WINTER 2016 president’s message
Embracing change; focus on core goals and value Annual Meeting Update.............2 Annual Mole Bowl Competition...................................4 Factoid............................................5 Donations Needed......................5 Survivor: CMS vs Physicians.....6 PAD at PAMED HOD Meeting...........................................9 Residency Program Corner.....10 ADD/Pfizer Grants Award......... 11 Legislative Update..................... 12
By: Glen H. Crawford, MD It has been my distinct pleasure to serve as president of the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) in 2016. This newsletter summarizes many of the outstanding accomplishments of our society over the past year. As the medical landscape continues to evolve rapidly, we strive to provide our members with value through our core strategic goals of education, advocacy and member engagement. Please see the PAD mission chart on page 15. The highlight of our educational program, our annual meeting, was held at The Omni Bedford Springs Resort in September. Meeting Chair, Lorraine Rosamilia, MD, and her dedicated team created a wonderful program for attendees. Please see page 2 for a summary of the meeting as well as some great photos from the many social activities that were available for attendees and their families. On the advocacy front, our core goals revolve around patient safety, professional standards, and ensuring fair and equitable economic practices. Political Advocacy Committee Chair, Bruce Brod, MD, outlines our involvement with PAMED's House of Delegates on page 9. Other highlights include legislative visits and a successful skin cancer screening at the capitol for Melanoma May in Harrisburg, efforts to beef up enforcement of our recently passed tanning safety bill, providing key input to the PAMED specialty leadership cabinet on progressing telemedicine legislation on the state level, and continued efforts to promote truth in advertising, and addressing the alarming escalation in price of dermatologic medications. We continue to look for innovative ways to engage with our members. With key participation from our resident committee, we overhauled our website CONTINUED ON PAGE 15
49th PAD Annual Meeting Update By: Lorraine L. Rosamilia, MD The 49th Annual Pennsylvania Academy of Dermatology Meeting was held in September at The Omni Bedford Springs Resort in Bedford, PA. This year’s speaker set, unique and diverse in its scope, provided insight on topics ranging from the doctor-patient relationship to inpatient dermatology, dermatologic legal pitfalls, and teledermatology. There was something for everyone. Dr. Mark Jackson kicked off the meeting with valuable pearls on chronic dermatitis and psoriasis. Dr. Alan Rockoff followed with communication anecdotes from his vast patient experiences and even a song about patients who make long lists. Our prestigious named lectures were given by Dr. Boris Lushniak, former Surgeon General, who addressed public health efforts for the Duhring Memorial Lecture, and Dr. Carrie Kovarik enlightened us on the complicated pros and cons of teledermatology for the Crumay Memorial Lecture. Dr. Robert Micheletti provided management advice for complicated medical dermatology patients. Challenging genital dermatologic cases were outlined by Dr. Libby Edwards, and frameworks for surgical management of highrisk squamous cell carcinomas and other procedural conundrums were
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addressed by Dr. Christian Baum. A practical socioeconomic session with Dr. Clifford Lober provided frightening yet enlightening legal issues germane to dermatology. The dinner event included a wonderful homage to the Academy Awards, replete with a red carpet and Walk of Fame handprint parting gifts. Finally, the resident symposium rounded out the conference, along with a new and entertaining Resident Mole Bowl competition, moderated by Dr.
Harry Nevus, the most popular and hypertrichotic conference participant. Resident winners of the oral presentation and poster sessions were Dr. Jake Fagan from Geisinger and Dr. Parth Patel from the University of Pittsburgh. We look forward to next year’s meeting, held slightly later in the fall, October 19-22, 2017, at the Hotel Hershey in Hershey PA. This will be the exciting 50th Anniversary of
Cynthia Bartus, DO and Lehigh Valley Hospital dermatology residents Elise Grgurich, DO and Lanny Dinh, DO accept the PAD Dermatologist of the Year award on behalf of Stephen Purcell, DO during the annual awards dinner.
WINTER 2016
Stephen Purcell, DO Receives PAD Dermatologist of the Year Award
PAD President Glen Crawford, MD presents Lorraine Rosamilia, MD with a presidential citation for her continuous efforts in planning the annual meeting. Dr. Rosamilia brought a special guest to the awards dinner, her newborn son, Charlie. the conference and will continue its tradition of including energetic and informative speakers, a patient Grand Rounds in conjunction with the Penn State Hershey Medical Center, the second annual Mole Bowl with MOC credit offered, and lots of exciting activities in Chocolatetown. Mark your calendars!
