Update from the PAMED Board of Directors Ransomware: Resources for the Smaller Practice Care Is Your Business, Change Is Ours the Healthcare Environment Is Changing

Allegheny County Medical Society

BulletinAugust 2017

Update from the PAMED Board of Directors Ransomware: Resources for the smaller practice Care is Your Business, Change is Ours The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols, cost-management and revenue management.

Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues ranging from HIPAA compliance to medical staff and peer review matters.

Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet these challenges. And we know what is ahead.

hh-law.com

Business • Employment • Estates and Trusts • Health Care Litigation • Oil and Gas • Public Finance • Real Estate Allegheny County Medical Society

BulletinAugust 2017 / Vol. 107 No. 8

Opinion Departments Articles

Editorial ...... 278 Society News ...... 290 Materia Medica ...... 294 Restaurant edition • PHP medical director presents Reslizumab (Cinqair®) Deval (Reshma) Paranjpe, MD, FACS program on physician burnout Megan Carr, PharmD • ACMS parking pass information Anna Bondar, PharmD, BCPS Editorial ...... 280 available Update from the PAMED Board of • Pittsburgh Ophthalmology Society Legal Summary ...... 298 Care is Your Business, Change is Ours Directors • PAMED Foundation offers medical Ransomware: Resources for the The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense Amelia A. Paré, MD, FACS student scholarships smaller practice competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols, Beth Anne Jackson, Esq. cost-management and revenue management. Perspective ...... 284 ACMS Alliance News ...... 292 Type II diabetes and the dietary Practice Management ...... 300 Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through conundrum Activities & Accolades ...... 293 Is your team drama from overstaffing? contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. William Simmons, MD Joe Mull, MEd We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues Reportable Diseases ...... 302 ranging from HIPAA compliance to medical staff and peer review matters. Perspective ...... 288 Special Report ...... 301 The ‘R’s’ have it Study reveals air pollution Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet Richard H. Daffner, MD, FACR contributes to alarmingly high these challenges. And we know what is ahead. asthma rates in Clairton Jennifer Elliott, PharmD Albert Presto, PhD Deborah Gentile, MD

On the cover Life is Good Terence W. Starz, MD hh-law.com Dr. Starz specializes in rheumatology and internal Business • Employment • Estates and Trusts • Health Care medicine. Litigation • Oil and Gas • Public Finance • Real Estate EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212; (412) 321-5030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above Affiliated with Pennsylvania Medical Society and American Medical Association Bulletin address. Medical Editor The Bulletin of the Allegheny 2017 PAMED DISTRICT TRUSTEE Deval (Reshma) Paranjpe County Medical Society welcomes Executive Committee Amelia A. Paré ([email protected]) contributions from readers, physicians, and Board of Directors Associate Editors medical students, members of allied COMMITTEES Charles Horton professions, spouses, etc. Items may President Awards ([email protected]) be letters, informal clinical reports, David J. Deitrick Donald B. Middleton Robert H. Howland editorials, or articles. Contributions President-elect Bylaws ([email protected]) are received with the understanding Robert C. Cicco Adele L. Towers John Kokales that they are not under simultaneous Vice President Finance [email protected] consideration by another publication. Adele L. Towers David J. Deitrick Scott Miller Issued the third Saturday of each Secretary Gala ([email protected]) month. Deadline for submission William K. Johnjulio Patricia L. Bononi Amelia A. Paré of copy is the SECOND Monday Treasurer Adele L. Towers ([email protected]) preceding publication date. Periodical Patricia L. Bononi Nominating Gregory B. Patrick postage paid at Pittsburgh, PA. Board Chair Matthew B. Straka ([email protected]) Lawrence R. John Bulletin of the Allegheny County Primary Care Joseph C. Paviglianiti Lawrence R. John Medical Society reserves the right to ([email protected]) edit all reader contributions for brevity, DIRECTORS Brahma N. Sharma clarity and length as well as to reject 2017 ([email protected]) any subject material submitted. Peter G. Ellis Todd M. Hertzberg Managing Editor The opinions expressed in the Barbara A. Kevish Meagan K. Sable Editorials and other opinion pieces David A. Logan ([email protected]) are those of the writer and do not necessarily reflect the official Jan W. Madison ADMINISTRATIVE STAFF policy of the Allegheny County Matthew B. Straka Executive Director Medical Society, the institution with Angela M. Stupi John G. Krah which the author is affiliated, or 2018 ([email protected]) the opinion of the Editorial Board. David L. Blinn Assistant to the Director Advertisements do not imply spon- William F. Coppula Amy G. Stromberg ([email protected]) ACMS ALLIANCE sorship by or endorsement of the Kevin O. Garrett ACMS, except where noted. Raymond E. Pontzer Bookkeeper President John P. Williams Susan L. Brown Kathleen Reshmi Publisher reserves the right to exclude 2019 ([email protected]) First Vice President any advertisement which in its opinion Thomas P. Campbell Director of Publications Patty Barnett does not conform to the standards of Michael B. Gaffney Meagan K. Sable Second Vice President the publication. The acceptance of advertising in this publication in no Keith T. Kanel ([email protected]) Joyce Orr way constitutes approval or endorse- Jason L. Lamb Assistant Executive Director, Recording Secretary ment of products or services by the Maria J. Sunseri Director of Member Relations Justina Purpura James D. Ireland Corresponding Secretary Allegheny County Medical Society of ([email protected]) Doris Delserone any company or its products. PEER REVIEW BOARD Treasurer Subscriptions: $30 nonprofit organi- 2017 Membership Relations Manager Josephine Martinez zations; $40 ACMS advertisers; $50 Donald B. Middleton Nadine M. Popovich Assistant Treasurer others. Single copy, $5. Advertising Ralph Schmeltz ([email protected]) Sandra Da Costa rates and information sent upon 2018 request by calling (412) 321-5030 or Sharon L. Goldstein online at www.acms.org. Bruce A. MacLeod 2019 Robert W. Bragdon COPYRIGHT 2017: John A. Straka ALLEGHENY COUNTY MEDICAL SOCIETY www.acms.org POSTMASTER—Send address changes to: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212. Leadership and Advocacy for Patients and Physicians ISSN: 0098-3772 If You Manage a Practice, You Don’t Want to Miss This Meeting!

Keeping up with MACRA and other important updates affecting your practice is no easy task. It seems like things are constantly changing, and physician practices say they don’t have time to keep up with it all. Don’t miss the Pennsylvania Medical Society’s (PAMED) popular practice administrator meetings this fall for the expert advice and help you need.

Topics to be discussed: 2017 Fall Meeting Schedule • Recent Pa. Supreme Court ruling changes Pittsburgh—Sept. 13 to informed consent Allegheny County Medical Society 713 Ridge Avenue • 2018 proposed Medicare Physician Fee Schedule Pittsburgh, PA 15212 • Medicaid updates 1-3 p.m. (Registration and lunch at Noon) • What’s in store for MACRA Year 2 Thank you to USI Affinity for supporting the program. …and more legislative, regulatory, and payer updates! Warrington—Sept. 19 Doylestown Health and Wellness Center Is it worth my time to attend? YES! 847 Easton Road, Route 611 Warrington, PA 18976 Some of the things past attendees say about 9-11 a.m. (Registration and breakfast at 8:30 a.m.) these meetings: Harrisburg—Sept. 27 • Invaluable PAMED* • Relevant to my job Penn Grant Centre 777 East Park Dr. • Always walk away with important updates Harrisburg, PA 17111 8:30-11 a.m. (Registration and breakfast at 7:45 a.m.)

* Live webcast is also available; call-in information will be provided prior to the meeting.

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These meetings are available exclusively to PAMED members as a free member benefit. 855-PAMED4U (855-726-3348) • [email protected] Editorial Restaurant edition

Deval (Reshma) Paranjpe, MD, FACS Medical Editor

ugust is upon us already. As you content, but chances are that skipping Aget ready to buckle down for the dressing will help with that. Take time to enjoy school, fall weather and a different Check out the on-national-trend Pittsburgh’s food scene, mindset, take some time to enjoy the Pittsburgh Poke on 500 Liberty Avenue share it with someone you culinary scene in Pittsburgh. Surprise! off Market Square. Poke is a fresh Ha- enjoy, and feed your body Our fair city is now a food mecca, and waiian fish salad preparation similar to there are more restaurants opening Seviche; it is one of the many protein and soul. than anyone can keep up with easily. options (most are cooked) available in Take a loved one or friend out to a bowls and burritos. Each has a base of complete with kitchen designed and lovely meal and go exploring – it’s the grains or greens, nine protein options, outfitted by the same company that small joys in life that add up and mildly seven sauce options, and a plethora of handled The French Laundry’s kitchen. decadent little pleasures that can get mix-ins and toppings. Out in the North Hills? The Break- you through a tough week. Feeling more decadent? Try Bakn neck Tavern, at the junction of 228 and First of all, get ready for Restau- (335 E Main St., Carnegie). It’s a Mars-Valencia Road, is a gorgeous rant Week Monday, Aug. 14, through restaurant featuring all things bacon, find in an unlikely location in Mars. Sunday, Aug. 20. Twenty-one excel- from breakfast to starters to mains Formerly an industrial factory turned lent restaurants will be offering prix- to desserts (but with plenty of other dive bar, the new owners have found a fixe multicourse meals for $20.17 or options as well). renowned chef to produce a delicious $35.17 per person in an effort to show- Kevin Sousa’s new jewel Superior American menu that rivals downtown case their talents and entice you back Motors has opened in Braddock (1215 Pittsburgh restaurants but stays satis- in the fall. For full details including par- Braddock Avenue), serving acclaimed fying and fulfilling. Brunch is excellent, ticipating establishments and menus, fine cuisine in the setting of an old car as are the burgers, the crab cakes, visit http://pittsburghrestaurantweek. dealership. The reviews are in, and the fried green tomatoes and the brilliant com/restaurants/summer-2017-restau- food is spectacular – and well worth desserts. The unexpected piece de rants/. the trip to Braddock. Sousa’s project resistance would be the housemade Ever wish you had a healthy fast deliberately dovetails into the revitaliza- pickles, which are the best I’ve ever food option? CoreLife Eatery on 8009 tion of Braddock. tried. McKnight Road in Ross Township (in The Twisted Frenchman is mov- Avor Thai in Cranberry is tucked in the same plaza as Nordstrom Rack) ing to 5925 Baum Boulevard from a tiny strip mall (900 Commonwealth offers grain, broth and green bowl its current East Liberty location. The Drive), but this new Thai restaurant of- options which do not contain artificial expansion will yield a downstairs fers a delicious menu of classics which additives of any kind, sweeteners, or casual bistro-style Bar Frenchman, and is slowly expanding. The restaurant is trans fats. Most are well under 600 the upstairs will be a larger version of spacious and soothingly decorated, calories, and filling. No word on sodium the original haute cuisine restaurant, and the service is unfailingly gracious

