The Stethoscope / Erie County Medical Society Quarterly Newsletter / December 2019

Stethoscope

theStethoscope the

September 2019 Issue

Quarterly Newsletter of the Erie County Medical Society

Quarterly Newsletter of the Erie County Medical Society • December 2019 Issue

A Message From Your President

Erie County Medical Society Statement on Consent Decree

by Jeffrey McGovern, MD, FCCP, FAASM

T

Jeffrey McGovern, MD, FCCP, FAASM President

Rebecca Doctrow

Executive Director rdoctrow@pamedsoc.org Phone: 814-866-6820 1438 West 38th Street Erie, PA 16508 Administrative Office/ Mailing Address: 777 East Park Drive Harrisburg, PA 17111 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.

he practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies.

These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems and the temptation for physicians to forsake their traditional commitment to the primacy of patients’ interests. To maintain the fidelity of medicine’s social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. (Annals of Internal Medicine, February 5, 2002) In July 2019, the Consent Decree established as an interim period for two large medical/insurance entities in Pennsylvania will expire. In the months leading up to this date, which has recently been reinforced by officials at both entities, there continues to be consternation and confusion about the outcome. Both administrative entities have proposed that patients need to choose insurance plans which allow them to seek treatment at the respective hospital and outpatient settings.

The Board members of the Erie County Medical Society (ECMS) comprised of physicians of the Eriecommunity with many collective years of living in and treating the Erie community have heard the concerns of both patients and physicians. The Board, charged with representing a majority of the physicians, feels compelled to issue a statement in regard to the implications of the Consent Decree. nA

s physicians, and remembering the Hippocratic Oath we avowed, we respect the dignity of all patients regardless of race, creed, or ability to render payment for services.

Continued on page 2

Erie County Medical Society Statement on Consent Decree Continued from page 1

nW

e will continue to maintain the highest ethical standards in treating our patients who seek our attention.

Season’s Greetings to You and Yours!

nW

e will refrain from calumniating our colleagues from another medical institution as they represent our honored profession.

Thank you for your dedication to Erie County Medical Society!

We have had a wonderful year and are looking forward to continued success through 2020.

n I n the event patients under our care require

transition to another provider based on their insurance requirements, the current physician will make recommendations to another provider with the utmost collegiality and charity.

Plan to attend these great PAMED events in the upcoming new year:

nW

e will strive individually and corporately to continue building up the medical community through our shared associations and societies. care and nonprocedural specialty care into a single code describing the work associated with visits that are part of ongoing, comprehensive care, or a patient’s single, serious, or complex chronic medical condition.

Year Round Leadership Academy Register by February 3, 2020 Marijuana 2020: Clinical Considerations and Conversations April 20, 2020 Practice Administrator Meeting April 29, 2020 House of Delegates October 23 - 25, 2020

Click Here for More Info on 2020 PAMED Events!

Stay tuned for more information on 2020 ECMS events!

Erie County Medical Society 777 East Park Drive, Harrisburg, PA 17111 814-866-6820

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DIABETES PREVENTION PROGRAM This class is a group-based lifestyle improvement program for adults with prediabetes or who are at risk of developing diabetes. The class empowers participants to improve their overall health and reduce their chance of developing the disease through healthy eating, weight loss, and physical activity. The class is led by a

EVEPROY UNDS

trained coach and includes 25 sessions over the course of a year.

To learn more about the program, please contact Devyn Peskorski at (814) 899-9622 or dpeskorski@ymcaerie.org

SIX MONTH MEMBERSHIP INCLUDED IN THE PRICE!

OF 2.2 IGHT

WE

LOST

ED REDUC

RFIDSIAKBETES O

BY

13%

ymcaerie.org 3

Diabetes Prevention Program Blood Tests:

n A1c (must be 5.7%-6.4%) n Fasting Plasma Glucose (100-125mg/dL) n2 -hour (75gm glucola) plasma glucose (140-199 mg/dL)

Cost

nT he program is valued at $429. This fee is necessary in order for the program to become sustainable. nT here are financial assistance/scholarship opportunities available. These are provided by grant funding. nW e are in the process of being able to bill Insurance companies. We will update you as our potential for insurance billing progresses. nU nfortunately, we are unable to bill Medicare or Medicaid at this time. We are working towards being able to but, the process takes years.

We hope to use grant money to provide the program to these individuals.