The PAD recognized Stephen Purcell, DO as the recipient of its 12th annual “Dermatologist of the Year Award” during the Annual Meeting. This prestigious honor recognizes a PAD member who has made significant contributions to the specialty of dermatology, as well as to the leadership and/or educational programs of the PAD throughout his or her career. Dr. Purcell is a dedicated educator. He leads the residency program’s teaching rounds, oversees resident clinic, teaches dermatology residents as well as non-dermatology residents and medical students on a daily basis, and has published multiple peer reviewed journal articles. Dr. Purcell has been pivotal in advancing osteopathic medicine in dermatology on the state and national level.
PAD board member Justin Vujevich, MD and resident Geoffrey Lim, MD network during the resident s’mores night.
About the Author Dr. Lorraine Rosamilia practices dermatology at Geisinger Scenery Park State College. She currently serves as Secretary of the PAD and is the editor of SkinLines.
Dr. Purcell received his medical degree from Chicago College of Osteopathic Medicine and completed his residency in dermatology at Lackland Airforce Base in San Antonio, TX. He is certified by the American Board of Dermatology and the American Osteopathic Board of Dermatology. Dr. Purcell is Chief of the Division of Dermatology at Lehigh Valley Health Network and Program Director of Lehigh Valley Health Network and Philadelphia College of Osteopathic Medicine Dermatology Residency Program. He is also Chairman of the Division of Dermatology at Philadelphia College of Osteopathic Medicine. Dr. Purcell is Chairman of the American Osteopathic Board of Dermatology. Dr. Purcell currently practices at Advanced Dermatology Associates, LTD.
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PAD Hosts First Annual Mole Bowl Competition By: Geoffrey Lim, MD The First Annual PAD Mole Bowl Competition kicked off on Saturday, September 17th, hosted by the one-andonly Dr. Harry Nevus from Punxsumoley, PA. Wearing a glistening silver jacket atop an AC/DC t-shirt and black-and-white zebra pants, Dr. Nevus (played by Dr. Justin Vujevich) made his debut by bedazzling the audience with a grand procession into the Omni Bedford Springs Resort conference hall to the rockin’ tune of Joe Esposito’s “You’re the Best Around.” The
participating residents—and one very brave medical student—competed under team names that were just as colorful, including Pokemole Go! (University of Pennsylvania), The SkIncredibles (University of Pittsburgh), Rash Decision Makers (Lehigh Valley), and Drexel Mother of Dragons (guess who?!).
among Troy Aikman, Bob Marley, John McCain, Patrick Dempsey, and Jimmy Carter was NOT diagnosed with melanoma? That answer—to the relief of all individuals with a second X chromosome—was Patrick Dempsey, also known as the neurosurgeon Dr. Derek “McDreamy” Shepherd on Grey’s Anatomy.
The Mole Bowl tested the participants’ knowledge across a broad field, including visual diagnosis (both clinical and dermatoscopic) of cutaneous neoplasms, melanoma risk factors1, genetics (TERT and POT1 2), and staging3, the BAP1 tumor syndrome4, and photoallergies5. And let’s not forget the bonus question: who
Competition was stiff from the start, and not even Dr. Harry Nevus’s hyperhidrosis beneath his copious mane of an unkempt ‘80s mullet and Lemmy Kilmister-meets-Duane Allman handlebar mustache could distract them from putting their best efforts forward in achieving the ultimate goal: the highly coveted silver Mole Bowl Champions Trophy. The format was rigorous: 15 questions (the dreaded multiple choice, no less!) with only 10 seconds per question following the completion of Dr. Nevus’s narration of the question stem. Meanwhile, the hum of suspenseful music from the popular gameshow Who Wants To Be a Millionaire was ominously playing in the background. After the teams’ answers were finalized and pencils placed down, the anxious dermatologists in the audience were prompted to submit their answers via a live polling system accessible from their smart phones. The tension was palpable, and the collective thoughts of “I don’t remember learning this in residency!” and “I think I’ll adjourn to the bathroom now...” were practically audible. A pause for dramatic effect followed before revealing that both competitors and audience members
Dr. Harry Nevus presents the coveted Mole Bowl to the winning SkIncredibles team from the University of Pittsburgh.
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WINTER 2016 alike answered correctly on over 75% of questions asked. Phew! With a final score of 14 out of 15 questions answered correctly, The SkIncredibles from the University of Pittsburgh narrowly edged out the formidable competition to claim the First Annual Mole Bowl Champions Trophy, which will make its home at the winning team’s institution until Dr. Harry Nevus returns in all of his classicrock-glory next year. The PAD thanks its trainee participants, audience members, conference coordinators, and especially Dr. Justin Vujevich for adding such a novel, exciting, and interactive event to be anticipated at the PAD for years to come. Endnotes 1 According to a landmark 2006 World Health Organization report, individuals who use tanning beds before the age of 35 have a 75% increased risk of developing melanoma. 2 These two genes increase susceptibility to melanoma through disruption of telomere maintenance. 3 For example, a melanoma with 1.1 mm Breslow thickness, 3 mitoses/hpf, negative ulceration, and no regional nodes or metastases is clinical stage 1B, NOT stage 2A!
