ECMS Stethoscope, January 2023

the Stethoscope

the Stethoscope

Kelli DeSanctis, DO President, ECMS

Kaela Luchs Association Coordinator kluchs@pamedsoc.org

Phone: 833-770-1542

Administrative Office/ Mailing Address: 400 Winding Creek Blvd. Mechanicsburg, PA 17050

eriecountymedicalsociety.org

The opinions expressed in this publication are for general information only and are not intended to provide specific medical, legal or other advice for any individuals. The placement of editorial content, opinions, and paid advertising does not imply endorsement by the Erie County Medical Society.

ECMS TRICKS OF THE T R ADE

for Early Career Physicians

Providing advice to prepare you for your personal and professional future

FEBRUARY 9 | 5:30PM | THE AMBASSADOR BANQUET & CONFERENCE CENTER

Erie County Medical Society is excited to provide the following presenters for our round table discussions.

Addiction & Burnout

Raymond Truex, MD | PHP

Dealing with Difficult Patients and Negative Reviews

Improving Communication: Office>Physician>Patient

Heather King | PAMED

Financial Advice & Planning

Quinto Ambrosetti, CFP | HBKS Wealth Management

Lucas Slezak, CFP, CIMA | Northwestern Mutual Generational Wealth Management

Medical Malpractice/Liability

Joel Snavely | Quinn Firm

Registration Rates:

ECMS Physician Members | Free

Students/Residents | Free Physician Non-Members | $25

Non-Physician Guests | $50

On the Rocks with a Twist

John Reilly, M.D.

In the ‘70s, first year students at New York University School of Medicine were required to participate in informal preceptor-led tours. These day-long ventures were meant to cultivate an appreciation for the unique clinical and sociologic ingredients that flavored the reputation and personality of Bellevue Hospital, our main teaching venue. It was such that in the winter of 1970, I joined a group gathered in a hallway outside the locked door of the main receiving ward of Bellevue Psychiatric Hospital at 30th Street and First Avenue in Manhattan. After some introductory comments and words of caution our preceptor, a Psychiatry Resident, brandished a large key and, with some effort, unlocked and pushed open the heavy door. We were ushered into a large common hall. The room conjured up the unsavory specter of a medieval asylum. Drab walls of green and brown defined a space filled with stale smells and a hazy mixture of fluorescent and incandescent light with little natural light coming through the barred yellowed windows. The brokenness contained within those walls was best captured by the muffled scraping and scratching sounds of men and women in pajamas and paper slippers shuffling around in no particular direction. Standing “gloomy and gated”, Bellevue Psychiatric Hospital was Bedlam surviving into the 20th Century.

As noted by Frederick Covan, Chief Psychologist at Bellevue 1980-94, it took “a lot to get into Bellevue. It was not the place for you if you (were) not feeling good today or you (were) really worried about the stock market”. The majority of people brought in by the police were, in his words, “severely mentally ill.” They presented a “danger to themselves or others”. Growing up in New York in the 50s, (even before TV’s “Law and Order”), it was understood that if you didn’t behave you could “wind up in Bellevue”. And there I was!

Fifty years ago, pharmacologic management of mental illness remained in a relatively early stage of development and aggressive treatment of the most severely mentally ill often began with detention leading to institutionalization for varying periods of time in state hospitals for the “criminally insane” (or when financially feasible, private institutions). The promise of effective and egalitarian treatment with medications managed through clinics or physician offices was yet to be realized. By the ‘80s, new classes of medications would foster a movement to de-institutionalize many of the mentally ill. Until then, hospitals like Bellevue served as clearing houses for people brought by the police for rapid assessment and disposition.

On the margin of the quiet commotion, I spotted a sad young man who was sitting in silence with his back rigidly propped against the wall and his legs, equally rigid, outstretched. Noting my interest, my preceptor explained that, unlike the others, that gentleman had been a ward resident for several days. He couldn’t walk. He exhibited paralysis of his lower extremities but despite thorough and intense evaluation, no cause for the disability had yet been found.

