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September 2018 | www.cmsdocs.org Pay Hikes The Shift to Value- Based Care Favors Primary Care Physicians

Accelerating Healthcare Innovation Through Collaboration Timeline: Your Society’s Proud Heritage New Guidance for Disposing of Electronic Devices and Media Publication of the Chicago Medical Society THE MEDICAL SOCIETY OF COOK COUNTY ISMIE is the perfect fit.

ISMIE’s customized coverage means that your medical professional liability insurance policy is always the perfect fit. No matter your specialty, tenure, full or part-time status, or practice setting, we ensure that you are safeguarded with protection, quality, service, and value. Discover why nearly 10,000 policyholders choose ISMIE at ismie.com/perfectfit.

PRESIDENT’S MESSAGE MEMBER BENEFITS FEATURES 2 Legislative Harvest 30 Calendar of Events By Vemuri S. Murthy, MD 10 Pay Hikes Favor Primary Care 31 Classifieds Docs Over Specialists PRACTICE MANAGEMENT Amid a growing shortage of primary care 4 Implementing Threat-based WHO’S WHO physicians and the shift to value-based Cybersecurity 32 Working for Better Patient Care care, organizations put a premium on By Gregory Garrett Board-certified internist Vineet Arora, primary care physicians’ skills. By Bruce MD, MAPP, serves as the director of Japsen HEALTHCARE INNOVATION GME Clinical Learning Environment and 6 Accelerating Innovation Through Innovation at the University of Chicago 14 CMS Timeline: 1850-1999 Collaboration Medicine. In that position, she helps In honor of the Chicago Medical Society’s By Steven Collens, MBA residents and fellows become more ISMIE’s customized coverage means that your medical proud past, Chicago Medicine offers this engaged in patient care values such as detailed timeline highlighting the Society’s LEGAL quality and safety, a goal that she is professional liability insurance policy is always the perfect successes. By Elizabeth Sidney 9 Disposing of Electronic Devices passionate about making successful. fit. No matter your specialty, tenure, full or part-time status, and Media 26 A Historical Sampling of Colorful By Stephanie T. Eckerle, Esq., and or practice setting, we ensure that you are safeguarded with CMS Presidents Meghan M. Linvill McNab, Esq. protection, quality, service, and value. Discover why nearly Our Society has certainly had its share of memorable presidents. Here we highlight 10,000 policyholders choose ISMIE at ismie.com/perfectfit. five especially colorful physicians. By Patrick Butler

Legislative Harvest EDITORIAL & ART OOKING AHEAD to the midterms, we know EXECUTIVE DIRECTOR Theodore D. Kanellakes that healthcare has been a rallying point in recent elections. It could be a decisive issue in November. ART DIRECTOR Regardless of what happens at the federal level, Thomas Miller | @thruform your Chicago Medical Society took the lead by EDITOR/EDITORIAL Ladvancing reforms locally. Elizabeth C. Sidney As health plan networks shrunk, we made sure plans sold EDITORIAL CONSULTANT in Illinois meet basic minimum standards. We laid out provi- Cheryl England sions of a bill that went on to become the Network Adequacy CONTRIBUTORS and Transparency Act. The legislation was enacted in 2017. As Patrick Butler; Steven Collens, MBA; a result, plans sold in Illinois must ensure adequate networks Stephanie T. Eckerle, Esq.; Gregory of physicians; notify patients when a provider is no longer in a network; and maintain Garrett; Bruce Japsen; Meghan M. up-to-date provider directories. Linvill McNab, Esq.; Vemuri S. Murthy, Your CMS also took on prescription drug price gouging. We’ve partnered with every- MD one from city aldermen to U.S. senators on transparency and accountability measures ADVERTISING for drug companies and PBMs. We’ve been active on other legislative priorities on behalf of patients such as: Fox Associates, Inc. 800-440-0231 • Preventing health plans from removing a drug from their formulary or changing its [email protected] Chicago • New York • Los Angeles tier status once the drug has been approved for coverage to treat a medical condition Detroit • Phoenix during the plan year. The new law also streamlines the process by which physicians can certify medical necessity. CHICAGO MEDICAL SOCIETY • Strengthening mental health parity. A new law prohibits all prior authorization and OFFICERS OF THE SOCIETY step-therapy requirements for treatment of substance use disorders. School districts can no longer discriminate against mental health and addiction coverage. PRESIDENT • Extending the period a patient can refill a prescription for a non-controlled Vemuri S. Murthy, MD substance from 12 months to 15 months. PRESIDENT-ELECT • Preserving continuity by giving Medicaid managed care enrollees the option to stay Dimitri T. Azar, MD

with their primary care physician if the contract between their physician and health SECRETARY plan is terminated. A. Jay Chauhan, DO • Raising the purchase age for all tobacco products, including e-cigarettes, from 18 TREASURER to 21. This national movement, called Tobacco 21, was adopted in Chicago as an Tariq Butt, MD ordinance, as well as in various other counties and cities and states. In spite of the CHAIR OF THE COUNCIL groundswell movement, however, Governor Rauner vetoed the legislation. Christine P. Bishof, MD

This is only a partial recap of the past year’s legislative bounty. Next month, we’ll VICE CHAIR OF THE COUNCIL Victor M. Romano, MD update you on advocacy to protect physician practice and reimbursement. Pushback from special interest groups is typically the roadblock to bills moving IMMEDIATE PAST PRESIDENT forward. That’s why critical mass and physician unity are so important. Clarence W. Brown, Jr., MD Will you be practicing in 2019? Now more than ever, a unified Chicago Medical CHICAGO MEDICINE Society must lead rather than react to the forces reshaping medicine and healthcare delivery. 515 N. Dearborn St. Chicago IL 60654 312-670-2550 www.cmsdocs.org

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K PRACTICE MANAGEMENT Implementing Threat-based Cybersecurity Patient care innovation requires safely storing and analyzing patient data by Gregory Garrett

ECHNOLOGY HAS brought analyze patient data—the most valuable resource healthcare to consumers’ fingertips, to the consumer, to the business of health and, we putting them at the nucleus of care and believe, to the security of a nation. Threat-based blurring the definition of a healthcare cybersecurity will be their lifeline. organization. Traditional technology Tentities are building healthcare apps, wearables Threat-based Cybersecurity: A and other connected devices, and consumers are Condensed Roadmap using them to track their health progress and feed Based on intent, threat-based cybersecurity is a data back to their provider, payer or both. Retailers forward-looking, predictive approach. Instead of are partnering with pharmacies, so both can gain focusing solely on protecting critical data assets or access to each other’s data and reach a greater following the basic script of a generic cyber program, number of consumers. Insurers are partnering with threat-based cybersecurity concentrates investments pharmaceutical manufacturers to leverage patient in the most likely risks and attack vectors based on data to improve outcomes and lower health costs. your company’s unique threat profile. But perhaps nothing says the healthcare How do healthcare organizations develop and company of the future has arrived as much as maintain a comprehensive cyber threat profile? the innovative partnership between Amazon, The first step is to assess and take ownership of JPMorgan and Berkshire Hathaway. your organizational DNA: the data assets and other Data-sharing between consumer health intellectual property that make you unique—or a organizations is of course net positive. Capitalizing potential target. Owning your organizational DNA on data is the first step to achieving precision starts with information governance: identifying, medicine and creating shared value across the managing, accurately categorizing, protecting and health ecosystem. But cyber risks are also growing optimizing organizational data from inception to as data sharing increases. final disposition. But, keep in mind that the data If organizations in the business of consumer assets you value most may not be the prime target health are going to sustainably innovate around for a would-be hacker. Your data on performance patient care, they must be able to safely store and outcomes, for example, is far harder to monetize on

Type of Breach

Unauthorized Access/Disclosure

Theft

Loss

Impro per D isposal

Hacking/IT Incident

0 10 20 30 40 50 60 70 80 90

4 | Chicago Medicine | September 2018 PRACTICE MANAGEMENT

the dark web than your patient database. organization’s networks, medical devices and The next step is to factor in the threat data understand their roles and responsibilities environment to understand current exploits and in defending against cyber threats. the most targeted vulnerabilities. As of July 12, so • Create an internal and external crisis far this year the U.S. alone has seen 176 reported communications plan to align with existing large-scale data breaches (those impacting enterprise risk management frameworks. 500 or more individuals), according to the U.S. • Implement cyber insurance claims preparedness Department of Health and Human Services. That and adequate coverage to identify and quantify number equates to 3.2 million patients impacted incurred event response costs for inclusion in an and spans 40 states. insurance claim. But more telling are the breach types and • Create an incident response plan to include the locations of breached information. The biggest participation of organization leadership and threats in 2018 have been unauthorized access/ key personnel from all technology, business, disclosure (77) and email (48), respectively. administration and clinical functions. What does this tell us? That to effectively detect and respond to risks, healthcare organizations need to: “Your data on performance outcomes, for

• Bolster their access controls—technical policies example, is far harder to monetize on the dark and procedures—to ensure that only authorized web than your patient database.” employees have access to protected health information (PHI) and to be more stringent about who they grant access. Capitalizing on data is one of the first steps • Implement stronger audit controls to track and to innovating patient care—and is crucial identify internal and external access to and to surviving in today’s blurry healthcare exploration of information systems that contain ecosystem. But to do so sustainably, in a PHI. way that protects patient privacy and data • Strengthen intrusion detection systems (IDS) security, will require a threat-based approach to more accurately monitor traffic moving to cybersecurity. And achieving threat-based throughout their networks and systems and cybersecurity is a journey spanning the entire identify suspicious activity and clear threats in corporate lifecycle. real time. And their IDS should be especially focused on email intrusions—their number one Gregory Garrett is the head of international attack vector. cybersecurity for BDO (www.bdo.com) supporting • Make top-down personnel education a priority over 2,000 information technology and cybersecurity to ensure all individuals with access to an professionals worldwide.

