C M S Bulletin - Allegheny County Medical Society

Transcription

Allegheny County Medical Society
Bulletin
January 2016
2016 ACMS
president & officers
When is a physician
an ‘agent’ of a hospital?
Care is Your Business, Change is Ours
The healthcare environment is changing. Physicians must focus on providing the highest quality care with intense
competition for their time. Medical practices face increased challenges tied to changes to regulation, insurance protocols,
cost-management and revenue management.
Houston Harbaugh has over 30 years of experience in helping physicians and medical practices manage change through
contract negotiations with hospitals and payors; contract management; advocacy and new practice start-up counsel.
We have provided critical support in practice mergers and acquisitions. And we have provided sound advocacy on issues
ranging from HIPAA compliance to medical staff and peer review matters.
Every challenge a medical practice can face, we have seen. We have helped practices of all size and structure meet
these challenges. And we know what is ahead.
hh-law.com
Business • Employment • Estates and Trusts • Health Care
Litigation • Oil and Gas • Public Finance • Real Estate
Bulletin
January 2016 / Vol. 106 No. 1
Articles
Articles
Departments
Feature .................................. 12 Special Report ..................... 38 Society News ........................ 16
2016 ACMS president and officers
Materia Medica ...................... 24
Rolapitant: Expanding the arsenal
against chemotherapy-induced nausea
and vomiting
Brent L. Scott
Karen M. Fancher, PharmD, BCOP
Practice Management .......... 28
Nine strategies to get employees
talking during one-on-ones
Joe Mull, MEd
Supporting quality health care for
people with intellectual, developmental
disabilities
Cheryl Pursley, RN, CDDN
Special Report ..................... 41
2016 Medicare fee schedule: Here’s
what you need to know
Pennsylvania Medical Society
Perspectives
Legal Report ......................... 30 Editorial ................................... 6
When is a physician an ‘agent’ of a
hospital?
William H. Maruca, Esq.
• 2016 Clinical Update in Geriatric
Medicine
• 14th International HELP conference
• Pittsburgh Ophthalmology Society
• Practice Managers Section
• ACMSF awards medical student
scholarship
ACMS Alliance News ............ 22
In Memoriam ......................... 22
• Gregory M. Hoyson, MD
Activities & Accolades ......... 23
Nourishment
Deval (Reshma) Paranjpe, MD, FACS
Editorial ................................... 8
Financial Health ................... 32 Old years’ resolutions
Don’t try to ‘beat the market!’
Gary S. Weinstein, MD, FACS
Charles Horton, MD
Editorial ................................. 10
Special Report ..................... 34 A man, by his deeds
Maximize your EHR, maximize your
reimbursement: Quality Insights offers
free help with meaningful use
attestation
Special Report ..................... 36
Social Media and HIPAA: Can They
Coexist Successfully in Your Practice?
Sherry Migliore, MPA, FACMPE,
FACHE
Timothy G. Lesaca, MD
On the cover
Ravenel Bridge – Charleston, S.C.
by Frederick Doerfler Jr., MD
Dr. Doerfler specializes in internal medicine and was the
first-place winner of the 2015 Bulletin Photo Contest.
Bulletin
Affiliated with Pennsylvania Medical Society and American Medical Association
2016
Executive Committee
and Board of Directors
President
Lawrence R. John
President-elect
David J. Deitrick
Vice President
Robert C. Cicco
Secretary
Adele L. Towers
Treasurer
William K. Johnjulio
Board Chair
John P. Williams
DIRECTORS
2016
David L. Blinn
Robert W. Bragdon
Thomas B. Campbell
Douglas F. Clough
Jason J. Lamb
2017
Peter G. Ellis
David A. Logan
Jan W. Madison
Matthew B. Straka
Angela M. Stupi
2018
Patricia L. Bononi
William F. Coppula
Kevin O. Garrett
Todd M. Hertzberg
Barbara A. Kevish
Amelia A. Paré
Raymond E. Pontzer
PEER REVIEW BOARD
2016
John G. Guehl
Rajiv R. Varma
2017
Donald B. Middleton
Ralph Schmeltz
2018
Sharon L. Goldstein
Bruce A. MacLeod
PAMED DISTRICT TRUSTEE
John F. Delaney Jr.
Medical Editor
Deval (Reshma) Paranjpe
([email protected])
Associate Editors
Charles Horton
([email protected])
Robert H. Howland
([email protected]))
Timothy Lesaca
([email protected])
Scott Miller
([email protected])
Amelia A. Paré
([email protected])
Gregory B. Patrick
([email protected])
Brahma N. Sharma
([email protected])
COMMITTEES
Awards
Donald B. Middleton
Bylaws
Robert C. Cicco
Communications
Amelia A. Paré
Finance
Karl R. Olsen
Gala
Patricia Bononi
Adele L. Towers
Nominating
Rajiv R. Varma
Primary Care
Lawrence R. John
Managing Editor
Meagan K. Welling
([email protected])
ADMINISTRATIVE STAFF
Executive Director
John G. Krah
([email protected])
Assistant to the Director
Dorothy S. Hostovich
([email protected])
Bookkeeper
Susan L. Brown
([email protected])
Director of Publications
Meagan K. Welling
([email protected])
Assistant Executive Director,
Director of Member Relations
James D. Ireland
([email protected])
Membership Relations Manager
Nadine M. Popovich
([email protected])
ACMS ALLIANCE
President
Kathleen Reshmi
First Vice President
Patty Barnett
Second Vice President
Joyce Orr
Recording Secretary
Justina Purpura
Corresponding Secretary
Doris Delserone
Treasurer
Josephine Martinez
Assistant Treasurer
Sandra Da Costa
www.acms.org
Leadership and Advocacy for Patients and Physicians
EDITORIAL/ADVERTISING
OFFICES: Bulletin of the Allegheny
County Medical Society, 713 Ridge
Avenue, Pittsburgh, PA 15212; (412)
321-5030; fax (412) 321-5323. USPS
#072920. PUBLISHER: Allegheny
County Medical Society at above
address.
The Bulletin of the Allegheny
County Medical Society welcomes
contributions from readers, physicians,
medical students, members of allied
professions, spouses, etc. Items may
be letters, informal clinical reports,
editorials, or articles. Contributions
are received with the understanding
that they are not under simultaneous
consideration by another publication.
Issued the third Saturday of each
month. Deadline for submission
of copy is the SECOND Monday
preceding publication date. Periodical
postage paid at Pittsburgh, PA.
Bulletin of the Allegheny County
Medical Society reserves the right to
edit all reader contributions for brevity,
clarity and length as well as to reject
any subject material submitted.
The opinions expressed in the
Editorials and other opinion pieces
are those of the writer and do not
necessarily reflect the official
policy of the Allegheny County
Medical Society, the institution with
which the author is affiliated, or
the opinion of the Editorial Board.
Advertisements do not imply sponsorship by or endorsement of the
ACMS, except where noted.
Publisher reserves the right to exclude
any advertisement which in its opinion
does not conform to the standards of
the publication. The acceptance of
advertising in this publication in no
way constitutes approval or endorsement of products or services by the
Allegheny County Medical Society of
any company or its products.
Subscriptions: $30 nonprofit organizations; $40 ACMS advertisers; $50
others. Single copy, $5. Advertising
rates and information sent upon
request by calling (412) 321-5030 or
online at www.acms.org.
COPYRIGHT 2015:
ALLEGHENY COUNTY
MEDICAL SOCIETY
POSTMASTER—Send address
changes to: Bulletin of the
Allegheny County Medical
Society, 713 Ridge Avenue,
Pittsburgh, PA 15212.
ISSN: 0098-3772
q
Allegheny County
MediCAl SoCiety
Leadership and Advocacy for Patients and Physicians
ACMS selects vendors for quality and
value. Contact our Endorsed Vendors
for special pricing.
