardization of GME training.

The requirements for a resident to graduate from a residency program have grown.

September SCMS Message 11

Continued on page 14

Medical Education continued from page 11

If the goal is to increase the physician workforce to improve the health of the

As UWSOM looks at further expansion

citizens of eastern Washington, then

of undergraduate medical education in

GME must expand to meet the workforce

eastern Washington and more specifically

needs. For GME to expand there must be

Spokane, graduate medical education

a way to finance the residency programs,

must expand as well. It is currently

there must be physicians willing to teach

estimated there will be more medical

and citizens willing to be the patient’s of

students graduating from medical

the residents. I look forward to engaging

school than there are first year residency

the physician community in Spokane

positions in 2013. Currently, there are 23

and eastern Washington in working to

first year positions for residents in family

accomplish this goal. Your help is needed

medicine, internal medicine and radiology

as well as the community’s to create the

in eastern Washington. (There are also

necessary “culture of medical education”

18 preliminary year positions but these

in Spokane and eastern Washington to

physicians must then have a residency

make this a reality.

position elsewhere to become board

We’ll come to you because we care.

Please contact the WWAMI Spokane

certified in a specialty such as anesthesia

office at 509-358-7794 if you are

or dermatology.) There are currently not

interested in helping create the culture of

enough residency positions for each of

medical education.

the 40 medical students who do their first year in eastern Washington to have a

Suzanne Allen, MD, MPH

residency position in eastern Washington.

Vice Dean for Regional Affairs with UWSOM

“For over 40 years we’ve provided the best home healthcare to the Inland Northwest, and today we're ranked as one of Medicare's elite agencies in the country. No wonder over 95% of our clients

Medical Referral Line One of the many benefits the

would recommend us. Call We are in need of more physicians to

me personally to see why

Spokane County Medical Society offers

whom we can refer patients. Wouldn’t

we're the right choice for

to its physician-members is our Medical

you like to be part of this service,

you and your clients."

Referral Line. This service allows SCMS

which assists both the physician and

staff to support area medical practices

the patient? Is your practice able to

by providing names of physicians

accept new patients? If so, please let us

accepting new patients to community

know by calling 325-5010, and we’ll fax

members who are searching for a

you a Medical Referral Update form to

physician. Our sincere thanks to those

complete and return.

of you who are already members of our Medical Referral Line!

– Mike Nowling President Family Home Care

We welcome physicians in all specialties, but our greatest need is for primary care physicians – especially those who accept Medicare and/or Medicaid!

Call Today 509.473.4900 www.familyhomecare.org September SCMS Message 14

Physician Opportunities PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Family Physicians (no OB) 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: April Mayer, April.

Mayer@providence.org, (509) 474-6609, www.providence.org/physicianopportunities.

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: Pat Isakson, Pat.Isakson@providence. org, (509) 474-6604, www.providence.org/physicianopportunities.

SWEDISH seeks a PRIMARY CARE PHYSICIAN for new Cle Elum Clinic. The ideal candiadate will be a Primary Care Provider, BC/ BE in Family Prractice or Internal Medicien. The physicin will lead an innovative care team model in a brand new clinic facility serving communities of Cle Elum, Roslyn, Ronald and Ellensburg.

Autonomy over practice/Generous compensation/Excellent Benefits and retirement/Innovative care models. For more information email your CV to Aaron Bryant, Physician Recruiter for Swedish Physician Division, at aaron.bryant@swedish.org or call 206-320-5925.

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) 325-0255 or Ed McCarron, Director of the House of Charity, at 624-7821.

PHYSICIAN OPPORTUNITIES AT CHAS – At Community Health Association of Spokane (CHAS), we believe doctors should practice what they are passionate about: serving patients and the community. We are looking for physicians to join our great team!

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. Experience pure patient care at CHAS. To learn more about physician employment opportunities, contact April Gleason at 509-710-8046 or agleason@chas.org.

PROVIDENCE PHYSICIAN SERVICES is recruiting for BE/BC Med-Peds physicians 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) 474-6605, www.providence.org/physicianopportunities.

