Lancaster Physician Spring 2015

Official Publication of The Lancaster City & County Medical Society

Mcare Settlement to Return $200 MILLION to Physicians

and Other Providers—Includes Future Protections

Measles Making An Unwelcome Comeback:

Declining Vaccination Rates Are To Blame

Your Community Resource For What’s Happening In Health Care Spring 2015

Physician-Assisted

SUICIDEWhat Could It Mean For

Lancaster Physicians?

Now that Ephrata Community Hospital and its respected physicians have come together with WellSpan Health, we’re excited to announce the arrival of our new maternal-fetal medicine specialists. With this addition to our physician family, we can now offer advanced specialty care to expecting moms right here in our community – for everything from gestational diabetes and preeclampsia, to premature birth complications and the delivery of multiples. Your goal is to have a healthy baby and WellSpan can get you there.

For an appointment call (866) 244-3492.

To learn more visit WellSpan.org/MFM.

WellDelivered.WellSpan Ephrata Community Hospital has welcomed

a new High-Risk Maternity Program into the world.

WellSpan Maternal-Fetal Medicine • 4150 Barrett Blvd • Ephrata

SPRING 2015OFFICERS

James M. Kelly, MDPresident

Lincoln Family Medicine

David J. Simons, DOPresident Elect

Community Anesthesia Associates

Robert K. Aichele, MDVice President

Aichele & Frey Family Practice Associates

Paul N. Casale, MDPast President

The Heart Group of Lancaster General Health

C. David Noll, DOSecretary

Ephrata Community Hospital

Stephen T. Olin, MDTreasurer

Lancaster General Hospital

DIRECTORS

Charles A. Castle, MD

Stacey Denlinger, DO

Laura H. Fisher, MD

Alyssa K. Jones, MD

John A. King, MD

Venkatchalam Mangeshkumar, MD

Karen A. Rizzo, MD, FACS

Jennifer Zatorski, MD

Interim Editor:Dawn Mentzer

Editors:Laura Fisher, MD

Lancaster Family AllergyJames Kelly, MD

Lincoln Family Medicine

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Reading PAHoffmannPublishing.com 610.685.0914

Lancaster Physician is a publication of the Lancaster City & County Medical

Society (LCCMS). The Lancaster City & County Medical Society’s mission

statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in

an increasingly complex environment.

For Advertising Info Contact:Kay Shuey, [email protected], 717.454.9179

2015 BOARD OF DIRECTORS Contents

Content SubmissionThe Lancaster Physician magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Lancaster City & County Medical Society. For more information or submission suggestions, please email [email protected].

6 WellSpan Health Expands its ‘Patient-Centered’ Approach to Lancaster County

8 Physician-Assisted Suicide

12 Lancaster Regional Medical Center & Heart of Lancaster Enhance Patient Experience

14 LGH’s Family Medicine Residency Program Celebrates 45 Years

16 What Physicians Should Know About The 2015 OIG Work Plan

Best Practices

4 President’s Message

18 Healthy Communities

27 Patient Advocacy

32 Medical Society Updates

40 Regulatory Updates

42 Restaurant Review

43 News & Announcements

46 LCCMS Foundation Updates

In Every Issue

C O V E R S T O R Y

Physician-Assisted Suicide:What Could it mean for

Lancaster Physicians? (p.8)

L A N C A S T E R 4 P H Y S I C I A N

L A N C A S T E R M E D I C A L S O C I E T Y . O R G

President’s Message

Visit lancastermedicalsociety.org

James Kelly, M.D.President

PAMED PhysiciansFighting for SGR Reform

By the time this edition of Lancaster Physician is published, Congress will have made a decision regarding the Medicare Sustainable Growth Rate (SGR). The SGR was enacted as part of the Balanced Budget Act of 1997, back when Newt Gingrich was Speaker of

the House and the Clintons had put forward an initial plan to overhaul our nation’s health care system. The goal of the SGR was to ensure increases in Medicare spending did not exceed annual GDP growth. The SGR is assessed on a yearly basis and is the primary method whereby payment rates are determined for health care services. This winter, PAMED physicians and staff have been hard at work lobbying for reform of this controversial process.

Since its inception, the SGR has been a flawed system. Since 1997, multiple short-term annual “patches” have been passed out of necessity. The patches are temporary adjustments to ensure care for seniors is not limited by a substantial drop in payments for health care services. The most recent 2014 SGR override is expected to expire March 31, 2015. If no further legislation is passed, Medicare payment rates to health care providers will fall 21.2%. A drop in reimbursement of this magnitude would in turn limit physicians’ ability to care for large numbers of Medicare patients while still covering overhead expenses. This will cause significant access issues for Medi-care beneficiaries, jeopardizing their ability to receive necessary primary and specialty care for chronic health care conditions.

Thankfully, this winter a bipartisan bill was introduced in the US Senate and House that will permanently repeal the SGR and look at Medicare payment reform. This is a progressive step that will lead us out of the volume-rewarding fee-for-service landscape and into payment based on coordinated quality care. The new model will allow for a small increase in reimbursement for health care professionals over the next four years, while readying us to enter the new Merit-Based Incentive Payment System (MIPS). Current Medicare incentive measures such as the Physician Quality Reporting System (PQRS) and electronic health record meaningful use will be stream-lined into one program, and payments for health care professionals will be adjusted based on performance and in comparison to peers. Bonuses will be awarded considering incurred risk and participation in alternate payment models (such as bundled payments). Reimbursements are also proposed for services such as chronic disease care management and medical home participation.

As I write this article, a final vote by Congress is expected in the next week, and PAMED phy-sicians continue to be in contact with legislators to express our support for this bill. I would like to extend thanks to our local legislators, especially Congressman Joe Pitts, who is an advocate for reform and one of the major sponsors of the bipartisan bill. While expected to pass, it is possible that another “patch” will be enacted, freezing rates and unnecessarily tabling the discussion for another year. Passage of the bill will be a first good step to improve overall health care delivery to seniors, ensuring access while enhancing quality and value of care for all.

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WellSpan Health Expands its ‘Patient-Centered’ Approach to Lancaster County

Physician-Assisted Suicide

Lancaster Regional Medical Center & Heart of Lancaster Enhance Patient Experience

LGH Family Medicine Residency Program Celebrates 45 Years

What Physicians Should Know About The 2015 OIG Work Plan

As Ephrata Community Hospital and its affiliated physicians continue their integration efforts with WellSpan

Health, patients are beginning to see more changes than just a new name and logo.

The regional health system’s primary care practices in Lancaster County now bear the

WellSpan brand identity and are moving to a new model of care—patient-centered medical homes.

Through these medical homes, physicians and caregivers work together to help patients achieve optimal health. To become a medical home, practices must adopt cutting-edge

WELLSPAN HEALTHExpands its ‘Patient-Centered’Approach to Lancaster County


S P R I N G 2 0 1 5

techniques in pursuit of a primary care triple aim: better population health, better experience of care and lower cost.

WellSpan has aggressively worked to expand the patient-centered medical home concept in its primary care practices throughout York, Adams and Lancaster counties. Karen Jones, MD, vice president and chief medical officer of WellSpan Medical Group, said medical homes represent a transformation in primary care.

“This is a paradigm shift in health care,” Jones said. “It’s very different from the way we practiced medicine in the last century.

“Before, physicians concentrated on patients who came to the office seeking care, and there wasn’t much focus on patients who weren’t present,” she continued. “Now, WellSpan is transforming care deliv-ery to optimize the health of individual patients and populations.”

Building a “Team-Based” CultureLast year, 28 WellSpan primary care practices in York and Adams

counties earned the Patient-Centered Medical Home recognition by the National Committee for Quality Assurance.

Now, WellSpan is bringing its Lancaster County practices into the “medical home” fold.

In the spring of 2014, the health system began the work of developing medical homes at six Lancaster County practices. By this summer, all WellSpan primary care practices will be actively involved in the patient-centered medical home model.

As part of WellSpan’s program, each practice designates a Quality Improvement Team to identify ways to improve care delivery and efficiencies. Once a month, the teams gather together as part of a collaborative to share information and best practices.

“It’s really about developing a team-based culture,” said C. David Noll, DO, associate medical director of quality and innovation at WellSpan Medical Group. “Our providers are genuinely excited about the opportunity to provide a broader and higher level of care to our patients, with more resources and improved processes.”

WellSpan’s medical home model includes “health coaches,” who are embedded in the primary care practices to help physicians coordinate the various services that patients require.

Much of the early work at the Lancaster County practices focus-es on identifying gaps in care for high-risk patients, particularly those transitioning from a hospital setting back into a home-based environment, Noll said. The collaborative works to share the knowledge they’ve learned, so patients experience a consistently high level of care.

Identifying at-risk patients is just the first step. Medical homes also strive to involve patients in their own care.

“You not only try to help them understand their condition from a medical perspective, you find out what they personally consider important,” Jones said. “When patients are engaged, you get better outcomes.”

Engaging patients as “partners” in healthWellSpan has established “patient partners” at each of its medical

home practices. Patient partners are patient volunteers who par-ticipate in monthly staff meetings and offer sug-gestions for improving the overall patient experience.

“Our patient partners have been engaged and excited about what we’ve been doing,” Noll said. “They’ve been help-ful in suggesting improvements in our communications and how we manage certain workflows so that we’re improving the overall patient experience.”

WellSpan physicians also encourage patients to take ownership of their health and actively participate in decision-making.

“We emphasize the idea of health care as a partnership,” Jones said. “Traditionally, physicians have been perceived as the sage leaders who know precisely what’s needed to cure an ailment. While a physician’s understanding of medical science is clearly an integral part of care, we also realize that no one knows the patient better than the patient.”

In today’s age, technology can help patients better manage their own health, particularly through the use of secure patient portals.

WellSpan Health’s patient portal, MyWellSpan.org, allows patients to access their medical records, view their lab and imaging results, send secure messages to their health care providers and even request an appointment.

More than 100,000 patients—including more than 11,000 in Lancaster County—have enrolled in the MyWellSpan.org patient portal to date.

“We’ve gotten positive feedback from our patients about the MyWellSpan portal,” Noll said, adding that all of these initiatives have the same goal.

“These are all tools that allow us to engage with patients and partner with them in their health care,” he said. “That leads to improved care and better patient outcomes.”

WellSpan Health Expands its ‘Patient-Centered Approach’



Physician-Assisted

SUICIDEWhat Could It Mean For Lancaster Physicians?