Banking, Financial
and Leasing
Services
Professional Liability Printing Services
Insurance
and Professional
Announcements
NORCAL Mutual
Real Estate Services
Supplies
Medical Banking,
Office VISA/MC Service
PNC Bank
Brian Wozniak, 412.779.1692
[email protected]
Helen Lynch, Coldwell Banker
Your Neighborhood Realtor
412.605.7259 (cell)
412.366.1600, ext. 319 (office)
Helen.Lynch@pittsburghmoves.
com
Group Insurance
Programs
Medical, Disability, Property
and Casualty
USI Affinity
Bob Cagna, 412.851-5202
[email protected]
Laurie Bush, 800-445-1212,
Service for New Associates,
ext. 5558; lbush@norcal-group. Offices and Address Changes
com
Society
Susan Brown, 412.321.5030
Medical and Surgical [email protected]
Allegheny Medcare
Michael Gomber, 412.580.7900
michael.gomber@henryschein.
com
Life Insurance
Auto and Home
Insurance
Liberty Mutual
Walter E. Jackson IV,
412.859.6605, ext. 51907;
walter.jackson@libertymutual.
com
Malachy Whalen & Co.
Malachy Whalen, 412.281.4050
Member Resources
[email protected]
BMI Charts, Healthy Lifestyle
Telecommunications Posters, Where-to-Turn cards
and IT solutions
Society
connecTel, Inc.
Scott McKinney, 412.315.6020, 412.321.5030
[email protected] [email protected]
Editorial
I
Nourishment
t’s January. It’s cold. And while the
sensible and most tempting thing to
do would be to come home after work
and snuggle under a pile of blankets
while drinking soup and watching television, I am here to suggest that you do
otherwise.
What on Earth is there to do in Pittsburgh in January, beyond hoping that
there’s enough snow at Seven Springs
to ski? Plenty.
For starters, check out some new
restaurants in our fair city. Pittsburgh
was recently voted Zagat’s #1 Food
Town of 2015, based on beauties like
these examples of epicurean enlightenment:
1. Morcilla (3519 Butler St., Lawrenceville): Well-known Pittsburgh
chef Justin Severino (of Cure fame)
has opened a classic tapas joint that
promises to please.
2. Tako (214 Sixth Ave., downtown –- across from Heinz Hall): Rick
DeShantz (of Meat and Potatoes and
Butcher and the Rye) has opened an
eatery with undersea decor featuring
Mexican/Asian/fusion street food and
wondrous cocktails. Try the eponymous
octopus tako taco, which features flavorful octopus that is so creamy it has
to have spent time sous vide, and the
Mezcal Old-Fashioned.
3. The Commoner (458 Strawberry
Way – in the Hotel Monaco, next to
the Omni William Penn downtown):
Although you may not be able to enjoy
the rooftop biergarten in this weather,
you can enjoy the art deco ambiance
of the hotel and the beautiful decor and
fare in this new hot spot.
6
Deval
(Reshma)
Paranjpe,
MD, FACS
4. Grapperia (3801 Butler St.,
Lawrenceville): A bar directly attached
to and around the corner from Piccolo
Forno; ideal for an aperitif or after dinner. A lovely little place serving many
kinds of grappa (brandy distilled from
grape pomace), bitter amari, Italian
wines, beer and small bites. Look for
the grappa cocktails – try the smooth,
cola-like Grappa 75 with its balsamic,
rosemary and prosecco flavors, or the
perfectly balanced Lavanda, which
improbably and deliciously features
lavender.
5. Station (4744 Liberty Ave.,
Bloomfield): Innovative and delightful
seasonal menu from alumni of Grit and
Grace and Craftwork Kitchen.
6. The Vandal (4306 Butler St.,
Lawrenceville): European inspired,
Wednesday-Saturday breakfast/
brunch/dinner; Sunday brunch.
7. Smoke BBQ Taqueria (4115 Butler St., Lawrenceville): Run by Austin
expats armed with an indoor smoker,
expect delectable brisket and apricot/
habanero-laced Berkshire pork tacos in
this beautifully appointed taqueria.
8. Whitfield (120 S. Whitfield St.,
East Liberty – in the new Ace Hotel – the former YMCA): An upscale
neighborhood gastropub featuring a
meat-centric menu with a few vegetarian options. Brunch and dinner daily.
Please consider donating
to your local food pantry
this winter or to the Greater
Pittsburgh Community Food
Bank ... You also might
consider collecting canned
goods in your office ...
9. Smallman Galley (2016 Smallman St., Strip District): Pittsburgh’s first
restaurant incubator features restaurants from four handpicked up-andcoming chefs. Carota Cafe, Aubergine
Bistro, Josephine’s Toast and Provision
Pgh are open for brunch and dinner
Tuesday-Saturday, Sunday brunch.
Closed Monday.
10. Muddy Waters Oyster Bar
(130 S. Highland Ave., East End):
Oysters and classic New Orleans
favorites, along with Sazeracs, Ramos
Gin Fizzes and champagne.
11. Gaucho Parrilla (1601 Penn
Ave., Strip District – right by the 16th
St. Bridge): Argentinian wood-fired grill
with multiple mouthwatering dishes of
steak, pork, chicken and shrimp and
four delicious sauces. A must try – and
among Yelp’s Top 10 Places to Eat
Nationally. Lunch and dinner Tuesday-Saturday.
12. 424 Walnut (424 Walnut St.,
Sewickley): Delicious classic American
fare with an emphasis on Italian specialties in a cozy neighborhood restaurant. Intimate, romantic and friendly
ambiance. Steaks and chops par
excellence, award-winning crab and
Bulletin / January 2016
Editorial
sausage soup, beautiful desserts and
excellent service. Lunch and dinner
Monday-Saturday.
13. The Twisted Frenchman (128
S. Highland Ave., East End): French
featuring steak, lamb, duck, pheasant
and a chef’s eight-course tasting menu.
14. Chaz and Odette (5102 Baum
Blvd., Shadyside): “Locally sourced,
Globally inspired” cuisine featuring
eclectic entrees and a selection of
international flatbreads ranging from
Korean BBQ chicken to Mumbai curry
and everything in between.
These are but a few of the new
gems to be discovered in Pittsburgh;
no doubt you have more in your neighborhood that I haven’t found. Even if
you missed January’s Winter restau-
rant week, go forth and nibble on the
culinary bonanza that has popped up
in our fair city. It will make the winter go
faster and the weather more bearable.
Stop in after work, or take someone
you care about to a special night out –
spread warmth and fill both belly and
soul.
And speaking of filling both belly
and soul, please consider donating to
your local food pantry this winter or
to the Greater Pittsburgh Community
Food Bank, and spread the love. You
also might consider collecting canned
goods in your office, to spread goodwill
among your patients as well. Also,
don’t miss the annual Southside Soup
Contest, which takes place Saturday,
Feb. 20 from noon to 3 p.m., and bene-
A&R Solutions is looking to hire
caring providers to work part time
at one of our area offices.
Fox Chapel • Greensburg • Kittaning • Butler
fits two local food pantries while letting
you sample delicious hot soups from
local restaurants in a three-hour soup
crawl that has become a cherished
local tradition.
Stay warm and nourished inside
and out this winter, so that you may
warm and nourish those in your care.
Dr. Paranjpe is an ophthalmologist
and medical editor of the ACMS Bulletin. She can be reached at reshma_
[email protected].
The opinion expressed in this column
is that of the writer and does not
necessarily reflect the opinion of the
Editorial Board, the Bulletin, or the
Allegheny County Medical Society.
A Professional Corporation
Certified Public Accountants
"Specializing in Physician Practices Since 1978"
We treat patients struggling
with opiate dependence.
•$2,500 signing bonus
• $400 per hour, competitive minimums
• Almost all MDs and DOs qualify
• Physician mentors available
to assist with training
Call Greg today at (412) 478-6736
aandrsolutions.com
Let us be the key to your future . . .
412-281-1901
www.3kcpa.com
7
Executive
Editorial
Committee
Old years’ resolutions
Charles Horton, MD
A
s we start the new year, a common topic of conversation is how
many New Year’s resolutions have
been made, adjusted and – inevitably – broken. By the second or third
week of 2016, exercise machines are
starting to regrow their protective layer
of clutter, TVs across the nation are
starting to feel like family members
again, and “short breaks” from diets of
various sorts are starting to look a lot
like habits. (Eat a well-rounded diet?