278 www.acms.org We will reduce your medical office and Editorial supply costs.

and perfect. Takeout and delivery also are available. AlleghenyAllegheny Lastly, do check out the food blog www.goodfood- We will reduce your pittsburgh.com, which gives daily and weekly updates 3 reasonsmedical office and concerning upcoming local food and beverage festivals, farm-to-table and other special dinners, and new restau- Medcareto consultsupply costs. rants. Medcare What a wonderful surprise to suddenly be living in a Mike Gomber culinary wonderland. Take time to enjoy Pittsburgh’s food scene, share it with someone you enjoy, and feed your for your medical supply needs body and soul. 3 reasons 1 Mike isn’t just a “sales rep.” Mike Dr. Paranjpe is an ophthalmologist and medical editor is a professional consultantto withconsult of the ACMS Bulletin. She can be reached at reshma_ [email protected]. an MBA and 30 yearsMike experience Gomber serving physicians. Savings,Savings, ServiceServicefor andand your Solutions!Solutions! medical supply needs The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the 2 Mike will find the best solution to Editorial Board, the Bulletin, or the your medical supply1 Mike needs, isn’t justnot a “sales rep.” Mike Allegheny County Medical Society. just the “product ofis the a professionalmonth” consultant with “Thethat others best are solution pushing.an MBA toand your 30 years experience “The best solutionserving physicians. to your 3 Allegheny Medicare is endorsed bymedicalmedical the Allegheny supplysupply2 CountyMike will needs.”Medicalneeds.” find the best solution to Don’t forget Society—the only yourmedical medical supply supply needs, not to submit your photos company that is! just the “product of the month” that others are pushing. Michael L. Gomber, MBA for the 2017 Bulletin Michael L.3 Gomber,Allegheny MBA Medicare is endorsed AlleghenyMoreMore than than 30 30 Medcare yearsyears meetingmeeting Photo Contest! by the Allegheny County Medical Savings, Servicephysicians’physicians’ andSociety—the needs needsSolutions! only medical supply (412)(412) 580-7900 580-7900 The deadline for submitting photos company that is! FaxMichaelFax (724) (724) L. Gomber,223-0959 223-0959 MBA is Friday, September 1, 2017. More Email:than 30 years michael.gomber meeting physicians’ needs Email:412.580.7900 michael.gomber Fax: 724.223.0959 All photos should be vertical with @henryshein.com endorsed by E-mail:@henryshein.com [email protected] Medcare ALLEGHENY a resolution of at least 300 dpi COUNTY MEDICAL Savings, Service and Solutions! and should be emailed to SOCIETY AlleghenyAllegheny Medcare Medcare Henry Schein, a Fortune 500 Company [email protected]. Henry Schein, a Fortune 500 CompanyMichael L. Gomber, MBA Together to serve to provide a one-stop Together to serve to provideMore a one-stop than 30 years meeting physicians’ needs For more information, solution for all your needs email Bulletin Managing Editor solution for all your needs 412.580.7900 Fax: 724.223.0959 endorsed by E-mail: [email protected] ALLEGHENY Meagan Sable at [email protected]. COUNTY MEDICAL SOCIETY Allegheny Medcare Henry Schein, a Fortune 500 Company ACMS Bulletin / August 2017 Together to serve to provide a one-stop solution for 279all your needs Editorial Update from the PAMED Board of Directors Amelia A. ParÉ, MD, FACS Associate Editor

s a physician, there is an intrin- beneficial. This emphasizes a “team” commissioner, and on the national Asic desire to make things better. approach and a continuum of care. level, Sen. Lindsey Graham has intro- Initially, improvements involve work, The American Board of Internal duced The Patient Freedom Act. technology and productivity. As we Medicine, ABIM, received a vote of no The specialty society dermatology age, we generate more connections confidence at the last American Med- representative gave an update on the throughout our Pittsburgh communi- ical Association (AMA) meeting with FDA requirements for sterile com- ty. Pittsburgh is a unique small city presentations by past PAMED Presi- pounding. Staff expects a two-year because it has experienced tremen- dent Scott Shapiro, MD, and current time frame for implementing these new dous periods of growth punctuated by PAMED President Charles Cutler, MD. changes. periods of decline. Pittsburgh knows Both have requested that all specialty The representative for the Pennsyl- how to help its neighbors but maintains societies sign on to this; however, vania chapter of the American Con- its individuality. The goal of the Penn- some societies have reported that they gress of Obstetricians and Gynecolo- sylvania Medical Society (PAMED) and are content with their board recertifi- gists discussed the changes that may the Allegheny County Medical Society cation process and are unsure about ensue with the repeal of the Affordable (ACMS) is to help each physician have their jurisdiction in the process involv- Care Act (ACA). Moreover, funding for his or her voice heard in Harrisburg ing other unrelated medical societies. the state Children’s Health Insurance and Washington, D.C. I would like to Oklahoma has delinked Maintenance Program (CHIP) was placed in ques- outline some of the activities that the of Certification (MOC) from licensure. tion. Psychologist and Congressman state and county societies have collab- James Goodyear, MD, head of the Tim Murphy met with ACMS members orated on in the past few months. PAMED Delegation, said there was concerning his thoughts on the ACA State Rep. Mark Mustio met with the little interest on the legislative level. and discussed how the legislation PAMED Board of Directors, and earlier Furthermore, he stated that grassroots would be treated as line items. this year ACMS, to discuss legislation advocacy on behalf of internists is Angela Botaeng, PAMED legal co-sponsored by Sen. Guy Reschen- needed and development/endorsement counsel, and Michael Siget discussed thaler to allow nurse practitioners full of other credentialing bodies may be the initial proposed regulations con- independent practice. Currently, 21 needed if the current MOC process for cerning the implementation of marijua- states allow this to varying degrees. internists cannot be improved. na for medical use. PAMED responded PAMED endorses a continued collab- In the specialty leadership portion in the comment period and will provide orative agreement to assure access to of the meeting, balanced billing for ER information as it becomes available. physicians. Numerous practitioners in doctors/hospital-based groups was Plans include a CME course that will our area rely and respect the counsel discussed. This has become more aid physicians who are interested in of the nurse practitioner; we want to problematic with narrow networks and prescribing marijuana. work together and assist in improv- tiered payment products. PAMED has Additional legislation has been ing arrangements that are mutually initiated discussions with the insurance introduced involving opioid prescribing.

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PAMED has worked to avoid addition- Pediatrics has voiced concern about clearly establish that its provisions al CME requirements as a mandate. documentation and record keeping of would lead to more deaths and inju- Some states have moved solely to these vaccinations. Bob Cicco, MD, ries and increased health care costs electronic prescribing for controlled vice president of ACMS, again remind- due to a broad relaxation of care,” medication. There is particular interest ed the ACMS board that immunization the letter stated. “The latest statistics in making opioid prescriptions e-pre- rates have declined in the United States show that medical errors, most of scriptions only. Currently, insurance and that here in Pittsburgh, we have which are preventable, are the third has variable coverage for addiction had outbreaks of measles and illness- leading cause of death in America. This services and rehabilitation success es that could be avoided by simple intolerable situation is perhaps all the has been limited. The cost of Narcan vaccination in a timely manner. A recent more shocking because we already has sharply increased and while the article in the Pittsburgh Post-Gazette know how to fix much of this problem. number of prescribed narcotics has lamented that Dr. Jonas Salk, a Univer- Congress should focus on improving declined, the number of overdoses has sity of Pittsburgh physician, would be patient safety and reducing deaths not. Allegheny County Health Depart- astounded by this new trend after years and injuries, not insulating negligent ment Director Karen Hacker, MD, and of hard work and research. providers from accountability, harming her staff gave an excellent presen- The Pennsylvania Orthopedic Soci- patients and saddling taxpayers with tation to ACMS to discuss the need ety has been instrumental in bringing the costs.” The legislation would apply for additional rehabilitation facilities attention to the problem of retrospec- to any patient who receives medical but expressed frustration with limited tive denials. Legislation that would care provided via a federal program, insurance payments for these services. limit the practice to 24 months is in the even plans purchased under the ACA A bed registry for addiction services legislature now. or employers’ plans that allow for has been proposed. Moreover, when The Quinn Bill on test results, which federal subsidies. As part of HR 1215, the Pennsylvania attorney general was would require radiologists to provide courts would limit how much attorneys at the last board meeting, the topic of direct patient results, seems to have receive from a patient’s ultimate award. Narcan distribution and new state ex- little support. This is the first such legislation to be penditures for Narcan were discussed. This year, a bill reintroduced a passed in five years. Drug take-back boxes are available in national Workers Compensation Fee Topics including telemedicine, some areas, but disposal and security Schedule. Many companies worry that POLST and credentialing will be have been prime concerns. this may spill over into a national fee introduced in the state legislature. In The Right to Try legislation, which schedule for medical services. Current- October, the Pennsylvania House of may be introduced, was discussed. ly, the country is divided into regions. Delegates advocated a moratorium on These devices or medicines often are Pittsburgh falls into the region with the fracking in the state of Pennsylvania, in phase 1 trials. Different types of lowest reimbursement for federally similar to those in Maryland and New practitioners who will not be recording funded insurance. York. There is no legislative appetite for data or outcomes may be deemed pre- On June 28, the U.S. House of this at this time, and the governor has scribers, which would allow expanded Representatives passed a bill placing not made any comments on the topic. access for investigational drugs. There caps on no economic damages similar Jaan Siderov, MD, gave an update is no language discussing patient to legislation in California. The Ameri- on the Practice Options Initiative to protections, care for side effects or can Association for Justice, a lobbying the PAMED Board and also recently supportive care. firm for plaintiffs’ attorneys, sent a letter gave a presentation to the ACMS. The Pharmacies have expressed an to the House prior to the bill passing mission triangle includes membership, interest in providing childhood immu- that urged legislators to oppose the bill. revenue and independence to preserve nizations. Currently, many pharmacies More than 75 organizations signed the physician autonomy, patient-centered, provide flu shots and shingles vacci- letter. “Even if HR 1215 applied only to physician led. There has been a strong nations, but the American Society of doctors and hospitals, recent studies Continued on Page 282