FACToid
By: John Barbieri, MD Case
A 55 year-old man with a history of chronic lymphocytic leukemia on ibrutinib presented with a few month history of intensely painful subcutaneous nodules on his thighs, which waxed and waned in severity. On exam, he had few ~1cm tender subcutaneous nodules with slight overlying erythema on his thighs bilaterally. A biopsy was performed, which demonstrated deep dermal to subcutaneous mixed inflammatory infiltrate composed of numerous lymphocytes with scattered leukocytoclasis, neutrophils, and rare eosinophils. GMS, AFB, and Fite stains were negative.
What’s the diagnosis? A. Leukemia cutis B. Ibrutinib associated panniculitis C. Angioinvasive fungal infection D. Sweet’s syndrome
Continue to page 11 for the diagnosis
Your Donations Are Needed!
4 BAP1 tumor syndrome includes uveal melanoma, cutaneous melanoma, and various internal malignancies including lung and kidney tumors. 5 Benzophenone-3 is a common ingredient in sunscreen known to cause photoallergy.
About the Author Dr. Lim is the Chief ResidentElect, PGY3 at the University of Pittsburgh Medical Center, Department of Dermatology. Dr. Lim is also part of the winning SkIncredibles team.
The PAD Public Health Education Fund which supports the annual Sun Shade Essay Contest is in need of funds. The PAD Health Education Fund was established to support grants and educational outreach regarding skin and sun safety. Your donation is tax-deductible. Go to the Foundation’s online giving page to make your gift to PAD... Click the “Designating my gift” drop down menu and choose “PAD Public Health Education Fund” to donate to this fund. The Foundation will acknowledge your tax-deductible gift.
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Survivor: CMS vs Physicians‌Outwit, Outplay, OutMIPS By: Emily Schwarz, MD, PhD Dermatologists can breathe a small sigh of relief after the final CMS rule on MACRA (Medicare Access and CHIP Reauthorization Act) eased up many of the daunting tasks that were upon us January 1, 2017. The final rule, referred to as the Quality Payment Program, is a mere 2,171 pages compared to 960 pages of the original MACRA. It appears CMS heard our desperate voices this past summer during the open comment season and the efforts of the AADA paid off. What do we do now to get our practices big and small ready for the QPP? If you are a first year Medicare participating provider, charge less than $30,000 in Medicare Part B, or see less than 100 Medicare patients each year, please stop reading. You are EXEMPT from the Merit-based Incentive Payment System (MIPS) in 2017. This article includes initial proposed guidelines for the rest of us to follow. Disclaimer: Physicians are still deciphering aspects of the QPP with more details to come. Overall, incentives and penalties at stake are listed in the MIPS Payment Ajustments Chart. Penalties and bonuses for reporting in 2017 will be applied in 2019.
MIPS Payment Adjustments Negative Year Adjustment
Positive Potential Adjustment Incentive
Potential Bonus
-4% 2019 +4%
3X for a 10% exceptional maximum performance of 12% bonus
-5% 2020 +5%
3X for a maximum of 15%
-7% 2021 +7%
3X for a 10% exceptional maximum performance of 21% bonus
-9% 2022 +9%
3X for a maximum of 27%
10% exceptional performance bonus
10% exceptional performance bonus
In the above scenario, the CMS budget for MACRA is neutral, and potential winners take from the losers. The maximum potential incentive has a scaling factor of three for a maximum of 12% in 2019. Additional incentive payments exist for those exhibiting exceptional performance. Abbreviations MACRA: Medicare Access and CHIP Reauthorization Act QPP: Quality Payment Program MIPS: Merit-based Incentive Payment System APM: Advanced Alternative Payment Model QRUR: Quality and Resource Use Report ACI: Advancing Care Information CPIA: Clinical Practice Improvement Activity PYP: Pick Your Pace QCDR: Qualified Clinical Data Registry
The first step is determining if your practice is participating in a Medicare approved Advanced Alternative Payment Model (APM/MACRA Track 2). If you
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WINTER 2016 are NOT, likely most dermatologists, then you are eligible for MIPS (MACRA Track 1) for the year 2017 and beyond. Below is a breakdown of the THREE MIPS components. The Resource Use category was removed from the QPP- this was the cost component estimated by your QRUR report.