DR. THOMAS GATES, MDFaculty Family Practice Residency

Program of LGH & Chairman of the Ethics Committee at LGH

DR. THOMAS MILLER, MDHospice & Community Care

of Lancaster County

Best Practices


S P R I N G 2 0 1 5


The “Death with Dignity” movement has been gathering momentum since Oregon voters legalized physician-assisted suicide (PAS) in 1997. Also in 1997, the U.S. Supreme

Court ruled that although there was not a constitutional right to PAS, individual states can properly decide for or against the issue. Washington state and Vermont have followed Oregon’s lead, and now the legislatures of our neighbors in Maryland and New Jersey, as well as Montana and Connecticut, are considering bills to legalize the procedure. In Pennsylvania, it is a felony for a physician to assist a patient in committing suicide. However, PA State Senator Daylin Leach from Montgomery County expects to introduce a “Death with Dignity Act,” allowing the practice in our state.

The movement to legalize PAS recently gained heightened exposure with the widely publicized case of Brittany Maynard, the 29-year-old Cali-fornia woman suffering from a brain tumor, who moved to Oregon and was assisted in taking her own life rather than experience an exhausting decline. Although it is not inevitable that we will be faced with legalized physician-assisted suicide in our state, the momentum cannot be denied, and most physicians will be confronted with questions, if not overt requests. In this article, we will attempt to give some framework for the discussion and some guidelines for responding to requests for our assistance with a patient’s suicide.

In an effort to address intractable suffering, loss of control, and loss of “dignity” associated with a terminal illness, proponents of PAS believe that physicians should have the legal ability to prescribe a lethal dose of a medication (usually a barbiturate) to a patient, who then self-administers the medication with the intent of causing death. Laws legalizing PAS typically contain mandatory safeguards and guidelines. The patient must be terminally ill (defined as a prognosis of 6 months or less) and not clinically depressed. There must be two separate requests from the patient, orally and in writing, separated by at least two weeks, and witnessed by two people. The patient must be told of other options (such as hospice and palliative care) that are able to address concerns and be certified to have met all requirements by two physicians.

Opponents of PAS have expressed concerns that legalization would lead to a “slippery slope,” a cascade of unwanted conse-quences brought on by the practice. Will insurance companies see PAS as an opportunity to cut costs, and then pressure patients to end their lives prematurely? Will the poor and marginalized be disproportionally affected? Will the “right to die” gradually come to be seen as a “duty to die?” And will acceptance of PAS gradually be extended beyond the terminally ill, to include all who suffer, even if not terminally ill?

Since 1997, Oregon has carefully tracked its experience with PAS, and in general these concerns have so far proven unfounded. Between 1998 and 2007, 541 lethal prescriptions were written in Oregon, with 341 associated deaths. Sixty-three percent of peo-ple who received a prescription chose not to use it. The median age was 69 years old, and 81 percent of the patients had a cancer diagnosis. Most patients were white, well-educated, insured, and enrolled in a hospice. PAS currently accounts for fewer than 80 deaths per year in Oregon. 1

A study that looked at the reasons people in Oregon chose PAS revealed that: 91 percent feared loss of autonomy, 88 percent feared loss of function and ability to participate in activities, 65 percent feared loss of dignity, 53 percent feared loss of bodily functions, 36 percent feared becoming a burden on family and friends, and 23 percent either had intractable physical pain or, more commonly, were afraid of future pain. Only 2.5 percent feared the financial consequences of their illness.2

It appears that the vast majority of suicides were committed not because of physical suffering, but out of psychosocial suffering, or anticipated suffering.

In Oregon, one in six dying patients will talk with their families about PAS, one in fifty will ask their physicians about the possibility, but only about one in 1000 patients actually avail themselves of PAS.1

In the US, 57 percent of physicians report they have received a request for assistance in dying. However, it is critical to recognize that such requests are usually not a straightforward request for death, but much more often a sign of patient crisis, a cry for help, a symptom of some failure of palliative care.

What should our response be to a request to help a patient end his/her life? We should avoid the mistake of saying YES. And we should avoid the mistake of saying NO. Either of those answers would cut off an opportunity for an important discussion of our

Continued on page 10



patient’s suffering and concerns, an oppor-tunity to address the root cause of his or her suffering. The Education in Palliative End of Life Care (EPEC) curriculum advises a 6-step protocol to respond to requests:

STEP 1:

Clarify the RequestOur response needs to be immediate

and compassionate, asking open-ended questions, asking about suicidal thoughts

and plans, and being aware of how our own biases may influence our response.

STEP 2:

Determine the Underlying CausesUnderstand the patient’s suffering. Is it fear of loss, of being a burden, of

physical symptoms? Is there spiritual suffering or a lack of sense of worth? Is there depression that can be treated?

STEP 3:

Affirm Your CommitmentListen and acknowledge fears, allow for the expression of emotion, explain

your role and commit to find solu-tions, and stand by the patient.

STEP 4:

Address Root CausesCommit to aggressive comfort measures and withholding or withdrawing unwanted life-prolonging procedures, address suf-fering and fears, and connect the patient

with our local palliative care programs and hospices. Help the patient select a personal advocate who will follow his/her wishes if he/she is not able. Help him/her to develop advance directives

and plan for death. Explore what “dignity” means to the patient and offer resourc-es to maintain dignity and reassure the patient you will do all in your means to

maintain dignity as defined by the patient.

STEP 5:

Educate About Legal AlternativesInform patients about refusal of treat-

ment, withdrawal of treatment, declining oral intake, and palliative sedation.

STEP 6:

Consult with ColleaguesSeek support from trusted col-

leagues. Get to know your palliative care colleagues in the community.

We find the demographic of those who chose PAS in Oregon disturbing, for it is our own demographic: white, well-educated,


HEALTH CARE TEAM

for yourLead the Way

Looking to advance your career? Want to hone your team-building skills? PAMED, in collaboration with the American Association for Physician Leadership(AAPL), has training options for individuals and groups.

www.pamedsoc.org/leadershipacademy

Questions? Contact Leslie Howell at (800) 228-7823, ext. 2624 or [email protected].

and insured. The reasons given are likely to be the same concerns we would have at the end of our own lives. The issue of PAS raises profound questions about our culture’s ability to deal with suffering. Suffering would seem to be an inevitable part of life, and the notion that it is best dealt with by a pill seems very impoverished.

Ivan Illich, in his 1976 book Medical Nemesis, describes how “culture makes pain tolerable by interpreting its necessity; only pain perceived as curable is intolerable.”

In our 21st century world, we have come to expect that all pain is curable, even the pain of death. The fact that what is inevitable has become so intolerable that we look beyond our traditional sources of strength in family, community, and faith to instead medically

“manage” death with a pill, raises the question: What kind of people have we become?

REFERENCES:

1. Hedberg K, Hopkins D, Kohn M. Five years of legal physician-assisted suicide in Oregon. N Engl J Med 2003; 348: 961-964.

2. Loggers ET, Starks H, Shannon-Dudley M et al. Imple-menting a death with dignity program at a comprehensive cancer center. N Engl J Med 2013; 368: 1417-1424.

3. Illich, Ivan. Medical Nemesis: The expropriation of health. p.134 (Random House, New York, 1976).

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Best Practices

As medical facilities shift to an out-come and quality based model, it’s more crucial than ever to optimize

resources to provide the best and most efficient care to our patients. As part of a broader initiative to enhance the patient experience, Lancaster Regional Medical Center (LRMC) and Heart of Lancaster Regional Medical Center (HLRMC) have streamlined patient transitions in care by using par8o’s Healthcare Operating Sys-tem—a cloud-based platform technology that connects providers, payers, and patients.

Simply put, par8o helps match the right patient to the right resource at the right

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Lancaster Regional Medical Center & Heart of Lancaster

Enhance Patient ExperienceWith Cloud-Based Technology To Match

Patients With Resources

time, providing a seamless, personalized patient experience.

The platform works independently of an EMR (electronic medical record) and provides a comprehensive view of how patients move through the hospitals and affiliated providers. It puts all necessary patient information at a provider’s fin-gertips electronically (e.g., test results, discharge plans, appointment scheduling and confirmation, etc). This results in more efficient and timely patient care, whether that care involves a visit to a specialist after an appointment with a PCP (primary care provider) or a follow-up with a PCP after

a late-night visit to the emergency room.

LRMC and HLRMC are part of a growing and diverse list of organizations that have adopted the par8o platform. Others that use it include the largest employer in the State of Nevada, MGM Resorts, and sev-eral pre-eminent academic medical centers, such as Harvard Medical School affiliated hospitals in Boston and facilities that are part of the Mount Sinai Health System in New York.

“This is the future of health care, and we are excited to be at the forefront,” said Russell Baxley, CEO, Lancaster Regional


S P R I N G 2 0 1 5

Enhancing Patient Experience

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Medical Center. “We can share patient information faster with providers. And the enhanced coordination of care has helped to improve patient service quality, reduce hospital and patient costs and ultimately reduce readmissions.”

There are several key steps that LRMC and HLRMC have taken to connect patients utilizing par8o:

➊ Physician Network Mapping Par8o provides a directory of providers and recognizes which

providers are available at any time within the network.

➋Identification of the Right Resources for Each Patient Par8o applies intelligence at the point of referral, allowing hospitals

to navigate the patient in a direction that aligns with both clinical goals and the availability of resources.

➌Empowered Allocation Improving communications between providers about pre-referral

needs, such as pre-visit testing, helps reduce unnecessary care and ensure that a patient’s clinical pathway is appropriate. Providers are able to shift away from the typical first-come, first-serve patient appointment scheduling. Schedulers can triage appointments based on referral urgency and reason for referral.

➍Engagement with Patients from the Beginning LRMC and HLRMC use par8o to proactively schedule patients with

an appropriate provider in the network to ensure appointments are scheduled in a timely manner. This takes the burden of that process away from the patient. Feedback from the patient about that provid-er can then also be recorded.

➎ Effective Tracking LRMC and HLRMC can track the flow of patients between providers

and also the time it takes for providers to contact patients—in real time. We can then easily report that data to all who need it.

The ResultsSince launching par8o in June 2014, LRMC and HLRMC have

managed over 25,000 patient transitions. In a short period of time, both hospitals have seen improvements in how patients are engaged throughout the platform.

Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center are directly or indirectly owned by a partnership that proudly includes physician owners, including certain members of the hospitals’ medical staffs.



Best Practices

In the early 1960s, Lancaster County and communities across the nation were experiencing a shortage of general

medicine doctors. Physicians were retiring and, in an age of specialization, not enough family physicians were graduating from medical schools to replace them.

An American Medical Association com-mission looked into the family medicine practice situation, described as “moribund,” and reported, indeed, there was a shortage of medical school graduates. To remedy that, the commission recommended an

increase in the physician manpower pool and the creation of a new specialty to attract students into family medicine.

In the midst of this growing family prac-tice movement was an interested Dr. Nikitas J. Zervanos, who interned at Lancaster General Hospital from 1962-1963 and who was serving in Greece as a U.S. Medical Corp officer. He wrote to his dean, Dr. Sam Gurin, at the Hospital of the University of Pennsylvania, to explore what his school was doing regarding the development of this new specialty.