Location of Breached Information

Paper/Films Other Portable Electronic Device Other Network Server Laptop Email Electronic Medical Record Desktop Computer Desktop Computer

0 10 20 30 40 50 60

September 2018 | www.cmsdocs.org | 5 HEALTHCARE INNOVATION Accelerating Innovation Through Collaboration An update from MATTER, Chicago’s healthcare incubator and innovation hub, three years after opening its doors By Steven Collens, MBA

Chicago Medicine is introducing a new magazine section—“Healthcare Innovation in Chicago.” Experts from academic centers, hospitals, tech incubators, among others, are writing about research and other projects at their institutions.

ASTROENTEROLOGIST Everybody wins: the insurance company saves Lawrence Kosinski, MD, had a money; the doctors are better able to do their jobs; problem. He would see his patients and patients are healthier. with inflammatory bowel disease Dr. Kosinski is one of the entrepreneurs who (IBD) when they came in for are part of MATTER, Chicago’s healthcare Gappointments, but he would lose touch technology incubator and innovation hub. with them between visits. Sometimes— Startups like SonarMD are ushering in too often, in fact—he would learn a new era of healthcare—moving us from a hospital that one of his from the episodic, reactive system patients had been admitted. His we have now towards a future state patients were, in his view, like where care is proactive, predictive submarines. They would surface and personalized. in his office and then disappear for Innovations like this one happen long stretches of time—periods during best in a collaborative environment, which he had no way of knowing how where people with shared passions can they were doing. He wanted the equivalent get together, bounce ideas off each other of a sonar system to keep track of them. Since and learn from one another. It was with people nothing existed, he built it. He developed a system such as Dr. Kosinski in mind that MATTER was to help him connect with his patients, and he called developed. it SonarMD. The Story of MATTER’s Origin “Chicago was lacking the key ingredient for a In 2013, under the auspices of Chicago Mayor Rahm Emanuel, a group of entrepreneurs successful healthcare innovation ecosystem: the came together to build a stronger healthcare ability for entrepreneurs to easily find mentors, entrepreneurial ecosystem. At the time, Chicago advisors, investors and partners, and to access had a $50 billion medical technology industry, which included 91 hospitals, six medical schools, educational resources to build their skills.” more than 500,000 healthcare jobs and nearly 60,000 students studying in a related field at local The problem Dr. Kosinski was solving was universities—not to mention a vibrant startup one that Blue Cross and Blue Shield of Illinois community. (BCBSIL) was interested in: on average, treating Chicago did not, however, have a home for the a patient with IBD costs BCBSIL $24,000 per healthcare community: the large companies were patient per year. BCBSIL agreed to pilot Dr. scattered across a wide urban and suburban area; Kosinski’s solutions, experimenting with a patient the startups were spread across the city; and there management fee that is adjusted based on the cost was no community infrastructure to bring them savings generated by SonarMD. all together to foster collaboration and innovation. The results were outstanding: patients were Chicago was lacking the key ingredient for a admitted to the hospital less often, with the successful healthcare innovation ecosystem: the hospitalization rate dropping from 17% to 5%. ability for entrepreneurs to easily find mentors, BCBSIL saved, on average, $6,000 per person advisors, investors and partners, and to access per year, for patients who responded to inquiries educational resources to build their skills. about their health at least 50% of the time. Today, In 2014, the State of Illinois provided $4 million BCBSIL will pay gastroenterologists across the to build a hub for the healthcare community. Civic state if they use SonarMD for their patients. leaders and area businesses came together to

6 | Chicago Medicine | September 2018 HEALTHCARE INNOVATION

Dr. Richard Vazquez (center) founded SafeStart Medical in 2012. A former general surgeon at Northwestern Memorial Hospital, Dr. Vazquez worked through the MATTER community to find other companies with which to partner. provide early operational support that allowed the next-generation healthcare and life sciences project to get off the ground. technologies. In 2017 alone, we hosted more than 500 programs, with topics ranging from MATTER Today human-centered design and entrepreneurial We opened MATTER’s doors in February 2015 finance to healthcare cybersecurity and the social with 30 startup companies and a few programs, determinants of health. and we have since grown to include more than 200 startup companies, 50 corporate partners Doing Something That Matters and dozens of programs supporting healthcare MATTER’s name was inspired by interviews with entrepreneurship and innovation. Today, our dozens of entrepreneurs. We found that, like all startups range from those that are barely more entrepreneurs, those in healthcare want to change than ideas, to companies with millions of dollars in the world, be their own bosses and participate revenue and dozens of employees. in the economic upside that can come with All told, our member companies employ 2,000 entrepreneurship. people and have raised more than $500 million But unlike other entrepreneurs, those in to fuel their growth. Their products—which healthcare tend to be in this field for very specific span health IT, medical devices, diagnostics and reasons. They have familial connections to the therapeutics—have been used by 100,000 clinicians and have benefitted more than 76 million people. “Like all entrepreneurs, those in healthcare want With MATTER’s non-profit and no-equity model as a foundation, this community has evolved to change the world, be their own bosses and into a neutral platform where entrepreneurs can participate in the economic upside that can come come together with industry leaders, scientists with entrepreneurship.” and clinicians to collaborate on developing

September 2018 | www.cmsdocs.org | 7 HEALTHCARE INNOVATION

healthcare industry or have been touched in deeply Stopping Diabetes Before It Even personal ways by disease or other health-related Starts circumstances. They are incredibly passionate Like many, HabitNu Founder Sindhu Rajan, PhD, not just about building businesses, but also about has lost family and friends to diabetes. More building healthcare businesses that will make the than 90 million adults in the U.S. are at risk of world a healthier place. Most will not be satisfied developing diabetes. Without intervention, 50% of building companies in other industries; they are these adults will likely develop diabetes in the next passionate about doing something that matters. five to seven years. Rajan previously spent 12 years researching “Our startups are always looking to connect diabetes at Yale University and the University of Chicago. During this time, she grew increasingly with physicians.” frustrated by the lack of evidence-based support What follows are a few recent examples of for people at risk for type 2 diabetes. innovators in the MATTER community who In 2015, she became one of the first have aligned these personal passions with entrepreneurs to join MATTER. With their professional pursuits to solve meaningful encouragement from our team, she started a problems in healthcare. Importantly, these are National Diabetes Prevention Program (DPP) all stories of collaboration. Just as Dr. Kosinski at MATTER, giving Chicagoans access to teamed up with Blue Cross and Blue Shield of this research-backed support program for the Illinois, these entrepreneurs teamed up with each first time. This project received early support other, and with large enterprises to develop novel from the American Diabetes Association and healthcare solutions. Advocate Heart Institute. But with one-in-three American adults at risk A Friendlier Experience for Surgical of developing diabetes, Rajan knew she needed to Patients scale—and to scale, she knew the DPP needed to Ten years ago, Tom Riley’s mother was diagnosed grow beyond a pen-and-paper model. with ovarian cancer. As she embarked on her Last month, HabitNu became one of only a journey as a cancer patient, Riley began his journey handful of digital DPP solutions in the nation as her caregiver and advocate. The two quickly to receive full recognition from the Centers for learned how challenging it could be to keep on top Disease Control. This recognition is a big step: of the care plan and understand what symptoms to Now, HabitNu qualifies for reimbursement from watch out for and when to escalate a concern to the the Centers for Medicare and Medicaid Services. doctor. Riley didn’t know it then, but his mother’s As a preventive service, people with prediabetes journey would eventually become the inspiration can participate in the DPP program as a free for TapCloud, a healthcare technology startup he benefit with no copay—and thanks to HabitNu’s founded in 2013 to improve the substantial portion technology, the program can scale to reach the 90 of the patient journey that happens in between million people who need it. doctor’s visits. At MATTER, Riley met Richard Vazquez, MD, Advancing Care and Improving a general surgeon at Northwestern Memorial Lives Hospital and founder of SafeStart Medical. Building a successful startup is hard. Building SafeStart improves the surgical safety process, a successful startup in healthcare is even more starting at the front desk and continuing all the difficult. way into the operating room. For startups like SonarMD, TapCloud, SafeStart Through a connection at MATTER, Riley and HabitNu, being part of a community like and Dr. Vazquez learned about the Ontario MATTER can make or break a company’s success. Telemedicine Network’s search for a one-and-done In this complex industry, the ability to not only solution that could meet the surgical needs of 220 access, but also build relationships with other hospitals in the Canadian province. They then entrepreneurs, innovators from established reached out to InTouch Health, a global telehealth organizations, patient advocates and clinicians is company with capabilities to quickly implement one of MATTER’s most important strengths. and scale a solution of this magnitude. Individually, Our startups are always looking to connect with none of the companies involved had the technology physicians. For more information about how to to fully address the problems outlined in the get involved, email [email protected] or register request. But together, they had all the right pieces. for one our upcoming programs at matter.health/ InTouch Health, SafeStart and TapCloud formed events. a new venture, InTouch Surgical, to combine their respective technologies—and they were selected Steven Collens, MBA, is chief executive officer of as the solution of choice for the more than 220 MATTER, a healthcare technology incubator. He hospitals in Ontario’s 14 Local Health Integration has no material interest in any of the companies Networks. mentioned in the article.