My studied scrutiny of the seated gentleman was disrupted by a loud commotion. I was shoved aside by a squadron of well-muscled attendants charging a patient who had become unexpectedly violent. After he was tackled and restrained, he received a shot of Thorazine a short time after which he more

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On the Rocks with a Twist

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obligingly accompanied the crew to a padded cell where he was straightjacketed for a time. It was then that I caught the glance of a well kempt middle aged male patient who seemed to regard the melee with the same calm wonder that I did. He did not appear to be delusional, agitated or depressed. His demeanor begged the question: “What is a guy like that doing here?” I approached and engaged him in what promised to be relaxed conversation in the eye of a tornado of the distressed. We spoke at length, constantly on the move to distance ourselves from paroxysms of angry or frightened cries. He spoke candidly and at length about his life. I observed and conveyed to him my sense that in contrast to the presumably dehumanizing experiences of the marginalized souls that surrounded us, his story seemed benign and his confinement, inexplicable and even unfair. He noted that he appreciated my listening as no one had given him a respectful audience since his arrival. He inferred that although I was yet untutored in matters of the mind, the mere power of my compassion was sufficient to help him to begin to discern the choices he would have to make to find a new positive direction to his life.

He then steered the conversation to me – my upbringing, my mother and father and what he divined as the weight of their collective expectations for me as I considered the choices I faced in my medical education and career. He offered counsel regarding what he perceived to be the challenge of maintaining the strength of relationships in the midst of the demands of a life in Medicine. His earnest concern and remarkable insight reinforced my sense of him as a special “regular guy.”It came to be time for my group to leave. We shook hands and he remarked with intense sincerity: “You made me feel so comfortable talking to you, opening up to you. You are gifted in that way and you should consider a career in Psychiatry. Thank you for helping me figure some things out”. As we were being ushered to the door, making way for the next group of students, I dallied a bit. I surveyed the room buoyed by the feeling that I might have serendipitously found my calling. I seemed to have a natural capacity to offer help to these lost souls.

I returned my attention to the paralyzed man wondering how I might straighten him out. As I did, another patient, a pale, long-haired and bearded fellow wearing a flowing white robe, sandals and a beatific countenance approached him. His arms outstretched, he motioned the seated man to rise up and walk. In response, the fellow rose slowly to his feet. There followed a tearful embrace. No one else noticed.

Exiting the ward, I turned to grab a final glimpse of the patient with whom I had shared such a mutually uplifting encounter. I saw that he had apparently been engaged in conversation with a female student. They parted but not before I observed him take hold of her hand and warmly proclaim: “Thank you! You have a gift! You made me so comfortable talking to you! You should consider becoming a Psychiatrist!”

CONGRATULATIONS!

CONGRATULATIONS!

2022 Everyday Hero Award

PAMED congratulates Jeffrey P. McGovern, MD on being a 2022 Everyday Hero Award recipient. This monthly award recognizes physicians who go above and beyond helping their patients and colleagues.

2022 Everyday Hero Award

PAMED congratulates Jeffrey P. McGovern, MD on being a 2022 Everyday Hero Award recipient. This monthly award recognizes physicians who go above and beyond helping their patients and colleagues.

Your colleagues deserve recognition! Nominate a deserving physician for a PAMED award at www.pamedsoc.org/awards.

Your colleagues deserve recognition! Nominate a deserving physician for a PAMED award at www.pamedsoc.org/awards.

Do you know a Pennsylvania physician who goes above and beyond to help patients? Nominate a physician for the Everyday Hero Award here.

