Allegheny County Medical Society
BulletinNovember 2016
Prescription Drug Monitoring Program Update from the House of Delegates 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
BulletinNovember 2016 / Vol. 106 No. 11 Articles Perspectives Departments
Materia Medica ...... 414 Editorial ...... 398 Society News ...... 403 Cabozantinib for renal cell carcinoma An exercise in gratitude • PAMED Foundation awards medical Melissa Blom, MD Deval (Reshma) Paranjpe, MD, FACS student scholarships • Medical Student Career Night Legal Summary ...... 416 Miller Time ...... 400 • Pittsburgh Ophthalmology Society Pennsylvania Prescription Drug Just another day • Pennsylvania Geriatrics Society – Care is Your Business, Change is Ours Monitoring Program operational Scott Miller, MD, MA, FAAHPM Western Division The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense Beth Anne Jackson, Esq. • Pittsburgh Urological Associates competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols, Perspective ...... 401 • Pittsburgh Diabetes Club cost-management and revenue management. Materia Medica ...... 418 The ACA revisited before the arrival of Praxbind® (idarucizumab) MACRA and MIPS ACMS Alliance News ...... 409 Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through Nicholas R. Giruzzi, PharmD, Thierry Verstraeten, MD contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. Nicole Payette, PharmD, BCPS In Memoriam ...... 412 We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues • Lowell G. Lubic, MD ranging from HIPAA compliance to medical staff and peer review matters. Special Report ...... 420 • Lawrence D. Ellis, MD Landmark initiative gets the green light • Walter Hiller Jr., MD Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet from PAMED’s House of Delegates • Robert B. Wolf these challenges. And we know what is ahead. Pennsylvania Medical Society • Yvonne Bohatch Maher, MD
Special Report ...... 422 Activities & Accolades ...... 413 Team up to tackle cardiovascular disease
Feature ...... 424 Ebensee: Recognition long delayed Fredric Jarrett, MD
On the cover Hot Metal Bridge hh-law.com by Bruce A. Wright, MD
Business • Employment • Estates and Trusts • Health Care Dr. Wright specializes in psychiatry. 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 2016 PAMED DISTRICT TRUSTEE Deval (Reshma) Paranjpe County Medical Society welcomes Executive Committee John F. Delaney Jr. ([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, Lawrence R. John Donald B. Middleton Robert H. Howland editorials, or articles. Contributions President-elect Bylaws ([email protected])) are received with the understanding David J. Deitrick Robert C. Cicco Timothy Lesaca that they are not under simultaneous Vice President Finance ([email protected]) consideration by another publication. Robert C. Cicco David J. Deitrick Scott Miller Issued the third Saturday of each Secretary Gala ([email protected]) month. Deadline for submission Adele L. Towers Patricia Bononi Amelia A. Paré of copy is the SECOND Monday Treasurer Adele L. Towers ([email protected]) preceding publication date. Periodical William K. Johnjulio Nominating Gregory B. Patrick postage paid at Pittsburgh, PA. Board Chair Matthew B. Straka ([email protected]) John P. Williams Bulletin of the Allegheny County Primary Care Brahma N. Sharma Lawrence R. John Medical Society reserves the right to ([email protected]) edit all reader contributions for brevity, DIRECTORS Managing Editor clarity and length as well as to reject 2016 any subject material submitted. David L. Blinn Meagan K. Welling Robert W. Bragdon ([email protected]) The opinions expressed in the Thomas B. Campbell Editorials and other opinion pieces Douglas F. Clough are those of the writer and do not necessarily reflect the official Jason J. Lamb ADMINISTRATIVE STAFF policy of the Allegheny County 2017 Executive Director Medical Society, the institution with Peter G. Ellis John G. Krah which the author is affiliated, or David A. Logan ([email protected]) the opinion of the Editorial Board. Jan W. Madison Assistant to the Director Advertisements do not imply spon- Matthew B. Straka Amy G. Stromberg ([email protected]) ACMS ALLIANCE sorship by or endorsement of the Angela M. Stupi ACMS, except where noted. 2018 Bookkeeper President Patricia L. Bononi Susan L. Brown Kathleen Reshmi Publisher reserves the right to exclude William F. Coppula ([email protected]) First Vice President any advertisement which in its opinion Kevin O. Garrett Director of Publications Patty Barnett does not conform to the standards of Todd M. Hertzberg Meagan K. Sable Second Vice President the publication. The acceptance of advertising in this publication in no Barbara A. Kevish ([email protected]) Joyce Orr way constitutes approval or endorse- Amelia A. Paré Assistant Executive Director, Recording Secretary ment of products or services by the Raymond E. Pontzer 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- 2016 Membership Relations Manager Josephine Martinez zations; $40 ACMS advertisers; $50 John G. Guehl Nadine M. Popovich Assistant Treasurer others. Single copy, $5. Advertising Rajiv R. Varma ([email protected]) Sandra Da Costa rates and information sent upon 2017 request by calling (412) 321-5030 or Donald B. Middleton online at www.acms.org. Ralph Schmeltz 2018 Sharon L. Goldstein COPYRIGHT 2016: Bruce A. MacLeod 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 q Allegheny County MediCAl SoCiety Leadership and Advocacy for Patients and Physicians ACMS selects vendors for quality and value. Contact our Endorsed Vendors for special pricing.
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 Professional Liability Posters, Where-to-Turn cards Insurance Allegheny County Medical NORCAL Mutual What does Society Laurie Bush, 800-445-1212, 412.321.5030 ext. 5558; lbush@norcal-group. ACMS [email protected] com membership do for me? Editorial An exercise in gratitude was doing an exam on a cantanker- Internet. Everyone can exercise his or I ous inpatient with visual changes Deval her right to be a political commentator, during this election season and the (Reshma) for better or worse. conversation went like this: Paranjpe, I am grateful for technology – even “Can you see me?” the sneaky side of it. How much more “Yes.” MD, FACS interesting and entertaining this elec- “What color is my hair?” tion year has become with the expo- “You’re a blonde.” that have come to light on both sides, sure provided by Wikileaks! Everybody (My hair is dark brown. Hmm.) and the daily bombshells dropped on actually does want to know how the “Can you see my hand?” both sides by Wikileaks, the FBI, the political sausage is made. This year, it “Yes.” bringers of allegations from the past has a name – a bona fide Weiner. All of and present, and the candidates them- “How many fingers am I holding the things that you imagined for years selves. When you think Jerry Springer up?” must go into making the sausage … and Geraldo might be spectacularly “Five.” actually do go into making the sau- appropriate Presidential debate mod- (I’m holding up one. Hmmm.) sage, and then some. How satisfying erators, something is wrong with the “What month is it?” after all these years to actually see the world. “October.” proof of this laid bare in print. While By the time you are reading this, “What year is it?” it’s a snapshot into the inner dealings we as a nation will have elected one of “2016.” the two candidates to office. Hopefully of one candidate, we can imagine the “Who’s the President?” there will not be a contested election analogous inner workings of every “Obama.” or whatever the 2016 version of the previous candidate and campaign you “Who are the two people running for Hanging Chad scandal may be, but can remember. President?” perhaps that may be too much to ask. I am grateful for the existence of (crickets, as he struggles to find the Whatever the outcome of the elec- email. Before email, none of these names) tion, and the outcome of our collective shenanigans would have ever seen the “Well, who are you voting for?” election anxiety, we can center our- light of day. (thinking this might provoke a strong selves with gratitude. Perhaps not for I am grateful for the instant news answer) the candidate who has been elected if society that the ability to post photos, “The idiot.” it isn’t the one you wanted, but for the video and text creates. No one can “Which one?” process in general, and for our country, get away with anything anymore. The (We both share a laugh.) and our people. spin on both sides is negated by the He (with great conviction): “Ross I am grateful that we have always power of direct images and video to Perot.” had a peaceful transition of power in the viewer, who can make up his or her We’ve never seen an election this country, however bitter the elec- own mind. season quite like this one. This man tion contest and however terrible the I am grateful for archived data, inter- at least has neurological dysfunction rhetoric. views and searches. How much easier to explain his disorientation. The rest I am grateful that we have a free it is to call out a candidate who said: “I of us can blame the media at large, press. While it may not be perfect and never said that!” with video, audio and the constant spin on every news item there’s plenty of spin, it is still free. I print proof to the contrary! from every news outlet, our own giddy am grateful that we have freedom of I am grateful for our peaceful voting disbelief at the latest shenanigans speech and freedom of speech on the traditions, and for Democrats and
398 Bulletin / November 2016 We will reduce your Editorial medical office and supply costs. Republicans wishing each other a good day and sharing coffee and doughnuts at the polls. Allegheny I am grateful for parents taking their kids to the polls We will reduce your and explaining the importance of voting. 3 reasons I am grateful that we all know in our hearts that no medical office and matter who wins, our nation and its freedoms, traditions supply costs. and institutions will prevail. I am grateful that our loyalty to Medcareto consult our country transcends party lines; I am grateful to be an American. Mike Gomber Happy Thanksgiving. for your medical supply3 needs reasons Dr. Paranjpe is an ophthalmologist and medical editor Mike isn’t just a “sales rep.” Mike of the ACMS Bulletin. She can be reached at reshma_ 1 to consult [email protected]. is a professional consultant with an MBA and 30 yearsMike experience Gomber serving physicians. The opinion expressed in this column is that of the writer Savings, Servicefor and your Solutions! medical supply needs and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, 2 Mike will find the best solution to or the Allegheny County Medical Society. your medical supply1 Mike needs, isn’t justnot a “sales rep.” Mike just the “product ofis the a professionalmonth” consultant with that others are pushing.an MBA and 30 years experience “The best solutionserving physicians. to your 3 Allegheny Medicare is endorsed There is an opening on the bymedical the Allegheny supply2 CountyMike will Medicalneeds.” find the best solution to Bulletin Editorial Board for an Society—the only yourmedical medical supply supply needs, not ASSOCIATE EDITOR. company that is! just the “product of the month” The position requires an interest that others are pushing. and flair for writing and Michael L. Gomber, MBA Allegheny Medicare is endorsed the willingness to contribute an More than 303 years meeting editorial column of 500-900 words Allegheny Medcareby the Allegheny County Medical twice per year. Savings, Servicephysicians’ andSociety—the needsSolutions! only medical supply Associate editors serve two-year (412) 580-7900company that is! terms; an associate editor may serve FaxMichael (724) L. Gomber,223-0959 MBA More than 30 years meeting physicians’ needs three consecutive terms. Email:412.580.7900 michael.gomber Fax: 724.223.0959 Selection of the final candidate will endorsed by E-mail:@henryshein.com [email protected] Medcare ALLEGHENY COUNTY be made by the Editorial Board and MEDICAL Savings, Service and Solutions! the ACMS Board of Directors. SOCIETY Allegheny Medcare Please email a short letter and a Henry Schein, a Fortune 500 CompanyMichael L. Gomber, MBA Together to serve to provide a one-stop More than 30 years meeting physicians’ needs writing sample to Bulletin solution for all your needs Managing Editor Meagan Sable 412.580.7900 Fax: 724.223.0959 endorsed by E-mail: [email protected] at [email protected]. ALLEGHENY COUNTY MEDICAL SOCIETY Allegheny Medcare Henry Schein, a Fortune 500 Company Bulletin / November 2016 Together to serve to399 provide a one-stop solution for all your needs ExecutivMillee rC ommittTime ee Just another day “What day is it today?” “he started talking with me about plan- I was at his bed. The effort required Scott ning for his funeral. He wanted a party to raise his head slightly and look in Miller, that would celebrate a shortened, but my direction was not lost on me. The MD, MA, well-lived life with his family and close weakness of his voice also conveyed friends. He wanted people to be able to the seriousness of his condition. He had FAAHPM attend without inconveniencing them. been admitted to our