Allegheny County Medical Society
BulletinDecember 2016
2016 ACMSF award winners Update: Opioid leglislation Macranomics: Summary and timetable Care is Your Business, Change is Ours The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols, cost-management and revenue management.
Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues ranging from HIPAA compliance to medical staff and peer review matters.
Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet these challenges. And we know what is ahead.
hh-law.com
Business • Employment • Estates and Trusts • Health Care Litigation • Oil and Gas • Public Finance • Real Estate Allegheny County Medical Society
BulletinDecember 2016 / Vol. 106 No. 12 Articles Perspectives Departments
Feature ...... 452 Editorial ...... 434 Society News ...... 444 2016 ACMSF award winners And what have you learned? • Pittsburgh Ophthalmology Society Christina E. Morton Deval (Reshma) Paranjpe, MD, FACS • Pennsylvania Geriatrics Society – Western Division Materia Medica ...... 458 Editorial ...... 436 • Pittsburgh Urological Association Combination inhalers for COPD Review: 2016 House of Delegates • Elder and end-of-life care program Care is Your Business, Change is Ours Maria Kiraly, PharmD Amelia A. Paré, MD, FACS held 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, Legal Report ...... 460 Perspective ...... 440 ACMS Alliance News ...... 448 cost-management and revenue management. Macranomics: Summary and timetable Shadowing in population health: Michael A. Cassidy, Esq. Using technology and process to Activities & Accolades ...... 449 Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through improve food accessibility in vulnerable contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel. Materia Medica ...... 462 communities In Memoriam ...... 449 We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues Suvorexant (Belsomra) for insomnia Anthony M. DiGioia III, MD • John J. Guehl Jr., MD ranging from HIPAA compliance to medical staff and peer review matters. Nathan Lamberton, PharmD Molly H. O’Brien • John F. Delaney Jr., MD, PhD, MPH Nicole Payette, PharmD, BCPS Angela D. Devanney Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet Maria DiGioia Community Notes ...... 450 these challenges. And we know what is ahead. Legal Report ...... 464 Pennsylvania’s new opioid laws Perspective ...... 442 Reportable Diseases ...... 450 and how they impact physicians Physician’s ‘Compression Syndrome’ Lauren N. Rulli, Esq. Robert S. Whitman, MD Editorial Index ...... 468 Special Report ...... 466 Advertising Index ...... 470 International refugees have unique medical needs Kerry McGee, MD On the cover
So Close, Yet So Far by Alan H. Klein, MD hh-law.com Dr. Klein specializes Business • Employment • Estates and Trusts • Health Care in orthopaedic surgery. Litigation • Oil and Gas • Public Finance • Real Estate EDITORIAL/ADVERTISING OFFICES: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212; (412) 321-5030; fax (412) 321-5323. USPS #072920. PUBLISHER: Allegheny County Medical Society at above Affiliated with Pennsylvania Medical Society and American Medical Association Bulletin address. Medical Editor The Bulletin of the Allegheny 2016 PAMED DISTRICT TRUSTEE Deval (Reshma) Paranjpe County Medical Society welcomes Executive Committee 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, Lawrence R. John Donald B. Middleton Robert H. Howland editorials, or articles. Contributions President-elect Bylaws ([email protected]) are received with the understanding David J. Deitrick Robert C. Cicco John Kokales that they are not under simultaneous Vice President Finance [email protected] consideration by another publication. Robert C. Cicco David J. Deitrick Timothy Lesaca Issued the third Saturday of each Secretary Gala ([email protected]) month. Deadline for submission Adele L. Towers Patricia Bononi Scott Miller of copy is the SECOND Monday Treasurer Adele L. Towers ([email protected]) preceding publication date. Periodical William K. Johnjulio Nominating Amelia A. Paré postage paid at Pittsburgh, PA. Board Chair Matthew B. Straka ([email protected]) John P. Williams Bulletin of the Allegheny County Primary Care Gregory B. Patrick 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 2016 ([email protected]) any subject material submitted. David L. Blinn Robert W. Bragdon Managing Editor The opinions expressed in the Thomas B. Campbell Meagan K. Sable Editorials and other opinion pieces Douglas F. Clough ([email protected]) are those of the writer and do not necessarily reflect the official Todd M. Hertzberg ADMINISTRATIVE STAFF policy of the Allegheny County Barbara A. Kevish Executive Director Medical Society, the institution with Jason J. Lamb John G. Krah which the author is affiliated, or 2017 ([email protected]) the opinion of the Editorial Board. Peter G. Ellis Assistant to the Director Advertisements do not imply spon- David A. Logan Amy G. Stromberg ([email protected]) ACMS ALLIANCE sorship by or endorsement of the Jan W. Madison ACMS, except where noted. Matthew B. Straka Bookkeeper President Angela M. Stupi Susan L. Brown Kathleen Reshmi Publisher reserves the right to exclude 2018 ([email protected]) First Vice President any advertisement which in its opinion Patricia L. Bononi Director of Publications Patty Barnett does not conform to the standards of William F. Coppula Meagan K. Sable Second Vice President the publication. The acceptance of advertising in this publication in no Kevin O. Garrett ([email protected]) Joyce Orr way constitutes approval or endorse- Amelia A. Paré Assistant Executive Director, Recording Secretary ment of products or services by the Raymond E. Pontzer Director of Member Relations Justina Purpura James D. Ireland Corresponding Secretary Allegheny County Medical Society of ([email protected]) Doris Delserone any company or its products. PEER REVIEW BOARD Treasurer Subscriptions: $30 nonprofit organi- 2016 Membership Relations Manager Josephine Martinez zations; $40 ACMS advertisers; $50 John G. Guehl Nadine M. Popovich Assistant Treasurer others. Single copy, $5. Advertising Rajiv R. Varma ([email protected]) Sandra Da Costa rates and information sent upon 2017 request by calling (412) 321-5030 or Donald B. Middleton online at www.acms.org. Ralph Schmeltz 2018 Sharon L. Goldstein COPYRIGHT 2016: Bruce A. MacLeod ALLEGHENY COUNTY MEDICAL SOCIETY www.acms.org POSTMASTER—Send address changes to: Bulletin of the Allegheny County Medical Society, 713 Ridge Avenue, Pittsburgh, PA 15212. Leadership and Advocacy for Patients and Physicians ISSN: 0098-3772 q Allegheny County MediCAl SoCiety Leadership and Advocacy for Patients and Physicians ACMS selects vendors for quality and value. Contact our Endorsed Vendors for special pricing.
Banking, Financial Medical and Surgical Printing Services and Leasing Supplies and Professional Services Allegheny Medcare Announcements Medical Banking, Michael Gomber, 412.580.7900 Service for New Associates, Office VISA/MC Service michael.gomber@henryschein. Offices and Address Changes PNC Bank com Allegheny County Medical Brian Wozniak, 412.779.1692 Society [email protected] Life Insurance Susan Brown, 412.321.5030 [email protected] Malachy Whalen & Co. Group Insurance Malachy Whalen, 412.281.4050 Programs [email protected] Auto and Home Employee Benefits, Disability, Insurance Dental & Vision Telecommunications Liberty Mutual USI Affinity and IT solutions 412.859.6605 Bob Cagna, 412.851-5202 connecTel, Inc. www.libertymutual.com/acms [email protected] Scott McKinney, 412.315.6020, [email protected] Member Resources BMI Charts, Healthy Lifestyle Professional Liability Posters, Where-to-Turn cards Insurance Allegheny County Medical NORCAL Mutual What does Society Laurie Bush, 800-445-1212, 412.321.5030 ext. 5558; lbush@norcal-group. ACMS [email protected] com membership do for me? Editorial And what have you learned? Rick: “Who are you really, and what were you before? What did you do and Deval I like this question. what did you think, huh?” (Reshma) I’ve started applying it to Ilsa: “We said no questions...” Paranjpe, situations in my own life, – Casablanca, 1942 MD, FACS good and bad. And I’ve lsa decided to be a Woman of Mys- found that it helps to make tery; imagine if she had actually we have to dig through layers of spin sense of confusing and I to get to any hard truths. And even answered Rick’s questions in Paris distressing events as well then, we have to admit that we may not and the truths he learned had colored as affirming and accepting his actions afterwards. The movie that really know the truth. Does anyone? we know and love might have had a I have a good friend whose tagline good ones. completely different ending, and Rick stays with me even when she is not might have been spared all manner of around. That tagline, which can be ing events as well as affirming and heartbreak and anguish, but his soul applied in so many situations, is: “And accepting good ones. The question might not have learned the lessons that what have you learned?” helps to process the news you see and it needed to learn. This simple question forces you read, as well as people’s reactions. 2016 has been a crazy, unusual, to analyze and reflect on whatever What a simple way to make sense of wild year full of the unexpected for experience you have just had, and the year and analyze what you actually many of us. Who thought in January distill that wisdom into concrete plans, know and don’t know! that Donald Trump had a chance of often without realizing what you have Examples, you say? Gladly. winning the Republican nomination, just done. If you see a story on the news let alone of becoming president? The She usually applies the line to her that is debunked later, what have you news has been filled with all sorts of son, when he returns from a fact-find- learned? Chances are: disturbing events on the world stage as ing mission about the price of ice • Not to believe everything you see well as domestically: violence, blood- cream at the concession stand, or what at face value shed, intolerance and a breakdown of time the pool closes, or who will be • To investigate for yourself civil discourse in general. The news speaking at a lecture. The same ques- • That news outlets may have their itself is delivered by personalities who tion is asked of this boy when he re- own agendas or at least are fallible yell at each other and at us. No matter turns from school, or a special lecture, If you took the back roads rather its medium, the news is mostly blatant or a field trip, or a tennis lesson. Now a than the highway to work and arrived commentary and editorializing rather teenager, he sometimes pre-emptively faster, what have you learned? Chanc- than even pretending to be straight volunteers the answer on his return: es are: facts delivered without judgment. We “So what I learned from all this was ...” • To take the back roads more often wonder what to believe at all. Before This makes her smile, because she If you are overwhelmed by MIPS the journalistic revolutions involving knows he is already processing the and MACRA, what have you learned? Vietnam and Watergate, how many of situation while he’s on the way home. Chances are: the “straight facts” that were dispas- Though I’m not a teenage boy, I like • To become informed sionately reported to us were actually this question. I’ve started applying it • To persevere factual and complete? Perhaps it is a to situations in my own life, good and • To try and change things, and be blessing that so-called journalists have bad. And I’ve found that it helps to proactive dropped any pretense and we know make sense of confusing and distress- If you have lost someone this year, I
434 Bulletin / December 2016 Editorial am sorry for your loss. What have you learned? Chances are: • To hold your loved ones closer • That life is fragile • To not take anything for granted The Hindus and Buddhists believe that our souls are trapped in an endless karmic cycle of birth and death, and that we advance toward freedom with every lesson our soul learns and absorbs. Breaking the cycle is the ultimate goal with nirvana as the reward. The cosmic taskmaster continually asks our unconscious: “And what have you learned?” with every life lived. Each new life is a chance to prove you’ve absorbed the lessons from the past life, learn something new, and move forward. It’s a giant game of chutes and ladders. So is our current life. Each new day is a new chance to move forward within this life, whatever your belief system may be. If Ilsa had answered Rick’s questions, he would never have learned to put the greater good first, and his soul would not have learned the lessons of sacrifice, vul- nerability and true love. Only by living through joy and loss and finding out the answers himself did he evolve. We are all on a quest for answers. As the year draws to a close and a new chance begins, I ask you to ask yourself: “And what have you learned?” Here’s looking at you, kid.
Dr. Paranjpe is an ophthalmologist and medical editor of the ACMS Bulletin. She can be reached at reshma_ [email protected].
The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.
For advertising information, contact Bulletin Managing Editor Meagan Sable at [email protected] Ruby Marcocelli or (412) 321-5030, ext. 105.