2021–2023 ECMS Board of Directors

Kelli K. DeSanctis, DO County President

Jeffrey P. McGovern, MD Immediate Past President

Amanda Marie Wincik, DO County President Elect

Laura F. Gephart, MD, FACOG, MBA

Thomas D. Falasca, DO At Large Member

Narendra S. Bhagwandien, MD At Large Member

Kirk W. Steehler, DO At Large Member

Geoffrey Betz, MD

ECMS New and Reinstated Members

New

Ram Baboo, MD—Resident

Nikole Bucsek, MD—Physician

David Carrington Christopher, MD—Physician

Kristina Damisch, MD—Resident

Alana Dasgupta, MD—Physician

Sacha De Souza Marion, MD—Physician

Lisa English Francazio, MD—Physician

Ruby Grewal, MD—Physician

Terry Henry Jon, MD—Physician

Walter Holtgrefe—Student

Dorcas Lacayo Allen Isidora, MD—Physician

Lisa Levine, MD—Resident

Brandon Madura Robert, DO—Resident

Blaine Massey Lee, DO—Resident

John Mingey R, MD—Physician

Michael Mosa, MD—Physician

Maheen Nadeem, MD—Resident

Ian Osburn Flanery, MD—Physician

Carlos Racedo Africano Julio, MD—Physician

Andrew Rogers McFarland, MD—Resident

Anuja Manju Sabapathy, MD—Physician

David Slupek, DO—Student

Zerline Tiu-Snyderman, MD—Physician

Allison J, Wahoff, DO—Physician

Rebecca Wolff—Student

Terri A. Zachos, MD, PhD—Physician

Reinstated

Brian Bansidhar , DO—Physician

Eric Bernstein Wright, MD—Physician

Mihir Buch Deepak, DO—Physician

Ravi Chekka Kumar, MD—Physician

Amie S. Coffman, DO—Physician

Richard L. Cogley, MD—Physician

Frederick Dudenhoefer J., MD—Physician

Michael Evankovich Richard, MD—Physician

Bradley P. Fox, MD—Physician

Daniel Gloekler Stuart, MD—Physician

Benjamin Greenberger Aaron, MD—Physician

Robert Hower David, DO—Physician

Anthony Ignocheck Raymond, MD—Physician

Ines K .Kananda , DO—Physician

Divya Koradia, MD—Physician

Carl Lauer Gregory, MD—Physician

David Lesseski Charles, DO—Physician

Brian McQuone Thomas , DO—Physician

Andrew Mecca Leonard, MD—Physician

Michael Miller, DO—Physician

Herbert Morrow John III, DO—Physician

James P. Ohr, DO—Physician

David Overare Esohwode, MD—Physician

Andres Pena Hernan, MD—Physician

Richard Petrella William, MD—Physician

Vincent B. Proy, MD—Physician

Logan Pyle Michael, DO—Physician

Joseph E. Rowane, DO—Physician

Erin Shaffer Elizabeth, DO—Physician

Harshit Shah, MD—Physician

David Snow Hunter, DO—Physician

Conrad Stachelek James, MD—Physician

Jeremy Stone Guy, MD—Physician

Jennifer Stull Carey, DO—Physician

Susheel Narain Thekkiam Muralidharan, MD—Physician

Kevin Thomas Albert, DO—Physician

Svetlana Tishchenko Feyster, DO—Physician

Timothy C. Trageser, MD—Physician

Lydia Travnik Angelique, DO—Physician

Michael Webster Lynn, MD—Physician

It’s time to renew your membership! Renew now to maintain access to great member benefits like our License Resource Center. www.pamedsoc.org/PayMyBill.

Women in Medicine Social Event

BE IT RESOLVED

Jeffrey P. McGovern, MD

In a 2019 survey to 1000 randomly chosen US physicians (Yale J Biol Med. 2019; 92(4): 575585) results revealed a discrepancy between a willingness to endorse and a willingness to practice physician assisted suicide (PAS). In addition, physicians were generally misinformed with regard to why patients seek PAS, and they are uncertain about the adequacy of safeguards. Lastly, physicians reveal a wariness of the slippery slope with respect to the legalization of PAS nationwide.

In a review of the attitudes and practices of PAS in the US, Canada and Europe (JAMA. 2016; 316(1):79-90) the authors report the relative rarity of the practice of PAS with most cases involving those with cancer and pain.