inpatient hospice He was in a good mood at the time, Friday, and his condition had suggested been taped to the walls. He had taken and it was part of his nature to care a prognosis of hours. I would not have up drawing, and had delighted in the about others in this way.” been surprised if he had not survived unusual results obtained as he used She paused for a moment in recog- the weekend. But he had. his declining upper extremity motor nition of the impact this conversation “It’s Monday,” I replied. function to what he called his “creative between the two of them a few months His face relaxed with my answer, advantage.” The drawings clearly ago had on him then and was having and his head returned to a more reflected people gathered in a festive on her now. comfortable resting place on his pillow. atmosphere. Both his joy of life and “I should just die on a Wednesday,” This small effort exhausted him, and disease progression were apparent. he had said. “You’d then have Thurs- he let out a small, weak sigh. I asked in “What day is it today?” he asked yet day and Friday to take care of all the return a few simple “Yes” or ‘No” symp- again the next morning on my rounds. details. Then an early Saturday burial tom-related questions, and then left the I was again surprised he had survived followed by a festive celebration Satur- room satisfied that he was comfortable the previous day. day night. No one would have to miss on his current medication regimen. “Today is Wednesday,” I answered. any work and everyone would have He had been diagnosed with multi- Once more again he sighed. It felt Sunday to recover. I’ll draw you exactly ple sclerosis two years ago, and despite different to me this time. A prolonged what I’m thinking. And then he let out aggressive attempts at treatment with and expanded sigh of relief. I started to such a satisfied sigh of relief.” ask my morning questions, but things both standard and research protocol I’m sure it was the exact same sigh had clearly and dramatically changed. medications, he had continued to that I had heard earlier this morning He was no longer breathing. He looked deteriorate. He had stopped working in right before he died. And I’m just as peaceful. order to spend more time at home with sure it is going to be a very well-attend- His wife was called and arrived his family. He was only 48 years old. ed celebration. “What day is it today?” he asked shortly thereafter. We offered our con- dolences and talked about his care. again the next morning on rounds as Dr. Miller, associate editor of the “Was he comfortable?” she asked. I walked into the room. His weakness ACMS Bulletin, is clinical associate “Yes, he was. I was with him. He was further compounded by his lack of professor of medicine in the section asked me what day it was, which wanting any significant nutrition since of Supportive and Palliative Care at his admission. he has done every day. I answered, UPMC. He also serves as full-time “It’s Tuesday,” I answered. ‘Wednesday.’ He passed away peace- medical director of the inpatient hos- Once again, he let out a small sigh, fully and comfortably right after that.” I pice facilities for Family Hospice. He weak and similar to the one yesterday. did not convey to her how surprised I can be reached at [email protected] Once again, he appeared to be other- was at its sudden occurrence. or (412) 572-8850. wise comfortable and no medication “Wednesday? You’re sure he knew changes were needed. it was Wednesday?” I was absolutely The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion I looked around the room and no- sure of that. of the Editorial Board, the Bulletin, or the ticed a few hand-drawn sketches had “A few months ago,” she continued, Allegheny County Medical Society.
400 Bulletin / November 2016 Perspective The ACA revisited before the arrival of MACRA and MIPS
ow are we fairing now that six comprehensive coverage or would we Hyears have passed since the Thierry be better off with merely catastrophic Affordable Care Act (ACA) was signed coverage more like all other forms of erstraeten into law March 23, 2010, by President V , insurances we have in our lives? The Obama? We were told that the noble MD rising cost of premiums was designed intent was to insure some 40 million to shift the tax burden on high earn- “uncovered” lives while at the same ers to fund the subsidized premiums time reign in the rising cost of health- they can afford only to realize that their for people who purchased insurance care and eliminating waste and fraud in plan doesn’t kick in until their $5,000 through the ACA. That clearly meets our system. So, where did we stray? deductible is met! the definition of redistribution of wealth The answers are a mixed bag This is particularly applicable to my in my opinion. Here is a little bit of at best: Yes, 91 percent of the U.S. chosen field of ophthalmology, where history: Following presidents’ FDR and this amount often remains below the population is currently covered by Truman’s progressive ideas, the IRS in cost of most surgical procedures I some health insurance plan, although 1951 implemented tax deductibility for perform (this includes the surgical fee 12 million people signed up instead of companies that gave their employees and the hospital or outpatient surgery the predicted 21 million. But the rise in group health coverage. center’s bill). I often hear young pa- premium continues to climb at a 4 to 5 And now the wolf is in the coop: The tients telling me, “Doc, I have medical percent clip per year. The slope of the third-party payer system is born. Just coverage, but I can’t afford my deduct- like an “all you can eat” pre-paid buffet, curve is being “bent” we are told, but ible.” So we, the physicians, are caught people started to use and expect cov- these numbers are in the context of an having, often through our staff, to ex- erage for everything rather than what unprecedented low inflation world (ex- plain the “system,” and these are tough they really need. These attitudes distort cept the continued rising cost of college waters to navigate if we want to remain the marketplace, and we now think that education, buying a home, rent …). our patients best advocate. We now health care dollars are other people’s The exclusion of pre-existing have to establish a one-year payment conditions as a denial of coverage is plan for our patients to cover the cost money (OPM). The result is over-con- excellent news for our sickest patients. of their deductible for a sight saving sumption, and inevitably prices rise. But is our coverage adequate? Sur- procedure. The bureaucracy placed us But to my point, there is one exception, veys by the Kaiser Foundation and the in that uncomfortable position! and that is the relative decreasing New York Times, amongst others, have Over the past 10 years, data I cost of cosmetic surgical procedures found that more than 50 percent of the reviewed show that the rise in cost of over the past 10 years. Competition population have more coverage than deductibles has gone up more than worked in that specific niche. In the what they would deem necessary. Most 250 percent, co-insurance up 110 per- 1960s, people assumed more than 50 citizens would prefer having the option cent, while the rise of workers’ wages percent of their health care costs; now, to buy a more tailor-made option them- has increased only 32 percent. The the share is down to 15 percent. Is that selves. However, there are no ade- only decline seen over the past five progress? I’m not so sure.... quate pricing tools to comparison-shop years has been co-pays for office vis- Let’s face it, our patients are not for different plans. The cynic in me its, down 26 percent. So, as a society, well-educated enough to be good believes this is by design: People tend we have to start asking ourselves if we consumers, and shopping around to choose the lower premium plans can afford (or better, if we really need) Continued on Page 402
Bulletin / November 2016 401 Perspective
From Page 401 How could we give consumers more will be based largely on self-reporting, is discouraged. We were promised skin in the game? Premium support and no provision exists for verification inter-state exchanges which were ex- for the Medicare population may be and penalty. By 2019, our fees will pected to breed competition, but they coming soon. Rationing has been tried be adjusted up or down by 4 percent, were not found to be practical. Lately, through HMO models. Some HCOs did depending on where we stand vis-a some large insurance companies try incentives for PCPs who control the vis our peers but without any real-time are pulling their ACA products off the access to specialists but results have feedback or recourse! Market-based market after incurring mounting losses been a mixed bag just like pre-proce- Incentive Payment System (MIPS) or which they may never recoup in spite dures authorization and mandatory Alternative Payment Model (APM) will of assurances given by the govern- second opinion for elective surgery. be on our menu with an estimated daily ment. My patients often complain that All these attempts have not moved the average of two hours in online quality the billing processes are still dauntingly needle and probably never will. If the reporting. It remains to be seen if this complicated. You need accounting physicians are viewed as the drivers will lower consumption, but it certainly expertise to navigate the forms. of health care costs, simply cutting will continue to raise the height and Compared to Canada and many the CPT payments in a fee for service number of hurdles we need to clear to European countries, the United States (F4S) model may discourage us at justify our income. We need to be bold spends about $3,000 more per year per some breaking point, but ultimately and educate our patients to be smarter capita for a five-year shorter life expec- patients still come to us because they “shoppers” and firmly remain on their tancy. The health care annual budget is expect to be cared for. side. If we present ourselves as their more than $3 trillion which represents Should “elective” surgery like unwavering advocate, we will retain 17 percent of GDP. So, we are either cataract surgery no longer be a their trust in navigating these unfriendly paying too much for what we are covered item? Should insurance only bureaucratic waters. getting, or we are getting a poor “prod- cover life-saving hospital admission or uct” for what we spend. Where is the surgery? Pay for performance (P4P) Dr. Verstraeten practices ophthal- money going? The administration costs is slated to appear in 2017 with the mology as a retina specialist at Allegh- represent 10 percent of the health care Medicare And Chip Reauthorization eny General Hospital and is president budget; physicians’ and professionals’ Act (MACRA), which was voted into of the Pittsburgh Ophthalmology So- payments, 31 percent; hospitals, 37 law in 2015. This is designed to reward ciety. He can be reached at bulletin@ percent; drugs and devices, 12 percent; quality and value over volume, so we acms.org. and nursing homes, 10 percent. So are told. Each physician’s data will why can’t the government engage the be collected for two years followed The opinion expressed in this column pharmaceutical companies like other by the establishment of an individual is that of the writer and does not countries do and negotiate lower prices score and comparison to our peers necessarily reflect the opinion of the for large insurance groups or allow based on four criteria. But two glaring Editorial Board, the Bulletin, or the Allegheny County Medical Society. re-importation (see the Epipen saga)? weaknesses jump out: This system Allegheny County Medical Society Leadership and Advocacy for Patients and Physicians
402 Bulletin / November 2016 Society News
PAMED Foundation awards Tranle Hong, of Mechanicsburg, Pa., is advocacy of the Pennsylvania Medical medical student scholarships a medical student at the University Society and scholarships such as the of Pittsburgh School of Medicine. He AMES, which supports Pennsylvanian The Pennsylvania Medical Society plans to specialize in obstetrics and medical students like myself.” Foundation has awarded Alliance Med- gynecology. He will receive $2,500 to Ahmed I. Kashkoush, son of ical Education Scholarships to Penn- apply to his tuition. Ismail Kashkoush and Soheir Kandil, sylvania medical students. The Penn- Hong said, “My hope for the future of Orefield, Pa., is a medical student sylvania Medical Society Alliance is is that we can foster a system that at the University of Pittsburgh School dedicated to healthy communities and inspires, trains, and supports Pennsyl- of Medicine and is the recipient of the the preservation of the doctor-patient vanian residents to become physicians Barbara Prendergast Alliance Medical relationship. The group has awarded its that understand the complexities in Education Scholarship offered through Alliance Medical Education Scholarship the communities they serve. In doing the Foundation. He intends to special- Fund for more than a decade to ben- so, we will not only help alleviate our ize in neurosurgery. He will receive efit deserving medical students. The state’s physician shortage but also help $2,500 to apply to his tuition. awards were presented at the House of promote community-centered health Kashkoush said, “Due to a predict- Delegates meeting in Hershey, Pa. care. To achieve that goal, I believe we ed workforce shortage being driven by Christopher X. Hong is the recipient need to offer more incentives for Penn- an expansion of health care insurance of the Dauphin County Medical Society sylvanians to train and practice medi- coverage to millions of previously Alliance award. Hong, son of Duc and cine in-state. I am very grateful for the Continued on Page 404