Bulletin / December 2016 435 ExecutivEditoriale Committee Review: 2016 House of Delegates he 2016 House of Delegates (HOD) Carignan, MD, brought a resolution to Tmeeting saw unprecedented com- Amelia look at other ways of board certifica- mitment to the future of Pennsylvania tion. PAMED adopted specific criteria arÉ medicine. However, this was merely A. P , for recertification, and these are posted one aspect of the meeting; the opiate MD, FACS on the reports from the HOD. This step crisis, maintenance of certification opposes MOC as criteria for hospital (MOC), the Foundation of the Pennsyl- recredentialing, and opposes MOC for as a medical service organization. vania Medical Society (PAMED), the participation in insurance panels and Deloitte performed a review last Pennsylvania Medical Political Action as criteria for licensure. There is no spring and presented their results to Committee (PAMPAC) and the Ameri- doubt that physicians want to provide the PAMED Board; the results then can Medical Association (AMA) del- quality care and participate in CME, but were presented to the HOD. More than egation all were topics of discussion. the current MOC process with specific 75 percent of the HOD approved of Election results revealed that PAMED Boards has questionable value. The the plan, and Deloitte will proceed with will have its fourth female president, HOD and the Board will continue to identifying the proper vendors. There anesthesiologist Danae Powers, MD, will be a buy-in per physician to partic- work with all stakeholders to create from the rural caucus. ipate. Physicians may benefit by econ- a physician-friendly and quality care During board meetings and Continu- omy of scale. It will begin in the Lehigh model by updating our current system ing Medical Education (CME) lectures, Valley region and will adapt to the dif- of MOC. managing patients with chronic pain ferent medical landscapes across the The PAMPAC Board met to discuss and use of the opiate data bank were state. This integrated network would be creation of a Physician’s Grassroots discussed. an alternative for physicians who may network. The benefits would include Numerous informational sessions be overwhelmed with the increasing the opportunity to meet with local were held to inform the delegates on mandates but benefit by sharing costs. legislators and build personal relation- the creation of a physician-led ap- The first step would be data aggre- ships with them. Moreover, PAMPAC proach to alternative payment models gation for MACRA. PAMED is willing would have quarterly teleconferences (APMs) and value-based care. Past to explore other payment models that with key legislators at the state and PAMED presidents Bruce MacLeod, may improve physician well-being and federal levels. PAMPAC will continue MD, and Ralph Schmeltz, MD, have provide better patient care. The Board to update the PAMPAC PULSE, a been early leaders in the formation of will be advised about progress, and bimonthly electronic newsletter detail- APMs for Pennsylvania physicians. any progress will be published in each ing political news that is important to PAMED immediate past president and Board report. Pennsylvania physicians and partici- entrepreneur Scott Shapiro, MD, has After a presentation by PAMED Vice pate in coalitions for PAMPAC-support- made this a hallmark of his last year. President Charles Cutler, MD, the AMA ed candidates. As a cardiologist in Philadelphia, his issued a statement of no confidence in On April 17, 2016, Act 16 was company manages more than 300 the American Board of Internal Medi- signed by Gov. Wolf, authorizing cardiologists, and they benefit from cine (ABIM) and presented AMA policy marijuana for medical use. To obtain shared cost and now are preparing for that requires criteria for MOC. First, marijuana for medical use from a the Medicare Access and CHIP Reau- there was a recommendation to end Department of Health (DOH)-licensed thorization Act (MACRA). Pennsylvania mandatory recertification exams and dispensary, the individual must submit physicians may now benefit from a a commitment to work with the Board a DOH-certificated form from a DOH Clinically Integrated Network (CIN) to support CME and ongoing quality registered physician. The patient must data collection/reporting service as well assessment. ACMS delegate Colleen have one of 17 serious medical con-
436 Bulletin / December 2016 We will reduce your Editorial medical office and supply costs. ditions defined by Act 16. The patient must have a valid identification card issued by the DOH. The DOH esti- Allegheny mates that it will take 18 to 24 months to fully implement We will reduce your this legislation. 3 reasons Another bill, SB 717, that would allow certified regis- medical office and tered nurse practitioners (CRNPs) to work independently to consultsupply costs. of a physician was supported by local senators despite Medcare physicians’ calls for a physician-led team. Only Sen. Randy Vulakovich voted against the bill and to support Mike Gomber physicians. Addressing the misleading claims made by for your medical supply needs proponents of SB 717: Collaborative agreements are a 3 reasons safe way of assuring that all patients have a physician Mike isn’t just a “sales rep.” Mike involved in their care. This ensures that a physician is 1 is a professional consultantto withconsult available with a predetermined plan for emergency ser- vices. Moreover, most CRNPs are employed by a hospital an MBA and 30 yearsMike experience Gomber serving physicians. or health system and therefore the cost of the collabora- Savings, Servicefor and your Solutions! medical supply needs tive agreement is zero. The often-cited 2015 study conducted by Duke Uni- 2 Mike will find the best solution to versity was advised by the Council Economic Institute, your medical supply1 Mike needs, isn’t justnot a “sales rep.” Mike whose advisory role was funded by the Pennsylvania just the “product ofis the a professionalmonth” consultant with Coalition of Nurse Practitioners. It was never published, that others are pushing.an MBA and 30 years experience peer reviewed or endorsed by Duke University. Eliminat- “The best solutionserving physicians. to your ing collaborative agreements would not increase access 3 Allegheny Medicare is endorsed to care, as CRNPs settle in the same areas as physicians by the Allegheny CountyMike will Medical find the best solution to do. medical supply2 needs.” The number of collaborative CRNPs has increased Society—the only yourmedical medical supply supply needs, not by 44 percent between 2008 and 2015. Physician over- company that is! just the “product of the month” sight in Pennsylvania is similar to that in 28 other states, that others are pushing. and many other have far more restrictive laws. While Michael L. Gomber, MBA Allegheny Medicare is endorsed CRNPs are integral and valuable members of the health More than 303 years meeting care team, their education and training falls far short of Allegheny Medcareby the Allegheny County Medical the education and training of physicians. Increasing the Savings, Servicephysicians’ andSociety—the needsSolutions! only medical supply responsibility and clinical authority of CRNPs is not an (412) 580-7900company that is! appropriate solution to a perceived shortage of physi- FaxMichael (724) L. Gomber,223-0959 MBA cians. House Majority Leader Rep. Mike Turzai has been More than 30 years meeting physicians’ needs instrumental in promoting a physician-led team and has Email:412.580.7900 michael.gomber Fax: 724.223.0959 been a champion for Pennsylvania physicians. endorsed by E-mail:@henryshein.com [email protected] Medcare ALLEGHENY ACMS President and Delegate Lawrence John, MD, COUNTY MEDICAL Savings, Service and Solutions! presented a resolution that would prevent the mandatory SOCIETY use of electronic prescribing as now used in New York. Allegheny Medcare Henry Schein, a Fortune 500 CompanyMichael L. Gomber, MBA Respectfully acknowledging the logistical difficulties that Together to serve to provide a one-stop More than 30 years meeting physicians’ needs mandatory e-prescribing overcomes, Dr. John gave a solution for all your needs compelling argument for the need to preserve the right to 412.580.7900 Fax: 724.223.0959 endorsed by E-mail: [email protected] write prescriptions. ALLEGHENY COUNTY The Foundation of PAMED acknowledged that one MEDICAL SOCIETY Continued on Page 438 Allegheny Medcare Henry Schein, a Fortune 500 Company Bulletin / December 2016 Together to serve to437 provide a one-stop solution for all your needs Editorial
From Page 437 Terstein, MD, from the New England authority. The body of organized med- in 10 Pennsylvanians suffer from Journal of Medicine in 2015: “Many icine must take up the task of fixing physicians are waking up to the fact this. … We are a profession that is still addiction. Raymond Truex Jr., MD, that our profession is increasingly con- honored and respected but we need announced to the HOD that at any trolled by people not directly involved to take a stronger approach and be time there could be up to 3,000 physi- in patient care who have lost contact more proactive in educating legisla- cians in Pennsylvania that may benefit with the realities of the day-to-day tors and the public about the damage from the services that the Foundation clinical practice. Perhaps it is time for that is being done to patient care. If provides. Each year, a doctor who has practicing physicians to take back the organized medicine does not stand up been helped gives testimony to the leadership of medicine.” for physicians (and their patients), who power of rehabilitation. Dr. Powers has been a practicing will?” AMA Delegation Chair James anesthesiologist for more than 30 We must work together to join Goodyear, MD, presented his report years, as our first female PAMED pres- PAMPAC and assist in making positive to the HOD along with Allegheny’s ident from Allegheny County, Carol changes for physicians. Allegheny own Carl Sirio, MD, AMA Board of Rose, MD, noted. Dr. Rose said, “(Dr. County physicians must bring their Trustees, and our AMA Delegation. Powers) has experienced medicine concerns to ACMS through our Dele- The AMA president this year is a hand being overrun with regulations, admin- gates to the House, our PAMED board surgeon from central Pennsylvania, istrators, malpractice concerns oner- trustee and ACMS board members. To- Andy Gurman, MD. Currently, Penn- ous contracts and insurer microman- gether we are stronger, and with your sylvania has 26 delegates/alternate agement. (Dr. Powers) sees young help, our HOD will be more productive delegates and nine reference commit- physicians emerge from training with in the years to come. Please feel free tees. Recently, the AMA urged Con- mountains of debt and listens to disillu- to contact me at [email protected]. gress to allow the Centers for Disease sioned doctors planning to retire early Control and Prevention to research or find alternatives to clinical practice. Dr. Pare is a plastic surgeon, as- gun violence spurred by the Orlando (Dr. Powers has) heard intelligent, sociate editor of the ACMS Bulletin, a shooting. Moreover, Rep. Tim Murphy motivated college students say that member of the ACMS Board of Direc- has bipartisan support for his mental they will NOT consider medicine be- tors and PAMED District Trustee. She health bill and is working with the cause doctors advise them against this can be reached at [email protected]. AMA to clarify HIPAA concerns. Rep. career choice. Doctors in the position Murphy is a child psychologist on the of caring for patients find themselves The opinion expressed in this column health care committee. trapped in an increasingly microman- is that of the writer and does not Finally, Dr. Powers was elected aged environment. Physicians shoul- necessarily reflect the opinion of the to be PAMED vice president. In her der the liability of patient care, yet too Editorial Board, the Bulletin, or the Allegheny County Medical Society. statement to the HOD, she quoted Paul often do not have the decision-making
Allegheny County Medical Society Leadership and Advocacy for Patients and Physicians
438 Bulletin / December 2016 Physicians’ HEALTH Program The Foundation of the Pennsylvania Medical Society 30 Years of Change – Transforming Lives “ONE IN TEN people suffer from addiction. At any time, there could be as many as 3,000 doctors in the state whom we could be helping.” Raymond Truex Jr., MD, FAANS, FACS
“Physicians, like the rest of the population, are vulnerable to chemical dependency, physical WHY SHOULD I disability or breakdowns in mental SUPPORT THE PHP? health. Your support of the • For 30 years the PHP has provided confidential support, 30 Years of Change Campaign monitoring and advocacy to those who may be struggling with will make sure the Physicians’ Health addiction or physical or mental challenge. Program will always be available to our • The PHP relies on contributions from physicians, hospitals fellow health care providers.” and others so that the cost to the participant can be kept as low as possible during challenging times. Raymond Truex Jr., MD, FAANS, FACS, • Your gift TODAY is an investment in an established endowment Honorary Chair of ensuring that the PHP will have funding support in perpetuity. 2016 PHP 30 Years of Change Campaign • Your gift provides a transformational opportunity for your fellow health care providers who deserve a chance to live life in recovery and good health. HOW CAN I HELP? PHP is a program of Please consider a gift to the PHP in honor of this anniversary to ensure that physicians will The Foundation of the always have a place to go to when help is needed. Let’s make the most of it! In celebration Pennsylvania Medical Society of this milestone, the campaign has received a $30,000 challenge grant from an anonymous – the charitable arm of physician – by making your gift TODAY you will help us to take full advantage of this generous PAMED. The program assists matching fund opportunity! all physicians (MDs and DOs), physician assistants, medical Go to www.foundationpamedsoc.org to see true stories of transformation and recovery. students, dentists, dental hygienists, and expanded If you want to learn more about how to make a contribution to the PHP Endowment, function dental assistants. visit www.foundationpamedsoc.org. You can also contact Director of Philanthropy Contact the PHP Margie Lamberson, CFRE, at [email protected] or 717-558-7846. at (717) 558-7819 or [email protected].
The official registration and financial information of the Foundation may be obtained from the Pennsylvania Department of State, Bureau of Charitable Organizations, by calling toll-free within Pennsylvania, (800) 732-0999. Registration does not imply endorsement. 777 East Park Drive • Harrisburg, PA 17105-8820
updated ad.indd 1 1/15/16 1:32 PM Bulletin / December 2016 439 Perspective Shadowing in population health: Using technology and process to improve food accessibility in vulnerable communities
*Third in a series Anthony M. Context Angela D. DiGioia III, Within the city of Pittsburgh, more Devanney than 200,000 children are classified as MD “food insecure.” Many of these children attend home-based child care centers in neighborhoods identified as “food deserts.” The challenge faced by the Molly H. Maria United Way and its associate program fitUnited was to find a way to reach O’Brien DiGioia these vulnerable populations in seven Pittsburgh neighborhoods, and to pro- vide these children with fresh, healthy were accompanied by fitUnited rep- servation of patients, families, custom- food options on a weekly basis. resentatives in the weekly delivery of ers or products as they move through Nationwide, home-based child care food to the home care providers. an experience in virtually any setting. centers, often run by grandparents and The value in combining the food Shadowing is the process by which we neighbors, are the only economically safety and expertise of the Food Bank, capture and document objective and viable child care option for working par- the logistical knowledge of Mission subjective details of the way patients ents and those looking for employment. Logistics, the program mission and and families, customers or products With limited resources, these centers, goals of fitUnited and the dollars of view any process or experience. which can account for between one numerous funders and nonprofit orga- Shadowing can provide vital insights and 20 children at a time, face signifi- nizations made for a project with many into the reality of how a process or cant challenges buying, obtaining and stakeholders. The silos inherent in this experience occurs and how it can feeding the children healthy, fresh food. collaboration intensified the need for improve. By capturing “hard” and “soft” The resulting program, Healthy an objective view of the project and its data, a complete picture emerges. Meals Home Delivery (HMHD), is a processes in order to identify priorities, Armed with reports, stakeholders are collaboration between fitUnited, the evaluate the return on investment and able to identify and eliminate unneces- United Way, The Greater Pittsburgh determine success. sary steps, foster collaboration among Community Food Bank and Mission silos, and engage both staff and Logistics. fitUnited staff coordinated The solution end-users in the co-design of an ideal and ordered the fresh, dry and fro- In order to fully understand the com- experience. zen foods from a number of sources, plex processes rolled into this program, goShadow was the solution to including the Food Bank. The Food which often were not coordinated, it quickly and accurately collect and Bank staff and volunteers sorted and was essential that fitUnited bring in a share this data. goShadow is a two- repacked the food for weekly delivery. partner to determine the current state part system made up of an iOS and The delivery routes were managed and of the program through shadowing. Android app, for on-the-go shadowing driven by Mission Logistics staff, who Shadowing is the direct, real-time ob- and tracking, and a cloud-based online