BE IT RESOLVED

That the PAMED has concerns about changes in medical and ethical standards, changes in decision-making procedures, and violation of the doctor-patient relationship, and BE IT RESOLVED the PAMED recommits to ethical principles of medicine based on the inherent dignity of life, even in its frailty; to strengthening and restoring the ethical medical decision-making processes and the physicianpatient relationship.

BE IT RESOLVED

That the PAMED joins its voice to other organizations in opposition to any legislation advocating or mandating for Physician Assisted Suicide or any law permitting prescriptions or interventions for the explicit or implied purpose of a person ending his or her life.

To my surprise no previous physician proposed such a resolution to the House of Delegates. There are many reasons why this proposal is necessary at this time but first it would be important to detail some recent studies on this issue. Especially at this age of instant information, “fake news” and partisan divides, the physician must do his/her duty in reviewing the data and making an informed and reasoned decision.

Finally, in a position paper by the American College of Physicians (Ann Intern Med. 2017; 167(8):576-578) forcefully contend that the ethical arguments against legalizing PAS remain the most compelling and concludes that they remain committed to “improving care for patients throughout and at the end of life.”

The data show that the practice of PAS is indeed on a slippery slope. As physicians caring for both the strong and vulnerable we have the moral duty to provide the best care possible for our charges. That kind of care is truly individualized but can also reflect the care we as physicians provide corporately.

In other words, the care we provide to our individual patients can also reflect on the care that physicians provide in our communities and nation. If we neglect the pain and moral distress of our patients and seek the way of PAS, how will our own patients and patients across this fruited land ever trust us with their intimate needs? If we as physicians do not seek a better way for our patients, I suspect that the physician will be surely swallowed up into the corporate morass of utilitarianism. We can all disagree on the minutiae of our practices, but let us agree that we must persist in doing right for the patient and staying at their side in their time of greatest need.

Leadership Training for ALL Physicians!

We believe that learning foundational leadership skills can help physicians succeed no matter where they are in their career.

Are you taking on new leadership roles and responsibilities at work? Are you looking for a way to connect with other physicians in the state and build your leadership skills?

PAMED’s Year-Round Leadership Academy is right for YOU!

ADVOCACY UPDATE—FROM PAMED

A Closer Look at Act 146—Prior Authorization Reform

Senate Bill 225

Senate Bill 225 amends Article XXI (Quality Health Care Accountability and Protection) of the Insurance Company Law of 1921, which regulates a wide range of issues affecting the relationship between managed care plans and their providers and enrollees, including plan responsibilities, utilization review of health care services and complaints. The current article only applies to managed care plans that are Medicaid managed care organizations (MCOs) and gatekeeper commercial insurance plans.

SB 225 amends the existing provisions in Article XXI to extend applicability to include all health care insurers and Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) managed care plans. The bill adds definitions and new sections to establish uniform standards for prior authorization, medication-assisted treatment and step therapy.

PAMED House of Delegates Recap

The Pennsylvania Medical Society held its first-ever hybrid House of Delegates on Saturday, October 22. To read a full recap of 2022 HOD, click here.

A Closer Look at Act 146 Prior Authorization Reform

Senate Bill 225

Senate Bill 225 amends Article XXI (Quality Health Care Accountability and Protection) of the Insurance Company Law of 1921, which regulates a wide range of issues affecting the relationship between managed care plans and their providers and enrollees, including plan responsibilities, utilization review of health care services and complaints. The current article only applies to managed care plans that are Medicaid managed care organizations (MCOs) and gatekeeper commercial insurance plans.

SB 225 amends the existing provisions in Article XXI to extend applicability to include all health care insurers and Medical Assistance (MA) and Children’s Health Insurance Program (CHIP) managed care plans. The bill adds definitions and new sections to establish uniform standards for prior authorization, medication-assisted treatment and step therapy.

Significant elements include:

Section 2111. Responsibilities of Insurers and MA and CHIP Managed Care Plans

All PA regulated health care insurers and the state’s Medicaid and CHIP managed care plans will now be governed under Article XXI. This section lists thirteen elements all insurers must comply with, including adopting and maintaining a definition of medical necessity used in determining authorization of health care services and required reporting to the PA Insurance Department on the number, type and disposition of all complaints, grievances and adverse benefit determinations filed with the insurer.

