Allegheny County Medical Society
BulletinDecember 2017
Update from ACHD Evolution of telehealth law 2017 ACMS Foundation award winners 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.
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Business • Employment • Estates and Trusts • Health Care Litigation • Oil and Gas • Public Finance • Real Estate Allegheny County Medical Society
BulletinDecember 2017 / Vol. 107 No. 12
Opinion Departments Articles
President’s Message ...... 422 Society News ...... 436 Feature ...... 442 Looking back; moving forward • Pennsylvania Geriatrics Society – 2017 ACMSF award winners David J. Deitrick, DO Western Division Christina E. Morton • Pittsburgh Ophthalmology Society Editorial ...... 424 • Intel ISEF Pittsburgh seeking judges Materia Medica ...... 448 ’Tis the season and volunteers Edaravone (Radicava®) for Care is Your Business, Change is Ours Deval (Reshma) Paranjpe, MD, FACS • Heart Health Walk held amyotrophic lateral sclerosis The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense • January program planned for Daniel Powell, PharmD competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols, Editorial ...... 426 physicians, practice managers cost-management and revenue management. ‘Thank you, sir, may I have another?’ Legal Report ...... 450 Joseph C. Paviglianiti, MD ACMS Alliance News ...... 440 Evolution of telehealth law Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through Michael A. Cassidy, Esq. contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. Miller Time ...... 428 In Memoriam ...... 441 We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues The cannabinoid conundrum • Joseph Francis Hakas, MD Special Report ...... 456 ranging from HIPAA compliance to medical staff and peer review matters. Scott Miller, MD, MA, FAAHPM Update from the ACHD Advertising Index ...... 453 Stephen Forest, MPH Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet Editorial ...... 430 Kristen Mertz, MD, MPH these challenges. And we know what is ahead. Update: PAMED Board of Trustees Editorial Index ...... 454 David Nace, MD, MPH Amelia A. Paré, MD, FACS Reportable Diseases ...... 458 Perspective ...... 432 Opioid crisis: Historic perspective and Classifieds ...... 458 current trends William Simmons, MD
On the cover Birds of a Feather Happy Holidays Terence W. Starz, MD hh-law.com from all of us at ACMS Dr. Starz specializes in rheumatology Business • Employment • Estates and Trusts • Health Care and internal medicine. Litigation • Oil and Gas • Public Finance • Real Estate EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212; (412) 321-5030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above Affiliated with Pennsylvania Medical Society and American Medical Association Bulletin address. Medical Editor The Bulletin of the Allegheny 2017 PAMED DISTRICT TRUSTEE Deval (Reshma) Paranjpe County Medical Society welcomes Executive Committee Amelia A. Paré ([email protected]) contributions from readers, physicians, and Board of Directors Associate Editors medical students, members of allied COMMITTEES Charles Horton professions, spouses, etc. Items may President Awards ([email protected]) be letters, informal clinical reports, David J. Deitrick Donald B. Middleton Robert H. Howland editorials, or articles. Contributions President-elect Bylaws ([email protected]) are received with the understanding Robert C. Cicco Adele L. Towers John Kokales that they are not under simultaneous Vice President Finance [email protected] consideration by another publication. Adele L. Towers Peter G. Ellis Scott Miller Issued the third Saturday of each Secretary Gala ([email protected]) month. Deadline for submission William K. Johnjulio Patricia L. Bononi Amelia A. Paré of copy is the SECOND Monday Treasurer Adele L. Towers ([email protected]) preceding publication date. Periodical Patricia L. Bononi Nominating Gregory B. Patrick postage paid at Pittsburgh, PA. Board Chair Matthew B. Straka ([email protected]) Lawrence R. John Bulletin of the Allegheny County Primary Care Joseph C. Paviglianiti Lawrence R. John Medical Society reserves the right to ([email protected]) edit all reader contributions for brevity, DIRECTORS Brahma N. Sharma clarity and length as well as to reject 2017 ([email protected]) any subject material submitted. Peter G. Ellis Todd M. Hertzberg Managing Editor The opinions expressed in the Barbara A. Kevish Meagan K. Sable Editorials and other opinion pieces David A. Logan ([email protected]) are those of the writer and do not necessarily reflect the official Jan W. Madison ADMINISTRATIVE STAFF policy of the Allegheny County Matthew B. Straka Executive Director Medical Society, the institution with Angela M. Stupi John G. Krah which the author is affiliated, or 2018 ([email protected]) the opinion of the Editorial Board. David L. Blinn Assistant to the Director Advertisements do not imply spon- William F. Coppula Dorothy S. Hostovich ([email protected]) ACMS ALLIANCE sorship by or endorsement of the Kevin O. Garrett ACMS, except where noted. Raymond E. Pontzer Bookkeeper President John P. Williams Susan L. Brown Kathleen Reshmi Publisher reserves the right to exclude 2019 ([email protected]) First Vice President any advertisement which in its opinion Thomas P. Campbell Director of Publications Patty Barnett does not conform to the standards of Michael B. Gaffney Meagan K. Sable Second Vice President the publication. The acceptance of advertising in this publication in no Keith T. Kanel ([email protected]) Joyce Orr way constitutes approval or endorse- Jason L. Lamb Assistant Executive Director, Recording Secretary ment of products or services by the Maria J. Sunseri Director of Member Relations Justina Purpura James D. Ireland Corresponding Secretary Allegheny County Medical Society of ([email protected]) Doris Delserone any company or its products. PEER REVIEW BOARD Treasurer Subscriptions: $30 nonprofit organi- 2017 Membership Relations Manager Josephine Martinez zations; $40 ACMS advertisers; $50 Donald B. Middleton Nadine M. Popovich Assistant Treasurer others. Single copy, $5. Advertising Ralph Schmeltz ([email protected]) Sandra Da Costa rates and information sent upon 2018 request by calling (412) 321-5030 or Sharon L. Goldstein online at www.acms.org. Bruce A. MacLeod 2019 Robert W. Bragdon COPYRIGHT 2017: John A. Straka ALLEGHENY COUNTY MEDICAL SOCIETY www.acms.org POSTMASTER—Send address changes to: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212. Leadership and Advocacy for Patients and Physicians ISSN: 0098-3772 NORCAL GROUP OF COMPANIES
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t’s amazing how quickly a year flies In the meantime, I want to person- members representing Pennsylvania at Ipast. It’s been a year that has been ally thank Jack for his friendship and the AMA, including members serving filled with challenges, accomplishments leadership over the years. We wish him in leadership and council positions. and changes. As I complete my year as all the best in his future endeavors. We always have an active, engaged your president and prepare to pass the We have had our share of accom- delegation at the annual PAMED gavel to my uncle, Dr. Robert Cicco, plishments this year. In collaboration House of Delegates meeting in Octo- in January, I wanted to update you on with the Allegheny County Health ber. This year, we successfully elected some of the activities of the Allegheny Department and The Hospital and my mentor, Dr. John, as vice president County Medical Society over the past Healthsystem Association of Pennsyl- of PAMED. He will ultimately become year. vania, we were able to successfully PAMED president in a couple years. The year started with the announce- lobby County Council to include elec- Dr. John will be the fifth ACMS member ment that our executive director (ED) tronic cigarettes in the ban on smoking to become PAMED president in the for the past three decades, Mr. Jack in public spaces. past 16 years. This is a tremendous Krah, plans to retire in spring 2018. Al- We met with federal legislators to accomplishment and attests to level of though this is a well-deserved accom- discuss ramifications of a possible involvement we have at the state level. plishment for one of the most respect- repeal to the Affordable Care Act. We continue to engage our young ed executives in the entire state, he will In response to a growing nation- physicians and medical students. They be sorely missed. Anyone who has had al trend of physician burnout, and are the future of our organization, and the good fortune to work with Jack in because of the visionary thinking of our membership numbers for students any capacity within the medical society my predecessor, Dr. Larry John, the and residents have grown sharply in over the years understands what a tre- ACMS is on the verge of launching a recent years. mendous impact he has had, not only Physician Wellness Program, seeking Despite these accomplishments, we within the ACMS, but also within our to offer free confidential counseling still have immediate issues facing our region and the state. Jack deserves a to physicians suffering from burnout, Society. Membership always continues long and prosperous retirement, but depression, or other crises. This is a to be at the forefront of our efforts. To his departure leaves us in unfamiliar much-needed service, and we hope those of you reading this article, I am territory, finding a new ED. to have the program operational in preaching to the choir. We need to The Executive Committee has the first quarter of the coming year. A grow our membership to ensure that formed a Search Committee to in- special thank you to the committee that we are adequately addressing the terview and hire a new ED. We have has been helping to form this program. needs of all the doctors in our district. engaged an executive search firm to ACMS continues to be a driving We continue to stand on the wall for assist us in this search. Rest assured force at both the Pennsylvania Medical you against what we believe to be an that the committee will do its due Society (PAMED) and the American intrusion on the doctor-patient rela- diligence to find the best person for the Medical Association (AMA). We have tionship, namely the threat of allowing job. a robust representation of ACMS nurse practitioners (NPs) to obtain an
422 www.acms.org President’s Message unrestricted medical license without We look forward to great things from but our mission remains the same. a collaborative agreement. Although you as you move on to a leadership We are here to provide advocacy and most of us work with and depend role in PAMED. You are a hard act for leadership to you and your patients. As upon our NP colleagues, we believe me to follow as Board chair next year! always, please feel free to reach out that granting an unrestricted medical Congratulations to Dr. Cicco as he pre- any time with any issues that you may license to these providers will serve to pares to take over as ACMS president. have. Thank you all for your support fractionate medical care, rather than It will be fun working with you next this year and have a very happy holi- creating a physician-led comprehen- year! We are blessed with an excep- day season. sive health care team that we strive for tionally active and engaged Board of to provide the best possible care for Directors who do a tremendous job Dr. Deitrick, outgoing president of our patients. We will continue the fight leading us through all the issues and ACMS, is an obstetrician/gynecologist in opposition to this bill. decisions that we face. Thanks to all and is on staff at Jefferson Hospital, AHN. He can be reached at ddeitrick@ Many challenges still await us, and of you for your time and dedication to acms.org. we are up to those challenges. Again, I organized medicine. want to thank Jack for his many years Finally, thank you to all the mem- The opinion expressed in this column of friendship and service to ACMS. I bers of the Allegheny County Medical is that of the writer and does not wish him well in retirement. Thank you Society. You are the reason that we necessarily reflect the opinion of the to the ACMS staff for the great job that are involved. We are here for you. The Editorial Board, the Bulletin, or the you do. Thanks to my friend, Dr. John. names of the leaders may change, Allegheny County Medical Society.