440 Bulletin / December 2016 Perspective platform which allows for the collabora- The cooperation between Greater Solutions, a digital patient connection tion and aggregation of data, as well as Pittsburgh Community Food Bank, The tool, and was the lead digital marketing one-touch creation of process maps, United Way, Mission Logistics, fitUnited production manager at Highmark. She time studies and other reports. and goShadow enabled the collabora- also has worked extensively in digital fitUnited partnered with goShadow tive identification of a scalable process marketing and production for nonprofit and their staff to shadow the HMHD for delivering healthy, fresh foods to in- organizations, including the Carnegie process from beginning to end. go- home care providers across Pittsburgh. Library of Pittsburgh. Shadow consultants shadowed the With thousands of children enrolled weekly repack of the food at the Food in relative and neighbor provider child Ms. Devanney is a founding mem- Bank, the loading of food into the care just in Pennsylvania, next steps ber of goShadow, a technology startup Mission Logistics delivery trucks and include obtaining approval for Child focused on end-user engagement, the movement and delivery of food and Adult Care Food Program funds to experiential redesign, process mapping into the homes of the care providers. be used for the sourcing and delivery and improvement. She first developed The goShadow app was employed to of healthy food by the U.S. Department her process improvement skills in 2006 timestamp and track each segment of Agriculture throughout the state as a project manager at the Institute for of the experience and collect insights of Pennsylvania and other pilot sites Healthcare Improvement in Cambridge, from the staff, volunteers and care across the United States. Mass., where she provided consulta- providers. The desktop program then For more information, please visit: tion and technical knowledge to hospi- was used to aggregate the data into a • fitUnited: https://uwswpa.org/ tals and organizations throughout the current state process map, time studies fit-united/ world. Ms. Devanney has been a team and other automated reports. • Greater Pittsburgh Community leader for Operation Walk Pittsburgh Using automatically created reports, Food Bank: https://www.pittsburghfood- since 2008 and has led the team to each stakeholder was provided a clear bank.org/ Cuba, Panama, Honduras, Guatemala view of the process, allowing all parties • goShadow: http://goshadow.org/ and Nicaragua to help hundreds of to share in the decision to make chang- patients to receive joint replacements es. Using time studies, goShadow was Dr. DiGioia is founder/medical di- who do not have the means or access to receive specialty care. able to track the time per box packed, rector of The Bone and Joint Center at to the time it took to pack enough food Magee-Womens Hospital of UPMC and Ms. DiGioia received her culinary for a week, for each of the more than the PFCC Innovation Center of UPMC, arts diploma from the Institute for 250 children in the program. Using and a practicing orthopaedic surgeon. Culinary Education in New York and a the True Cost Methodology (TCM), He developed the Patient and Family master’s in food studies from New York goShadow was able to discover the Centered Care Methodology and Prac- University. She has previous experi- specific cost of food per week per child, tice and Shadowing, a simple approach ence in nutrition education and teach- house and neighborhood along with to viewing care experiences through the ing culinary skills to children and adults the time associated with repack and eyes of patients and families which has and is currently the program manager delivery of fresh, frozen and non-per- been shown to improve outcomes and for fitUnited at the United Way of ishable food per child. experiences while decreasing costs. Southwestern Pennsylvania. Over the course of the project, using goShadow reports, effective Ms. O’Brien is a founding member The authors can be reached at incremental changes were made in the of goShadow, a technology startup fo- [email protected]. repack process to reduce repack time cused on end-user engagement, expe- from 3 hours 5 minutes, to 1 hour 32 riential redesign, process mapping and The opinion expressed in this column minutes. Similar changes were made improvement. She has worked in digital is that of the writer and does not to the delivery process, reducing drive production and marketing for more than necessarily reflect the opinion of the and delivery time by more than 3 hours 10 years. In healthcare, Ms. O’Brien Editorial Board, the Bulletin, or the Allegheny County Medical Society. per day. was the marketing manager for MDNet
Bulletin / December 2016 441 Perspective Physician’s ‘Compression Syndrome’ merican practicing physicians are the physician. being consumed by a “Compres- A Robert S. *ACCOUNTABLE CARE ACT: sion Syndrome.” The practice of medi- Allows for unfairly grouping physicians cine has always followed the dictates of Whitman, and then profiting themselves by taking the Hippocratic Oath that require a new MD a portion of the collected income. physician to swear, upon a number of *PHYSICIAN QUALITY REPORT- healing gods, to uphold specific ethical ING SYSTEM: A program in which standards, and those of the god As- ment results in appointments that are physicians are required to join to avoid clepius, who represented the pertinent consumed with the physician’s hands penalties by Medicare by submitting healing aspect of the medical arts. more on the computer and less on the codes that represent quality of care to Today, we are witness to overwhelm- patient! the patient. ing diagnostic and therapeutic advance- *LIMITED USEFULNESS: Equally *ICD-10: This recent, more sophis- ments providing exceptional support for disappointing, this computer information ticated billing coding system with a the patient’s illness and offering a longer cannot be universally received else- greatly increased number of refined and more meaningful survival. where because of software limitations. diagnostic codes was instituted early in However, since the 1900s, the prac- *BUREAUCRACY: GOVERNMENT 2014, requiring more intense searches tice of medicine has been unfortunately AND INSURANCE CARRIERS: Man- and must be submitted carefully or be and significantly altered. Health care aged care plans have succeeded in subject to non-payment penalties. providers from the bureaucracies now reducing compensation for all services These constant and increasing forc- require all physicians to participate in in every field of medicine including es surrounding today’s physician identi- requirements that do not benefit either hospitals, specialty centers and the fy those symptoms that have seriously the patient or themselves. These con- physician offices. Their concerns ap- limited his capability to provide serious trolled requirements not only include a pear to be more for the profit made and ethical care and compassion for his mandated performance, but also the not the quality of care. patients – and allows for the develop- physician’s failure to comply is subject- *OFFICE APPOINTMENT OVER- ment of the physician’s “Compression ed to penalties! LOAD: The reduced compensation Syndrome.” And so the physician’s “Compres- received results in increased number Today, the practice of medicine in the sion Syndrome” has developed: a con- of patient appointments, and, because United States has become a successful dition by which the progressive pres- of the time constraints, a significant de- business venture unfortunately now sures surrounding the physician today crease occurs in the usual comprehen- being meticulously structured by an have both reduced and compromised sive medical management and care. interfering new order of healing gods! their practice and the Hippocratic Oath *MALPRACTICE INSURANCE of medicine. COSTS AND LITIGATION INCREAS- Dr. Whitman graduated in medicine Being perpetually pressured, the ES: More than 60 percent of physi- from the University of Pittsburgh and syndrome develops with the following cians over 55 have been sued at least practiced internal medicine for more than symptoms: once! Failure to diagnose is the leading 40 years, retiring in 2001. He developed *HANDS-ON LOST: A mandatory motive. Decreased preciseness allows the Suburban East Medical Center in requirement for all patient information for increasing errors! Malpractice Wilkins Township with Marvin Levick, MD. and prescriptions to be electronically insurance continues to be exorbitant He can be reached at [email protected]. generated by the computer and failure with a range from $4,000 to $20,000 to comply with this time-consuming annually. Observed changes provided The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion method results in threatening economic by the Affordable Care Act (ACA), of the Editorial Board, the Bulletin, or the penalty by the provider. This require- groups are profiting for themselves, not Allegheny County Medical Society.
442 Bulletin / December 2016 Welcoming Yoshihiro Komatsu, MD General and Esophageal Surgeon
Dr. Komatsu is a general surgeon with fellowship training in Allegheny Health Network minimally invasive surgery and advanced endoscopy. He joins Esophageal and Lung Institute Blair Jobe, MD and the physicians of Allegheny Health Network 4815 Liberty Avenue Esophageal and Lung Institute. Mellon Pavilion, Suite 158 He has clinical expertise in esophageal cancer and esophageal Pittsburgh, PA 15224 surgery, gastrointestinal surgery, GERD surgery, hiatal hernia repair, and Barrett’s esophagus. He specializes in advanced One Nolte Drive endoscopy including POEM, a therapeutic endoscopic Kittanning, PA 16201 procedure, and LINX a reflux management system for GERD, as well as minimally invasive surgical techniques. Dr. Komatsu earned his medical degree at Juntendo University School of Medicine in Tokyo, Japan and completed his general Call 724.260.7300 surgery residency at Juntendo University Shizuoka Hospital. to make an appointment He continued his postdoctoral training as a research associate or visit AHN.org. at the University of Pittsburgh Medical Center and at the Esophageal and Thoracic Research Institute at the Allegheny Singer Research Institute. He then completed his minimally invasive surgery and advanced endoscopy fellowship training at the Esophageal and Lung Institute at Allegheny Health Network.
New patients are welcome. Most major insurance plans are accepted.
Bulletin / December 2016 443 Society News
POS to welcome ogy, which is the oldest and largest along with registration, will be sent to Joseph F. Rizzo III, MD educational course that is designed for the membership in January. Members residents-in-training. also are encouraged to visit the society Thierry Ver- Members are reminded that regis- website for updates. straeten, MD, presi- tration begins at 4 p.m. with the first The named lecture honors Harvey dent of the Pittsburgh lecture beginning at 4:30 p.m. Tarek E. Thorpe, MD, an ophthalmologist Ophthalmology Soci- Shazly, MD, will present a resident whose techniques and inventions of ety (POS), is pleased case presentation at 5:35 p.m. The medical instruments contributed to the to announce Joseph POS business meeting begins at 5:50 study of the eye. Dr. Thorpe’s accom- Rizzo III, MD, David p.m., followed by a social. Dinner and plishments included modifying the G. Cogam Professor Dr. Rizzo the second lecture will commence at slit lamp (and he was one of the first of Ophthalmology in 7:05 p.m. members of his profession to teach its the field of neuro-ophthalmology; di- To register for the meeting, please use as a biomicroscope for examining rector, Neuro-Ophthalmology Service, visit www.pghoph.org. The deadline to the eyes) and inventing a gonioscope, Massachusetts Eye and Ear, Boston, register for the meeting is Dec. 30. a small instrument with prisms used to Mass., as guest speaker for the Jan. 5. observe various portions of the inner 2017, monthly meeting. Dr. Rizzo was POS Annual Meeting part of the eye. The gonioscope is invited to present to the membership slated for March 17, 2017 considered important in the treatment by POS member John Charley, MD. of glaucoma (increased pressure within Dr. Rizzo sees complex neuro-oph- The 2017 Annual the eye). He also invented the endo- thalmic disorders by referral within Meeting will take place scope, an instrument for finding small New England and worldwide. His Friday, March 17, foreign bodies within the eye, and other clinical expertise informs his research, 2017, at the Pittsburgh instruments used in eye surgery. and he devotes a major portion of his Marriott City Center, Dr. Thorpe presented annual professional focus to developing new with the Annual Ban- therapeutic options for patients with quet being held at the lectures before the American Academy vision disorders. Dr. Rizzo focuses his Duquesne Club. Dr. Hill of Ophthalmology to which physicians research on understanding the mecha- The Society came from throughout the world. For nisms of vision loss, improving diag- welcomes Warren E. Hill, MD, medical many years, he conducted yearly nostic methods and developing new director, East Valley Ophthalmology, courses at UPMC Montefiore Hospital, treatments for blinding diseases. In Mesa, Ariz., as the 53rd Thorpe Lectur- where he taught the use of the slit lamp particular, his clinical research includes er. Dr. Hill has devoted the majority of and lectured on a variety of subjects the study of optic neuritis/multiple his professional activities to performing associated with his profession. He sclerosis, ischemic optic neuropathy, challenging anterior segment surgery published some 50 papers on various pseudotumor cerebri and giant cell ar- for other ophthalmologists and the aspects of his profession. teritis. He also founded the Boston Ret- mathematics of intraocular lens power In 1980, Dr. Thorpe was named inal Implant Project in the late 1980s to calculations in unusual clinical situa- “Man of the Year” by the Pittsburgh develop a retinal prosthesis and offer a tions. He has published many scientific Ophthalmology Society and estab- new therapeutic option for patients who articles, served as visiting professor for lished the Harvey E. Thorpe Lecture, have acquired blindness. numerous grand rounds and has de- delivering the first lecture in the series. As director of the neuro-ophthal- livered more than 550 presentations to This lecture continues today and is the mology service, he also designs and ophthalmic societies both in the United highlight for the POS annual meeting. provides oversight for the fellowship States and internationally. 38th Annual Meeting for program in neuro-ophthalmology. For Dr. Hill was extended the invitation more than 25 years, he has directed to serve as the Thorpe Lecturer by Ophthalmic Personnel set the neuro-ophthalmology section of POS member Deepinder Dhaliwal, Running concurrently with the POS the Lancaster Course in Ophthalmol- MD. The annual meeting brochure, Annual Meeting is the 38th Annual
444 Bulletin / December 2016 Society News
Meeting for Ophthalmic Personnel. term: Fred Rubin, Geriatrics Teacher of the Year Close to 200 ophthalmic technicians, MD, president, and Award nominations open assistants, coders, photographers and Judith S. Black, MD, front office staff are expected to attend MHA, secretary/trea- The Pennsylvania Geriatrics Society – Western Division (PAGS-WD) is ac- this year’s meeting at the Pittsburgh surer. cepting nominations for the Geriatrics Marriott City Center. The Board of Teacher of the Year Award. The award This well-respected annual program Directors welcomes is designed for ophthalmic techni- Dr. Rubin may be presented to two outstanding newly elected mem- teachers for their dedication and com- cians and administrative personnel bers Christine Herb, to provide clinical updates as well as mitment to geriatrics education. MD, Lyn Weinberg, The awards will recognize and hon- relevant and key technical sessions as MD, and Rollin or both a physician and a professional it relates to ophthalmology. Planned Wright, MD. Mem- from another health care discipline by co-chairs Pamela Rath, MD, and bers re-elected to the including nursing, advanced practice, Laurie Roba, MD, this year’s program Board of Directors physical therapy, pharmacy, occupa- is broken into four segments to allow include: Anthony tional therapy, dentistry, audiology, attendees to select the program they Giampolo, MD, MBA, Dr. Black speech-language, pathology and social are most interested in and obtain cred- DAAPM, ABPN, Shuja work, who have made significant con- its. Credits are only granted following Hassan, MD, and Karen Powers, tributions to the education and training approval by the JCAHPO with the MD. Neil M. Resnick, MD, also was of learners in geriatrics and to the formal application for the 2017 confer- re-elected as the Council of State Af- progress of geriatrics education across ence under consideration. filiate Representative (COSAR) to the the health professions. Members and Highlights for the 2017 program American Geriatrics Society (AGS). non-members of the Pennsylvania include clinical sessions on: Pediatrics, Geriatrics Society will be considered. Cornea (infectious diseases), Glauco- COSAR is the governing body of the AGS state affiliates, with the Society Eligible nominees will have demon- ma, Neuro-Ophthalmology, Oculoplas- strated leadership and inspired learn- tics and Uveitis. Risk management being a local affiliate of the American Geriatrics Society. Each will assume ers to better the care of older adults session offerings include: chart audit, and will have contributed to the growth coding, HIPAA, cross training staff and their role beginning Jan. 1, 2017. The Society, founded by a small of geriatrics in their professions. Teach- work-up protocol. The program will ing expertise and/or education program group of physicians in 1991, remains once again feature the popular work- development are valued in the selec- a strong organization in the region shop sessions. tion of the recipient for this honor. dedicated to improving the health Registration for the program will be- Award eligibility and criteria, along gin in January 2017. Visit www.pghoph. and well-being of all older adults. with the nomination form, is available org periodically for updates on course Engaging and educating health care on the society’s website at www.pag- offerings as well as the complete agen- professionals from all disciplines in swd.org. Nominations must be received da. Please contact Nadine Popovich, the provision of quality health care is before Jan. 4, 2017. Questions regard- administrator, at npopovich@acms. the focus of the organization, through ing the awards or nomination process org or (412) 321-5030 with additional numerous educational program can be directed to Nadine Popovich, questions. offerings held throughout the year. administrator, at [email protected] Interested health care professionals Geriatrics Society or (412) 321-5030. are welcome to join the society with Awardees will be recognized at the announces 2017 officers membership information available on dinner symposium held in conjunction The Pennsylvania Geriatrics So- the society website at www.pagswd. with the 2017 Clinical Update in Geriat- ciety – Western Division (PAGS-WD) org or by contacting Nadine Popovich, ric Medicine scheduled Thursday, April is pleased to announce the following administrator, at (412) 321-5030 or 6, 2017, at the Pittsburgh Marriott City re-elected officers for the 2017-19 [email protected]. Continued on Page 447
Bulletin / December 2016 445 The New World of Health Care is complicated. Are You Prepared?