Section 2116. Emergency Services

Explicitly states that insurers/MA/CHIP can’t require a health care provider to submit a request for prior authorization for an emergency service.

Section 2153. Provider Portal

Within 18 months of the effective date of this section (Jan. 2023) insurers/MA/CHIP are required to have established a provider portal on their publicly accessible website that includes electronic submission of prior authorization requests, access to applicable medical policies, information regarding how to request peer -to-peer review, contact information for the insurer’s relevant clinical or administrative staff and instructions for submission of prior authorization requests if the portal is unavailable for any reason. Within six months following establishment of a provider portal the insurer/MA/CHIP shall make access to training available to health care providers and their staff on the use of the portal.

Section 2154. Medical Policies and Clinical Review Criteria

Insurers/MA/CHIP are required to make current medical policies available through their provider portal and publicly accessible website, review each medical policy annually and notify providers of changes at l east 30 days prior to application. Each medical policy shall identify the clinical review criteria used in the policy development. The clinical review criteria adopted must be based on applicable nationally recognized medical standards, be consistent with governmental guidelines, provide for the delivery of clinically appropriate care and reflect current medical and scientific evidence regarding emerging procedures, clinical guidelines and best practices as articulated in independent peer-reviewed medical literature.

Section 2155. Prior Authorization Review

(A) An insurers/MA/CHIP is required to make a prior authorization determination based on its medical policy, administrative policy, all relevant medical information related to the cover ed person and any medical or

scientific evidence submitted by the requesting provider. At the time of review insurers/MA/CHIP shall verify the covered person’s eligibility.

(B) Insurers/MA/CHIP shall list on their publicly accessible website the health care services which require prior authorization.

(C) Upon receipt and review of a prior authorization request insurers/MA/CHIP must notify the health care provider of any missing information necessary to make a determination and shall identify such information with sufficient specificity to allow the provider to submit what is necessary.

(D) A request for prior authorization may only be denied after review by, or in consultation with, a licensed health care provider with appropriate training, knowledge or experience in the same or similar specialty that typically manages or consults on the health care service in question.

(E) If a prior authorization request is denied the insurer/MA/CHIP must make a peer -to-peer review available. The peer reviewer shall meet the same qu alifications as described in (D) and must have the authority to modify or overturn the prior authorization decision. The procedure for requesting a peer-to-peer review must be available on the insurer/MA/CHIP provider portal and publicly available website.

(F) A health care provider may designate another licensed member of the provider’s clinical staff as a qualified proxy to complete the peer -to-peer review. The proxy must be qualified to perform or prescribe the requested health care service and must have knowledge of the covered person’s condition and the requested procedure.

(G) Peer-to-peer review shall be available to a requesting health care provider from the time of a prior authorization denial until the internal grievance process or internal adverse benefit determination process commences.

(H) Determination on prior authorization requests submitted to M MA/CHIP shall be communicated within 2 business days of the receipt of all supporting information reasonably necessary to complete the review.

(I) Determinations on prior authorization requests submitted to i insurers shall be made within the following timelines:

1) Urgent health care service – as soon as possible but not more 72 hours after submission. If related to an ongoing urgent health care service and the request is made at least 24 hours prior to reduction or termination of the treatment, within 24 hours.

2) Non-urgent health care service – within 15 days of submission.

3) Prescription drug or Step Therapy- if urgent then within 24 hours; all others within 2 business days but not more than 72 hours.

(J) Insurers/MA/CHIP can’t deny a claim for a closely related service for failure to get prior authorization provided the health care provider notifies the insurer no later than 3 days after completion of the service but prior to submission of the claim.