8 | Chicago Medicine | September 2018 LEGAL Disposing of Electronic Devices and Media New guidance for healthcare providers and their business associates By Stephanie T. Eckerle, Esq., and Meghan M. Linvill McNab, Esq.

N AUGUST 7, 2018, the HHS Office of Civil Rights (OCR) issued HIPAA Policies and Procedures guidance on disposing of electronic The third topic that OCR focuses on is the proper devices and media. This guidance destruction and disposal of ePHI. OCR reminds “Electronic is important for all healthcare covered entities and business associates that their media must Oproviders since it applies to any covered entities or HIPAA policies and procedures must address the be cleared, business associates who store ePHI on desktops, disposal of ePHI. OCR provides examples of what laptops, copiers, cell phones, USB devices and such policies must contain, such as ensuring that purged, or other electronic storage devices. In addition, OCR’s the policies determine and document the appropri- destroyed guidance also reminds covered entities and business ate method to dispose of hardware, software consistent with associates it is critical to properly dispose of paper and the data itself. In addition, covered entities records that contain PHI. should also ensure that workforce members who NIST Special The guidance issued by OCR focuses on the dispose of PHI or supervise others who dispose of Publication following four tasks covered entities and business PHI receive training on such disposal. 800-88 associates can do to ensure their PHI as well as electronic devices are disposed of properly: (1) Destruction and Disposal of ePHI Revision 1, undertaking a thorough risk analysis; (2) properly Last, PHI should be destroyed to ensure it is not Guidelines decommissioning and disposing of devices and considered unsecured. OCR highlights the follow- media; (3) having HIPAA policies and procedures ing methods: for Media that address the disposal of devices and PHI; and Sanitization, (4) properly destroying or disposing of PHI. • Paper, film, or other hard copy media must be so that the shredded or destroyed so that the PHI cannot be Risk Analysis read or reconstructed. Redaction is specifically PHI cannot be HHS highlights that one of the first things a excluded as a means of data destruction. retrieved.” covered entity should ensure is that their risk • Electronic media must be cleared, purged, analysis addresses the PHI stored on electronic or destroyed consistent with NIST Special devices and media. A few questions covered Publication 800-88 Revision 1, Guidelines for entities may want to consider when conducting a Media Sanitization. risk analysis are as follows: Although this guidance was just issued, OCR has • What data is maintained and where is it stored? actively addressed the failure to properly dispose of • Is the data disposal plan up to date? PHI in settlements with covered entities as well as • Are all asset tags and corporate identifying in multiple other publications. marks removed? For example, in 2015 OCR entered into a • Is data destruction handled by a certified Resolution Agreement with a pharmacy due to the provider? pharmacy’s alleged disposing of patient records in a dumpster that was accessible to the public. OCR Decommissioning of Devices found that among other things, this pharmacy OCR also focuses on the importance of properly failed to: (1) reasonably safeguard PHI; (2) imple- decommissioning devices. This is the process of ment proper written policies and procedures in taking hardware or media out of service prior to its compliance with HIPAA’s privacy rule; and (3) pro- final disposal. HHS highlights three steps covered vide HIPAA training to members of its workforce. entities and business associates should take: This Resolution Agreement as well as other guidance issued by OCR demonstrate that all cov- • Ensuring devices and media are securely erased ered entities and business associates need to make and then either securely destroyed or recycled. the proper disposal and destruction of PHI as well • Ensuring that inventories are accurately updated as devices containing PHI a top priority. to reflect the current status of decommissioned devices and media. Stephanie T. Eckerle, Esq., and Meghan M. Linvill • Ensuring that data privacy is protected via McNab, Esq., practice in the Indianapolis office of proper migration to another system or total the law firm Krieg DeVault. They can be reached at: destruction of the data. [email protected] or [email protected].

September 2018 | www.cmsdocs.org | 9 PAY HIKES Pay Hikes Favor Primary Care Docs Over Specialists Amid growing shortage and shift to value-based care, organizations put a premium on primary care physicians’ skills By Bruce Japsen

“A compensation HE COMPENSATION of primary A compensation trend is clearly forming and pri- care physicians is rising much faster mary care physicians are the apparent winners as trend is clearly than the pay of specialists as more and these reimbursement models take hold among com- forming and more reimbursement from insurance mercial health insurers and, increasingly, Medicare primary care companies is tied to value-based and Medicaid health programs that are moving to Tmodels. In the value-based approach to medical pay-for-performance and value-based models. physicians are care, physicians are paid and provided bonuses and the apparent incentives to keep people in outpatient care. And Inflation Outpaces Specialist winners as that means more reimbursement goes to primary Compensation care physicians. Over the last five years, specialist compensation these The 2018 Medical Group Management has risen only 5.69%, thanks to new value-based reimbursement Association annual compensation survey shows pay models from insurance companies and models take median primary care doctor compensation rose Medicare that reward primary care doctors who nearly 2% to $257,726 in 2017 from $253,629 in work to keep patients healthy and out of the more hold.” 2016. That compares to specialists’ compensation expensive hospital setting. Compensation for that is barely rising at all, increasing less than specialists was $402,233 in 2013 and has generally 1% in 2017 to $425,136 from $423,392 in 2018, risen at a rate below the 2% general inflationary according to the 2018 MGMA DataDive Provider rate. Meanwhile, all primary care compensation Compensation, which comes from a dataset of has risen 10.62% to $257,726 in 2017 from more than 136,000 providers from more than $232,989 in 2013. 5,800 organizations including doctor, hospital and The trend toward greater emphasis on primary academic-owned practices. care and the patient getting care in the right

% Increase in Median Compensation Over Last 5 Years by Primary Care Breakout

TOTAL TOTAL COMPENSATION WORK RVUS COLLECTIONS ENCOUNTERS

Family Medicine (without OB) 12.05% 0.87% 2.64% -6.96%

Geriatrics 10.02% -3.43% 4.22% -2.24%

Internal Medicine: General 8.88% 3.07% 9.15% -2.88%

Obstetrics/Gynecology: General 4.49% -0.82% -1.76% -4.24%

Pediatrics: General 4.84% -4.26% -0.67% -7.93%

Urgent Care 12.92% -12.73% -4.24% -14.74%

Source: MGMA 2018 Provider Compensation Survey

10 | Chicago Medicine | September 2018 September 2018 | www.cmsdocs.org | 11 PAY HIKES

$ Difference in Median Incentive Amounts Offered to Newly Hired Primary Care Physicians Over Last 5 Years SIGNING BONUS AMOUNT CME PAID AMOUNT

Family Medicine (without OB) $4,375 $1,000

Internal Medicine: General $5,000 $1,000

Obstetrics/Gynecology: General $0 $500

Pediatrics: General $7,000 $500 Source: MGMA 2018 Provider Compensation Survey

place, in the right amount and at the right time nearly two-fold rise in median compensation is unlikely to change given the shift from fee-for- for primary care physicians over their specialist service medicine. counterparts and increased additional Value-based care models are becoming incentives, we can now see the premium the dominant form of reimbursement. Major organizations are placing on primary care insurers including Aetna, Blue Cross and Blue physicians’ skills,” MGMA president and CEO Shield of Illinois, Cigna and UnitedHealth Dr. Halee Fischer-Wright said. Group this year said they have now shifted more To be sure, demand for primary care physicians than one-half of their payments to value-based remains the highest amid a nationwide doctor models, which pay physicians and hospitals shortage. The Association of American Medical based on outcomes and quality measures. That Colleges’ most recent analysis shows there will be means more reimbursement to doctors will a shortage of up to 120,000 physicians “across a come via bundled payments, accountable care number of disciplines by 2030.” And when it comes organizations (ACOs), medical home models to primary care physicians, the AAMC estimates and pay-for-performance contracts. “With a a shortfall “of between 14,800 and 49,300 primary

Winners: Family Medicine

THE RISE in primary care this trend, but show that by utilizing organization, access to care increases. compensation isn’t necessarily tied more non-physician providers in their Ultimately, both the number of patient to an increase in productivity, the practice, administrators can actually encounters as well as their satisfaction 2018 MGMA DataDive Provider boost their practices’ revenue and can increase,” said Ken Hertz, principal Compensation survey found. A closer productivity by allowing physicians to consultant at MGMA. “This is a win-win look at this data shows that when focus on the most acute cases,” said Dr. for both patients and practices – broken down by primary care focus, Halee Fischer-Wright, president and CEO patients’ health outcomes improve while family medicine physicians saw a 12% of MGMA. practice revenue increases.” rise in total compensation over the While primary care practices with a Additionally, the data shows that most past five years, while their median higher non-physician provider (NPP) to practices generally reported an increase number of work relative value units physician ratio (0.41 NPPs per physician in expenses since 2013. These findings are (wRVUs) remained flat, increasing by or more) report greater expenses, they in line with a July 2018 MGMA Stat poll in less than 1%. Meanwhile, practices are also report earning more in revenue after which 69% of respondents indicated their also offering more benefits to attract operating costs than practices with fewer practice has seen overhead expenses and retain physicians, including higher NPPs (0.20 or fewer NPPs per physician), increase in the past year. signing bonuses, continuing medical regardless of specialty. Physician-owned The data finds that over the past education stipends, and relocation practices with 0.41 or more NPPs per five years, median operating costs for expense reimbursements. physician report earning $100,748 more primary care practices have risen by in revenue after operating expenses per 13%, from $391,798 per physician to Medical Practices with Non- physician than practices with 0.20 or $441,559 per physician. With overall Physician Providers fewer NPPs. In hospital-owned primary expenses on the rise, practices continue MGMA’s DataDive Cost and Revenue care practices, that difference is $131,770 to have evergreen expenses, where analysis for 2018 found that medical more in revenue after operating costs per general operating costs make up 32¢ practices benefit when they utilize more physician. of every dollar collected in physician- non-physician providers due to the “Because these non-physician owned practices. Of that IT represents increased revenue and productivity. “The providers can effectively complement 2¢, drug supply 6¢, and building findings not only further demonstrate primary care services for the occupancy another 6¢.