At that time, Penn Medicine was not in the forefront in these negotiations. Dr. Gurin told Dr. Zervanos to get in touch with Dr. Joel Alpert at Harvard. Dr. Alpert was a pioneer in pediatric primary care training and Director of the Family Health Care Program, which was preparing physicians of internal medicine, pediatrics and general practice for academic careers in the proposed new specialty of family medicine.

Dr. Zervanos also contacted Dr. James Z. Apple, a general practitioner in Lancaster County and president of the American Medical Association, who provided strong encouragement. Following additional train-ing in internal medicine at the Philadelphia VA and Penn, Dr. Zervanos completed his fellowship at Harvard and came to LGH in July 1969 to establish Lancaster General Hos-pital’s Family Medicine Residency Program.

At its core curriculum was—and still is—a commitment to community service, administering to the underserved in both the urban and rural settings, and providing comprehensive care to women through all aspects of pregnancy—all concepts unheard of at that time.

Forty-five years later, as founding director and one of the first physicians in the coun-try to tackle development of a three-year specialization program in family medicine, Dr. Zervanos has guided Lancaster Gen-eral Health’s Family Medicine Residency Program to national prominence.

In September 2014, the program was ranked fourth in the nation in the Family Practice category by Physician network Doximity and U.S. News & World Report; and in January 2015 it was ranked number one in the northeastern United States.

“The proof of our success is the quality of our family physicians in Lancaster County and around the country,” said Dr. Zervanos, who continues to serve as Director Emeritus.

“So many of our graduates—so many—are stars in their respective communities.”

Dr. Stephen D. Ratcliffe, who succeeded Dr. Zervanos as Program Director in 2002,

LANCASTER GENERAL HOSPITAL’S FAMILY MEDICINE RESIDENCY PROGRAM

Celebrates 45 Years O F C A R I N G F O R T H E C O M M U N I T Y

Dr. Nikitas J. Zervanos, left, founder and Director Emeritus of Lancaster General Hospital’s Family Medicine Residency Program, and Dr. Stephen D. Ratcliffe, current Program Director, recently celebrated the program’s national ranking with more than 200 current residents and graduates.


S P R I N G 2 0 1 5

45 Years of Caring for the Community

said the residency program’s 500 graduates include leaders in health systems, academics, and physician practices, and they are making an impact both locally and globally.

“One-third of Family Medicine Residency graduates remain in Lancaster County, and about two thirds of the 2015 class will remain in Lancaster County to practice family medicine,” he said. “If you do the math, we’ve been serving close to 1 million people because of the Lancaster General Family Medicine Residency program.”

Dr. Ratcliffe credits LG Health’s support of family medicine based clinical services and an infrastructure that gives residents the opportunity to develop critical and analytical skills to help them in their future practice.

“Lancaster General Health’s Research Insti-tute and Comprehensive Care Medicine, which treats patients with HIV, are two examples of how we provide our residents with in-depth and wide-range knowledge in the medical field.”

Where are some of LGH’s Family Medicine Residency graduates today? Here’s a partial listing of those serving in Lancaster County:

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Over 40 years ofremarkable outcomesand compassionatecare.

Dr. Jeffrey R. Martin: Lead Physician for LG Health’s Care Connections, which helps high risk, high-utilizing patients at LG Health Physicians’ practices and Southeast Lancaster Health Services better manage their care. (As a resident, Dr. Martin volunteered with Vantage House, a program of Gaudenzia/Lancaster residential drug and alcohol treatment center for women with children, and he continues volunteering as medical director.)

Dr. Christine Stabler: Vice President of LG Health Academic Affairs.

Drs. Harrison McGrath & Andrea Stern: Established a new family practice in Mount Joy in 2013.

Dr. Steve Diamantoni: Managing Physician of Diamantoni & Associates and Lancaster County Coroner.

Dr. Kirsten Johnsen Martin: Medical Director of Southeast Lancaster Health Services.

Dr. Pam Vnenchak: Deputy Director of LGH Family Medicine Residency.

Dr. Donna Cohen: Assistant Deputy Director of LGH Family Medicine Residency.

Dr. Matthew Beelen: Director of LGH Geriatrics Fellowship.

Dr. John Wood: Chair of LGH Department of Family Medicine and Medical Director of Care Connections.

Dr. Christian Hermansen: Medical Director of Downtown Family Medicine and six other LG Health Physicians practices.

Drs. Chris Hager & Brian Young: Members of Managing Council for LG Health Physicians.

Dr. Kristin Nebel: Lead Physician of Geriatrics & Associates.



Each year, the Office of the Inspector General (OIG) releases its work plan, which identifies the areas of health

care on which the agency will focus its fight against fraud and abuse in Medicare and Medicaid. The work plan serves as a roadmap that can make the challenge of navigating the world according to Medicare a bit less daunting.

This year’s work plan includes three new project areas:

1. Hospital Wage Data Used to Calculate Medicare Payments: The OIG will determine whether there are appropriate controls in place for the collection and reporting of wage data, to ensure that only eligible services and compensation are included in the wage data reported.

2. Adverse Events in Post-Acute Care: The OIG will examine adverse events and temporary harm events to identify contributing factors, the extent to which the events were preventable, and the associated costs to Medicare.

3. Independent Clinical Laboratory Bill-ing Requirements: Medicare is the single largest payer of lab service, and the fact that lab spending has increased by almost 30 percent in a five-year period from 2005 and 2010 has got the attention of the OIG.

The OIG will use 13 measures to indicate possible questionable billing practices.

The OIG’s annual work plan also includes projects that have been carried over or extended from previous work plans, including:

• New Inpatient Admission Criteria: A review will be done to determine the impact of new inpatient admission criteria on hospital billing, Medicare payments, and beneficiary copayments. The review will also report billing variations among hospitals.

• Medicare Oversight of Provider-Based Status: Provider-based status allows facil-ities owned and operated by hospitals to bill as hospital outpatient departments. This can result in higher payments for the facilities, and increased beneficiary coinsurance liabilities. The OIG wants to determine whether provider-based facilities meet the Centers for Medicare and Medicaid Services’ criteria.

• Comparison of Provider-Based and Free-Standing Clinics: Medicare pay-ments for physician office visits in provider-based clinics and free-standing clinics will be compared to determine the difference in payments.

• Oversight of Hospital Privileging: The OIG will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials and review of the National Practitioner Databank. Medicare requires participating hospitals have a medical staff that operates under bylaws approved by the governing body.

• Part B Services During Nursing Home Stays: Congress directed OIG to monitor Part B billing for abuse during non-Part A stays to ensure that no excessive services are provided. Several broad categories of services, such as foot care, will be examined.

• Ophthalmologists inappropriate and questionable billing: Claims data will be reviewed to identify “potentially inappropriate and questionable billing” for ophthalmology services during 2012. This is driven by the fact that, in 2010, Medicare allowed more than $6.8 billion for services provided by ophthalmologists.

• Imaging Services, payments for practice expenses: A review of Medicare Part B payments for imaging services to deter-mine whether they reflect the expenses incurred and whether the utilization rates reflect industry practices. The focus will be on the practice expense components, including the equipment utilization rate.

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Healthy Communities

Epinephrine auto-injectors can help save lives when administered properly. Now, thanks to the School Access to

Emergency Epinephrine Act, schools around Pennsylvania are able to take measures to further ensure student safety.

Signed into law by former Pennsylvania Governor Tom Corbett on October 31, 2014, the School Access to Emergency Epinephrine Act permits schools to store epinephrine auto-injectors for adminis-tering to a student in the event that he or she is suffering anaphylaxis, a potentially life-threatening allergic reaction. It also requires designated faculty and staff members of participating school districts to complete a training program through which they learn the proper storing and administering techniques of epinephrine auto-injectors. The program also helps these individuals recognize symptoms of anaphylaxis (e.g., itching and swelling of the lips, watery eyes, swelling eyelids, nausea) in order to treat students as soon as possible.

Districts around the state are eager to begin the training process. Lead Nurse Sue

Myers elaborates on Solanco school district’s plans for its training program: “We are coordinating the Lancaster County school nurses with our certified NASN trainer Lisa Albert to present the ‘Saving Lives’ in partnership with Lancaster General Health’s

nursing director Claire Mooney and the Future Nurses Club. Then this fall, we are going to target as many staff and faculty members as we possibly can.”

Although students with known allergies have been permitted to carry and self-ad-minister their own epinephrine auto-injector prescriptions for some time, Myers explains that before the School Access to Emergency Epinephrine Act was put into place, students who have undiagnosed allergies and even students without prescribed epinephrine auto-injectors were not protected. Now, however, if a student is suffering an allergic reaction, a trained faculty or staff member’s liability is covered when administering an epinephrine auto-injector to the student. It also benefits students with known aller-gies who happen to forget their prescribed epinephrine auto-injectors or who may be carrying expired epinephrine auto-injectors.

In addition, Myers endorses the presence of epinephrine auto-injectors in schools by stating, “Epinephrine auto-injectors are easy to use, quick to administer, and low-cost to maintain adequate supplies through various programs.”

But who is providing the schools with epinephrine auto-injectors?

According to allergy specialist Dr. Clark Kaufman, participating schools can contact Mylan to receive two two-packs of EpiPen® Auto-Injectors at no cost as long as those schools produce written prescriptions.

The EpiPen4Schools® program was designed by Mylan Specialty to provide qualifying schools with either the EpiPen® or EpiPen Jr®, depending on the needs of individual schools. It is also possible for

A Step to Save Student Lives In Event of Life-Threatening Allergic Reactions

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schools to obtain one two-pack of each.

Myers adds that Mylan will also replace used EpiPen® Auto-Injectors.

“A large percentage of accidental ingestion cases occur in schools...and it is essential to treat an allergic reaction early on,” Kaufman says. He explains that medicine like Benadryl can take nearly half an hour to begin treating symptoms, whereas relief provided by the EpiPen® occurs shortly after injected and is much more effective in treating anaphylaxis.

Making the choice whether to keep epinephrine auto-injectors on hand in schools can prove to be a life or death decision, as Kaufman estimates that approximately one in four cases of allergic reactions can be fatal and that more deaths occur from food allergy reactions than from allergic reactions to bee stings and insect bites.

Treating a student with an epinephrine auto-injector does not, however, eliminate the need for the student to receive immediate professional medical attention. “Epinephrine will work for about

half an hour,” Kaufman explains, “and some children may have secondary reactions. Taking the child to the hospital is standard procedure to ensure that the recovery for the treatment is complete.”

He also explains that parents have nothing to fear from use of an epinephrine auto-injector: “The medica-

tion in the EpiPen® is a natural chemical the body already makes itself.” Therefore, there is no harm in administering an

epinephrine auto-injector to a person when he or she is mistaken for experiencing an allergic reaction.

This act is not an excuse for children with known allergies to avoid keeping their own epinephrine auto-injectors handy, how-ever. Myers stresses that these children need to be champions for themselves by carrying their prescribed personal medications with them as part of their daily attire.