New Clinic Opening Soon in Northeast Spokane - Yakima Valley Farm Workers Clinic is growing! We will be opening our new clinic early next year and we are looking for two physicians (FM, FM/ OB, IM/Peds) to join our dedicated team of providers. If you have a passion for working with the underserved, we would like you to consider becoming a member of our team. We offer competitive compensation, a generous benefits package, a hiring bonus/ relocation, a great work/life balance and a monthly stipend for 3rd year residents. Yakima Valley Farm Workers Clinic (YVFWC) is the largest community health center in the Pacific Northwest. We are dedicated to providing our patients with the highest quality care and offer them affordable health care options. YVFWC is the largest community health center in the Pacific Northwest. It provides comprehensive medical, dental and social services in over 17 Pacific Northwest communities. Our mission celebrates diversity. We are committed to equal opportunity employment.

Apply online at www.yvfwc.org or contact Tanya Gutierrez, Provider Recruiter via email at tanyag@yvfwc.org or call 1-877-983-9247 for more information.

September SCMS Message 15

Inland Northwest Medical Group Management Association

of the annual local medical office salary survey. The annual membership fee of $70.00 covers the ten monthly educational lunch meetings, plus a summer and winter social. At less than $6.00 a month the return on investment is extraordinary! If your manager is not a member of the INMGMA or if you would like more information about joining the INMGMA, please contact

Are your managers members of the Inland Northwest Medical

our Membership Coordinator Marsha Pinat at (509) 466-6393

Group Management Association (INMGMA)? If not, your clinic

ext. 22 or marsha@orthospecialtyclinic.com or contact our

may be missing out on excellent local healthcare management

2010 President Robert Hartnett at (509) 363-3100 ext. 126 or

resources. In 1971 regional medical office managers founded

rhartnett@spineteamspokane.com.

the INMGMA to provide a local venue for meetings of interest to its members. Our core purpose is to improve the effectiveness of medical group practices and the knowledge and skills of the individuals who manage them. We engage local speakers to hold ten educational sessions per year on relevant healthcare management topics. Topics have ranged from improving the collections process, how to create effective teams, human resource law changes, and ensuring a secure IT network.

Members are able to access a wealth of knowledge from their peers within the community, enhancing their skills in managing your practice. Members also participate and receive the results

September SCMS Message 16

As always, those of us involved in education need support

GME Growth

as we look at this mountain to climb. There are a number of

Earlier the summer, a task force was convened to address the development of GME (resident and fellowship) opportunities in Eastern and Central Washington. In part, this was commissioned by the UWSOM to address the disparity in distribution of GME slots East and West of the Cascades (100 and 1550 slots respectively). GME slots are an expensive endeavor and literally take an “Act of Congress” to change funding mechanisms for if there is to be a transition in federal support. As one might imagine, there are a lot of obstacles to changing this distribution of GME slots across the nation and health care reform may or may not play a role in this.

challenges that we need to take on in order to be successful in this endeavor. We believe this community will benefit from all of our support as we prepare to “step up to the plate”. We ask that you keep in mind how you personally could help in the transition of Spokane into a leader in Medical Education within the state.

If you would like more information about GME growth, or how to engage in medical education, please contact John McCarthy MD at mccaj@uw.edu or 358-7795 John McCarthy, MD WWAMI Clinical Coordinator – Eastern & Central Washington

Nonetheless, Eastern Washington continues to have a relative dearth of training positions. There is a clear positive correlation between residency training sites and where physicians ultimately choose to practice. It is clear that this community benefits from our residencies adding colleagues to our rosters. With that in mind, it would behoove all of us to work to bring GME opportunities to this community.