MIPS Components
1. 60% QUALITY. Replaces the PQRS program. 2. 25% ADVANCING CARE INFORMATION. Assumes the MU component. 3. 15% CLINICAL PRACTICE IMPROVEMENT ACTIVITY. New component. 100% MIPS Composite Performance Score from 0-100 points (MIPS CPS) The reporting period extends from January 1, 2017 until December 31, 2017. All reporting is due to CMS by March 31, 2018. Payment adjustments will go into effect January 1, 2019. The good news is you can pick anytime to start reporting from January 1, 2017 until October 2, 2017. The latest and greatest is that providers can PICK YOUR PACE (PYP) to report in MIPS. Here’s how it breaks down: 1. Do nothing: Don’t report at all and you will receive a 4% negative adjustment in 2019. 2. Do a little: Report one Quality Measure OR do one Clinical Improvement Activity OR report five ACI measures for a 90 day period and get no penalty in 2019. 3. Do more: Report 90 days of MIPS data including >1 Quality Measure OR >1 Clinical Improvement Activity OR >5 ACI measures in 2017 and receive a neutral or small positive payment in 2019. 4. Do a lot: Report 90 days or ideally the full year of MIPS data and get a possible big incentive bundle in 2019! This includes reporting six quality measures, two CPIA activities, and >5 ACI measures.
What can you do in your practice after selecting your PYP? Let’s start with Category “Do a lot” where you plan full MIPS participation. If you have the right EMR, it might not be difficult! First check to see if your EMR platform is ready to report PQRS data to CMS at the end of the year. If you want fulfill all the points on the Quality category, you will need to report SIX PQRS measures including one outcomes or high quality care measure. There is no requirement for a cross-cutting measure in 2017. YOU MUST REPORT ON 50% OF ALL ELIGIBLE INSTANCES ACROSS ALL INSURERS (page 413 Final Rule). This is quite different than reporting on 50% of all Medicare Part B patients. CMS will increase the threshold to 60% for 2018. What SIX measures are easiest for dermatologists? First, CMS approved a new measure 440 which is favorable if the pathology reports on BCCs/SCCs are reported from the pathologist to the clinician within seven days of receiving the tissue specimen. In addition, recommended measures could be the three melanoma measures (137, 138, 224), and the Pneumovax (111) and Advance Care
Plan (47) for the over 65 crowd. If your EMR is good at tracking new patients with biopsy results faxed back to the primary care physician, you might choose Measure 265. You could also report the tobacco measure (226), but that would apply to all patients over age 18. The solo outcomes measure in Dermatology is 410, reporting clinical success in psoriasis patients who have been on oral/biologic medication for at least six months. As for the new Measure 440, most of our reports are obtained in seven days and that is documented in the pathology report. Make sure you can report PQRS data through your EMR or through a registry such as AAD Data Derm. AAD Data Derm performs onboarding with many EHR vendors. For more information, see https://www.aad.org/practice-tools/ dataderm. AAD Data Derm can also be used to report with paper charts. A Group Reporting Option (GRPO) also exists for two or more providers. This would be used if you would like to report under one TIN number. You can register through CMS Enterprise Portal and make an Enterprise Identity Management (EIDM) account at https://portal.cms.gov/wps/portal/ unauthportal/home. This option is only available April 1, 2017 through June 30, 2017.
How do I report Advancing Care Information measures? This part of the score has re-routed the MU portion of CMS reporting. Check to make sure your EMR is certified. For the basic five measures, you will need: a security risk analysis, electronic prescribing, electronic access for patients into a patient portal, and a summary of care for at least one unique patient is sent and accepted through EHR (via the CONTINUED ON PAGE 8
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SURVIVOR Continued from page 7 HISP address). You will have to attest to these components and check with your EHR vendor for more details. Additional measures above and beyond the five basic measures are: secure messaging to a patient through the EHR (biopsy results, questions) and provide patient specific education on one patient electronically. For bonus points on the ACI component, it’s important to REPORT DATA IN TWO REGISTRIES. One registry can be AAD Data Derm. For the second registry, dermatologists can utilize the Pennsylvania Cancer Registry (PCI) at: http://www.health.pa.gov/ MyRecords/Registries/Cancer/Pages/ CancerRegistry.aspx#.WAUW3uArKhc. BCCs and SCCs are not reportable. Sign up at the link to register your intention to report. For a security risk analysis tool, see: https://www.healthit. gov/providers-professionals/securityrisk-assessment.