Sounds great! Pizzas are round, pies
are round, Oreos are round ... yep, I’ll
eat plenty of round things!)
This year, I’m going to try something
a little different. I’m making old years’
resolutions.
By way of explaining, let me give a
little background. As I write this, I’m in
the midst of a very unintended break
from a pretty busy lifestyle, courtesy
of an equally unintended break in my
right fibula. While I wouldn’t recommend that as a fun experience in itself,
the chance to slow down and catch
up with life has been unexpectedly
refreshing. Already I’ve finished a book
I’d long meant to read (C.S. Lewis’
“The Pilgrim’s Regress”), spent time
just sitting and talking with my family,
gone through emails from past years to
reconnect with old friends, and started
filling in my address book so that future
rounds of Christmas-card writing can
skip the ever-popular game of “Does
anyone remember where we wrote
Dave’s address last year?”
It all started like so many habits do,
really – it was just something to fill the
time. The elaborate brace on my ankle
made it clear that anything especially
physical was out of the question, and
while I was able to get around without
assistance, taking it easy was the order
of the day (and, for that matter, the
order of the orthopedic surgeon). But
as time passed, I realized that redeeming the time – to use that wonderful old
expression – felt really good. It felt like
… the way things used to be.
Call an old family friend? Sorry,
too bus- … actually, sounds like a
great idea. Sit and read a book with
my daughter? Yep, right aft- … hmm.
Right after I sit down here on the sofa
– come sit with Daddy! Take a leisurely
walk through Trader Joe’s and think up
a surprise dinner for my wife? Sure,
nex- … next aisle might have just what
goes with that. (For the record, the fish
tacos were a hit.)
The more I slowed down and enjoyed life, the more I remembered how
life used to be. It’s not that I didn’t have
projects and goals; rather, it’s that I had
allowed life to be about more than just
those projects and goals. There was
work, there was sweat ... and there was
enjoyment. So while my original plan
had been to hit the ground running in
2016 and embark on a lengthy list of
projects with renewed vigor, I’m going to
take the opposite approach now. I’m going to slow down, enjoy the serendipity
of each new day, and count my blessings. I’d say it’s a New Year’s resolution
... but given how far back those ideas
go, it’s more like an old years’ resolution.
Dr. Horton specializes in anesthesiology and is associate editor of the
ACMS Bulletin. He can be reached at
[email protected].
Leadership and Advocacy
for Patients and Physicians
8
Diagnosis: Exhaustion.
Another double shift. Deep breath, exhale.
It’s time you were cared for. Prescription:
The Hefren-Tillotson MASTERPLAN , a ﬂuid
formula for your life. With an in-depth
discussion of your goals, MASTERPLAN
develops a coordinated plan for all of your
investment and ﬁnancial planning needs,
managed by Hefren-Tillotson. One less
worry and more peace of mind.
888-405-0990 / Hefren.com
Hef-Till_ACMS_MP-FINAL.indd
1
Bulletin
/ January 2016
9
10/13/15 11:21 AM
Editorial
I
A man, by his deeds
s Martin Shkreli a name that will live
in health care infamy? Fortunately
for him, he is a young man, and thus
has many years to live before history
proclaims a final verdict. On the other
hand, if his ultimate aspiration was to
be an example of corporate psychopathic behavior, then he might have
already succeeded.
Several months ago, Turing Pharmaceuticals, led by chief executive
Shkreli, purchased the rights to the
medication Daraprim. Hardly a new
drug, nor for that matter an undiscovered financial goldmine, Daraprim had
been on the market for more than 60
years and is considered a standard of
care for toxoplasmosis.
Almost immediately after the
purchase, Turing Pharmaceuticals
dramatically increased the price of
Daraprim from $13.50 per pill to $750.
Alarmed patients, HIV and AIDS
patient advocacy groups, the HIV
Medicine Association and politicians
including Hillary Clinton, Donald Trump
and Elijah Cummings responded in
uncharacteristic unity and agreement,
calling the actions of Turing and Shkreli
“price gouging” and unjustifiable for the
medically vulnerable patient populations affected by this decision.
Shkreli’s response to this controversy was revealing and possibly defining. His defense was based upon the
assertion that Daraprim was unprofitable at its former price, and from his
perspective it was virtually being given
away. He also cast himself as a victim
of media hyperbole and went so far as
to challenge one of his most outspoken
critics, John Carroll of Fierce Bio-
10
Timothy
G. Lesaca,
MD
tech, by calling him “a moron.”
The missing essential from Shkreli’s
retort was acknowledgement that his
decision might cause considerable
hardship upon others. Instead he proclaimed, “We needed to go to a price
where we could make a profit,” seemingly oblivious to the fact that the price
was increased by about 5,000 percent.
If anything positive could come
from this, it would be that Mr. Shkreli
has, at least for the sake of intellectual
discussion, given an identifiable face
to the concept of the corporate psychopath. To be fair, I have never met
him, and it would be inappropriate for
me to proclaim him mentally ill. I do
not know what lives in his heart, but
I believe it was St. Basil who said, “A
tree is known by its fruit, a man, by his
deeds.”
Unlike the prototypical psychopath
who exerts control through physical violence, corporate psychopaths victimize primarily by psychological means.
Emotionally disconnected from others,
they view people as objects to be used,
thriving from the feeling of power and
control. They are skilled at convincing
others that they are trustworthy and
talented, yet in reality their influence
upon corporations is usually destructive. As managers, they are characteristically poorly organized and adversely
influence organizational productivity
and effectiveness.
Although often found to be superficially charming and successful,
corporate psychopaths are ruthlessly
manipulative. They typically are pathologic liars, emotionally shallow, without
empathy or remorse, and fail to take
responsibility for their actions.
Dr. Robert Hare, a renowned researcher in the area of criminal psychology, has said that if he didn’t look
for psychopaths to study in prisons, he
would instead look for them in stock
exchanges. One might contemplate
that the health care industry is the new
fertile ground for the emergence of
the corporate psychopath. There are
several reasons why this might be the
case.
At this point in history, many health
care organizations across the country
are administratively and financially unstable and chaotic. The future of health
care has never been more uncertain,
with a constantly changing corporate
climate characterized by frequent turnover of key personnel.
The health care industry is vulnerable because history has taught us that
the destabilization of modern corporations has led to the ascendency of the
corporate psychopath. Furthermore,
the corporate psychopath is often
singled out for rapid promotion in other
industries due to perceived attributes of
charm and decisiveness. History also
shows that the corporate psychopath
is more likely to be drawn to large
lucrative financial organizations due to
the potential rewards.
Such a person could easily assimilate into a chaotic and high turnover
Editorial
workplace and be welcomed and
promoted as the ideal leader due to
charisma and charm. Possibly the
greatest risk, however, underlies the
question of whether the health care
industry is either willing or capable of
identifying the corporate psychopath. I
personally find it difficult to imagine our
industry willingly submitting to the use
of instruments and protocols designed
to identify psychopathic managers.
Even worse is my suspicion that most
health care systems are in denial that
such a problem could even exist.
The typical provider in the health
care industry, including the physician,
might be among the easiest population
for the corporate psychopath to deceive. You were trained to be benevolent and to not render harsh judgment
220 Hillcrest
$995,000 – FOX CHAPEL
upon others. Many of you have surrendered your administrative tasks to
others due to lack of time. Most of you
do not own your own practices, cannot
control or influence your payers, and
are usually not consulted when major
administrative decisions are made that
impact your practices and your lives.
You have more patients than you have
time, and each day the disarray is
greater than the day before. You have
few alternatives than to have hope and
faith that those who are tasked with
administration are equally benevolent.
In his book, “Without Conscience,”
Dr. Hare wrote of the corporate psychopath, “If we cannot spot them, we
are doomed to be their victims, both as
individuals and as a society.” If Martin
Shkreli is the modern embodiment of
the corporate psychopath in health
care, he was fortunately relatively
easy to identify. Our concern should
be those who go totally unrecognized.
Otherwise, if we are too late, then each
of us already has a Shkreli in our lives,
smiling smugly and laughing to himself,
convinced that we, too, are morons.