12 | Chicago Medicine | September 2018 PAY HIKES

% Increase in Median Compensation Over Last 5 Years by Geographic Region PRIMARY CARE SPECIALTY NONPHYSICIAN PHYSICIANS PHYSICIANS PROVIDERS

Eastern 11.85% 2.13% 3.80%

Midwest 10.23% 10.25% 4.11%

Southern 8.96% 4.75% 6.17%

Western 10.94% 8.19% 26.56% Source: MGMA 2018 Provider Compensation Survey care physicians” by 2030. to the National Commission on Certification of The shortage and move to value-based models is Physician Assistants. also benefitting primary care professionals such as Though compensation is on the rise and that’s nurse practitioners and physician assistants. The good for physicians and other providers, MGMA MGMA analysis shows “Non-physician provider said the survey points to a “concerning trend compensation has increased at a rate of 8% over we’ve seen in the American healthcare system for the last five years.” some time—we are experiencing a real shortage of That mirrors other analyses showing the doctor primary care physicians,” MGMA CEO Dr. Fischer- shortage and the push toward a team-based Wright said. “Many factors contribute to this approach to medical care are boosting the pay problem, chief among them is an increasingly aging of nurse practitioners and physician assistants. population that’s outpacing the supply of chronic For example, physician assistant compensation care they require.” rose to $107,000 in 2017, or 3%, compared to $104,000 in 2016. And PA salaries are rising at Bruce Japsen is a health care journalist, speaker, an even faster pace than primary care physicians author and regular contributor to Chicago Medicine with PA salaries up nearly 13% to $107,000 in who also writes for Forbes. He can be reached at 2017 compared to $95,000 in 2012, according [email protected].

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September 2018 | www.cmsdocs.org | 13 HISTORY

Ships pass through raised bridges on the Chicago River, undated. Photo courtesy of the Chicago History Museum.

In honor of the Chicago Medical Society’s proud past, which includes many public health strides, Chicago Medicine is present- ing a detailed timeline of events in CMS' history from 1850 to 1999 as well as highlights of colorful presidents from the past. As with the articles we printed last month, you’ll find information about medicine in Chicago and the physicians who devoted themselves to improving public health in the city, raising medical education standards and combating quackery. Future magazine issues will continue the series up to the present.

14 | Chicago Medicine | September 2018 HISTORY CMS Timeline Highlights from our history 1850-1999 By Elizabeth Sidney

N ITS 150 years, CMS has had a history Chicago delegation travels there by stagecoach. as colorful as it is long. But some historians would date the Society’s first meeting to Oct. 1852—Dr. Nathan S. Davis reorganizes the medi- 3, 1836, when physicians met in the office of cal society. Rules of procedure are simplified, the Chicago Insurance Co. with Dr. Levi D. requirements for a quorum are reduced, and the IBoone acting as secretary. While the date of origin name is changed to Cook County Medical Society. remains unclear, records show that the Society did Emily Blackwell, sister to Elizabeth, the first not meet regularly between 1836 and 1850. Here woman to be awarded a medical doctorate in mod- are some highlights: ern times, is denied permission to complete her studies at Rush after ISMS censured the school for 1837—Rush Medical College receives its charter, admitting a woman. two days before Chicago receives its city charter. 1855—Dr. Levi Boone is elected mayor of Chicago 1840—First call for a state medical convention of on “Know-Nothing” ticket. The quarantine plac- physicians in Illinois to band against “irregular” ard is introduced with signs reading “Smallpox practitioners. Here” after 30 die from the disease.

1843—Rush Medical College, named after Dr. 1857—The Rush faculty votes to establish a graded Benjamin Rush, one of four physicians to sign course along lines proposed by Dr. Nathan S. the Declaration of Independence, opens to a Davis, but President Dr. Daniel Brainard vetoes class of 22 students. Courses consist of a 16-week the idea fearing that students will seek education curriculum, held in two rented rooms. The elsewhere. A Rush Medical College student and original site occupied the same location as the city sexton are charged with “resurrectionism” as current CMS building. body snatching was called among the students.

1847—First general hospital in the Chicago area 1858—CMS’ name reverts to Chicago Medical is established in a large warehouse known as Society. Tippecanoe Hall. 1862—The CMS treasury holds assets of 25 cents; 1848—Dr. Levi Boone, a relative of pioneer Daniel membership is listed at 45. Boone, is elected city physician and shortly after- wards made alderman of the 2nd ward. 1864—CMS Committee on City Poor recommends that Chicago support dispensaries and visiting 1849—Cholera is brought to Chicago by the physicians for the needy and work against patent immigrant boat John Drew from New Orleans. medicine advertisements. The Chicago Medical Medical profession and city officials also work College is incorporated. to prevent the spread of smallpox. Physicians volunteer to vaccinate the poor without charge. 1865—Dr. Mary H. Thompson establishes a hospital for indigent women and children. 1850—Birth of CMS with Dr. Levi Boone as the first president (April 19). Its constitution stresses 1866—Cook County Hospital opens. Dr. Edmund the scientific goals of the new body and the Andrews introduces antiseptic techniques in society upholds “proper ethical rules and a more Chicago; he tests Lister’s carbolic spray on courteous standard of professional intercourse” operative cases in the wards of Mercy Hospital. among members. Dr. Nathan S. Davis organizes the first voluntary hospital, Illinois General 1868—Michael Reese Hospital opens. Hospital of the Lakes, in the Lake House Hotel on the corner of North Water and Rush Streets. 1869—CMS protests the political nature of The hospital later becomes Mercy Hospital. The appointments to Cook County Hospital. The Illinois State Medical Society (ISMS) is formed Chicago Medical College becomes the medical and the first meeting is held in Springfield. The department of Northwestern University. For the HISTORY

St. Luke's Hospital, 1865. Photo courtesy of Rush-Presbyterian-St. Luke's Medical Center Archives.

The Cook County Hospital house staff, undated. Photo courtesy of the Chicago History Museum.

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next 20 years, it is known as Chicago Medical College, the Medical Department of Northwestern University.

1870—Classes begin at the Women’s Hospital Medical College. Sarah Hackett Stevenson, who later held the first American Medical Association (AMA) seat occupied by a woman, is a future graduate of the college.

1871—Great Chicago Fire. Physicians inspect camps of homeless; work to prevent disease. City birth and death records are lost in the fire. Dr. William E. Quine, secretary of CMS, saves the Society’s records from 1850 to 1871.

1872—In the aftermath of the fire, the death rate increases from 32.6% to 27.6% deaths per 1,000 persons. Smallpox attacks 2,382 and killed 655. Fatalities among children under five are the highest ever recorded.

1875—CMS leaders first discuss plans for a 1884—Curriculum standards for all the state’s Cook County Hospital, permanent CMS home. Until now, meetings had medical schools are adopted. 1890. Photo courtesy been held in physicians’ homes and offices, at the of Cook County Court House, Masonic Temple, and the Chicago 1885—Bodies that would ordinarily be buried Hospital. Public Library. Every meeting space eventually at public expense are turned over to medical becomes too small. It would be another 104 years institutions, thanks to passage of a state anatomical before CMS found a permanent home. law.

1877—First discussion of germ theory of disease at 1886—The Chicago Policlinic commences post- Medical Society meetings. First public regulation graduate education of medicine. Early faculty of the practice of medicine. The Medical Practice includes Drs. Christian Fenger, Nicholas Senn, and Act provides that all physicians in the state must Fernand Henrotin. register. Doctors with diplomas from approved medical schools must be licensed immediately; 1888—Dr. Bayard Holmes of Chicago Medical those lacking them must be examined by a state College gives the first instruction in bacteriology in medical board. Chicago.