By allowing the storage and administering of epinephrine auto-injectors by trained faculty and staff members in public and private schools, the School Access to Emergency Epinephrine Act may just be the next revolutionary step in ensuring the survival of students not just in Lancaster County but throughout the state of Pennsylvania as well.



Measles has made a comeback. Hav-ing been considered eliminated from the United States as of

2000, there have been more cases of measles in 2014 and early 2015 than we have seen in decades. The latest outbreak originated from an amusement park in California and had caused 176 cases involving 17 states as of March 13, 2015. After experiencing a fifteen-year high number of cases (644) in 2014, it is very likely that the U.S. will see even more cases of measles this year than last.

So, why has measles made a comeback? This resurgence is not due to a new strain of the measles virus, it’s not due to global warming, and not even health care reform can be blamed. The primary reason for

the spike in cases is declining vaccination rates. The vast majority of cases occurring in the U.S. today are among those that are unimmunized against the virus.

The first measles vaccine was licensed in the U.S. in 1963. Prior to use of the measles vaccine, nearly 550,000 measles cases were reported annually in the U.S., and of those cases, each year an average of 48,000 people were hospitalized, 1,000 people developed chronic disability due to encephalitis, and 500 died. Those are staggering statistics. Thanks to widespread use of the vaccine, the prevalence of measles in our country experienced a sharp decline in the 1960s and remained very low at the turn of the millennium. There were fewer than 100

cases per year from 2000-2013. Measles has not been completely eradicated from the U.S. partly because it is still common worldwide, with an average of 20 million cases and 146,000 deaths annually.

For those who think measles is a mild illness, think again. Measles starts with fever (as high as 105°F), malaise, and the three C’s—cough, coryza (runny nose), and conjunctivitis. These symptoms could be confused for the flu or a bad cold but are then followed by a rash that spreads from the head to the body and then to the legs. Common complications of measles include ear infection, pneumonia, and diarrhea. A less common but more severe complication, occurring in one out of 1,000 cases, is acute

MEASLES MAKING AN UNWELCOME COMEBACK:

CURTIS L. HERSHEY, MDLancaster General Health, Lincoln Family Medicine

Healthy Communities



S P R I N G 2 0 1 5

encephalitis (infection of the brain), which often results in perma-nent brain damage. One to two out of 1,000 children affected by measles die from respiratory or neurologic complications. Subacute sclerosing panencephalitis (SSPE) is a rare but fatal complication of measles characterized by seizures and progressive decline of neurologic function, which develops between seven to ten years after measles infection.

Those at highest risk of complications from measles include chil-dren less than 5 years of age, adults over 20 years of age, pregnant women, and those with compromised immune systems. Measles is one of the most contagious illnesses; after close contact with someone with measles, 90 percent of susceptible people (those who lack immunity) will develop the illness. Measles is spread by direct contact and by airborne exposure via coughing, sneezing, etc. The rash usually appears two weeks after exposure, but the incubation period can range from one to three weeks. Those with measles are contagious from four days prior to onset of the rash to four days after the rash disappears.

The diagnosis of measles should be confirmed by laboratory testing of either blood or nasal swab samples (or both). Treatment involves supportive care and alleviation of symptoms, as well as treatment for possible complications including antibiotics for secondary bacterial infections, such as ear infections and pneumonia. Due to the very high chance of spreading the illness to contacts, people with confirmed or suspected measles should be quarantined and excused from school or work until the contagiousness period passes.

Measles

The most recent measles outbreak has caused concern among many people who fear measles could spread throughout the U.S. and come to our area. While this has not yet happened, it is still a possibility. If nothing else, there has been raised awareness of this potentially dangerous but very preventable illness. I am also hope-ful that this will also cause parents to think twice before making a decision to withhold immunizations from their children. Again, the vast majority of measles cases in the U.S. occur in those who are not vaccinated.

The measles vaccine is a safe and effective method to prevent measles. A single dose of the MMR (measles, mumps, rubella) vaccine is 93 percent effective at preventing measles. A two-dose administration of the vaccine (as is recommended in the immuni-zation guidelines) is 97 percent effective. Herd immunity, in which nearly all individuals in a given community are immunized against a particular illness, increases the vaccine’s effectiveness, making it nearly impossible for a widespread outbreak of measles in a fully vaccinated community.

The MMR vaccine is recommended as part of the routine vacci-nation schedule for children, with the first dose given at age 12-15 months of age and the second dose given at 4-6 years of age. The

MMR vaccine is also indicated for other groups of patients that don’t have evidence of immunity to measles. Evidence of immunity includes at least one of the following: written medical records documen-tation of two doses of measles-containing vaccines given at appropriate intervals; laboratory evidence of measles immunity and laboratory confirmation of measles infection; and birth before 1957 (it is presumed that everyone born prior to 1957 had measles). College students, health care workers, international travelers, and adults born during or after 1957 without any of the listed evidence of immunity should receive at least one dose of MMR. Infants at least 6 months of age who will be traveling internationally should receive at least once dose of MMR prior to travel.

Again, measles is a potentially serious illness, which is preventable by a very safe and effective vaccine. If you are not certain you are immune to measles and think you are at risk, talk to your pri-mary care doctor. If you are a parent of a child who has not yet been immunized, protect your child from measles and have him or her vaccinated.



Healthy Communities

Burnout among physicians is occurring at an alarming rate and is on the rise, with nearly half of all doctors

surveyed reporting that they suffer from the condition. In this year’s Medscape Physician Lifestyle Report, 46 percent of all physicians reported burnout, which is commonly described as “loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment.” Physicians

Physician BurnoutA Local Take On A National Epidemic

SUSAN SHELLY

in five specialties: critical care, emergency medicine, family medicine, internal medi-cine and general surgery reported burnout at a rate of 50 percent or higher.

Some believe that physician burnout is actually significantly higher than reported, as doctors may be reluctant to admit they are feeling overly stressed. Results of physician burnout vary, but can include anxiety, low

morale, reduced levels of effectiveness, drug or alcohol abuse, and depression. Physician burnout affects doctors throughout the national health care system—including those in Lancaster County.

“I think it touches every single physician,” said Dr. Lee M. Duke, II, chief physician executive and chief medical officer at Lan-caster General Health. “The extent within any one physician is hard to know, but I believe everyone is touched by it.”

According to Dr. Anthony Mastropietro, system chief medical officer at Lancaster Regional and Heart of Lancaster Regional Medical Centers, a primary cause of phy-sician burnout is that demands on doctors continue to increase as resources shrink.

“Physicians are just being stressed to do more and more and more, for less and less and less,” he said.

Dr. Jon Shapiro, medical director at the Foundation of the Pennsylvania Medical Society’s Physician’s Health Program, shared that physician burnout was first identified several decades ago, but has accelerated due to a number of factors, including:

• A shift among physicians from being self-employed to becoming employees

• Increase in federal regulations

• The transition to electronic health records

• Ongoing pressures surrounding the threat of malpractice

• Push for larger volume with decreased reimbursements

• A shift from fee-for-service to pay-for-performance payment model

Shapiro said all of these factors, when added to an already stressful environment, can affect productivity and cause doctors to feel like they’re losing control of how


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they perform their work. “Physicians feel like they’re losing control over how they deliver care,” he explained. “They have ceded control to insurance companies and health care institutions and government.”

Duke points out that electronic record keeping has many advantages and probably has improved patient care, but it’s time consuming for doctors and frustrating for many patients who feel they are not getting the attention they should be. Many doctors have to add hours to their day to keep up with the electronic records, and according to Duke, “Many patients have complained that the doctor seems to spend more time with the computer than the patient.”

can have a bad night in the ER—maybe you lose a patient—but you’ve got to show up for work the next day,” he explained.

“There’s no taking time off because of some-thing like that.”

All of these pitfalls are causing many phy-sicians to re-evaluate the longevity of their careers. A 2013 survey of more than 20,000 doctors, conducted by Deloitte, noted that 62 percent of respondents felt “it is likely that many physicians will retire earlier than planned in the next one to three years.”

According to Heather Wilson, executive director of the Foundation of the Penn-sylvania Medical Society, the importance of reigning in physician burnout rises to a new level of priority with a well-docu-mented doctor shortage already looming and an aging population needing increasing amounts of medical care. “When a physician stops practicing medicine (due to burnout), it’s a tragedy for all the training and time put into that career,” Wilson said. “It’s a very bad thing for the institution and for patients who depend on quality care being available to them.”

She shared the issue of physician burnout is complex, and, while the answer to the problem is not clear, it is taken seriously and is being addressed. The state’s Physician Health Program provides help and resources for doctors, family members, and medical practices across Pennsylvania. And, the Foundation of the Pennsylvania Medical Society is planning a retreat for doctors to address this issue later this year.

“I think the fact that we’re talking about burnout and bringing it to the forefront of conversation is a good thing,” Wilson said.

“The key to solving this problem is to catch it (burnout) early and address it.”

Instituting a team approach to care, such as with a patient centered medical home model, may relieve some stress for physicians,

hopes Duke. But, doctors will still be called upon to shoulder the bulk of the work and be burdened with administrative tasks that have become the new norm.

Carl J. Manelius, director of physician affairs, shared that Lancaster General Health is looking closely at the issue of physician burnout and working to assure that its doctors are able to maintain a favorable work-life balance. The health system held a program on physician burnout and has resources in place for doctors who ask for help. “It’s certainly something that’s on our radar screen here,” said Manelius.

Lancaster Regional and Heart of Lancaster Regional Medical Centers also are paying attention to the issue of physician burnout, and are working to keep conditions favorable for doctors. “We work really hard to make sure our people are fairly paid, with benefits and consideration for their time,” remarked Mastropietro. He praised doctors throughout Lancaster County, saying they are commit-ted to patient care and heroic in the face of increasing responsibilities and stress. “I just thank God for all the dedicated physicians I work with and around the county who continue to work to serve patients.”

Duke believes the solution to physician burnout is to get doctors back to doing what they trained for—working with patients and practicing medicine without all the distrac-tions they currently face. “I’m not sure how we can make that happen, but as doctors, we need to reconnect with why we put our scrubs on in the morning, and what makes us smile when we’re leaving in the afternoon,” said Duke. “We need to remember why we went into medicine in the first place.”

“Physicians are just being stressed to do more and more and more, for less and less and less.”

Government regulations, including the Affordable Care Act and policy and payment changes to Medicare and Medicaid, are another major source of stress for doctors. For younger doctors with high amounts of student debt, decreased reimbursement for services is a particularly acute problem.

“You can’t expect people to come out of medical school with $200,000 worth of debt and not consider what they’re going to get paid to be important,” Duke shared.

“There’s a high level of deferred income until a doctor starts practicing, and there’s got to be some reward for that.”

“The old idea of the rich doctor is quickly becoming passé,” said Mastropietro.