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BNY MELLON CENTER | 500 GRANT STREET | SUITE 2500 | PITTSBURGH, PA 15219 | 412.391.1334 Editorial ’Tis the season
Deval (Reshma) Paranjpe, MD, FACS Medical Editor
anukkah, Christmas and the New a high rate of suicide; for some, the in Uptown and Rainbow Kitchen (www. HYear are upon us suddenly. Per- depression and pain of being alone rainbowkitchen.org) in Homestead are haps you will spend these holidays with is simply too much. Be on the alert just a few local organizations in need of family, or with friends, or on a vacation for signs of depression and suicidal volunteers to prepare and serve meals far away from the grey and cold of behavior in your patients, and be ready leading up to the holidays – and every Pittsburgh. Perhaps you are looking with resources to offer. Sometimes all it day throughout the year. forward to the holiday season and pre- takes is knowing that one person cares 3. Collect/donate toys, and wrap paring happily; perhaps you are baking to save a life. Be that person. and distribute them to children in need. delights to have and share. Perhaps Here are some other things that The USMC’s Toys for Tots (toysfortots. you are frantically shopping and trying you can do to spread love and share org) program may be the best known of to think of gifts your loved ones will like. happiness (and if you are the one who these programs; there also are similar Perhaps you are resolved to actually is feeling down, these things can help programs such as The Human Ser- send holiday cards this year. Perhaps you feel better – giving to and helping vices Center Corporation (hscc-mvpc. you are in the throes of making a fruit- others proves that our existence is org), which serves the Mon Valley cake, against your better judgment. worthwhile and needed): Area, and Treasures for Children (Sal- Or perhaps you are dreading the 1. Donate food, funds and/or time to vation Army program). Lydia’s Place holidays. For many, the holidays can your local food bank. The Greater Pitts- distributes toys to children of incarcer- be full of strife, sadness, or pain. burgh Community Food Bank (www. ated parents. Family gatherings can be sources of pittsburghfoodbank.com) is a worth- 4. Give, collect, wrap and distribute conflict, anxiety, depression and fights, while charity, and monetary donations gifts for adults who need kindness. beyond the relatives one may not want may be more efficient than canned Presents for Patients (www.presents- to face. Some people may not want to goods as food banks may be able to forpatients.com) is a St. Barnabas go to gatherings so they don’t have to purchase twice the amount of food you charity; Light of Life distributes holi- answer questions about their personal can with the same funds via bulk rates. day gifts to homeless people. Or just lives. “When are you going to get mar- 412 Food Rescue (www.412foodres- choose someone you think could use ried? Have a baby? Retire?” Or face cue.org) also is a worthy cause, and some love and cheer, and supply it pity: “I’m so sorry about your divorce/ redirects good fresh food to families however you wish. bankruptcy/job loss.” Those who have in need when it otherwise might have 5. Take part or sponsor someone lost relatives during the year find it es- been tossed out. in a charity run, bikeathon, or other pecially painful to mark the first holiday 2. Serve meals to those in need. program. without their loved one. The Salvation Army (wpa.salvation- 6. Find other creative ways to give Our patients are going through army.org), Light of Life Ministries back by checking out Pittsburgh Cares the same emotions. Some are joyful; (www.lightoflife.org), the Jubilee Soup (www.pittsburghcares.org), a unique some are in pain. The holidays have Kitchen (www.jubileesoupkitchen.org) nonprofit which matches volunteers
424 www.acms.org WeWe willwill reducereduce youryour Editorial medicalmedical officeoffice andand supplysupply costs.costs. with opportunities throughout the community via other AlleghenyAllegheny nonprofits and charities. Volunteer assignments range from food pantry work to neighborhood beautification to We will reduce your assembling science kits to teaching art, dance and other 33 reasonsreasonsmedical office and educational activities. You can find a yearlong calendar on to consult the website which advertises available opportunities for MedcareMedcareto consultsupply costs. which you can volunteer. 7. Lastly, involve your children in these volunteer op- MikeMike GomberGomber portunities and instill in them both your love for your fellow forfor youryour medicalmedical supply supply needs needs humans and the good feeling that giving back brings. 3 reasons Involve your family, friends and loved ones; it’s hard to get 1 Mike isn’t just a “sales rep.” Mike in a fight with each other when slinging mashed potatoes 1 Mike isn’t just a “sales rep.”to Mike consult and gravy for appreciative strangers. isis aa professionalprofessional consultantconsultant withwith ’Tis the season for giving, and loving. Much love and anan MBAMBA andand 3030 yearsyears Mikeexperience experience Gomber joy to you and yours this holiday season. servingserving physicians.physicians. Savings,Savings, ServiceServicefor andand your Solutions!Solutions! medical supply needs Dr. Paranjpe is an ophthalmologist and medical editor 22 MikeMike willwill findfind thethe bestbest solution solution to to of the ACMS Bulletin. She can be reached at reshma_ youryour medicalmedical supplysupply1 Mike needs,needs, isn’t not justnot a “sales rep.” Mike [email protected]. justjust thethe “product“product ofofis thethe a month” professionalmonth” consultant with that others are pushing. The opinion expressed in this column is that of the writer “Thethat others best are solution pushing.an MBA toand your 30 years experience and does not necessarily reflect the opinion of the Editorial 3 AlleghenyMike Medicareserving is endorsed physicians. Board, the Bulletin, or the Allegheny County Medical Society. 3 Allegheny Medicare is endorsed by the Allegheny County Medical bymedical the Allegheny supply2 CountyMike will needs.”Medical find the best solution to Society—the only medical supply Society—the only yourmedical medical supply supply needs, not company that is! companyGomber that is! just the “product of the month” There are currently two openings that others are pushing. on the Bulletin Editorial Board for Michael L.3 Gomber,Allegheny MBA Medicare is endorsed AlleghenyMore than 30 Medcare years meeting ASSOCIATE EDITOR. Savings,Allegheny“The best solutionService to yourandMedcareby medical Solutions!the Allegheny supply needs.” County Medical The position requires an interest Savings, Servicephysicians’ andSociety—the needs Solutions! only medical supply (412) 580-7900 Michael L. Gomber,company MBA that is! and flair for writing and the Fax (724) 223-0959 willingness to contribute an More Michaelthan 30 years L. meeting Gomber, physicians’ MBA needs More 412.580.7900 Email:than 30 years michael.gomber Fax:meeting 724.223.0959 physicians’ needs editorial column of 500-900 words endorsed by E-mail:412.580.7900 [email protected] Fax: 724.223.0959 LLEGHENY @henryschein.com Aendorsed by COUNTY E-mail: [email protected] ALLEGHENY Allegheny Medcare twice per year. Associate editor MEDICAL SCOCIETYOUNTY terms are for two years; they may MEDICAL AlleghenySavings, Medcare Service and Solutions! SOCIETY Allegheny Medcare serve three consecutive terms. HenryAllegheny Schein, a Fortune Medcare 500 Company TogetherHenry Schein,Schein, to serve a a Fortune Fortuneto provide 500 500 Company a Company Michaelone-stop L. Gomber, MBA TogetherTogethersolution to serve for to allto provide provideyour needsa one-stop a one-stop Please email a short letter and a More than 30 years meeting physicians’ needs solution for for all all your your needs needs writing sample to Bulletin 412.580.7900 Fax: 724.223.0959 endorsed by E-mail: [email protected] Managing Editor Meagan Sable at ALLEGHENY COUNTY [email protected]. MEDICAL SOCIETY Allegheny Medcare Henry Schein, a Fortune 500 Company Together to serve to provide a one-stop ACMS Bulletin / December 2017 solution for 425all your needs Editorial ‘Thank you, sir, may I have another?’ Joseph C. Paviglianiti, MD Associate Editor
ell, it’s that time again: college make one look around for people with my own doctor (hope he’s not read- Wapplication season. Having grounding and perspective – those ing this) how I felt frustrated by my survived last year’s escapade with my who are steadfast in their beliefs, their lack of control over my career – that procrastinator son, we are deep in the ethics and their positive outlook. Those there were many forces outside of throes of college app essays with my who can look past the traumatic news my daily physician-patient interaction daughter this year. It’s actually a good blip of the day and fall back on their that caused me much anxiety: anxiety thing, since I can now bang the other faith and belief that the foundations about whether my group would be able side of my head against the wall, to of this nation are still strong, bedrock to continue to survive in private prac- match last year’s flat side. What struck strong, and can withstand any short- tice; anxiety about the inevitable, but me this year, though, was the range of lived discord. Perhaps what does not perhaps foolish onslaught of EHR and essay topics. Last year, essays ran the kill us makes us stronger? Indeed, our the health care dollars that EHRs suck gamut of what students thought they hope lies in the belief that Americans up. My doctor is one of those people could do to become more extraordinary will always fight to make the country who possesses not just knowledge, versions of themselves. It was a time, better and not succumb to those who but wisdom – someone I look to for a few months before the 2016 presi- would divide us and to not give up on hope and strength and perspective in dential elections, when Americans felt ourselves. the daily struggle that is being a physi- like change and opportunity were in the In the microcosm that is medicine, cian. He suggested that I stop com- air, when we held out hope of trying to we are faced with many of the same plaining and do something (“attend a better ourselves and better our nation struggles that our nation is facing, but PAMED annual meeting … and, most with a new course. on a different scale. Integrated medi- importantly, speak up!”). He made Well, much like Bible history can cine. EHR. Prior authorizations. Access some calls, and before I could say be divided into B.C. and A.D., college to care. The opioid crisis. Within our “procrastination,” I found myself at the app essay history can be divided into medical system, things are happening PAMED House of Delegates 2016. I B.T. and A.T. (before Trump and after now, on our watch, and it is up to us to expected to be my usual shy wallflow- Trump). This year, colleges are asking make sure that changes have the best er self, but that was not allowed. The point blank what my daughter’s plans interests of Americans in mind. We, ACMS delegates asked my opinion on are to “bridge the divisions that are as physicians, must lend our medical pretty much anything and everything developing between fellow Americans.” expertise to solving these health crises, (and I didn’t even know them). People The first paragraph of her main essay before others who lack training try to cared about me and my point of view. used words like “divisiveness,” “hate” do it for us. It was eye-opening to see how these and “loss of civility.” Not exactly a real I had the good fortune of attending physicians, some in corporate medi- pick-me-up and quite a change in my second Pennsylvania Medical cine, some in private practice, carved essay topics in one year. Society (PAMED) meeting in Hershey out positions on the many issues In these divisive times, it does in October. A year ago, I mentioned to facing us in medicine. What surprised
426 www.acms.org Editorial
me the most, though, was that I had maybe that is because I have yet to whether you are an official delegate, a voice, if only I had the courage to get involved personally. I pay my AMA there is opportunity to be heard and use it. This was strongly encouraged dues but wonder if they really accom- make real input into where our profes- by the other members of the ACMS plish anything. But, as they say, all pol- sion is going. Lend your expertise. Delegation, a very supportive group itics is local; thanks to the ACMS, I DO I am reminded of the movie “Animal of people I had never met before, but NOT feel powerless locally anymore. House,” where Kevin Bacon is pledg- now count as colleagues. Despite our I have been given the opportunity to ing a fraternity and during the hazing many situational differences in prac- get involved in the ACMS and PAMED scene, he bends over (while ominous tice, we were fighting for Allegheny and to have my local voice heard in secret society music is playing) and County medicine. For Pennsylvania the shaping of local policy that protects gets paddled by his fraternity brothers medicine. For our patients. Against the my patients, and equally important, (who are supposed to be his friends), forces (insurance companies, state my practice. I left my second PAMED while he repeats the mantra, “Thank and national government policies) that House of Delegates meeting feeling you, sir, may I have another?” Insur- might not have patients’ best interests the same as I left the first: that we had ance companies and big government in mind. In 2016, we inaugurated a accomplished real things to protect our are supposedly our friends, but mostly clinically integrated network, which patients and our profession on a real seem self-serving and clueless about was historic. We ratified legislation and local level. the real practice of real medicine on on reforming maintenance of certifi- We ALL have the opportunity to get real patients. Will we continue to bend cation (MOC). This year, we tackled involved in the ACMS and PAMED … over and get spanked into submission the quagmire of “prior authorization.” not just by paying our dues. There is by those who would divide us and P.S.: If you want to change the prior so much more that your organization make us powerless, or will we unite, authorization mess, look up HB 1293 needs and wants from you. They (we) find our voices, find our causes, stand and call your legislator and gently and need and want your ideas, your input, our ground and advocate for our pa- respectfully voice your opinion. your perspective and experience, and tients and for our profession? By default, if you are reading this your wisdom. article, you are likely already a member Two easy things that we can all do: Dr. Paviglianiti is a pediatric oph- of the ACMS, so I realize I am preach- 1. Invite a friend to join the ACMS. thalmologist and associate editor of the ing to the choir. Until recently, I was in 2. Make plans to attend the 2018 ACMS Bulletin. He can be reached at that choir … the voiceless choir where PAMED Annual Meeting in October [email protected]. only a few are really singing. I paid my 2018 in Hershey. Hershey is a great membership dues, but did not really town; your kids/grandkids will love the The opinion expressed in this column “sing;” I was inactive. I felt my voice Hershey Lodge (amazing pool!). It’s is that of the writer and does not didn’t matter. I felt powerless. only a half-day out of your clinic, since necessarily reflect the opinion of the To be honest, I still feel that way most of the meeting is on the weekend. Editorial Board, the Bulletin, or the Allegheny County Medical Society. about the larger entity of the AMA, but Be a part of the ACMS Delegation; Allegheny County Medical Society Leadership and Advocacy for Patients and Physicians
ACMS Bulletin / December 2017 427 Miller Time The cannabinoid conundrum Scott Miller, MD, MA, FAAHPM Associate Editor
am now one of approximately 150 see a concomitant decrease in their (such as pills, oils, or lotions). Addition- I physicians across the state of Penn- use of opiates, benzodiazepines and ally, the presence of endocannabinoid sylvania who has been registered antipsychotics. receptors (CB1 and CB2) throughout and certified as a medicinal cannabis Of course, as a physician, I under- the entire body are being isolated and participating physician. Once medicinal stood that recreational marijuana is not studied in great detail. Thus, there is cannabis is available, likely by summer a known single entity. Rather, each in- an explosion of information which is 2018, I will be able to do a thorough dividual batch of inhaled marijuana has very suggestive of a significant medical history and examination of a patient an undetermined amount of all of the benefit to the use of cannabinoids in who has already registered with the individual cannabinoids that are known treating chronic pain, nausea and an- state and who is interested in using to come from the plant (phytocannabi- orexia in end-of-life care, among many medicinal cannabis, and determine his noids). The two most commonly known other conditions that are not confined or her medical eligibility. If he or she are THC (tetrahydrocannabinol) and to the end of life. meets all the requirements, I am able CBD (cannabidiol). Most recreational In fact, in order to meet the state of to provide them a certificate which al- users are looking for the psychoactive Pennsylvania requirements, I had to lows them to then receive their medic- “high” that is provided by the THC take a very informative 4-hour course inal cannabis at their local dispensary, component. on the topic. It was available online, one of many such dispensaries that But less so my end-of-life patients, and the state offers you four differ- are spread out across the state and will who were looking for the improved ent options. My course started with soon be open for business. pain, improved nausea and improved a five-question pre-test followed by I am an end-of-life care hospice appetite that also were provided, most- seven video modules over 4 hours (you physician, and in my practice of this ly by the CBD components. do not have to start and finish on the specialty, I have encountered over the And over the course of my years same day) and then was followed by years a small number of dying pa- providing hospice care, clinical science a 25-question post-test which requires tients who swear by their recreational has intervened and has provided quite an 80 percent passing score to be- marijuana use. I have encouraged a bit of useful information and data. come officially qualified. I learned an these patients who use recreational The multitude of phytocannabinoids incredible amount of useful information, marijuana to be open about it with me, present in the marijuana plant are be- and because the use of marijuana in and I have thus anecdotally learned of ing isolated and studied, and the ratio a medicinal capacity is exploding, not its value, to each of them, in treating of the THC (psychoactive and medic- only across the United States but also such symptoms as nausea, chronic inal) component to the CBD (mostly across the world, I encourage all physi- pain and anorexia when “nothing else medicinal) can now be more precisely cians to take the course regardless of worked.” I have anecdotally seen these grown (Pennsylvania is in the process whether you are interested in actually patients describe “feeling much better” of doing just this), and then made providing patients with the means to and also have been able to objectively available in a non-smoking format obtain medicinal cannabinoids.
428 www.acms.org Miller Time
So, what’s the conundrum? There’s of which phytocannabinoid compounds 30 states, and recreational marijuana still a lot we don’t know, and we are and in what combinations are appro- use has been legalized in about 10 forging ahead anyway individual by priate for each patient or each medical states. In addition, Pennsylvania lists individual, while at the same time learn- disease. Mostly, patients with an appro- 17 medical conditions for which a ing, studying and researching as we go priate medical indication who have patient can register to be able to try along. This is not the typical manner failed traditional therapies are willing a medicinal marijuana product. Much in which medications are developed, to use these products in a kind of more information is available on the studied, researched and prescribed. trial-and-error process with the clinician Pennsylvania Medical Society website The first and most important problem is or pharmacist at the dispensing site. (www.pamedsoc.org). that marijuana is and remains classi- Other conundrums include an As I mentioned at the outset, the fied as a Schedule 1 narcotic for which uncertainty about the effects of life-long patients I care for who have success- there is no legitimate medical use. As use of this product when starting out at fully benefited from using recreational a result, physicians cannot actually a younger age, like for control of intrac- cannabis have motivated me to be- prescribe medicinal cannabis at this table seizures in a child or adolescent. come one of a handful of physicians so time in the same manner as all other Or how using medicinal cannabis with far to register and become certified. It prescription drugs. Rather, physicians high THC ratios might affect your job is time for physicians and other health only provide written certification that performance (think bus driver or pilot or care professionals to carefully evaluate a patient who has registered with the surgeon or any industry which regu- all the benefits and conundrums of this state and meets all the registration and lates the use of other substances like developing medicinal industry. eligibility requirements is now able to alcohol and opiates while on the job). receive a medicinal cannabis product Or how the use of the medicinal can- Dr. Miller, associate editor of the from their local dispensary. And be- nabis is impacted by the ongoing use ACMS Bulletin, is clinical associate cause of the same federal restrictions, of recreational marijuana in the same professor of medicine in the section the pharmaceutical industry and the patient. Or what hospitals and hospices of supportive and palliative care at insurance industry are not active play- are able to do if you are admitted while UPMC. He also serves as full-time ers in the process at this time. Patients using state-legally prescribed medicinal medical director of the inpatient hos- much obtain the product from the local cannabis which these same hospices pice facilities for Family Hospice. He state-licensed dispensary and not their and hospitals are barred from prescrib- can be reached at smiller@familyhos- pharmacy, and are all generally paying ing or allowing on site. pice.org or (412) 572-8800. cash. There is widespread acceptance A second conundrum is knowl- across the United States and the world The opinion expressed in this column edge-based. While there is some good that the dangers of marijuana have is that of the writer and does not evidence for the efficacy of medicinal been exaggerated and the benefits necessarily reflect the opinion of the cannabis, there is not really much undervalued and understudied. Me- Editorial Board, the Bulletin, or the exacting science yet about what dose dicinal marijuana is now legal in about Allegheny County Medical Society.
Retiring? ACMS Members: New Partner? New Address? Congratulatory Professional announcement advertisements message? are available to ACMS members at our lowest prices. Contact Meagan Sable, managing editor, at [email protected].