How do I report a Clinical Practice Improvement Activity? There are 90 CPIAs to choose from on page 946 of MACRA; they are
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categorized into high, medium, and low point activities. If you are a practice of 15 or less providers, you can report two activities. If you are 16 or more providers, you can report three activities- for full MIPS credit. Easy activities to report for dermatologists are: make same day emergency appointments in your schedule for Expanded Patient Access, report in a Qualified Clinical Data Registry (QCDR) registry like the PA cancer registry or AAD Data Derm (see links above) to participate in Care Coordination, refer and document any visit notes back to the referring provider via the EHR for Care Coordination, communicate test results to the patient in a timely manner which most of us note in our biopsy logs for Care Coordination, and use reminders (phone calls, emails, patient portal) to alert patients about an upcoming service for Population Management (we do this for the melanoma recall system). Pick one for 90 days to do a little or more and pick two for 90 days through the full year to do a lot! Many of these activities are already practiced by PA Dermatologists. These are the basic first steps to prepare for January 1, 2017. Continue to utilize the many resources that
exist, as we all strive to incorporate these new guidelines into our practice without too much disruption. It’s much easier to make a plan in January rather than October of next year. Feel free to contact me with any questions at emmaj27@hotmail.com. Resources: 1. https://qpp.cms.gov 2. www.aad.org/practice-tools/macraresource-center 3. http://www.nationalpartnership.org/ research-library/health-care/advancingcare-information-meaningful-use-20.pdf 4. Final Rule: https://qpp.cms.gov/docs/ CMS-5517-FC.pdf 5. https://qpp.cms.gov/docs/Quality_ Payment_Program_Overview_Fact_ Sheet.pdf 6. https://qpp.cms.gov/docs/QPP_ Executive_Summary_of_Final_Rule.pdf 7. http://healthmonix.com/mips-pro/
About the Author Emily J Schwarz, MD, PhD is currently working at Dermatology and Mohs Surgery Center PC in Sellersville while she builds her solo practice in North Wales (www.schwarzderm.com).
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PAD Represented at PAMED HOD Meeting: Summary of Key Resolutions By: Bruce A. Brod, MD PAD supported PAMED resolutions including calling for sunscreen access for children resolution Resolution 16-204 – Eliminating Barriers to Children Possessing and Using Sunscreen in School One of the priorities of the PAD is to remove the barrier in place so that children in Pennsylvania schools have easy access to sunscreen before they go outside for activities while in school or in after school programs. Unfortunately, public schools in Pennsylvania require a physician’s note and also require the school nurse to apply sunscreen to children. The reason stems from a loophole in the laws governing public education and ties into the fact that sunscreen is classified as an OTC drug by the FDA. The resolution which met with zero opposition calls on the PAMED to lobby to allow students to bring and possess sunscreen and sunprotective clothing to school. Resolution 16-207 – Promote Teen Health Week PAD actively supported this resolution calling for PAMED to actively promote teen health week. A number of PA county medical societies will be organizing the second annual teen health week in Pennsylvania this
January. The PAD plans to support this by introducing educational materials on the dangers of sun exposure and indoor tanning for teens. Resolution 16-302 – Retrospective Payment Denial of Medically Appropriate Studies Dermatologists deal with serious and less commonly recognized diseases. Unfortunately, when studies such as costlier MRIs are ordered for these patients, payment is sometimes denied after the fact by the insurers. This resolution calls for PAMED to advocate for evidenced based policies pertaining to coverage so that our patients will not be faced with high out of pocket costs. Resolution 16-COW – Practice Option Initiative Concept and Funding This was the flagship resolution that was adopted at the meeting. This will allow for PAMED to expend up to 15 million dollars to explore the possibility of a clinically integrated physician driven network. In doing so it will better position physicians to survive in a MACRA driven system that will require quality measures, value based care, and alternative payment models.
Resolution 16-303 – Clinical Pathways There is concern that clinical pathways including allowable prescription treatment options that are developed by insurers will restrict physicians from prescribing certain treatments for patients. The PAD co-sponsored this resolution that calls on PAMED to advocate for transparency in the development of clinical pathways and best on evidenced based practices. Visit www.pamedsoc.org for more information
About the Author Dr. Bruce Brod currently practices dermatology and is on the faculty at the University of Pennsylvania. Dr. Brod is a Clinical Professor of Dermatology at the University of Pennsylvania School of Medicine where he teaches and supervises at the Contact Dermatitis Clinic on a regular basis. Dr. Brod is currently a Board Member of both the PAD and is President of the American Contact Dermatitis Society. He is a Fellow of the College of Physicians in Philadelphia and is chair of the AAD Congressional Policy Committee.
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residency program corner
University of Pennsylvania Department of Dermatology By: John Barbieri, MD
2015-2016 Residents from the Department of Dermatology at the University of Pennsylvania Perelman School of Medicine.