ACMS Bulletin / August 2017 281 Editorial

From Page 281 Shinal v. Toms involving informed the physician informed consent.” If you interest in assistance to meet MACRA/ consent. The majority of the Supreme have concerns that were addressed MIPS requirements (webinar available Court (Wecht, Doughtery, Todd and in this article, please contact me at [email protected]. As your Board at the PAMED website). Once the final Donohoe) felt that a physician may representative, I want your voice to be rules are announced, data may be col- not delegate his obligation to pro- heard. Change takes time, but we want lected beginning in January 2018 and vide sufficient information in order to to build consensus with our patients, if submitted correctly, practitioners may obtain informed consent. The majority other medical practitioners and insur- avoid a 4 percent Medicare cut. Keep opined that “informed consent requires ance carriers to help shape healthy, in mind that doctors with low overall back and forth face to face exchange productive members of society. We Medicare payments will be exempt which might include questions that may have different specialties, but our from this penalty. The submissions are the patient feels the physician must goals are the same: We want to make due March 31, 2018, for the perfor- answer personally before the patient things better. mance data. The Centrally Integrated feels informed and becomes willing to Many months ago, my dog, Scooter, Network has contracted with Mingle consent.” The preceding case, Valles graced the pages of this magazine and analysis as a turn-key product directed v. Albert Einstein, was used to illustrate he has since passed away. My hus- by a physician. A June 18 webinar is that the hospital is not liable but the band asked me why I missed him so archived for viewing. In the past, this physician is for informed consent. This case specifically addressed informa- much. I replied, “Scooter was a good company had a 98 percent success listener; he did not always have the rate with the Payment Quality Report- tion that physician extenders give to patients in a neurosurgical case with right answer, but I felt that he listened.” ing System (PQRS) and the registry I have tried to learn from my dog to an unexpected outcome. In malprac- is adaptable, Qualified Clinical Data be a good listener; I want to help. Join tice cases, this often is a fall-back Registry (QCDR) certified, and may be me and the Allegheny County Medical plan; if the plaintiff attorney cannot used in offices with EMR. Currently, Society to help make our medical com- prove negligence, then the attorney PAMED members receive a discount munity better and stronger. resulting in payment of the administra- will attempt to prove that the plaintiff would have made different decisions if tive fee only. Forty-two percent of all Dr. Paré is a plastic surgeon and as- Pennsylvania physicians are indepen- they had known all of the risks. Justice sociate editor of the ACMS Bulletin. She dent and are concentrated in Berks, Baer provided the dissenting view: “A can be reached at [email protected]. Dauphin, Lancaster, Lehigh and York physician cannot assign duty to obtain counties, according to Pennsylvania a patient’s informed consent to a mem- The opinion expressed in this column Department of Health data. ber of his staff or anyone else and thus is that of the writer and does not In June 2017, Pennsylvania Su- avoid liability … however, this does not necessarily reflect the opinion of the preme Court Justice Wecht delivered mean that a physician is barred from Editorial Board, the Bulletin, or the Allegheny County Medical Society. the majority court decision concerning using qualified staff members fulfilling Allegheny County Medical Society Leadership and Advocacy for Patients and Physicians

282 www.acms.org NORCAL GROUP OF COMPANIES

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or many, the onset of Type II ultimate cause, diabetes, goes under factor for Type II diabetes. Fdiabetes is so gradual over many the radar. The Centers for Disease Control years that it is looked upon as a benign Death from Type II diabetes is at and Prevention (CDC) says that Type disease. However, by the time you start absolute epidemic proportions, striking II diabetes accounts for about 90 to experiencing the classic symptoms of people of color, Native Americans, Afri- 95 percent of all diagnosed cases of constant hunger, fatigue, dry mouth, can Americans and Latinos in a dispro- diabetes in adults. They go on to say blurry vision, frequent urination, etc., portionately high fashion. After stating that 29.1 million people in the Unites and if you happen to be older, overall of that, how can I tell a patient that it States have diabetes, of which 8.1 weight, physically inactive and on a didn’t have to happen? million may be undiagnosed, unaware fast food/highly processed food diet, According to the National Institute of their condition. The World Health diabetes’ devastating affect on organs of Diabetes and Digestive and Kidney Organization (WHO) states 400 million such as the kidneys, eyes, heart, Diseases in a February 2017 “Type II people live with Type II diabetes world- nervous system, foot and dentition Diabetes Statistics and Facts” report, wide; however, in developing nations, have already been years in the mak- the devastating effects of Type II dia- more than half of the diabetic cases ing. When someone underrepresents betes, in the vast majority of cases, is go undiagnosed. In the United States, the potential dangers by giving it a preventable. Weight loss and increased we diagnose 1.4 million new cases of diagnosis like “pre-diabetes,” one may physical activity can reduce the chance diabetes every year. Compared to the think it’s just a warning shot over the of pre-diabetes turning into Type II total population, more than one in 10 bow; in reality, pre-diabetes puts one diabetes by 58 percent, and 71 percent adults over the age of 20 have diabe- on a trajectory that will shorten their in people over 60 years old. Glyco- tes in the United States, and for adults lifespan by years. Pre-diabetes signals sylated Hemoglobin (A1C) helps define over 65, in the United States, it is one that continuing on this path could result diabetes. Type II diabetes is an A1C of in four. According to the CDC, diabetes in progressive renal failure, eventually 6.5 percent or higher; pre-diabetes is is the 7th leading cause of death in the dialysis, vascular disease, blindness an A1C between 5.7 percent and 6.4 United States. and frequent, long hospital stays with percent; and normal is an A1C of less Type II diabetes used to be called surgeons cutting away at the conse- than 5.7 percent. The good news is, “adult onset” because until 10 years quences of diabetes with heart surgery, according to the Institute of Diabetes ago, Type II diabetes affected less than vascular surgery and amputations. and Digestive Disease, for overweight 3 percent of adolescents. Now, it com- The death rate from Type II diabetes people with pre-diabetes, losing 5 to 7 prises 45 percent of all cases of diabe- is devastatingly high among specific percent of body weight through exer- tes in adolescents. Type II diabetes is ethnic groups but goes frequently cise and healthy eating could prevent even more common in non-Caucasian unreported because a lot of doctors the onset of Type II diabetes complete- pediatric populations like Native Amer- don’t put diabetes on the death certifi- ly. Seconding this report, the American icans, African Americans, Asian/Pacific cate. They say kidney disease or heart Academy of Family Physicians states Islanders and Hispanics. The symp- disease or vascular collapse, and the that obesity is the single greatest risk toms of excessive fatigue, excessive

284 www.acms.org PerspectivePerspective

thirst, frequent urination and increased squarely in the middle of the corn the Marshallese people of the South hunger are not easy to spot in kids, but subsidy issue that has made its way Pacific Marshall Islands regarding the there should be heightened concerns if into almost every processed food and evolution of diabetes. In both groups, the child is obese. In the past 30 years, sugar-sweetened drink in large quan- diabetes or obesity were virtually the CDC states that obesity in children tities. I normally don’t read the Huff- unheard of. As their hunting lands were has doubled and obesity in adoles- ington Post; however, a Jan. 23, 2014, encroached upon and government cents has quadrupled. article by Mark Hyman, MD, founder handout of the westernized diet be- Now for the conundrums. The of UltraWellness Center, states that came the norm, these people who lived USDA Food Pyramid, now replaced the average adult consumes more off the land eating seafood, wild life by MyPlate, and food pyramids from than 20 teaspoons of HFCS per day, and edible plants started eating Spam, around the globe (China’s Food which is approximately 150 pounds a canned corned beef, soda, ramen noo- Pagoda to Greece’s Food Pyramid) year. The average child consumes 34 dles, Kool-Aid powder and sugary cere- have a consistent pattern of cereals, teaspoons a day. To put this in per- als. The Vedda people could still hunt, grains, breads, pasta and other starchy spective, the average 20-ounce soda so their incidence of diabetes rose but carbohydrates as the base of the diet, contains 15 teaspoons of sugar and not so much. On the other hand, the recommending six to 11 servings a day all of it is HFCS. From his research, new diet became the sole diet for the and fats near the top of the pyramid he claims that the glucose and fruc- Marshall Islanders. Their rate of Type in the “use sparingly” category. What tose which are bound together during II diabetes became 28 percent in the is confusing is that dietary fats from the chemical process making HFCS Marshallese people, which is among healthy sources have been shown to become separated in our bodies and the highest in the world. More than 75 actually increase weight loss, reduce the fructose is postulated to have a percent of the women and 50 percent heart risk, lower blood sugars, lower direct effect on the liver, turning on fat of the men became overweight. cholesterols and maintain proper brain production. Controversy exists about In 2005, Canvasback Missions, function. Yet those same studies tell the manufacturing techniques and Inc., a nonprofit Christian organization about carbohydrates causing seri- metabolism of HFCS. But in the midst that specializes in medical missions, ous issues from weight gain to fuzzy of the argument, I did find evidence in partnership with the Marshall Island thinking to heart disease. Furthermore, that too much added sugar of any kind Ministry of Health and Loma Linda the “high carb, low fat” mantra doesn’t can contribute unwanted calories that University, started a Diabetes Wellness address the issue of “good carbs” are linked to health problems, such Program and lifestyle intervention for (whole grains) vs. “bad carbs” (highly as weight gain, metabolic syndromes, the entire island. They used diet and processed carbs and sugary drinks); high triglyceride levels and Type II exercise to overcome insulin resistance “good fats” (polyunsaturated fats: liquid diabetes, and all of these increase the and restore insulin sensitivity. They vegetable oil, nuts, and seeds) vs. “bad risk of heart disease. The American went with a 100 percent plant- and sea- fats” (trans fats: margarine, packaged Heart Association recommends that food-based diet, minimal refined carbo- baked goods, fried foods in most fast most women should get no more than hydrates, high fiber, moderate amounts food restaurants and anything made in 100 calories a day of added sugar of good fats (no trans fats), high partially hydrogenated vegetable oil); (about 6 teaspoons) and that most antioxidants and a low glycemic load. and “good protein” vs. “bad protein” men get no more than 150 calories a Over the two-year program, a huge (processed meats). It also is amazing day of added sugar (9 teaspoons). The number of participants transformed that the highly subsidized industries heavily processed and fast food that their lives and health, lost significant (dairy, corn and wheat) are heavily we are accustomed to eating go way weight, became highly active again and featured on the pyramids. beyond those levels. some were declared diabetes free and Another conundrum is high-fructose There are some lessons we can others at least didn’t require significant corn syrup (HFCS), which is a political- learn from the aboriginal Vedda people medications anymore. ly strong, highly protected sweetener of the jungles of Sri Lanka (India) and Continued on Page 286