Dr. Lesaca is a psychiatrist specializing in children and adolescents and is
associate editor of the ACMS Bulletin. He can be reached at tlesaca@
hotmail.com.
One Woodcliff
$1,175,000 – FOX CHAPEL
312 Olde Chapel Trail
$1,150,000 – FOX CHAPEL
4 Trillium
$760,000 – FOX CHAPEL
11
Feature
2016 ACMS president and officers
Lawrence R. John, MD
2016 ACMS president
Dr. John is a board-certified family
physician with UPMC. He is a native of
Uniontown, Pa., and a graduate of the
University of Notre Dame. He attended Case Western Reserve University
School of Medicine in Cleveland, Ohio,
and completed his residency training in
family practice in Pittsburgh at the St.
Margaret Hospital Residency Program.
He has practiced medicine his entire
career at UPMC St. Margaret Hospital.
He is grateful for the continued support
of his five partners.
Dr. John also received certificates
from the University of Pittsburgh’s
Joseph M. Katz Graduate School of
Business for Physician Leadership and
Management while completing a miniMBA program.
Dr. John has been a member of
ACMS since 1977 and has served on
the Board of Directors since 2007.
He has co-chaired the ACMS Primary
12
Care Working Group since 2008. He
was ACMS treasurer in 2012, secretary
in 2013, vice president in 2014 and
president-elect this past year while
also serving on the Executive Committee during these years. Dr. John also
served on the Communications Committee from 2007 to 2010, the Finance
Committee in 2012 and the Bylaws
Committee in 2014.
At the state level, Dr. John participated as an alternate delegate to the
Pennsylvania Medical Society from
2008 to 2009, then as a delegate since
2010. He served as vice chair of the
ACMS delegation from 2011 to 2013.
In addition to his responsibilities
with ACMS, Dr. John also serves on
the By-Laws and Credentialing committees at UPMC St. Margaret. He is
a member of committees at UPMC
including the Risk Management (CMI)
and the PAC Committee (Advisory
Panel for University Service Organization). He has been a clinical instructor
in the Department of Family Medicine,
University of Pittsburgh School of
Medicine, since 1997. Dr. John served
as the team physician for Fox Chapel
Area School District from 1980 to 2014,
providing athlete physical exams and
on-field coverage for high school football games. He has been inducted into
the Fox Chapel Area School District
Hall of Fame for his years of service. Dr. John’s wife, Martha D. John,
MD, is a practicing pediatrician with
Children’s Community Pediatrics –
Allegheny, and they reside in Fox
Chapel. They have four children:
Joseph F. John, DSc, MHA, FACHE,
Vice President of Operations, The
Emory Clinic, Inc., Assistant Dean of
Administration for the Robert W. Woodruff Health Sciences Center, Emory
University, Atlanta, Ga.; Jeffrey Lawrence John, JD, with Amatis Controls in
Aspen, Colo.; Kathryn S. John, with the
Blum-Kovler Foundation in Chicago,
Ill.; and Jeremy R. John, MD, MPH, a
general surgery resident at the Tulane
University School of Medicine, New
Orleans, La.
David J. Deitrick, DO
2016 ACMS president-elect
Dr. Deitrick is
board certified
in obstetrics and
gynecology. He
is a member of
Jefferson Womens’ Health /
Metropolitan OB/
GYN Associates
and is on the staff of Jefferson Hospital
of Allegheny Health Network.
A member of ACMS since 1990, Dr.
Deitrick served on the Board of Directors from 2004 to 2006 and was the
Board of Directors Presidential Appointee from 2007 to 2011. He was ACMS
treasurer in 2013, secretary in 2014
and vice president in 2015, serving on
the Executive Committee during that
time. Dr. Deitrick participated on the
Communications Committee from 1999
to 2004 and the Nominating Committee
from 2001 to 2002. He chaired the Legislative Committee from 2002 to 2006.
Dr. Deitrick also served on the Finance
Committee from 2011 to 2013, as well
as the Membership Committee from
2007 to 2012, serving as chair in 2007.
Feature
At the state level, Dr. Deitrick was
an alternate delegate to the Pennsylvania Medical Society House of Delegates from 1999 to 2001 and again
in 2008. He served as delegate from
2002 to 2007 and again from 2009 to
2013. Dr. Deitrick also was a member
of the Pennsylvania Medical Society
Political Action Committee (PAMPAC)
Board of Directors from 2001 to 2005.
Dr. Deitrick served as the division
director for University of Pittsburgh
Physicians Womens’ Health in the
Department of Obstetrics, Gynecology
and Reproductive Sciences at UPMC
Mercy Hospital for many years and
was a member of the Medical Executive Committee at UPMC Mercy.
Dr. Deitrick graduated from the
Kansas City University of Medicine
and Biosciences in Kansas City, Mo.,
in 1993. He completed his residency
at Bridgeport Hospital in Bridgeport,
Conn., in 1997. Dr. Deitrick is a Fellow
of the American College of Obstetricians and Gynecologists.
Dr. Deitrick and his wife, Gretchen,
reside in McMurray with their sons,
Adam, Nathaniel and Benjamin.
Robert C. Cicco, MD
2016 ACMS vice president
Dr. Cicco is
board certified
in pediatrics and
neonatal-perinatal medicine.
He most recently
served as associate director of
the Neonatal
Intensive Care Unit at West Penn Hospital and clinical assistant professor,
pediatrics, at Temple University School
of Medicine.
A member of ACMS since 1980,
Dr. Cicco has served on the Board of
Directors and Executive Committee
since 2014. He was the ACMS treasurer in 2014 and secretary in 2015. At
the state level, Dr. Cicco served as a
delegate to the Pennsylvania Medical
Society in 2013. He was a member
of the PAMED Task Force on State
of Medicine from 2010 to 2013. In
addition, he has been the recipient of
several prestigious awards including
the ACMS Physician Volunteer Award
and the PAMED Physician Volunteer
Award. In 2012, the Pennsylvania
Chapter of the American Academy of
Pediatrics named Dr. Cicco Pediatrician of the Year.
Dr. Cicco is a past president of
Parent Care, a national association of
parents and professionals that advocates for family-centered NICU care.
Dr. Cicco is a past president of the
Pennsylvania Chapter of the American
Academy of Pediatrics and also serves
as the co-chairman of the Committee
of the Fetus and Newborn for the state
chapter. In addition, he is a member
of the Committee to Establish Recommended Standards for Newborn
ICU Design; has served on numerous
health department advisory committees
over the years; and currently serves on
the Advisory Committee for the Pennsylvania metabolic screening program
and the Allegheny County Health
Department’s child death review team.
Dr. Cicco graduated from Case
Western Reserve University School
of Medicine in 1976. He completed
his residency at Children’s Hospital in
Pittsburgh and a fellowship at Magee
Womens Hospital of UPMC.
Dr. Cicco and his wife, Anita, reside
in Scott Township. They have four
sons, Brian, Michael, Steven and
Patrick.
Adele Towers, MD, MPH
2016 ACMS secretary
Dr. Towers,
board certified in
internal medicine
and geriatric
medicine, is
affiliated with
UPMC Presbyterian Shadyside
Hospital, and
sees patients at the Benedum Geriatric
Center at Montefiore Hospital.
A member of ACMS since 1988,
Dr. Towers has served on the Board of
Directors since 2011. She served as
ACMS treasurer in 2015 and also was
a member of the Executive Committee
and ACMS Foundation Board that
same year. In addition, Dr. Towers has
been a member of the Awards Committee since 2011 and the Foundation
Gala Committee, serving as co-chair
since 2014.
Dr. Towers has been an associate
professor of Medicine and Psychiatry
at the University of Pittsburgh School
of Medicine since 1992. She was
the medical director of UPMC Health
Information Management from 2007
to 2013. Dr. Towers currently serves
as medical director of UPMC Home
Health and is senior clinical advisor of
the UPMC Technology Development
Center.
Dr. Towers also is a member of
several professional societies including
the American College of Physicians,
American Geriatrics Society, American Medical Association and Western
Pennsylvania / West Virginia Geriatrics
Society.