ACMS Bulletin / December 2017 429 Editorial Update: PAMED Board of Trustees Amelia A. ParÉ, MD, FACS Associate Editor
’m proud to serve as your local repre- sylvania when using Modifier 25 to bill insurance to physicians who are Isentative on the Pennsylvania Medical for Evaluation & Management (E&M) unable to obtain insurance from the Society (PAMED) Board of Trustees. services. private insurance market. Two bills Here is an update from a busy fall: PAMED sent a letter to IBC about were signed into law – House Bill (HB) possible inconsistencies with imple- 118 and HB 674 – that require the JUA House of Delegates mentation of this policy, which took to give the state $200 million from its Physicians from Allegheny County effect Aug. 1, 2017. To learn about holdings, or face abolishment Dec. 1. and across Pennsylvania attended our PAMED’s participation in a new nation- If the JUA is forced to close its annual meeting – which we call the al coalition to oppose reduced payment doors, the bills require the Pennsylva- House of Delegates – Oct. 14-15 in for E&M services billed with Modifier nia Department of Insurance to offer Hershey. To read a full recap of the res- 25, and how impacted practices can the medical professional liability insur- olutions, which included topics such as weigh in, visit http://bit.ly/2iNAqlv. ance that the JUA was responsible for informed consent and scope of practice providing. advocacy, visit http://bit.ly/2jeqZZ9. Nov. 2 PAMPAC fundraiser Prior authorization legislation in Coraopolis New leadership PAMED is advocating for legisla- On Nov. 2, PAMPAC members in We also welcomed new leadership tion that would streamline the prior the Pittsburgh area held a fundraiser at our House of Delegates. ACMS authorization process with insurance for Rep. Mark Mustio. Board Chair Lawrence John, MD, was companies. House Bill 1293 currently As chair of the House Professional elected vice president. resides in the House Insurance John Gallagher, MD (Sharon), was Licensing Committee, Rep. Mustio Committee, and PAMED is arranging elected Board chair, and F. Wilson wields great influence in the discus- meetings with physicians and Jackson, MD (Mechanicsburg), was sion of independent practice for nurse Representatives on that committee. elected Board vice chair. Theodore practitioners. He has been supportive Patient stories are critical to passing Christopher, MD (Philadelphia), of PAMED’s efforts to maintain the this legislation, so please encourage was sworn in as our 168th presi- physician-led team as the fundamental your patients impacted by prior autho- dent, and Danae Powers, MD (State unit for health care in Pennsylvania. rization to share their stories online College), became president-elect. Bills would take $200 million at http://bit.ly/2AsZQZN, or by calling PAMED’s Knowledge Center at (855) IBC Modifier 25 update from JUA 726-3348. PAMED has received patient PAMED continues to actively op- The Joint Underwriting Associa- stories from 19 different counties in pose Independence Blue Cross’ (IBC) tion (JUA) is an independent nonprofit Pennsylvania – many thanks to those policy change that reduces reimburse- created by the Commonwealth to who have already contributed to this ment to physicians in eastern Penn- provide medical professional liability effort!
430 www.acms.org Editorial
We will share these patient stories with lawmakers, and If you’re active on Facebook, Twitter, or LinkedIn, join a select few have been made into public videos. To watch, PAMED’s Social Media Ambassadors Program at http://bit. visit http://bit.ly/2AKmjUJ. ly/2ApqQve. You’ll receive email alerts every other Friday POLST legislation that include pre-packaged posts to share on your social network. One of PAMED’s 2017 legislative priorities recently took a step forward. Rep. Bryan Cutler introduced HB 1196 to Don’t forget to renew help patients with end-of-life care decisions. If you haven’t already done so, please visit http://bit. HB 1196 legally codifies Pennsylvania Orders for Life ly/2jMUG31 to renew your PAMED membership by Dec. Sustaining Treatment (POLST). You can find background 31. Please know that your dues dollars and continued input information on POLST and this legislation at http://bit.ly/2k- are vital to ensuring that physicians have a strong voice in kQmMg. Pennsylvania’s evolving health care system. Ways you can get engaged Nominate a deserving physician member for PAMED’s Dr. Paré is a plastic surgeon and associate editor of the new Everyday Hero Award. We will select one winner every ACMS Bulletin. She also serves as district trustee for the month starting in January. For more information, visit http:// PAMED House of Delegates. She can be reached at apa- bit.ly/2ApLPOL. [email protected].
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ACMS Bulletin / December 2017 431 PerspectivePerspective Opioid crisis: Historic perspective and current trends
William Simmons, MD
e think of “drug problems” as a market in China, and Levant, another Wmodern phenomenon. But, the British company, purchased nearly Physicians are in the best first reference to opium in the history of half of the opium coming out of Smyr- position to spend the time to the world was attributed to the Sume- na and Turkey strictly for import into communicate with patients rians in lower Mesopotamia, 3400 Europe and the United States. In 1839, B.C. Martin Booth’s book, “Opium: A China was being destroyed by opium. and make the right decisions History,” by Simon Schuster, Ltd., 1996 The Chinese commissioners tried to on adequate opioid and tracked down this first reference. The suppress opium traffic by ordering non-opioid pain coverage, Sumerians referred to the opium poppy foreign ships to surrender their opium. limiting excess availability as Hul Gil, the “joy plant.” They passed Because the British opium trade was and curbing the unintended along the plant and its euphoric effects government-controlled, the British sent to the Assyrians. Booth’s book tracked warships to the Coast of China, starting addictions. opium from the Assyrians to the Baby- the first of two Opium Wars (1839 and lonians and eventually to the Egyptians 1856) with China. Germany, found that diluting mor- in 1300 B.C. Nearly 1,000 years later, The Indian Journal of Anesthesia, phine with acetyls produces a drug Arab traders took opium from the Nov. 2016, in an article called “The diacetylmorphine and coins the name Egyptian field and first introduced it to Isolation of Morphine,” by Serturner, “heroin.” China in 400 A.D. describes how in 1803, Friedrich Britain was not the only government According to the book “Opium: The Serturner of Germany discovered the suspected of involvement in the drug Downfall of Imperial China,” copyright active ingredient of opium, dissolving it trade. A number of writers have alleged 1999, China was the home of sophis- in acid and neutralizing it with ammo- that the American Central Intelligence ticated culture and rich history. They nia. The result was a drug he initially Agency (CIA) was involved in drug had porcelain, silk, gunpowder and tea called morphium after the Greek god trafficking. The allegations include a production. Europe wanted products of dreams, Morpheus. This later was charter airline service called Air Ameri- from China, but China wanted nothing changed to morphine. An Anaesthesia ca transporting raw opium from Burma from Europe. In 1606, Queen Eliza- and Intensive Care, Feb. 2000, article and Laos during the Vietnam War and beth I chartered ships to purchase the entitled “Intravenous Equipment: The involvement with the South American finest Indian opium to transport back Beginning of Things” discusses Dr. Contra smuggling drugs during the to England. By 1750, British East India Alexander Wood of Endinburgh, who 1980s. Multiple federal investigations Company took over the opium-growing in 1855, published a new technique of acknowledge the trafficking, but fail to districts of India and Britain dominated administering morphine by injections conclude a link to the CIA. the opium trade out of Calcutta. Opium with a syringe. He finds the effects Throughout history, a repeating was only used for medicinal purposes instantaneous and three times more theme seems to clearly exist. Addiction in China. British East India Company potent. In 1895, Heinrich Dresser, in the rich or powerful was referred to cultivated a huge recreational opium working with the Bayer Company of as a health problem or sickness. Poor
432 www.acms.org PerspectivePerspective
and minorities were considered junkies forcement along America’s borders and cause of accidental death in the United and their addiction a crime. This arresting millions of nonviolent drug States, claiming 59,000 lives in 2016. pattern was never made more clear in offenders. Like the previous attempts at ASAM states 259 million prescriptions American history than in 1986, when alcohol prohibition, regardless of all the were written for opioids in 2012, which U.S. Congress passed a law that cre- money spent, drug use and distribution is enough for every American adult to ated a 100 to 1 sentencing disparity for has flourished among us. have their own bottle of pills. ASAM the trafficking or possession of crack Today, we see a different face on also states that 276,000 adolescents compared to penalties for trafficking the opioid crisis. The Kaiser Family were current nonmedical users of pain of powder cocaine. Persons convict- Foundation indicates non-Hispanic relievers, with 122,000 having an ad- ed in federal court of possession of whites make up more than 80 percent diction to prescription pain relievers. 5 grams of crack cocaine (generally of the overdose deaths in the United The declaration of a public health used by blacks) received a minimum States. Opioid use has changed in issue is not enough. Physicians are mandatory sentence of 5 years in other ways as well. From a December caught in a vicious pendulum. In the federal prison. On the other hand, 2016 manuscript, “White Paper: Opioid 80s and 90s, many articles were possession of 500 grams of powder Use, Misuse and Overdose in Women,” written about the problem of under cocaine (generally used by whites) overdose deaths from prescription prescribing acute pain medications, carried the same 5-year sentence. pain killers increased more than 400 particularly postoperatively. After Human Rights Watch showed a wide percent among women, compared to a massive pharmaceutical push to racial disparity in arrests, prosecutions, 237 percent among men. They went increase prescriptions and doctor sentencing and deaths. In the 1980s on to say heroin use increased 100 shopping by some patients, now we and 90s, African-American drug users percent among women and only 50 see the consequences of over-pre- made up 35 percent of drug arrests, 55 percent among men. The CDC states scribing. This crisis cannot be legislat- percent of convictions and 74 percent that women are more likely to have ed or administrated away. Physicians of the people sent to prison for drug chronic pain and use prescription drugs are in the best position to spend the possession crimes. Nationwide, African for longer periods and in larger doses time to communicate with patients and Americans were sent to state prisons than men. With this new face comes a make the right decisions on adequate for drug offenses 13 times more often new response. Instead of demonizing opioid and non-opioid pain coverage, than other races. substance use as criminal behavior like limiting excess availability and curbing In August 2010, President Obama they did in the 1980s during the crack the unintended addictions. signed the Fair Sentencing Act into law. epidemic, our nation now emphasizes The legislation dramatically reduced dignity, respect and treatment, not Dr. Simmons is associate professor, the 100 to 1 sentencing disparity be- incarceration and initiation of a public University of Pittsburgh School of Med- tween powder and crack cocaine. health crisis. icine, Department of Anesthesiology, It has been four decades since The difficulty of the current drug UPMC Presbyterian Shadyside Hospi- Richard Nixon declared the “war on crisis is that it involves illicit drugs (her- tal, immediate past president, Gate- drugs” in 1971. The United States has oin) and licit prescription pain relievers way Medical Society, Inc., and chair, the largest prison population in the (oxycodone, hydrocodone, codeine, Journey to Medicine Academic Men- world, with 2.3 million behind bars. morphine, Fentanyl and others). Of the torship Program. He can be reached at Human Rights Watch states that more 20.5 million Americans over the age of [email protected]. than half a million are incarcerated for 12, the American Society of Addiction a nonviolent drug law violation. More Medicine (ASAM) states that 2 million The opinion expressed in this column than $1 trillion has been spent on the have a substance use disorder involv- is that of the writer and does not “war on drugs,” fighting the drug gangs ing pain relievers and 591,000 have necessarily reflect the opinion of the in their home countries, marketing “Just a substance use disorder involving Editorial Board, the Bulletin, or the Allegheny County Medical Society. Say No” style messages with law en- heroin. Drug overdose is the leading
ACMS Bulletin / December 2017 433 COUNTYOF ALLEGHENY
Rich Fitzgerald County Executive
Dear Medical Providers, I am writing to you today to tell you about a service that will help you obtain home visiting services for women who are pregnant or recently delivered. Comprehensive home visiting services provide parents and caregivers with the necessary skills and tools to raise healthy children. Home visiting services have been heavily researched and have impacted critical outcomes: • increased use of prenatal care • increased pregnancy duration and birthweight • increased use of healthcare and community resources • improved maternal and family nutrition • improved growth and developmental outcomes. There are many free home-visiting programs in Allegheny County but it is difficult to figure out which is best for your patient.Allegheny Link to Home Visiting Services—1-866-730-2368—can help with this decision and connect your patients to home visiting services. Allegheny Link to Home Visiting Services is a collaboration of the Allegheny County Health Department (ACHD) and the Allegheny County Department of Human Services (DHS). It is a one-stop shop referral line for home visiting services in Allegheny County.It is designed to help patients who are looking for extra assistance or guidance throughout the parenting process. Callers will be helped to identify the best home visiting services for them by trained staff. Contact our offices today by phone (412-247-7950) or [email protected] ( ) to receive an Open Doors to Home Visiting toolkit, which includes the resources you will need to make a smooth and easy referral to Allegheny Link to Home Visiting Services. Families under your care may access the Allegheny Link to Home Visiting Services by calling 1-866-730-2368. We believe that the Allegheny Link to Home Visiting Services will Open Doors to home visiting services in our County. Sincerely,Sincerely,
Dr.Dr. KarenKaren HHackeracker
Karen Hacker, MD, MPH, Director Allegheny County Health Department Maternal & Child Health Program Hosanna House • 807 Wallace Avenue • 4th Floor Pittsburgh, PA 15221 Phone 412.247.7950 • fax: 412.247.7959 • www.achd.net
Open doors to . And specially-trained professionals. And privacy. And resources. These free, voluntary programs are available to everyone, starting from pregnancy through school age. Your link to home visiting: 866-730-2368 Contact the Allegheny County Health Department for a toolkit TODAY! Call (412) 247-7950 or email [email protected] SocietyPerspective News
PAGS-WD hosts fall program From left are The Pennsylvania Geriatrics Society Judith Black, MD, – Western Division (PAGS-WD) held MHA, PAGS-WD their annual fall program Nov. 9 at the secretary/treasur- University Club in Pittsburgh. More er; Toren Finkel, than 70 internists, family practitioners, MD, PhD, guest geriatricians, geriatric psychiatrists, presenter, and pharmacists, nurses, nursing home Fred Rubin, MD, administrators and social workers PAGS-WD attended the evening dinner program. president. The society gratefully acknowledges support for the program from Abbott Nutrition; AHN Healthcare@Home; naviHealth (a Cardinal company); Presbyterian SeniorCare Network; Optum; and Sanofi. The annual fall program, which began in 2003, has been a popular and well-respected program attracting dis- tinguished guest speakers, comprised of both national and local faculty. This year was no exception, as the Society welcomed Toren Finkel, MD, PhD, professor of medicine, University of Nadine Popovich / Pittsburgh School of Medicine; director, ACMS Aging Institute of UPMC Senior Ser- vices and the University of Pittsburgh. biological aging and, perhaps more tion in the Health Sciences. The confer- Dr. Finkel has made seminal contribu- importantly, potential interventions ence will be held April 5-7, 2018, at the tions to our understanding of aging, to delay aging and promote healthy Pittsburgh Marriott City Center. and his lab’s research focuses on the longevity. Dr. Finkel shared some of The fastest-growing segment of role of cellular metabolism and oxida- these advances, along with efforts to the population comprises individu- tive stress in aging and age-related move geroscience from the bench to als above the age of 85 years. The diseases. He is the author or co-author the clinic. purpose of the conference is to provide of more than 200 publications. Accord- an evidence-based approach to help ing to Google Scholar, Dr. Finkel ranks Dates set for 2018 Clinical th clinicians take exceptional care of as the 12 -most highly cited author in Update in Geriatric Medicine aging and the 11th-most cited in cardio- these often-frail individuals. Designed vascular disease. Planning is underway for the 26th by course directors Shuja Hassan, MD; Dr. Finkel presented “Geroscience annual Clinical Update in Geriatric Judith Black, MD; and Neil Resnick, and the Promise of Eternal Youth.” The Medicine conference, jointly provided MD, along with the PAGS-WD planning presentation focused on recent discov- by the PAGS-WD, UPMC/University of committee, this award-winning course eries in the field of geroscience, which Pittsburgh Institute on Aging, Univer- is designed for family practitioners, aims to explain biological mechanisms sity of Pittsburgh School of Nursing, internists, geriatricians and other health of aging and has provided insights and University of Pittsburgh School of care professionals who provide care to into molecular processes that underlie Medicine Center for Continuing Educa- older adults.