The Department of Dermatology at the University of Pennsylvania Perelman School of Medicine strives to serve as a leading intellectual center for understanding and treating all aspects of skin and its diseases through excellence in patient care, education, and research. The residency program at the University of Pennsylvania has grown to include 17 residents. In addition to the traditional residency track, residents may also elect to join the Global Health track or the Healthcare Leadership and Quality Improvement tracks, among others. The Department
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also offers a “3+1� combined clinical and research track and a five year combined medicine and dermatology program. Additionally, fellowship positions are available in cutaneous oncology, pediatric dermatology, dermatopathology, autoimmune disease, and dermatologic surgery. Faculty members and residents bring a broad set of interests in basic science, clinical, epidemiology, and health services research. The Department has a diverse range of medical and surgical specialty clinics, staffed by over 50 full-time faculty members across nine locations. Many community dermatologists also dedicate their time to participate in these clinics and to help teach the residents. Partnerships with programs in Botswana, Guatemala, and Japan have created new opportunities to
learn and share with our international colleagues. As a resident, I have been incredibly fortunate to learn from faculty with diverse skill sets and to grow within a department that is supportive, caring, and dedicated to developing the next generation of dermatologists. The Pennsylvania Dermatology community has also been tremendously welcoming and I am looking forward to continuing to meet the incredible dermatologists in our region. About the Author Box Dr. Barbieri is a dermatology resident at the University of Pennsylvania Perelman School of Medicine. Dr. Barbieri is also a resident member of the PAD Board of Directors.
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FACTOID Continued form page 5 Diagnosis B. Ibrutinib induced panniculitis
Discussion
AAD/Pfizer Grants Awarded to Jules Lipoff, MD and University of Pennsylvania By: Jules Lipoff, MD Dr. Jules Lipoff and the University of Pennsylvania dermatology program have been awarded an Independent Grant for Learning and Change by the AAD and Pfizer for a study focused on access to care. The Pennsylvania Academy of Dermatology and Dermatologic Surgery is the sponsoring organization. The study's goal is to identify barriers for patient adherence with dermatology prescriptions (namely, systemic doxycycline and minocycline and topical retinoids for acne), such as the role of out-of-pocket cost to patients. The team has already collected data on acne medication prescriptions. Qualitative patient surveys to identify barriers to adherence are currently under way. Upon completion of this data collection, Dr. Lipoff and his team will analyze the data and create a provider toolkit for dermatologists and internal medicine physicians to improve primary adherence with their patients.
Targeted therapies, such as tyrosine kinase inhibitors, are becoming increasingly common treatments for a variety of hematologic malignancies. In patients with lymphoid malignancies receiving iburtinib who present with painful subcutaneous nodules, it is important to consider ibrutinib induced panniculitis in addition to other etiologies such as infection. Diagnosis of this uncommon entity is aided by the absence of constitutional symptoms and the histopathologic pattern of a lymphohistiocytic lobular panniculitis with prominent leukocytoclasis and occasional eosinoiphils. While the mechanism is unknown, druginduced immune modulation has been proposed by some authors. Treatment options include low-dose systemic steroids, intralesional steroids, and NSAIDs. Most patients are able to continue treatment for their underlying hematologic malignancy. References Fabbro SK, Smith SM, Dubovsky JA, et al. Panniculitis in Patients Undergoing Treatment With the Bruton Tyrosine Kinase Inhibitor Ibrutinib for Lymphoid Leukemias. JAMA Oncol. 2015 Aug;1(5):684-6.
About the Author Dr. Barbieri is a dermatology resident at the University of Pennsylvania Perelman School of Medicine. Dr. Barbieri is also a resident member of the PAD Board of Directors.
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legislative update
General Election Update By: Milliron Goodman Voters across the nation and Keystone State headed to the ballot box yesterday for the general election. Nationally, Republican Donald Trump scored a late-night victory in the heated presidential election that was at times “too close to call” in key battleground states, including Pennsylvania. No Democrat has gotten to the White House without winning Pennsylvania since Truman in 1948. Democrats hold a 4-to-3 registration advantage over Republicans, and Trump’s victory breaks the Democrats’ winning streak in Pennsylvania’s presidential elections. Yesterday Pennsylvania voters also elected incumbent Republican U.S. Senator Pat Toomey (49%) over Democrat Katie McGinty (47%) in a down-to-the-wire race that puts Republicans in position to maintain Senate control. McGinty is the former chief of staff to Governor Tom Wolf. The hotly contested race is hailed as one of the most expensive U.S. Senate races in history. Pennsylvania voters also approved a question on the ballot to increase the mandatory retirement age of state judges from 70 to 75.