Dr. Towers graduated from the
University of Connecticut School of
Medicine in 1986. She completed
Continued on Page 14
13
Perspective
From Page 13
an internship and residency in internal medicine at the
University of Pittsburgh School of Medicine in 1989. She
also fulfilled a fellowship in geriatric medicine from the
University of Pittsburgh School of Medicine in 1991, and
received her Masters in Public Health the same year
from the Department of Epidemiology, Graduate School
of Public Health at the University of Pittsburgh.
Dr. Towers resides in Wilkinsburg, Pa.
William K. Johnjulio, MD
2016 ACMS treasurer
Dr. Johnjulio is certified by the
American Board of Family Medicine. He is chair of the Department
of Family Medicine at Allegheny
Health Network (AHN) and is
responsible for overseeing all clinical, administrative and academic
components of the department. Dr.
Johnjulio was formerly the program
director of Forbes Family Medicine Residency at AHN.
A member of ACMS since 2004, Dr. Johnjulio has
served on the Board of Directors since 2013. He was a
member of the Awards Committee in 2013 and the Membership Committee in 2015. He currently serves on the
Executive Committee and ACMS Foundation Board.
Dr. Johnjulio has held academic appointments in the
departments of family medicine at Forbes Regional Hospital, Temple University and Lake Erie College of Medicine, as well as at the University of Pittsburgh College of
Pharmacy.
Dr. Johnjulio graduated from the University of Iowa
College of Medicine and completed postgraduate training with a family medicine internship at the University of
Rochester/Highland Hospital and a residency in family
medicine at the University of Iowa Hospitals and Clinics.
He also completed a Faculty Development program at
Duke University and a Physicians Leadership Academy
Fellowship at UPMC Mercy Hospital.
Dr. Johnjulio is a member of the American Academy of
Family Physicians and the Society of Teachers of Family
Medicine. He also is a member of the Medical Staff Executive Committee at AHN.
Dr. Johnjulio and his wife, Margot, reside in Fox Chapel and have two children, Will and Grace.
14
Ruby Marcocelli
The New World of Health Care is complicated.
Are You Prepared?
Allegheny County Medical Society members:
The new world of Health Care ushered in by the Patient Protection and Affordable
Care Act (ACA) has created uncertainty and confusion for most people. There
are new regulations and requirements. Individual and employer mandates.
Penalties for not purchasing coverage. On Exchange and Off Exchange access.
As an Allegheny County Medical Society member, you have help.
Talk to USI Affinity, the ACMS’s endorsed insurance broker and partner. Our
benefits specialists are experts in Health Care Reform. We can help you choose
a health plan that provides the best coverage and value while ensuring you will
be in compliance with complex new IRS and
Department of Labor regulations. We’ll also
provide you the kind of world class service
and support you need to make sure you get
the most out of your health care benefits
after you buy.
You can also check out the NEW Allegheny
County Medical Society Insurance Exchange,
a convenient and secure online portal where
you can find competitively priced insurance
coverage for all your needs, including a wide
variety of medical and dental plans.
To learn more, contact USI Affinity today!
Call 800.327.1550, or visit the ACMS Insurance
Exchange at www.usiaffinityex.com/acms
15
Society News
2016 Clinical Update
in Geriatric Medicine set
The Clinical Update in Geriatric
Medicine will be held April 7-9 at the
Marriott Pittsburgh City Center. This
award-winning course has been a popular and respected resource for more
than 24 years. It is jointly sponsored by
the Pennsylvania Geriatrics Society –
Western Division (PAGS-WD), University of Pittsburgh Institute on Aging
and University of Pittsburgh School
of Medicine Center for Continuing
Education in the Health Sciences. The
program is designed by course directors Shuja Hassan, MD; Judith Black,
MD; and Neil Resnick, MD, along with
the PAGS-WD planning committee.
As our population continues to age,
the number of elderly persons in our
area hospitals, clinics and nursing
homes has grown significantly. The
fastest-growing segment of the population are those above the age of 85
years. The conference aims to provide
an evidence-based approach to help
clinicians take exceptional care of
these often frail individuals. Highlights
of the three-day conference include:
• Geriatric Pharmacology – helpful
tips on managing medications in your
complex older patients • Acute Care of the Elderly – clinical
pearls from a national expert on inpatient care of the older adult • Symposium on Geriatric Syndromes – updated, evidence-based
information on falls, delirium, osteoporosis and depression • Geriatric Cardiology – updated
information on hypertension specific
to the older patient, atrial fibrillation
management along with using novel
oral anticoagulants, and chronic heart
failure • Appropriate prescribing of antibiot16
ics for older adults • Symposium
focusing on patient
care at the end of
life, and living with
hospice care • Advanced
Practice Providers Dr. Blazer
session
The conference
continually attracts
distinguished guest
faculty. This year’s
exceptional guest
presenters include:
Dan G. Blazer, MD, Dr. Lipsitz
MPH, PhD, vice
chair of Psychiatry,
Duke University,
Durham, N.C.; Sharon K. Inouye, MD,
MPH, director of the
Aging Brain Center
at the Institute for
Dr. Palmer
Aging Research,
Hebrew SeniorLife,
Boston, Mass.; Lewis A. Lipsitz, MD,
director, Institute for Aging Research
and Senior Scientist, professor of Medicine, Harvard Medical School, Boston,
Mass.; Barbara Messinger-Rapport,
MD, chief medical officer/ Hospice
Care at Hospice of the Western Reserve, Cleveland, Ohio; and Robert M.
Palmer, MD, MPH, John Franklin Chair
of Geriatrics at the Glennan Center for
Geriatrics and Gerontology, Eastern
Virginia Medical School, Norfolk, Va.
Local expert faculty also will enhance
the program and provide key evidence-based sessions.
Registration will be accepted in
January at https://ccehs.upmc.com/
liveFormalCourses.jsf. For additional
information, contact (412) 647-8232 or
email [email protected].
Members of the PAGS-WD receive
a discount when registering for the
conference! To inquire about becoming a member or current membership
status, contact Nadine Popovich,
administrator, (412) 321-5035, ext. 110,
or email [email protected]. Apply
for membership on the Society website
at www.pagswd.org.
14th International HELP
conference slated in Pittsburgh
The International
Hospital Elder Life
Program (HELP)
conference will be
held in conjunction
with the Clinical
Update conference
April 7-8 at the Mar- Dr. Inouye
riot Pittsburgh City
Center. Designed
by course directors
Sharon Inouye, MD,
MPH; Fred Rubin,
MD; and Shin-Yi Lao,
MPH, BSN, RN, this
two-day international
conference educates Dr. Rubin
HELP teams regarding strategies for delirium prevention,
using HELP to improve hospital-wide
care of the elderly, and creating a
climate of change.
Expert clinicians and experienced
members of the HELP sites will share
evidence-based information and
clinical insights on selected topics regarding the influence of HELP, delirium
updates and the larger policy implications of care for the elderly. Updates on
collaborative papers, expansion of the
program and innovative site projects
also will be presented.
For more information, please contact Krystal Golacinski, UPMC Center
Society News
for Continuing Education in the Health
Sciences, at (412) 647-7050 or email
[email protected].
Pittsburgh Ophthalmology
Society meets at ACMS
The Pittsburgh Ophthalmology
Society (POS), under the direction of
Thierry Verstraeten, MD, president,
welcomed guest speaker Andrew
Huang, MD, MPH, Dec. 3 at the
(ACMS) building. Dr. Huang, professor,
Ophthalmology and Visual Sciences,
and director, Cornea Lab, Washington
University School of Medicine, St. Louis, Mo., presented “Recent Advances
in Ocular Surface Reconstruction” and
“Surgical Management of IOL Dislocation and Iris Defect.” He was invited
by POS member Deval Paranjpe, MD,
FACS. Jason Hooton, MD, resident
at the University of Pittsburgh Eye
Center, presented a case for review
and discussion. The POS would like to
thank Alimera Sciences for supporting
the evening’s program.
POS member honored
Michael Azar, MD, POS chair of the
by-laws and rules committee, Thorpe
Circle administrator and past president,
was honored at the Dec. 3 meeting
with the Pennsylvania Academy of
Ophthalmology’s (PAO’s) Distinguished
Service Award. The award is presented
to a member of the Academy for extraordinary work on behalf of the PAO
of contributions to their specialty. Dr.