ACMS Bulletin / August 2017 285 Perspective

From Page 285 African Americans are dying in large numbers from the consequence of Type II diabetes because of the kind and quality of food that they had to eat. My father, aunt and a cousin suffered from the consequences of poorly controlled Type II diabetes. Two had to have lower extremity amputations, one suffered blindness and all died from the complications of Type II diabetes, but diabetes was never mentioned on their death certificates. What I have learned in my investigations of this topic is that the treatment of Type II diabetes doesn’t fall on the doctors. Patients should see their doctors only as a periodic coach/consultant. Instead, the real responsibility lays squarely on the shoulders of an educated patient and his family. Patients should spend more time with nurse diabetes educators and dieticians who are willing to think outside of the USDA Food Pyramid box and truly learn the life-saving value of a low-glycemic, low-carbohydrate, high fiber and good (no processed/fast food) protein diet and exercise to avoid the horrific consequences of poorly controlled Type II diabetes in its latter stages.

Dr. Simmons is associate professor, University of Pitts- burgh School of Medicine, Department of Anesthesiology, UPMC Presbyterian Shadyside Hospital, immediate past president, Gateway Medical Society, Inc., and chair, Jour- ney to Medicine Academic Mentorship Program. He can be reached at [email protected].

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

For advertising information, contact Bulletin Managing Editor Meagan Sable at [email protected] or Ruby Marcocelli (412) 321-5030, ext. 105.

286 www.acms.org The Pennsylvania Medical Society supports legislation that reforms prior authorization in Pennsylvania, and needs your help to identify patients who have experienced prior authorization delays. • Please share the information below with your patients. • Visit www.pamedsoc.org/PriorAuth to learn about the legislation and how physicians can contribute.

Frustrated With Insurance Delays Standing Between You and Your Health?

Was your physician-approved treatment plan/medication delayed by an insurance company’s prior authorization process? This outdated process jeopardizes medical practices’ ability to provide you with timely care. You can help reform this process by supporting current state legislation.

Visit www.pamedsoc.org/ShareYourStory or call the Pennsylvania Medical Society at (855) 726-3348 to share your story and communicate with your local legislators.

The project is supported by the Pennsylvania Medical Society and our physician-led medical specialty partners. 777 East Park Drive • PO Box 8820 • Harrisburg, PA 17105-8820 • [email protected] • www.pamedsoc.org

17/568 MagAd PerspectivePerspective The ‘R’s’ have it

Richard H. Daffner, MD, FACR

h, the “R’s” have it. Not the “arrrgh” grams in the Caribbean and Latin basic first-aid and hygiene supplies Aattributed to pirates (derived from American countries to improve and for the homeless as well as mobility gravelly voiced British actor Robert to have a sustained impact on health devices (canes, crutches, wheelchairs) Newton, famous for playing Long John care; and the reliance on volunteers for Western Pennsylvania residents. Silver in movies and on television, who for most of the labor-intensive sorting, The majority of the donations come often exclaimed, “Har har, me lads …”). preparation and packing of the recov- from the two large hospital systems in I mean a group of other “R” words – ered materials. For nearly 30 years, the Pittsburgh region, Allegheny Health recovery, reuse, repurpose, recycle, Global Links has developed a produc- Network and UPMC. Other, smaller restore, recondition, rebuild and repair. tive partnership with the Pan American independent facilities also donate their More on that later. Health Organization/World Health surplus. In addition, individuals are Retirees (another “R” word) often fill Organization (PAHO/WHO) as well as encouraged to donate surplus mobility their time volunteering their services for with in-country ministries of health and devices (wheelchairs, walkers, crutch- a large variety of charitable organiza- the medical and administrative leaders es, canes). There are two drop-off tions. Two years ago, while working on of existing public health systems in points – the main Global Links facility a carpentry project at the food pantry their target regions. on Trumbull Drive, Greentree, and at at South Hills Interfaith Movement In addition, Global Links has a Construction Junction in the East End. (SHIM), I met my now-retired ophthal- worldwide impact through their Suture In 2013, Global Links moved to mologist, Dr. Irving Weinberger. He and Donation and Medical Service Trip their present location in Greentree and his wife, Joan, had been volunteering programs. Global links collects surplus consolidated its warehouse and admin- at the SHIM food pantry. Irv told me sterile sutures, not only from the Pitts- istrative and volunteer operations in that he and Joan also had been work- burgh region, but also from hospitals one site. The present building is 40,000 ing every other week at Global Links, across the United States. These vitally square feet and houses approximately where they, along with another couple, needed sutures are redistributed to re- 5,000 boxes on the shelves as well as had been packing surplus medical source-poor hospitals around the world. another 3,000 furnishing items – hos- supplies for shipment to Central and The medical service trips allow health pital beds, tables, chairs, examining South America. He found the work care professionals from Western Penn- tables, IV poles. In addition, there are interesting and suggested that I could sylvania to improve health conditions in several thousand pieces of durable use my skills with tools to repair and communities throughout the world. medical equipment – canes, walkers, recondition wheelchairs. I have been More recently, Global Links has crutches and wheelchairs. Global Links volunteering at Global Links ever since. started Community Partners, a branch has, in addition, an active recycling Global Links is a nonprofit organi- that partners with local safety net orga- program for paper, cardboard and zation that was founded in 1989 with nizations such as free clinics, human “grayboard,” glass and plastic. three primary goals: the recovery of services charities, women’s shelters, Donated supplies, many of which medical surplus from local hospitals; crisis nurseries and maternity care are in original manufacturers’ cartons, the establishment of long-term pro- homes. Community Partners provides are carefully sorted and then packed

288 www.acms.org PerspectivePerspective

Dr. Daffner and one of his “patients” at Global Links. Note the walls lined with spare parts in the background.

Photo provided

after being entered into the inventory. have a small supply of new parts, such disassembled and stripped for parts. When Global Links receives an order, as wheels and seats. My colleagues Anything we remove that cannot be they can quickly obtain the items using and I have found that the hardest part reused is recycled. their computerized inventory system. of our job is finding compatible parts Our rebuilt wheelchairs do not stay I am one of a group of about six for those chairs that are missing theirs. at Global Links for long. In recent “wheelchair wranglers” who work It is not unusual for us to adjust the weeks, there have been shipments of mostly solo in our wheelchair workshop brakes, straighten leg rests, patch 10 chairs each to Bolivia and Hondu- that is separate from the main machine small tears in arm and leg rests, seats ras. I am sure that the people in these shop. Volunteers in our wheelchair and seat backs or replace them if the medically indigent areas are grateful facility should have basic mechanical tears are too large. Every attempt is for the caring volunteers and staff at skills and should be familiar with bicy- made to pay attention to cosmetics, Global Links. I am proud to be part of cle maintenance/repair. Our job is to that is, to assure that the colors of the the team helping people in medically select chairs, do a thorough inspection seats, leg pads and arm rests match. indigent areas. Individuals interested of all parts, make sure that wheels turn, Any labels, including painted ones on in volunteering their services at Global that brakes hold and that all parts are the seat backs, are removed or painted Links may contact Stacy Bodow, com- present. Most of the wheelchairs that over. Thus, we recondition, restore and munity engagement manager, at (412) are donated to Global Links are well- repair the chairs. Once all repairs are 361-3424. used. Many have IV pole/oxygen tank made, each chair is given a thorough holders attached (to prevent theft from cleaning and then tied up for shipping. Dr. Daffner is a retired radiologist the hospitals) that have to be removed. On average, it takes about four hours who practiced at Allegheny General Many chairs are missing parts, which to recondition one wheelchair from Hospital for more than 30 years. He is we endeavor to replace from our sup- start to finish. emeritus clinical professor of radiology ply of spare parts either cannibalized There are, inevitably, a small num- at Temple University School of Medicine from chairs deemed unusable or donat- ber of chairs that are deemed unsuit- and is the author of nine textbooks. He ed from local hospitals. In addition, we able for repair. These are carefully can be reached at [email protected].