Democrats Sweep State Row Offices Pennsylvanians are known for splitting their tickets. While Trump edged a victory, Democrats went three for three sweeping Pennsylvania’s row offices in races where Democrats heavily outspent Republicans. Two of those races were open seats. Former Attorney General Kathleen Kane and state Treasurer Rob McCord both resigned after being charged with crimes. In the closely watched race for attorney general, former state Representative and Montgomery County Commissioner Josh Shapiro defeated Republican state Sen. John Rafferty 51 percent to 49 percent. Rafferty is the current Chairman of the Senate Transportation Committee. Rafferty will continue to serve in the Senate. His term does not expire until 2018. Joe Torsella, a former executive officer of the National Constitution Center, beat military veteran and businessman Otto Voit in the race to become state treasurer. Torsella took 51 percent of the vote. The only row office incumbent, Auditor General Eugene DePasquale, won a second term over Republican challenger Northampton County Executive John Brown 50 percent to 45 percent.
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GOP Gains Seats in PA General Assembly; Senate GOP Gains Coveted VetoProof Majority All 203 state House seats and half the Senate (25 seats – odd numbered districts) were on the ballot this year. The general election did not shake up the balance of power in the Pennsylvania General Assembly. In fact, Republicans added to their sizeable majorities in both chambers. With Donald Trump on the top of the ticket and rural Pennsylvanians energized, Republicans in the state House picked up four seats, but lost one, gaining a 122-81 advantage. The four seats are in the GOP-leaning west, which heavily supported Trump while the gain made by the Democrats is in Monroe County, which carried Clinton and McGinty. Republicans in the state Senate picked up three seats for a 34-16 majority – the coveted veto-proof majority. However, overriding a veto would also require a two-thirds majority in the state House (135 members). Below is a look at some of the key races across the state. To view all races, visit the Department of State website.
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Open Seats There were 23 open seats. Fifteen lawmakers did not seek reelection. Four lawmakers lost their primary election and several lawmakers ran for a different office. Of those open seats, three in western Pennsylvania flipped from Democrat to Republican. Open Seat
Newly Elected
Sen. Patricia Vance (R-Cumberland), Chair Senate Public Health & Welfare Committee
Mike Regan (R), current House Representative
Sen. Shirley Kitchen (D-Philadelphia), Chair Senate Public Health & Welfare Committee
Sharif Street (D)
Sen. Lloyd Smucker (R-Lancaster), Chair Senate Education – Elected to Congress
Scott Martin (R)
Sen. John Wozniak (D-Cambria), Chair Senate Transportation Committee
Wayne Langerholc, Jr (R), seat flipped
Rep. Mike Regan (R-Cumberland) – Elected to State Senate
Dawn Keefer (R)
Rep. Nick Kotik (D-Allegheny), Chair House Gaming Oversight Committee
Anita Astorino Kulik (D)
Rep. Peter Daley (D-Washington), Chair House Consumer Affairs Committee
Donald Cook (R), seat flipped
Rep. Ted Harhai (D-Westmoreland), Chair House Game & Fisheries
Justin Walsh (R), seat flipped
Rep. Mauree Gingrich (R-Lebanon), Chair House Labor & Industry Committee
Francis Xavier Ryan (R)
Rep. John Payne (R-Dauphin), Chair House Gaming Oversight Committee
Thomas Mehaffie, III (R)
Rep. Sandra Major (R-Susquehanna), Republican Caucus Chair
Jonathan Fritz (R)
Rep. Mike Vereb (R-Montgomery)
Michael Corr (R)
Rep. Chris Ross (R-Chester), Chair House Commerce
Eric Roe (R)
Rep. Thaddeus Kirkland (D-Chester)
Brian Kirkland (D)
Rep. Bill Adolph (R-Delaware), Chair House Appropriations Committee
Alexander Charlton (R)
Rep. Julie Harhart (R-Northampton), Chair House Professional Licensure Committee
Zachary Mako (R)
Rep. Kevin Schreiber (D-York)
Carol Hill-Evans (D)
Rep. Mark Cohen (D-Philadelphia), Chair House State Government Committee – Lost Primary
Jared Solomon (D)
Rep. Frank Farina (D-Lackawanna) – Lost Primary
Kevin Haggerty (D), former state Representative
Rep. Tonyelle Cook-Artis (D-Philadelphia) – Lost Primary
Chris Rabb (D)
Rep. Lynnwood Savage (D-Philadelphia) – Lost Primary
Morgan Cephas (D)
Rep. Steve Santarsiero (D-Bucks) – Lost bid for Congress; did not run for House seat
Perry Warren, Jr (D)
Rep. Dwight Evans (D-Philadelphia) Elected to Congress
Isabella Fitzgerald (D)