Azar has been a member of the PAO
Board of Directors for 20 years. His
previous positions on the PAO Board
include secretary of Medical Practice
and Payment Systems, representative on the Medicare Carrier Advisory
Above, from left,
Deval Paranjpe,
MD, FACS; POS
President Thierry
Verstraeten, MD;
and guest speaker
Andrew Huang, MD,
MPH, are pictured
at the Dec. 3 POS
meeting.
At left, Michael
Azar, MD, left, is
pictured with Kenneth Cheng, MD,
after being presented with the Pennsylvania Academy
of Ophthalmology’s
Distinguished Service Award.
Nadine M. Popovich /
ACMS
17
Welcoming
Jamil B. Alkhaddo, MD
Endocrinology
For an appointment,
please call
Dr. Alkhaddo is a fellowship-trained endocrinologist specializing
in diabetes, thyroid and adrenal conditions in adult patients.
He joins The Center for Diabetes and Endocrine Health.
The Center for Diabetes
and Endocrine Health
1900 Waterdam Plaza
Building 3, Second Floor
McMurray, PA 15317
He received his medical degree from the Aleppo University in Aleppo,
Syria. He completed his internal medicine internship and residency
at the State University of New York in Buffalo, N.Y., serving as chief
resident. He completed his clinical fellowship at the University of
Minnesota in Minneapolis. He is board-certified by the American
Board of Internal Medicine.
724.941.7490
AHN.org
Dr. Alkhaddo holds memberships with a number of medical societies,
including the American Medical Association, the American Association
of Clinical Endocrinologists, the Endocrine Society and the American
Diabetes Association.
He has medical staff privileges at Allegheny General Hospital
and Canonsburg Hospital.
As always, new patients are welcome. Most major insurances are accepted.
Ad Size: 7 .5 x 9.75
18
Society News
sia cataract surgery.
Committee and president (2003-2005). Along with Dr. Robert
Osher, he has pioKenneth Cheng, MD, PAO Board
member and secretary, Legislation and neered artificial iris
prosthesis use in the
Representation, presented the award
United States, aiding
during the business meeting.
in the rehabilitation
POS speaker announced
of acquired traumatic Dr. Snyder
iris defects or conPrem Subramanigenital
iris defects
an, MD, PhD, professuch as aniridia and
sor of Ophthalmoloocular albinism. He
gy, Neurology, and
is a diplomate of the
Neurosurgery; vice
American Board of
chair for Academic
Ophthalmology, a
Affairs, Ophthalmology; division chief, Dr. Subramanian fellow of the Amer- Dr. Blaydon
ican Academy of
Neuro-ophthalmolOphthalmology and
ogy, University of Colorado School of
Medicine, will be the guest speaker for a member of the
the Feb. 4 POS meeting. POS member American Society of
Cataract and RefracJohn Charley, MD, invited Dr. Subrative Surgeons. He
manian. Faizan Pathan, MD, resident
is actively involved
at the University of Pittsburgh Eye
in teaching other
Center, is scheduled as the resident
Dr. Regillo
ophthalmologists
presenter for the evening.
through these organizations and
POS Annual Meeting
serves as a frequent “guest professor”
to be held March 18
nationally and internationally.
He continues to contribute to
The Pittsburgh Ophthalmology
ophthalmology textbooks and scientific
Society’s Annual Meeting will be held
March 18, 2016, at a new location, the journals as author, editor and reviewer;
sits on the editorial boards of EyeWorld
Pittsburgh Marriott City Center Hotel.
and Cataract & Refractive Surgery
The society is pleased to announce
Today; and has produced several
Michael E. Snyder, MD, as the 36th
Thorpe Lecturer. Dr. Snyder serves on award-winning surgical videos. He is
actively involved in developing new
the Board of Directors, Cincinnati Eye
devices for intraocular implantation
Institute (CEI), and is chair, Clinical
and new ophthalmic applications for
Research Steering Committee. The
Harvey E. Thorpe Lecture, established pharmaceuticals including FDA studies.
Dr. Snyder was the first in the United
in 1980, when the Society named Dr.
States to implant an artificial iris cusThorpe “man of the year,” recognizes
an individual of Dr. Thorpe’s stature as tom-matched to the uninjured eye.
Additionally, the POS is honored
a researcher, teacher and inventor.
to welcome guest faculty Sean BlayDr. Snyder specializes in diseases
don, MD, FACS, and Carl Regillo,
and surgery of the front of the eye, including small-incision, topical anesthe- MD, FACS. Dr. Blaydon is program
From Page 17
director for the Oculofacial Plastic and
Reconstructive Surgery Fellowship at
Texas Oculoplastic Consultants, Austin,
Texas; and clinical assistant professor
at the University of Texas Health Science Center in San Antonio. Dr. Regillo
is director, Retina Service, Wills Eye
Hospital; and professor of Ophthalmology, Thomas Jefferson University,
Philadelphia, Pa. Running concurrently with the POS
Annual Meeting will be the Annual
Meeting for Ophthalmic Personnel.
Ophthalmic technicians, assistants,
coders, photographers and front office
staff are invited to attend this dynamic
meeting. The program is broken into
four segments, allowing attendees to
select from numerous courses. The application for JCAHPO credits for each
course has been submitted. Courses
(with credit designation) will be listed
on the online registration. Registration
for both programs will begin Jan. 7. To
register, please visit pghophg.org and
click on “Registration.”
Practice Managers Section
meets at ACMS
Practice administrators had the
opportunity to sharpen their skills at the
Dec. 3 meeting of the ACMS Practice
Managers Section. Expert facilitators
presented a quick overview of their
topic and then allowed participants to
share their perspectives, experiences
and ideas, as well as having the opportunity to ask questions. Each session
was 20 minutes, giving attendees the
opportunity to engage and interact with
all six facilitators.
Thank you to the following presenters who provided a dynamic atmosphere for this first-time offering: Billing
and Coding, presented by Ruby MarcoContinued on Page 20
19
Society News
From Page 19
celli, Fenner Consulting; Fraud Prevention, presented by Heidi Danko and
Drew Besket, PNC Healthcare Banking;
Leadership and Office Culture, presented by Joe Mull, Ally Training & Development; Legal Tune-Up, presented by
Jim Southworth, Dickie, McCamey &
Chilcote, PC; OSHA and Office Safety,
presented by Matthew Spady, CLYM
Environmental Services; and Technology Update, presented by Marty Stranges, Pittsburgh Computer Solutions.
Door prizes were graciously donated by Joe Mull, MEd, of Ally Training &
Development. Congratulations to the
following lucky winners: Kathy Kubicky,
Mary Florio, Carolyn Lanzendorfer and
Celeste Rhodes. Each received a $25
gift card to a local restaurant.
The next meeting will be held Jan.
21 and will feature Curtis Solomon,
CPHRN, of NORCAL Mutual, who will
present “Pain Management & Opioid
Prescribing: Managing the Risks.” Register online at www.acms.org/events or
call (412) 321-5030.
Attendees of the Dec. 3 Practice Managers meeting discuss legal issues with
Jim Southworth of Dickie, McCamey & Chilcote, PC.
Attendees
of the Dec. 3
Practice Managers meeting
listen to Drew
Besket and
Heidi Danko of PNC
Healthcare
Banking.
Allegheny County MediCAl SoCiety FoundAtion
Awards Gala
Wine & Chocolate
JOIN US FOR
March 5, 2016
www.acmsgala.org
20
Society News
ACMS Foundation awards
medical student scholarship
The Allegheny
County Medical
Society Foundation
(ACMSF) recently
awarded a $4,000
scholarship to medical student Diana
Huang of Pittsburgh. Ms. Huang
Ms. Huang,
daughter of David Huang and Tracy
Zheng, attends the Lewis Katz School
of Medicine at Temple University,
Philadelphia.
“I am so grateful to the Allegheny
County Medical Society for continuing
to fund this important scholarship.