436 www.acms.org SocietyPerspective News
• Board Review for Clinicians training of learners in geriatrics and The dinner symposium, “Past, Pres- to the progress of geriatrics educa- ent and Future of Geriatrics,” will be tion across the health professions. presented by William Applegate, MD, Members and non-members of the MPH, MACP, editor of the Journal of Pennsylvania Geriatrics Society will be the AGS (JAGS), and former president considered. of the American College of Physicians, Eligible nominees will have demon- Speakers are dean and head of the Health System strated leadership and inspired learn- selected by a multi- at Wake Forest University, and prima- ers to better the care of older adults disciplinary committee ry investigator for the seminal SHEP and will have contributed to the growth of academic and study of systolic hypertension and the of geriatrics in their professions. practicing clinicians landmark SPRINT trial. Teaching expertise and/or education based on two criteria: Conference credits include AMA program development are valued in (1) expertise – nation- PRA Category 1 credits™, AAFP, the selection of the recipient for this ally recognized and Dr. Applegate Nursing, Risk and ACPE credits. honor. often responsible for Registration begins January 2018. Award eligibility and criteria, along advances relative to practice, and (2) In the interim, please contact Nadine with the nomination form, is available ability – to share it in a practical, suc- Popovich, administrator, at npopo- on the society’s website at www.pag- cinct and entertaining way to facilitate [email protected] or (412) 321-5030 for swd.org. Nominations must be received its easy incorporation into a practice. additional information. on or before Jan. 4, 2018. Questions Conference highlights include: Members of the PAGS-WD receive regarding the awards or nomination • “Year in Review,” covering high- a discount when registering for the process can be directed to Nadine lights of recent advances/controversies conference! To inquire about becoming Popovich, administrator, at npopovich@ • State-of-the-art updates on com- a member or current membership sta- acms.org or (412) 321-5030. mon geriatric conditions, and tailored tus, contact Ms. Popovich or visit www. Awardees will be recognized at the to each setting, i.e., office, hospital, pagswd.org. dinner symposium held in conjunction with the 2018 Clinical Update in Geri- home, nursing home. Geriatrics Teacher of the Year • Geriatric Cardiology Symposium atric Medicine scheduled for Thursday, on TAVR, heart failure, lipids and pul- Award: Call for nominations April 5, 2018, at the Pittsburgh Marriott monary hypertension. The Pennsylvania Geriatrics Society City Center. Recipients will be honored • Special topics: New approaches – Western Division (PAGS-WD) is with a plaque and receive compli- to chronic pain in the elderly; Practical seeking nominations for the Geriatrics mentary membership in the society for incorporation of the Beers list; the Teacher of the Year Award. The award one year. Geriatric ER; Geriatric Trauma Con- will be presented to two outstanding POS announces January, sultation; How to elicit goals of care; teachers for their dedication and com- Deprescribing; Case-based solutions to mitment to geriatrics education. February presenters difficult end-of-life issues The annual award will recognize Sharon Taylor, MD, president, is • Multiple breakout sessions al- and honor both a physician and a pleased to announce the guest faculty lowing attendees to design their own professional from another health care for the Jan. 11 and Feb. 1 meetings of course and affording close interactions discipline, including nursing, advanced the Pittsburgh Ophthalmology Society with experts on challenging topics and practice, physical therapy, pharmacy, (POS). real-world cases occupational therapy, dentistry, audiol- On Jan. 11, 2018, the POS will • Keynote talk on the “Biology of ogy, speech-language pathology and welcome Sunir J. Garg, MD, FACS, Aging” by an internationally renowned social work, who have made significant professor of ophthalmology of The authority. contributions to the education and Continued on Page 438
ACMS Bulletin / December 2017 437 SocietyPerspective News
From Page 437 Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa. He is a member of the Retina Society, Mac- ula Society, American Dr. Garg Uveitis Society and the American Society of Retina Specialists. His research interest is primarily in macular degeneration, diabetic retinopathy, uveitis and vitreoret- inal surgery. He has Dr. Chen reminded that 2018 membership dues for ophthalmic technicians, assistants, published more than invoices have been mailed. Kindly technologists, scribes and administra- 200 peer-reviewed and non-peer-re- submit your renewal on or before Jan. tive personnel, is currently underway. viewed papers, and is editor or co-ed- 11. If you are unsure of your member- Highlights for the 2018 conference itor of three textbooks. He is editor ship status, contact Nadine Popovich, include: Retinal Injections, Cataract in chief for Retina Times, the official administrator, at [email protected] Refractive Surgery, Periocular Tumors, publication of the American Society of or (412) 321-5030. Imaging Session, Inherited Retinal Retina Specialists. He has received an Diseases, HIPAA Security and Privacy, Invitation to non-members Achievement Award from the American MIPS/MACRA, Cybersecurity, Stress Academy of Ophthalmology and a of the POS Management, Efficient Patient Work- Senior Honor Award from the American The POS has notified ophthalmolo- up, Pleasing the Problematic Patient, Society of Retina Specialists. Thank gists who have never been a member Using Technology to Improve Efficiency you to Carl Zeiss Meditec and Genen- of the organization to invite them to an and Phone Etiquette. tech for support of this program. upcoming monthly meeting. A save the date postcard has been On Feb. 1, the POS will welcome To take advantage of this opportu- sent to previous attendees. Complete John J. Chen, MD, PhD, to Pittsburgh. information, including topics and Dr. Chen is a consultant, Department nity, please contact Nadine Popovich, speaker details, will be available on the of Ophthalmology, and assistant pro- administrator, at (412) 321-5030 or POS website, www.pghoph.org. Oph- fessor of ophthalmology and neurology [email protected]. thalmic personnel are asked to visit the at the Mayo Clinic, Rochester, Minn. 39th Annual Meeting for Dr. Chen’s presentations include: “Pap- POS website periodically for updates. Ophthalmic Personnel slated illedema and Intracranial Pressure” and Intel ISEF Pittsburgh seeking “Case Studies on the Use of OCT: Its The 39th Annual Meeting for Oph- Utility and Potential Artifacts.” Thank thalmic Personnel, presented by the judges and volunteers you to Regeneron and Spark Thera- POS, is scheduled for Friday, March The Intel International Science and peutics for support of the program. 23, 2018, at the Pittsburgh Marriott City Engineering Fair (ISEF), the world’s Registration for each meeting can Center. largest pre-college science competi- be found by visiting the POS website Planning for this well-respected tion, is returning to Pittsburgh in 2018 at www.pghoph.org. Members also are annual program, which is designed at the David L. Lawrence Convention
438 www.acms.org SocietyPerspective News
Heart Health Walk held
Photo provided ACMS member Terence Starz, MD, led a Heart Health Walk Nov. 1 at Cumberland Woods Village, Allison Park.
Center. This competition brings to- assignments. Judge training is avail- Don’t want to judge? Volunteer to gether 1,700 students in grades 9-12 able. Parking and all meals are provid- help. There are all kinds of jobs to do, from 75 countries, regions and territo- ed free. including being an interpreter in any of ries. These are the best and brightest Students consistently rank talking 20 languages. Go to: https://student. in the world, having won at local, with the judges as the high point of societyforscience.org/volunteers to regional, state and national fairs to get their experience. Judging also is a learn more. For more information, here. Twenty percent of competitors great opportunity to network with fellow email [email protected]. hold patents or published papers. judges – more than 1,000 profession- January program planned for We need your help! Approximately als from around the region and around 1,000 judges in 22 categories are the world. The students are our future physicians, practice managers needed, covering the whole of science leaders and workers for industry, uni- Joe Mull, MEd, will and engineering. Judges are required versities and research facilities – it’s an present “What Phy- to have a BA, BS or a master’s degree opportunity to meet your future stu- sicians & Managers with a minimum of six years related dents, colleagues and employees. You Must Do to Engage professional experience OR a PhD, also will advance STEM education, and & Inspire Healthcare MD, or equivalent. Senior-level grad- promote good will. Teams,” at 6 p.m. uate students also may qualify. If in Intel ISEF was held in Pittsburgh Wednesday, Feb. 7, doubt, apply, and credentials will be in 2012 and 2015, and was a huge 2018, at the ACMS Mr. Mull reviewed. Judges are expected to success. Join us to help make the 2018 building. be available from Tuesday afternoon fair even better. Visit https://student.so- Physicians and practice managers (register no later than 5 p.m.) May cietyforscience.org/grand-award-judges are encouraged to attend. For more 15 through Wednesday evening, May and click Apply to be a Grand Awards information or to register, visit http://bit. 16, 2018, to complete their judging Judge at Intel ISEF 2018 in Pittsburgh. ly/2y7UHUm, or call (412) 321-5030.
ACMS Bulletin / December 2017 439 AlliancePerspective News
Helping Hands auction bidding. The social side of Oc- Champagne Brunch PAMED ALLIANCE ANNUAL tober’s convention in Hershey included segment, while MEETING an inaugural dinner and reception for current President OCTOBER 14-15, 2017 Theodore A. Christopher, MD, FACEP, Kathleen J. Reshmi Hershey Lodge and Convention the 168th president of PAMED. A has conducted the Center, Hershey, Pa. lovely reception was held to welcome General Meeting, for PAMED Alliance co-presidents 2017- the business element Weekend happenings, Saturday 2018 Caryl Schmitz and Donna Baver of the ACMSA Decem- Mrs. Roarty and Sunday, Oct. 14-15, 2017, at Rovito. Of course, ACMSA expresses ber gathering. the Hershey Lodge and Convention congratulations and well wishes to the For seven consecutive years, Mrs. Center, Hershey, Pa. Meetings of incoming leaders in Harrisburg, and Rose Kunkel Roarty (event chair) the Pennsylvania Medical Society respectful thanks, with deepest appre- and Patty Barnett (co-chair) have (PAMED) House of Delegates were ciation to outgoing officers. assembled “Dream Team” committees held Saturday and Sunday. Topics on deserving of recognition, including Liz PAMED Alliance’s meeting agenda HIGHLIGHTING ALLIANCE Blume, Sandra Da Costa, Doris Delse- were national, state and county Alli- LEADERSHIP rone, Michel Franklin, Eileen Gerneth, ance membership, subject of Alliance (Part two of five) Dr. and Mrs. William Hetrick, Rose bylaws, and legislative issues. Fun in REVIEWING ACMSA’S HOLIDAY Kutsenkow, Lois Levy, Jo Martinez, fundraising was ongoing throughout CHAMPAGNE BRUNCH AND Nessa Mines, Joyce Orr, Gerry Orr, the convention weekend. This year, DECEMBER GENERAL MEETING Justina Purpura and Kathleen Jennings ACMS Alliance (ACMSA) made a di- Reshmi. This team works together rect monetary contribution in support of In the spirit of giving, it is appro- planning every detail for an early start the state alliance’s AMES Fund. Now priate to recognize the people and to the holiday season for our ACMSA in its 17th year, the PAMED Alliance elements of support through under- family! Medical Education Scholarship Fund writing by leadership and committee ACMSA leaders and committees (AMES Fund) has awarded more than members, as well as very generous always amaze with ever-fresh ideas, 141 scholarships totaling $344,500 gestures of support and participation hard work and communication in cre- in direct scholarship aid to medical via Alliance membership, family and ating the event, worthy of our time and school students enrolled in Pennsyl- friends in attendance, and/or mail- support. vania colleges and universities. The in contributions. The purpose of our A great amount of effort is required AMES Fund was established in the fundraising event is to enhance and for planning and execution of all of our year 2000. The late Letha Barber, MD, advance through scholarship aid the events. From club bookings and ar- ACMS Alliance president, 1997-98, current generation of doctors, soon to rangements for venues, menus, music and PAMED Alliance president, 1998- be entering the medical community. and décor, to invitations, post-event ac- 99, had a significant role as visionary Since early on in the new millenni- knowledgements and event proceeds with leadership skills in development of um, ACMS Alliance presidents Sandra check presentation to ACMS Founda- the AMES Fund. The very first schol- Da Costa, Irene Payan, Joyce Orr, tion. Contribution and/or solicitation of arships were awarded in 2003. ACMS Patty Barnett and Justina Purpura fundraising elements, such as table Alliance is proud indeed, to have have arranged our most memorable offerings of raffle baskets, gift cards, been, from the very start, a part of this festive holiday events with December’s fine wine selections, spa certificates, successful PAMED Alliance project, all General Meeting. original art work, sports memorabilia, the while fulfilling an important tenant Of particular note, from 2012 to tickets to performing art events – and, of our own mission pledging continuing present, it has been three-time Pres- Content and text by decades of monetary support as well ident Rose Kunkel Roarty, who has Kathleen Jennings Reshmi as donations of in-kind items for silent undertaken leadership of the Holiday
440 www.acms.org AlliancePerspective News
of course, the ever popular 50/50 Raffle are the VIP – all so very important part of the revenue-generating elements of the holiday celebration, as in fun in fundraising! Pro- ceeds will benefit scholarships by way of ACMS Foundation directed to the PAMED Foundation, for third-year medical students enrolled in colleges and universities in Allegheny County and the western Pennsylvania region. Each year, the Holiday Brunch program includes a warm, merrymaking chilled Champagne Welcome, an abbreviated ACMSA General Meeting, Entertainment and Thompson Award selection and presentation. The award element has Season’s Greetings its own procedural check list carried out by the Awards to Committee. Every bit of festive fun, friendship and family Allegheny County has been captured as together, we embrace the reason for Medical Society the season by way of camaraderie among us. Family, Friends and Colleagues Through the years, Rose Kunkel Roarty has offered extraordinary enthusiasm, vision in ways and means to bring WISHING YOU AND ALL OF YOURS people together in lovely social settings … all the while ben- A MOST MEANINGFUL AND efitting important causes as articulated in our Alliance mis- MEMORABLE HOLIDAY SEASON sion of partnership with Allegheny County Medical Society WITH THE VERY BEST OF HEALTH AND HAPPINESS projects in the interest of patient, physician and community. IN THE NEW YEAR Indeed, we are grateful! It was enchanting to share time and from place with each and all of our members, family, friends and Allegheny County Medical Society guests, to ring in the holidays! Alliance
InPerspective Memoriam
Joseph Francis Hakas, MD, 86, viding care for more than 3,000 patients. Danver (Drew); sons Joe Jr. (Sharon) died Thursday, November 16, 2017. Dr. Hakas was an active member of and David (Elizabeth); brother Ted Dr. Hakas graduated in medicine the Allegheny County Medical Society, (Judy) Hakas; niece Hope; grandchil- from the University of Pittsburgh Medi- serving on the Board of Directors, and dren Melanie, Maggie, David Jr., Adam, cal School and served an internship at a fellow in family practice. Dan, Abigail and Emma; and many Columbia Hospital. Deceased are his first wife, Edith nieces, nephews and extended family He established his family medicine Holt; and his second wife, Cynthia members. practice in Mt. Washington, working Kaufmann. Services were held Tuesday, through South Side Hospital and practic- Surviving are his third wife, Trudy November 21, 2017, at William Slater ing there for 30 years, at one point pro- Sebastian Cramer; daughter Arlene Funeral Service, Scott Township.