1878—Antisepsis made part of the routine at Cook 1889—More than 30 papers dealing with surgery, County Hospital. Regulations for medical colleges internal medicine and nervous diseases are read at established. No medical school can graduate two CMS meetings. classes of students in one year or fail to require two full terms of lectures for graduation. The city 1890—CMS membership reaches 560, a three-fold council makes slaughterhouses subject to licensure. increase over the preceding decade. A prepaid medical program is inaugurated in Chicago by Dr. 1880—Physicians are more open to the concept J.K. Crawford and former Health Commissioner of quarantine. The Board of Health makes first Dr. Oscar De Wolf. Although tried by CMS for inspections of Chicago factories and packing unprofessional conduct and convicted, the doctors houses. A CMS committee report charges some are not expelled from the Medical Society. clinics with abusing medical charity, stating they are operated by medical schools interested only in 1891—Provident Hospital and Training School increasing the number of clinical cases. is founded and incorporated. CMS publishes the Chicago Medical Record, a monthly filled with 1881—Dr. Mary Bates wins an internship position papers read before the Society as well as reports of at Cook County Hospital despite difficulty in the proceedings of its meetings. securing the approval of the county board because she is female. The first regular class sessions begin 1892—Northwestern University makes the at The College of Medicine of the University of Women’s Hospital Medical College a department of Illinois, located on Harrison and Honore Streets. the university.

September 2018 | www.cmsdocs.org | 17 HISTORY

The Columbian Exposition, 1893. Medical and related exhibits were shown in many buildings. The fair contained three working hospitals and hosted several international meetings on or near the grounds. The site is where the Museum of Science and Industry now stands. Photo courtesy of the Chicago History Museum.

Nurse weighing infant, undated. Photo courtesy of the Chicago History Museum.

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1893—A total of 23 surgical papers are 1905—CMS becomes the largest local medical presented at Medical Society meetings, along organization in the world. Its treasury contains with 16 microscopial exhibits. A public health $15,000 and membership reaches 2,000. Chicago bacteriological laboratory opens to conduct schools produce more homeopathic graduates than microscopic examinations of milk samples and to any other city. examine throat cultures for diphtheria. A “boil the water” crusade against typhoid begins. 1907—The Public Relations Committee champions the Society’s causes in the state legislature. CMS 1894—Last major smallpox epidemic (1,033 die opposes bills to license optometrists, osteopaths, in its second year). Vigorous vaccination efforts and chiropractors. CMS forms a milk commission (1,084,500 given) result in a reduction of cases to to ensure a pure and reliable source of milk for seven in 1897. The Public Health Department issues infant feeding. The commission undertakes the circulars on hot-weather care of babies. inspection of milk, dairies, and cows belonging to producers who want their product certified. 1895—The first diphtheria antitoxin is issued, and Chicago now has 55 dispensaries, 16 of them con- a corps of antitoxin administrators are appointed. nected with hospitals, nine with medical schools Daily analysis of the water supply is inaugurated. and 30 unattached.

1896—Chicago becomes the second city in the 1909—Chicago becomes the first city in the U.S. to United States to inspect medical schools. adopt a compulsory milk pasteurization ordinance. The Illinois Medical College becomes the Medical 1898—CMS is incorporated with a 12-man board of Department of Loyola University. The university trustees, a president, vice-president, secretary and itself dates back to 1869. nine other members elected by affiliated specialty societies and the membership at large. 1910—The Municipal Social Hygiene Clinic is established, and dispensaries are required to 1899—Campaign against infant mortality enlists report venereal diseases. The policy of multiple support of a voluntary corps of 73 physicians. voting comes to an end at CMS meetings. Now one member has only one vote. A total of 143 of 227 1900—CMS now has eight specialty societies. candidates for state office solicited by the Public According to the new constitution, all members Relations Committee sign pledges agreeing to of affiliated groups must be CMS members. Four support a uniform method of admission to medical permanent committees emerge—membership, practice in Illinois. publications, judiciary and auditing. The Public Relations Committee concentrates on pure-food 1912—Sterilization of Chicago’s water begins, and legislation and on the abolition of patent medicine within four years the entire supply is being treated, advertising. causing a dramatic decline in the city’s typhoid fever rate—from the second highest among the 20 1901—CMS condemns fee splitting by referring largest U.S. cities in 1881 to the lowest by 1917. physicians and specialists. 1913—Chicago physicians take control of the 1902—The Medical Society begins publication of a Illinois State Medical Society. weekly bulletin. 1914—CMS physicians wishing to attend the ISMS 1903—CMS becomes a county medical society meeting in Decatur board the Illinois Central again. Railroad. The train, composed of a drawing room, compartment and open section sleeping cars, buffet 1904—The Medical Society divides into component car, and diner, serves as a hotel for the three-day branches where scientific and social meetings are meeting. CMS is led by President Dr. Charles P. held, while the business of the Society as a whole Caldwell. is transferred to a council of delegates from the new branches and the specialty societies. Larger 1915—CMS meetings are held on the sixth floor of meeting spaces become necessary. The number the Marshall Field Annex at 25 E. Washington. The of trustees is reduced from 12 to five and they Society is responsible for most of the charity work are given sole custody of all Society property and being performed in the field of infant health. funds. Eleven branch societies are in operation. Each branch has its own officers and programs. 1917—CMS forms a grievance committee instructed to “hear complaints and adjust differences between 1904—The Medical Society begins public lectures members of CMS and the public.” The Municipal series to enlighten laymen on medical subjects. Contagious Disease Hospital is established. Immunization against diphtheria with von

September 2018 | www.cmsdocs.org | 19 HISTORY

Behring’s toxin-antitoxin begins in public schools mostly to connect calls with Loop-area physicians. and institutions. The Chicago Medical School, which had been organized under the name of the 1936—Summer brings 210 deaths from sunstroke Chicago Hospital College of Medicine, assumes the and heat exhaustion, compared to 11 from the same title Chicago Medical School. cause in 1935.

1918—Influenza becomes a reportable disease with 1937—Chicago schools open three weeks late the pandemic reaching Chicago and causing 381 because of a polio scare. deaths on one day (Oct. 17) alone. 1938—CMS recommends that a nonprofit, 1920—The Public Health Institute is organized voluntary health insurance plan be formed for as a venereal disease clinic with Dr. Joseph G. marginal economic groups unable to afford medical Berkowitz as medical director. The AMA goes and surgical care, and who do not qualify for free on record as being opposed to compulsory health service. insurance. Chicago physicians, also, oppose state medicine, compulsory health insurance, county and 1942—The Chicago Intensive Treatment Center for state health agencies. Venereal Disease launches an effort so successful that it wins a War Department commendation in 1921—Congress passes the Sheppard-Towner Act 1943 and leads to declining venereal disease rates providing for grants-in-aid to states for child and following WWII demobilization, in contrast to maternal health. The AMA lobbies against state soaring rates in other large American cities. compliance with the terms of the law. 1944—At the urging of CMS physicians Drs. 1925—At 515 N. Dearborn, the Victorian structures Casper M. Epsteen and Charles H. Phifer, the first are razed to make way for the Portland Cement clinical conference is held at the Stevens Hotel Association headquarters, which later becomes the (now the Conrad Hilton and Towers). Registration CMS building. A cornerstone box (time capsule) fee is $5 for four days. containing photos and documents is sealed away inside the building, not to be opened until 1983. 1945—The Murray-Wagner-Dingell health bill is introduced. This plan proposes a 4% payroll tax 1929—Dr. Louis E. Schmidt is dropped from on the incomes of all persons earning less than CMS membership because of his association with $3,600 annually to cover all costs of medical the Public Health Institute, which advertises its care. CMS opposes the medical insurance services. provision of the bill. Dr. R.J. Humels is forced to take his name off matchbooks distributed by 1930—An intensive campaign against diphtheria Wagner’s Greasing Palace. results in 400,219 injections being given in three months. 1946—Writing a newspaper column is judged unethical for a physician in practice. CMS is 1931—CMS criticizes Henrotin Hospital and nine located at 30 N. Michigan on the 15th floor. CMS other institutions for advertising. has 5,700 members.

1932—Physicians are sent to the homes of mothers 1947—The scientific exhibit comes into vogue at unable to take children to welfare stations for the Midwest Clinical Conference. Membership diphtheria inoculations. Cases drop to 154 with dues reach $25. nine deaths, compared to 1,266 cases with 68 deaths the previous year. 1948—CMS institutes a voluntary medical insurance program coordinated with the 1933—CMS moves to 185 N. Wabash Ave. local Blue Cross plan. Called the Blue Shield Chicago Medical Service Plan, it is offered to 1934—As a result of drinking contaminated water Chicago Tribune employees. The organization is at the Union Stock Yards, 69 persons contract subsequently amalgamated into the statewide typhoid fever, 11 of whom die. The federal Illinois Medical Service Plan. Under pressure program of free medical service for recipients of from the Society, the city increases the number of unemployment relief is adopted. emergency ambulances in operation to five. The Society had recommended 20. 1935—An ordinance passes requiring that only Grade A milk and milk products be sold in Chicago. 1948—The Midwest Clinical Conference includes A premature infant welfare program is initiated. the reading of scientific papers, clinicopathologic The CMS physician referral service, started in the conferences, a panel on what’s new in medicine mid-1920s, is reestablished as a “reference bureau,” and surgery, and a panel on obstetrics.

20 | Chicago Medicine | September 2018 HISTORY

1949—Cook County has five TB deaths a day. Surgical clinic of the General hospitals will not accept TB cases, and legendary Dr. John B. public sanitariums are full. Murphy. This undated photo is taken from Dr. 1950—Six thousand physicians and surgeons are Murphy's office win- on the CMS active role; at least 6,000 attend the dow. Photo courtesy of 1950 clinical conference. Illinois becomes a unified Mercy Hospital. membership state. CMS President Dr. Willard O. Thompson announces support for private prepaid hospital and medical care plans.