Health care providers—particularly physi-cians—face grueling schedules, Duke noted, and they are expected to meet those time demands regardless of circumstances. “You

Healthy Communities Physician Burnout

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Patient Advocacy

From Coverage To Care (C2C) was launched by the Centers for Medicare and Medicaid Services (CMS) to help consumers who have health insurance for the first time understand their new coverage and help them get the primary care and preventive services they need. In addition, it gives information to health care providers and staff so they can more effectively answer questions from patients.

Project Access Lancaster County (PALCO) uses this resource with their clients and finds it to be very helpful in orienting clients to the health care system. Many people who have never had health insurance before need to learn where they should go for care and the differ-ence between when to call their doctor’s

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You can find more about C2C and access its tools by visiting the CMS web-site and typing search term “C2C” at https://marketplace.cms.gov.



Patient Advocacy

The Affordable Care Act (ACA) and the expansion of Medicaid in Pennsylvania have made immense strides in expanding access to affordable health coverage. However,

some lower- and moderate-income consumers still struggle to afford coverage and care, even with the help of federal financial assistance. The Lancaster County Medical Foundation is gathering

information on what is working well and what gaps exist as this new world of health coverage develops. It seems clear there will be individuals who will find “affordable” care beyond their means.

The Lancaster County Medical Foundation proposes creating a countywide medical support program, targeted to assist primarily low-income families whose insurance has high copays and deductibles; we would also assist individuals without health insurance as a system of last resort.

PALCO ceased to provide donated medical services to low-income Lancaster County residents on April 1st of 2015. PALCO will continue to assist individuals in applying to the ACA program and the Medicaid expansion program, Healthy PA.

Lancaster County Medical Foundation’s PALCO Program Launches Countywide

Medical Support Program

LISA RIFFANACHTExecutive Director, PALCO (Project Access Lancaster County)

An Initiative To Help Residents Afford & Understand Affordable Health Care


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PALCO Launches Medical Support Program

Premium AssistanceWhile initial reports from the Health Benefit Exchange indicate

that most people are maintaining their premium payments, recent information shows that some enrollees ended their enrollment either due to non-payment or voluntarily.

PALCO will pilot a premium assistance program, with $50,000 of foundation dollars. For people who live at or below 200 percent of the federal poverty level (FPL), PALCO will pay half of their premiums for one year. Individuals who earn below 138 percent of the FPL are eligible for Medicaid. Above that level, they must buy their insurance through the ACA exchange.

Nearly 10,300 people in Lancaster are newly enrolled in the Affordable Care Act. Many more had the chance to buy subsidized health insurance on the Marketplace (starting November 15, 2014) for a fraction of the sticker price.

A mid-range “silver plan” that costs $540 on the open market is just $127 a month once federal subsidies kick in for a 50-year-old Lancaster couple whose income is $30,000. This is about 5 percent of their wages. For a couple scraping by on $30,000, there is little discretionary income, and even 5 percent can be a hit they can’t afford. Needing to fix the car or repair the water heater could make the insurance unaffordable during that month. The new premium assistance program would help ensure that people who took a chance and signed up for coverage won’t have to drop out if the premiums become too expensive.

PALCO would limit the program because it could not assist a huge number of people. To be eligible for premium assistance, individuals would need to meet three basic requirements. 1) Be a resident of Lancaster County, 2) purchase a silver plan available among the insurance providers listed in the Health Insurance Marketplace, and 3) be under 200% of the federal poverty guidelines. In order to comply with the guidance issued by Centers for Medicare and Medicaid Services (CMS), PALCO would have to provide financial assistance for a full year. The silver level plans are the only plans that provide tax credits as well as cost sharing assistance to individuals, making the out of pocket costs more affordable.

Hospitals or their foundations have long paid premiums for some patients. But the issue of “third-party payments” has taken on new urgency because of a provision in the federal health law that could leave providers on the hook for unpaid bills. Under the law, insurers must give subsidy-eligible enrollees who fall behind on payments a 90-day “grace period” before cancelling their policies.

While insurers must cover bills for the first 30 days, they may hold off paying those bills for the next 60—and ultimately, deny payment if the patient doesn’t catch up on premiums. That means doctors and hospitals face the prospect of not getting paid for their services, or having to seek payment directly from their patients.


Just as with PALCO, we would ask the local hospitals and insur-ance carriers for financial support to provide the premium assistance dollars. Highmark Blue Shield has voiced interest in funding such a program. This program aligns with hospitals’ charitable missions and helps a vulnerable population obtain much-needed health care coverage. Hospitals are required by law to give some charitable care for free to the community. Paying the premiums of low-income people may make those charity dollars go farther. It seems a more cost-effective option than waiting for uninsured people to show up in their emergency rooms, ultimately unable to pay their bills.

Mental HealthPoor mental health has been closely linked to physical health,

particularly to the prevention of individuals taking part in healthy behaviors and recovery from chronic disease. Based on state and national data, more than one in six Lancaster County residents (nearly 98,000 individuals) have a diagnosable mental, behavioral, or emotional condition. Many more are likely undiagnosed and untreated, including those without health insurance or with high copays and deductibles. The current system of care is fragmented and in need of repair to form a strong link between medical care and mental health (MH) services. Our county lacks resources for patients to turn to for help and there is no quick, seamless provider referral and feedback system.



This new initiative, intended as a payment system of last resort, is targeted to assist individuals without health insurance and the primarily low-income families whose insurance has high copays and deductibles. Based on the 350 uninsured and underinsured individuals served in 2013 by local non-profit MH providers, an estimated 450 individuals will receive support in Year One with approximately eight visits per year.

Specialty CarePALCO would continue to assist the uninsured. Primary care

is available to this group through Southeast Lancaster Health Ser-vices on a sliding scale fee. Copays and the full costs of specialist charges are roadblocks to further care where it becomes necessary. We would negotiate lower fees with specialists willing to see the undocumented, perhaps at the Medicaid or Medicare rate. Specialists would not be asked to provide routine care, such as diabetic eye checks, only needed treatment or evaluation. Compensation for providers would be paid by PALCO.

Patient Advocacy

Many of these Americans are now contending with unfamiliar insurance terms and are at risk of making uninformed choices that they may regret. This matters because those with low health literacy already tend to experience poorer health and to generate increased costs.

Our ACA Counselors have spent up to five hours helping just one patient apply for insurance through the Marketplace. We need to explain basics like premiums and deductibles, as well as how to compare insurance options. We have walked patients through checking to make sure their current doctors will be covered under new plans. Notably, despite having proficient health literacy and training, the coordinators have sought assistance to confirm the finer details. Clearly, these are not easy tasks.

A required part of receiving assistance through these new initia-tives would be that the families participate in a health literacy class developed by PALCO, with tools from the Marketplace.

Families will also be required to participate in financial education classes through Tabor Community Services. They may choose between: “Budgeting: Making a Money Plan That Works,” “Sav-

ings: Making Your Money Work for You,” “Banking Basics,” or “Good Credit and How to Get It.”

Additionally, Preferred Health Care (PHC) offers an online wellness portal that we will make available to grantees. Counseling on such topics as quitting smoking, losing weight, eating better, treating depression, and reducing alcohol use can improve health and reduce costs by preventing illness.

Preventative CareBefore the health care law, too many Americans did

not get the preventive care they needed to stay healthy, avoid or delay the onset of disease, and reduce health care

costs. Often because of cost, Americans used preventive ser-vices at about half the recommended rate. The Affordable Care

Act makes preventive care affordable and accessible by requiring certain private health plans to cover certain recommended preventive services without charging a deductible, copayment, co-insurance, or other cost sharing. Under this new requirement, those services (including well-woman visits, support for breastfeeding equipment, domestic violence screening and counseling) became more broadly available without cost sharing.

We will require that all individuals participating in these initiatives have an annual physical.

PALCO is a trusted service provider for the medical community and the uninsured. PALCO has strong expertise in coordination of donated services as well as culturally competent insurance enrollment and navigation. By developing a countywide medical support program, we will support the local medical community as we navigate the new health care system.

Health LiteracyA recent study from the Urban Institute indicates that a majority

of those most likely to use the Marketplace are not confident in how well they understand even rudimentary health insurance terms.

Health literacy involves the ability to obtain, process, and understand the health information necessary to make appropriate decisions. It’s clearly essential to selecting health insurance. More Americans are enrolling in federal- and state-based marketplaces, but being insured is only the beginning when it comes to reducing health disparities related to literacy.

PALCO Launches Medical Support Program


S P R I N G 2 0 1 5

Patient Advocacy

❶Increasing the responsibility of CRNPs is not the solution to shortage of physicians.

❷The best and most effective care occurs when a team of health care professionals with complementary—not interchangeable—skills works together.

❸The collaborative requirement between CRNPs and physicians enhances rather than impedes the ability of CRNPs to deliver quality patient care.

❹The education and training of a CRNP falls significantly short of the education and training of a physician.

❺Collaborative requirements do not prevent CRNPs from currently practicing in rural and underserved areas.

❻Current licensure standards are not arbitrary; they serve an especially important function in supporting critical safety and quality objectives.

❼A majority of states require CRNPs to have a physician’s collaboration or supervision in order to practice, with many states requiring even more stringent oversight than what currently exists in Pennsylvania.

Many physicians across the state, as well as the Pennsylvania Medical Society (PAMED), support physician-led, team-based care, in which all health care team members work together collaboratively, but the physician is the leader of the team.

Legislation that has been already introduced in the House, House Bill 765, and is expected to be re-introduced in the Senate, proposes an unacceptable alternative—allowing certified registered nurse practitioners (CRNPs) to practice independently without a link to the team through their collaborative agreement with a physician.

Why keep the team together? Here are seven reasons:

Urge your state legislators to maintain physician-led, team-based care across Pennsylvania, and oppose HB 765 and any other legis-lation that would allow CRNPs to obtain independent licensure and eliminate collaborative agreements between CRNPs and physicians.

Learn more at www.pamedsoc.org/teambasedcare.

To Keep The Health Care Team Together

REASONS



Medical Society Updates

On a brisk autumn day in 2009, an unseasonably cold wind swept through a gathering of physicians

in Hershey. In one blast, it turned the doctors’ normally congenial, pleasant gathering on health issues like the H1N1 pandemic and changes in Medicare, into a sea of surprised and angry faces.

The meeting was the gathering of more than 250 member physicians and others for the annual PAMED House of Delegates in Hershey, Pa.

The cold wind: News that the Pennsylvania General Assembly and then-Gov. Rendell had raided the Mcare Fund—taking funds that were not taxpayer dollars, but rather solely money from doctors and hospitals—in order to balance the 2009-2010 state budget.

“I recently had a considerable amount of money taken from me,” said James Good-year, MD, PAMED president at the time.

“I had paid my medical liability insurance bills, confident they would use my money as intended to help injured patients. But a highly sophisticated organization suddenly took it all and said it needed it for something else. Who took it? Our state government.”