Allegheny County Medical Society www.acms.org
ACMS Bulletin / December 2017 441 Feature 2017 ACMSF award winners
Christina E. Morton Operation Walk ness and raise essential funds for the Pittsburgh is one of 14 organization. From events, both large ach year, the Allegheny Coun- teams in the United and small, to trip logistics and supply Ety Medical Society Foundation States. Along with two collection and coordination, the home (ACMSF) recognizes outstanding teams in Canada and team is an essential part of the success individuals and community organiza- one in Europe, they of each trip. provide life-changing Dr. DiGioia and Dr. Weiss are proud tions for the contributions they have Dr. DiGioia made to the health care needs of the education, service and to accept this award on behalf of the Pittsburgh community and beyond. surgery completely more than 300 Operation Walk volun- The 2017 ACMSF award winners will free of cost to patients teers who have donated their time both be honored at the ACMSF Celebration in need worldwide. at home and abroad. Their dedication of Excellence Awards Gala, Saturday, Since its inaugural trip and generosity have made so many Feb. 24, 2018, at Heinz Field. Come to Antigua, Guatema- life-changing surgeries possible. and celebrate Pittsburgh’s world- la, in 2009, Operation “An Operation Walk Pittsburgh trip is class medical community with your Walk Pittsburgh has among the most rewarding experiences colleagues, friends and family at this made eight interna- Dr. Weiss one can have as a medical profession- fun-filled event! tional mission trips, al. The teamwork between our travel traveling to Cuba, Guatemala, Panama team, the home team and the doctors, Physician Volunteer Award and Honduras, performing more than nurses and staff in the countries we Anthony M. DiGioia, III, MD, and 500 surgeries. A team of 50 to 70 vol- visit is truly a model for international Michael W. Weiss, MD, co-medical unteers including surgeons, anesthe- medical cooperation,” said Dr. DiGioia. directors of Operation Walk Pittsburgh, siologists, physical therapists, medical Dr. DiGioia earned his medical are the 2017 recipients of the ACMS technicians, nurses and enthusiastic degree from Harvard Medical School Physician Volunteer Award. The award family members are recruited to assist in 1986. He completed his residency in recognizes physicians for the donation during these missions which not only orthopaedic surgery at the University of of their time or talents for charitable, provide orthopaedic surgeries, but also Pittsburgh School of Medicine, followed clinical, educational or community aim to promote international medical by a fellowship at Massachusetts Gen- service activities, domestically or inter- cooperation. eral Hospital. Certified by the American nationally. The Pittsburgh Chapter of Opera- Board of Orthopaedic Surgery, Dr. Di- Dr. DiGioia formed Operation Walk tion Walk was one of the first teams to Gioia is the medical director of the Bone Pittsburgh, a local chapter of the perform no-cost hip and knee replace- and Joint Center at Magee-Womens national organization Operation Walk, ments for patients in need in the United Hospital of UPMC, where he specializes in 2008. Operation Walk is a private, States, which was a way for the team in total hip and knee replacement sur- nonprofit, volunteer medical service to give back to those close to home in gery. Dr. DiGioia lives in Pittsburgh with organization that provides free surgi- their own communities. his wife, Cathy. He is the father of three cal treatment for patients with arthritis The work to fundraise, recruit daughters, one of whom is currently or other debilitating bone and joint volunteers and collect supplies for in an orthopaedic residency program conditions, in developing countries, these mission trips occurs year-round. in Philadelphia. His family traveled on who would otherwise have no access The Operation Walk Pittsburgh home each Operation Walk Pittsburgh mission to orthopaedic care. team works tirelessly to spread aware- as humanitarian volunteers.
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“Each year, we find that the vol- accessible, low-cost curriculum to help unteers get just as much out of the people deal with stress by finding their experience as the patients and families own internal strength. It is remarkable.” in each of the countries that we serve. LEAD Pittsburgh’s cornerstone I never expected to feel so much love product, SCoRE® (Student Curriculum and happiness from those that we have on Resilience Education), is a digital been able to help and seeing the ap- program that helps develop resilience preciation and love on the faces of our a community health issue. skills by covering topics such as stress volunteers is amazing. We feel hon- LEAD Pittsburgh (Leading Edu- management, building positive support ored to do this work,” said Dr. Weiss. cation & Awareness for Depression), networks, self-care and goal setting. Dr. Weiss earned his medical founded in 2003 as a nonprofit organi- The program is designed to support degree from Rutgers Medical School zation, is a unique community initiative first-year college students and to help in 1979. He completed an internship at advocating for the recognition and high school seniors as they prepare for Pennsylvania Hospital, followed by a acceptance of depression as a treat- the transition to college. residency in orthopaedic surgery at the able medical condition and for the need With funding from Autism Speaks, University of Miami School of Medicine, to eliminate barriers to treatment. SCoRE was adapted and became serving as chief resident at Jackson LEAD helps to spread the message SCoRE Propel for students on the Memorial Hospital from 1983 to 1984. that there is no shame in struggling spectrum, those with social anxiety, Certified by the American Board of with mental health challenges, and and students with other developmental Orthopaedic Surgery, Dr. Weiss is a there is hope for a good life. Illness challenges. founding member of Tri Rivers Muscu- does not define an individual whether SCoRE’s most recent adaptation, loskeletal Centers, where he special- it is physical or emotional, and there is CoRE (Curriculum on Resilience Edu- izes in total hip and knee replacement much help available for those in need. cation), is a curriculum for adults in the surgery. Dr. Weiss lives in Wexford Sheila Fine is the principal founder workforce designed to help employees with his wife, Carol. He is the father of and board chair of LEAD Pittsburgh, consider their resilience factors, and two daughters. His daughter, Katie, is which evolved in response to her build skills to enhance not only their a nurse educator and is a proud team exploration of depression: its causes, own workplace experience but also leader for Operation Walk Pittsburgh. treatments and prevention. LEAD that of the clients they serve. LEAD The entire Operation Walk Pitts- Pittsburgh’s work amply illustrates how believes that resilience education in the burgh team is in the process of orga- progress toward the goal of supporting workplace will help employers with staff nizing their fourth mission to Antigua, those living with depression through retention, especially in environments of Guatemala, in summer 2018. For more education, advocacy for increased ac- high stress, frequent change, intense information, to get involved or learn cess to treatment, reduction of stigma, public/client contact and burn-out more about the work of Operation Walk and building resilience skills requires potential. CoRE also compliments Pittsburgh, please visit www.opera- community-wide involvement and courses and practicum experiences in tionwalkpgh.org. fundamental systemic changes. Social Work and Counselor Education graduate programs. Benjamin Rush Community “As impressive as their early results have been, what is most special about In addition to LEAD’s resilience Organization Award the LEAD Pittsburgh team is how they building programs, the organization’s LEAD Pittsburgh has been selected did it,” said Keith Kanel, MD. “A small community outreach includes monthly as the 2017 Benjamin Rush Communi- group of committed citizens saw a “Coffee & Connect” speaker events at ty Organization Award recipient. Estab- need and acted. They became experts area Starbucks locations. The speak- lished in 1947, the award recognizes in mental health, fundraising, com- er series aligns well with Starbucks’ a company, institution, organization or munication and project evaluation. At mission to bring people together, and agency that is successfully addressing the end of the day, LEAD created an Continued on Page 444
ACMS Bulletin / December 2017 443 Feature
From Page 443 medicine by one’s classmates. education, his clinical guidance has im- they are pleased to support LEAD in Following graduation, Dr. Blandino proved the health care of thousands of its mission to raise awareness and fulfilled an internship and residency in persons in Western Pennsylvania. He educate the community about mental family practice at Williamsport Hos- has a unique skill to effectively improve wellness topics. As part of its emphasis pital in Williamsport, Pa. In 1981, he health care in Western Pennsylvania began his clinical career at The Matilda through multiple avenues while always on prevention and early identification, Theiss Health Center, a community maintaining his sense of humor and LEAD recently partnered with local health center in the Terrace Village warmth, which makes David most teen producers to support the creation Housing Project Neighborhood in the deserving of this award.” of a TV show about youth and mental Hill District of Pittsburgh, and sub- Dr. Blandino has served on the health, and a follow-up townhall event sequently began a clinical teaching boards of many organizations including to keep the conversation going. career with the Shadyside Hospital Jefferson Regional Medical Center, LEAD Pittsburgh continues to be a Family Practice Residency. Later in Allegheny Valley Hospital, West Penn voice for those living with depression his career, he completed a master of Allegheny Health System, Gateway and is proud to support the community science degree at the University of Health Plan, Highmark Blue Cross Blue through its work. “My passion and hope Pittsburgh within the clinical research Shield (Highmark Inc.) and the more are for more individuals to know that training program in 2007. recently formed Highmark Health and they are not alone, and to reach out for As a family physician, Dr. Blandino the Allegheny Health Network. He has help to have healthier lives and thrive,” has been engaged in nearly all as- served as chairman of Corporate Gov- said Sheila Fine. “The mind and body pects of health care, including clinical ernance and Nominating Committee for work together and must be considered practice, clinical teaching, writing and both Highmark Health and Highmark, together for true health.” research, health care administration, Inc., and is chairman of the board of Nathaniel Bedford Primary clinical leadership and health care cor- the Allegheny Health Network. Care Award porate governance, while always main- Since leaving UPMC, Dr. Blandino taining a community health perspective. has worked as a staff physician at the David A. Blandino, Dr. Blandino has served as a clinical East Liberty Family Health Care Center MD, has been chosen associate professor at the University of (ELFHCC) since 2008. ELFHCC is a as the 2017 Nathaniel Pittsburgh, Department of Family Med- Federally Qualified Health Center with Bedford Primary Care icine since 1993. He also fulfilled many a faith-based mission, which now has Award recipient. Pre- leadership roles within the Shadyside/ four clinical sites. He has been a mem- sented by the ACMS UPMC Shadyside Family Practice ber of the Allegheny County Medical since 1975, the award Residency Program and the hospi- Society Committee on Primary Care Dr. Blandino recognizes a primary tal including program director for seven since 2008 and currently serves on the care physician for exemplary, compas- years and department chairman for 10. board of directors of the Pittsburgh Re- sionate, comprehensive and dedicated He also was the co-founder and medi- gional Health Initiative. In addition, he care of patients. cal director of Shadyside Family Health is a member of several professional so- Dr. Blandino graduated magna cum Center, P.C., the residency programs cieties including the Society of Teach- laude with honors in mathematics from faculty plan from 1996 to 2002. ers of Family Medicine and American the University of Pittsburgh in 1974. “During his 37-year clinical career, Academy of Family Physicians. He received his medical degree from David has demonstrated outstand- A member and elder of Friendship the University of Pittsburgh School of ing medical expertise and judgment, Community Presbyterian Church, Dr. Medicine in 1978 and was the recipient developing a devoted clientele,” said Blandino has chaired or served on of the Dr. Maud L. Menten Memorial Donald Middleton, MD, who nominat- several of its committees as well as its Prize, which is awarded to a senior ed Dr. Blandino for this recognition. session over the years. Dr. Blandino best qualified to advance the ideals of “Through medical student and resident and his wife, Barbara, reside in West
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Oakland, where they raised their three comes based on data member of the ABTS Cardiac Consul- children, Katharine Nienhuis, Jonathan from the Scientific tant Subcommittee. Dr. Magovern also Blandino and Elizabeth Blandino-Lo- Registry of Transplant is a reviewer for the Annals of Thoracic pez. They also are proud grandparents Recipients. Surgery and the Journal of Thoracic of Chapin and Zoe Nienhuis. “Dr. Magovern is and Cardiovascular Surgery. a renowned heart Ralph C. Wilde Leadership Recent recognition and/or awards re- surgeon with an ceived by Dr. Magovern include: “Best/ Dr. Magovern Award outstanding record of Top Doctor” by Pittsburgh Magazine George J. Magovern Jr., MD, pro- clinical, academic and administrative (2002-17), the American Heart Associ- fessor and system chairman, Depart- leadership,” said Srinivas Murali, MD, ation Peter A. Safer Pulse of Pittsburgh ment of Thoracic and Cardiovascular medical director, Allegheny Health Award (2015), and recent winner of the Surgery, Allegheny Health Network, is Network Cardiovascular Institute. Pittsburgh Business Times “Lifetime the 2017 Ralph C. Wilde Leadership “His vision and leadership have made Career Achievement Award” (2017), Award recipient. This award recog- AGH and the entire Allegheny Health honoring his commitment to quality nizes a physician who demonstrates Network one of the nation’s premier health care in the region and a career exceptional skill in their clinical care of cardiac programs.” filled with medical milestones. patients and dedication to the ideals of Dr. Magovern has served as the Dr. Magovern and his wife, Jamie, the medical profession as a teacher or surgical director of the McGinnis Car- reside in Sewickley. They have three profession leader. diovascular Institute at AGH since 2007 children, George Magovern III, Abigail Dr. Magovern was greatly inspired and is associate program director of and Anne. by his late father, who was a distin- Allegheny General Hospital’s Thoracic guished cardiac surgeon at Allegheny Surgery Residency Program. He is a Richard E. Deitrick Humanity General Hospital (AGH). Dr. Magovern professor of cardiothoracic surgery, in Medicine Award often shadowed his father and watched Drexel University College of Medicine. Jeanette E. South- him perform open-heart surgeries Dr. Magovern was behind the Paul, MD, Andrew from an observation area that left him implementation of AGH’s Open Heart W. Mathieson UPMC interested and excited about the field of Surgery Observation Program in 2008, professor and chair, cardiac surgery, leading him to follow in which has provided more than 10,000 Department of Family his father’s footsteps. middle, high school and vocational stu- Medicine, University Dr. Magovern graduated from the dents from around the tri-state area the University of Pittsburgh School of unique opportunity of watching a live of Pittsburgh School Dr. South-Paul Medicine in 1978 and secured a much open-heart surgery via an observation of Medicine, is the sought-after internship in surgery at the deck. The program has successfully 2017 Richard E. Deitrick Humanity in Johns Hopkins Hospital. The program encouraged young people to consider Medicine Award recipient. This award was pyramidal and of 20, he was one or reinforce their decision to pursue a honors a physician who has improved of only five chosen to finish the chief career in health care. the lives of patients by caring for them residency in 1985 with board eligibility In 2012, Dr. Magovern was appoint- with integrity, honesty, and respect of in general and cardiothoracic surgery. ed to the Board of Directors for the their human dignity, and serves as a Dr. Magovern joined AGH the same American Board of Thoracic Surgery role model for other physicians. year and launched the hospital’s heart (ABTS). Of note, he and his father, Dr. Dr. South-Paul is the first woman transplant program in 1987 and its left George J. Magovern Sr., are the only and the first African American to serve ventricular assist device program a father/son cardiac surgeons to serve as a permanent department chair of year later. Today, AGH’s heart trans- on the ABTS since its inception in the School of Medicine at the Univer- plant program is one of the country’s 1948. Additionally, he serves as a cer- sity of Pittsburgh, and one of a small best in patient care quality and out- tifying examiner for the ABTS and is a Continued on Page 446