ACMS Bulletin / August 2017 289 SocietyPerspective News

PHP medical director presents program on physician burnout At the July 11 ACMS Board of Directors meeting, Jon Shapiro, MD, medical director of the Pennsylvania Physi- cians Health Program (PHP), presented via Dr. Shapiro Skype “Addressing Physician Burnout and Stress.” The purpose of the program was to allow participants to “identify and implement practical approaches and utilize available resources to effectively recognize and address concerns related to physician impairment, specifically View the full PowerPoint presentation from PHP Medical Director Jon burnout and stress, in the workplace.” Shapiro, MD, at https://www.acms.org/office-resources/addressing-phy- The full PowerPoint presenta- sician-burnout/. tion can be found at www.acms.org/ office-resources/addressing-physi- If you have any questions, contact gery in the Department of Ophthalmol- cian-burnout/. the Society at (412) 321-5030. ogy, William Beaumont Hospital, Royal Please note: Parking spaces for Oak, Mich. Dr. Hart was invited by POS ACMS parking pass Pitt football games are located in the member Ian Conner, MD, PhD. information available lot at the corner of Brighton and West- Dr. Hart received his medical To purchase an ACMS lot park- ern avenues. degree with distinction in biomedical research from Wayne State University ing pass for Steelers or Pittsburgh Pittsburgh Ophthalmology Panthers football games, please visit School of Medicine, before completing https://www.acms.org/parking-for-steel- Society meeting scheduled transitional and ophthalmology resi- er-and-pitt-football/. The Pittsburgh dency training at William Beaumont • Parking permits are presold on a Ophthalmology Soci- Eye Institute, where he served as chief “first come” basis. ety (POS), under the resident during his final year. As an • Parking availability for games is leadership of Presi- active member of the medical commu- guaranteed for permit holders. dent Sharon Taylor, nity, Dr. Hart is a member of several • Passes will be mailed to you at MD, starts the monthly professional organizations. Throughout your designated address. meeting series Sept. his practice experience, Dr. Hart’s work • Parking passes are non-refund- 14 by welcoming John Dr. Hart has appeared in numerous publica- able. C. Hart Jr., MD, FACS, tions, award-winning presentations and • Keep your passes safe; no dupli- as guest speaker. abstract papers. cates will be issued. Dr. Hart is professor of ophthal- Meeting registration begins at 4 • Parking will be supervised by a mology at Oakland University/William p.m., with the first lecture at 4:30 p.m. commercial operator, and passes will Beaumont Hospital School of Medicine Kenneth Taubenslag, MD, resident at be collected at each game. and co-chief of Anterior Segment Sur- UPMC Eye Center, will present a case

290 www.acms.org SocietyPerspective News

after the first lecture. Dr. Hart’s second (first lecture) and “Pearls and Pitfalls The Foundation of the Pennsylva- lecture is scheduled for 7 p.m. Dr. Hart of OCT in Glaucoma” (second lecture). nia Medical Society administers the will present: “Conquering the Complex Anagha Medsinge, MD, resident at fund for the ACMS Foundation, which Cataract” and “Malpositioned IOLs – UPMC Eye Center, will present a case encourages physicians to contribute to Diagnosis and Management.” Vendors after the first lecture. the scholarship to help area students who participated in the 2017 annual offset the cost of medical education. In meeting are invited to attend the social, PAMED Foundation offers 2004, ACMS Foundation established which takes place in between the first medical student scholarships the scholarship and distributed its first and second lectures. The Foundation of the Pennsyl- award in 2007. Please note registration is required vania Medical Society offers several Applications are accepted through for each meeting and is handled online scholarships available to Pennsylvania Sept. 30. at www.pghoph.org. Registration residents enrolled in fully accredited Scholarship for Students of questions may be directed to Nadine medical schools. South Asian Indian Heritage Popovich at [email protected] or “We recognize that medical stu- The Foundation of the Pennsylvania (412) 321-5030. dents play a vital role in the future of Medical Society is offering a $2,000 POS announces speaker medicine in Pennsylvania so we proud- scholarship from the Endowment for ly administer scholarships to deserving South Asian Students of Indian De- for October meeting students across the commonwealth,” scent. Students must be of South Asian The Society will said Executive Director Heather Wil- Indian heritage and enrolled full time welcome Sanjay son. Additional scholarships are offered in their second, third, or fourth year at Asrani, MD, as guest throughout the year and information an accredited Pennsylvania medical speaker for the Oct. 5 can be found on the Foundation’s web- school. meeting. Dr. Asrani is site at www.foundationpamedsoc.org. Jitendra M. Desai, MD, and Saryu professor of ophthal- Allegheny County Medical J. Desai, MD, Sewickley, Pa., initiated mology at Duke Uni- Society Medical Student Scholarship this scholarship within the Founda- versity and director of Dr. Arsani Allegheny County Medical Society tion in 2002 to provide an opportunity the Duke Eye Center (ACMS) Foundation, in conjunction for South Asian Indian students who of Cary and the Duke Glaucoma OCT with the Foundation of the Pennsyl- demonstrate academic excellence. Reading Center. He actively pursues vania Medical Society, is offering a They invite others to contribute to the research on pressure fluctuations, new $4,000 scholarship to third- or fourth- fund to secure its future. devices and drugs for glaucoma treat- year Pennsylvania medical students For information about these schol- ment, drug delivery and new imaging from Allegheny County. Applicants arships, call the Foundation’s Student modalities for glaucoma. must be U.S. citizens enrolled full time Financial Services office at (717) Dr. Asrani will present “Intermittent in an accredited Pennsylvania medical 558-7852, or visit www.foundationpa- Angle Closure: The Missed Epidemic” school. medsoc.org.

Retiring? Professional announcement advertisements New are available to ACMS members at our lowest prices. Partner? Congratulatory Contact Meagan Sable, managing editor, Message? at [email protected] for information. New Address?

ACMS Bulletin / August 2017 291 AlliancePerspective News

SAVE THE DATE and as always, an exciting 50/50 p.m. PAMPAC and PAMED will host Tuesday, September 26, 2017 drawing is planned. Valet parking their welcome reception at 8 p.m. that ACMSA Autumn General Meeting is available. ACMSA members and evening. and Luncheon spouses will be in attendance, along The PAMED Alliance Annual South Hills Country Club with Alliance and ACMS family, friends Meeting is scheduled for Saturday, Oct. Meet and Greet: 10:30 a.m. and guests. Expect a formal invitation 14, and Sunday, Oct. 15. The annual Commence Meeting: 11 a.m. with full particulars soon. business meeting, installation of 2017- • • • For interested parties not on the 18 officers and various lectures will Renowned re- Alliance mailing list, email invitations take place. PAMED Alliance also will searcher and ACMSA can be arranged by contacting Amy be hosting their annual silent auction Autumn General G. Stromberg at (412) 321-5030 or to benefit the AMES Fund during the Meeting guest speak- [email protected]. We are deeply inaugural dinner Saturday. Information er Judith L. Yanowitz, grateful for the leadership of Barbara on submitting an item for the auction PhD, Magee-Womens Wible, and of event Committee Mem- and sponsorship opportunities will Research Institute, bers Doris Delserone and Margaret be available by mid-August. Back by will present: “Chromo- Dr. Yanowitz Kennedy for engaging an acclaimed popular demand is the PMSA Wellness somes you can count guest speaker! Room that takes place in Cocoa Suite on: What worm germ cells teach us 5 from noon Friday, Oct. 13, through Pennsylvania Medical Society about fertility.” noon Sunday, Oct. 15. Luncheon proceeds benefit ACMS Alliance Annual Meeting Attendees and their guests to the Alliance community service projects “If your actions inspire others to PAMED HOD and PAMED Alliance and organizations in Allegheny County dream more, to learn more, and to be- Annual Meeting will be able to take and beyond. come more, you are a leader.” – John time to relax and experience mini ses- Another spectacular season and Quincy Adams sions of massage therapy, reflexology, another fine reason to get together The Alliance of the Pennsylvania Reiki and learn about essential oils. All conducting work of the Alliance com- Medical Society (PAMED) will be hold- proceeds from the Wellness Room go bined with social benefits of fellowship ing its Annual Meeting Oct. 14-15 at to the AMES fund. among our friends and family, all the Hershey Lodge in conjunction with New this year: Stop by the PAMED together sharing many common bonds. the PAMED House of Delegates. The Registration Desk and support the Leadership chair of General Meeting planning committee will meet July 17 to AMES fund by “dipping” your credit/ I is Mrs. LeRoy Wible with Committee finalize the details but basic information debit card in the “Dip Jar.” For as little members Mrs. Robert Bloom, Dr. and follows. PAMED Alliance membership as $30, you can lend your support Mrs. William Hetrick, Mrs. F. Byron is not required for the business ele- to the AMES fund and help provide Kennedy and Mrs. Eugene Delserone. ments of PAMED Alliance’s Annual medical education scholarships to our The program of the day includes a brief Meeting. Pennsylvania medical students. business meeting of the Alliance, with Guests are encouraged and wel- summary of the Governing Board’s come to participate in all events and Content provided by Robbi-Ann M. Wrap Up 2017-Kick Off 2018 meeting social activities. Members and guests Cook, PAMED Alliance Association ex- in June. There will be formal recogni- must register. For specific information ecutive, Pennsylvania Medical Society tion of ACMS Alliance Past Presidents on member and member guest reg- Alliance, PO Box 8820, Harrisburg, in attendance. Also slated is Alliance istration, visit https://www.pamedsoc. PA 17105, (717) 909-2688, rcook@ Year 2016-17 check presentation to orgalliance or call (717) 558-7750, ext. pamedsoc.org. ACMS Executive Director, Mr. John G. 1503. Krah, for ACMS Foundation. The Board of Directors meeting will Content and text by Kathleen Jennings Reshmi There will be wonderful door prizes be held Friday, Oct. 13, from 5 to 7:30

292 www.acms.org ActivitiesPerspective & Accolades

Group names ACMS member announce Dr. Joseph Club is a non-sectarian, non-political 2017 Man of the Year Maroon as the 2017 association of successful business Man of the Year for professionals organized to “promote ACMS member Joseph Maroon, the Circus Saints & good fellowship, contribute to worthy MD, has been named the Circus Saints Sinners Club, Bob charities and to have fun. Metaphori- and Sinners Club of America, Bob Prince Tent. This nom- cally speaking, the members – due to Prince Tent 2017 Man of the Year. ination is the result their human imperfections – represent Dr. Maroon is clinical professor and of a distinguished Dr. Maroon ‘Sinners,’ who strive to be ‘Saints’ of vice chairman of the Department of medical and fitness mercy by helping those less fortu- Neurological Surgery at UPMC. He career that has helped a countless nate.” also is Heindl Scholar in Neuroscience number of his patients achieve superior Past man of the year honorees at the University of Pittsburgh, the overall health results. Most important- include Arnold Palmer, Art Rooney, team physician for the Pittsburgh Steel- ly, Dr. Maroon had served as a friend Bruno Sammartino, Myron Cope, Bob ers and chief medical adviser to World and mentor to all his patients and Prince, Rocky Bleier and Stan Musial. Wrestling Entertainment. colleagues through his daily efforts and Dr. Maroon was honored at the Local chapter president William community involvement.” Circus Saints and Sinners Club annual Wolfe said in a statement, “It is with The organization’s website says, dinner July 25 at the LeMont Restau- great honor and privilege that we “The Circus Saints and Sinners rant, Pittsburgh.