In Memoriam

Morris Everett Fuller, MD

This will allow and enhance training of medical students and strengthen our depth of resources inevitably benefitting our

On July 20, 2010, Morris Everett Fuller passed away.

community. Simply put, this is the right thing to do and the

Elisabeth, his wife of 46 years, was by his side. He was born

timing is correct from a planning perspective (growth of Graduate

in Schenectady, New York on October 10, 1917 where he

Medical Education while attempting to grow Undergraduate

grew up. In 1939 he graduated from Union College with his

Medical Education). Unfortunately, the financial environment

BA in science. He completed medical school at Syracuse

is tenuous at best as we explore what this region would most

University in 1943. During WWII he was in the US Army

benefit from.

in the Medical Corps from 1946 to 1949. He completed

The planning community is addressing the needs and

his American Board of Surgery prep at Gorgas Hospital,

resources of the region and is attempting to complete a

Panama. From 1950 to 1966 he was a dedicated Christian

thoughtful analysis of what can realistically be added to our

medical missionary in Ecuador with his wife, a registered

region. There has been discussion of enhanced residency

nurse. In 1966 to 1981 he practiced general surgery in

training in Family Medicine, Internal Medicine, Psychiatry and the

Whittier, California. He continued part time mission work

potential for residency training in specialties such as Pathology,

from 1981 to 1990. Dr. Fuller moved to Spokane and

Anesthesiology, Emergency Medicine, Surgery, Obstetrics/

worked at Franklin Park Minor Emergency from 1990 to

Gynecology and Pediatrics. Furthermore, there has been

1991 and as a medical consultant for the Washington State

discussion of Fellowship training in Cardiology, Critical Care

Office of Disability Insurance from 1990 until his retirement

and Pulmonology. These are all very preliminary discussions;

in 2008.

however, they illustrate the breadth of interest and depth of need for Eastern Washington.

Dr. Fuller is survived by his wife, Elisabeth; his brother, Curtis; his five remaining children; Nancy Fuller-Boyes and

On October 15, Paul Ramsey, MD, Dean of the UW School

her husband, Billy; David Fuller and his wife, Tammy; Dan

of Medicine will be convening a summit to address GME in the

Fuller and his wife, Michele; Rick Fuller and his wife, Anne

WWAMI region. Eastern Washington is not the only area that is

and Don Fuller and his wife Shelley; sixteen grandchildren

hoping to grow regional training opportunities and people from

and ten great-grandchildren. He was preceded in death by

the Western Washington, Montana, Idaho and Alaska will be

a son, Larry Fuller and daughter, Susan Fuller.

convening here to create a plan for GME growth.

September SCMS Message 17

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.

Meetings & Events CATEGORY I CME SEMINARS Moderate (Conscious) Sedation and Analgesia: 3.0 Hour(s) of Category I CME credit, sponsored by the Spokane County Medical Society. Conference held on September 30, 2010 at the Deaconess Health and Education Center. Contact Jennifer Anderson at (509) 325-5010 or email jennifer@spcms.org for more information.

2010 Diabetes Professional Symposium: 6.0 Hour(s) of Category I CME credit. Jointly sponsored by the Spokane County Medical Society. Conference held on November 12, 2010 at the Davenport Hotel. Contact Emily Fleury at (509) 232-8139 or email FleuryE@cherspokane.org for more information.

OTHER MEETINGS AND CONFERENCES Latest on Meaningful Use Presented - Leading healthcare reform and meaningful use experts are the featured speakers for this year’s Northwest Medical Informatics Symposium. The symposium brings together leading national and regional experts presenting the latest developments in the health reform debate and the implications of meaningful use for both urban and rural healthcare providers and hospitals. The gathering, presented

by Inland Northwest Health Services in partnership with eHealth Initiative, is scheduled for September 15-16, 2010 in Spokane.

More information, and a list of featured speakers, is available through the symposium website at www.nmis.info.

Caduceus Recovery Group Meeting for Healthcare Professionals – Meets every Thursday evening, 6:15 p.m. – 7:15 p.m., at 626 N. Mullan Rd, Spokane. Contact (509) 928-4102 for more information. Non-smoking meeting for Healthcare Providers in recovery.

Physician Family Fitness Meeting – Physician Family Fitness is a recently created meeting for physicians, physician spouses, and their adult family members to share their common problems and solutions experienced in the course of a physician’s practice and family life. The meetings are on Tuesdays from 6:30 p.m. – 8 p.m. at the Sacred Heart Providence Center for Faith and Healing Building, due east of the traffic circle near the main entrance of SHMC. Enter, turn right, go down the stairs, Room 14 is on your right. Format: 12-Step principles, confidential and anonymous personal sharing; No dues or fees. Guided by Drs. Bob and Carol Sexton. The contact phone number is (509) 624-7320.