ACMS Bulletin / December 2017 445 Feature
From Page 445 ty, contraception and more. Benjamin. She is an active member of number of African-American chairs “Dr. South-Paul has given the Browns Hill Bible Chapel and resides in in medical schools nationwide. She department the full-time leadership Munhall. it needed to develop more medical has dedicated her career to improving Executive Leadership Award community health and rectifying health students pursuing family practice,” said Mr. James Troup, care disparities in America, especially Lawrence John, MD, who nominated chief executive direc- those that affect people in poverty and Dr. South-Paul for this award. “Be- people of color, bettering health care cause of her high-profile role, she has tor, Pediatric Alliance, for all Americans in the process. been able to enlighten students to the is the recipient of the Dr. South-Paul earned a bachelor’s virtues of a career in family practice. 2017 Executive Lead- degree in medical technology from the Her passion and enthusiasm have ership Award, pre- shined through to lead many students sented to an individual University of Pennsylvania in 1975. Mr. Troup She attended the University of Pitts- into a career of family medicine.” who has demonstrat- burgh School of Medicine on an Army Beyond her family medicine in- ed exemplary leadership and advocacy scholarship and graduated in 1979. A terests, she also has an interest in for physicians, displaying administra- family practice residency at Eisenhow- socio-cultural issues in health care tive guidance and support to physi- er Army Medical Center in Ft. Gordon, and health care in special populations. cians to improve their ability to improve Ga., and a fellowship at the University She is a widely recognized speaker the lives and health of the people of of North Carolina, Chapel Hill, followed. and accomplished author on cultural our community. She served as a medical corps competence in medical education; the Mr. Troup has served as CEO of officer in the U.S. Army for 22 years, impact of race, ethnicity, and culture on Pediatric Alliance since 2008. It is the rising to the rank of colonel prior to her health; cultural diversity and academic largest physician-owned practice in retirement from the Army and her ap- medicine; and the development of Western Pennsylvania with 17 office pointment at the University of Pittsburgh minority faculty. locations and more than 60 providers. School of Medicine. While on the faculty A member of numerous professional Under Mr. Troup’s leadership, he has of the F. Edward Hébert School of Med- and scientific societies, Dr. South-Paul positioned Pediatric Alliance for future icine of the Uniformed Services Univer- is a former chair of the northeast region growth and development through a sity of the Health Sciences (USUHS) in minority affairs section of the Associa- refined strategic plan which includes Bethesda, Md., Dr. South-Paul served tion of American Medical Colleges. She practice development through organic as chair of the Department of Family is a diplomate of the American Board growth and acquisition, an investment Medicine, vice president of Minority of Family Medicine and a fellow of the in technology, collaborating with the Affairs and president of the Uniformed American Academy of Physicians. major health systems in the Pittsburgh Services Academy of Family Physicians. Dr. South-Paul is the recipient of area, a commitment to planning and She is widely recognized for her multiple honors and accolades, includ- executing on Quality Improvement, Hu- research in maternal-child health, espe- ing election into the National Academy man Resources and Finance initiatives, cially teen pregnancy. She created the of Medicine and the Gold Humanism and a persistent focus of maintaining Maikuru program through the depart- Society. She has been awarded both Pediatric Alliance’s independence. ment of family medicine at the Univer- the Uniformed Services University of Mr. Troup has motivated the physi- sity of Pittsburgh School of Medicine, the Health Sciences Distinguished cians of Pediatric Alliance to expand where she works with teen mothers to Service Medal and the American Acad- their role in the medical community develop the education and training they emy of Family Physicians Exemplary while maintaining their commitment to need to have careers that allow them Teaching Award. excellent primary care. He has helped to be productive and independent. She Dr. South-Paul is the wife of Michael the practice become a Certified Patient partners them with mentors and orga- Paul, MD, and the mother of two ac- Centered Medical Home and has led nizes classes on self-esteem, spirituali- tive-duty Army officers, Augustine and its clinical staff management team to
446 www.acms.org Feature ensure Pediatric Alliance attains the jamin Rush Individual the needs of body and soul. Working highest levels of Meaningful Use. Award recipient. Es- with Father Ryan has been one of the “I have been privileged to work with tablished in 1947, the greatest privileges of my career.” Mr. Troup as president of the board of award recognizes an Father Ryan has fulfilled many Pediatric Alliance for the last several individual who is not assignments within the Pittsburgh years,” said Jennifer R. Romero, MD. a physician, and who Catholic Diocese, including parochial “Mr. Troup has shown excellent leader- devotes time, skills or vicar at St. John Fisher in Churchill, Father Ryan ship, guidance and motivation for the resources to assisting parochial vicar at Annunciation on physicians of Pediatric Alliance.” others and contributes to the advance- Pittsburgh’s North Side, chaplain at Beyond his role within Pediatric ment of health care. Ohio Valley Hospital in Kennedy Town- Alliance, Mr. Troup launched Bi Con- Father Ryan received a BA in ship, and part-time vicar at St. John of sulting in 2011, which offers full-cycle philosophy from St. Vincent College in God Parish in McKees Rocks. implementation, project management, Latrobe in 1962 and an STB in the- He has served on several boards custom integration, and application and ology from St. Mary’s Seminary and in the City of Pittsburgh and Allegheny template development for all NextGen University in Baltimore, Md., in 1966. County, including the Family Support products across multiple practices and Father Ryan was ordained on May 14, Policy Board, SWPA Area Health Ed- specialties. 1966, by Bishop John Wright at St. ucation Center and Healthy Start, Inc. He is vice president of the Board of Paul Cathedral in Pittsburgh’s Oakland and was a member of the Allegheny Directors of the Bradley Center, and neighborhood. County Children’s Cabinet. At the local an advisory member on the Clinical Combining two ministries of parish level, Father Ryan regularly attends the Connect Board, which is Western and community for 42 years, Father meetings of the Stowe Township Com- Pennsylvania’s first Health Information Ryan served as the director of Focus missioners and the Sto-Rox School Exchange. He is an active member of on Renewal in McKees Rocks from District. Medical Group Management Associa- May 1975 until April 2012. Founded in He has received numerous awards, tion and PAeHealth Initiative and is a 1969, Focus on Renewal is a nonprofit including the Caritas Award from shareholder and board member of Fo- organization serving the poor and Catholic Charities of the Diocese of cusMD, which is an accountable care elderly. Pittsburgh, the Public Citizen of the business partner, providing expertise in The organization grew to include Year Award from the Pennsylvania reimbursement programs and medical the Sto-Rox Neighborhood Family Association of Social Workers, the office workflows. Health Center, food bank, early child- Community Hero Award from United Mr. Troup received master’s de- hood programs and adult education Cerebral Palsy of Pittsburgh, the 2005 grees from the University of Virginia programs, a public library, and the arts Carolyn Baxter Lifetime Achievement in management and information center named for Father Ryan. An Award from the Pennsylvania Forum technology, and from the University of apartment building for seniors, a credit for Primary Healthcare and the 2015 Pittsburgh in nonprofit management. union and the community health center Lifetime Achievement Award from the He completed post-graduate training were established as a response to the Pennsylvania Association of Communi- at Harvard University School of Public community’s needs. ty Health Centers. Health in health information technology. Father Ryan also was the director of Father Ryan continues to serve as Mr. Troup resides in Beaver Falls the Sto-Rox Family Health Center until the priest-in-residence of St. John of with his wife, Stephanie, daughter June 2017. God Parish. He celebrated his golden Lizzie and son Quinn. “When it comes to elevating the jubilee of priesthood on May 15, 2016. Benjamin Rush Individual health of a community, few have done it as completely as Father Ryan,” said Ms. Morton is a communications Award Keith Kanel, MD, who nominated Fa- consultant. She can be reached at Father Regis Ryan is the 2017 Ben- ther Ryan for this award. “He has met [email protected].
ACMS Bulletin / December 2017 447 Materia Medica Edaravone (Radicava®) for amyotrophic lateral sclerosis
Daniel Powell, PharmD that there is only a modest increase Airlie House diagnostic criteria. The in tracheostomy-free survival with no primary efficacy outcome was change myotrophic lateral sclerosis (ALS), reversal of neuronal degeneration4. in baseline ALS functional rating scale Acommonly known as Lou Gehrig’s There also is the dilemma of cost asso- (ALSFRS-R) from the initial 12-week disease, is a progressive neurodegen- ciated with riluzole. With the high price pre-observation period to the 24-week erative disease of the motor neurons of riluzole, is there a measurable net treatment period. The ALSFRS-R in the brain and spinal cord. In 1874, clinical benefit to the patient given the scores the patient’s ability to perform Jean-Martin Charcot first described the modest data supporting its use? Given the following tasks and functions: correlation between sclerotic descend- the current lack of therapies demon- speech, salivation, swallowing, hand- ing axons of the lateral spinal cord with strating efficacy, there is need for a writing, cutting food and handling associated muscular atrophy.1 Patients greater understanding of the epidemiol- utensils (with or without gastrostomy), typically present with either limb-on- ogy and pathophysiology of ALS to aid dressing and hygiene, turning in bed set disease or bulbar onset disease, in drug development. and adjusting bed clothes, walking, leading to aphasia, loss of ability to eat, The FDA recently approved edar- climbing stairs and breathing. This breathe and move. After symptom on- avone (Radicava®) as an orphan drug study, however, failed to demonstrate set, only 20 percent of patients survive for the treatment of ALS. The exact efficacy by producing a non-statistically 5 to 10 years.2 Negative prognostic mechanism of edaravone in unknown, significant change in ALSFRS-R score indicators include increased age of but is purported to act as a free radical of 0.65 points in the edaravone group onset, early respiratory dysfunction and and peroxynitrate scavenger pre- compared to placebo (95 percent CI: bulbar-onset disease. venting oxidative damage, potentially -0.09-2.19; p=0.411). Subgroup analy- There have been very few advanc- inhibiting ALS progression.5 Edara- sis showed that patients with “clinically es in the treatment of ALS, with most vone is given intravenously in cycles, definite” ALS trended toward increased therapy consisting of palliation and starting with 14 days of once-daily efficacy, however still non-statistically a focus on respiratory management edaravone followed by 14 days off. For significant. and nutrition. The only prior FDA-ap- subsequent cycles, patients will receive A post-hoc subgroup analysis was proved medication for ALS is riluzole once-daily edaravone for 10 out of 14 then performed by Koji, et al., in an (Rilutek®), an oral medication first days, followed by 14 days off. Edara- attempt to identify patients for future approved in 1995. Riluzole acts to vone is given as a flat dose of 60 mg, trials that could potentially benefit inhibit glutamate release, inactivates with no dose modifications for renal or the most from edaravone.7 They voltage-dependent sodium channels hepatic dysfunction. defined two new subpopulations: and interferes with intracellular activity Koji, et al., and the Edaravone efficacy-expected subpopulation following receptor binding.3 Riluzole’s ALS Study Group first conducted a (EESP) and greater-efficacy-expect- efficacy is controversial, with the 36-week, double-blind, parallel-group, ed (dpEESP2y). EESP consisted of original trial suggesting the slowing placebo-controlled trial examining the patients with FVC ≥80 percent and of progression of ALS and improved efficacy and safety of edaravone in ≥2 points for all item scores in the survival in patients with bulbar onset ALS patients.6 The trial consisted of ALSFRS-R scale. dpEESP2y con- ALS. A meta-analysis, however, shows 206 confirmed ALS patients meeting sisted of subpopulation within EESP
448 www.acms.org Materia Medica
having a diagnosis of “definite” or of patients in both groups receiving ALS patients meeting stringent defi- “probable” ALS. The primary end- dual therapy. There was a statistically nitions based on clinical trials. There point remained change in ALSFRS-R significant difference of 2.49 in least- also has been little to no overall surviv- during the 24-month treatment pe- squares mean difference in ALSFRS-R al benefit shown with edaravone, with riod. After re-analysis, there was a scores between patients receiving benefits only seen in functioning and statistically significant change of 2.2 edaravone versus placebo (95 percent quality of life. (p=0.036) and 3.01 (p=0.0270) points CI 0.66-3.98; p=0.0013). Patients There also are issues with logistics in ALSFRS-R score in the EESP and were then eligible to participate in an and benefit management. Edaravone dpEESP2y subgroups, respectively. open-label 24-week extension of the cycles can consist of 10-14 days of Clinical significance was not claimed same study, but there was no sta- infusions with an estimated cost of by this group; however, they con- tistical analysis or placebo group to ~$12,000 per cycle. As this is a recent cluded that a second phase III study actively compare, limiting the usability FDA approval, addition to third-party could potentially demonstrate edara- of the data.9 This initial expectation payer formularies could take time for vone’s efficacy utilizing the EESP and of edaravone was to inhibit neuronal approval, if it all. At this early stage, dpEESP2y definitions as inclusion degeneration secondary to oxidative clinicians must continually weigh clin- criteria. damage. This trial did not examine ical benefits versus risk and costs, to The post-hoc analysis led to a survival benefits, only functioning determine if edaravone is appropriate. second phase III trial performed by and quality of life. Further trials are Koji, et al., and the Edaravone ALS 19 necessary to establish if ALSFRS-R Dr. Powell is a PGY1 pharmacy Study Group.8 This was a double-blind, improvements correlate with slowing practice resident at Allegheny General parallel-group study using the EESP of disease progression and survival Hospital. At the time of this writing, definitions developed by the post- benefits. Dr. Powell was on clinical rotation in hoc subgroup analysis. The primary These edaravone trials culminated the Center for Pharmaceutical Care efficacy analysis included 134 Japa- with FDA orphan-drug approval in at Allegheny General Hospital. For nese patients with ALS between the May 2017. Although this is the first any questions concerning this article, ages of 20-75. The primary endpoint FDA-approved drug specifically for please contact Dr. Powell at the Allegh- was change in ALSFRS-R score from ALS since 1995, expectations of the eny Health Network, Allegheny General baseline to the end of cycle 6. Patients clinical benefits from edaravone must Hospital Center for Pharmaceutical also were able to receive concurrent be tempered. Efficacy has only been Care, Pittsburgh, Pa., (412) 359-3192 therapy with riluzole, with 91 percent proven in a small subpopulation of or [email protected].