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ACMS Bulletin / August 2017 293 Materia Medica Reslizumab (Cinqair®)

Megan Carr, PharmD controlled after infusion of reslizumab, effects included upper respiratory tract Anna Bondar, PharmD, BCPS therapy should be reassessed and infections, sinusitis, influenza and patients should seek further medical headache.2 Background treatment.1 Efficacy Reslizumab (Cinqair®) is a newly In clinical trials, malignant neoplasm approved therapy for patients with within six months of therapy was Reslizumab’s impact on frequency severe, eosinophilic asthma.1 Eosino- reported in 0.6 percent of patients re- of asthma exacerbations was evaluated phils are key mediators of inflammatory ceiving reslizumab infusion compared in two duplicate, randomized, place- response and airway remodeling in to 0.3 percent in the placebo group. bo-controlled trials. The trials included asthma and are dependent on interleu- No distinct neoplasm and no specific patients aged 12-75 years with asthma kin-5 (IL-5) for activation. Reslizumab tissue site was identified in the trials.1 who were inadequately controlled by is a monoclonal antibody that acts as Another monoclonal antibody used inhaled corticosteroids, had blood an IL-5 antagonist, thereby blocking the for eosinophilic asthma carries a warn- eosinophils greater than 400 mcg/mL formation and activity of eosinophils to ing for diminished immune response and had more than one asthma exac- reduce inflammation and remodeling.2 against parasitic infections. It is un- erbation per year. In both trials, annual Reslizumab serves as an add-on main- known if reslizumab has an impact on asthma exacerbations were reduced tenance therapy for those patients with the immune response against parasitic by 50 to 55 percent in patients treated poorly controlled eosinophilic asthma. infections, since patients with parasitic with reslizumab compared to placebo. infections were not studied in resli- Reslizumab also reduced the rate of Safety zumab clinical trials. Because of this exacerbations that required the use of Avoid reslizumab in patients with uncertainty, it is recommended to treat systemic corticosteroids compared to 1-2 known hypersensitivity to reslizumab or patients with parasitic infections before placebo. In addition, for those treated any of its components. There is a black initiation of reslizumab. If a patient with reslizumab, the time to first exac- box warning for anaphylaxis with resli- develops a parasitic infection during erbation was significantly longer than 2 zumab infusion. In placebo-controlled the course of reslizumab and does not those in the placebo group. There have trials, anaphylactic reactions were show any response to anti-parasitic been no clinical studies to date, howev- reported in 0.3 percent of patients who treatment, discontinue reslizumab.1 er, to assess if the use of inhaled corti- received reslizumab infusions. In those costeroids can be reduced or eliminated 1 patients, reactions occurred as early as Tolerability in patients treated with reslizumab. the second dose of reslizumab. Resli- Reslizumab is generally a well-tol- Reslizumab was demonstrated to 1-3 zumab should be administered in a erated drug. The most commonly significantly improve FEV1 at week four, health care setting and patients should reported adverse effect was naso- or after one dose, of therapy compared be monitored for an adequate period of pharyngitis.2-3 Its adverse effect profile to placebo in those same duplicate 2 time after administration by health care was similar to placebo in clinical trials. trials. Reslizumab continued to show professionals for signs of hypersensi- In one clinical trial, nasopharyngitis forced expiratory volume (FEV1) im- tivity or anaphylaxis.1 occurred in 11 patients who received provement at weeks 16 and 52 in one 2 Reslizumab is not indicated to treat reslizumab; of those 11 patients, eight of the clinical trials. Reslizumab also acute asthma exacerbations or patients patients had nasal polyps at baseline significantly reduced blood eosinophil 2-3 with deteriorating disease. If asthma before initiation of reslizumab infusion. counts compared to placebo. worsens in severity or becomes un- Other commonly reported adverse Continued on Page 296

294 www.acms.org New! Referrals Made Easy 1-844-MD-REFER Call us to make patient referrals to Allegheny Health Network (AHN) specialists. We’ll arrange appointments for your patients. Our referral team has an advanced knowledge of AHN services, doctors, and locations. We can help your office: • Search 1,300 AHN physicians in 60 specialties throughout western Pennsylvania • Schedule appointments with doctors • View your referred patients’ medical information on demand Plus, call 1-844-MD-REFER to learn about AHN continuing medical education, physician networking events, or active clinical trials. AHN Referring Physician Center For more information, visit doctors.ahn.org/referral. 1-844-637-3337

1-844-MD-REFER ad.indd 1 8/2/17 1:00 PM Materia Medica Physician Compensation From Page 294 and Reslizumab’s effect on quality of life was assessed using the Asthma Quality of Life Questionnaire (AQLQ) and symptom control was assessed using the Asthma Control Practice Evaluations Quesitonnaire-7 (ACQ-7) and Asthma Symptom Utility Index (ASUI). Analysis of these surveys demonstrated that Including Billing Audits patients who received reslizumab had a significant improve- 2 ment in both quality of life and symptom control. For information, contact John Fenner Price The cash price for one infusion (one 10 milliliter vial) of reslizumab is $1,002. This price is similar to omalizumab, 3 Penn Center West the other monoclonal antibody on the market indicated for Pittsburgh, PA 15276 asthma therapy.5 412-788-8007 Simplicity fennercorp.com [email protected] Reslizumab is an infusion that is given once every four weeks. Reslizumab has been studied in patients for dura- Specializing in hoSpital and phySician tions up to one year. There are no set recommendations conSulting Since 1991 with officeS in: on duration; patient-specific factors should be taken into ohio • pennSylvania • virginia consideration to determine length of therapy. The recommended dose is 3 mg/kg given via intravenous infusion over 20 to 50 minutes. It should be given in a health care setting References by a health care professional in order to safely monitor for 1. Cinqair (reslizumab) [prescribing information]. Frazer, the occurrence of anaphylaxis.1 PA; Teva Respiratory, LLC; March 2016. 2. Castro M, Zangrilli J, Wechsler ME et al. Reslizumab for Bottom line inadequately controlled asthma with elevated blood eosinophil counts: results from two multicenter, parallel, double-blind, Reslizumab (Cinqair®) is a novel biologic therapy used randomized, placebo-controlled, phase 3 trials. Lancet Respir as add-on maintenance therapy for adults with poorly con- Med. 2015;3:355-66. trolled asthma, specifically with an eosinophilic phenotype.1-3 3. Castro M, Mathur S, Hargreave F et al. Reslizumab It is generally well tolerated and has been demonstrated to for poorly controlled, eosinophilic asthma: a randomized, significantly reduce rates of exacerbation, FEV and blood placebo-controlled study. Am J Respir Crit Care Med. 1 2011;184:1125-1132. eosinophil counts as well as improve quality of life and 4. Anti-IgE Therapy. In: UpToDate Online. Hudson (OH): symptom control in patients poorly controlled on inhaled Lexicomp, inc.; [updated Nov 2016, accessed Dec 12 2016]. corticosteroids who have blood eosinophil counts greater https://www.uptodate.com/contents/anti-ige-therapy?source=- than 400 mcg/mL.2 search_result&search=asthma%20and%20parasitic%20infec- tion&selectedTitle=2~150. 5. Reslizumab: Drug Information. In: UpToDate Online. Dr. Carr is a PGY-1 pharmacy practice resident at UPMC Hudson (OH): Lexicomp, Inc.; [updated 2016, accessed St. Margaret and can be reached at [email protected]. Nov 14 2016]. https://www-uptodate-com.pitt.idm.oclc.org/ Dr. Bondar is a PGY-2 ambulatory care resident at UPMC contents/reslizumab-drug-information?source=search_result&- St. Margaret and can be reached at [email protected]. search=reslizumab&selectedTitle=1~12 Heather Sakely, PharmD, BCPS, served as editor and is director of geriatric pharmacotherapy and director of the PGY2 Geriatric Pharmacy Residency Program at UPMC St. www.acms.org Margaret. She can be reached at [email protected].