Allegheny County Medical Society members: The new world of Health Care ushered in by the Patient Protection and Affordable Care Act (ACA) has created uncertainty and confusion for most people. There are new regulations and requirements. Individual and employer mandates. Penalties for not purchasing coverage. On Exchange and Off Exchange access. As an Allegheny County Medical Society member, you have help. Talk to USI Affinity, the ACMS’s endorsed insurance broker and partner. Our benefits specialists are experts in Health Care Reform. We can help you choose a health plan that provides the best coverage and value while ensuring you will be in compliance with complex new IRS and Department of Labor regulations. We’ll also provide you the kind of world class service and support you need to make sure you get the most out of your health care benefits after you buy. You can also check out the NEW Allegheny County Medical Society Insurance Exchange, a convenient and secure online portal where you can find competitively priced insurance coverage for all your needs, including a wide variety of medical and dental plans.
To learn more, contact USI Affinity today! Call 800.327.1550, or visit the ACMS Insurance Exchange at www.usiaffinityex.com/acms
446 Bulletin / December 2016 Society News
Elder and end-of-life care program held
The Allegheny County Medical Society and the Allegheny County Bar Association hosted “Elder and End of Life Care: The Intersection of Law and Medicine” Nov. 16 at the Rivers Club. At left are moderators Melaine Rothey, Esq., President of ACBA; and Lawrence John, MD, President of ACMS. Above are panelists and ACMS members Judith Black, MD, Allegheny Health Photos provided by ACBA Network; and Richard Hoffmaster, MD, UPMC.
From Page 445 clinicians take exceptional care of information will be available at https:// Center. Recipients will be honored with these often-frail individuals. Designed ccehs.upmc.com/liveformalcourses.jsf a plaque and receive complimentary by course directors Shuja Hassan, MD; in early 2017. membership in the society for one year. Judith Black, MD; and Neil Resnick, MD; along with the PAGS-WD planning PUA program announced Clinical Update in Geriatric committee, this award-winning course The Pittsburgh Medicine set for April 6-8, 2017 is designed for family practitioners, Urological Associa- Mark your calendar for the 25th internists, geriatricians and other health tion (PUA) will host annual Clinical Update in Geriatric care professionals who provide care to “Pathophysiology, Medicine conference. Jointly provided older adults. Diagnosis and Man- by the PAGS-WD, UPMC/University of Speakers are selected by a mul- agement of OAB” at tidisciplinary committee of academic Pittsburgh Institute on Aging, University 6 p.m. Wednesday, and practicing clinicians and based on Dr. Dmochowski of Pittsburgh School of Nursing, and Feb. 8, 2017, at The two criteria: (1) expertise – nationally University of Pittsburgh School of Med- Capital Grille, Pittsburgh. recognized and often responsible for icine Center for Continuing Education The guest speaker will be Roger in the Health Sciences, the conference advances relative to practice, and (2) R. Dmochowski, MD, MMHC, FACS, will be held April 6-8, 2017, at the Pitts- ability – to share it in a practical, suc- burgh Marriott City Center. cinct and entertaining way to facilitate professor, Department of Urology, Van- The fastest-growing segment of its easy incorporation into a practice. derbilt University, Nashville, Tenn. the population comprises individu- Join the PAGS-WD and save on regis- For more information or to register, als above the age of 85 years. The tration! Visit www.pagwd.org to join or contact Amy Stromberg, administrator, purpose of the conference is to provide renew your membership. Brochures will at (412) 321-5030, ext. 103, or astrom- an evidence-based approach to help be mailed in January 2017. Conference [email protected].
Bulletin / December 2016 447 Alliance News
SUMMARY: PAMED Saturday evening’s affair included and artfully arranged by the Commit- ALLIANCE ANNUAL MEETING the Inaugural Dinner for 2017 PAMED tee, as well as the ever popular 50/50 OCTOBER 22-23, 2016 President Charles Cutler, MD, of raffle by RK Roarty, this year for the HERSHEY LODGE AND Montgomery County, as well as AMES late Dr. Joseph Roarty, carried on the CONVENTION CENTER Scholarship Awards presentation by holiday spirit of giving by our member- PAMED Alliance. From start to finish, ship and guests. The well-planned Annual Meeting the Annual Meeting in glorious, au- In recent years, the Holiday Cham- of the Pennsylvania Medical Society tumnal Hershey was a productive and pagne Brunch has become a favorite Alliance with its busy agenda including most memorable experience! Join us tradition, heralding a cherished social AMA Alliance President Rosemary for a similar gathering in spring 2017! time as well as fellowship in fundraising. Xavier’s introduction of the new Opioid Proceeds from Alliance events benefit Awareness video and handouts to the HOLIDAY BRUNCH ACMS Foundation, for scholarship grants Alliance attendees, with discussion on AND CHAMPAGNE TOAST to medical college students and students how each county can use the materials CELEBRATING ACMSA’S in degree/certificate programs for health in ways most fitting their county’s per- XCI ANNIVERSARY care careers in Allegheny County. In sonal style. It was mentioned that there addition, Alliance events support direct will be money available through the The Alliance of Allegheny County giving for local or global disaster relief, state alliance to assist the counties as Medical Society, now in its 91st year and ACMS programs which nurture and they work to bring Opioid Awareness to of continuous community service in develop healthy children and families for communities in Pennsylvania. partnership with the Medical Society, a healthy Allegheny County. Continuing with meeting matters, gathered together with family and there was induction of 2017 PAMED friends at Edgewood Country Club Sun- DIRECT DONATIONS ACCEPTED Alliance President Kathleen A. Hall, day, Dec. 4, to celebrate the season and THROUGH APRIL 1, 2017 and Alliance Leadership for the new a remarkable milestone of the Alliance Members, Family, Friends, Guests, Alliance year, including nomination and organization. A vital and visible part of Organizations, Recipients installation of regional directors, with the Holiday Brunch and Champagne Your contribution in support of our our own ACMS Alliance member, San- Toast was its leadership. Serving as organization is deeply appreciated! dra Da Costa, continuing to represent event chair was Mrs. Rose Kunkel Roar- Donor, please write check to: ACMS Southwestern Pennsylvania. In appre- ty, with co-chairs Mrs. Alan Barnett and Foundation, and mail to: ciation for her very effective 2016 term Mrs. Michael Kutsenkow and committee ACMS Alliance now concluding, there was presenta- members Mrs. Robert Blume, Mrs. John 713 Ridge Avenue tion of the gavel and President’s Pin to Da Costa, Mrs. Eugene Delserone, Mrs. Pittsburgh, PA 15212 Your donation will be formally Caryl Schmitz. John W.B. Franklin, Mrs. George Ger- acknowledged. The auction element to benefit neth, Mrs. William Hetrick, Mrs. Marshall the AMES Fund (Alliance for Medical Levy, Mrs. Augusto Martinez, Mrs. Sam- Season’s Greetings to Alleghe- Education Scholarship) was achieved uel Mines, Mrs. Joseph Novak, Mrs. ny County Medical Society Family, with flair! Fine items were donated from Donald Orr, Mrs. Lawrence Purpura and Friends and Colleagues. WISHING many counties throughout Pennsylva- Mrs. Chandra Reshmi. YOU AND ALL OF YOURS A MOST nia. For fun and fellowship, PMSA reg- The gorgeous holiday deco set- MEANINGFUL AND MEMORABLE istrants, members and guests enjoyed ting at Edgewood and place setting HOLIDAY SEASON WITH THE VERY a class on wine and chocolate pairing chocolates gifted by Sarris Candies BEST OF HEALTH AND HAPPINESS by an experienced, expressive Hershey enhanced the fun, festive afternoon IN THE NEW YEAR! Lodge wine educator/sommelier. Attend- with traditional seasonal entertainment ees sipped and tasted and laughed to- provided by the Laura Daniels Duo. As gether, fostering and enhancing growing always, raffle basket with wonderful Content and text by Kathleen Jennings Reshmi friendships in the state Alliance! goodies and gifts generously donated
448 Bulletin / December 2016 Activities & Accolades
ACMS member featured living with the disease and those trying laborative Commit- on diabetes panel to treat it and also made recommenda- tee to revise the ACR– tions to ensure effective treatment for ACOG–AIUM–SRU ACMS Board mem- those living with the condition. Practice Parameter ber and ACMS Foun- Dr. Bononi is medical director for for the Performance dation Gala Committee Allegheny Health Network’s Center for of Obstetrical Ultra- Co-Chair Patricia Diabetes and has clinical and research sound. Bononi, MD, partici- Dr. Böhm-Vélez is Ö expertise in diabetes, endocrinology, Dr. B hm-Vélez pated in the Pittsburgh a radiologist and pres- endocrine cancer, thyroid disease and Post-Gazette and ident of Weinstein Imaging Associates, metabolism disorders. Highmark Foundation Dr. Bononi a private practice focused on women’s Health Care Forum, ACMS member to head imaging with offices in Shadyside, Diabetes Crisis: Ending the Epidemic, South Hills and North Hills. She also is Dec. 14 at the August Wilson Center. ultrasound committee chair of the Pennsylvania Radiological The forum explored the diabetes Marcela Böhm-Vélez, MD, has been Society (PRS) Breast Imaging Commit- crisis, its alarming growth, the people appointed again as the chair of the Col- tee.
In Memoriam
John J. Guehl Jr., MD, 96, of Mt. Surviving are children Fern (Larry) U.S. Army Reserves. Lebanon, died Sunday, November 13, Winans, John J. Guehl III, MD, Johan- Dr. Delaney was a board-certified 2016. na (Ron Wilkin) Guehl and Alisyn (Pat) psychiatrist, neurologist and geriatric Dr. Guehl graduated in medicine Hurley; and many grandchildren and psychiatrist and served as medical from the University of Pittsburgh. He great-grandchildren. director of Milestone. He served as opened a general family medicine Services were held Nov. 16, 2016, president of ACMS in 2010, and he practice in Sheraden before deciding to at William Slater II Funeral Service in most recently served as the District 13 sell the practice and enter a residency Scott. trustee for the Pennsylvania Medical program at the University of Pitts- *** Society and president of the History of burgh’s Western Psychiatric Institute John F. Delaney Jr., MD, PhD, Medicine Society. and Clinic. He then practiced in East MPH, 78, of Fox Chapel, died Sunday, Surviving are his wife, Rose Ham- Liberty and Mt. Lebanon. November 27, 2016. mond Delaney; brother Daniel (Dee) He was one of the first psychiatrists Dr. Delaney graduated in medicine Delaney; niece Anne Delaney; nephew in the region to become certified to from the University of Pittsburgh and Daniel (Haley) Delaney and their chil- administer electroconvulsive therapy, served his residencies at the University dren Adele and Jack; and sister-in-law or electroshock therapy. of Pittsburgh and Western Psychiatric Joella Hammond. Deceased is his wife of 60 years, Institute and Clinic. Services were held Nov. 30, 2016, at Fern Mary Lhota Guehl. He was a retired colonel with the St. Joseph Church, O’Hara Township. Allegheny County Medical Society Leadership and Advocacy for Patients and Physicians
Bulletin / December 2016 449 Community Notes Reportable Diseases Allegheny County Health Department Local group’s study results presented Quarterly (Q) Selected Reportable Diseases at Radiology Society meeting 2014 Q1-3 2015 Q1-3 2016 Q1-3** Weinstein Imaging Associates is honored to announce Disease* Jan-Sep Jan-Sep Jan-Sep that the results of their Automated Breast Volumetric Campylobacteriosis 81 106 81 Sonography (ABVS) study entitled “Using BI-RADS Mis- Cryptosporidiosis 21 21 23 matches to Assess Clinical Differences in Intepretation Giardiasis 63 51 49 between Whole-Breast Physician-performed Handheld Guillain-Barre 9 6 4 Invasive Haemophilus influenzae 8 8 14 Ultrasound (HHUS) and Supine Automated Ultrasound Hepatitis A 3 2 6 (AUS) Compared for Equivalence in Lesion Detection” Acute Hepatitis B 13 6 2 were presented at the Radiology Society of North Amer- Legionellosis 53 41 56 ica (RSNA) meeting in Chicago Nov. 29, 2016. They are Listeriosis 2 4 1 very thankful to all their patients who participated and Malaria 4 2 5 Meningitis, Viral 29 22 19 made this possible. Meningococcal Invasive Disease 0 2 1 Pertussis 104 69 60 Salmonellosis 81 138 112 Shigellosis 10 89 36 Shiga-toxin producing E. coli 5 15 12 Looking for answers S. pneumoniae Invasive 28 35 39 West Nile Virus Infection 1 2 0 to your questions about government Zika Cases Among Allegheny County Residents Confirmed Cases: 11 benefits and services? Probable Cases: 1 (as of November 28, 2016) USA.gov has you *Case classifications reflect definitions utilized by CDC Morbidity covered. and Mortality Weekly Report. It’s your official **These counts do not reflect official case counts since current year numbers are not yet finalized. Inaccuracies in working case counts source for government may be due to reporting/investigation lag. NOTE: Disease reports may be filed electronically via PA-NEDSS. information. To register for PA-NEDSS, go to https://www.nedss.state.pa.us/ NEDSS. To report outbreaks or diseases reportable within 24 hours, USA.gov please call the Health Department’s 24-hour telephone line, (412) 687-2243. 1 (800) FED-INFO
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450 Bulletin / December 2016
2017 Summer Internship
DATES ABOUT May 30th through August 3rd The Jewish Healthcare Foundation (JHF) is recruiting graduate (Mondays through Thursdays) students interested in innovations in healthcare delivery, policy, and patient safety for paid summer internship opportunities. JHF is a TIMELINE public charity with two non-profit operating arms—the Pittsburgh The 10-week program includes project Regional Health Initiative (PRHI) and Health Careers Futures orientations and a mandatory Perfecting Patient (HCF)—that offers a unique blend of research, education, CareSM training from May 30th to June 8th. grantmaking, and program management to improve population Interns will then be dedicated to project positions health and the outcomes of care, with a focus on quality, efficiency, for the remaining eight weeks. and safety of health care.