Bulletin / November 2016 403 Society News
From Page 403 uninsured Americans, I envision that the future of Pennsylvania medicine will primarily encompass public policy initiatives that support primary care infrastructure in order to ultimately improve patient health care access.” Medical Student Career Night held in Shadyside The University of Pittsburgh Med- ical Student Chapter of the American Medical Association and the Allegheny County Medical Society hosted first- and second-year medical students Oct. 20 at the Herberman Conference
Center for the 2016 Medical Student Nadine Popovich / ACMS Career Night. ACMS President Lawrence John, MD, center, is pictured with medical stu- Medical students discussed the dents George Gabriel, left, and Fred Brown Oct. 20 at Medical Student Career realities of day-to-day medical prac- Night. tice with physicians from a variety of specialties and practice settings. The physician volunteers shared why they chose a specific specialty, what attri- butes are important when considering a specific specialty, and how to balance a medical career and personal life. Many thanks to co-chairs Mr. Fred Brown and Mr. George Gabriel for their work arranging the evening, and a huge thank you to our many physician volunteers for giving so freely of their time to help the medical students. POS hosts Brian Caputo, MD, memorial lecture The Pittsburgh Ophthalmology So- ciety (POS) continued its educational program offerings with a meeting Nov. Nadine Popovich / ACMS 3. This program was the Brian Caputo, From left, Kenneth Cheng, MD, Thierry Verstraeten, MD (POS president), MD, memorial lecture, with Sean Dona- Sean Donahue, MD, PhD (presenter), and Reem Hanna, MD, are pictured at hue, MD, PhD, pediatric ophthalmolo- the POS Brian Caputo, MD, Memorial Lecture Nov. 3. gist, Vanderbilt Eye Institute, Nashville, Tenn., serving as guest presenter. Igor case for review and discussion. The Dr. Donahue, who was a classmate Bussel, MD, resident at the University society gratefully acknowledges Optos of Dr. Caputo, was honored to pres- of Pittsburgh Eye Center, presented a for providing support for the program. ent the Brian Caputo, MD, Memorial
404 Bulletin / November 2016 Society News
Lecture: “Preschool Vision Screening: hundreds of lectures on glaucoma and Technology Changes Process.” The cataract to thousands of ophthalmol- presentation also provided thoughtful ogists in 40 states and over a dozen remembrances of Dr. Caputo, with countries. Ophthalmology magazine ty-specific measures and resources colleagues offering their personal named Dr. Radcliffe one of the world’s will be included in the presentation. reflections. Reem Hanna, MD, wife of top ophthalmologists under the age of MACRA begins to collect measures Dr. Caputo, was in the audience for the 40 in May 2015. in 2017! Mark your calendar to attend presentation. Registration is required. To register, this informative Ophthalmology specific During the business portion of the visit www.pghoph.org or before Dec. 1. program! meeting, the society confirmed four Registration is accepted online at new members: Michaela Hickey, DO; POS to host MACRA program www.pghoph.org. For more informa- Jared Knickelbein, MD, PhD; Srinivas Thierry Verstraeten, MD, POS tion, contact Nadine Popovich, admin- Kondapalli, MD; and Judith Rodnite, president, is pleased istrator, at (412) 321-5030 or npopo- MD. In addition, Matthew Pihlblad, to announce an oph- [email protected]. MD, and Alison Zambelli, MD, were thalmology-specific introduced as candidates for member- Medicare Access and PAGS-WD hosts fall program ship. Drs. Pihlblad and Zambelli will be CHIP Reauthoriza- The Pennsylvania Geriatrics Society confirmed as members at the Dec. 8 tion Act (MACRA) – Western Division (PAGS-WD) hosted business meeting. presentation hosted their annual fall program Nov. 1 at the by the POS. “Future Ms. Swinnich University Club, Pittsburgh. More than POS to welcome of Physician Reim- 75 attendees participated in this year’s Nathaniel Radcliffe, MD bursements: MACRA and APMs” will exceptional presentation, “Natural The Society is pleased to welcome be presented Saturday, Dec. 10, by Evolution of Telemedicine for Care of Nathan Radcliffe, Jennifer Swinnich, associate director, the Elderly,” which featured a panel MD, director, Glauco- Practice Support, Pennsylvania Med- presentation. The society gratefully ma Service, clinical ical Society, at the Allegheny County acknowledges support for the program assistant professor, Medical Society, 713 Ridge Ave, from Curavi Health, Optum, Presbyteri- NYU Langone Oph- Pittsburgh, PA. an SeniorCare Network, Sanofi, UPMC thalmology Associ- The program is complimentary to For Life and UPMC Resources for Life. ates; cataract and members of the POS, as well as prac- Moderated by Namita Ahuja, MD, glaucoma surgeon, Dr. Radcliffe tice administrators or key staff. Regis- senior medical director, Medicare and New York Eye Surgery tration and breakfast begins at 8 a.m. Geriatric Programs, UPMC Health Center, Dec. 8. Dr. Radcliffe was invit- with the program to commence at 8:30 Plan, clinical assistant professor, Divi- ed by POS member Ian Conner, MD, a.m. The society gratefully acknowl- sion of Geriatric Medicine, University of PhD. The program is co-sponsored by edges Vertical Solutions for support of Pittsburgh, distinguished panel pre- support from Carl Zeiss Meditec and this program. senters included: Jack Cahalane, PhD, Regeneron. The two-hour MACRA ophthalmol- MPH, chief, General Adult Service Dr. Radcliffe is a board-certified ogy presentation will include a brief Line, Western Psychiatric Institute and ophthalmologist who is an experienced overview of MACRA and the Quality Clinic, UPMC Health System; Steven glaucoma and cataract surgeon. Prior Payment Program (QPP). Discussion Handler, MD, PhD, CMD, associate to June 2014, Dr. Radcliffe served as includes the four Merit-Based Incentive professor, University of Pittsburgh the director of the Glaucoma Service Payment Systems (MIPS) categories School of Medicine, Division of Geri- at Weill Cornell Medical College for outlined in MACRA, and the alterna- atric Medicine and Department of six years. Dr. Radcliffe has published tive payment models. Timelines and Biomedical Informatics, chief medical more than 40 peer-reviewed publica- steps one can take now to prepare for informatics officer, UPMC Community tions in glaucoma research, has given 2017 also will be addressed. Special- Continued on Page 406
Bulletin / November 2016 405 Society News
From Page 405 Provider Services; and Andrew Wat- son, MD, MLitt, FACS, chief medical information officer, International and Commercial Services, medical director, UPMC Telemedicine, medical director, Center for Connected Medicine. The enlightening panel presentation reviewed the background and evidence for telemedicine. Discussion included an overview of new applications in telemedicine and the value and role of telemedicine as an effective tool for physicians and health care systems in the care of elderly patients. The annual fall program provides
PAGS-WD members the opportunity Nadine Popovich / ACMS to network and attend a lecture en- From left, Fred Rubin, MD, PAGS-WD president; Jack Cahalane, PhD, MPH, compassing relevant topics specific presenter; Steven Handler, MD, PhD, CMD, presenter; Judith Black, MD, sec- to geriatrics and the older population. retary/treasurer; Namita Ahuja, MD, moderator; and Andrew Watson, MD, Membership is open to all health care MLitt, FACS, presenter, are pictured Nov. 1 at the University Club, Pittsburgh. disciplines. If you are interested in membership, or would like to renew clinicians take exceptional care of • Symposium on membership dues, please contact these often frail individuals. Designed neurodegenerative Nadine Popovich, administrator, at by course directors Shuja Hassan, MD; diseases including 412-321-5035. ext. 110, or npopo- Judith Black, MD; and Neil Resnick, Parkinson’s disease [email protected]. MD; along with the PAGS-WD planning and Alzheimer’s committee, this award-winning course • Symposium Clinical Update in Geriatric is designed for family practitioners, covering the latest Medicine set for April 6-8 internists, geriatricians and other health updates for common Dr. Applegate Planning is underway for the 25th care professionals who provide care to cardiovascular condi- annual Clinical Update in Geriatric older adults. tions, including hypertension and acute Medicine conference, jointly sponsored Speakers are selected by a mul- MI in the elderly by the PAGS-WD, UPMC/University of tidisciplinary committee of academic • Multiple breakout sessions, includ- Pittsburgh Institute on Aging, University and practicing clinicians based on ing: Prognostication in Chronic Dis- of Pittsburgh School of Nursing and two criteria: (1) expertise – nationally ease, Decision Making Capacity, Billing University of Pittsburgh School of Med- recognized and often responsible for Code Primer, Using Antipsychotics in icine Center for Continuing Education advances relative to practice, and (2) Long Term Care and Foot Problems in the Health Sciences. The conference ability – to share it in a practical, suc- The dinner symposium, “Past, will be held April 6-8, 2017, at the Pitts- cinct and entertaining way to facilitate Present and Future of Geriatrics,” will burgh Marriott City Center. its easy incorporation into a practice. be presented by William B. Applegate, The fastest-growing segment of Conference highlights include: MD, MPH, MACP, AGSF, former presi- the population comprises individu- • Evidence-based evaluation and dent of the American College of Physi- als above the age of 85 years. The treatment of multiple common clinical cians, dean of the School of Medicine purpose of the conference is to provide problems seen in the office, hospital and head of Health Sciences at Wake an evidence-based approach to help and long-term care Continued on Page 408
406 Bulletin / November 2016 Welcoming to Allegheny Health Network
Lisa Guthrie, DO – Internal Medicine Rebecca Fishman, MD – Breast Surgical Oncology Dr. Guthrie is a board-certified Dr. Fishman is a board-certified internal medicine physician offering general surgeon with fellowship- patients comprehensive and training in breast surgical compassionate primary medical care. oncology. She has clinical She has particular clinical interest expertise in breast surgery and in preventive care, annual wellness care for patients with breast cancer exams, management of chronic and breast disease. She joins the conditions, as well as same day physicians of AHN Breast Surgeons with an office at urgent care for acute illnesses and injuries. She joins the Mellon Pavilion in Pittsburgh. physicians of AHN Primary Care – Stone Quarry with an office on Camp Horne Road in Pittsburgh. Sarah Homitsky, MD – Psychiatry
Dr. Homitsky is a psychiatrist M. Scott Halbreiner, MD – Cardiac Surgery specializing in child and adolescent psychiatry and Dr. Halbreiner is a board-certified pediatrics. She has clinical cardiac surgeon. He has specialty expertise in providing integrated expertise in coronary artery perinatal psychiatric services for bypass graft surgery, heart women with behavioral health valve reconstruction, repair and issues, including perinatal and replacement, aortic root and postpartum depression. She is the medical director aortic arch surgery, mechanical for the Women’s Perinatal Psychiatry Program at West circulatory support (ventricular assist devices) and Penn Hospital. extracorporeal membrane oxygenation (ECMO), heart and lung transplantation, minimally invasive heart surgery and structural heart disease. He joins the physicians of Vladimir Valakh, MD – Radiation McGinnis Thoracic & Cardiovascular Surgical Associates Oncology with an office at Allegheny General Hospital. Dr. Valakh is a board-certified radiation oncologist with specialty expertise in Nidhi Khosla, MD – Obstetrics and Gynecology treating gynecologic cancers, head and neck cancers, Dr. Khosla is an obstetrician/ thoracic malignancies and gynecologist specializing in gastrointestinal tumors. He minimally invasive gynecological has technical expertise in brachytherapy, treatment surgery. She also provides women planning, stereotactic body radiation therapy (SBRT) and their developing newborns and intensity modulated radiation therapy (IMRT). He with outstanding comprehensive joins the Allegheny Health Network Cancer Institute obstetrical care. She cares for women Division of Radiation Oncology at West Penn Hospital. of all ages and throughout all life stages. She joins the physicians of Allegheny Women’s Health with offices in the North Hills, at Allegheny General Hospital and at West Penn Hospital.