O

ur CDC-approved Diabetes Prevention Program helps adults at risk of developing type 2 diabetes adopt and maintain healthy lifestyles by eating healthier, increasing physical activity, and losing a modest amount of weight. Together, these positive changes help reduce their chances of developing the disease. Based on research funded by the National Institutes of Health and Centers for Disease Control and Prevention, programs like these have been shown to reduce the number of new cases of type 2 diabetes by 58%. This reduction was even greater (71%) among adults aged 60+. The program is:

Referrals

nR eferral Pad can be filled out and given to patients. They can then contact and give the form to us. nR eferral Form can be filled out and faxed to the Chronic Disease Department at the YMCA. The fax number is (814) 899-0179. We will then reach out to the patients and ask if they would like to enroll in our Diabetes Prevention Program. nO nce a patient is enrolled, with their permission, we can send updates on their progress in the class. This is typically done after session 8, session 16, and completion of the program. nW e are open to other referral suggestions.

nF acilitated by a Y-USA trained Lifestyle coach using motivational interviewing methods. nY earlong with 19 sessions in the first 6 months and 6 sessions in the last 6 months. nG roup based which provides support for participants. nO pen to all community members. A YMCA membership is not required. Participants will actually be provided with a 6 month YMCA membership.

Goals

nF at gram goal = 25% daily calories nR educe body weight by 7% n I ncrease physical activity to 150 minutes per week

Additional Programs

nW ellness for Life, provided by the Regional Cancer Center – Currently Offering n Moving for Better Balance – Currently Offering n Blood Pressure Self-Monitoring – Early 2020 n Alzheimer’s Flex and Reflect – Spring 2020 n Smoking Cessation –TBD n Healthy Weight and Your Child – TBD n Diabetes Management - TBD

Qualifications

nA t least 18 years old, nO verweight (BMI ≥ 25), nD iagnosed with prediabetes via a blood test or gestational diabetes. If a blood test is not available, participants must have a qualifying risk score (5 or higher on the National Prediabetes Risk Test)

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Prediabetes Risk Test 1. How old are you?

Write your score in the boxes below

Younger than 40 years (0 points) 40–49 years (1 point) 50–59 years (2 points) 60 years or older (3 points)

2. Are you a man or a woman?

Man (1 point)

Woman (0 points)

3. If you are a woman, have you ever been diagnosed with gestational diabetes?

Yes (1 point)

No (0 points)

4. Do you have a mother, father, sister, or brother with diabetes?

Yes (1 point)

No (0 points)

5. Have you ever been diagnosed with high blood pressure?

Yes (1 point)

No (0 points)

6. Are you physically active?

Yes (0 points)

No (1 point)

7. What is your weight category?

Height

Weight (lbs.)

4'10"

119-142

143-190

191+

4'11"

124-147

148-197

198+

5'0"

128-152

153-203

204+

5'1"

132-157

158-210

211+

5'2"

136-163

164-217

218+

5'3"

141-168

169-224

225+

5'4"

145-173

174-231

232+

5'5"

150-179

180-239

240+

5'6"

155-185

186-246

247+

5'7"

159-190

191-254

255+

5'8"

164-196

197-261

262+

5'9"

169-202

203-269

270+

5'10"

174-208

209-277

278+

5'11"

179-214

215-285

286+

6'0"

184-220

221-293

294+

6'1"

189-226

227-301

302+

6'2"

194-232

233-310

311+

6'3"

200-239

240-318

319+

6'4"

205-245

246-327

328+

1 Point

2 Points

3 Points

You weigh less than the 1 Point column (0 points)

(See chart at right)

Adapted from Bang et al., Ann Intern Med 151:775-783, 2009. Original algorithm was validated without gestational diabetes as part of the model.

Total score: If you scored 5 or higher

You are at increased risk for having prediabetes and are at high risk for type 2 diabetes. However, only your doctor can tell for sure if you have type 2 diabetes or prediabetes, a condition in which blood sugar levels are higher than normal but not high enough yet to be diagnosed as type 2 diabetes. Talk to your doctor to see if additional testing is needed.

Type 2 diabetes is more common in African Americans, Hispanics/Latinos, American Indians, Asian Americans, and Pacific Islanders.

Higher body weight increases diabetes risk for everyone. Asian Americans are at increased risk for type 2 diabetes at lower weights (about 15 pounds lower than weights in the 1 Point column).