FREE CME Course for Rural Physicians on Opioids – Project ROAM: On October 30, 2010 Washington State University and the University of Washington – supported by a grant from the Life Sciences Discovery Fund - will present a free CME course in Seattle that will teach rural physicians and a member of their practice staff how to use Suboxone for addiction. This course will allow physicians to receive legal permission to prescribe the medication.

Questions e-mail Roger A Rosenblatt MD, MPH at rosenb@u. washington.edu, or call 206-685-1361. Space available for only 25 in this inaugural course, so please respond as soon as possible.

and 19% neutral on the question. Responses to other questions

Ethics and Professionalism continued from page 9

suggested that for the most part, enhancement wasn’t a common a person perform better than humans have ever been able

issue in respondents’ practices. Most reported that patients

to perform in the past” is an enhancement. But they were

asked for interventions the physician considered enhancement

pretty evenly divided on whether medicine that doesn’t treat a

no more often than once a month, if at all. 87% said they rarely

recognized disease counts, with just about one-third saying it

offered interventions they considered enhancement rather

does, a third saying it doesn’t, and a third neutral. And while a

than therapy and nearly as many (86%) said they rarely actually

majority (68%) agreed that medicine that makes a person better

prescribed a service or medication they considered to be

than normal for his or her age is enhancement, when asked

enhancement.

whether the same is true of medicine that prevents normal deterioration due to aging respondents were more evenly

Reprinted, with permission, from the AMA Professionalism and

divided—46% agreeing this is enhancement, 35% disagreeing

Ethics Newsletter (July 2010)

September SCMS Message 18

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.

NEW PHYSICIANS Grawe, Glenda H., MD Pediatrics/Pediatric Emergency Medicine Med School: U of Utah (1996) Internship/Residency: U of Wisconsin (1999) Fellowship: U of Minnesota (2006) Practicing with Spokane Emergency Physicians beginning 9/2010 Halaby, Mohsen, MD Internal Medicine Med School: U of Assiut, Egypt (2002) Internship: Kingsbrook Jewish Medical Center (2006) Residency: Kaiser Permanente (2009) Practicing with Sound Physicians beginning 10/2010

Curnow, Alfred J., MD Internal Medicine Med School: Loma Linda U (2007) Practicing with PPS Faculty Hospitalists beginning 9/2010 Falter, Thomas R., MD Anesthesiology Med School: Loma Linda U (2005) Practicing with Physician Anesthesia Group, PS since 8/2010 Georgeson, Keith E., MD Surgery/Pediatric Surgery Med School: Loma Linda U (1969) Practicing with Pediatric Specialties beginning 9/2010 Intzes, Stefanos, MD Pediatrics/Pediatric Hematology/Oncology Med School: Memorial U of Newfoundland (2004) Practicing with Judy L. Felgenhauer, MD, PS since 8/2010 Kruger, Trisha W., MD Urology Med School: Loma Linda U (2004) Practicing with Spokane Urology since 8/2010

Harvey, John P., MD Pediatrics/Neonatal-Perinatal Medicine Med School: Uniformed Services U Health Science (1997) Internship/Residency: Brooke Army Medical Center (2000) Fellowship: Wilford Hall Medical Center (2003) Practicing with Pediatrix Medical Group beginning 10/2010 Mallo, Rebecca D., MD Internal Medicine Med School: U of Washington (2006) Internship/Residency: Internal Medicine Residency Spokane (10/2010) Practicing with Hospital Specialists, LLC beginning 11/2010 Wagner, Mary Kay, MD Pediatrics Med School: U of Texas Medical Branch, Galveston (1984) Internship: U of Texas, Medical Branch, Galveston (1985) Residency: Oregon Health Sciences U (1987) Practicing with Valley Young People’s Clinic since 8/2010

NEW PHYSICIANS PRESENTED A SECOND TIME Aguiar, Alfredo, MD Anesthesiology Med School: U of California, Los Angeles (2005) Practicing with Anesthesia Associates, PS since 8/2010