(K) Upon denial of a prior authorization request insurers/MA/CHIP are required to provide covered persons with a specific statement detailing appeal rights

Section 2156. Step Therapy Considerations

If an insurer/MA/CHIP has a medical policy that includes step therapy criteria for a prescription drug it must include as part of its prior authorization process a request for an exception to its step therapy criteria. A request for an exception shall be evaluated based on the covered person’s individualized clinical condition and consider contraindications, clinical effectiveness of required prerequisite drugs, expected clinical outcomes of the requested drug and whether the required step t herapy criteria has already been satisfied under a previous insurer.

Section 2157. Medication-Assisted Treatment

Insurers/MA/CHIP are required to make coverage available for at least one drug approved by the FDA for use in MAT for opioid use disorders, including at least one of each of the following without requiring prior authorization: Buprenorphine/naloxone prescription drug combination product; injectable and oral naltrexone; methadone. If such drug is covered as a pharmacy benefit, then the insurer shall cover the drug on the lowest non preventive cost tier.

Section 2164.1.

External Review Applicability and Scope

Establishes the authority of the PA Insurance Department to receive and adjudicate external review of insurers adverse benefit determinations that are based on medical necessity, appropriateness of service, health care setting, level of care or effectiveness of a covered benefit.

Section 2164.2. Notice of Right to External Review

Insurers must notify covered persons of their right to request an external review at the same time the insurer sends written notice of an adverse benefit determination.

Section 2164.10. Minimum Qualifications for Independent Review Organizations. Clinical reviewers ass igned to conduct external reviews must be a physician or other appropriate health care provider who has expertise in the treatment of the covered person’s condition, is knowledgeable about the recommended health care service, is board certified in the area of medicine appropriate to the subject of the review and has no history of disciplinary action.

Effective Date:

Section 2153 requiring development of provider portals goes into effect in January 2023.

Remainder of bill goes into effect January 2024.

For more information

Visit https://www.pamedsoc.org/laws -advocacy/pamed-priorities for a list of PAMED’s advocacy priorities. For any questions on legislation, please contact PAMED’s Government Relations Staff at govtrelations@pamedsoc.org

WHAT IS A FRONTLINE GROUP?

A “Frontline Group” is how PAMED identifies those groups with 100% physician membership. The benefits include:

• Group discounts

• Ability to split the invoice between multiple locations (satellites) or to one corporate entity (Parent)

• Group invoicing, which streamlines the membership process

• Free administrative staff membership

• Opportunity to attend monthly 30-minute webinars, held the first Thursday of every month, covering the most pertinent topics in PA, only offered to Frontline Groups

• Ability for two administrators to attend the bi-annual Practice Manager meetings

• Access to bonus materials from trusted vendors, like Norcal

• Westminster Family Medicine 100.00%

• Wayne Primary Care 100.00%

• Tri-State Pain Institute LLC 1

• Scott J M Lim DO LLC

• Saint Vincent Urgent Care East

• Saint Vincent Post-Acute Care Services

• Saint Vincent Neonatal Services

• ReJuv LLC

• Primary Care Associates of Erie

• Presque Isle Colon & Rectal Surgery

• McClelland Family Practice

• Laser Eye Surgery of Erie Inc

• Kenneth R Mink MD Dermatology

• Hope Direct Healthcare 100.00%

• Harry L Haus MD 100.00%

• Hand Microsurgery & Reconstructive Orthopaedics LLP 100.00%

• Frank C Pregler DO 100.00%

• Erie Retinal Surgery Inc 100.00%

• EPN Rheumatology 100.00%

• ENT Specialists of NW PA 100.00%

• Comprehensive Plastic Surgery 100.00%

• Central Erie Family Care 100.00%

• Bayview Nephrology Inc 100.00%

• Arthritis Associates of Erie 100.00%

• Allegheny Clinic Fairview Family Practice 100.00%

• Albion Family Practice 100.00%

Exercise for the Holidays and the New Year!