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You can reduce your risk for type 2 diabetes

Risk Test provided by the American Diabetes Association and the Centers for Disease Control and Prevention.

Find out how you can reverse prediabetes and prevent type 2 diabetes through a CDC-recognized lifestyle change program at https://www.cdc.gov/diabetes/prevention/lifestyle-program.

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Legislative UPDATE seeking to reform the current prior authorization process. Recently, two bills have been introduced: House Bill 1194 by Representative Steven Mentzer of Lancaster County, and Senate Bill 920 by Senator Kristin Phillips-Hill of York County. These bills seek to improve patient care and relieve physicians of the many frustrating hurdles that health insurers require physicians to navigate. It is quickly becoming clear to both lawmakers and patients that prior authorization needs reformed as more and more patients are facing denials for services recommended by their physician. Positive change will largely be driven by patient and physician engagement on this issue since overcoming the political influence of the state’s health insurance industry will be challenging.

UPDATED DECEMBER 12, 2019

T

he House and Senate are both beginning to

“ramp up” activity for the 2020 calendar year and the second half of the 19/20 regular session.

Among the issues that will be debated before the legislature this year, healthcare is sure to be front and center as proposals addressing CRNP independent practice, opioids, Medical Assisted Treatment (MAT) for opioid use disorder, prior authorization, out-of-network/surprise billing, and health insurance credentialing are all on the potential short list.

CRNPs continue to push legislators to grant them the same autonomous clinical authority as physicians. Senate Bill 25, having passed the Senate for the second straight session, currently awaits consideration by the House Professional Licensure Committee. House Bill 100, a companion bill to Senate Bill 25 is on the same docket. PAMED has, over the past several months, urged physicians to voice their concerns to lawmakers…especially those who sit on this key committee. While PAMED recognizes the valuable contributions CRNPs provide to health care teams, our policy remains firm—CRNPs are not equipped to practice without the benefit of a physician’s immediate availability through a collaborative agreement. CRNPs are aggressively lobbying legislators…physicians must do the same if we are to preserve a collaborative system that is the model in 28 other states across the country.

Opioid awareness is ubiquitous throughout the physician community and remains a top priority in the legislature. As we approach the end of the year, two opioid bills have the potential of moving—Senate Bills 566, and 675. The first would take existing opioid prescribing guidelines developed by PAMED, in cooperation with the Department of Health, and codify them in regulations. While the intention of the legislation is to ensure that physicians adhere to the guidelines, PAMED feels strongly that guidelines should not be mandated and must, by their very nature, be flexible given the uniqueness of each and every patient. In addition, treatment protocols change often and placing guidelines into the regulatory process would likely result in physicians being caught between new treatment protocols and outdated regulations - potentially denying patients the most up-to-date care.

PAMED engaged Susquehanna Polling and Research, Inc. to poll 3,300 Pennsylvanians to see how they felt about the healthcare professionals that care for them. Some of the counties polled included; Allegheny, Chester, Lackawanna, Lancaster, and Potter. The results highlighted that 92% of those polled are satisfied with the access they have to physicians and other medical providers in their area.

In another overwhelming majority, a combined 73% of those surveyed support collaborative agreements between physicians and CRNPs, instead of allowing CRNP’s to practice independently.

Continued on page 7

PAMED, along with a number of other stakeholders, including patient advocacy organizations, are

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Legislative UPDATE continued There are several other important issues either pending before the state legislature or “waiting in the wings.” These include, but are by no means limited to, the following:

Continued from page 6

Senate Bill 675 seeks to restrict the use of medically assisted treatment (MAT) for patients suffering from opioid use disorder. Drugs like buprenorphine have been proven to be the most effective treatment for patients who suffer from addiction. Currently, the bill also requires patients to seek behavioral therapy to qualify for buprenorphine treatment. While it is considered best practices to receive counselling in addition to MAT, PAMED opposes the language mandating therapy. PAMED is part of a broad-based coalition, strongly oppose this legislation.

n Out of Network Billing, -House Bill 1862, has been formally introduced and passed the House Insurance committee. PAMED and the broad coalition of providers oppose the bill as written and have slowed the momentum of this bill. Efforts are underway to seek amendments to the legislation that will level the playing field between providers and insurers while at the same time remove patients from the middle. PAMED supports the following two amendments:•

Another opioid bill to highlight, Senate Bill 572 requires patients to submit to a drug test and to have the patient sign an opioid treatment agreement prior to receiving an initial opioid prescription.