ELIGIBILITY Current graduate students including but not limited to:
Policy & Law Rehabilitation Public Health Computer Science Medicine Business Social Work Education Nursing Epidemiology 2016 JHF Summer Interns Exceptions are made on occasion for undergraduate students. As an intern, you will: gain exposure to JHF, PRHI, and HCF, learn PRHI’s Perfecting Patient CareSM quality improvement TO APPLY methodology for health professionals, Please complete the online application, including a report to a mentor and work with a project team, personal statement, resume, and letter of contribute to team projects (preliminary list below), and reference: http://www.qitcenter.org/2017-jhf- summer-internship.html present your experience and contributions to staff and Boards
For questions and additional information, please contact Nancy Zionts, COO and Chief Program INTERNSHIP PROJECT POSITIONS Officer ([email protected]). (subject to change)
DEADLINE: February 1, 2017 Adolescent Behavioral Health Patient Safety Fellowship AIDS Free Pittsburgh Practice Transformation INTERVIEWS: February 1st through 28th Healthcare Reform Network Senior Connections Managed Long-Term Care Tomorrow’s HealthCare™ The Future of Health Care Women’s Health Activist Movement
JEWISH HEALTHCARE FOUNDATION | 650 SMITHFIELD STREET, SUITE 2400 | PITTSBURGH, PA 15222 | WWW.JHF.ORG
Bulletin / December 2016 451 Feature 2016 ACMSF award winners was able to shoe Our Hearts to Your Soles uses Christina E. Morton approximately 50 financial donations to help fund the homeless men at costs of shipping the shoes and socks ach year, the Allegheny Coun- the Light of Life to each site across the country, with Ety Medical Society Foundation Ministries in the almost 100 percent of donations going (ACMSF) recognizes outstanding City of Pittsburgh. directly to the homeless. UPMC, individuals and community organiza- Today, the Arthrex, Integra Lifesciences and indi- tions for the contributions they have organization has vidual personal donations consistently made to the health care needs of the grown into a large provide support for the charity. Dr. Stephen Conti Pittsburgh community and beyond. national charity, A graduate of the New Jersey The 2016 ACMSF award winners will providing free Medical School in Newark, Dr. Stephen be honored at the ACMSF Celebration examinations and Conti began his medical career with a of Excellence Awards Gala Saturday, shoes to 30-plus residency in orthopaedic surgery at the March 4, 2017, at Heinz Field, East sites across the Hospital for Joint Diseases at NYU as Club Lounge. The medical society country and caring well as a fellowship in foot and ankle encourages you to attend this fun- for some 24,000 surgery from the Center for Orthopae- filled evening with your colleagues homeless persons dic Care in Cincinnati. and friends and celebrate Pittsburgh’s since 2007. Dr. Stephen Conti has been a world-class medical community. “It’s hard to Dr. Matthew Conti clinical professor with the University of conceive that from Pittsburgh School of Medicine as well Physician Volunteer Award a single visit to Light of Life Ministries as the medical schools at Drexel and Stephen F. Conti, MD, well-re- over a decade ago, Our Hearts to Your Temple, and has authored more than nowned orthopaedic surgeon spe- Soles would celebrate over 10 years 50 peer-reviewed scientific articles on cializing in foot and ankle injuries as a national charity,” said Dr. Stephen the foot. and conditions, and his son, Matthew Conti. “We are so thankful for the gen- Dr. Stephen Conti served as the Conti, MD, are the 2016 recipients of erous support of the many health care director of foot and ankle surgery at Al- the ACMS Physician Volunteer Award. professionals and volunteers that have legheny General Hospital from 2003 to The award recognizes a physician for been with us throughout this journey 2013, where he oversaw orthopaedic the donation of their time or talents for and are honored to be recognized by research and started a wound care and charitable, clinical, educational or com- the Allegheny County Medical Society lower-extremity Lymphedema Center, munity service activities, domestically for our work with those in need.” where he served as medical director. In or internationally. Over the years, Our Hearts to Your 2013, he became the founding practice In September 2004, Dr. Stephen Soles has partnered with several partner of the Orthopaedic Specialists Conti helped his son, Matthew, a high organizations and sponsors to expand – UPMC. school student at the time, to establish its efforts across the United States. Dr. Stephen Conti resides in the the charity Our Hearts to Your Soles – With the help of Red Wing Shoes, North Hills with his wife, Carol, and a nonprofit organization that provided Dignity U Wear, numerous orthopaedic has three children, Matthew, Laura and free medical foot screening examina- surgeons and hundreds of volunteers, Christopher. tions and shoes to the less fortunate the organization has been able to con- Dr. Matthew Conti attended the people of the metropolitan Pittsburgh sistently provide 5,000 pairs of shoes University of Notre Dame and spent his area. On Feb. 24, 2006, Our Hearts to and 14,000 pairs of socks to men and junior year studying at Oxford Univer- Your Soles launched its first event and women in need each year since 2012. sity in England. He double majored in
452 Bulletin / December 2016 Feature
pre-medical studies and economics, “We are so very grateful and hum- graduating summa cum laude. Dr. bled to be chosen as the recipient of Matthew Conti attended Weill-Cornell the 2016 Benjamin Rush Community Medical School in New York City and Organization Award,” Ms. Herbert graduated in May 2016. He is currently added. “It is a testament to the gener- a first-year orthopaedic resident at the osity and unwavering commitment of Hospital for Special Surgery in New our volunteer providers, students and York City. supporters.” Benjamin Rush Community Nathaniel Bedford Organization Award Primary Care Award The Birmingham Free Clinic has Eileen M. been selected as the 2016 Benjamin Boyle, MD, has bilitation sciences. Last year, the clinic Rush Community Organization Award. been chosen as had more than 2,500 patient encoun- Established in 1947, the award recog- the 2016 Nathan- ters, facilitated nearly $399,000 worth nizes a company, institution, organi- iel Bedford Pri- of free prescriptions through Patient zation or agency that is successfully mary Care Award addressing a community health issue. Assistance Programs and worked recipient. Present- Founded in 1994, the Birmingham with volunteers who served more than ed by the ACMS 3,000 hours. since 1975, the Free Clinic is operated by the Program Dr. Boyle for Health Care to Underserved Popu- “It has been an absolute privilege award recognizes lations (PHCUP) and is located on the for our staff and volunteers to serve our a primary care physician for exemplary, South Side of Pittsburgh in facilities community by providing compassion- compassionate, comprehensive and donated by the Salvation Army. ate, quality care to anyone in need. We dedicated care of patients. The PHCUP offers quality medical, take the over two-decades-long trust Dr. Boyle earned her undergraduate pharmaceutical and specialty care ser- that our community members have degree in biology from the University of vices to uninsured and medically placed in us very seriously, and are Pennsylvania in 1978, and graduated underserved individuals at Birming- committed to serving them as long as from Hahnemann Medical College in ham, and at no cost to any patient, we are needed,” said Mary Herbert, 1983. She completed her residency in with support from the Salvation Army, MS, MPH, practice coordinator/clinical internal medicine at St. Vincent Hospi- volunteers, individual donations and the director, PHCUP/Birmingham Free tal in Worcester, Mass., in 1986. Division of General Internal Medicine at Clinic. Board certified in internal medicine, UPMC. The mission of the PHCUP is to The Birmingham Free Clinic and Dr. Boyle served as a primary care facilitate, provide and improve access PHCUP strive to provide a place where provider at the East Liberty Fami- to high-quality care for those in need, every individual has access to high ly Health Care Center, a Federally through community partnerships, volun- quality, compassionate heath care. Qualified Health Center, for the last 30 teerism, service learning and advocacy. More than half of the patient population years, having fulfilled a National Health The Birmingham Free Clinic at the clinic includes housed individuals Service obligation at this practice. provides general medicine clinic ser- who are working class or working poor, She served as the associate medi- vices and hosts 15 monthly specialty but are ineligible for Pennsylvania state cal director of the Center from 2005 clinic sessions supported by a volun- Medicaid; do not receive employee through 2010 and as the CEO of the teer staff of physicians, pharmacists, health benefits; have recently lost East Liberty Family Health Care Center nurses and an interdisciplinary team benefits due to unemployment; or are from March 2010 through May 2015, of health professional students from ineligible for government subsidies to while still maintaining an active clinical the schools of medicine, pharmacy, purchase insurance through the Afford- practice. dental, nursing and health and reha- able Care Act exchanges. Continued on Page 454
Bulletin / December 2016 453 Feature
From Page 453 tional skill in their Dr. Imbriglia also is the chief of “I spent my whole career taking care clinical care of pa- surgery at the Western Pennsylvania of the underserved population,” said tients and dedica- Surgery Center (WPSC), which he and Dr. Boyle. “East Liberty Family Health tion to the ideals his partner, Glenn Buterbaugh, MD, Care Center has a Christian-based of the medical spearheaded in 2000. The WPSC is mission, but serving these patients was profession as a a free-standing ambulatory surgery my own personal mission, too. I just teacher or profes- center that provides surgical and loved it.” sion leader. anesthesia services to patients in the After grad- convenience of an outpatient set- Dr. Boyle was physician champion Dr. Imbriglia of the team that worked on the Diabe- uating from ting. Dr. Imbriglia and his colleagues tes National Health Disparities Col- Hahnemann Medical College in 1970, perform approximately 3,000 hand and laborative, as well as lead physician Dr. Imbriglia completed two years of shoulder outpatient surgeries at the for implementation of the practice’s general surgery at UPMC where he Hand Center every year. two electronic health records. She worked and operated with Dr. Wilde. Dr. Imbriglia is a member of numer- implemented Toyota lean principles He continued his orthopaedic residen- ous professional societies including as the Health Care Center’s method cy and hand fellowship training at Co- the American Academy of Orthopaedic for quality and process improvement. lumbia-Presbyterian Medical Center Surgeons, Pennsylvania Orthopaedic Dr. Boyle was instrumental in attain- in New York City in 1976. He came to Society, American Society for Surgery ing Level 3 Patient Centered Medical Pittsburgh a year later and has been of the Hand, Academic Orthopedic Home accreditation through NCQA in private practice ever since. Society, American Orthopedic Asso- for both medical sites. In addition, Dr. Imbriglia was the founder and di- ciation, The American Association for she was the team lead in attesting for rector of the Hand Fellowship Program Hand Surgery and American Society Meaningful Use for all providers in the at Allegheny General Hospital (AGH) for Reconstructive Transplantation, practice. from 1983 to 2000 and was the director among others. This past November, Dr. Boyle start- of the Division of Hand Surgery at AGH He and his colleagues have ed a new chapter in her professional from 1988 to 2000. Since 2001, he has published more than 100 original career and began working part-time at been clinical professor of Orthopaedic peer-reviewed articles on hand and Steel City Internal Medicine at an office Surgery at the University of Pittsburgh shoulder disorders, the most recent site in Ellwood City. School of Medicine, where he also addressing the safety of hand and Dr. Boyle has served on the board served as the director of the Hand and upper-extremity surgical procedures of the Pennsylvania Association of Upper Extremity Fellowship Program at a freestanding ambulatory surgery Community Health Centers (PACHC) until 2014. center which was published in the and is currently a board member of “I have had the privilege of training prestigious Journal of Bone and Joint the Western Pennsylvania Area Health nearly 120 hand fellows since the Surgery in 2016. Education Consortium (AHEC). early 1980s who now practice all over Dr. Imbriglia served as the associate Dr. Boyle and her husband, Dr. the country,” said Dr. Imbriglia. “We editor of the Journal of Hand Surgery James Boyle, reside in Indiana Town- offer one of the top five hand training in 1993. He presently serves on the ship and have three grown children, programs in the nation.” board for The Children’s Institute in Jim, Kristen and Ellie. Dr. Imbriglia is chairman of the Pittsburgh, where he previously held Ralph C. Wilde board of the Hand & UpperEx Center the position of board chairman from and is the most senior staff member. 2007 to 2011. Leadership Award The Hand & UpperEx Center is a Dr. Imbriglia and his wife, Carolyn, Joseph E. Imbriglia, MD, FACS, is premiere organization of orthopaedic reside in Shadyside. They have four the 2016 Ralph C. Wilde Leadership physicians and therapists dedicated adult children, three of whom live in Award recipient, which recognizes a to the prevention and treatment of all Pittsburgh, and their oldest son, John, physician who demonstrates excep- disorders of the hand and shoulder. lives in New York City.