Call 412.DOCTORS to make an appointment or visit AHN.org.
Bulletin / November 2016 407 Society News
From Page 406 Society – Western Division Geriatrics at The Capital Grille, Forest University, editor of the Journal Teacher of the Year Award. Pittsburgh. of the AGS (JAGS) and primary inves- The award will be presented to two The guest speaker tigator for the seminal SHEP study of outstanding teachers for their dedica- will be Roger R. Dmo- systolic hypertension and the landmark tion and commitment to geriatric edu- chowski, MD, MMHC, SPRING trial. cation. The annual award will recognize FACS, professor, De- The conference brochure, includ- and honor both a physician and a partment of Urology, ing registration and complete credit non-physician health professional who Vanderbilt University, Dr. Dmochowski information, will be available in January have made significant contributions to Nashville, Tenn. 2017. Conference details also can be the education and training of learners For more information or to register, viewed on the society website at www. in geriatrics and to the progress of contact Amy Stromberg, administrator, pagswd.org. geriatrics education across the health at (412) 321-5030, ext. 103, or astrom- professions. Members and non-mem- [email protected]. 15th International HELP bers of the Pennsylvania Geriatrics conference set Society will be considered. Eligible Greater Pittsburgh Diabetes The International Hospital Elder nominees have demonstrated leader- Club meeting slated ship and inspired learners to better the Life Program (HELP) conference will The Greater care of older adults and have contrib- be held in conjunction with the Clinical Pittsburgh Diabetes uted to the growth of geriatrics in their Update in Geriatric Medicine confer- Club will meet Thurs- professions. Teaching expertise and/ ence April 6-7, 2017, at the Marriot day, Dec. 1, at the or education program development are Pittsburgh City Center. Designed by ACMS building. The valued in the selection of the recipient course directors Sharon Inouye, MD, speaker will be Irl B. for this honor. MPH; Fred Rubin, MD; and Sarah Hirsch, MD, professor Award eligibility and criteria, along Dowd, LICSW, MPH, this two-day in- of Medicine, Metab- Dr. Hirsch ternational conference educates HELP with the nomination form, is available olism, Endocrinology teams regarding strategies for delirium on the society’s website at www.pag- and Nutrition, University of Washington prevention, using HELP to improve swd.org. School of Medicine. hospital-wide care of the elderly, and Awardees will be recognized at the creating a climate of change. dinner symposium held in conjunction Dr. Hirsch will present, “Diabetes: Registrants benefit from the shared with the 2017 Clinical Update in Geriat- Insulin and Other Drug Costs – What knowledge of experts and peers, state- ric Medicine, scheduled for Thursday, Patients and Providers Need to Know.” of-the-art geriatrics updates, presenta- April 6, at the Pittsburgh Marriott City Attendees will learn the various rea- tions from HELP sites across the coun- Center, Pittsburgh, Pa. Recipients will sons medication costs, insulin in par- try and updates from HELP Central, as be honored with a plaque and receive ticular, have risen in the United States well as networking with colleagues. complimentary membership in the and what patients and providers can For more information on the confer- society for one year. do to reduce the cost of medications ence, please email [email protected] Award nomination questions may be without compromising care. vard.edu or visit the HELP conference directed to Nadine Popovich, adminis- Continuing education credits are website periodically for updates: http:// trator, at [email protected] or (412) available. The program is free for mem- www.hospitalelderlifeprogram.org/ 321-5030. bers, residents and fellows; there is a about/help-conference/. $25 fee for non-members and guests. PUA program announced For more information on the program Geriatrics Teacher of the Year The Pittsburgh Urological Associa- or the GPDC, contact Amy Stromberg, Award: Call for Nominations tion (PUA) will host “Pathophysiology, administrator, at (412) 321-5030, or as- Nominations are now being ac- Diagnosis and Management of OAB” [email protected], or visit the ACMS cepted for the Pennsylvania Geriatrics at 6 p.m. Wednesday, Feb. 8, 2017, website, www.acms.org.
408 Bulletin / November 2016 Alliance News
William D. Hetrick, MD ACMS Alliance past presidents were recognized at the General Meeting and Luncheon held Sept. 27. From left are Mrs. John Da Costa, Mrs. William Hetrick, Mrs. CS Reshmi, Mrs. Alan Barnett, Mrs. LeRoy Wible, Mrs. Rose Kunkle Roarty, Mrs. Robert Blume and Mrs. Richard Hershey.
MR. ARNOLD PALMER personal and professional skills and known, recognized and will be remem- A TRIBUTE AND THANKS accomplishments, now treasured even bered and referenced well beyond his TO A LEGEND more, for his body of work. Proceeds legendary lifetime. from our affairs benefit community A simple yet very elegant gentle- We take this occasion to express service projects, scholarship aid, disas- man, diplomat, ambassador, Mr. Palm- thanks and appreciation to a legend. ter relief in Allegheny County and the er’s persona and legacies will endure Because a giant in global realms was Pittsburgh region. and inspire longer than all the collec- so responsive to frequent requests for Arnie’s skill as a golfer was matched tive long shots in his entire illustrious donation of personalized auction items only by the quality of his character; career in professional golf, business for fundraising events is our reason to ethics, warm, wonderful, ebullient and and philanthropy. Our organization say thanks from our Allegheny County energetic persona, all together em- expresses appreciation and condolenc- Medical Society Alliance to Mr. Arnold phasize his versatility and profound es on the recent passing of Mr. Palmer Palmer for his philanthropic generosity humanity. – a phenomenal, celebrated figure through several decades. His gifted There is understanding that the who has been very kind and helpful to memorabilia and items are prized be- loss is shared among legions of family, our Allegheny County Medical Society cause they provide a connection to Mr. friends and fans, here and everywhere! Alliance. Palmer. Winning bidders are proud and Certainly, there are many memories delighted to walk away with treasured of happy, thrilling, brief encounters keepsakes of deepest appreciation or sustained relationships with Arnie! Content and text by Kathleen Jennings Reshmi for who Mr. Palmer is and for all his His influence among entire spheres is
Bulletin / November 2016 409 The New World of Health Care is complicated. Are You Prepared?
Allegheny County Medical Society members: The new world of Health Care ushered in by the Patient Protection and Affordable Care Act (ACA) has created uncertainty and confusion for most people. There are new regulations and requirements. Individual and employer mandates. Penalties for not purchasing coverage. On Exchange and Off Exchange access. As an Allegheny County Medical Society member, you have help. Talk to USI Affinity, the ACMS’s endorsed insurance broker and partner. Our benefits specialists are experts in Health Care Reform. We can help you choose a health plan that provides the best coverage and value while ensuring you will be in compliance with complex new IRS and Department of Labor regulations. We’ll also provide you the kind of world class service and support you need to make sure you get the most out of your health care benefits after you buy. You can also check out the NEW Allegheny County Medical Society Insurance Exchange, a convenient and secure online portal where you can find competitively priced insurance coverage for all your needs, including a wide variety of medical and dental plans.
To learn more, contact USI Affinity today! Call 800.327.1550, or visit the ACMS Insurance Exchange at www.usiaffinityex.com/acms
410 Bulletin / November 2016 Allegheny Please include the County ACMS Foundation Medical in your year-end giving: Society • Achieva – Disability Healthcare Initiative Webinar Series • Anchorpoint Counciling Ministry – Youth Development Program Foundation • Angels’ Place – Showcase of Scholars Project 713 Ridge Avenue • Carnegie Institute, Pittsburgh Regional Science and Engineering Fair – Pittsburgh, PA 15212-6098 Two student awards for projects in topics related to medicine (412) 321-5030 • Family House, Inc. – Family Assistance Program FAX (412) 321-5323 • Hilltop Community Healthcare Center – Reach Out and Read Program www.acms.org • Independent Family Resource Group – Learning Support Resource Program • Jeremiah’s Place – Protecting Children, Strengthening Families, Transforming Created, funded and Communities Project • Parkinson Foundation Western Pennsylvania – Parkinson’s Support Groups in Western administered by physicians Pennsylvania since 1960, the Allegheny • Pittsburgh Action Against Rape – Parents in the Know-Expansion of Curriculum County Medical Society • Providence Connections, Inc. – Children and Youth Enrichment-Developing Healthy Children Project Foundation has given • Propel Schools Foundation – Afterschool Fitness and Nutrition Program more than $2.9 million to • Spina Bifida Association of Western Pennsylvania – Blueprints Family Networking Group various community • Sto-Rox Neighborhood Health Council, Inc. – Community Outreach Worker Project programs. • The First Tee of Pittsburgh – First Tee of Pittsburgh at Pleasant Ridge Life Skill Over the past year, the Experience Clinics • The Foundation of the Pennsylvania Medical Society – ACMS Foundation Medical foundation contributed to Student Scholarship Fund or sponsored the • United Methodist Church Union – Children’s Table organizations and • United Way – Community-Based Chronic Care Self Management Program activities listed here: • University of Pittsburgh School of Medicine – Medical Student Career Night • Ward Home, Inc. – Health and Wellness Enhance Program
The annual ACMS Allegheny County Medical Society Foundation Foundation Community Name Awards Gala raises funds Address for the foundation’s medical student and CCAC’s health Phone career scholarships. Plan to attend the 2017 Gala on Please send your tax-deductible contribution to ACMS Foundation, 713 Ridge Avenue, Pittsburgh, PA 15212-6098. Checks should be made March 4! out to ACMS Foundation. For more information, please call (412) 321-5030.