Although I am currently attending medical school in Philadelphia, growing up
in Pittsburgh helped form my interest
in medicine. Throughout my undergraduate career at the University of
Pittsburgh, I shadowed many doctors
at UPMC and volunteered my time
at the former UPMC South Side and
the UPMC Urgent Care in Shadyside.
I continue to learn from patients and
physicians in Pittsburgh through
rotations at the West Penn Allegheny
Health System. Participating in organized medicine through the PA Medical
Society and AMA has helped me build
connections with so many wonderful
physicians from across the state and
nation, and it inspires me to be able to
work together to create a better environment of health for patients.
“This scholarship helps to lessen
the financial burden of training for me
as I continue on my path to become a
family physician and serve on the front
lines of patient care. Again, thank you
for your support of medical students,
and know that your contributions make
a huge difference in our lives.”
Ms. Huang is considering a specialty in family medicine.
UniOntOwn, PA
Medical Director Opportunity
at Uniontown Hospital
Emergency Resource Management, Inc., (ERMI) is
now accepting EM BE/BC or other board-certified
physicians with experience for the Medical Director
position at Uniontown Hospital.
ERMI is the largest employer of emergency medicine
physicians in Pennsylvania and is part of UPMC, one
of the nation’s leading integrated health care systems.
We offer an outstanding compensation and benefit
package, including occurrence malpractice insurance,
an employer-funded retirement plan, paid health
insurance, CME allowance, and more.
For more information, contact our recruiter at
412-432-7400 or email at [email protected].
www.EmergencyResourceManagement.com
EOE Minority/Female/Vet/Disabled
72504 TACS
21
Alliance News
ALLIANCE MEMBERSHIP AREAS OF OPPORTUNITY
Please check to indicate your area of interest.
We’ll be in touch to welcome you with enthusiasm.
We will mentor you into activities you’ve selected.
We will acknowledge your support of events and projects.
Thanks from all of Alliance for your reply! 412-321-5030
□ Community Service
□ Public Health Education
□ Event Planning
□ Communication
□ Fundraising
□ Leadership
□ Unable to actively participate, but will support
Alliance events and projects to benefit Health Education
Projects, Community Service Organizations, Disaster Relief
and ACMS Foundation
ACMSA Calendar 2016
Sat., March 5
Tue., March 8
ACMS Foundation Gala (Heinz Field East Club Lounge – D. Hostovich 412-321-5030)
Doctor’s Day Recognition Gala program ad (Donation to ACMS Foundation)
Governing Board Meeting: Nominations and Year-End Gifting (ACMS)
Fri./Sat., April 1-2 Carnegie Science Center PRSEF Heinz Field Club (ACMSA Judges TBD)
Tue., April 14
Governing Board Meeting (ACMS)
Fri., April 15-17
Northeastern Regional Meeting – Hosted by PAMED Alliance, Gettysburg, Va.,
– Venue and Details TBD (ACMSA Reps and Gifting TBD; S. DaCosta; This meeting replaces Spring Confluence)
Tue., April 26
Past Presidents Luncheon
(Leadership and Venue TBD)
Tue., May 3
Combined Board Meeting (ACMS)
Tue., May 17
Gen. Meeting III Annual Mtg. and Lnchn.; Confirm Leadership Appointments; PAMED Alliance President Visit; New Member
Recognition (Leadership/Venue TBD)
22
2016-2017
MEMBERSHIP APPLICATION
ALLEGHENY COUNTY MEDICAL SOCIETY ALLIANCE
Level
Member
Resident
County
$ 35.00
$ 20.00
Please send me information on:
____ Pennsylvania Medical Society Alliance
____ American Medical Society Alliance
Last Name ______________________________________
First Name ______________________________________
M.I. _____
Address: ________________________________________
City ____________________ State _____ Zip __________
Phone: (Area Code) _______________________________
Fax: (Area Code) _________________________________
Email: __________________________________________
Please Indicate:
__ New Member __ Reinstated __ Resident Spouse __ Other
Make Checks Payable to: Allegheny County Medical Society Alliance
713 Ridge Avenue, Pittsburgh, PA 15212-6098
Content and text by Kathleen Jennings Reshmi
In Memoriam
Gregory M. Hoyson, MD, 59, of McCandless
Township, died Sunday, December 27, 2015.
Dr. Hoyson graduated in medicine from the
University of Pittsburgh and served his internship
and residency at Children’s Hospital of Pittsburgh of
UPMC.
For three decades, Dr. Hoyson was an admired
pediatrician at his practice, Bellevue Pediatric Associates of Bellevue, Richland and Cranberry.
Surviving are his wife, Ann Schratz Hoyson;
children Elizabeth Tobay (Jason), Katherine Baeder
(Daniel) and Mitchell Hoyson; his mother, Patricia
Hoyson; siblings Jimmy Hoyson and Tammie Ammon
(Drew); and mother-in-law Rita Schratz.
Services were held Thursday, December 31, at St.
Sebastian Church, Ross.
Activities & Accolades
Gateway Medical Society receives award
ACMS member honored
William Simmons, MD, was presented
Gateway Medical Society has been selected as a 2015with the Western Pennsylvania Execu16 Jefferson Award recipient in recognition of its Journey to
tive Humanitarian Award from Achieving
Medicine (JTM) program.
Greatness, Inc. (AGI) at AGI’s Pittsburgh
Gateway Medical Society volunteer members William
City League Hall of Fame awards banquet
Simmons, MD, president, Jan Madison, MD, and Anita
Jan. 2, 2016, at the Pittsburgh Athletic
Edwards, MD, are being honored for their work with the
Dr. Simmons
JTM program, which educates and mentors minority boys in Club.
The event honors local sports heroes
grades 6-12 about the art and science of medicine.
and those who started in Pittsburgh City Leagues and
Drs. Simmons, Madison and Edwards have volunteered
went pro, as well as many champions of local humanitarian
16 hours per month to provide instructional sessions; they
efforts.
also volunteer an additional 50 hours per year for mentoring,
Dr. Simmons is currently the president and chairman of
planning and enrichment program activities.
the Board of the Gateway Medical Society (GMS), as well as
JTM currently has 85 students enrolled with many consis- chair of the department’s Advisory Committee on Diversity
tently earning 4.0 GPA on their academic reports. JTM was
and co-chair of the UPMC/University of Pittsburgh Physician
awarded partner status with the Pittsburgh Public School
Inclusion Council Retention Committee. In his spare time,
System in 2014. For more information about the JTM prohe is a mentor for GMS’s academic mentorship program for
4514_3882_orthopedic_specialists_doctor_ad_7.5x4.875_acms_bulletin.qxp_Layout 1 12/8/15 3:13 PM Page 1
gram, visit www.gatewaymedicalsociety.org.
African American males.
100 FIRST AVE, SUITE 200, PITTSBURGH, PENNSYLVANIA 15222
SWOP DIGITAL PROOFING BAR
Specialized orthopaedic care. Close to home.
Front row (L-R): Christopher C. Schmidt, MD; Mark E. Baratz, MD; Dean G. Sotereanos, MD; Stephen F. Conti, MD
Back row (L-R): Mark A. Fye, MD; Thomas B. Hughes Jr., MD; Alan H. Klein, MD; Periklis A. Papapetropoulos, MD
Orthopaedic Specialists–UPMC
With decades of combined experience treating patients in western Pennsylvania, the physicians of Orthopaedic
Specialists–UPMC offer a broad range of expert orthopaedic services, including shoulder, hand, elbow, and spinal surgery;
foot and ankle surgery, knee and hip surgery, joint replacement, fracture care, arthroscopic surgery, and general orthopaedics.
Along with our many convenient locations, our physicians now see patients at the new UPMC Lemieux Sports Complex.
McKeesport
Bethel Park
North Hills
Moon Township
Steubenville
Monroeville
South Side
Washington
To schedule an appointment at Orthopaedic Specialists-UPMC, or for more information, call 1-877-471-0935 or visit UPMC.com/OrthoSpecialists.
Affiliated with the University of Pittsburgh School of Medicine, UPMC is ranked among the nation’s best hospitals by U.S. News & World Report.