454 Bulletin / December 2016 Feature
Benjamin Rush the clinic take me out of my sheltered Dr. Manzi Individual Award suburban life.” received her Ms. Grimes turned her volunteer- bachelor’s degree The 2016 ism into a family affair, recruiting her in biology from the Benjamin Rush husband, Bernie Grimes, MD, a retired University of Notre Individual endocrinologist, in 2008, and their Dame, her med- Award recipient son, Michael Grimes, MD, a practicing ical degree from is Mary Carroll endocrinologist at Allegheny General the University of Grimes. Estab- Hospital, in 2014, to care for patients at Pittsburgh School Dr. Manzi lished in 1947, the the health center. of Medicine and award recognizes “We are so blessed by the presence a master’s degree in public health from an individual who Ms. Grimes of Mary Carroll and her family in our the University of Pittsburgh Graduate is not a physician, lives, those of the staff, volunteers and School of Public Health. Dr. Manzi who devotes time, skills or resources to most of all, our patients,” said Annette completed her medical internship and assisting others and contributes to the Fetchko, administrator, CCFHCC. residency at Duke University Medical advancement of health care. Ms. Grimes also spends her time Center and was appointed assistant Ms. Grimes began volunteering at tutoring inner-city children and teach- chief resident. She completed her fel- the Catholic Charities Free Health Care ing English to refugees through the lowship in rheumatology at the Universi- Center (CCFHCC), also known as “The Pittsburgh Literacy Council. She is a ty of Pittsburgh Medical Center. Miracle on 9th Street,” in February Family Promise Meals volunteer at St. As a leader in her field, Dr. Manzi 2008. The center opened a year earlier Benedict’s Church, a hospital Eucha- has played an important role in advanc- to provide quality medical and dental ristic minister and helps to sew Dignity ing quality, innovation and best practices care at no cost to individuals who do Robes – specially designed robes for not have employer-sponsored health that have improved the treatment of women undergoing radiation treat- insurance, cannot afford private insur- patients with autoimmune illnesses. She ments associated with breast cancer – ance, or who do not qualify for Medic- is internationally known for her research at St. Louise de Marillac Church. aid or other types of assistance. and patient care in lupus, and she has “When I learned that Catholic Char- Ms. Grimes and her husband reside published more than 200 reports of ities opened a free clinic in downtown in McMurray. They have four adult research on lupus and related diseases Pittsburgh, I immediately was interest- children and eight grandchildren. such as cardiovascular disease. “Dr. Manzi represents the highest ed,” said Ms. Grimes. “I always wanted Richard E. Deitrick to be involved with people needing standards of a physician,” said Patricia care.” Humanity in Medicine Award Bononi, MD, medical director, AHN Cen- Ms. Grimes, a retired ESL (English Susan M. Manzi, MD, MPH, is the ter for Diabetes and Endocrine Health. as a Second Language) teacher, has 2016 Richard E. Deitrick Humanity in “Not only does she have superb medical logged more than 2,223 hours volun- Medicine Award recipient, which hon- knowledge and clinical skills, but she teering at the CCFHCC, by interview- ors a physician who has improved the treats every patient as a unique person ing and helping individuals enroll in the lives of patients by caring for them with with integrity, compassion and dignity. free care clinic through the eligibility integrity, honesty, and respect of their She embodies all of the qualities that process, with an in-kind value of nearly human dignity, and serves as a role this award represents.” $112,000. model for other physicians. Dr. Manzi and her colleagues at the “I have met so many wonderful peo- Dr. Manzi is chairwoman of the Lupus Center of Excellence helped de- ple including volunteers and patients,” Department of Medicine at Allegheny sign Avise SLE™, a blood test to help said Ms. Grimes. “We have become Health Network and director of the clinicians diagnose lupus with greater a community of friends. Everyday I Lupus Center of Excellence. She is ease and accuracy. Avise SLE™, go home with a new appreciation of a vice chair and professor at Temple which became commercially available peoples’ difficult lives. My days spent at University. Continued on Page 456
Bulletin / December 2016 455 Feature
From Page 455 exemplary leader- Doctor column in the Pittsburgh in 2012, uses one blood sample from ship and advoca- Post-Gazette, which addressed reader a patient to check for five distinct cy for physicians. questions on medical issues by ACMS bio-markers that help to rule-in the Over a sustained physician members and more. diagnosis of systemic lupus erythema- time, the recipient The society built a fully accessible tosus while ruling out other rheumatic shall have dis- playground at YMCA Camp Kon-O- diseases. Dr. Manzi received the Pitt played administra- Kwee and Spencer in Fombell, Pa. The Innovator Award and the Pittsburgh tive guidance and society also conducted Medical Ex- support to physi- change Forums, which paired commu- Business Times BusinessWomen First Mr. Krah Award in recognition of this technology. cians to improve nity and corporate leaders with practic- Dr. Manzi has been invited to speak their ability to improve the lives and ing physicians for a two-day shadowing at universities and medical centers health of the people of our community. and educational experience; formed throughout the United States and Mr. Krah has served as the soci- Allegheny MedCare, a group purchas- around the world on her research and ety’s executive director since January ing organization for physicians’ medical expertise in autoimmune conditions and 1989 and has dedicated his career to and surgical supplies; and helped the she has served on a number of commit- advocacy for physicians and patients. society start and operate a central tees for the National Institutes of Health “It has been an honor and privilege Credentials Verification Service. (NIH) and the FDA Advisory Board. to work with Jack for the past 10 years,” “Jack fully understands what makes Dr. Manzi is medical director of the said Lawrence John, MD, 2016 ACMS doctors tick and how best to serve them,” Lupus Foundation of America (LFA) and president. “He is the most dedicated said Dr. John. “His skills and insight leads efforts to address gaps in educa- administrator I have ever been associat- are amazing and impress me on a daily tion, research and the health care needs ed with in my career.” basis. Physicians have been served com- of people with lupus. She also is a mem- During his tenure as executive prehensively under his leadership, and ber of the LFA’s board of directors and director, Mr. Krah has worked extensively ACMS has been blessed to have Jack at medical scientific advisory council. to help physicians achieve meaningful the helm all of these years.” Dr. Manzi received the Clinical tort reforms in Pennsylvania and led local Mr. Krah currently serves on the Practice Award from the Pennsylvania legislative efforts to stop Medicare fee board of directors of the Pittsburgh chapter of the American College of schedule cuts scheduled under the Medi- Regional Healthcare Initiative, and has Physicians in recognition of her excep- care Standard Growth Rate formula. previously served on the boards of the tional service to people with lupus in Mr. Krah was instrumental in helping American Association of Healthcare 2012. She was presented with the LFA the society establish a medical student Executives, the Better Business Bureau National Advocacy Leadership Award scholarship fund for students from Al- of Western PA, the North Side Civic in 2015 for her leadership and support legheny County and an endowed health Development Council, the Consumer of biomedical research to accelerate care studies scholarship at the Commu- Credit Counseling Service of Western the development of new treatments for nity College of Allegheny County. PA and the Pittsburgh Society of Associ- diseases like lupus. The society has supported many ation Executives (PSAE). He has served Dr. Manzi and her husband, Joseph public health initiatives addressing as president of the PSAE and received Ahearn, MD, reside in Franklin Park domestic violence, childhood obesity, the Joe Gilbert Outstanding Association and have five adult children. smoking cessation, and alcohol and Executive Award from the organization. drug abuse. The society also has Mr. Krah and his wife, Nancy, Executive Leadership Award participated in public service radio and reside in Upper St. Clair and have two John G. Krah, executive director, television campaigns including Straight adult daughters. Allegheny County Medical Society, is Talk About Healthcare on KQV; The the first recipient of the ACMS Admin- Power of Prevention campaign; Health Ms. Morton is a communications istrative Leadership Award, presented Capsules on KDKA-TV; Healthy 4 consultant. She can be reached at to an individual who has demonstrated Life with WTAE-TV; and the Dear [email protected]
456 Bulletin / December 2016 Please share with a colleague!
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Bulletin / December 2016 457 Materia Medica Combination inhalers for COPD linergic (LAMA) individually. dence interval for the rate ratio was Maria Kiraly, PharmD The FLAME trial2 is the only less than the non-inferiority margin of published study which evaluates a 1.15; therefore, indacaterol-glycopyrro- hronic obstructive pulmonary LABA-LAMA combination against nium showed non-inferiority to sal- Cdisease (COPD) is a common, a LABA-ICS combination. The trial meterol-fluticasone with regard to the preventable and treatable disease that compared salmeterol-fluticasone annual rate of all COPD exacerbations. is characterized by persistent airflow (LABA-ICS) versus indacaterol-glyco- Time to first exacerbation was longer in limitation that is usually progressive pyrrolate (LABA-LAMA) to determine if the indacaterol-glycopyrronium group and associated with an enhanced one combination was more effective in compared to the salmeterol-fluticasone chronic inflammatory response in reducing the number of exacerbations group (71 vs. 51 days, P<0.001). The the airways and the lungs to noxious COPD patients’ experience. It was a incidence of adverse events and death particles or gases. The characteristic 52-week, randomized, double-blind, was similar in the two groups. It was symptoms of COPD are chronic and double-dummy, non-inferiority trial in concluded that in patients with COPD progressive dyspnea, cough and which the primary outcome was the who had a history of exacerbation sputum production that can vary from annual rate of all COPD exacerbations. during the previous year, indacater- day-to-day.1 According to the Global The safety of both products was as- ol-glycopyrronium was consistently Initiative for Chronic Obstructive Lung sessed as well. It was found that in the more effective than salmeterol-fluti- Disease (GOLD) guidelines, patients per-protocol population (n= 3,362), the casone in preventing exacerbations with moderate to severe COPD (stage annual rate of all COPD exacerbations and was associated with no detectable C or D) are encouraged to use either was 3.59 in the indacaterol-glycopyr- increase in adverse events. a combination of a long-acting beta ronium group and 4.03 in the salmet- This article will compare the three agonist (LABA) and an inhaled cortico- erol-fluticasone group (P=0.003). The LAMA-LABA combination products now steroid (ICS) or a long-acting anticho- upper limit of the 95 percent confi- available on the market.
Domestic Abuse Palm Cards Available Writers wanted! Where-to-Turn cards give important We are calling for authors for 2017 for the ACMS information and phone numbers for victims Bulletin Perspective columns. of domestic violence. The cards are the size Is there an issue that you would like to address for of a business card and are discreet enough your colleagues’ consideration and reading? to carry in a wallet or purse. Perspective columns appear in each monthly issue Quantities of cards are available of the Bulletin and are on a topic of your choice. at no cost, for distribution within Your specialty, ethical questions, current public Allegheny County, by contacting the policy – all are of interest. Columns should be Allegheny County Medical Society at approximately 600-900 words. (412) 321-5030. For more information, contact Meagan Sable, * Please note phone numbers, information on palm card Bulletin managing editor, at [email protected]. valid only for Allegheny County, Pa.
458 Bulletin / December 2016 Materia Medica
Stiolto Respimat Anoro Ellipta Utibron Neohaler Tiotropium bromide (LAMA) / Umeclidinium (LAMA) / Glycopyrrolate (LAMA) / Generic Name Olodaterol (LABA) Vilanterol (LABA) Indacaterol (LABA) Dosage Two inhl once daily One inhl once daily One inhl twice daily Dosage 15.6 mcg/27.5 mcg 2.5 mcg/2.5 mcg 62.5 mcg/25 mcg Strength 60 actuations 30 inhalations Box of 60 capsules (two actuations equal one dose) 7 inhalations (institutional pack) Box of 6 capsules Pack Size Dosage Form Inhalation Spray inhaler Dry Powder inhaler Dry Powder inhaler Price¥ (Boehringer Ingelheim) (GlaxoSmithKline) (Novartis Pharmaceuticals)
$378.82 $106.20 (7) and $315.68 (30) $35.74 (6) and $297.81 (60) Increased risk of asthma-related death is considered a class effect of LABAs All LABAs are contraindicated in patients with asthma without use of a long-term asthma control medication Warnings and Not indicated for relief of acute Precautions Not indicated for treatment of Not indicated for treatment of bronchospasm or treatment of asthma asthma asthma Pts with hypersensitivity to Pts with hypersensitivity to Pts with severe hypersensitivity to tiotropium, ipratropium, olodaterol, indacaterol, glycopyrrolate, or to any milk proteins or any ingredients or any component of this product of the ingredients Pharyngitis, sinusitis, lower Nasopharyngitis, cough, and back respiratory tract infection, pain constipation, diarrhea, pain in Nasopharyngitis and hypertension Adverse (>3% incidence and higher than extremity, muscle spasms, neck (incidence >2 percent and higher Reactions placebo) pain, and chest pain than placebo) (incidence >1 percent and higher than placebo) LAMA: long-acting anticholingeric; LABA: long-acting beta-agonist; inhl: inhalation; CI: contraindicated ¥The pricing data provides representative AWP and/or AAWP price from a single manufacturer of the product; pricing data should be used for benchmarking purposes only
The LABA-LAMA inhalers approved for COPD can improve lung 3 References function in patients with moderate to severe COPD. While there are 1. Global Initiative for Chronic Obstructive Lung differences between the products in regards to dosing frequency and Disease (GOLD). Global strategy for the diagnosis, dosage form, how they compare in efficacy and safety with each other management, and prevention of chronic obstructive still remains to be determined. The GOLD guidelines have not been pulmonary disease. Dec 2015, updated 2016 (http:// updated at this point to include LABA-LAMA combination products in goldcopd.org). the management of COPD. 2. Wedzicha, JA, et al. “Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD.” New Engl J Med. 374.23: 2222-2234. Jun 2016. Dr. Kiraly is a PGY1 pharmacy practice resident at Allegheny 3. Seebri Neohaler and Utibron Neohaler for COPD. General Hospital. At the time of this writing, Dr. Kiraly was on clinical Med Lett Drugs Ther 58.1491: 39-41. Jan 2015. rotation in the Center for Pharmaceutical Care at Allegheny General Hospital. For any questions concerning this article, please contact Dr. Kiraly at the Allegheny Health Network, Allegheny General Hospital, Center for Pharmaceutical Care, Pittsburgh, Pa., (412) 359-3192, or www.acms.org email [email protected].
Bulletin / December 2016 459 Legal Report Macranomics: Summary and timetable
*First in a series Michael A. The Pennsylvania he Department of Health and Medical Society has THuman Services (HHS) and the Cassidy, Centers for Medicare and Medicaid Esq. established a website Services (CMS) issued final reg- for MACRA tools and ulations Oct. 14, 2016, regarding the implementation of the Medicare and enhanced quality reporting and the information: https:// Access and CHIP Reauthorization Act development of Alternative Payment www.pamedsoc.org/ of 2015 (MACRA) health care reim- Mechanisms (APMs). tools-you-can-use/ bursement reform, and there has been Major components of MACRA an accompanying deluge of news and topics/macra announcements advising health care MACRA contains the following three major initiatives: providers to prepare for MACRA im- reductions in the Medicare Physician 1. MACRA repeals the sustain- plementation beginning Jan. 1, 2017. Fee Schedule for the last 10 years. As able growth rate (SGR) physician fee Most physicians understand MACRA you recall, the proposed reduction for calculator and replaces it with a fixed contains three major components that 2015 was 21.5 percent. In the past, one-half percent (that’s right – one- aim to, once again, reform and restruc- the traditional SGR fix was simply new half percent) increase on “regular” ture the country’s health care system legislation postponing the proposed Medicare, i.e., the Medicare physician to reduce costs, improve efficiency increase until future years without fee schedule established as part of and enhance quality – which sounds actually fixing the problem. The results suspiciously like the Triple Aim philos- RB-RVS, which will apply from 2016 were similar to those you would per- ophy first espoused by Donald Berwick through 2025. sonally experience if you failed to pay in his “Triple Aim” article while at the 2. MACRA combines the existing the minimum payment on your credit Institute for Healthcare Improvement three quality reporting programs into card statements; the next statement and then later in 2010 as administrator the new Merit Based Incentive Pay- would be double the last statement, of CMS. ment System (MIPS). The new quality However, there is abundant con- reporting begins Jan. 1, 2017, for resulting in ever-escalating minimum fusion about the timing, content and calendar year 2017 (CY 2017) but it will payments. impact of MACRA and the Allegheny not effect physician payments until Jan. MACRA enacted a permanent SGR County Medical Society thinks it would 1, 2019 (CY 2019). fix by completely repealing the SGR be advisable to: 3. MACRA establishes the founda- formula and replacing it with specifical- 1. Summarize the major compo- tion for new APMs, which are intended ly stated “regular” Medicare physician nents of MACRA; to be the future of health care reform, fee schedule updates as follows: 2. Identify the timetable; and but which will not be operative until 1. One-half percent (0.5 percent) 3. Provide specific information about 2019 and thereafter, assuming every- per year for calendar years 2016, the various components based upon thing goes according to plan. 2017, 2018 and 2019. the timetable of the role out. 2. Zero percent (0 percent) increas- This article will provide a summary SGR repeal es for calendar years 2020, 2021, of the components, identify the timeta- We can assume most physicians 2022, 2023, 2024 and 2025. ble and set the stage for future articles are familiar with the Standard Growth 3. A supposedly permanent one- on the substance of MACRA health Rate (SGR) methodology that has fourth percent (0.25 percent) increase care reform, which is newly combined generated ever-increasing proposed thereafter.