296 www.acms.org q Allegheny County MediCAl SoCiety Leadership and Advocacy for Patients and Physicians

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Banking, Financial Medical and Surgical Printing Services and Leasing Supplies and Professional Services Allegheny Medcare Announcements Medical Banking, Michael Gomber, 412.580.7900 Service for New Associates, Office VISA/MC Service michael.gomber@henryschein. Offices and Address Changes PNC Bank com Allegheny County Medical Brian Wozniak, 412.779.1692 Society [email protected] Life Insurance Susan Brown, 412.321.5030 [email protected] Malachy Whalen & Co. Group Insurance Malachy Whalen, 412.281.4050 Programs [email protected] Auto and Home Employee Benefits, Disability, Insurance Dental & Vision Telecommunications Liberty Mutual USI Affinity and IT solutions 412.859.6605 Bob Cagna, 412.851-5202 connecTel, Inc. www.libertymutual.com/acms [email protected] Scott McKinney, 412.315.6020, [email protected] Member Resources BMI Charts, Healthy Lifestyle Posters, Where-to-Turn cards Allegheny County Medical Society 412.321.5030 What does ACMS [email protected] membership do for me? Legal Summary Ransomware: Resources for the smaller practice

Beth Anne Jackson, Esq. solid business continuity plan in the event of • Have a viable business continuity plan a ransomware attack. (It also recommends – know what your practice is going to do WannaCry. Petya. These two ransom- not paying the ransom if you fall prey to an in the event of a system crash or ransomware attacks affected health care providers attack; you may not get the decryption key ware attack BEFORE one happens – and both globally and locally, encrypting the pro- to unlock your data.) Here’s a more detailed practice it. viders’ data and holding the decryption key list of steps to get your practice on its way to • Set up your system so that software for ransom. Think your practice is too small preventing ransomware, malware and virus patches are uploaded and installed auto- to be a victim? Think again. While hackers intrusions on your systems. matically on a daily basis. may not necessarily be directly targeting 1. Take your HIPAA Security Risk 3. Create and implement a strong your practice computer system, according Assessment seriously. Really seriously. If data security training program based on to Microsoft, ransomware such as any you don’t have the in-house resources to strong policies. An employee clicking on a malware or virus can infect your computer perform the assessment, hire a third-party malicious email attachment (from a spoofed by any of the following means: consultant. email address that makes it look like it’s • Visiting unsafe, suspicious, or fake 2. Follow through on the weaknesses from a valid source) or infected link or websites identified in your Security Risk Assessment. logging into a fake website with their login • Opening emails and email attachments That means, inter alia, that you may need credentials is all that’s needed to com- from people you don’t know, or that you to: promise your system, regardless of what weren’t expecting • Replace unsupported systems, such security measures you take. Consequently, • Clicking on malicious or bad links in as Windows XP. (This was a factor in it is recommended that practices: emails, Facebook, Twitter, and other social the WannaCry attack on the U.K.’s NHS • Firmly limit use of office computers media posts, or instant messenger chats, hospitals.) to office business to reduce the risk of a like Skype • Ensure that regular backups of all your compromise. Even if you don’t have a fully implement- data occur automatically and daily. • Don’t click on links even in “valid” ed electronic medical record, you still need • Install and maintain high-quality emails. Rather, close the email and then to be concerned: How would losing all of anti-malware software (the one that comes log in to your account directly from your your billing data impact your cash flow? free with your computer or that you can browser through the known website, instead How can a physician practice protect download for free is not necessarily the best of, for example, obtaining your practice itself? The FBI recommends prevention and can leave you exposed to new viruses credit card statement from the link in an efforts – both in terms of awareness and malware). email from your credit card company. It is training for employees and robust technical • Encrypt your data and all portable a couple extra steps, but it’s worthwhile to prevention controls and the creation of a devices. avoid compromising your account.

Serving the legal needs of health care practitioners and facilities • Regulatory - Stark, Anti- 4050 Washington Road Kickback, HIPAA, EMTALA BETH Suite 3N McMurray, PA 15317 • Compliance training and policies ANNE • Physician-hospital contracts 724 941-1902 JACKSON [email protected] • Employment contracts Esq. LLC www.jacksonhealthlaw.com • Joint ventures and other business transactions • Operational issues and policies

298 www.acms.org Legal Summary

4. Consider cyber liability insurance coverage. The process of qualifying can Resources help you get your cybersecurity in order, 1. HHS Cyber Security Guidance Material: https://www.hhs.gov/hipaa/for-profes- and many insurers have preferred vendors sionals/security/guidance/cybersecurity/index.html (technical, legal and public relations) on call This page includes: that will help you in the event of a breach or • Cyber Security Checklist and Infographic ransomware attack. • Ransomware Guidance 5. Be aware of and consult the resourc- • National Institute of Standards and Technology (NIST) Cybersecurity Framework es available to you. A list of resources is • Office for Civil Rights Cyber Awareness Newsletters included below. 2. The Industrial Control Systems Cyber Emergency Response Team (ICS-CERT) Physicians can’t be, and don’t need to (part of the Department of Homeland Security) be, tech experts. However, they do need • Sign up for Alerts: https://public.govdelivery.com/accounts/USDHSUSCERT/ to be aware of the risks to their practice, subscriber/new hire appropriate employees or contractors • Recommended Practices: https://ics-cert.us-cert.gov/Introduction-Recommend- to optimize their systems, and set a good ed-Practices example for employees by following the 3. Pennsylvania Medical Society: PAMED members who have questions can con- computer security policies in place for the tact the Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@ practice. pamedsoc.org. Other resources on the PAMED website include the AMA Ransom- ware Guidance: https://www.pamedsoc.org/PAMED_Downloads/AMA%20Ransom- DISCLAIMER: This article is for informa- ware%20Guidance.pdf tional purposes only and does not constitute legal or IT advice. You should contact Ms. Jackson is the sole member of Beth Pennsylvania. She can be reached at (724) your attorney and IT consultant to obtain Anne Jackson, Esq. LLC, a law firm that 941-1902 or [email protected]. advice with respect to your specific issue or serves the legal needs of health care prac- Her website is: www.jacksonhealthlaw.com. problem. titioners and facilities in western and central Follow her on Twitter @bajhealthlaw1.

Thank you for your membership in the Allegheny County Medical Society The ACMS Membership Committee appreciates your support. Your membership strengthens the society Affiliated with Pennsylvania Medical Society and American Medical Association and helps protect our patients. Please make your medical society stronger by encouraging your colleagues to become members of the ACMS. For information, call the membership department at (412) 321-5030, ext. 110, or email [email protected].

ACMS Bulletin / August 2017 299 Practice Management Is your team drama from overstaffing? Joe Mull, MEd

ecently, the night before speaking All at once, I was struck by how Rat a conference, I had the chance absolutely accurate her statement was. If the challenges of the role to share dinner with the chief operat- As I travel the country training exceed their abilities or ing officer of a rather large state-wide managers from so many walks of life in don’t rise to an appropriate comprehensive health system in the health care, I’ve seen for years the im- level of difficulty, people are Midwest. We were joined by a former pact of understaffing. Every day, clinics colleague of hers who also has spent and hospitals struggle to find and retain less likely to be engaged. years working in health care. talent, suffer budget cuts that lead to Throughout the evening, we trad- barebones staffing and endure the appropriate level of difficulty, people ed stories, talked about the state of agony of call-offs. These are the under- are less likely to be engaged. It’s the affairs in health care and collectively staffing pain points most every health latter scenario that lends credence to bemoaned the lack of training and care manager has encountered or lives this COO’s observation. support most front-line leaders get to with regularly. And surely these cause When employees are bored, they navigate the people management chal- their own kinds of drama in clinics and look for problems to solve. Sometimes lenges they face every day. I enjoyed hospitals everywhere. Truth be told, I those problems aren’t really problems. the chance to spit-ball and “shoot the can’t remember the last time I met a They also can spend time, as well as breeze” with these sharp, experienced front-line healthcare leader who told mental and emotional energy, on things ladies, especially because they had me she thought her clinic was over- that otherwise wouldn’t be worthy of it each spent years on the frontlines in staffed. That’s why the COO’s state- if the role were indeed more testing of healthcare. They get it. ment initially caught me by surprise. them. It was during this conversation that But what if you are overstaffed and When clinics are overstaffed, there’s the COO made an observation I hadn’t don’t realize it? What happens when not enough to keep everyone firing on really considered before. you have more people working than all cylinders. Downtime, boredom, or We were talking about what I often you truly need? not enough to do simply create oppor- talk about in workshops and keynotes: In short: drama. The truth is that tunities for drama to creep in. drama. The gossip, infighting, cliques there’s all kinds of research in psychol- So … if you are experiencing higher and score-keeping that infect many ogy, sociology and employee engage- levels of drama at your site, ask your- health care teams to one degree or ment that tells us that employees who self: Are you overstaffed? another. That’s when she said this: are engaged live in a kind of intellectu- “You know, Joe, I’ve found that if al “sweet spot” where the full breadth Mr. Mull is a leadership trainer and that kind of drama is happening on and scope of their talents and experi- keynote speaker. He works with health a team, it’s often because they are ence must be brought to bear during care organizations that want their overstaffed.” the workday in order to be successful practice leaders to engage, inspire and “You mean understaffed?” I replied. in their job. If the challenges of the role succeed. To learn more or bring Joe to “No,” she said. “Overstaffed.” exceed their abilities or don’t rise to an your site, visit www.joemull.com.