Despite the magnitude of the loss and the daunting uphill court battles they would face, the physicians did not turn away in resignation to this injustice heaped upon their giving profession. Instead, they imme-diately shouldered the burden, aligned with

the Hospital & Healthsystem Association of Pennsylvania (HAP), and filed legal actions.

PAMED had already aligned with HAP and the Pennsylvania Podiatric Medical Association (PPMA) to appeal the 2009 assessment and challenge Mcare’s inappro-priate build-up of reserves via assessment overcharges. PAMED and HAP filed similar appeals in each subsequent year for the 2010–2014 assessments.

The goals of the actions were to ensure that, in the future, the commonwealth never

“By no means does this mean

the battle is won. Pennsylvania

physicians’ medical liability rates are still too high. Too

many frivolous suits are still filed. The Mcare Fund still has a $1.3 billion unfunded liability. But a small bit of justice has been achieved. It just

means that when we unite, we can stand up for our rights and win.”

— Karen Rizzo, MDPAMED President

Mcare Settlement to Return $200 Million to Physicians and Other Providers—Includes Future Protections

45% Decline in Medical Liability Filings*

The fact is that PAMED has made a lot of progress on tort reform, and our list of

accomplishments is pretty long. For example, did you know that annual medical liability

lawsuit filings are down 45 percent from what they were a little more than a decade ago?

That’s right—medical liability lawsuits against physicians and hospitals have been cut nearly

in half thanks to our hard work.

*Data demonstrates a 45% decline in the total number of medical liability filings between 2012 and the base

years 2000–2002.

Reprinted with permission from Pennsylvania Physician Magazine ©2015


S P R I N G 2 0 1 5

provides $500,000 of medical professional liability coverage to physicians, hospitals, and certain other health care providers above their basic coverage. The covered health care providers must pay an annual assessment to fund the cost of the fund’s claim payments and other expenses.

The settlement agreement requires that $200 million be returned to physicians, hospitals, and other health care providers

—$139 million in refunds for prior assess-ment overpayments and $61 million via a reduction to the 2015 Mcare assessment.

Perhaps more importantly for future Penn-sylvania physicians, the settlement includes key protections against any future diversion. Moving forward, the commonwealth agreed that Mcare funds will be held in trust and will not be considered the general revenue of the commonwealth.

The commonwealth also has agreed to operate the fund on a pay-as-you-go basis going forward. This means that health care providers will not be required to put money into the fund until it is needed and the fund will not be able to build up substantial reserves such as those diverted in 2009.

“Without the Pennsylvania Medical Society and our partners on their side, impacted physicians may not have found justice,” said PAMED President Karen Rizzo, MD. “This is a valuable benefit to membership,” she said, asking all nonmembers to consider joining and thanking members for their support.

“This is just one reason why the Pennsyl-vania Medical Society plays an important function on behalf of physicians,” said Dr. Rizzo. “Without a strong membership, physi-cians do not have a strong voice in Harrisburg.”

2015 Assessments Reduced by Almost 50 Percent

Last November, Pennsylvania physicians and hospitals heard more good news regard-ing their Mcare assessments. The Mcare Fund announced that the 2015 assessment will be 12 percent of the prevailing primary

FROM A PHYSICIAN’S PERSPECTIVE: An Interview with Daniel Glunk, MD

Q: You were president of PAMED when this whole thing started. Take me back to that time. How did you feel as a PA physician? As president of PAMED?

A: We had heard that raiding these funds was being considered, but we were quite surprised by this action. We had worked very hard to try to dissuade them from doing that. The first was when they took the money from the retention account and that was followed by the $100 million they took from the Mcare Fund.

My view was that taking the money from the retention account could be considered business as usual, but raiding Mcare was personal and required action.

Q: What do you mean by that?

A: The retention account was being funded through cigarette tax. This money was supposed to be used to fund the Mcare abatements in effect from 2003 to 2007. However, the state underfunded the abatements and then took the money that had been earmarked for that purpose. It was very disappointing to learn that the physicians with partial abatements actually funded the abatement program. What was clear was that the money from the Mcare Fund was money that physicians and other health care providers had paid directly into that fund.

Q: This has been a several year battle. How did those feelings change over the years? How did you feel when you found out about the recent settlement?

A: We had a lot of discussions and serious thought at that time about whether or not we should pursue legal action and what the potential consequences would be. But in the end, it was the right thing to do. And then we started winning, and we kept winning, which really was quite encouraging. But, then again, every time we won, we thought they’d have to figure out a way to settle with us, and that didn’t happen. The years went on and it ended up in the Supreme Court. We kept fighting the fight but didn’t know what the conclusion would be. We must congratulate the then-Corbett administration for taking the right action.

Q: How vital was PAMED and its physician leadership to this outcome?

A: It was very important that PAMED’s leadership understood what was at stake and that each succession of leadership took on this challenge and kept moving it forward. It wouldn’t have been successful if everyone in succession hadn’t continued to state that this was an important thing and we needed to have protection against it happening again. It also wouldn’t have happened without PAMED, HAP, PPMA, and other groups working together to carry this through.

Q: What would you say to nonmembers who question the value of PAMED?

A: Every Pennsylvania physician has benefited from this. Nonmembers who collect this windfall should consider putting part of their payout toward joining organized medicine. The money would more than pay for membership dues. The more members PAMED enlists, the stronger the physician voice is in the state when it comes to policy change. More work like this can be done on behalf of the physician workforce.

Mcare Settlement


diverts assessment dollars paid by physicians, hospitals, and other health care providers to the state’s general fund again.

Finally, in late October 2014, after more than six years in the courts, PAMED, HAP, and PPMA settled their litigation with the

commonwealth regarding the Mcare Fund and appeals of prior assessments and the challenge to the transfer of $100 million to the general fund from Mcare in 2009.

The Mcare Fund, administered by the Pennsylvania Department of Insurance,

3 Reasons Why You Should Initiate3 Reasons Why You Should Initiate

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You can avoid deactivation of your billing privileges and disruption to your reimbursement.

717-DOC-HELP (717-362-4357) • www.pamedsoc.org/revalidation

� e March 26, 2016, revalidation deadline is closer than you think. Plus, that date is NOT the submission deadline; it’s the deadline by which your enrollment application must be processed and approved and updates to the PROMISe™ system must be completed.

1Pennsylvania’s Department of Human Services (DHS) expects longer wait times for approvals so it’s imperative to submit applications immediately.2

You won’t receive a written notice from the DHS. It’s your responsibility to initiate the revalidation process.3


S P R I N G 2 0 1 5

premium, or overall, 47.8 percent lower than the 2014 assessment of 23 percent.

Part of the decrease stems from the $61 million that the Mcare settlement required to be used to reduce the 2015 assessment. The remainder stems from a substantial reduction in the claim payments in 2014. The starting point for the assessment calculation is 110

FAQs About the Mcare SettlementPhysicians have many questions about the settlement and how it will process their refunds. While it will take more than a year for the state to develop and implement the complicated formula for calculating refunds, in the meantime here are answers to some common questions.

Who is eligible for the refunds? Physicians will be eligible for a refund if they paid an Mcare assessment (or an assessment was paid for them) for any time during 2009, 2010, 2011, 2012, or 2014 (excluding 2013). Some physicians have multiple primary policies and pay multiple assessments, so they are entitled to a refund for each policy in each year that is covered.

Why is 2013 excluded?Refunds are for overpayments. Looking at assessment calculations over the years, it was determined that there weren’t overpayments in 2013, which is why there are no refunds for assessments paid in 2013.

When will I get my refund?The refunds may not be made until 2016 due to the extensive calculations required to determine the amount payable to each eligible health care provider and the large number of providers that will be eligible for a refund. However, the 2015 assessment will be reduced by about $61 million (about one-third from what it would have otherwise been).

Will I be required to remit my refund to an employer who wrote the check for my assessments? This will vary depending upon your circumstances. For example, even though an employer wrote the check, you may have ultimately borne the cost due to an overhead reduction from your compensation pool. The settlement does not impact any contractual or other obligation that a health care provider may have to remit a refund.

How much will the refunds be? This will vary depending upon the years in which you paid an assessment and the amount of the assessments that you paid. A percentage reduction will be calculated for each year and you will receive a refund for each year in direct proportion to the assessment that you paid.

I’m retired at end of 2014. As a retiree, will I be part of this? If you were practicing at any time from 2009-2014, you will be eligible for a refund for those years, excluding 2013. Since you will not be practicing and paying an assessment in 2015, you will not share in the 2015 prospective assessment relief.

I was talking to my state Representative, and he doesn’t know where the money will come from.Right now, the money is in the Mcare Fund. This is not money the state is repaying back to the Mcare Fund. It’s money that has accumulated in the fund as a result of over charges. The commonwealth has agreed that there is $200 million in the fund for this settlement.

Get the latest information and updates on the Mcare settlement at www.pamedsoc.org/mcare.

Making a Difference to Reduce Defensive MedicineRecent Pennsylvania Supreme Court data on medical liability lawsuit filings and verdicts show a decline in the number of filings in Pennsylvania, continuing a spiraling trend seen in eight of the last 10 years since systematic collection of the statistics began. While there is a great deal more to do, we have achieved many important remedies addressing major physician concerns, including:

• APOLOGY: Makes physician apologies and other benevolent gestures (except admissions of fault or negligence) to a patient after a poor outcome inadmissible to prove liability in a medical liability action.

• EXPERT WITNESS QUALIFICATIONS: Establishes expert witness qualifications.

• VENUE: Requires that cases be filed only in the county where cause of action arose.

• JOINT AND SEVERAL LIABILITY: Modifies this rule so that defendants less than 60 percent liable are only responsible for their proportionate share of the award.

• CERTIFICATE OF MERIT: Requires attorneys to also file a professional liability action to file a certificate of merit, stating that he or she has a supporting report from a qualified expert.

• PUNITIVE DAMAGES: Allowed only if a provider engaged in willful or wanton conduct or in reckless disregard to rights of others and caps damages.

• AFFIDAVIT OF NON-INVOLVEMENT: Allows defendants to get quick dismissal by filing this, stating that they were not involved with the plaintiff’s care.

• COLLATERAL SOURCE RULE: Limits double recoveries for past “losses” covered by collateral sources.

• PERIODIC PAYMENT: Mandated for future medical damages with cut off at death.

• REDUCTION TO PRESENT WORTH: Mandates reduction to present worth of future work loss damages.

• STATUTE OF REPOSE: Seven-year absolute time limit on filing claims, with some exceptions.

• REMITTITUR: Requires the court to consider the adverse impact of a verdict on availability or access to health care in community when ruling on motion to reduce verdict.

Next Steps in the Medical Liability BattleWhile we have accomplished a great deal, we have much more to do. Frivolous lawsuits are still being filed and liability insurance costs remain high for physicians. PAMED’s vigorous tort reform agenda includes the following initiatives:

• Strengthen the Certificate of Merit Supreme Court Rule.