460 Bulletin / December 2016 Legal Report
Merit-Based Incentive will be extremely complex. This pro- fully. Based on significant feedback, Payment System cess is too complex to describe in the this area is simplified into supporting remaining space allotted for this first the exchange of patient information The future for regular Medicare pay- article, but just allow me to hint at the and how technology specifically ments and increases was transferred complexity and uncertainty by quoting supports the quality goals selected by to the Merit-Based Incentive Payment the CMS summary: the practice. The cost performance System (MIPS). MIPS has two structur- “Within MIPS, the second pathway category has also been simplified al components: of the Quality Payment Program, we and weighted at zero percent of the 1. A combination of the three exist- believe that the unification into one final score for the transition year of ing quality reporting mechanisms into Quality Payment Program can best be one reporting program; and CY 2017. Given the primary focus on accomplished by making connections 2. The establishment of merit-based quality, we have accordingly indicated across the four pillars of the MIPS pay- percentage increases or decreases as our intention to align these measures ment structure identified in the MACRA follows: fully to the quality measures over time legislation – quality, clinical practice • Plus/minus 4 percent for 2019 in the scoring system.” improvement activities (referred to as • Plus/minus 5 percent for 2020 The takeaway is that CYs 2017 “improvement activities”), meaningful • Plus/minus 7 percent for 2021 and 2018 will be measurement years use of CEHRT (referred to as “advanc- • Plus/minus 9 percent for 2022 and with no payment impact until 2019. ing car information”), and resource thereafter However, learning the quality reporting use (referred to as “cost”) – and by The MIPS positive/negative adjust- program over the next two years will emphasizing that the Quality Payment ments are a zero-sum game, so that be of paramount importance. Thus, Program is at its core about improving any potential bonus payments must the next article in this series will be a the quality of patient care. Indeed, the be offset by payment decreases to the summary of the quality reporting pro- bedrock of the Quality Payment Pro- physicians who do not qualify for the cess, to attempt to make some sense gram is high-quality, patient-centered bonuses generated by MIPS reporting. of the language quoted above. There- care followed by useful feedback, in a after, the next articles will deal with the Combined quality reporting continuous cycle of improvement. The development of APMs. The articles principal way MIPS measures quality Until now, CMS has operated three will be curated on the ACMS website. quality reporting programs: of care is through evidence-based clinical quality measures which MIPS In addition, the Pennsylvania Medical 1. PQRS – Physician Quality Re- Society has established a website porting System eligible clinicians can select, the vast for MACRA tools and information as 2. VBPM – Value-Based Payment majority of which are created by or follows: https://www.pamedsoc.org/ Modifier supported by clinical leaders and tools-you-can-use/topics/macra. 3. MU – Meaningful Use Attestation endorsed by a consensus-based Just as an aside, note that MACRA These programs will be combined process. Over time, the portfolio of into a new quality measurement tool quality measures will grow and devel- is not part of the Affordable Care Act which will have four components: op, driving towards outcomes that are and is unlikely to be impacted by the 1. ACI – Advanced Care Information of the greatest importance to patients repeal initiatives likely to be forthcom- (the replacement for Meaningful Use and clinicians. Through MIPS, we have ing following the Republican presiden- Attestation) the opportunity to measure quality tial victory. 2. Resource Utilization (which is the not only through clinician-proposed cost factor) measures, but to take it a step further Mr. Cassidy is a shareholder at 3. Quality by also accounting for activities that Tucker Arensberg and is chair of the 4. CPIA – Clinical Practice Improve- physicians themselves identify: name- firm’s Healthcare Practice Group; he ment Activities ly, practice-driven quality improvement. also serves as legal counsel to ACMS. The new reporting process will The MACRA requires us to measure He can be reached at (412) 594-5515 begin Jan. 1, 2017, for CY 2017 and whether technology is used meaning- or [email protected].
Bulletin / December 2016 461 Materia Medica Suvorexant (Belsomra) for insomnia balance for a given individual. Studies by patient-estimated sleep latency Nathan Lamberton, have suggested that falls in the elderly and maintenance time. However, 30 PharmD are related to their ability to adapt their and 40mg doses appeared to pro- balance in response to changes in sen- duce more robust results than 15 and icole ayette N P , sory information, such as body sway.2 20mg, suggesting a dose-dependent PharmD, BCPS Two randomized, placebo-controlled response. The effect was seen similarly trials evaluated the safety of a single between males and females. uvorexant (Belsomra®) is a highly night of use compared to eight consec- The NNT to achieve a ≥ 6 point Sselective antagonist for the orexin utive nights of suvorexant use on next improvement on the Insomnia Sever- 1 and orexin 2 receptors in the hypo- morning driving abilities. Significant ity Index (ISI) at three months from thalamus. Endogenous neuropeptides effects were seen after one night of baseline was 8 (95 percent CI: 6-14) orexin A and orexin B act on these suvorexant use in patients <65 years for both the higher (30 and 40mg) and receptors promoting wakefulness; of age receiving 20 or 40mg, but there lower dose (15 and 20mg) regimens. therefore, by inhibiting these recep- was no significant change seen with Additionally, to achieve ≥ 6 point 1 tors, suvorexant promotes sleep. the 15 or 30mg doses.3 improvement on the ISI at 1 month, the Suvorexant is a schedule IV controlled In clinical trials, increased suicidal NNT = 6 (95 percent CI: 5-9) for 30 or substance and is FDA-approved for the ideations occurred in only one patient 40mg and 10 (95 percent CI: 7-19) for treatment of insomnia. (0.2 percent) with 15 or 20mg and nine 15 or 20mg.3 A 6-point improvement in Safety patients (0.7 percent) with 30 or 40mg. the ISI score correlates to a patient’s However, these results were confound- subjective improvement in their degree Potential safety concerns with the ed by a prior and/or current history of of insomnia (i.e., clinical insomnia to use of suvorexant include daytime depression with suicidality.3 subthreshold insomnia). The ISI is a impairment, increased hypoxia or patient-completed, subjective 28-point apnea in patients with COPD, sleep Tolerability assessment of their sleep hygiene as it apnea, suicidal ideation and behavior Suvorexant is generally well toler- applies to satisfaction and ability falling changes. ated; studies show the adverse events asleep, interference with daily function- Two crossover studies evaluated with the highest rates of occurrence ing and stress related to sleep issues. the safety of suvorexant in patients with are daytime somnolence, headache concomitant COPD and sleep apnea and dizziness. Daytime somnolence Price (n=26, n=25, respectively) and found was the most common adverse effect, A 30-day supply of suvorexant no increased risk of apnea. However, occurring in 7 percent of patients and (available in 5, 10, 15 and 20mg) costs significant heterogeneity between the nearly double in the treatment group nearly $270, regardless of strength. groups decreased the likelihood that a versus placebo3,4 (NNH = 13). All three Other FDA-approved medications for meaningful difference would be found if side effects are dose-dependent, the treatment of insomnia include zolp- one were truly present. occurring >10 percent in patients taking idem (Ambien; $7 for 30-day supply), Of four placebo-controlled studies 40mg or greater. eszopiclone (Lunesta; $25 for 30-day evaluating the safety of suvorexant on supply) and ramelteon (Rozerem; $312 daytime impairment, only one study Effectiveness for 30-day supply).5 found significant decreases in bodily All four study doses (15, 20, 30 function. The decreases in function and 40mg) were superior to placebo Simplicity were in the areas of word recall and for sleep latency and sleep mainte- Patients are instructed to take suv- body sway area, which is the degree of nance as confirmed both objectively orexant no more than once per night, postural sway while trying to maintain by polysomnography and subjectively within 30 minutes of bedtime and with
462 Bulletin / December 2016 Materia Medica
at least 7 hours available before awak- therefore has increased regulations re- years are similar, it is recommended ening. Typically, patients start at a low garding its prescribing and dispensing. to use with caution in adults >65 years dose (5-10mg) before titrating to higher due to the possibility of hangover 1 Bottom line available strengths (15-20mg). effects. Suvorexant is primarily metabo- Suvorexant has been shown to be lized by CYP 3A4. Therefore, patients effective in decreasing sleep latency At the time of authorship, Dr. and increasing sleep maintenance. taking moderate inhibitors (such as Lamberton was a PGY1 pharmacy amiodarone, erythromycin, fluconazole, This medication provides an addition- practice resident at UPMC St. Margaret diltiazem, verapamil6) should use low- al option for patients experiencing and can still be reached at lamber- est possible strength of 5mg and those insomnia, albeit with generally a higher taking potent 3A4 inhibitors (such as associated cost. No head-to-head [email protected]. Dr. Payette was clarithromycin, nefazodone, azole studies have been done to compare a PGY2 family medicine-ambulatory antifungals, atazanavir, darunavir, efficacy between agents to guide de- care pharmacy resident at UPMC St. indinavir, lopinavir, nelfinavir, ritonavir, cision-making. Adverse effects include Margaret. Heather Sakely, PharmD, saquinavir, tipranavir6) should avoid its somnolence, headache and dizziness. BCPS, provided editing and mentoring use altogether. Suvorexant is a fed- Although the tolerability and efficacy for this article and can be reached at erally controlled C-IV substance and profiles for patients <65 years and >65 [email protected].
References Proszkowiec M. Relations between postural Clin Pract, December 2014, 68, 12, 1429– 1. Suvorexant In: DRUGDEX® System stability, gait and falls in elderly persons--pre- 1441. doi: 10.1111/ijcp.12568. [database on the Internet]. Greenwood Vil- liminary report. Ortop Traumatol Rehabil. 4. Suvorexant (Belsomra) [package lage, CO: Thomson Micromedex. [cited 2016 2008 Sep-Oct;10(5):478-85. insert]. New Jersey: Merck & Co, Inc; 2014. Jan 2]. Available from: http://www.microme- 3. Citrome L. Suvorexant for insomnia: a 5. Suvorexant [Internet]. Good Rx. dexsolutions.com/micromedex2/librarian. systematic review of the efficacy and safety Accessed 2016 Jan 2. Available from: http:// 2. Baczkowicz D, Szczegielniak J, profile for this newly approved hypnotic. Int J www.goodrx.com.
Thank you for your membership in the Allegheny County Medical Society The ACMS Membership Committee appreciates your support. Your membership strengthens the society Affiliated with Pennsylvania Medical Society and American Medical Association and helps protect our patients. Please make your medical society stronger by encouraging your colleagues to become members of the ACMS. For information, call the membership depart- ment at (412) 321-5030, ext. 110, or email [email protected].