1951—CMS moves to 86 E. Randolph Street (at Michigan Ave.) on the 9th floor.

1952—Dr. Robert R. Mustell founds the CMS emergency house call service. He signs up more than 250 physicians. Chicago counts 1,203 cases of polio, including 82 deaths and hundreds of Chicago River and people with paralysis. The Society first offers life Harbor from the Rush insurance for its members. Chicago’s Municipal Street Bridge, 1915. Tuberculosis Sanitarium, once scandal-ridden, is Photo courtesy of declared first rate by the Chicago Sun-Times, which the Chicago History attributes the improvement to CMS and to Mayor Museum.

September 2018 | www.cmsdocs.org | 21 HISTORY

Cook County Hospital, Martin Kennelly. discrimination against black physicians in the city’s Ward 7, undated. hospitals. The state’s first medical political action Photo courtesy of 1955—Chicago is one of the first cities in the committee, IMPAC, is formed. The CMS weekly the Chicago History United States to introduce the Salk vaccine. CMS Bulletin expands. Museum. at first objects to mass inoculations, calling them “dangerous,” and insisting the family doctor should 1961—A lead poison survey begins on Chicago’s administer them in his office. CMS participates in west side. The CMS Bulletin, renamed Chicago mass polio inoculations and receives a certificate Medicine, becomes a journal. of commendation from the National Foundation for Infantile Paralysis. 1962—Chicago Medicine goes biweekly in August. The Sabin vaccine arrives. 1956—Dr. Mustell’s emergency service is the second largest service of its kind in the world, 1963—CMS recommends a program using Sabin handling 8,000 cases a year with 250 doctors. Oral Polio Vaccine on a larger scale in Chicago. Mass inoculations of the Salk vaccine are given in The city’s public health department carries out this all parts of the city following warning signs of an proposal. approaching epidemic. Chicago introduces water fluoridation. 1964—Branch-sponsored clinical education programs come to an end as hospitals increasingly 1957—CMS chides Dr. Herman Bundesen, presi- take on this function. dent of the Chicago Board of Health, for supporting a city plan that would mix health and politics. The 1965—The first mention of Category 1 credit issue is whether the health commissioner should offered to physicians. Family planning begins in share administrative authority with the board and a limited number of clinics. CMS moves to 310 S. its president. Dr. Samuel Andelman is eventually Michigan Ave. The emergency house call service appointed as health commissioner. serves more than 20,000 people.

1960—A committee cosponsored by CMS and the 1966—Citywide lead poisoning screening and Institute of Medicine in Chicago reports extensive therapy begin. Medicare goes into effect. During

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the CMS Midwest Clinical Conference, physicians begins phasing out. learn the mechanics of Medicare, the role of the Fiscal Intermediary under Parts A and B, and the 1975—Outpatient TB services are assumed at role of the Hospital Utilization Review Committee. five health centers and control is placed under the Board of Health. Physicians gain CMS’ 1967—The number of patients seen through CMS’ permission to make announcements about emergency home service plunges from 13,006 to themselves for public benefit, such as when 6,819. they open or close an office. More than 1,000 malpractice suits are filed in Cook County. As 1968—A gonorrhea screening culture program a result, the CMS Council authorizes a one-day starts in all Board of Health stations in conjunction “medical moratorium” on non-emergency with the U.S. Public Health Service. A meat medical care. CMS decides to allow former CMS inspection program is developed under the USDA presidents to become ISMS presidents. The CMS Wholesome Meat Act. Council votes to shut down the emergency home service, thus paving the way for the city’s 911 1969—Mayor Richard J. Daley appoints Dr. system. Morgan O’Connell as acting health commissioner. CMS protests Daley’s “undue delay” in appointing 1976—The largest immunization program in the a qualified commissioner. Dr. Murray C. Brown, city’s history is launched to protect citizens from director of the regional environmental control swine flu. ISMS forms the Illinois State Medical division of the U.S. Public Health Service, is hired Inter-insurance Exchange to provide malpractice as the new commissioner. CMS welcomes Dr. insurance for Illinois physicians. CMS begins using Brown. State legislation is proposed to penalize Tel-Med, a nationally produced audiotape series fee-splitting. to educate patients. Cook County establishes a medical examiner system. 1970—CMS trustees vote to join the Institute of Medicine in Chicago and 14 specialty societies 1977—The Department of Public Health initiates in support of an anti-fee splitting amendment to screening for PPNG (penicillinase-producing the medical licensing law. The Council votes not Neisseria gonorrhoeae) with guidelines sent to to support the legislation. The state legislature all Chicago physicians. A major conference is approves the fee-splitting measure. The CMS sponsored by the department for Chicago health Council rejects a proposal to accept medical professionals on infant mortality. Dr. Clifton L. students, but it reverses itself a year later when Reeder becomes the first CMS president-elect it votes to accept AMA student chapters as admitted to regular meetings of the president and affiliated societies with voting privileges. CMS officers. forms a foundation to monitor Chicago-area healthcare. Known as the Foundation for 1978—The Midwest Clinical Conference charges a Medical Care, it helps the government police registration fee of $12.50. the profession. 1979—CMS purchases the CMS building from the 1971—The peer review process at CMS is codified Worsham School of Mortuary Science, and moves and the work divided among three committees: its offices there in 1980. The CMS Tel-Med Service Ethical Relations; Grievance; and Prepayment handles 75,000 calls during the year. Plans. 1980—Under FTC pressure, the AMA changes its 1972—Chicago is the nation’s first city to limit position on advertising. Yellow pages now seek lead content in household paint to .06%. Chicago physician advertising. The new CMS building is Medicine introduces a fresh new look and format. dedicated. The AMA Committee on Accreditation Page size increases, paper quality improves, of CME authorizes CMS to give CME credits. typography and layout are revamped. 1981—Mayor Byrne proposes a 1% citywide 1973—Forty Chicago hospitals are approved tax on services performed by a variety of to receive emergency and trauma cases by city professionals, including physicians, lawyers, vehicles (police or fire) in accordance with the dentists, architects, etc. CMS president Dr. state statute on Emergency Medical Service. Robert C. Hamilton speaks before the City Regulations are issued for abortion establishments Council arguing that the tax would simply be following a U.S. Supreme Court decision. Dr. passed on to patients as a “tax on the sick.” He Henrietta Herbolsheimer becomes the Society’s vigorously opposes the tax and is successful first woman officer. after several months. CMS begins a series of instructional sessions about managing the 1974—The Municipal Tuberculosis Sanitarium business aspects of medical practice.

September 2018 | www.cmsdocs.org | 23 HISTORY

in medical malpractice lawsuits. The Tel-Med AIDS tape surges in popularity with over 1,000 requests received in March alone. CMS creates an AIDS awareness public service announcement.

1988—CMS responds to more than 24,000 physician referral calls from the public and distributes 50,000 Tel-Med and Physician Referral Service brochures. CMS opposes Medicare Part B premiums on behalf of senior citizens, and it works with the Cook County Department of Public Health to provide healthcare for the indigent. CMS introduces a resolution encouraging pathways for foreign medical graduates seeking leadership positions in organized medicine.

1989—CMS distributes the bimonthly Senior Health newsletter to nearly 800 senior citizens organizations, and it develops a brochure for the The class of 1881 at public on the Living Will Act and the Durable the entrance of Mercy 1983—The new façade of the CMS building is Power of Attorney. It supports city resolutions Hospital. Dr. Nathan completed. Panels of durable Indiana limestone prohibiting cigarette advertising on billboards, Smith Davis (with top replace the pre-cast concrete slabs, which had increasing the legal age to purchase tobacco to 21, hat) stands centrally sheathed the building since 1925. CMS seals away a and requiring the posting of signs where liquor above the steps. Photo new time capsule containing CMS bylaws, a roster is sold to warn pregnant women. CMS continues courtesy of Galter issue, Chicago Medicine, historical materials and efforts to oppose the “hold-harmless” clauses used Library, Northwestern photographs. A Chicago-area AIDS Task Force is by insurance companies. University Feinberg established. CMS hosts a sesquicentennial exhibit School of Medicine. for the city—with 45 oil paintings showing the 1990—Physician artwork goes on display for the history of medicine. The exhibit traces medicine first time at the Midwest Clinical Conference. CMS from ancient Egypt and Babylonia to the discovery sends Spanish news releases and public service of insulin and the “era of antibiotics.” The Tel-Med announcements about current health issues to system plays its first AIDS tape, scripted by CMS. the Hispanic media. CMS testifies in support of a city ordinance regulating disposal of medical and 1984—An ordinance makes Chicago the first city in infectious waste. The Medical Society also initiates the nation to ban the sale of leaded gasoline. a speakers’ bureau program for area schools and civic organizations. 1985—More than 4,000 physicians rally in Springfield for medical malpractice reform. 1991—For the first time, the Midwest Clinical Eleven reforms are passed. While considered a Conference features a general session dialogue breakthrough year, physicians do not get a cap on with the CMS Executive Committee and Executive far right above: The awards for pain and suffering. All Chicago-area Director. Iron Lung, undated. blood donations are now screened for AIDS. Photo courtesy of 1992—CMS creates the Wood Street Branch, and it the Chicago History 1986—Only 784 malpractice suits are filed as holds 21 programs on OSHA regulations for more Museum. opposed to 1,945 in 1984. CMS membership grows, than 1,500 physicians and office staff. CMS designs partly because of the insurance exchange and and distributes more than 3,000 OSHA exposure far right below: also because of gains on malpractice legislation. control plans. The Medical Society also writes and Members of the Rush The CMS insurance trust is merged with announces 200 health messages as part of “The Medical College programs operated by ISMS. The merger results WMAQ Medical Report,” and introduces the CMS faculty: (1) William in Physicians’ Benefits Trust. After 10 years, CMS Member Service Line. B. Herrick (2) John Tel-Med receives 5,000 calls a month to hear Evans (3) Thomas selections from 218 tapes. CMS launches a “Give, 1993—Dr. Sandra F. Olson becomes CMS’ first Spencer (4) Nathan Save, Teach” campaign in an effort to dispel myths woman president. Physicians enrolled in ISMIE S. Davis (5) Afred W. about the dangers of donating blood. spend $51 million on malpractice defense. Davisson (6) Josiah President Clinton launches healthcare reform B. Herrick, undated. 1987—CMS representatives help write into law proposals. CMS opposes economic credentialing Photo courtesy of a new role for the Medical Society whereby it by hospitals, as well as unannounced physician Rush-Presbyterian-St. serves as an advisor to the Illinois Department of office inspections by the Chicago Department Luke's Medical Center Registration and Education. ISMS lobbies for, but of Revenue. CMS leaders make two trips to Archives. does not win, a $250,000 cap on pain and suffering Washington, DC, to discuss proposed health