References placebo controlledstudy of efficacy and safety of edara- 1. Taylor JP, Brown RH, Cleveland DW. Decoding ALS: From vone (MCI-186) in amyotrophic lateral sclerosis patients. Genes to Mechanism. Nature. 2016;539(7628):197-206. ALSFD.2014;15:610. 2. Kiernan, Matthew C et al. Amyotrophic lateral sclerosis. Lan- 7. Edaravone (MCI-186) ALS 16 Study Group. A post-hoc cet. 2011;377(9769):942 – 955. subgroup analysis of outcomes in the first phase III clinical study of 3. Bensimon G, Lacomblez L, Meininger V, et al. A Controlled edaravone (MCI-186) in amyotrophic lateral sclerosis. ALSFD 2017; Trial of Riluzole in Amyotrophic Lateral Sclerosis. N Engl J Med. 18 Suppl 1:11. 1994; 330:585-59. 8. Writing Group and Edaravone (MCI-186) ALS 19 Study 4. Miller RG1, Mitchell JD, Moore DH. Riluzole for amyotrophic Group. Safety and efficacy of edaravone in well-defined patients lateral sclerosis (ALS)/motor neuron disease (MND). Cochrane with amyotrophic lateral sclerosis: a randomized double-blind, place- Database Syst Rev. Mar 2012;(3):CD001447. bo-controlled trial. Lancet Neurol. 2017; 16:505. 5. Radicava (edaravone) [prescribing information]. Jersey City, 9. Writing Group and Edaravone (MCI-186) ALS 19 Study NJ: MT Pharma America Inc; May 2017. Group.Open-label 24-week extension study of edaravone (MCI-186) 6. K Abe et al. Confirmatory double-blind, parallel-group, in amyotrophic lateral sclerosis. ALSFD. 2017; 18 Suppl 1:55.
ACMS Bulletin / December 2017 449 Legal Report
Evolution of telehealth law
Michael A. Cassidy, Esq.
variety of telehealth bills have has launched numerous initiatives to pill mills had established a business Abeen introduced in the Pennsyl- expand telehealth. model based upon patient completion vania Legislature seeking to expand Medicare recognized telehealth of online questionnaires accompanied telehealth coverage by mandating coverage in the Balanced Budget Act by prescriptions from out-of-state either coverage or payment parity for of 1997 by allowing reimbursement for unlicensed physicians for these Medicaid and commercial insurance telehealth visits using only “real time” medications, which were then emailed coverage. Just this month, there also technology, except for a pilot program to either the patient or to a mail order was a federal proposal to relax Veter- in Alaska and Hawaii allowing “store pharmacy, regardless of the location ans Administration (VA) rules so that and forward” technology. Medicare of the patient. Some states or their physicians practicing with the VA could allowed reimbursement coverage for a medical boards, either through legisla- practice not only in any VA facility, limited number of patient encounters, tion or regulation, have begun requiring regardless of state license as they do primarily various office visits, provid- physicians to be licensed in the state in now, but also via telehealth at locations ed there was an adequately licensed which the telehealth patient is located. other than actual VA facilities, i.e., vet- practitioner at the originating site Most states had previously permitted erans’ homes. Medicare policy is ob- (where the patient was located) and a certain forms of telehealth by allowing viously determined by the Centers for physician at the distant site (where the physicians to diagnose and write pre- Medicare & Medicaid Services (CMS). telehealth care was being delivered), scriptions for existing patients or to act Although none of these proposals is far and the communication occurred with a as consultants with other physicians, enough along in the legislative process synchronous (i.e., real time) audio and without specifically requiring licensing to warrant specific analysis, I thought it visual communications methodology. within the state. would be helpful to review the concept Medicare has slowly but continuously of telehealth before reviewing specific expanded the number of allowable Telehealth expansion legislation as it develops. Current Procedural Terminology (CPT) Medicare telehealth coverage has codes. The current list of approved been expanded throughout the years. A Background information Medicare telehealth services appears brief but helpful explanation of covered The national focus on expanding on page 452. Medicare telehealth services is pro- telehealth first generated national Congress also enacted the Ryan vided in Medicare Learning Network, attention more than two decades ago Haight Act in 2008 to limit online publication: ICN 901705 November when both federal and state govern- pharmacies after the highly publicized 2016. ments first sought to protect patients death of Ryan Haight as the result of Concurrent with increasing state by restricting the online prescription an overdose following one of the “pill regulation concerns, the mobile app business and enforcing state physi- mill” prescriptions. Since dispensing of segment is relentlessly pursuing cian licensing laws. More recently, the prescription drugs has always re- opportunities to expand the telehealth omnipresent “mobile apps” generation quired a physician prescription, online business model by using apps that
450 www.acms.org Legal Report
allow “store and forward” communica- tions, through which a potential patient could leave their medical and payment information and a recorded audio Telemedicine is a and visual message in the store and forward system, which is now probably “the cloud.” The physician could then priority for PAMED respond with a prescription or an online Telemedicine is one of the Pennsylvania Medical Society’s (PAMED) ad- diagnosis. A number of national health vocacy priorities. If properly regulated, it has the potential to improve patient care telehealth models have devel- access to care. oped, i.e., Teladoc, Doctor on Demand Working in cooperation with the Hospital and Healthsystem Association (with Dr. Phil), Dermatologists OnCall, of Pennsylvania, PAMED has been supportive of legislation that would Virtual Doctor, etc. establish a statutory framework under which telemedicine could operate in In addition to the purveyors of Pennsylvania. telehealth, large third-party payers While telemedicine services are being offered every day throughout and large self-insured national com- the state, the process lacks important safeguards that only state law can panies are providing online telehealth provide. The bills, Senate Bill 780 and House Bill 1648, would establish a services to promote wellness, make statutory definition for telemedicine, mandate that telemedicine services are chronic care more accessible and reimbursed and would prohibit “audio only” services (video must be avail- improve access to care both at home able if either the patient or provider requests it). and while traveling, all with the hope Learn more about this and PAMED’s other advocacy priorities at www. that expansion of preventative services pamedsoc.org/Advocacy. will simultaneously improve health and reduce costs. 3. Expanding allowable technolo- the cost of care. Conversely, concerns State legislative responses gies from just the synchronous interac- that easier access to care would dras- Almost every state has responded tion with medical practitioners at both tically expand the volume of patient to telehealth concerns in a number of sites to more sophisticated store and visits without necessarily improving ways: forward technologies, with the intent of care; and that online care would not 1. Regulating physician licensing increasing accessibility. match the intensity and effectiveness by defining certain online connections 4. Mandating insurance coverage of face-to-face care also present con- as establishing a physician-patient parity, meaning that any visit covered cerns about increased costs. In fact, a relationship in the state of the patient’s in person should be covered via tele- July 2017 study entitled, “The Impact location, and thereby imposing both health. of E-Visits on Visit Frequencies and 5. Mandating payment parity, mean- licensing, malpractice and insurance Patient Health: Evidence from Primary ing uniform or at least comparable coverage concerns for physicians. Care,” authored by Hessam Bavafa, 2. Requiring telehealth companies payments for similar services. Lorin M. Hitt and Christian Terwiesch to treat the online interactions as legit- Third-party insurers have traditional- and published by the University of imate physician-patient relationships, ly acknowledged both the benefits and Wisconsin School of Business, finds which therefore applies the protections the risks of telehealth expansion. Early normally expected with such relation- access to care, efficient management as follows: “We find that e-visits trigger ships, i.e., the creation and preserva- of chronic care and enhanced wellness about 6 percent additional office visits, tion of medical records, protection of programs have always been recog- with mixed results on phone visits and identity and protected health informa- nized as methodologies to improve patient health.” tion (PHI), etc. patient health and possibly decrease Continued on Page 453
ACMS Bulletin / December 2017 451 Legal Report
CY 2017 Medicare Telehealth Services (cont.)
Service HCPCS/CPT Code This table provides the CY 2017 list of Medicare telehealth services. End-Stage Renal Disease (ESRD)-related services for home CPT code 90966 CY 2017 Medicare Telehealth Services dialysis per full month, for patients 20 years of age and older End-Stage Renal Disease (ESRD)-related services for CPT code 90967 Service HCPCS/CPT Code dialysis less than a full month of service, per day; for Telehealth consultations, emergency department or initial HCPCS codes G0425–G0427 patients younger than 2 years of age (effective for services inpatient furnished on and after January 1, 2017) Follow-up inpatient telehealth consultations furnished to HCPCS codes G0406–G0408 End-Stage Renal Disease (ESRD)-related services for CPT code 90968 EHQH¿FLDULHVLQKRVSLWDOVRU61)V dialysis less than a full month of service, per day; for patients 2-11 years of age (effective for services furnished 2I¿FHRURWKHURXWSDWLHQWYLVLWV CPT codes 99201–99215 on and after January 1, 2017) Subsequent hospital care services, with the limitation of CPT codes 99231–99233 End-Stage Renal Disease (ESRD)-related services for CPT code 90969 1 telehealth visit every 3 days dialysis less than a full month of service, per day; for Subsequent nursing facility care services, with the limitation CPT codes 99307–99310 patients 12-19 years of age (effective for services furnished of 1 telehealth visit every 30 days on and after January 1, 2017) Individual and group kidney disease education services HCPCS codes G0420 and End-Stage Renal Disease (ESRD)-related services for CPT code 90970 G0421 dialysis less than a full month of service, per day; for Individual and group diabetes self-management training HCPCS codes G0108 and patients 20 years of age and older (effective for services services, with a minimum of 1 hour of in-person instruction G0109 furnished on and after January 1, 2017) to be furnished in the initial year training period to ensure Individual and group medical nutrition therapy HCPCS code G0270 and CPT effective injection training codes 97802–97804 Individual and group health and behavior assessment and CPT codes 96150–96154 Neurobehavioral status examination CPT code 96116 intervention Smoking cessation services HCPCS codes G0436 and Individual psychotherapy CPT codes 90832–90834 and G0437 and CPT codes 99406 90836–90838 and 99407 Telehealth Pharmacologic Management HCPCS code G0459 Alcohol and/or substance (other than tobacco) abuse HCPCS codes G0396 and Psychiatric diagnostic interview examination CPT codes 90791 and 90792 structured assessment and intervention services G0397 End-Stage Renal Disease (ESRD)-related services CPT codes 90951, 90952, Annual alcohol misuse screening, 15 minutes HCPCS code G0442 included in the monthly capitation payment 90954, 90955, 90957, 90958, Brief face-to-face behavioral counseling for alcohol misuse, HCPCS code G0443 90960, and 90961 15 minutes End-Stage Renal Disease (ESRD)-related services for home CPT code 90963 Annual depression screening, 15 minutes HCPCS code G0444 dialysis per full month, for patients younger than 2 years High-intensity behavioral counseling to prevent sexually HCPCS code G0445 of age to include monitoring for the adequacy of nutrition, transmitted infection; face-to-face, individual, includes: assessment of growth and development, and counseling education, skills training and guidance on how to change of parents sexual behavior; performed semi-annually, 30 minutes End-Stage Renal Disease (ESRD)-related services for home CPT code 90964 Annual, face-to-face intensive behavioral therapy for HCPCS code G0446 dialysis per full month, for patients 2-11 years of age to cardiovascular disease, individual, 15 minutes include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents Face-to-face behavioral counseling for obesity, 15 minutes HCPCS code G0447 End-Stage Renal Disease (ESRD)-related services for home CPT code 90965 Transitional care management services with moderate CPT code 99495 dialysis per full month, for patients 12-19 years of age to medical decision complexity (face-to-face visit within include monitoring for the adequacy of nutrition, assessment 14 days of discharge) of growth and development, and counseling of parents CPT only copyright 2016 American Medical Association.
4 Telehealth Services CPT only copyright 2016 American Medical Association.
3 Telehealth Services
CY 2017 Medicare Telehealth Services (cont.) EHR Documentation, Service HCPCS/CPT Code Transitional care management services with high medical CPT code 99496 decision complexity (face-to-face visit within 7 days of Coding, and Billing discharge) Advance Care Planning, 30 minutes (effective for services CPT code 99497 furnished on and after January 1, 2017) Advance Care Planning, additional 30 minutes (effective CPT code 99498 for services furnished on and after January 1, 2017) Consulting Services Psychoanalysis CPT code 90845 Family psychotherapy (without the patient present) CPT code 90846 Family psychotherapy (conjoint psychotherapy) (with patient CPT code 90847 (Analysis, Training, and Audits) present) 3URORQJHGVHUYLFHLQWKHRI¿FHRURWKHURXWSDWLHQWVHWWLQJ CPT code 99354 requiring direct patient contact beyond the usual service; ¿UVWKRXU 3URORQJHGVHUYLFHLQWKHRI¿FHRURWKHURXWSDWLHQWVHWWLQJ CPT code 99355 Contact: John Fenner or requiring direct patient contact beyond the usual service; each additional 30 minutes Beth Ann Fleischmann, RN, BSN, CPC Prolonged service in the inpatient or observation setting CPT code 99356 UHTXLULQJXQLWÀRRUWLPHEH\RQGWKHXVXDOVHUYLFH ¿UVWKRXU (list separately in addition to code for inpatient evaluation and management service) Prolonged service in the inpatient or observation setting CPT code 99357 UHTXLULQJXQLWÀRRUWLPHEH\RQGWKHXVXDOVHUYLFH HDFK additional 30 minutes (list separately in addition to code for prolonged service) 3 Penn Center West Annual Wellness Visit, includes a personalized prevention HCPCS code G0438 SODQRIVHUYLFH 3336 ¿UVWYLVLW Pittsburgh, PA 15276 Annual Wellness Visit, includes a personalized prevention HCPCS code G0439 plan of service (PPPS) subsequent visit 412-788-8007 Telehealth Consultation, Critical Care, initial, physicians HCPCS code G0508 typically spend 60 minutes communicating with the patient [email protected] and providers via telehealth (effective for services furnished on and after January 1, 2017) [email protected] Telehealth Consultation, Critical Care, subsequent, HCPCS code G0509 physicians typically spend 50 minutes communicating with the patient and providers via telehealth (effective for services furnished on and after January 1, 2017)
For ESRD-related services, a physician, NP, PA, or CNS must furnish at least one “hands on” visit (not telehealth) each month to examine the vascular access site. specializing in health care
CPT only copyright 2016 American Medical Association. consulting since 1991
5 Telehealth Services Legal Report
From Page 451 concerns, such as confidentiality of and sary to deliver each. Conclusion access to medical records. The Pennsylvania Medical Society 2. Regulating mobile apps as is actively involved in the legislative Although telehealth has been medical devices to ensure safety and process regarding telehealth regula- around for almost 20 years now, and is efficacy. tion, as described in the accompanying garnering significant web-based provid- 3. Determining what types of physi- sidebar (page 451). er attention, its development is never- cian encounters can be reliably deliv- theless just nascent. The challenges in ered via telehealth from a perspective the near future will be: of effective treatment and patient Mr. Cassidy is a shareholder at 1. Defining the level of physi- safety. Tucker Arensberg and is chair of the cian-patient contact required to estab- 4. Establishing a reimbursement firm’s Healthcare Practice Group; he lish a physician-patient relationship value for telehealth services versus also serves as legal counsel to ACMS. which triggers licensing, malpractice physical encounter services when tak- He can be reached at (412) 594-5515 coverage and other patient protection ing into account the resources neces- or [email protected].