Bulletin / November 2016 411 In Memoriam
Lowell G. Lubic, MD, 90, of Surviving are his wife, Jacqueline C. *** Chadds Ford, Pa., formerly of Squirrel Ellis; children Thomas D. Ellis (Phyllis), Yvonne Bohatch Maher, MD, Hill, died Sunday, October 9, 2016. Holly E. Eisenbrandt (Peter) and Je- 66, of Fox Chapel, died Wednesday, Dr. Lubic graduated in medicine rome M. Ellis (Heather); 19 grandchil- November 2, 2016. from the University of Pittsburgh and dren; and seven great-grandchildren. Dr. Maher graduated in medicine completed his residency at Columbia Deceased is a daughter, Mary from Georgetown University, where Presbyterian in New York City. He was Christine Ellis. she completed her residency in internal prominent member of the Pittsburgh Services were held Oct. 24, 2016, in medicine prior to completing her fellow- medical community for five decades. St. Paul Cathedral. ship in cardiology at Allegheny General Dr. Lubic’s specialties included *** Hospital. epilepsy, stroke and brain tumors. Walter Hiller Jr., MD, 81, of Pitts- She was a founding member of the He had the first MRI machine used in burgh, died Saturday, October 29, Pittsburgh Heart Group, where she private practice in the Pittsburgh area, 2016. practiced cardiology at St. Francis and purchased from Toshiba, which brought Dr. Hiller graduated in medicine Allegheny General hospitals. it to his office from Japan. from the University of Utah; served Surviving are her husband, Thomas Surviving are his wife, Janet Kimball his internship at Cincinnati General D. Maher Jr., MD; children Timothy Lubic; daughters Leslie Finkel and Jen- Hospital; and completed his residency J. Maher (Lauren), Andrew C. Maher nifer Poluka; three grandchildren; one at Western Psychiatric Institute. (Jamie), Dr. Katherine A. Maher (David great-granddaughter; and a brother, He recently had been recognized Benchener), Dr. Michael H. Maher Robert Lubic. for 50 years of service as a psychia- *** trist, including serving at St. Francis (Meghan) and Thomas D. Maher Lawrence D. Ellis, MD, 84, of Pitts- Hospital and as medical director of the III; sisters Colette B. Mehle (Roger) burgh, died Friday, October 14, 2016. Irene Stacy Medical Center in Butler, and Therese B. Gaus; brother-in-law Dr. Ellis graduated in medicine from Pa. Dr. John C. Maher Sr. (Mary Ellen); the University of Pittsburgh; served his Surviving are his first wife, Joan; his stepbrothers D. Colby Vincent and internship at Health Center-University second wife, Martha; two daughters; J. Scott Vincent; and grandchildren Hospitals; and completed his residency and four grandchildren. Lillian, Charles, Lucy, Robert, Joseph at UPMC Presbyterian Hospital. Services were held Nov. 3, 2016, at and Patrick. His specialties included internal Worrell Funeral Home, Inc., Sharps- Services were held Nov. 7, 2016, in medicine, oncology and hematology. burg. St. Scholastica Church.
Robert B. Wolf, 70, of Franklin and bar association, now widely of the Department of Health in 2010 Park and McCandless, died Sunday, used throughout the state. He was and is used today. His legal skill was October 30, 2016. instrumental in the development and significant in achieving a legislative Mr. Wolf was an attorney with passage of Pennsylvania Act 169 of draft that is expected to be introduced the firm of Tener, Van Kirk, Wolf and 2006, the Advance Care Directives in an upcoming session in Harrisburg. Moore in Pittsburgh and practiced law and Health Care Decision-making for Surviving are his wife, Mary Ellen for 42 years. He focused on trust and Incompetent Patients law. Barr Wolf; children Elizabeth (Henry estate law. Mr. Wolf was the legal force and Matthew) Wolf Fourcade and David E. He served as chair of the Alleghe- a great partner in the spread of the (Suzanne) Wolf; brother Richard (Hel- ny County Medical Society/Allegheny Physician Orders for Life-Sustain- en) Wolf; and grandchildren Jackson County Bar Association Uniform Living ing Treatment (POLST) Paradigm. Robert Wolf and Roman Wolf. Will Committee, which produced the He served on the committee which Services were held Nov. 7, 2016, state’s only advance medical directive helped develop the POLST form, in Schellhaas & Sons Funeral Home & form endorsed by both a medical which was approved by the secretary Cremation Services, Inc., Sewickley.
412 Bulletin / November 2016 In Memoriam
Noted Pittsburgh physician dies titioners in the Pittsburgh areas. He remembered as an excellent diagnosti- was a lifelong member of the Allegheny cian and caregiver. He was an inspira- Peter G. Ellis, MD County Medical Society and served as tion to the many physicians in training Lawrence Ellis, MD, passed away president in 1976. He also served as who served under him over the years. on Friday, October 14, 2016. Dr. Ellis president of the Leukemia/Lymphoma trained at the University of Pittsburgh Society of America as well as the pres- Peter G. Ellis, MD, is the nephew of and served the Pittsburgh community ident of the medical staff of Presbyte- Dr. Lawrence Ellis and is deputy direc- for more than 40 years as an internist rian Hospital, where he practiced for tor, Clinical Services, associate chief and hematologist. He was a profes- the majority of his career. He authored medical officer, UPMC Cancer Centers, sor of medicine at the University of numerous papers as well as the text- clinical professor of medicine, Universi- Pittsburgh Medical School and was book “Bone Marrow Biopsy,” edited by ty of Pittsburgh School of Medicine. He recognized among the premier prac- colleague John Krause, MD. He will be can be reached at [email protected].
Activities & Accolades
Pittsburgh physician awarded care and is dedicated to improving the award at its annual Signature Chefs for LGBT, HIV work primary care delivery model across Auction Nov. 7 at the Omni William all clinical disciplines, and particularly Penn Hotel, Pittsburgh. ACMS member for LGBT and HIV positive individuals. In 2014, Dr. Logan helped lead the Martin Seltman, MD, Under Dr. Seltman’s leadership, Metro opening of Jefferson Hospital’s Women has been named the Health Center has become renowned and Infants Center, Pennsylvania’s first 2016 Outstanding for its work with the transgender pop- new obstetrics unit in more than 30 Primary Care Clinician ulation and now serves more than 500 years. – Special Population transgender individuals from multiple Colleagues, administrators and pa- Category by Penn- states. tients consistently describe Dr. Logan sylvania Association Dr. Seltman ACMS Board member honored using one word: compassion. In addi- of Community Health tion to his medical practice, he partners Centers. by March of Dimes Foundation in a local program that provides safe, Dr. Seltman will be presented the The March of new cribs for those who cannot afford Primary Care Excellence (APEX) Dimes Foundation them. Outstanding Primary Care Clinician – Western PA has “Our goal is to give mothers and Award in recognition of his significant named David A. babies the best possible start toward a contribution to the delivery of primary Logan, MD, FACOG, rewarding and healthy life journey,” Dr. care to vulnerable populations, thereby medical director of Logan said. improving quality, access and out- Obstetrical Services Dr. Logan received his medical comes of care. at Jefferson Hospital, Dr. Logan degree from the University of Pitts- Dr. Seltman has served Metro Com- part of Allegheny burgh School of Medicine. He com- munity Health Center as its medical Health Network (AHN), as its 2016 pleted his internship and residency at director since 1999. He is a board-cer- Medical Honoree, recognizing his ded- West Penn Hospital, where he also tified family practitioner with an added ication and passion for helping babies served as medical staff president. He is qualification in geriatric medicine. Dr. and their families. board-certified by the American Board Seltman uses a holistic approach to The March of Dimes presented the of Obstetrics and Gynecology.