Lindfors, Dennis P., MD Diagnostic Radiology Med School: Louisiana State U (2003) Practicing with Radia Inc., PS since 7/2010 Miles, Kathyrn M., MD Obstetrics and Gynecology Med School: U of Washington (2006) Practicing with Northwest OB/GYN since 8/2010 Nguyen, Jimmy D. MD Neurology Med School: U of New Mexico (2003) Practicing with Providence Stroke & TIA Center since 8/2010 Patel, Jiten D., MD Internal Medicine/ Pulmonary Disease/Critical Care Medicine Med School: U of the West Indies (2001) Practicing with Deaconess Medical Center beginning 9/2010 Ramey, David B., MD Neurology/Sleep Medicine Med School: St George’s U (2005) Practicing with Kootenai Medical Center since 8/2010

NEW PHYSICIAN ASSISTANT

Burns, Erica M., MD Orthopaedic Surgery Med School: Creighton U (2004) Practicing with Inland Orthopaedics of Spokane beginning 9/2010

Adams, Jessica A., PA Physician Assistant Med School: U of Washington, Medex Northwest (2010) Practicing with Rockwood Kidney and Hypertension Center beginning 9/2010

September SCMS Message 20

Membership Recognition for September 2010

In The News continued from page 5 Recent American Urological Association Appointment SCMS Board member Louis Koncz, PA-C was appointed to the new NonPhysician Provider Education Committee of the American Urological Association at the group’s national meeting in San Francisco. Koncz practices at the Rockwood Urology Center.

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

10 Years Theresa M. Vance, PA-C

9/1/2000

Allen R. Seely, MD

9/19/2000

Craig M. Bone, MD, MPH

9/19/2000

Diane W. McCarthy, MD

9/19/2000

John R. Rowles, MD

9/19/2000

Lynn G. Lagerquist, MD

9/19/2000

Michael R. Leachman, MD

9/19/2000

Neil K. Worrall, MD

9/19/2000

Susan K. Lehman, DO

9/19/2000

Tamara B. Grim, MD

9/19/2000

Physician Health is Important.

Eastern Washington Physician Health Committee We are available to assist you in the following areas: t t t t t t t t t

.BSJUBM BOE 'BNJMZ *TTVFT %FBUI PG 4QPVTF PS 'BNJMZ .FNCFS %SVH "MDPIPM .JTVTF -BXTVJU &EVDBUJPO BOE 4VQQPSU .2"$ 045&0 #PBSE *TTVFT #PVOEBSZ *TTVFT %JTSVQUJWF #FIBWJPS &MEFS $BSF 1SBDUJDF .BOBHFNFOU

ɨJT DPNNJUUFF B GVTJPO PG UIF GPSNFS 4$.4 DPNNJUUFF BOE POF JODMVEJOH NFNCFST PG NFEJDBM TUBĊT PG $PNNVOJUZ )FBMUI 4FSWJDFT BOE 1SPWJEFODF )FBMUI $BSF )PTQJUBMT NFFUT RVBSUFSMZ UP FEVDBUF PVSTFMWFT BCPVU QIZTJDJBO IFBMUI JTTVFT SFWJFX VUJMJ[BUJPO BOE TBUJTGBDUJPO XJUI UIF 8FMMTQSJOH &BSMZ "TTJTUBODF 1SPHSBN &"1 BOE QMBO BDUJWJUJFT QSPHSBNT BOE SFTPVSDFT UP BEESFTT OFFET JO UIFTF BSFBT 4PNF PG UIF HVJEJOH QSJODJQMFT PG UIJT DPNNJUUFF BSF The medical profession and healthcare community should foster physician well-being A sense of community with one’s peers is vital to personal well-being Changes in the healthcare environment and contributing to personal and professional challenges and new stressors for physicians Physicians should have resources available to them to anticipate and manage episodic personal issues

COMMITTEE MEMBERS Jim Shaw, MD, $IBJS Steve Brisbois Michael Metcalf Paul Russell Phil Delich Michael Moore