Michael J Platto, MD

Physical Medicine and Rehabilitation

With the new year fast approaching, starting a new exercise program will soon be on many patients’ minds. Making good on this resolution is much less certain. Doctors understand regular activity is a core component of overall health and wellness. Weight loss, stress reduction, improved immune response, decreased risk of cancer, lessening of anxiety depression, improved cognition and overall improved sense of well-being are just some of the known benefits. Despite this knowledge, most Americans still do not exercise the recommended minimum of 150 minutes per week. Barriers to regular exercise are often great. Doctors may prefer to concentrate on other important medical issues, where less effort is required, and behavior can be more easily modified. Indeed, it has been shown that only one third of patients report they have received physical activity counseling by their PCP.

Doctors are aware of the multiple barriers to exercise. Common refrains include being “too busy”, “too tired”, “too expensive”, “too painful”, “no childcare”, “gas costs too much”, “too cold out”. Other commonly identified barriers are embarrassment over body image, the feeling exercise is boring, and the lack of motivation. During the holidays, these barriers become even greater.

It is of course much more time efficient to prescribe a medication and order a lab test for symptoms of pain, fatigue, and anxiety. In most cases, patients are very satisfied to learn their symptoms can be treated with a pill or could be due to a medical condition such as a low thyroid or B12 level. It is much more difficult, less rewarding and results less impressive, when trying to get a patient to exercise more as a way to treat their symptoms. In the long term however, it is hard to think of any treatment with less side effects and more positive benefit than exercise.

The upside is that the patients who are the most difficult to motivate are often the ones who have the most to gain from even a small amount of exercise. Minor increases in physical activity in inactive individuals may lead to marked reductions in the risk for chronic disease and mortality.

In motivating patients to exercise, it is important to stress that at least some regular physical activity is better than none. Patients should be encouraged to do what they are able to do, and then gradually increase activity over time. It is important to find out what the patient likes to do, whether it be walking, biking, swimming, going to the gym or to the mall. Walking 10-15 minutes per day is better than sitting on the couch all day. Walking slowly around a warm therapy pool will provide some exercise, which is easily tolerated, even in an older patient with multiple arthritic joints. Stretching in the shower first thing in the morning is another important exercise that can be easily incorporated and serves as a good warm up for the day. The key is finding something a patient likes to do and that they can continue for the long term.

Patients should also be reminded that some pain and fatigue is to be expected, especially when first starting to increase activity. If a new activity is started slowly, they should be assured they are not doing “damage”. Often the pain is a sign they are working muscles they are not used to using and can be a sign of improved physical conditioning.

Health coaches and personal trainers can also help in motivating and guiding exercise programs. Many insurance plans including UPMC, Highmark, and Aetna provide these free of charge. Physical and/or Occupational Therapy can also be helpful to get a patient started who is severely deconditioned and/ or has multiple medical conditions. With improved strength and confidence, patients can then often be transitioned to a selfdirected gym or home exercise program.

Exercise education can be time consuming. It is not specifically reimbursed and may lead to a dissatisfied patient who was expecting a medication, vitamin or hormone supplement and instead got a lecture. In the long-term, however, benefits of improved health, sense of accomplishment and sense of well-being can be much more rewarding to the patient and their physician than another pill.

Mental Health Practitioner Day

Are you interested in becoming an independent evaluator or treatment provider for the Pennsylvania Physicians’ Health Program?

Please register for our PHP Mental Health Practitioner Day on February 8, 2023

Mental Health Practitioner Day Agenda

8:30 a.m.—Welcome Message

8:40 a.m.—PHP Overview

9:40 a.m.—Evaluations

10:30 a.m.—Drug Testing Overview

11:00 a.m.—Using Spectrum 360 for Reporting to the PHP

11:30 a.m.—Breakout sessions— Meet the PHP staff and Q & A

12:00 p.m.—Closing remarks

Register to participate for FREE in the Mental Health Practitioners Day at www.foundationpamedsoc.org/MHPRegistration

Share the contact info of 3 or more of your peers who may be interested in participating in our upcoming Mental Health Practitioners Day and you’ll be entered to win a $50 Amazon gift card (even if you can’t attend)!

www.foundationpamedsoc.org/ShareWithPeers

An understanding of and ability to work with medical professionals and the PHP is paramount.