300 www.acms.org Special Report Study reveals air pollution contributes to alarmingly high asthma rates in Clairton sthma is a disease that is increasingly recognized as a Amajor public health concern, especially in the Pittsburgh area. It is one of the country’s most common and costly diseases, affecting one in 13 people with annual costs around $56 billion.1,2 Pennsylvania has a slightly higher asthma rate (9.6 percent) compared to the rest of the United States (9 percent), and children (10.2 percent), especially black non-Hispanic children (19.3 percent), are disproportionately 3 affected. Asthma is one of the top causes of missed school Jennifer Albert Deborah days, and chronic school absenteeism can have a profound Elliott, Presto, PhD entile impact on a child’s ability to learn, participate in physical G , MD activities and develop healthy peer relationships.1,4 PharmD Despite advances in the treatment of asthma and an disease. With funding from the Heinz Endowments Breathe abundance of available medical care, Pittsburgh remains Project as well as the Jefferson Regional Foundation, three a very challenging city in which to live with asthma. The local researchers partnered to conduct the Surveillance and Allergy and Asthma Foundation of America currently ranks Tracking of Asthma in our Region’s Schoolchildren (STARS) Pittsburgh the 27th most challenging U.S. city in which to study. Deborah Gentile, MD, and Jennifer Elliott, PharmD, live with asthma based on a combination of factors includ- both from the School of Pharmacy at Duquesne University, ing a high prevalence of asthma, high poverty rates, a high developed an accurate and efficient method to conduct rate of poor asthma control and high levels of exposure to asthma surveillance and tracking among elementary school known asthma triggers including air pollutants and envi- children in the Pittsburgh region. They utilized a validated 5 ronmental tobacco smoke (ETS). Numerous studies have survey to assess asthma prevalence, severity and control shown that air pollution is associated with an increased risk among the study population.8-10 They also collected informa- of asthma development, increased respiratory infections tion on known modifiable risk factors such as obesity and and wheezing, and increased emergency visits and hospi- ETS exposure. Regional air pollution data from the group talizations for asthma.6 Particulate matter (PM) affects more of Albert Presto, PhD, at Carnegie Mellon University was people than any other pollutant, and the most health-dam- used to explore associations between asthma outcomes aging particles are those with a diameter of 2.5 microns or and levels of outdoor air pollutants such as PM2.5 and Black less (i.e., PM2.5) given their ability to penetrate deep within the lung.7 Carbon (BC). Pennsylvania does not have a consistent mechanism A total of 213 children from Clairton Elementary School in place to reliably predict regional asthma prevalence, were enrolled in the study. Results revealed that asthma and national and state asthma surveillance data cannot rates in the children from Clairton are nearly double the rate be extrapolated to local areas due to inadequate sample reported by the state of Pennsylvania (18.4 percent vs. 10.2 sizes. Given that there is currently no cure for asthma, but percent, respectively). As in previous studies, African-Amer- it can be adequately managed with proper prevention and ican and poorer children from Clairton have significantly treatment, it became critical to identify a way to determine higher rates of previously diagnosed asthma compared to regional asthma prevalence as well as the impact of mod- white and wealthier children. ifiable contributors to the development and control of the Continued on Page 302

ACMS Bulletin / August 2017 301 Reportable Diseases Special Report

Allegheny County Health Department From Page 301 Quarterly (Qt) Selected Reportable Diseases Additionally, this assessment resulted in the initial Disease* 2015 Qt 1-2 2016 Qt 1-2 2017 Qt 1-2** identification of asthma in 15 percent of the study popula- Campylobacteriosis 50 42 44 tion. This rate is striking since it represents at-risk children Cryptosporidiosis 11 5 12 who were not previously diagnosed with asthma. Obesity Giardiasis 33 22 19 Guillain-Barre 4 4 4 and ETS exposure also are highly prevalent among this Invasive Haemophilus influenzae 7 8 13 cohort of children, with one in four children identified as Hepatitis A 2 3 3 obese and over half exposed to significant ETS. Despite a Acute Hepatitis B 3 0 7 lack of association between asthma and obesity detected, Legionellosis 15 26 41 there were several associations identified between asthma Listeriosis 2 1 1 outcomes and outdoor air pollution and ETS exposure. Malaria 1 2 3 Meningitis, Viral 9 11 8 The mean residential distance from the Clairton Coke Meningococcal Invasive Disease 2 1 1 Works Plant, the largest coke plant in North America, is Pertussis 49 39 29 one mile, and 25 percent of children reside at least par- Salmonellosis 66 48 70 tially in the path of prevailing wind from the plant. Children Shigellosis 45 31 4 who reside within closer proximity to and partially in the Shiga-toxin producing E. coli 5 5 5 S. pneumoniae Invasive 33 31 33 path of prevailing wind have significantly higher average West Nile Virus Infection 0 0 0 BC and PM2.5 exposure than children living farther away or Zika Virus Infection 0 6 1 outside the path or prevailing wind. An alarming 60 percent

*Case classifications reflect definitions utilized by CDC Morbidity of the children studied from Clairton had PM2.5 exposures and Mortality Weekly Report. above the recommended World Health Organization **These counts do not reflect official case counts, as current year threshold to reduce premature mortality.7 And, unlike other numbers are not yet finalized. Inaccuracies in working case counts major cities in which the most polluted area is the city cen- may be due to reporting/investigation lag. ter, children living in Clairton have higher exposures than NOTE: Disease reports may be filed electronically via PA-NEDSS. children living in the city of Pittsburgh. To register for PA-NEDSS, go to https://www.nedss.state.pa.us/ There also was a higher prevalence of previously NEDSS. To report outbreaks or diseases reportable within 24 hours, please call the Health Department’s 24-hour telephone line, diagnosed asthma among children exposed to higher (412) 687-2243. levels of PM2.5, BC and ETS. In fact, exposures to PM2.5 and BC in the upper quartile compared to the lower For more complete surveillance information, see ACHD’s 10-year summary of reportable diseases: http://www.achd.net/epi/pubs/ quartile increased the risk of asthma nearly two-fold, the pdf/2015_AC_Reportable_Diseases.pdf. same effect size seen with ETS exposure. There also was a higher prevalence of newly discovered asthma among

children exposed to higher levels of PM2.5 and BC. Uncon- trolled asthma was much higher in Clairton children (64.1 Free classified ad online percent) compared to all children in the United States (38 percent) and in the state of Pennsylvania (27 percent) Place a classified advertisement with a previous diagnosis of asthma.11 in the Bulletin, and your ad will The rates of childhood asthma as well as poorly con- appear online FOR FREE on the ACMS trolled asthma among Clairton children are alarming and website, www.acms.org, for the unacceptable. This study reveals that asthma prevalence and burden is related to racial and socioeconomic dispari- duration of your advertisement. ties as well as ETS and air pollution exposure. These results For information, call Meagan Sable highlight the need for state-mandated asthma screens as at (412) 321-5030, ext. 105. well as novel treatment delivery models for high-risk groups, such as school-based clinics. Most importantly, primary

302 www.acms.org Special Report BOARD-CERTIFIED DERMATOLOGIST PITTSBURGH, PENNSYLVANIA prevention measures are imperative to for Atmospheric Particle Studies at decrease exposures to the harmful air Carnegie Mellon University. pollutants contributing to the asthma epidemic in Clairton. Dr. Gentile is director of clinical • Nationally Recognized Practice • Established in 1981 research, Adult and Pediatric Allergy • Competitive Compensation Package Dr. Elliott is an associate professor and Asthma, a Division of the Pediat- • Flexible, Part-Time Schedule of pharmacy practice in the School of ric Alliance, adjunct professor of phar- Pharmacy at Duquesne University. macy, Duquesne University School of The Skin Center Medical Spa, the #1 medspa in Pennsylvania and Ohio, is seeking a part- Pharmacy. time board-certified dermatologist to meet the Dr. Presto is an associate research growing demand of our dermatology practice professor in the Department of Me- The authors can be reached at in our suburban Pittsburgh, PA office. chanical Engineering and the Center [email protected]. Founded by board-certified cosmetic surgeon, Dominic Brandy, MD, The Skin Center boasts a nationally accredited surgical center, a vein References al. Health effects of air pollution. J Allergy practice and four medical spa locations in addition to our dermatology practice. 1. CDC. Asthma. https://www.cdc. Clin Immunol. 2004; 114(5):1116-23. gov/asthma/default.htm. Last accessed 7. World Health Organization. Ambient With a 35-year history of excellence in 6/20/2017. (outdoor) air quality and health. http://www. elective cosmetic surgery, The Skin Center 2. CDC. National Surveillance of Asth- who.int/mediacentre/factsheets/fs313/en/. would afford you an opportunity to deliver ma: United States, 2001-2010. https://www. Last accessed 6/20/2017. patient-centered care with great autonomy. As an integral member of our team of cdc.gov/nchs/data/series/sr_03/sr03_035. 8. Jones DA, Morphew T. Clement LT, clinicians, PAs, RNs and aestheticians, pdf. Last accessed 6/20/2017. Kimia T, Dyer M, et al. A school-based you would become a trusted advocate and 3. Pennsylvania Department of Health. case identification identifying inner city chil- resource for your patients who seek both 2015 Pennsylvania Asthma Prevalence dren with asthma. Chest 2004;125:924- routine preventative care as well as those Report. http://www.health.pa.gov/My%20 934. facing complex skin issues. Health/Diseases%20and%20Condi- 9. Maio S, Sherrill DL, MacNee We are seeking clinical expertise in areas tions/A-D/Asthma/Documents/2015%20 W, Lange P, Costabel U, et al. The including: PENNSYLVANIA%20ASTHMA%20PREV- European Respiratory Society spirom- ALENCE%20REPORT%20UPDATED%20 etry tent: a unique form of screening • Skin cancer screening and treatment FEB%2023%202016.pdf. Last accessed for airway obstruction. Eur Respir • Medical and surgical treatment of both 6/20/2017. J. 2012 Jun;39(6):1458-67. doi: common and complex skin conditions 4. Sturdy P, Bremner S, Harper G, 10.1183/09031936.00111910. Epub 2012 (acne, eczema, psoriasis, actinic keratoses, cutaneous infections, alopecia, cysts, Mayhew L, Eldridge S, Eversley J, et al. Jan 20. hyperhidrosis, warts, vitiligo, connective Impact of asthma on educational attain- 10. Wan KS, Chiu WH, Yang W. tissue diseases, hidradenitis, hair and nail ment in a socioeconomically deprived Asthma diagnosis and severity monitoring disorders, etc.) population: a study linking health, educa- in primary school children: Essential role of • Cosmetic procedures including soft tissue tion and social care datasets. PLos One sequential testing of exhaled nitric oxide. augmentation and neurotoxins 2012;7:e43977. Allergol Immunopathol 2013 July 2. DOI: 5. Asthma and Allergy Foundation of 10.1016/aller.2013.04.007. America. Asthma Capitals 2015. http:// 11. CDC. Uncontrolled asthma among www.aafa.org/media/Asthma-Capitals-Re- persons with current asthma. https:// port-2015-Rankings.pdf. Last accessed www.cdc.gov/asthma/asthma_stats/ 6/20/2017. uncontrolled_asthma.htm. Last accessed 6. Bernstein JA, Alexis N, Barnes C, et 6/20/2017. Contact: Please direct inquiries and CV to [email protected]

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ACMS Bulletin / August 2017 Dermatology_AlleghenyCountyMedicalSociety_RecruitmentAd.indd7/18/17 3031 8:49 AM