Bulletin / November 2016 413 Materia Medica Cabozantinib for renal cell carcinoma
kinase inhibitor therapy.2 The dose used clinical trial evaluating cabozantininb Melissa Blom, MD in the renal-cell carcinoma trial was in renal cell carcinoma. The rate of significantly smaller at 60mg orally daily. treatment discontinuation due to side Background effects was 9 percent. All patients Safety Renal cell carcinoma is the most fre- manifested adverse events, the most quent histological type of kidney cancer. Patients with a Karnofsky perfor- common being diarrhea (74 percent), Worldwide, it affects more then 300,000 mance status of less then 70 percent fatigue (56 percent), anorexia (46 or a history of uncontrolled illness patients and results in the death of more percent), palmar-plantar erythrody- were excluded from clinical trials and then 140,000 patients yearly. Nearly 30 sesthesia (PPE) (42 percent) and careful monitoring is advised in such percent of cases present with metastatic hypertension (37 percent). The most cases (i.e., these are highly functional disease at diagnosis. Even in patients common grade 3-4 adverse events patients). Cabozantinib undergoes were hypertension (15 percent), diar- treated with localized disease who are hepatic metabolism through CYP3A4. rhea (11 percent), fatigue (9 percent), treated with curative intent, the disease If combined with a CYP3A4 inducer, PPE (8 percent), anemia (5 percent), will recur in its metastatic form in around such as carbamazepine, glucocorti- alanine aminotransferase elevation one-third of cases. In the recent years, coids, progesterone, among others, its (5 percent) and hypomagnesemia (5 multiple tyrosine kinase inhibitor oral dose should be increased by 20mg at percent). agents were approved for the treatment a time to a maximum of 80mg daily or of metastatic renal-cell carcinoma, intolerable toxicity. Similarly, the dose Efficacy including VEGFR tyrosine kinase inhib- should be reduced in the presence of a Cabozantininb was compared with itors (sunitinib, pazopanib, sorafenib, CYP3A4 inhibitor, such as amiodarone, everolimus in 658 patients with met- axitinib) and the mTOR inhibitor ever- azithromycin, fluconazole, sertraline, astatic renal-cell carcinoma who had olimus. They have provided a much among others, by 20mg at a time to prior VEGFR therapy. The primary anticipated improvement in progression a minimum of 20mg daily. St. John’s outcome was duration of PFS defined free survival (PFS) and overall survival wort or grape juice should not be used as the time from randomization to the (OS) compared with the small benefit concomitantly with cabozantinib. Rare time or disease progression or death. provided by older therapies such as but life-threatening side effects include Secondary outcomes were response interferon alfa and chemotherapy. gastrointestinal perforation, fistulas, rate and overall survival. Cabozantinib is a small-molecule hemoptysis and gastrointestinal hemor- The estimated PFS was 7.4 months inhibitor of tyrosine kinases. It was first rhage when used for thyroid carcinoma with cabozantinib and 3.8 months approved, by the FDA, for treatment of at the higher dose of 140mg orally daily. with everolimus with a hazard ration metastatic medullary thyroid carcinoma These events were not reported in the (HR) of 0.58 (95 percent CI, 0.45 to in 2012.1 The dose for this indication metastatic renal-cell carcinoma trial us- 0.75; p<0.001). Prospectively tested was 140mg orally daily. More recently, it ing a starting dose of 60mg orally daily. subgroup stratification by prior VEGFR was approved by the FDA for the treat- Because patients with severe hepatic therapy or MSKCC prognostic risk ment of metastatic renal cell carcinoma and renal impairment were excluded category revealed maintained supe- who had received prior anti-angiogenic from clinical trials, cabozantinib is not rior efficacy of cabozantininb. Partial therapy. The latter was based on the recommended in patients with CrCl < response was more frequent in the METEOR trial, which is a randomized, 30 ml/min and Child-Pugh class C. cabozantininb group (21 percent vs. 5 open-label, phase 3 trial comparing percent, p<0.001). Progressive disease cabozantinib with everolimus in patients Tolerability occurred in 14 percent of patients with metastatic renal-cell carcinoma that Dose reductions were necessary in assigned to cabozantininb and in 27 had progressed after VEGFR tyrosine 60 percent of patients enrolled in the percent of patients in the everolimus
414 Bulletin / November 2016 Materia Medica
group. OS was more recently report- Bottom line ed in an update of the METEOR trial Cabozantininb is active in patients References and also favored cabozantinib (21.4 1. Schoffski P, Elisei R, Muller S, with metastatic renal-cell carcinoma months vs. 16.5 months, HR=0.66, et al. An international, double-blind, who had disease progression on prior p=0.00026).3 randomized, placebo-controlled phase VEGFR-targeted therapy. Most patients III trial (EXAM) of cabozantinib (XL184) Price required dose reduction of the standard in medullary thyroid carcinoma (MTC) patients (pts) with documented RECIST A one-month supply (28 days) of 60mg orally daily dose. It provides a progression at baseline. J Clin Oncol cabozantininb (Cometriq) for the met- new alternative to this patient popula- 2012; 30 (suppl):5508 2. Choueiri TK, Escudier B, Powles astatic renal-cell carcinoma indication tion and represents advancement in the treatment of renal-cell carcinoma. T, et al. Cabozantinib versus Everolimus costs about $5,660.80. Because of re- in Advanced Renal-Cell Carcinoma. N cent FDA approval, it is often covered Engl J Med 2015 Nov 5;373(19):1814- by local insurance companies after Dr. Blom is a Geriatric Fellow at 23. UPMC St. Margaret. Heather Sakely, 3. Choueiri TK, Escudier B, Powles prior authorization from the provider. T, et al. Cabozantinib versus Everolimus PharmD, BCOP, served as content ed- in Advanced Renal-Cell Carcinoma (ME- Simplicity itor, is the director of Geriatric Pharma- TEOR): final results from a randomized, Cabozantininb is taken orally once cotherapy, Medical Education at UPMC open-label, phase 3 trial. Lancet Oncol. daily one hour prior or two hours after St. Margaret and can be reached at 2016 Jun 3. Pii: S1470-2045 (16). food ingestion at the dose of 60mg. [email protected].
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Bulletin / November 2016 415 Legal Summary Pennsylvania Prescription Drug Monitoring Program operational, then quickly updated
Beth Anne Jackson, Esq. • Delegates and physicians/prescribers must follow acceptable use policy (posted on the PDMP website) – criminal and civil pen- Status. The Pennsylvania Prescription Drug Monitoring Program alties apply to unauthorized access to and/or misuse of information (PDMP), established by Act 191 of 2014, opened for queries Aug. 25, gained from the PDMP. 2016. Pharmacies began reporting prescriptions dispensed in June • The physician/prescriber remains responsible for delegates’ use and were required to report prescriptions dispensed within 72 hours of the PDMP. Documentation of queries of the PDMP is important not just for of dispensing. That potentially significant lag time was reduced to 24 maintaining a complete medical record, but also for demonstrating hours under Act 124 of 2016, signed by Gov. Wolf on Nov. 2, 2016. your compliance with Act 191. Accordingly, you should note in the Act 124 goes into effect Jan. 1, 2017. record every time you query the PDMP regarding a new patient and/ Physician/prescriber obligations. Under Act 191, physicians or new prescription (including refills) (“Queried PDMP; no red flags” and other prescribers were required to search the PDMP the first suffices). Further, note in the record anytime you decline to write a time a patient is prescribed a controlled substance (to establish a prescription based on the PDMP report or write a prescription despite baseline) and thereafter anytime a physician believes that a patient a PDMP report: Be sure to reflect your clinical decision-making. may be abusing or diverting drugs. Act 124, however, requires that Recommended actions. While yet another non-reimbursed pa- a prescriber query the PDMP every time he or she prescribes a con- tient care requirement, the PDMP can provide important information trolled substance. Another act signed the same day, Act 125, restricts about your patients and may even yield some surprises about how the ability of physicians to prescribe opioids to minors, limiting the your DEA number has been used. amount prescribed to a seven-day supply and requiring other steps • Register all physician/prescribers in the practice if not registered to be taken before writing such prescriptions. Act 125 will become already, even if you generally do not prescribe opioids. effective once the relevant boards publish the notice required by the • Authorize delegates to conduct the queries for you, if desired. act. • Have all physicians, prescribers and any delegates sign off on Importantly, physicians may delegate the actual conduct of the the acceptable use policy. search query to any person employed or supervised by them; how- • Post the state-created notices in waiting rooms and patient care ever, DOH prefers that licensed nurses perform such duties. Some areas. basic rules apply, so choose your delegates carefully and monitor • Routinely query the PDMP when required or warranted by the what they do: circumstances. • Delegates must set up their own accounts and passwords, and • Document the queries in the medical record as described the physician must approve. above. • Delegates may not share an account. • Run a report on all prescriptions written by all prescribers in • Only patients may be looked up on the database (no employ- your practice to check for forged prescriptions (use a DEA number ees, friends, etc.) – this rule applies to physicians as well. search – instructions are on the PDMP portal) and take appropriate
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
416 Bulletin / November 2016 Legal Summary legal action if forged/unauthorized prescriptions found. If you generally do not write prescriptions for controlled substances, you’ll want to register just to make sure that no one is forging prescriptions with your DEA number. • Post the required patient notice posters in your office.1
Import. Failure to query the database as required can re- sult not only in compromised patient care, but also sanctions from your licensing board. Misuse of the database can result in civil and/or criminal penalties. Understand your obligations and act accordingly.
DISCLAIMER: This article is for informational purposes only and does not constitute legal advice. You should contact your attorney to obtain advice with respect to your specific issue or problem.
Ms. Jackson is the sole member of Beth Anne Jackson, Esq. LLC, a law firm that serves the legal needs of health care practitioners and facilities in southwestern and central Pennsylvania. She may be reached at (724) 941-1902 or bjackson-law@verizon. net. Her website is: www.jacksonhealthlaw.com. Follow her on Twitter: @bajhealthlaw1.
Reference 1. Sample posters in English and Spanish as well as FAQs are available online at the PDMP portal website: http:// www.health.pa.gov/Your-Department-of-Health/Offices%20 and%20Bureaus/PaPrescriptionDrugMonitoringProgram/Pag- es/Prescribers.aspx#.V_ulJugrKhc
Domestic Abuse Palm Cards Available Where-to-Turn cards give important in- formation and phone numbers for victims of domestic violence. The cards are the size of a business card and are discreet enough to carry in a wallet or purse. Quantities of cards are available at no cost, for distribution within Allegheny County, by contacting the Allegheny County Medical Society at (412) 321-5030. Ruby Marcocelli * Please note phone numbers, information on palm card valid only for Allegheny County, Pa.
Bulletin / November 2016 417 Materia Medica Praxbind® (idarucizumab) RE-VERSal Effects of idarucizumab zumab-dabigatran complex is cleared Nicholas R. Giruzzi, on Active Dabigatran (RE-VERSE AD) by the kidneys, but does not have to be PharmD trial, 123 dabigatran-treated patients dose adjusted for renal impairment.5 Nicole Payette, (>90 percent for atrial fibrillation stroke prevention) with either overt, uncon- Efficacy harm P D, BCPS trollable, or life-threatening bleeding Idarucizumab binds dabigatran and or those requiring surgical intervention its active acyl-glucuronide metabolites raxbind® (idarucizumab) is a that could not be delayed for at least with higher affinity than the binding humanized monoclonal antibody P eight hours, were administered idaru- affinity of dabigatran to thrombin, neu- fragment (Fab) indicated in patients tralizing their anticoagulant effect.1 The treated with Pradaxa® (dabigatran) cizumab. Of those, 18 deaths were reversal of dabigatran’s anticoagulant when reversal of anticoagulant effects reported, two patients suffered from effect with idarucizumab is seen within is needed such as emergency sur- gastrointestinal (GI) hemorrhage and minutes of the intravenous infusion.7 geries, procedures, life-threatening or five patients experienced thrombotic Three randomized, placebo-con- uncontrolled bleeding.1 events: One had a deep-vein throm- bosis (DVT) and pulmonary embolism trolled trials with a total of 283 subjects Safety (PE) two days after treatment, one assessed the safety, dose-response In the phase I trial for idarucizumab, experienced a DVT, PE and left atrial and efficacy of idarucizumab on healthy male volunteers not on dab- thrombus nine days after treatment, reducing unbound dabigatran and co- igatran (N=110; 27 placebo, 83 idaru- one had a DVT seven days after agulation parameters. Study subjects cizumab) 18-45 years old with body treatment, one had a non-ST segment were either given 220mg or 150mg mass indexes (BMIs) 18.5-29.9 kg/m2 elevation myocardial infarction 13 days of dabigatran twice daily. The plasma received between 20mg and 8 grams after treatment and one experienced concentrations of unbound dabigatran (gm) idarucizumab as a one-hour in- ischemic stroke 26 days following treat- were reduced to below the lower limit travenous (IV) infusion or 1, 2, or 4gm ment. None of the patients was receiv- of quantification immediately after the idarucizumab as a five-minute infusion. ing antithrombotic therapy at the time administration of 5gms idarucizumab, The primary safety endpoint was the of the event.2 Other reported adverse regardless of dabigatran dose re- percentage of subjects with adverse events include: hypokalemia (9/123, 7 ceived.1 When compared with placebo, events arising during the treatment percent), delirium (9/123, 7 percent), the subjects’ dTT, ECT, aPTT, TT and period (treatment administration until constipation (8/123, 7 percent), pyrex- ACT parameters returned to baseline 14 days post-administration) that were ia (7/123, 6 percent) and pneumonia levels after administration of idaruci- considered to be drug related. There (7/123, 6 percent).1 zumab and these reductions in plasma were no differences in the overall concentrations were observed over a incidence of adverse events observed Tolerability 24-hour period.1 in those receiving placebo or idaruci- Idarucizumab is a well-tolerated A prospective cohort study to zumab. Thirty-eight percent of patients medication. The most notable side determine the safety and efficacy reported at least one adverse event effects are from headache, back pain, of 5gms of idarucizumab in patients with the most frequently reported being nasopharyngitis and skin irritation. The treated with dabigatran presenting headache, nasopharyngitis, back pain adverse events profile of idarucizumab with life-threatening or uncontrolled and skin irritation. There also were no revealed no unexpected or clinically bleeding or those requiring an ur- clinically relevant local skin reactions relevant safety concerns, and there gent procedure was performed.2 The observed.6 was no relationship between dose and primary endpoint was the maximum In the interim analysis of the adverse event frequency. The idaruci- percentage reversal of anticoagulant
418 Bulletin / November 2016 Materia Medica
effect of dabigatran within four hours are needed for one dose; therefore, a Bottom line after the administration, on the ba- dose will cost ~$7,000.3 Praxbind® (idarucizumab) is a hu- sis of the determination at a central manized monoclonal antibody fragment laboratory of dilute thrombin (dTT) Simplicity and ecarin clotting time (ECT).2 The Idarucizumab is indicated in patients indicated for patients being treated ® interim analysis included 90 patients being treated with Pradaxa® (dabig- with Pradaxa (dabigatran) that need who received idarucizumab, 68 with atran) that need reversal of the anti- reversal for emergency surgery/urgent elevated dTT and 81 with elevated coagulant effects due to an emergent procedures or for life-threatening/ ECT, idarucizumab normalized the test procedure or uncontrolled bleeding. uncontrollable bleeding. It is available results in 88 percent to 98 percent of The recommended dose of idarucizum- only intravenously (IV) doses as 5gms, the patients, an effect that was evident ab is 5gm (two separate 2.5gm dose and is supplied in 2.5gm/50mL sin- within minutes.2 Concentrations of vials) intravenously either as a bolus gle-use vials. unbound dabigatran remained below via syringe or as an infusion by hang- 20ng/mL at 24 hours in 79 percent of ing the vials. Infusion of each 2.5gm Dr. Giruzzi is a PGY-1 pharmacy 2 the patients. These results indicate vial should take no longer than five to practice resident at UPMC St. Marga- 10 minutes with the second vial being that idarucizumab is a rapid-acting ret and can be reached at giruzzinr@ reversal agent for dabigatran and the administered no later than 15 minutes upmc.edu. Dr. Payette is a PGY-2 effects are seen for at least 24 hours after the end of the first vial. ambulatory care pharmacy resident at after administration. Prior to administration, if using a preexisting IV line, it is necessary to UPMC St. Margaret. Heather Sakely, Price flush with normal saline. Although there PharmD, BCOP, served as content ed- Boehringer Ingelheim Pharmaceuti- is limited evidence, if clinically relevant itor, is the director of Geriatric Pharma- cals announced the price of Praxbind® bleeding occurs or a second urgent cotherapy, Medical Education at UPMC (idarucizumab) in the United States to procedure is required, an additional St. Margaret and can be reached at be approximately $3,500/vial. Two vials 5gm dose can be considered. [email protected].