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system reforms. CMS also adopts a gun control resolution and begins publishing Health Reform Report for CMS members.

1994—The Illinois legislature passes a reform package that caps non-economic damages at $500,000. The CMS Executive Committee travels to Washington, DC, to meet with legislators and discuss proposed Medicare-related legislation. CMS co-sponsors a violence prevention seminar and begins developing model language for use by hospital medical staff in their bylaws.

1996—CMS presses its position on “drive-through deliveries” and care for mothers and newborns. The Council approves the concept of an in-house physician credentialing service. CMS votes to support a proposed ordinance that would prohibit smoking in all enclosed public areas. The Medical Society approves the development of two educational seminars: “Buying or Selling a Medical Practice,” and “Risk Management.” Illinois Gov. Jim Edgar signs into law two bills concerning patients’ rights, both of which contain provisions developed by CMS.

1997—In Best v. Taylor Machine Works Company, the Illinois Supreme Court strikes down the Civil Justice Reform Amendments of 1995, declaring the entire legislation in violation of the Illinois Constitution. CMS participates in the formation of the Managed Care Patients’ Rights Act, which ISMS introduces in the Illinois General Assembly. The CMS Council calls for an “immediate statewide moratorium on for- profit takeovers of hospitals, insurance plans, HMOs, physician practices and other healthcare institutions.” CMS seeks legislative relief to allow for private billing under Medicare. The Medical Society supports the formation of an IMG Section at the AMA.

1998—CMS supports collective bargaining by employed and self-employed physicians. The Medical Society backs reasonable guidelines for determining fraud and abuse, which should be developed in conjunction with organized medicine. CMS implements the CMS-DOCS phone line, a service line for new members, and joins a coalition with the Chicago Bar Association and other local groups to review judgeships in Cook County. The CMS Council passes a resolution opposing human cloning.

1999—CMS is named a benchmark association for the 1998 Midwest Clinical Conference by the Learning Resources Network (LRN), an international association in lifelong learning. The conference is one of seven association conferences to achieve this distinction. CMS forms a Collective Bargaining Committee.

September 2018 | www.cmsdocs.org | 25 CMS PRESIDENTS A Historical Sampling of Colorful CMS Presidents Our Society has had its share of innovative, and sometimes controversial, presidents By Patrick Butler

HE CHICAGO Medical Society has departments; enforced a long-ignored Sunday had its share of local legends. And it all saloon closing law; and raised the annual liquor started with Dr. Levi Boone, a physician license fees tenfold, from $30 to $300. who ended up as mayor of Chicago. On April 21, hundreds of German workers, Here is our look at some of our most incensed at being unable to spend their one free Tcolorful physician presidents! day of the week socializing with family and friends in their favorite bierstuben, marched on City Levi Boone Hall. During the melee, a policeman was seriously Despite his solid accomplishments as the founding wounded and his fleeing assailant shot in the back. president of the Chicago Medical Society, Dr. Levi Dr. Boone himself later admitted his mistake and Boone is unfortunately best remembered today as reportedly didn’t argue when an investigating the mayor who provoked the city’s first full-scale committee recommended hiring more German and Dr. Fishbein turned riot. The ultraconservative nephew of early Irish police. JAMA into one of the American explorer Daniel Boone had been elected The “Know Nothing” influence soon most popular profes- by the nativist “Know Nothing” party on a promise evaporated and Chicagoans continued to enjoy sional journals of the to put Chicago’s Irish and Germans in their place. beer on Sunday, at least until Prohibition reared era. He kicked out all foreigners in the fire and police its head 65 years later.

Morris Fishbein During a 60-year career, Dr. Morris Fishbein— another CMS president—wrote more than 40 books explaining the medical profession to the lay public—and to itself. After his 1912 graduation from Rush Medical College and a brief apprenticeship at the McCormick Institute for Infectious Diseases, Dr. Fishbein went to work for the Journal of the American Medical Association. After becoming editor in 1924, he declared war on then-rampant quackery and promoted sound, scientific medical practice as he turned JAMA into one of the most popular professional journals of the era. He also founded a lay magazine, Hygea, and the American Medical News Weekly; organized a public relations department for the AMA; and edited the World Wide Abstracts of General Medicine. After his “retirement” in 1950, Dr. Fishbein signed on as medical editor of Encyclopedia Britannica. In 1969, he published his long-awaited autobiography, Morris Fishbein, MD. His other books ranged from Do You Want to Become a Doctor? (1939) and The Handy Home Medical Encyclopedia, a 1953 best-seller, to his more scholarly 1947 History of the American Medical Association. A few years before his death in 1976 at age 87, the University of Chicago created a new history- of-science professorship in Dr. Fishbein’s name. To the very end, he spent much of his time urging his colleagues on to higher levels of excellence.

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To some, Dr. Fishbein’s prescription for success must have seemed more than a little hard to swallow. During a 1965 graduation address at Chicago Medical College, for example, the eminent spokesman for organized medicine warned that, “The modern doctor must combine the tactfulness of a diplomat, the eloquence of a lawyer, the impartiality of a judge, the decisiveness of a general, the frankness of a witness, and the astuteness of a man on trial for his life, with the precision of a mathematician, the imagination of an artist, the altruism of a philanthropist and the tenacity of a pawnbroker.”

Nicholas Senn If you were a turn-of-the-century Chicago physician, you either loved or hated Dr. Nicholas Senn. There was no in-between. His lectures and prolific writings were legendary—and for some insufferable—in an age when even medical academics sometimes stopped just short of throwing punches to bolster their arguments. Once, after visiting Dr. Lawson Tait, Dr. Senn wrote a scathing review of the eminent gynecologist’s work habits in JAMA. The outraged Dr. Tait, in turn, called Dr. Senn “a typical specimen of the medical tramp, one of the most vulgar I have ever met.” Yet there was never any question about the flamboyant, publicity-seeking clinician’s raw courage. At a time when next to nothing was known about cancer’s contagiousness, Dr. Senn implanted major medical journals of the 1880s and 1890s, Dr. Senn was among several malignant growths in his forearm to test but he also organized the Association of Military the first to use the one of his theories about how tumors spread. Surgeons. He accumulated one of the best medical then-unpredictable Fortunately, Dr. Senn was wrong at that time. and surgical libraries anywhere in the country, x-rays in the treatment He was also among the first to use the then- a 10,000-volume treasure trove that can now be of leukemia. unpredictable x-rays in the treatment of leukemia. found in the Illinois Institute of Technology’s John And his classes in everything from microscopy Crerar Library. to plastic surgery were often standing-room-only Dr. Nicholas Senn’s even better-known events at Chicago Medical College, where Dr. memorial, of course, is the North Side public high Senn taught from the 1880s right up to his death school named in his honor. in 1908 (with a brief break for service in Cuba as a National Guard surgeon general during the Christian Fenger Spanish-American War). Not surprisingly, some medical historians date Born in Switzerland in 1844, Senn came first to the birth of scientific medicine in Chicago from Wisconsin with his parents and graduated from the 1877 arrival of Dr. Christian Fenger, another Chicago Medical College in 1868. After serving his CMS president. Hailed as the “Father of Modern residency at Cook County Hospital, he returned Pathology,” the one-time Danish army doctor and to Milwaukee where he practiced medicine by day member of the Egyptian National Board of Health and spent most evenings in a private laboratory was the first surgeon in Chicago to use rubber experimenting on everything from gastrointestinal gloves and cotton scrubs in an operating room. lesions to bone tuberculosis. He also performed Chicago’s first vaginal In the late 1870s, he returned to Europe for hysterectomy for cancer; taught the Chicago another MD degree from the University of Munich Medical College’s first bacteriology classes; and (American patients were especially impressed with was the first doctor anywhere in North America continental medical degrees—particularly German to demonstrate the bacterial nature of acute ones). By 1897, Dr. Senn had also picked up a PhD endocarditis. Also a pioneer in brain surgery, from the University of Wisconsin. Fenger developed a technique for removing tumors Despite his heavy work and study load, Dr. Senn with an aspirating needle. And while he was at it, not only found time to contribute to most of the he also developed what was to become a classic