AdvertisingPerspective Index 2017 Bulletin Advertising Index: July-December
Accounting Legal Kline Keppel & Koryak PC...... (412) 281-1901 Beth Anne Jackson LLC...... (724) 941-1902 Fox Rothschild LLP...... (412) 391-1334 Billing/Claims/Collections Houston Harbaugh PC...... (412) 281-5060 Fenner Physician Billing...... (412) 788-8007 Tucker Arensberg PC...... (412) 566-1212 Fenner Consulting...... (412) 788-8007 Wilder Mahood McKinley & Oglesby...... (412) 261-4040 Clinical Medical Supplies/Equipment Allegheny Health Network...... (724) 933-1445 Allegheny Medcare...... (412) 580-7900 Louis Stokes Cleveland VA Med Center...... (877) 838-8262 Secured Med Waste...... (877) 861-8970 Medical Rehabilitation, Inc...... (412) 622-4314 The Skin Center MD...... (412) 429-1151 Miscellaneous UPMC Tri Rivers...... (866) 874-7483 AAMRO...... (800) 489-1839 Vujevich Dermatology Associates, PC...... (412) 429-2570 Allegheny County Health Department...... (412) 247-7950 Medical Opportunities...... (800) 479-1666 Financial Institutions Montaj Hong Kong Custom Tailors...... (412) 824-9565 PNC Bank...... (800) PNC-7908 Real Estate/Development Insurance Berkshire Hathaway: The Preferred Realty... (800) 860-SOLD Malachy Whalen & Company, Inc...... (412) 281-4050 Berkshire Hathaway: Julie Wolff Rost ...... (412) 521-5500 NORCAL Mutual...... (800) 445-1212
ACMS Bulletin / December 2017 453 EditorialPerspective Index
Volume 107 No. 7 July 2017 Pages 241-272 Volume 107 No. 8 August 2017 Pages 273-304 Volume 107 No. 9 September 2017 Pages 305-340 Volume 107 No. 10 October 2017 Pages 341-376 Volume 107 No. 11 November 2017 Pages 377-416 Volume 107 No. 12 December 2017 Pages 417-460
A J, K, L Self-care: From African-American cultural ACMS Alliance News ...... 253, 292, 320, Legal Report: necessity to milennial mental health 356, 392, 440 CSI: Your office – What to do when you get a movement ...... 314 Activities & Accolades ..... 254, 293, 357, 391 subpoena, CID, or search warrant ...... 262 William Simmons, MD B, C William H. Maruca, Esq. Pipelines: High school to college vs. high school Classifieds ...... 267, 458 Recent decision may change how physicians to incarceration – The dark side of zero-tolerance D, E obtain informed consent ...... 326 policies for African-Americans ...... 350 Editorial: Lauren Rulli, Esq. William Simmons, MD Follow the money ...... 246 Extending your reach: What can you delegate Life lessons from a millennial hospice Deval (Reshma) Paranjpe, MD, FACS to extenders? ...... 372 patient ...... 384 What will you get for your nickel? ...... 248 William H. Maruca, Esq. Keith R. Lagnese, MD, FACP, HMDC Gregory B. Patrick, MD, FACP, FCCP Evolution of telehealth law ...... 450 Opioid crisis: Historic perspective and Restaurant edition...... 278 Michael A. Cassidy, Esq. current trends ...... 432 Deval (Reshma) Paranjpe, MD, FACS Legal Summary: William Simmons, MD Update from the PAMED Board of Directors ...... 280 Beth Anne Jackson, Esq...... 298, 398 Poetry Corner ...... 338 Amelia A. Paré, MD, FACS Legislative Update ...... 388 Practice Management: Joe Mull, MEd Eclipse ...... 310 M Is your team drama from overstaffing?...... 300 Deval (Reshma) Paranjpe, MD, FACS Materia Medica: When maxed-out employees say: ‘Where’s my Ask your doctor if deprescribing medication is Immune checkpoint inhibitors: A revolution in raise!?’ ...... 396 right for you ...... 312 cancer treatment ...... 256 President’s Message: David J. Deitrick, DO Robert H. Howland, MD Karen Fancher, PharmD, BCOP Looking back; moving forward ...... 422 How can I help me today?...... 346 Lixisenatide (Adlyxin) ...... 265 Q, R Deval (Reshma) Paranjpe, MD, FACS Gina Ayers, PharmD Reportable Diseases ...... 302, 458 A new order? ...... 348 Sydney P. Springer, PharmD, BCPS S John Kokales, MD Reslizumab (Cinqair) ...... 294 Society News ...... 250, 290, 316, 352, Open-door policy ...... 382 Megan Carr, PharmD 386, 436 Deval (Reshma) Paranjpe, MD, FACS Anna Bodnar, PharmD, BCPS Special Report: ’Tis the season ...... 424 Extended-release injectable naltrexone: A Need to know: POLST ...... 268 Deval (Reshma) Paranjpe, MD, FACS proactive approach to alcohol use Rick Hoffmaster, MD ‘Thank you, sir, may I have another?’ ...... 426 disorders...... 322 ACMS Foundation awards grants to community Joseph C. Paviglianiti, MD Carlie Bodenschatz, PharmD candidate organizations ...... 270 Update: PAMED Board of Trustees ...... 430 Betrixaban (Bevyxxa): A new direct oral Study reveals air pollution contributes to Amelia A. Paré, MD, FACS anticoagulant...... 363 alarmingly high asthma rates in Clairton ..... 301 F Kurt W. Wolfgang, PharmD, BCCCP Jennifer Elliot, PharmD Feature: Lifitegrast (XiidraR) ...... 363 Albert Presto, PhD 2017 ACMSF award winners ...... 442 Neil Turco, PharmD Deborah Gentile, MD Christina E. Morton Nicholas Giruzzi, PharmD, BCPS Updates from ACHD ...... 329 G, H, I Edaravone (RadicavaR) for Amyotrophic Jennifer Fiddner, MPH In Memoriam: Lateral Sclerosis ...... 448 Kristen Mertz, MD, MPH Leonard A. Stept, MD ...... 254 Daniel Powell, PharmD Group aims to help independent doctors .... 332 John S. Kennerdell, MD ...... 319 Miller Time: Scott Miller, MD, MA, FAAHPM Quality Insights offers free Quality Payment Program John (Jack) Shirk Kennerdell: 1935-2017 – Just another day ...... 400 support to Pennsylvania practices ...... 334 Father of neuro-ophthalmology ...... 358 The cannabinoid conundrum ...... 428 2017 Nominating Committee report...... 336 Michael Kazim, MD N, O, P Environmental epigenics: A link between air ‘Into orbit’ from Natrona Heights ...... 360 Perspective: pollution and lung disease in children ...... 372 Joseph C. Maroon, MD Type II diabetes and the dietary Stephanie Lovinsky-Desir, MD, MS In memoriam: John S. Kennerdell, MD ...... 361 conundrum ...... 284 Update from the ACHD ...... 456 Thierry Verstraeten, MD William Simmons, MD Stephen Forest, MPH John F. Moyer Jr., MD ...... 390 The ‘R’s’ have it ...... 288 Kristen Mertz, MD, MPH Joseph Francis Hakas, MD ...... 441 Richard H. Daffner, MD, FACR David Nace, MD, MPH 7.5 x 9.75
Allegheny Health Network Welcomes Dolores Santamaria, MD Neurologist and Headache Specialist
Certifi ed by the American Board of Psychiatry and Neurology, Dr. Santamaria is the director of the Headache Center at Allegheny Health Network (AHN). She is certifi ed as a headache specialist by the United Council for Neurologic Subspecialties and is committed to providing patients with personalized and compassionate expertise through multifaceted treatments and care.
Dr. Santamaria began her medical education in Moscow, Russia, where she was born and raised, and went on to earn her medical degree from Santiago of Compostela University in Galicia, Spain. AHN Neuroscience Institute She completed her residency at Pennsylvania Allegheny Neurological Hospital, University of Pennsylvania Health System, and Thomas Jeff erson University Hospital, both Associates in Philadelphia, Pennsylvania. 4815 Liberty Ave. Suite 439 Dr. Santamaria is fl uent in Russian and Spanish. Pittsburgh, PA 15224 She has medical privileges at Allegheny General, 412-359-8850 Allegheny Valley, and West Penn hospitals.
Call to schedule an appointment.
As always, new patients are welcome. Most major insurance plans are accepted. AHN.org Special Report Update from the ACHD Disease surveillance update: Invasive pneumococcal disease in Allegheny County
Stephen Forest, MPH Kristen Mertz, MD, MPH David Nace, MD, MPH
nfection with Streptococcus pneumo- Iniae can cause serious illness and leads to more than 400,000 hospital- izations and more than 20,000 deaths annually in the United States.1 About 30 percent of adult community-ac- quired pneumonia is due to S. pneu- moniae with a case fatality rate of 5 to 7 percent.2 Pneumococci also cause invasive disease, including approxi- mately 5,000 cases of pneumococcal bacteremia without pneumonia each year with a case-fatality rate of about 20 percent but up to 60 percent among elderly patients.2 S. pneumoniae also cause more than 50 percent of all cases of bacterial meningitis in the United States with a case fatality rate of about 8 percent among children and 22 percent among adults.2 In 2014, the Advisory Committee for Immunization Practices (ACIP) recom- mended that both the 13-valent pneu- mococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal poly- saccharide vaccine (PPSV23) be given in series to adults aged ≥65 years.3 A dose of PCV13 should be given first Image 1 – Recommended intervals for sequential use of PCV13 and PPSV23 for immunocompetent adults aged ≥65 years – Advisory Committee on followed by a dose of PPSV23 at least 4 1 year later to immunocompetent adults Immunization Practices, United States aged ≥65 years.4 Image 1 provides guidance on the sequence and timing received PPSV23 in the past.4 but invasive pneumococcal disease, of the two vaccines, including situations In Allegheny County, pneumococcal primarily as bacteremia and meningitis, in which individuals may have already pneumonia is not a reportable condition, must be reported. From 2007 to 2016,
456 www.acms.org Special Report the Allegheny County Health Depart- Figure 1 ment (ACHD) investigated 493 cases of invasive pneumococcal disease (see Figure 1). There were 347 hospitaliza- tions (68.4 percent) and 36 deaths (7.3 percent). Only 53 (10.8 percent) cases had readily available documentation of immunization status at the time of reporting. Of the 441 (89.5 percent) specimens tested for drug resistance, the majority (94.6 percent) were not drug-resistant. Incidence increased with age and was highest for those aged 90 and older (see Figure 2). It should be noted that these data are likely an un- derestimate of invasive pneumococcal disease burden in Allegheny County due Figure 2 to underreporting. To reduce the incidence of pneu- mococcal disease in Allegheny County, ACHD encourages clinicians to follow ACIP immunization recommendations, especially for patients 65 years and old- er. Studies of pneumococcal vaccination have shown reduced clinical disease and reduced mortality, particularly among older adults and frail individuals.5
Mr. Forest and Dr. Mertz are on staff at ACHD. Dr. Nace is on staff at UPMC and the University of Pittsburgh. They can be reached at [email protected].
References November 17, 2017. the Advisory Committee on Immunization 1. Huang SS1, Johnson KM, Ray GT, 3. Tomczyk S, Bennett NM, Stoecker C, Practices (ACIP). MMWR 2015; 64 (No. Wroe P, Lieu TA, Moore MR, Zell ER, Linder Gierke R, Moore MR, Whitney CG, Hadler S, 34):944-947. JA, Grijalva CG, Metlay JP, Finkelstein JA. Pilishvili T. Use of 13-Valent Pneumococcal 5. Nace DA, Archibald-Pannone LR, Healthcare utilization and cost of pneumo- Conjugate Vaccine and 23-Valent Pneumo- Ashraf MS, Drinka PJ, Frentzel E, Gaur S, coccal disease in the United States. Vac- coccal Polysaccharide Vaccine Among Adults Mahajan D, Mehr DR, Mercer WC, Sloane cine 2011; 29(18):3398-412. doi: 10.1016/j. Aged ≥65 Years: Recommendations of the PD, Jump RLP. Pneumococcal vaccina- vaccine.2011.02.088. Epub 2011 Mar 11. Advisory Committee on Immunization Practic- tion guidance for nursing home residents: 2. Centers for Disease Control and es (ACIP). MMWR 2014; 63(37):822-825. Recommendations from AMDA’s Infection Prevention. Pneumococcal Disease: Clinical 4. Centers for Disease Control and Advisory Committee. J Am Med Dir Assoc Features. https://www.cdc.gov/pneumococ- Prevention. Intervals Between PCV13 and 2017; 18(2)99-104. PMID: 28126142 PMCID: cal/clinicians/clinical-features.html Accessed PPSV23 Vaccines: Recommendations of PMC5308482.
ACMS Bulletin / December 2017 457 Reportable Diseases Allegheny County Health Department Quarterly (Qt) Selected Reportable Diseases Disease* 2015 Qt 1-3 2016 Qt 1-3 2017 Qt 1-3** Campylobacteriosis 106 81 76 Cryptosporidiosis 21 23 19 Giardiasis 51 49 25 Guillain-Barre 6 4 5 Invasive Haemophilus influenzae 8 13 25 Hepatitis A 2 7 5 Acute Hepatitis B 6 2 11 Legionellosis 41 56 82 Listeriosis 4 1 3 Malaria 2 5 4 Meningococcal Invasive Disease 2 1 1 Pertussis 69 60 53 Salmonellosis 138 113 123 Shigellosis 89 36 10 Shiga-toxin producing E. coli 15 13 8 S. pneumoniae Invasive 35 40 36 West Nile Virus Infection 2 0 1 Zika Virus Infection 0 11 1
*Case classifications reflect definitions utilized by CDC Morbidity and Mortality Weekly Report. **These counts do not reflect official case counts, as current year numbers are not yet finalized. Inaccuracies in working case counts may be due to reporting/investigation lag.
NOTE: Disease reports may be filed electronically via PA-NEDSS. To register for PA-NEDSS, go to https://www.nedss.state.pa.us/ NEDSS. To report outbreaks or diseases reportable within 24 hours, please call the Health Department’s 24-hour telephone line, (412) 687-2243. For more complete surveillance information, see ACHD’s 10-year summary of reportable diseases: http://www.achd.net/epi/pubs/ pdf/2015_AC_Reportable_Diseases.pdf.
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