References Looking for answers 1. Praxbind®[Package Insert]. Available from: http://www.accessdata.fda.gov/ drugsatf- to your da_docs/label/2015/761025lbl.pdf. Accessed 30 Nov 2015. 2. Pollack CV, Reilly PA, Eikelboom J, et al. Idarucizumab for Dabigatran Reversal. N questions about Engl J Med. 2015;373(6):511-20. government 3. Faircild D, Hefner J. “Dabigatran-reversal agent price set”. Available from: http:// www.jwatch.org/fw110754/2015/10/20/dabigatran-reversal-agent-price-set. Accessed 30 benefits and services? Nov 2015. USA.gov has you 4. Johnson, S. “FDA approves drug to counter effect of blood thinner Pradaxa”. covered. Available from: http://www.modernhealthcare.com/article/20151016/ NEWS/151019922. Accessed 30 Nov 2015. It’s your official 5. Pollack CV, Reilly PA, Eikelboom J, et al. Design and rational for RE-VERSE AD: A source for phase 3 study of idarucizumab, a specific reversal agent for dabigatran.Thromb Haemost 2015; (114):198-205. government 6. Glund S, Moschetti V, Norris S, et al. A randomized study in healthy volunteers to information. investigate the safety, tolerability and pharmacokinetics of idarucizumab, a specific antidote to dabigatran. Thromb Haemost. 2015; (113):943-951. USA.gov 7. Idarucizumab. In: In Depth Answers [database on the Internet]. Ann Arbor (MI): Tru- ven Health Analytics; 2015 [cited 30 Nov 2015]. Available from: www.micromedexsolutions. 1 (800) FED-INFO com. Subscription required to view.
Bulletin / November 2016 419 Special Report Landmark initiative gets the green light from PAMED’s House of Delegates heers and applause broke out at Other important issues among insurers for observation status, Cthe Hershey Lodge Oct. 23, 2016, addressed at PAMED’s HOD standardizing the development of clini- as Pennsylvania physicians voted cal pathways, and ending retrospective overwhelmingly in favor of a landmark While the historic vote was one payment denial of medically appropriate Practice Options Initiative to create highlight of this year’s HOD, physicians studies, procedures and testing. clinically integrated networks (CINs) for addressed many other significant Explore Legislation that Would physicians in the state. health care issues at the HOD. Here’s Help Protect Physicians and Pa- The message from physicians from a look at just a few: tients and Ensure Physicians’ Clini- across the state at the Pennsylvania Continue to Work to Ensure a cal Autonomy – Resolutions approved Medical Society’s 2016 House of Dele- Fairer, Less Burdensome Mainte- by delegates at the HOD include: gates (PAMED-HOD) was resounding: nance of Certification (MOC) Pro- • Ensuring fairness for physicians Let’s assist in providing physicians with cess – The physicians at this year’s cleared of wrongdoing by their state practice options, which would in turn HOD remained committed to address- licensing board. ensure patient access to quality care in ing concerns with MOC and approved • Actively preserve the ability of Pennsylvania. resolutions to: physicians to write prescriptions and “As a delegate from Northampton • Petition the American Medical As- oppose any mandate that requires all County Medical Society, I feel privi- sociation (AMA) to analyze the financ- prescribing in Pennsylvania to be done leged to vote for this historic resolution. es of the American Board of Internal electronically. Great job done by the PA Medical Medicine (ABIM). Address Public Health Issues Society!” said Vasu Singh, MD, a family • Adopt a position favoring the Affecting Patients in Pennsylvania medicine physician from Bethlehem. acknowledgement of an alternative – The delegates called on PAMED to The Practice Options Initiative will board, such as the National Board of address health care hot topics, such as: create CINs as well as a Management Physicians and Surgeons (NBPAS). • Eliminating barriers to children Services Organization (MSO). It is a Address Pennsylvania’s Opioid possessing and using sunscreen in direct response to the evolving health Abuse and Overdose Crisis – Physi- schools. care delivery system, which is moving cians voted to: • Opposing legislative interference rapidly toward value-based care. It • Support liability protection in ad- with facilities that provide medically will support all physicians by providing ministration of naloxone in schools and accepted standard of care reproductive practice options and helping physi- increase availability of opioid rescue services for women. cians maintain leadership and clinical medication and medication-assisted • Opposing tobacco usage in the autonomy. The initiative aims to help treatment. Commonwealth of Pennsylvania. physicians succeed in MACRA and • Work with statewide stakeholders • Exploring the health effects of alternative payment models. and county medical societies to identify fracking. PAMED members who are in- and remove existing barriers for Penn- • Promoting Teen Health Week, terested in learning more about sylvania patients seeking addiction which is Jan. 9 – 13, 2017. CINs or MSOs can contact Dennis treatment. Another notable change that Olmstead, PAMED’s Senior Advisor Advocate for More Consistent emerged from the 2016 HOD is that of Health Economics and Policy, at and Transparent Insurer Processes – the Young Physicians Section opted to [email protected] or PAMED will advocate for the standard- undergo a name change to the Early 855-PAMED4U (855-726-3348). ization and transparency of processes Career Physicians Section, a decision
420 Bulletin / November 2016 Special Report
Jack Krah / ACMS Members of the Allegheny County Medical Society and PAMED House of Delegates are pictured at the conference. which recognized changing demograph- well-attended and provided physicians on social determinants? ics and the fact that individuals begin with guidance on navigating the chal- Eighteen residents also participated their medical careers at different ages. lenges they face in their daily practice. in the annual poster contest. Learn more More than 200 physicians attended this at www.pamedsoc.org/PosterContest. New PAMED President year’s AEC, taking advantage of the inaugurated at HOD opportunity to earn up to 10 credits of More PAMED resources The HOD also featured an Oct. 22 CME per person. Find more information about these inaugural event during which Charles Several physicians who attended ongoing PAMED advocacy efforts related to issues discussed at the HOD Cutler, MD, MACP, an internal medi- the conference stopped by PAMED’s Oct. 21-23: cine specialist from Norristown, was CME exhibit table and took advantage • Maintenance of Certification – sworn in as the 167th president of of the chance to use the technology on hand to complete PAMED’s existing www.pamedsoc.org/MOC PAMED. Read an excerpt from Dr. online child abuse recognition and • PAMED’s “Opioids for Pain: Be Cutler’s speech at www.pamedsoc.org/ reporting training course, which meets Smart. Be Safe. Be Sure.” Initiative – CutlerSpeech. the state’s requirements for license www.pamedsoc.org/OpioidInfo Several physicians also were elect- renewal. The child abuse reporting • Credentialing and Insurance ed to PAMED leadership positions at training course is available at www. Reforms – www.pamedsoc.org/Insur- the HOD. Learn more at www.pamed- pamedsoc.org/childabusecme. anceReforms soc.org/Newsroom. Fourteen medical students partic- And, learn more about all of AEC tackles issues ipated in PAMED’s first ever Health PAMED’s advocacy efforts at www. pamedsoc.org/Advocacy. like value-based care Care Topics Debate. The audience earned CME by judging the strength of PAMED members with questions The Annual Education Conference arguments on the following topics: about advocacy initiatives can contact (AEC) component of this year’s event • Should medical marijuana be legal our Knowledge Center at 855-PA- served as a complement to the activi- in Pennsylvania? MED4U (855-726-3348) or Knowl- ties of the HOD. Sessions addressing • Should we eliminate the use of opi- [email protected]. roles and skills needed by physicians oids to treat chronic, non-cancer pain? of the future, MACRA and approaches • Should public funds focus more on Article reprinted with permission to chronic pain management were understanding disease mechanisms or from the Pennsylvania Medical Society.