September 2018 | www.cmsdocs.org | 27 CMS PRESIDENTS

uterine operation. In an era when even eminent professionals paid for public jobs, Dr. Fenger had to borrow the money to buy a staff appointment at Cook County Hospital, which he soon helped transform into a major teaching institution at least partly with his ever-popular autopsies. Over the years, he mentored other medical greats including Dr. Daniel Hale Williams, one of Dr. Fenger is hailed as the nation’s first black surgeons, who did the first the "Father of Modern open-heart operation at Provident Hospital; Dr. Pathology." Ludwig Hektoen, another future CMS president; and Dr. Frank Billings, credited with making Chicago the medical mecca it is today. While he had a well-deserved reputation for mercilessly driving his students and associates, Dr. Fenger was also known for calling beer-and-pretzel breaks at appropriate junctures in especially lengthy surgeries. Indeed, Dr. Fenger, who spoke 11 languages fluently and was known to read all the relevant literature he could find before doing an unfamiliar procedure, had none of the arrogance somehow expected of “great” 19th century doctors. In fact, he’d often end major lectures—even before distinguished groups—with the caveat, “But this is only what I think. That does not matter.”

Daniel Brainard Depending on which story you want to believe, Rush Medical College founder Dr. Daniel Brainard first made his mark here either by delivering the child of a homeless woman who had become the charity “project’ of the emerging social set or by performing a difficult leg amputation on an injured canal worker. Either way, the European-trained pioneer who came to Chicago in 1835 from Oneida County, NY, looking more like a derelict than a doctor, soon became one of Chicago’s emerging Dr. Brainard founded medical elite. Rush Medical College Besides starting the city’s first medical college and was eventually (in 1843 with 22 students), Dr. Brainard was among elected as vice presi- the first local doctors who operated for stomach dent of the American tumors, strangulated hernias, strabismus and tear Medical Association. duct obstructions. He would later stun the medical world by successfully removing a malignant soft palate tumor—without anesthesia—in less than 10 minutes. The patient lived, despite being “considerably depressed from the shock and loss of blood,” Dr. Brainard noted later. Dr. Brainard’s research on the treatment of snake bite and complicated fractures eventually led to his election as vice president of the American Medical Association. He had even been invited to lecture in Paris in 1853 before the prestigious French Academy. A scholar to the end, Dr. Brainard was writing a paper on the treatment of cholera when he died of that very disease in his suite at the Sherman House in the spring of 1866.

28 | Chicago Medicine | September 2018

MEMBER BENEFITS Calendar of Events

SEPTEMBER community’s contributions, Ruby 312-670-2550, ext. 344; or Ave., Chicago. For information, more events take place on the [email protected]. contact Ruby 312-670-2550, ext. 19 CMS Executive Committee following Saturday and Sunday. 344; or [email protected]. Meeting Meets once a month to 6:00 p.m. Location: University 20 CMS Executive Committee plan Council meeting agendas; Club of Chicago, 76 E. Monroe Meeting Meets once a month to NOVEMBER conduct business between St. For information, please go to: plan Council meeting agendas; quarterly Council meetings; www.zlpchicago.org. conduct business between 10-13 AMA Interim House and coordinate Council and quarterly Council meetings; of Delegates CMS actively Board functions. 8:00-9:00 OCTOBER and coordinate Council and participates in the American a.m. CMS Building, 33 W. Grand Board functions. 8:00-9:00 Medical Association’s Ave., Chicago. For information, 2 CMS Council Meeting The a.m. CMS Building, 33 W. Grand policymaking meetings, contact Ruby 312-670-2550, ext. Society’s governing body Ave., Chicago. For information, advocating for both members 344; or [email protected]. meets three times a year to contact Ruby 312-670-2550, ext. and their patients. Resolutions set a legislative agenda and 344; or [email protected]. adopted by the CMS governing 21 Polish American Medical to conduct business on behalf Council typically advance Society of Chicago This of the Society. All members 20 CMS Board of Trustees to the Illinois State Medical year, PAMS celebrates the are encouraged to submit Meeting Meets every other Society, where they are centennial of Poland’s regaining resolutions to the Council. month to make financial implemented, before ultimately its indendence. Along with an 7:00-9:00 p.m., Maggiano’s decisions on behalf of the reaching the AMA. CMS independence day banquet on Banquets Chicago, 111 W. Grand Society. 9:00 – 11:00 a.m. delegates to the AMA also may Friday, recognizing the medical Ave. To RSVP, please contact CMS Building, 33 W. Grand submit a resolution directly to the AMA House. Physicians are encouraged to exercise this outstanding membership privilege, ensuring that GET GOVERNMENT FUNDING their voice is heard at the highest levels of organized TO STUDY THE EFFECTS OF ADRENALINE. medicine and well beyond. Gaylord National Harbor Hotel, the Gaylord National Resort & Convention Center, National Harbor, Maryland. For information, contact Ruby 312-670-2550, ext. 344; or [email protected].

17 Indian American Medical Association in Illinois Annual Gala The IAMAIL holds its 38th Annual Gala Banquet & Business Meeting. Begins at 5:00 p.m.; Ashton Place 341 75th St., Willowbrook. For details, go to: https://iamaill.org.

20 CMS Council Meeting ©2009 Paid for by the U.S. Air Force. All rights reserved. The Society’s governing body meets three times a year to As a U.S. Air Force flight surgeon, blasting off in a jet is just part of the job. set a legislative agenda and When you use your talents to care for the heroes who fly for our country, to conduct business on behalf it’s more than an honor. It’s a thrill. AIRFORCE.COM of the Society. All members are encouraged to submit resolutions©2009 Paid for by the U.S. Air Force. All rights reserved. to the Council. TSgt Allan Hipol (773)-842-4901 [email protected] 7:00-9:00 p.m., Maggiano’s Banquets Chicago, 111 W. Grand Ave. To RSVP, please contact Ruby 312-670-2550, ext. 344; or [email protected].

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September 2018 | www.cmsdocs.org | 31 WHO’S WHO Working for Better Patient Care Hospitalist strives to help other clinicians make patient care better by Cheryl England

Dr. Arora, a board- INEET ARORA, MD, MAPP, a certified internist, board-certified internist, has a rather is passionate about unusual job title—Director of GME helping residents and Clinical Learning Environment and fellows learn to work Innovation—at the University of in teams in order to VChicago Medicine. What does that mean exactly? improve the quality “It’s a bridging position,” she says. “My job is to of patient care at help residents and fellows become more engaged hospitals. in the patient care goals such as quality and safety that hospitals value. Residents are often seen as transient healthcare providers at hospitals, but we can’t ignore the physicians working on the frontlines at those institutions.” An example of her research in that position is how to improve resident hand-offs. The quandary, she explains, is that when residents work long hours they become fatigued, but when they work shorter hours there are more patient hand- offs—both of which can harm patient care. “I also do a lot of work around the patient experience,” she says. “We know that residents will often wake a patient up at 4 a.m. for blood work. While that shows the resident is conscientious it also increases healthcare expenses and harms the patient experience. It might be better to decrease the frequency of lab work for stable patients.” “If a patient is readmitted, I’m always asking what Dr. Arora is also highly passionate about I could have done better.” researching ways to better train residents how Dr. Arora also finds her position at U of C to work in teams. “I’m always asking, ‘How can influential since improving training and education we bring residents, nurses and other providers affects the trainee’s ability to care for patients in together to improve care on what they see as the real world now and in the future. “As someone problems,” she says. “If the providers are not all on who works with medical trainees, I find that the same page, it can drive patients crazy.” when they succeed, I succeed,” she says. “I’m also As a hospitalist, Dr. Arora gets a lot of her ideas a strong advocate for adequate representation of simply by being on the ground floor working with women at the table,” she says. “I also care deeply residents, nurses and patients. “I’m always thinking about the balance between work and family—espe- about patients before they come in and after they cially since I am married to another busy physician leave, including how they are discharged,” she says. and we have an active four-year-old!”

Dr. Arora’s Career Highlights

DR. ARORA earned her medical than 100 peer-reviewed publications, Society of Hospital Medicine. She is degree from the Washington University with widespread coverage in The New a noted female voice in academic in St. Louis and completed her York Times, NPR, and the Associated medicine, and received widespread residency, chief residency, and Press. She currently serves on the media coverage in 2016 for calling on master’s degree in public policy at board for the American Board of academic institutions to fix the gender the University of Chicago. An accom- Internal Medicine. She has received pay gap in medicine. She is a founding plished researcher, she is the current numerous awards including induction member of the Women of Impact, a principal investigator of FDA and NIH into the American Society for Clinical 501c3 organization that is dedicated grants to improve care and learning Investigation and being named a to promoting women leaders in in healthcare. She has authored more “Master of Hospital Medicine” by the healthcare.

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