• Tighten the expert witness requirements under Act 13.

• Require a finding of gross negligence to award non-economic damages.

• Require clear and convincing evidence of gross negligence to find liability in emergency care.

• Obtain limits on plaintiffs’ attorney fees.

• Provide immunity from medical liability lawsuits to physicians who volunteer at non-profit clinics.

percent of the prior year claim payments and expenses.

Claim payments declined 19.7 percent from $193.9 million in 2013 to $155.7 million in 2014. At this point in time, it is not known whether the reduction in claim payments will be sustained, as they have fluctuated significantly in recent years.

Mcare SettlementMedical Society Updates



Last fall’s Mcare settlement requires that $200 million be returned to physicians, hospitals, and other health care providers. This includes $139 million in refunds for prior

assessment overpayments for 2009, 2010, 2011, 2012, and 2014.

Who is eligible to receive refunds?

How are refunds calculated?

Are physicians required to remit their refund to another person or entity that paid the assessment, such as a medical practice or hospital?

What should physicians and medical practices do over the next few months to protect their interests?

These are some of the questions the Pennsylvania Medical Society (PAMED) attempted to answer in a new website, www.McareRefund.org, which debuted April 1.

The first round is refund checks, tentatively scheduled to be sent to physicians in the first quarter of 2016.

But to ensure that they make informed decisions and receive payment of refunds that they are entitled to keep, physicians need to understand several possible scenarios and actions that could arise from those scenarios.

For example, a person or entity that paid the assessment for the physician may make a claim on that refund. The claim period has started and runs through August 19. Physicians will be notified of a claim through the mail—tentatively scheduled for the fall of 2015—and will be directed to a website where they must choose whether a claimed refund should be paid to them or have Mcare pay the claimant.

A person or entity that paid your refund also may ask you to fill out an assignment agreement if it did not make a claim on the refund. Medical practices and other assessment payors are permitted to begin asking for assignment agreements once they obtain the required forms from Mcare. The form to request these assignment agreement forms is now available on the Mcare website.

The www.McareRefund.org website that PAMED created was designed to give physicians and medical practices the proper information to help them understand these scenarios and make the best decision.

PAMED also has a webinar on www.McareRefund.org that provides an overview of the Mcare refund process.

WebsiteExplains Process

For Obtaining Your Mcare Refund


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The House Professional Licensure Committee held a meeting on April 1 to consider HB 516, which would provide for the licensure of “naturopathic doctors,” and grant them a

formal scope of practice.

The bill would permit licensed naturopaths to independently prevent, diagnose, and treat human health conditions, injuries, and diseases. They could order and perform physical and laboratory examinations, and order diagnostic imaging studies.

They would be authorized to utilize invasive routes of admin-istration for their tests and treatments that include “oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcu-taneous and intramuscular.”

This concerns us for several reasons. The level of credibility that state licensure establishes could be misleading to the average Pennsylvanian by implying that naturopathy is equivalent to mainstream medicine.

“Naturopathic medicine” is defined in HB 516 as “a system of primary health care.” Patients may see unproven and possibly unsafe treatments by “naturopathic doctors” as a substitute for conventional medical care.

If there is doubt about whether the bill allows naturopaths to perform a particular test or treatment, the question would likely be resolved in their favor, as Section 102 (4) specifically calls for the act to be “liberally construed.”

And, there is no requirement in HB 516 that naturopaths collaborate or refer complicated medical cases to a physician. Shouldn’t a naturopath who is concerned enough about a patient to order a CAT scan immediately refer that patient directly to a physician?

There are also concerns of oversight and logistics. HB 516 would require the State Board of Medicine to estab-lish and maintain the necessary infrastructure for a mere handful of people. Our information is that fewer than 100 naturopaths would qualify for licensure under HB 516. The vast majority of Pennsylvania naturopaths would remain unlicensed after the bill is enacted, adding confusion and providing little, if any, protection to the general public.

Similar legislation was approved by the House during the 2013-14 session, but died in the Senate. As we did then, we’ll share our concerns with lawmakers. Stay tuned, and we’ll keep you up to date on any important developments.

Naturopathic Licensure Bill Scheduled for Committee Consideration

SCOT CHADWICK




60-210 days. In some instances, the local MAC needed to “recycle the provider file” to correct the problem. This in turn, by the press of a button, corrected the problem, allowing the practice to resubmit its attestation. In other instances, the Electronic Funds Transfer (EFT) information for the group needed to be updated for those providers not yet revalidated.

➋ EHR payment adjustment being assessed despite successful attestation

Imagine being a successful user of MU and receiving your 2015 Medicare reimbursements reduced by 1 percent with remittance code N700 (Payment adjustment based on Electronic Health Record). Your practice never received a letter from CMS advising that your provider was subject to a penalty, your attestations were successful, and you have documentation stating such. One of your providers was audited, but the result of that audit was favorable again with supporting documentation. So, how can your practice be assessed a penalty?

In order to get to the root of the problem, PAMED placed a call to the EHR Information Center (888-734-6433) and is awaiting further information on this issue. At this point, we do not have any clear-cut answers as to how and why this is happening. We do know that an informal review form should not be completed unless a penalty letter was received by the provider. This is an error on CMS’ end, which will need to be corrected. What is unfortunate is the administrative burden the practice’s billing staff will face in reapplying the 1 percent corrected payments.

➌ Prepayment audit letter received only after two days of submitting Stage 2 attestation

We can only speculate that CMS has realized the difficulties physicians have had meeting the objective thresholds for Stage 2 due to the stringent requirements. Therefore, after

Regulatory Updates

Numerous eligible professionals have been working dili-gently to meet Meaningful Use (MU) measure objective thresholds, whether by using the Flexibility Rule or by

attesting to the stringent requirements of Stage 2 in 2014.

The Pennsylvania Medical Society (PAMED) has received quite a bit of feedback from our membership regarding the MU program, and some potential problems and issues they are experiencing such as:

• Attestation rejections related to information within the PECOS system not aligning with the information within the EHR Incentive Program Registration and Attestation System

• EHR payment adjustment being assessed although attestation was successful

• Prepayment audit letter received only after two days of submitting Stage 2 attestation

Let’s take a moment to discuss each one of these topics individually.

➊ Attestation rejections due to PECOS mismatch with EHR Incentive Program Registration

According to the Centers for Medicare and Medicaid Services (CMS), providers who received this rejection would need to contact their local Medicare Administrative Contractor (MAC) Enrollment department because information within the PECOS system does not match what is listed in the EHR registration and attestation system.

When researching this problem, PAMED found a direct correlation to the revalidation process. Numerous practices having revalidated one or more providers within their group still had remaining providers yet to be revalidated, a sce-nario that seemed to cause the attestation to be rejected. Providers still in the revalidation process also would be rejected for a PECOS mismatch. In conversation with CMS representatives, revalidation processing may range from

MEANINGFUL USE ATTESTATION IS COMPLETE, Now Breathe a Sigh of Relief — Or Can You?

CONTRIBUTED BY PENNSYLVANIA MEDICAL SOCIETY’S PRACTICE SUPPORT TEAM


S P R I N G 2 0 1 5

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providers submit attestation, audit requests follow shortly thereafter. Some feedback PAMED has received from its members is that audit requests have been received within two days of attestation or even within hours after Stage 2 attestation.

Providers need to be certain to have all of their documen-tation ready and in hand to send to Figliozzi and Company to support all the Core and Menu objectives. Any measures that were answered with a yes/no, screenshots, or reports from the EHR supporting that answer should be provided.

Let’s take the example of Core Measure 11 (Generate patient list by specific conditions). When attesting, the system simply states, “generate at least one report listing patients of the eligible professional with a specific condition.” The provider must mark a yes or no. To support this measure in the case of an audit, the practice will need to show that a report was indeed run during the attestation period to support their answer.

MU continues to be a controversial issue and struggle for many providers. Those providers who choose not to participate due to the burdensome requirements and associated costs, as well as those providers who choose to participate to avoid the associated payment adjustments to their Part B fee-for-service reimbursements, must deal with aggravating issues like those issues listed above.

PAMED has the resources to help practices meet MU require-ments, earn incentives, and avoid penalties.

One of the most common causes for a failed audit is insufficient documentation of the Security Risk Analysis (SRA). PAMED has a toolkit available to assist practices in the completion of the SRA. This toolkit and other HIPAA-related resources can be found at www.pamedsoc.org/hipaa.

PAMED has educational webinars on MU, available at www.pamedsoc.org/webinars. MU incentives and penalties also will be a topic at our spring practices manager meetings across the state. Learn more and register at www.pamedsoc.org/managermeeting. Watch your email inbox for the Daily Dose, PAMED’s daily, all-member email, as it contains the latest news and resources to help you and your practice navigate the challenges you face, such as MU.

PAMED members who have questions about MU can contact our Practice Support Team at (717) DOC-HELP, that’s (717) 362-4357.

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Regulatory Updates



Ma(i)son230 N Prince St., Lancaster, PA 17603

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Restaurant Review

My husband and I had been hoping to dine at Ma(i)son for quite some time. Many of our

close friends have told us how delicious the food is, and we liked the owner’s vision of creating a menu based on farm to table dishes. When I was asked to write a restaurant review, I felt it was the perfect opportunity for my husband and I to take advantage of a night out together.

We went to Ma(i)son on a Wednesday night in February. When I called the restau-rant to make a reservation, I was prompted by the answering machine to schedule my reservation online through the OpenTable link on their website. It was easy to do, and I was able to edit my reservation later that day without difficulty.

Ma(i)son is located in downtown Lancaster off of Prince Street. Parking is available on Prince Street and on the side streets. Upon entering the small, quaint restaurant, we were greeted by our waiter who was expecting us. We were seated at our table and then given a brief introduction to the style and set up of the restaurant since it was our first time dining there.

I would describe the ambiance as having a refined rustic feel. The main wall is made of reclaimed barn wood and is where the restaurant’s large chalkboard menu is dis-played. Ma(i)son’s seating area is small and cozy and is overlooked by an open kitchen. True to what the Ma(i)son website shares about the owners wanting to create an atmosphere that is intimate and inviting, dining there does make one feel like a guest

at a dinner party in their home. In fact, “maison” is “home” in French.

The only copy of the menu was posted on the chalkboard. Perhaps because of our age, we had to get up from our table to get a good view of the menu. The selection was limited, which we expected given the farm to table concept. Our waiter informed us that the menu changes weekly based on the production from the local farms and artisans they do business with. There were eight different appetizers and salads to choose from; they ranged in price from $13–$15. There were four entrée options available, ranging in price from $17–$28. They told us nearly any dish could be prepared vegetarian, vegan, or gluten-free upon request.