Interestingly, while the bill mandates the screening, it does not require health insurers to pay for it...

Without mandatory insurance coverage for the screening, patients who cannot afford the tests would be unable to receive appropriate treatment for their chronic pain. PAMED understands and recognizes that more needs to be done to help those with opioid use disorder such as alternatives therapies, non-opioid medications, and early and effective substance use disorder treatment. Senate Bill 572 recently passed the General Assembly and was signed by the Governor as Act 112 of 2019.

For several legislative sessions, PAMED has been seeking a legislative remedy that would speed up the health insurance credentialing process for physicians. PAMED is pleased that House Bill 533, legislation to address this issue, is beginning to get some traction in the General Assembly. Newly licensed physicians, or physicians moving into a different insurance market, often experience lengthy delays in getting credentialed by insurers. During that process these individuals are unable to treat patients often denying patients access to care.

House Bill 533 seeks to limit the amount of time insurers can take to approve, or deny, credential applications to 45-days and standardizes the process by requiring the use CAQH application forms. Several organizations, including the Hospital Association, have joined with PAMED to see this measure cross the finish line.

n

he Kaufer amendment (#A3599) – T Supported by the provider community, this amendment will remove the median in-network rate as the state mandated payment standard and put in its place “all reasonably necessary costs,” which is the existing payment standard for emergency services in our state and has been for the past 20 plus years.

n

The Rothman amendment (#A3601) – As currently drafted, this bill only permits arbitration to look at the accuracy of a payment determined by an insurer, with no checks and balances in place.

This amendment calls for independent dispute resolution (IDR) to look at whether the payment is appropriate. Further, it encourages fair physician claims and insurer payments from the beginning, as both sides rise additional expense if take to IDR through the American Arbitration Association (AAA).

n PAMED is seeking to amend or repeal Act 112 of 2018. The Act requires physicians who interpret imagining studies that show a “significant abnormality” must notify patients that the studies have been read and that follow-up with the referring physician is recommended. Recently, Rep. Jozwiak authored HB 2103 which seeks to Continued on page 8

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Legislative UPDATE continued Continued from page 7

n Medical ID Badges- Senate Bill 842/House Bill 1880, these bills aim to remove the requirement for surnames to be displayed on health care employees’ identification badges. Senate Bill 842 passed the senate and was referred to the House Health Committee. PAMED continues to support both bills. n Rural Health- Senate Bill 314, which was signed into law as Act 108 of 2019. Senate Bill 314 creates the Pennsylvania Rural Health Redesign Center Authority and the Pennsylvania Rural Health Redesign Center Fund. n Tobacco- Senate Bill 473, recently was signed into law as Act 111 of 2019. This increases Pennsylvania’s minimum legal sales age for tobacco from 18 to 21. PAMED supported this initiative.

For more information about any of the items mentioned above, please visit the Advocacy Section of PAMED’s web site at www.pamedsoc.org.

The Quote

CORNER

The physician's highest calling, his only calling, is to make sick people healthy—to heal, as it is termed.

–Samuel Hahnemann 8

Member NEWS New Members

Reinstated Members

Sara Atallah, MD

Lisa Anne Mainier, DO

Joseph Anthony Cody, MD Daniel Strickler Mackey, MPH Brendan Miccio Alexis Marie Oropallo Christopher Anthony Sanfilippo, DO Cole Asaro Schailey

2019–2021 ECMS Board of Directors Jeffrey P. McGovern, MD, FCCP, FAASM President

Timothy D. Pelkowski, MD At Large Member

Narendra Bhagwandien, MD Immediate Past President

Paul Malaspina, MD At Large Member

Kelli DeSanctis, DO President Elect

Kirk Steehler, DO At Large Member

Terence O. Lillis, MD Secretary/Treasurer

Amanda Marie Wincik, DO At Large Member

Peter S. Lund, MD, FACS AMA Representative

Justin Webber, MD Resident Representative

Kathleen Anne Costanzo, DO At Large Member

Michael Furey Student Representative

Thomas Falasca, DO, FACA, FACPM At Large Member

eriecountymedicalsociety.org

The Stethoscope • Quarterly Newsletter of the Erie County Medical Society • December 2019 Issue