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LEGISLATIVE UPDATE Continued from page 12 In the highly contentious race to represent the 15th senatorial district, Democratic incumbent Rob Teplitz was defeated by Republican challenger John DiSanto. DiSanto garnered 61,091 votes to Teplitz’s 57,711 votes. DiSanto is the former president of Triple Crown Corporation – a construction and property management company – and is now a crop farmer. In 2012, Teplitz won the election in the historically Republican stronghold. Since then, redistricting happened and dramatically changed the political landscape. Republicans now hold the advantage because the last redistricting swapped out portions of Dauphin and York counties with Republican rich Perry County. Teplitz is currently the chairman of the Senate Local Government Committee. He also serves on the Senate Agriculture and Rural Affairs, Appropriations, Community, Economic & Recreational Development, Education, and Finance Committees. In the 49th state Senatorial District, Republican builder Dan Laughlin beat one-term Democratic incumbent Sean Wiley for the Senate seat representing Erie County. In the tight race, Laughlin secured 54,899 votes to Wiley’s 47,723. Wiley is Chair of the Senate Banking & Insurance Committee and Senate Intergovernmental Operations Committee. He also serves on the Appropriations, Joint Legislative Conservation, Aging and Youth, Community, Economic & Recreational Development, and Game and Fisheries Committees.
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With nearly 59% of the vote, Republican Aaron Bernstine ousted incumbent State Representative Jarrett Gibbons (D-Lawrence). Gibbons was running for his sixth two-year term after first getting elected in 2006. Bernstine campaigned as a reformer and a citizen outside the establishment. His message to voters was the district needed someone to “sell it” to potential businesses and employers. Bernstine is a farmer, businessman, and entrepreneur. Gibbons is the Southwest Democratic Caucus Secretary. He is Chair of the House Tourism & Recreational Development Committee and serves on the House Professional Licensure Committee. Republican newcomer Matthew Dowling (12,736) defeated incumbent Democratic State Representative Tim Mahoney (11,375). Dowling is a businessman and development director of the Boy Scouts of America Westmoreland Council. His campaign promises include fiscal discipline and job creation. The 51st legislative district includes parts of Fayette and Somerset Counties. Mahoney currently serves on the House Liquor Control, Local Government, Agriculture, Game and Fisheries, and Tourism and Recreational Development Committees.
In a close rematch, Republican state Senator Tom Killion (68,916) defeated Democrat Marty Molloy (65,198). Molloy, a non-profit executive, lost to Killion in April in a special election for the seat vacated by Dominic Pileggi. Senate Democrats were hoping to chip away at the GOP control in the southeastern part of the state where polls were showing high support for Clinton. The 9th Senatorial District seat includes portions of Delaware and Chester Counties.
What’s next? The state House is expected to return to Harrisburg on November 14 and the state Senate on November 16 to vote on leadership positions for the upcoming 2017-18 session. There will be many new faces next session, new committee assignments and new committee chairs. If you have not done so already, we urge you to take the time to get to know your local House and Senate member. It is important to know him/her, but more important he/she know who you are. Now is the time to reinforce your relationship prior to the new session. We will continue to keep you updated. If you have any questions, please do not hesitate to contact us.
WINTER 2016
PRESIDENT’S MESSAGE Continued from page 1 (www.padermatology.org), Facebook (group name is Pennsylvania Academy of Dermatology and Dermatologic Surgery), and redesigned our Newsletter. John Barbieri, MD (PGY 3 dermatology resident at Penn) serves as chair of the resident engagement committee. Please see his Program Spotlight on page 10. As you are all likely aware, MACRA is coming this January! Emily Schwarz, MD, PhD, has written an outstanding summary of this topic with a particular emphasis on tips for dermatologists on the front lines of
patient care (see page 6 for the full story). In this environment of incredible change, and with full understanding of the many competing societies for your time and financial support, I hope this newsletter communicates to you how valuable our organization is to dermatologists in the state of Pennsylvania. Together with an outstanding cadre of volunteers and our executive staff in Harrisburg, we need your support to achieve our mission of promoting the highest standards of dermatologic care in the Commonwealth.
About the Author Dr. Glen Crawford is the founder of the Pennsylvania Centre for Dermatology, serves as Section Chief of Dermatology at the Pennsylvania Hospital, and he is a Clinical Associate Professor at the University of Pennsylvania where he co-directs the contact dermatitis specialty clinic. He began his term as PAD President on January 1, 2016.
PAD mission statement and strategic objectives
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