Since the restaurant style is BYOB, my husband and I brought a bottle of wine to share as we enjoyed our dining experience. Our waiter was helpful and knowledgeable when assisting us in selecting our menu options. We started with the Lyonnaise salad with a farm-fresh fried egg on top. It was absolutely delicious and made to perfection. We also had the Mussels on Toast, which was flavorful and fun to try. The freshly baked bread served with homemade butter was a nice complement to the food.

For our entrée selections, we decided on the Pan-roasted Monkfish and the Beef Cheeks and Parsnips. We loved the monk-fish dish, as the fish was cooked perfectly and the Brussels sprouts and pistachio pesto added a delicious flavor to the fish.

While the monkfish was outstanding, the beef cheeks were just okay in comparison. Perhaps it was because the sauce served with it was a bit overwhelming, and they also seemed a bit dry to us. Despite my disappointment in the beef, I did enjoy the crisp parsnips that were part of the dish. We both agreed that when we came back, it would probably be best to order two appetizers and then split an entrée. That would provide the perfect amount of food for the two of us.

Although we were completely stuffed after our entrees, we wanted to have the full Ma(i)son experience so we indulged in two desserts and French press coffee. My husband chose the Chocolate Soufflé Cake and I had their Peanut Butter Chocolate Dessert. They were both a lovely finish to our meals.

Overall, our experience at Ma(i)son was excellent from start to finish. The waiter was friendly, the service was excellent, and our food was fabulous. I would give Ma(i)son 4 out of 5 stars. We enjoyed the ambiance and we believe in supporting the concept of farm to table. We will definitely be going back to Ma(i)son in the near future.

JILL K. SATORIE, M.D.OBGYN of Lancaster

M A( i )SONAN URBAN COOKERY


S P R I N G 2 0 1 5

Welcome…New Members

Congratulations...Reinstated Members

In Remembrance…DECEASED Member

News & Announcements

Theresa A. Walls, DO

Theresa A. Walls, DO, 65, of Lancaster, formerly of Engle-wood, NJ, passed away on November 30, 2014. Dr. Walls was a practicing psychiatrist who studied Biology and Theology at St. Peter’s University in New Jersey. She was a graduate of the Philadelphia College of Osteopathic Medicine and received her residency training at Thomas Jefferson University in Philadelphia. She completed her Master’s Degree in Bioethics at the University of Pennsylvania and was interested in the changing doctor- patient relationship.

Dr. Walls had been the Medical Director at Ephrata Community Hospital since 2005. She had previously served there as the Clinical Director, staff psychiatrist, and chair-person of the Bioethics Committee. Previously, she served as the Medical Director for the former Community Hospital of Lancaster Mental Health Services, was a member of the Ethics Committee of Hospice Community Care, the Bioethics Tribunal for the Diocese of Harrisburg and the Board of the Samaritan Counseling Center.

RGAL Recognized for Patient Safety and

Quality of Care

Four Convenient Locations

• Lancaster Health Campus • Oregon Pike-Brownstown• Women’s Digestive Health Center • Elizabethtown

RGAL is honored to be the only GI practice in Central Pennsylvania to receive two prestigious National and State recognitions for patient

safety and quality of care.

To learn more about the commitment to quality and patient safety by RGAL physicians

and staff, visit www. RGAL.com.

• National Quality and Safety Recognition from the American Society of Gastrointestinal Endoscopy (ASGE) for commitment to quality and safety of the RGAL endoscopy centers.

• Pennsylvania Patient Safety Authority Recognition as a leader in quality initiatives focused on patient safety.

www.RGAL.com • 717.544.3400

January

Meghan Dermody, MDLGHP – Surgical Group

Zachary Andrew Geidel, MDCocalico Family & Sports Medicine

Rodney Moussa Jamil, MDLGHP – Hematology & Medical Oncology

Kathryne J. Stabile, MDOrthopedic Associates of Lancaster Ltd.

Joan Brumbaugh Thode, MDResident

Kristy Whitman, MDLGHP – Family & Maternity Medicine

December

Mandy Renea Fannin, MDTrout Run Family Practice

Amy C. Hancock, MDLGHP – Geriatrics

Christopher J. Peterson, MDAnesthesia Associates of Lancaster Ltd

January

Scott T. Reibel, MDHeart Specialists of Lancaster County

Maung Kyaw Win, MDGeneral Internal Medicine of Lancaster

February

Candice Capstick Boyer, DOLancaster County Osteopathic & Integrative Health

David DoyleAdministrator, Lancaster Cardiology Group, LLC

Jack Wright, MDHospice & Community Care

February

Gerald W. Rothacker, Jr., MDOrthopedic Associates of Lancaster

Daniel J. Schlegel, MDPenn State Hershey Medical Group – Fishburn Road




Frontline GroupsThe Lancaster City & County Medical Society thanks these groups for 100% membership in the Medical Society for 2015.

Allergy & Asthma Center

Brain Orthopedic Spine Specialists

Cardiac Consultants PC

Community Anesthesia Associates

Community Services Group

Dermatology Associates of Lancaster Ltd

Eastbrook Family Health Center

Eye Associates of Lancaster Ltd

Family Eye Group

Hospice & Community Care

Hypertension and Kidney Specialists

Internal Medicine Specialists of Lancaster County

Keyser & O’Connor Surgical Associates Ltd

Lancaster Cancer Center Ltd

Lancaster Neuroscience & Spine Associates

Lancaster Physicians For Women

Lancaster Radiology Associates Ltd

LGHP – Lincoln Family Medicine

LGHP – Manheim Family Medicine

OBGYN of Lancaster

Southeast Lancaster Health Services Inc

Lancaster City & County Medical Society Annual Business Meeting & Dinner

Lancaster Country Club 6:15 pm

APRIL

JUNE

MARK YOUR CALENDARS!

Lancaster City & County Medical Society Young Physicians Social

Bent Creek Country Club6:30 pm

Earn your Certificate in Population HealthTailored for front-line staff, Pennsylvania College of Health Sciences’ new Population Health Certificate provides an understanding of the principles of population health management and tactical skills to increase patient engagement. The 15-week online course emphasizes collaboration through the use of a multidisciplinary cohort. Participants are eligible for 45-hours of ANCC continuing nursing education hours or general continuing education units.

SKILLS COVERED INCLUDE:

Discounts are available for employer cohorts. For more information, call (717) 544-2539 or visit www.PACollege.edu/OneGroup/pophealth.

• Assessing needs and barriers• Achieving success with

motivational interviews

• Understanding the change process• Building empowering relationships

with patients


S P R I N G 2 0 1 5


Hypertension & Kidney Specialists (HKS) has been faithfully serving the patients of Lancaster County for 35 years. HKS began as Nephrology Associates of Lancaster in

1980, founded by Dr. Laurence Carroll. The practice continues to flourish and now has nine board certified nephrologists and five CRNPs. HKS recently renovated their office at 2110 Harrisburg Pike, Suite 310 within Suburban Outpatient Pavilion, and they have a satellite office in Stevens.

HKS provides care for patients at all of the local hospitals. There are five outpatient dialysis units where HKS treats their patients. The group is recognized nationally for its high percentage of patients who chose a home modality, such as peritoneal dialysis or home hemodialysis. To meet the needs of the county, a new hemodialysis unit will open in Leola this fall. The group is anticipating welcom-ing two new physicians in 2015. To keep patient care local, our patients requiring transplant care have the convenience of seeing the Pinnacle Transplant team in our office. We are optimistic that the University of Pennsylvania transplant team will be affording our patients the same opportunity.

FRONTLINE GROUP SPOTLIGHT

Hypertension & Kidney Specialists

HKS, as a group, is recognized for excellence, sought for teaching appointments, medical directorships and comprehensive medical evaluations. They remain committed to serving the patients of Lan-caster with hypertension or kidney diseases, which is the founding mission for which HKS was founded.

2110 Harrisburg Pike, Suite 310, Lancaster, PA 17604 • 717.544.3234 • www.kidneydrs.com



LCCMS Foundation Updates

Lancaster Medical Society Foundation: Supporting the Future of Health Care

Apply now by visiting our website: www.lancastermedicalsociety.org

If you wish to contribute, please contact the foundation at 717-393-9588 or [email protected].

Since 1991, the Lancaster City & County Medical Society, through its charitable foundation, has been supporting local students who are exploring—or working toward—a career in health.

In addition to the Lancaster Medical Society Scholarship Foun-dation Awards*, which are given to students who are beginning or continuing their education in medical school, the foundation also encourages those interested in science.

Sara J. Sigafoos Memorial AwardThe Lancaster Medical Society Foundation is dedicated to

supporting a strong health care team. Each year the foundation honors this commitment by recognizing four nursing student graduates from the Lancaster Campus of Harrisburg Area Community College (HACC).

The Sara J. Sigafoos Memorial Award is a financial award pre-sented to nursing students who demonstrate outstanding clinical skills and passion for medical service.

The Lancaster Medical Society Foundation is pleased to partner with HACC on this award. As we continue to promote physician-led, patient- centered care, we recognize the importance of supporting students who will become valuable members of health care teams.

*About the Lancaster Medical Society Scholarship FoundationThe Lancaster Medical Society Scholarship Foundation provides funding to Lancaster County residents

attending medical school. Recipients must exemplify good character, motivation, and academic excellence, and demonstrate financial need.

Since its establishment in 1991, the Foundation has awarded over $200,000 in scholarship funds. Any Lancaster County resident fulfilling the criteria listed above and pursuing—or continuing—a medical degree at an accredited medical school may now apply for the Lancaster Medical Society Scholarship Foundation scholarship. Applications are due by July 1, 2015 for the 2015–2016 academic year.

What inspires these hands?PennStateHershey.org/skillHe watched his grandparent battle a chronic illness. She diagnosed her older cousin with breast cancer. He learned he could quickly change the course of a disease with his own hands. Driven by inspiration, these hands treat some of the most complex cases around.

Meet the surgeons behind the hands at PennStateHershey.org/skill.

U.Ed. MED 6217-15 SRG

It’s your brain that hears. Not your ears.

Hearing loss is associated with 5 times increased risk of dementia*

When the sound signals from your ears are compromised, your brain has to work even harder to fill in the gaps. This extra effort can take its toll. In fact, studies have shown that, over time, hearing loss can lead to isolation and depression. That’s why it makes sense to take care of your patients’ hearing health the same way you care about the rest of their health: There’s a lot more riding on it than just their hearing.

Hearing Care is Health Care.

B�er Hearing...B�er Life!

a&e audiology&Hearing Aid Center

Hearing Aids Tinnitus Diagnostic Testing Adults, Children and BabiesFive Doctors of Audiology

LANCASTER: 2160 Noll Drive, Suite 100LITITZ: 235 Bloomfield Drive, Suite 111

WILLOW STREET: 226 Willow Valley Lakes Drive, Suite D

717-283-4661HaveBetterHearing.com

(*Lin et al., JAMA, January 2013)

Lancaster Physician Spring 2015

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Transcript of Lancaster Physician Spring 2015