Bulletin / December 2016 463 Legal Report Pennsylvania’s new opioid laws and how they impact physicians
n Nov. 2, 2016, the Pennsylvania before dispensing an opioid drug OLegislature passed a package product or benzodiazepine prescribed of new laws aimed at combating the Lauren N. to a patient if 1) the patient is a new growing heroin and opioid epidemic. Rulli, Esq. patient of the dispenser; 2) the patient These laws have a significant impact pays cash when he/she has insurance; on practicing physicians statewide, 3) the patient requests a refill early; especially because some took effect or 4) the patient is getting opioid drug immediately after they were signed write prescriptions for refills of opioid products or benzodiazepines from into law, while others are not effective prescriptions. more than one prescriber. until Jan. 1, 2017. Below is a detailed • Substance abuse referrals. Phy- • Queries by prescribers. A pre- sicians in these settings are required summary of what these new laws scriber shall query the PDMP system to refer individuals for treatment if the entail, their respective effective dates each time a patient is prescribed an individual is believed to be at risk for and the new legal requirements for opioid drug product or benzodiaze- substance abuse. physicians. pine. However, a query is not required • Prescription Drug Monitor- if the patient has been admitted to a Act 122 – Opioid prescribing ing Program. The law requires that licensed health care facility or is in limits in emergency rooms physicians query the Prescription Drug observation status in a licensed health Monitoring Program system to deter- care facility after the initial query, as Act 122 has several components mine whether a patient is under treat- long as the patient remains admitted to that affect physicians in hospital emer- ment with an opioid drug product by or in observation at the facility. gency departments and urgent care another provider. However, this does • Education for licensing. Licens- facilities. not apply to any medication provided ing boards shall require that individ- • No more than a seven-day sup- to a patient while undergoing treat- uals applying for an initial license ply. Under Act 122, physicians in these ment in an emergency department. or certification that authorizes the settings may not prescribe opioids in Physicians who violate this law licensee to be a dispenser or prescrib- excess of a seven-day supply. There is may face licensure sanctions by the er, to submit, no later than 12 months an exception that allows a physician to state board. Compliance with the law after obtaining an initial license or prescribe more than a seven-day sup- means that the physician is presumed certification, documentation showing ply to treat a patient’s acute medical to be acting in good faith and will have the completion of at least two hours condition or if it is deemed necessary immunity in any civil action. of education in pain management to treat pain associated with a cancer The law takes effect Jan. 1, 2017. or identification of addiction, and at diagnosis or palliative care. For this to Act 124 – Prescription Drug least two hours of education in the happen, the physician must document practices of prescribing or dispensing in the patient’s medical record that a Monitoring Program revisions opioids. non-opioid alternative was not appro- Act 124 amends the Prescription • Education for license renewals. priate under the circumstances. Drug Monitoring Program (PDMP) law Licensing boards also shall require • No refills. The law also provides by adding the following provisions: that dispensers and prescribers who that, no matter the amount prescribed, • Queries by dispensers. A dis- are applying for the renewal of a li- physicians in these settings may not penser shall query the PDMP system cense or certification complete at least
464 Bulletin / December 2016 Legal Report
two hours of continuing education in – Discuss with the minor and the and osteopathic medical colleges and pain management, identification of minor’s parents/guardian/authorized training facilities. While the law does addiction or the practice of prescribing adult the risks of addiction and over- not require this education for gradua- or dispensing opioids. This education dose associated with taking controlled tion, individual education facilities can shall be a portion of the total continu- substances containing an opioid. If mandate it for their students. ing education requirements – not in consent is by an authorized adult (as • Patient voluntary non-opioid addition to them. opposed to a parent or guardian), there directive. This part of the law allows This requirement does not apply to is a 72-hour dosage limit. for patients to execute a voluntary prescribers who are both exempt from – Obtain written consent for the non-opioid directive form to deny or re- the drug enforcement administration’s prescription from the minor’s parent/ fuse the administration or prescribing requirement for a registration number guardian/authorized adult. The law of a controlled substance containing and do not use the registration number requires the Department of State’s Bu- an opioid. These forms shall be devel- of another person or entity as per- reau of Professional and Occupational oped and published by the Department mitted by law to prescribe controlled Affairs, with the licensing boards, to of Health. Patients can revoke their substances in any manner. create a standardized consent form for forms for any reason in writing or orally Act 124 takes effect Jan. 1, 2017. parents/guardians/authorized adults to at any time. sign. Act 125 – Prescribing Physicians and their employees These requirements do not apply if who act in good faith are immune from opioids to minors treatment is associated with a medi- criminal and civil liability if they fail to • No more than a seven-day cal emergency as documented in the offer or administer a prescription for supply. This law limits the number minor’s medical record or compliance a controlled substance containing an of opioids prescribed to minors to no would be detrimental to the minor’s opioid under the voluntary non-opioid more than a seven-day supply, unless health or safety. directive form. the prescriber determines that more Violations of this law subject the This part of the law took effect Nov. than a seven-day supply is required prescriber to administrative sanctions 2, 2016. to stabilize the minor’s acute medical by the appropriate licensing board. condition. For this to happen, the The law took effect Nov. 2, 2016, Conclusion prescriber must document the acute with respect to the requirement that The Pennsylvania Legislature has medical condition in the minor’s med- the licensing boards create a stan- determined that physicians should ical records and indicate the reason dardized consent form. All other parts have an increased role in battling the why a non-opioid alternative is not of the law take effect after the form is opioid and heroin epidemic that has appropriate to address the condition. published. affected so many lives. While these The law also contains an exception Act 126 – Opioid education intentions seem noble, physicians are for situations in which the opioid now faced with increased administra- prescription is to treat pain associated and patient directive tive burdens in treating patients as well with cancer, use in palliative care and Act 126 is broken into two parts, as as potential licensure sanctions and the management of chronic pain not summarized below: liability for failing to comply with the associated with cancer. • Safe opioid prescription edu- new requirements. Physicians should • Procedure for prescribing opi- cation. Beginning Aug. 1, 2017, the take the time to familiarize themselves oids to minors. The law requires that, licensing boards shall implement a with these new laws and implement before prescribing opioids to a minor curriculum addressing safe prescrip- their requirements into their practice. for the first time, a prescriber must do tions of controlled substances con- the following: taining opioids. The curriculum may Ms. Rulli is an associate at Tucker – Assess whether the minor has be offered in medical schools, medical Arensberg and is a member of the taken or is currently taking prescription training facilities (including nursing and firm’s Healthcare Practice Group. She drugs for substance use disorder. optometry schools), dental schools, can be reached at (412) 594-5510.
Bulletin / December 2016 465 Special Report International refugees have unique medical needs ast year, more than 600 internation- monthly stipend for the first three Lal refugees found new homes in Kerry months after arrival, are administered. Pittsburgh, and the coming year may Refugees are automatically granted c ee see even more. As our communities M G , eight months of health insurance, and learn to open our arms to some of the MD children are eligible for CHIP. Medical most vulnerable families from around appointments, including specialist the world, health care providers in par- appointments when necessary, are co- ticular need to be aware of the unique than for any other immigrant group ordinated by the agencies within days set of health and social needs these entering the U.S.” of the refugees’ arrival in Pittsburgh. families bring with them. The process, she explains, includes Refugees arriving from camps “Refugee” is a categorization de- on-the-ground, in-depth interviews with abroad often have immediate, as well fined by the United Nations. Individuals the U.S. State Department, FBI, and as continuing, health care needs. “The are classified as refugees when they Homeland Security workers, biographi- need for ongoing, culturally sensitive, have crossed beyond the borders of cal security checks and fingerprints for integrated care is one of the most their home country due to a well-found- biometric security screening. It typically important needs for all refugees to ed fear of persecution and are unable takes several years. successfully adjust to life in Pittsburgh,” to safely return. Medical exams also are part of the says Johnson. “So many of them come Fewer than one percent of refugees screening process. The goal of the from areas of the world where they are ultimately resettled in third-party medical screening, says Johnson, “is to don’t have access to reliable, primary host countries like the United States identify applicants with serious health medical care and thus never learned – the majority either return home or issues that could prevent admission to how to manage chronic conditions, remain in the country to which they the U.S., such as drug/alcohol addic- such as diabetes and hypertension.” initially fled. The number of refugees tion, sexually transmitted diseases In the longer term, nutrition and accepted by the United States each or mental disorders that could cause lifestyle factors are important as year is determined by the federal applicants to harm others.” Entry can international refugee families adjust government, and potential candidates be denied until an individual receives to a change in food availability and living in temporary camps are entered treatment. the pressures of an unfamiliar culture. into a screening process for resettle- In addition, applicants are screened Parenting and hygiene practices may ment in the United States. for communicable illnesses, to assess be inconsistent with local expectations. Rebecca Johnson, supervisor for fitness for travel and resettlement, Families who have spent many years the Community Assistance and Refu- and to detect pregnancy or chronic living in refugee camps may be unac- gee Resettlement (CARR) project of conditions that would require medical customed to the structure and risks the Northern Area Multi-Service Center follow-up. Adults and children are pro- inherent in our urban and suburban (NAMS), one of three agencies that vided with necessary vaccines. neighborhoods. work with the State Department to Upon arrival in the United States, Mental health needs are ongoing resettle refugees in Pittsburgh, states, refugee families are paired with an for many refugees. “In camps, refu- “The screening process that refugees agency, such as NAMS, to arrange gees usually cannot work and often undergo – no matter what country they for their immediate needs and ensure have limited access to activities and are coming from – is more rigorous that federal benefits, such as a small education, so poverty and boredom
466 Bulletin / December 2016 Special Report
are widespread,” says Johnson. “As a lies. “Overall, many refugees do well period, and Immigrant Services and result, some experience depression, in their new lives in Pittsburgh and Connections (ISAC), a collaboration which can limit their ability to integrate are able to adjust to life quickly and of several agencies funded through into life and become self-sufficient after without issues.” the Allegheny County Department of resettlement. Mental health issues can Federal benefits assist newly ar- Human Services, remains a resource also be exacerbated by the frustrations rived refugee families with housing and for refugees throughout their lives. of resettlement, such as not having case management for three months, As physicians, recognizing the work or knowing how to navigate local beyond which families are expected challenges that refugees face allows systems.” to be self-sufficient. Adults are urged us to better address the unique medi- She points out that another issue to find paying jobs and take English cal, psychological and social needs of for resettled families is domestic classes, with a goal of naturalization these individuals. And as people, un- violence. “Yes, violence is found in within five years of arrival. derstanding the journeys of our neigh- all communities, refugee or not,” she When necessary, intermediate and bors will make us all better citizens of says. “But the high levels of stress and long-term services are available to the world. uncertainty in refugee households can refugees in Pittsburgh who continue to put them at a higher risk for violence.” demonstrate need. NAMS maintains Dr. McGee is a pediatrician and Johnson stresses that these problems some resources for families needing writer living in Mt. Lebanon. She can arise in a minority of resettled fami- support after the initial resettlement be reached at [email protected].
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Bulletin / December 2016 467 Editorial Index
Volume 106 No. 7 July 2016 Pages 249-284 Volume 106 No. 8 August 2016 Pages 285-316 Volume 106 No. 9 September 2016 Pages 317-352 Volume 106 No. 10 October 2016 Pages 353-392 Volume 106 No. 11 November 2016 Pages 393-428 Volume 106 No. 12 December 2016 Pages 429-472
A F Your contract has been terminated or ACMS Alliance News ...... 269, 299, Feature: was not renewed – now what? ...... 274 336, 370, 409, 448 Ebensee: Recognition long William H. Maruca, Esq. Activities & Accolades ...... 267, 300, delayed...... 424 Medical marijuana and a physician’s 334, 372, 413, 449 Fredric Jarrett, MD role ...... 348 C 2016 ACMSF award winners ...... 452 Barry Nelson, Esq. Classifieds ...... 349 Christina E. Morton HIPAA turns 20 ...... 379 Community Notes...... 266, Financial Health William H. Maruca, Esq. 301, 450 Building your financial framework as a Macranomincs: Summary and D young physician ...... 302 timetable ...... 460 E Daniel B. Spickard, CLTC Michael A. Cassidy, Esq. Editorial: Colleen F. Nolfi Pennsylvania’s new opioid laws and The ‘trend’ of empathy ...... 254 G how they impact physicians ...... 464 Lauren N. Rulli, Esq. Deval (Reshma) Paranjpe, MD, FACS H Legal Summary: Our greatest freedom ...... 256 I Beth Anne Jackson, Esq...... 309, 416 Timothy G. Lesaca, MD In Memoriam: Legislative Update ...... 388 Black sheep ...... 290 Peter M. Winter, MD ...... 234 M Deval (Reshma) Paranjpe, MD, FACS Roland T. Keddie, MD, JD ...... 234 Materia Medica: Humpty Dumpty ...... 292 Raymond Eugune Felgar, MD ...... 297 Concepts in diabetes management: John Kokales, MD Berrylin June “BJ” Ferguson, MD .. 297 Concentrated insulin products ...... 270 Maiden voyage ...... 322 Philip P. Ripepi, MD, FACS ...... 334 Linda Nicolaus, PharmD Deval (Reshma) Paranjpe, MD, FACS Anthony R. Haradin, MD ...... 334 Nuedexta® (dextromethorphan/ Now this! ...... 324 E. Reese “Jess” Owens, MD ...... 374 quinidine) ...... 306 Charles Horton, MD James Raymond Dornenburg, MD..374 Maria A. Felton, PharmD Waterfalls...... 358 Lowell G. Lubic, MD ...... 412 R. Christopher Durigan, PharmD, Deval (Reshma) Paranjpe, MD, FACS Lawrence D. Ellis, MD ...... 412, 413 BCPS Organization medicine ...... 360 Walter Hiller Jr., MD ...... 412 Patiromer (Veltassa®): A new option for Gregory B. Patrick, MD, FACP, FCCP Robert B. Wolf ...... 412 treating hyperkalemia ...... 343 An exercise in gratitude ...... 398 Yvonne Bohatch Maher, MD ...... 412 Alaina Koval Deval (Reshma) Paranjpe, MD, FACS John J. Guehl Jr., MD ...... 449 Daclizumab HYP: A new option for And what have you learned? ...... 434 John F. Delaney Jr., MD, PhD, MPH ... 449 relapsing-remitting multiple Deval (Reshma) Paranjpe, MD, FACS J sclerosis ...... 376 Review: 2016 House of K Karen M. Fancher, PharmD, BCOP Delegates ...... 436 L Sacubitril/valsartan (Entresto) ...... 387 Amelia A. Paré, MD, FACS Legal Report: Matthew Joseph, PharmD, BCPS
468 Bulletin / December 2016 Editorial Index
Gregory Trietley, PharmD, BCPS Kevin O. Garrett, MD, FACS S Cabozantinib for renal cell The haunting ...... 364 Society News ...... 262, 296, 330, carcinoma ...... 414 Anna Evans, MD 366, 403, 444 Melissa Blom, MD The ACA revisited before the arrival of Special Report: Praxbind® (idarucizumab) ...... 418 MACRA and MIPS ...... 401 PAMED launches opioid abuse Nicholas R. Giruzzi, PharmD Thierry Verstraeten, MD initiative: Opioids for pain. Be smart. Nicole Payette, PharmD, BCPS Shadowing in population health: Using Be safe. Be sure...... 280 Combination inhalers for COPD .... 458 technology and process to improve Evidence-based approaches are most Maria Kiraly, PharmD food accessibility in vulnerable promising to address bullying ...... 281 Suvorexant (Belsomra) for communities ...... 440 Matthew Masiello, MD, MPH, FAAP insomnia ...... 462 Anthony M. DiGioia III, MD Fine Foundation, JHF promote Nathan Lamberton, PharmD Molly H. O’Brien excellence in patient safety, health care Nicole Payette, PharmD, BCPS Angela D. Devanney quality ...... 346 Miller Time: Maria DiGioia Jewish Healthcare Foundation Just another day ...... 400 Physician’s ‘Compression The medical field can help reduce Scott Miller, MD, MA, FAAHPM Syndrome’ ...... 442 opiate-related overdose deaths ...... 383 N Robert S. Whitman, MD Karen Hacker, MD, MPH O Photo Feature: Eric Hulsey, DrPH, MA P 2016 ACMS Foundation Gala ...... 144 2016 Nominating Committee Perspective: Practice Management: report ...... 385 Independence ...... 258 Having ‘The Talk’ with a toxic Liability risks of telemedicine: State Cynthia Hartz Scott, MD employee ...... 277 standards among considerations .... 386 Room 31 ...... 260 Joe Mull, MEd Dustin Shaver Richard H. Daffner, MD, FACR Are cliques crippling your clinic? .... 382 Landmark initiative gets the green light Lessons from the dinosaurs ...... 294 Joe Mull, MEd from PAMED’s House of Richard H. Daffner, MD, FACR Profile: Delegates...... 420 Whither the art of medicine ...... 326 Meet your 2016 ACMS president: Pennsylvania Medical Society Richard H. Daffner, MD, FACR Lawrence R. John, MD...... 84 Team up to tackle cardiovascular How a PCP can identify a good Christina E. Morton disease ...... 422 psychotherapist: The four t’s of Q Quality Insights therapy ...... 328 R International refugees have unique Leo Bastiaens, MD Reportable Diseases ...... 278, 384, medical needs...... 466 Les petites cellules grises ...... 362 450 Kerry McGee, MD
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Bulletin / December 2016 469 Advertising Index 2016 Bulletin Advertising Index: July-December
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