Robert Sexton Jim Frazier Mira Narkiewicz Patrick Shannon Deb Harper

September SCMS Message 22

Sam Palpant Alexandra Wardzala Mike Henneberry Tad Patterson Hershel Zellman

improvement allowance. Available space:

“A” General Medical Practice or Urgent

*Suite 210 - 2286 sq/ft *Suite 209 - 1650

Care Center space. A Tenant Improvement

sq/ft *Suite 205 - 1560 sq/ft *Suite 302 -

Allowance is Available, subject to terms of

RE AL ESTATE

2190 sq/ft

lease. Floorplans and marketing materials

Luxury Condos for Rent/Purchase near

For Lease 3700 sq ft of second floor space

Hospitals. 2 Bedroom Luxury Condos

in a new 18,900 sq ft building available

at the City View Terrace Condominiums

December 2009. It is located just a few

are available for rent or purchase. These

blocks from the Valley Hospital at 1424

beautiful condos are literally within

N. McDonald (just South of Mission). First

walking distance to the Spokane Hospitals

floor tenant is Spokane Valley Ear Nose

North Spokane Professional Building has

(1/4 mile from Sacred Heart, 1 mile from

Throat & Facial Plastics. $24 NNN. Please

several medical office suites for lease.

Deaconess). Security gate, covered

call Geoff Julian for details (509) 939-1486

This 60,000 sf professional medical office

carports, very secure and quiet. Newly

or email gjulian@spokanevalleyent.com.

building is located at N. 5901 Lidgerwood

Classified Ads

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.

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

Priest Lake Waterfront Cabin for Rent--

area, reception and waiting area. 963

Beautiful 2 story cedar cabin "The Water's

sq ft total, original lease $23/sq ft; will

Edge" on the East Shore--Sleeps 8-10.

negotiate lower rate. Excellent location

Spectacular lake and mountain views, dock.

in a full-service medical building with

See it at www.getlostatpriestlake.com or call

lab and full radiology services. For more

1-208-443-2100 or 1-877-443-LAKE.

information, call (509) 981-9298.

MEDICAL OFFICES/BUILDINGS

can be emailed upon request. Please contact Patrick O’Rourke, CCIM with O’Rourke Realty, Inc. at (509) 624-6522 or cell (509) 999-2720.

Email: psrourke@comcast.net.

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. Floorplans 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,

South Hill – on 29th Avenue near

with O’Rourke Realty, Inc. at (509) 624-6522

Southeast Boulevard - Two offices now

or cell (509) 999-2720.

available in a beautifully landscaped setting.

Email: psrourke@comcast.net.

Good location and spacious suite available

Building designed by nationally recognized

next to Valley Hospital on Vercler. 2,429

architects. Both offices are corner suites

sq ft in building and less than 10 years

with windows down six feet from the ceiling.

old. Includes parking and maintenance of

Generous parking. Ten minutes from Sacred

building. Please call Carolyn at Spokane

Heart or Deaconess Hospitals. Phone (509)

Cardiology (509) 455-8820.

535-1455 or (509) 768-5860.

Northpointe Medical Center Located

Indian Trail Professional Building has

owners, light use. Excellent condition,

on the North side of Spokane, the

medical space available for lease. A

maintained by SHMC engineering.

Northpointe Medical Center offers

11,243 sf professional medical / office

Original $22,000 – listed at $12,495

modern, accessible space in the heart of

building located in the growing Indian Trail

on E-Bay, asking $8,000 or best offer.

a complete medical community. If you

Community directly across from the new

Cast saw $125. Two antique wooden

are interested in locating your business

Sundance Shopping Center. Address is

exam tables $200 each. Call Melissa

here, please contact Tim Craig at (509)

5011 W. Lowell Ave or the SWC of Indian

Sousley, MD at (509) 953-4299 or email

688-6708. Basic info: $23 sq/ft annually.

Trail and Lowell Avenue, Spokane, WA. The

onedocmom8@aol.com.

Full service lease. Starting lease length

main floor space located off of the main

5 years which includes an $8 sq/ft tenant

floor entrance consists of 4,389 sf of Class

September SCMS Message 23

OTHER Quinton Q4500 Stree Testing Combination, including treadmill, recording paper, electrodes, two solo