Bulletin / November 2016 421 Special Report Team up to tackle cardiovascular disease reventive cardiovascular care is health care providers, community orga- About Quality Insights at the heart of better health for P nizations and patients the opportunity As the Quality Innovation Net- people with Medicare. According to the to share, learn and make a difference. work-Quality Improvement Organi- Million Hearts® initiative, almost half Our efforts align with the national zation (QIN-QIO) for Pennsylvania, of the 75 million Americans who have Million Hearts® initiative that seeks New Jersey, Delaware, West Virginia hypertension do not have the condition to prevent one million heart attacks and Louisiana, Quality Insights is com- under control. About 11 million of them and strokes by 2017. All assistance do not know their blood pressure is too mitted to collaborating with providers is provided free of charge under a high and are not receiving treatment to and the community on the Centers for contract that Quality Insights has with control it, even though most of these Medicare & Medicaid Services’ goals the Centers for Medicare & Medicaid individuals have health insurance and of better health, smarter spending and visit a health care provider each year. Services (CMS) through July 2019. healthier people. Our data-driven qual- To combat this serious condition, Learn more about how Quality ity initiatives improve patient safety, Quality Insights Quality Innovation Insights can help your practice get reduce harm and improve clinical care Network offers a wealth of free evi- to the heart of cardiovascular care. locally and across the network. To learn dence-based resources to improve car- Contact Shikina Wills at swills@wvmi. about Quality Insights’ health care diac health. We also convene Learning org or 1-877-346-6180, ext. 7825, to quality improvement initiatives, visit and Action Networks (LANs) to give get started. www.qualityinsights-qin.org.
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422 Bulletin / November 2016 Physicians’ HEALTH Program The Foundation of the Pennsylvania Medical Society 30 Years of Change – Transforming Lives “ONE IN TEN people suffer from addiction. At any time, there could be as many as 3,000 doctors in the state whom we could be helping.” Raymond Truex Jr., MD, FAANS, FACS
“Physicians, like the rest of the population, are vulnerable to chemical dependency, physical WHY SHOULD I disability or breakdowns in mental SUPPORT THE PHP? health. Your support of the • For 30 years the PHP has provided confidential support, 30 Years of Change Campaign monitoring and advocacy to those who may be struggling with will make sure the Physicians’ Health addiction or physical or mental challenge. Program will always be available to our • The PHP relies on contributions from physicians, hospitals fellow health care providers.” and others so that the cost to the participant can be kept as low as possible during challenging times. Raymond Truex Jr., MD, FAANS, FACS, • Your gift TODAY is an investment in an established endowment Honorary Chair of ensuring that the PHP will have funding support in perpetuity. 2016 PHP 30 Years of Change Campaign • Your gift provides a transformational opportunity for your fellow health care providers who deserve a chance to live life in recovery and good health. HOW CAN I HELP? PHP is a program of Please consider a gift to the PHP in honor of this anniversary to ensure that physicians will The Foundation of the always have a place to go to when help is needed. Let’s make the most of it! In celebration Pennsylvania Medical Society of this milestone, the campaign has received a $30,000 challenge grant from an anonymous – the charitable arm of physician – by making your gift TODAY you will help us to take full advantage of this generous PAMED. The program assists matching fund opportunity! all physicians (MDs and DOs), physician assistants, medical Go to www.foundationpamedsoc.org to see true stories of transformation and recovery. students, dentists, dental hygienists, and expanded If you want to learn more about how to make a contribution to the PHP Endowment, function dental assistants. visit www.foundationpamedsoc.org. You can also contact Director of Philanthropy Contact the PHP Margie Lamberson, CFRE, at [email protected] or 717-558-7846. at (717) 558-7819 or [email protected].
The official registration and financial information of the Foundation may be obtained from the Pennsylvania Department of State, Bureau of Charitable Organizations, by calling toll-free within Pennsylvania, (800) 732-0999. Registration does not imply endorsement. 777 East Park Drive • Harrisburg, PA 17105-8820
updated ad.indd 1 1/15/16 1:32 PM Bulletin / November 2016 423 Feature Ebensee: Recognition long delayed rom 1943 to 2012 is a long time, but Fit was only at the end of this 69- Fredric year time span was when I was able to arrett retrieve enough information about my J , father’s World War II military service to MD ask the U.S. Army to correct his military records. My father, Dr. Julian Everett Jarrett, attached to General George Patton’s passed away prematurely when I was a Third Army. college freshman. He volunteered as a In the waning days of World War medical officer and was commissioned II, a reconnaissance tank unit, part of shortly after the beginning of the war, General Patton’s Third Army, discov- four months after I was born. Physi- ered a concentration camp at Ebensee, a beautiful town at the foot of the Aus- cians volunteering for military service Dr. Julian Everett Jarrett did not have a finite term of enlistment. trian Alps, located at the southern tip of The Army stated that my father’s com- Lake Traunsee. This camp, a subcamp half patients per bed. Twelve hundred mission would be in force “during the of KZ Mauthausen, was a slave labor unburied bodies lay in the morgue. pleasure of the president and for the camp used to construct tunnels and The camp prisoners weighed an duration of the present emergency plus perform research in support of the V2 average of 75 pounds; roughly half had six months.” rocket program headed by SS officer tuberculosis; many had typhus fever; My efforts to retrieve the details of Dr. Wernher von Braun, and ultimate- most had lice. They had been subsist- his military service were thwarted by a ly to exterminate the prisoners. The ing on 500-1,000 calories daily while fire in the early 1970s, which destroyed tankers who liberated this camp found doing hard labor. records at the Army’s storage facility in it covered so completely with mud and The 139th Evacuation Hospital was St. Louis. With the help of my nephew, excrement that they burned their boots equipped and staffed to care for 400 Benjamin Jarrett, we were able to piece and uniforms after leaving. They found sick and wounded soldiers as inpa- together records from the National more than 11,000 prisoners in various tients; the initial hospital population in Archives and the Holocaust Museum. stages of starvation, mainly Polish and the camp was three times this number, Two books were of help: “A Sur- Russian POWs who were employed as and the disease spectrum and chal- geon in Combat” by William V. McDer- slave laborers. lenges were far different. Physician mott, who served with the 30th Field Initially, the 30th Field Hospital prisoners assisted with medical care. Hospital, and “Inside the Gates,” by assumed responsibility for the camp, Delousing with DDT was performed Dr. Richard G. MacDonald, son of the but was overwhelmed by the volume daily for the prisoners after clothing commander of the 139th Evacuation of work required and were promptly and bedding were burned. Hospital. After serving in Alaska and relieved by the 139th Evacuation Hos- Army engineers immediately the Aleutians, my father was assigned pital, which was a larger medical unit. replaced the box latrines with more per- to this hospital, which had trained at The SS guards had dynamited the manent ones. A water supply was creat- Ft. Shelby, Mississippi, then embarked plumbing system before abandoning ed and outdoor showers were provided. from Boston to Normandy. Their the camp, so the prisoners were forced Bulldozers were used to clear additional troopship was hit by a torpedo during to relieve themselves outdoors. The land for tents. The three decker bunks the Atlantic crossing. They arrived hospital building had triple-decker were sawed into double-decker bunks; at Le Havre and after brief support bunks, the lowest four inches from 500 beds were provided in the tent operations in Germany, they were the ground, and averaged two and a wards within 24 hours.
424 Bulletin / November 2016 Feature
Approximately half of patients had mingled uncontrollably with hospital After the prisoners had been no clothing. Most had no blankets. patients. Theft of food and physical stabilized medically, the hospital The hospital was able to “procure” 16 fights over food supplies were com- received orders for “direct deployment” railroad cars of German uniforms so mon. Many of the prisoners could not to the Pacific Theater of Operations, that each prisoner was given at least be trained to use latrines. Most of the to ultimately support the American one set of clothing as well as three SS guards had fled to the hills when invasion of Japan. They boarded naval blankets. Only half had eating utensils, the camp was liberated and occasion- transports on Aug. 12, 1945, and just so the remainder were given tin cans ally would attempt to re-enter in the after they passed west of Gibraltar, the to eat from. Chlorine solution was evenings to steal food. Those who Japanese surrender was announced used daily to clean eating utensils and remained had been dealt with by the and the ship was redirected to Bos- kitchen equipment. prisoners. ton. Prior to this, my father had been The Army found that the starving The hospital commander, Colonel transferred to an engineer battalion patients often were made worse by Hugh MacDonald, needed additional and soon thereafter returned to the the Army’s rations, which the prison- civilian labor to remove bodies and United States. He was discharged after ers’ GI tracts could not tolerate. Since clean barracks. He requisitioned 50 three-and-a-half years of Army ser- they could not resist the opportunity to women from the town burgomeister, vice, returned to the private practice of gorge themselves, deaths ensued from who refused because he thought medicine, entered a radiology residen- overeating. The hospital quickly found the work was unsuitable for the local cy several years later, and thereafter that replacement of vitamins and mini- women. The hospital commander said joined the radiology department at mal caloric intake was more beneficial his “request” was actually an order. He Harvard Medical School. for most patients. Plasma transfusions prevailed, and the women performed During his lifetime, he spoke freely were liberally used on prisoners too ill well. Additional manpower was provid- about his experience in Alaska and to eat, with spectacular benefit. ed by German prisoners and civilians. the Aleutians, but said little of his work General Patton originally had The Germans had surrendered at Ebensee. What remained were thought that female nurses should not shortly after the 139th Evacuation his photographs of a Rhine crossing be assigned to this camp because they Hospital arrived, and this part of Austria on pontoon bridges and later rather would not be able to tolerate the condi- was within the future Russian zone. gruesome pictures of the camp itself. tions. He was persuaded to change his A Russian general visited the camp The work of the 139th Evacuation mind, and the nurses present per- and attempted to intimidate one of the Hospital is a tribute to the dedication formed admirably. on-duty nurses into turning over all the and resourcefulness of its staff. The When the camp was first liberated, Russian patients to his jurisdiction. The records I was able to retrieve showed the 30th Field Hospital estimated a dai- Russians were known to execute their that my father had never received two ly death toll of 300, most from malnu- repatriated POWs and to her credit, bronze service stars that had been trition and disease. The SS planned on the nurse refused. What language she recommended, as well as Aleutian and a quota of deaths daily; if it fell short, used was not recorded. She returned central Europe campaign decorations. additional prisoners were strangled by to Ebensee in 2015 at age 92 for the The Army was most gracious in award- the guards. As the Allies approached, 70th anniversary of the camp libera- ing these posthumously and correcting the camp’s SS commander had plans tion. his military record in 2012. to execute all remaining prisoners by Within a few weeks, the prisoners’ placing them in the tunnels and sealing medical situation was stabilized. The Dr. Jarrett is a general and vascular the entrance and exits with dynamite. daily death toll was minimized. Patients surgeon in Pittsburgh and served as After the camp was liberated, the daily with typhus fever were transferred to a surgeon in the U.S. Army. His book, death toll dropped to 30, most from another facility and all survived. Once “To Fruit Street and Beyond,” was starvation and its complications. the prisoners could walk one mile, they recently published by Archway/Simon Prisoner discipline was a major were transported by the military for and Schuster. He can be reached at problem. The ambulatory prisoners repatriation to their native countries. [email protected].
Bulletin / November 2016 425 Please share with a colleague!
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