23
Materia Medica
Rolapitant: Expanding the arsenal against
chemotherapy-induced nausea and vomiting
Brent L. Scott
Karen M. Fancher,
PharmD, BCOP
C
hemotherapy-induced nausea and
vomiting, also known as CINV, is
a commonly feared adverse effect of
patients undergoing chemotherapy.
Without appropriate prophylaxis, 70 to
80 percent of patients undergoing chemotherapy experience vomiting, and
historically, up to 20 percent of cancer
patients would delay or discontinue potentially curative chemotherapy solely
because they could not tolerate the
nausea and vomiting that accompanied
it.1,2 In addition, uncontrolled nausea
or vomiting may result in metabolic imbalances, nutrient depletion, anorexia,
wound dehiscence, esophageal tears,
aspiration pneumonia or degeneration
of self-care.3 However, great progress
has been made in the last few decades, which has resulted in improved
patient experiences and quality of life.1
New agents continue to be developed
to further minimize both the frequency
and complications of CINV.
Chemotherapy-induced
nausea and vomiting
CINV is thought to be a complex
process involving several sites within
the medulla as well as multiple neurotransmitters. The proposed mechanism begins with contact between the
antineoplastic agent and the gastrointestinal tract, specifically the small
intestine. This can occur either through
24
direct contact or delivery to the site by
blood. Upon contact, enterochromaffin
cells within the small intestine release
serotonin (5-HT), which binds to 5-HT3
receptors on vagal afferent fibers.
These receptors stimulate the chemotherapy receptor trigger zone (CTZ)
within the area postrema of the brain.
The CTZ also can be stimulated to a
lesser extent by dopamine and neurokinin-1 (NK-1). The CTZ then signals the
central vomiting center to coordinate
impulses sent to the salivation center,
respiratory center and the pharyngeal,
gastrointestinal and abdominal muscles that lead to vomiting.2,4 In summary, activation of the vagal nerve and
the release of neuroactive agents in
the gastrointestinal tract, along with the
dorsal vagal complex communicating
with the vomiting center of the brain,
causes the vomiting reflex.5, 6
The incidence and severity of CINV
can be affected by several factors.
These factors include the specific
chemotherapy agents used, dose of the
agents, route of the agents and individual patient characteristics such as
female gender, younger age, a history
of motion sickness and minimal alcohol consumption.3 The most important
and reliable factor among these is
the specific chemotherapy agent(s)
used.3 CINV can be classified into four
levels according to the emetogenicity
of the chemotherapy regimen, or the
likelihood of experiencing emesis if the
chemotherapy agent is administered
without prophylaxis. These levels include: (1) high emetic risk – 90 percent
or more of patients experience acute
emesis; (2) moderate emetic risk – 30
percent to 90 percent of patients experience acute emesis; (3) low emetic risk
– 10 percent to 30 percent of patients
experience acute emesis; and (4) minimal emetic risk – fewer than 10 percent
of patients experience acute emesis.3
Examples of high risk agents include
cisplatin, dacarbazine, high doses of
cyclophosphamide and carmustine.6
CINV also can occur in phases.
Acute CINV usually occurs within a
few minutes to several hours after drug
administration and commonly resolves
within the first 24 hours, while delayed
CINV develops in patients more than
24 hours after chemotherapy administration and can last six to seven days.3
Cisplatin, cyclophosphamide, carboplatin and anthracyclines are some of the
agents that commonly cause delayed
emesis.6 Acute CINV is mostly mediated by 5-HT3 signaling, while NK-1 and
substance P signaling is thought to
play a larger role in delayed CINV.7,8
Prophylaxis of CINV
The optimal strategy for CINV prophylaxis in patients at moderate or high
risk currently includes a 5-HT3 receptor
antagonist, dexamethasone and an
NK-1 receptor antagonist.3 Agents
that can be given as “rescue” therapy
after unsuccessful prophylaxis include
dopamine antagonists, lorazepam,
metoclopramide and/or olanzapine.
Serotonin receptor antagonists are
widely considered the most effective
prophylactic agent for CINV during
the acute setting.1 The introduction of
selective 5-HT3 receptor antagonists in
Materia Medica
the early 1990s, such as ondansetron,
granisetron and dolasetron, revolutionized the management of CINV. These
agents now form the cornerstone of
prophylaxis for chemotherapy with moderate to high emetogenic potential, and
have greatly improved the quality of life
of cancer patients undergoing chemotherapy.6 They are extremely well-tolerated, with the most frequent adverse
effects including headache, constipation
and diarrhea. Palonosetron, a second
generation 5-HT3 receptor antagonist,
has shown evidence in reducing both
acute and delayed CINV episodes.
Palonosetron has a half-life of 40 hours,
is more potent and has a higher binding
affinity than first-generation agents.5
Palonosetron is currently recommended
as the preferred 5-HT3 receptor antagonist for use with moderately emetogenic
chemotherapy regimens.3, 9
The second agent used to prevent
CINV is corticosteroids. The mechanism by which corticosteroids prevent
emesis is poorly understood, but it
is believed that corticosteroids may
improve emetogenic control in a synergistic manner with other antiemetic
agents.10 Dexamethasone is commonly
chosen and also is the most extensively researched. Doses of dexamethasone vary between 8 and 20mg per
day depending on the emetic potential
of the chemotherapy. Major side effects
of steroids in this setting are hyperglycemia and insomnia.1
Neurokinin-1 receptor antagonists
exert their mechanism of action by
inhibiting substance P from binding
NK-1 receptors in the vagus and
primarily from preventing activation of
the vomiting center. The first agent in
this therapeutic class was aprepitant
(Emend®), and its prodrug fosaprepitant. When combined with a 5-HT3
receptor antagonist and dexamethasone, NK-1 receptor antagonists have
shown improved acute CINV control
when compared to a 5-HT3 receptor antagonist, dexamethasone and
placebo. NK-1 receptor antagonists
also have shown activity in preventing
delayed CINV versus placebo. NK-1
inhibitors are usually tolerated quite
well, but some cases of hiccups and
fatigue have been reported.5 Aprepitant is known to be metabolized by
the cytochrome P-450 3A4 pathway,
and caution should be advised when
administering other drugs metabolized
through this same pathway.6
A combination product of two antiemetic agents has recently received
Food and Drug Administration (FDA)
approval. This product combines netupitant, an NK-1 receptor inhibitor, with
palonosetron in an oral tablet known as
NEPA (Akynzeo®). NEPA was studied
in clinical trials in combination with
dexamethasone versus palonosetron
and dexamethasone. Patients who
received NEPA experienced less CINV
during the delayed phase compared
to patients who received palonosetron and dexamethasone.9 Adverse
effects observed in these studies
included headache, asthenia, fatigue
and dyspepsia. Netupitant, similar to
aprepitant, also is a known inhibitor of
cytochrome P-450 3A4, and requires a
dosage reduction of dexamethasone.1
The successful addition of NK-1
receptor antagonists to other agents
for CINV prevention has prompted the
development of a novel NK-1 receptor
antagonist, rolapitant.
Rolapitant
Rolapitant (Varubi®) exerts its mechanism of action in the same way as the
other NK-1 receptor antagonists: by
inhibiting the binding of substance P to
the neurokinin-1 receptors. Rolapitant is
a unique agent due to its extended halflife of 180 hours, its lack of cytochrome
P-450 CYP3A4 metabolism and its prolonged receptor binding.11 The studied
one-time dose of 180mg has shown the
potential to prevent CINV throughout
the highest risk period of 120 hours
post chemotherapy.7
Rolapitant’s safety and efficacy
were examined in two recently published phase III trials. The first trial
examined rolapitant’s effectiveness
and side effect profile pertaining to
its use with moderately emetogenic
chemotherapy or regimens containing
an anthracycline and cyclophosphamide in 1369 patients. This study was
an international study that included
patients over the age of 18, those who
had not previously received moderate
or high emetogenic chemotherapy, a
Karnofsky performance score of 60 or
greater, and a life expectancy of at least
4 months. The study was double-blind,
and computer stratified randomization
was used. All patients in the study
received 2mg of granisetron and 20mg
of dexamethasone, as well as either
180mg of rolapitant or placebo prior to
chemotherapy. All patients then went on
to receive 2mg of granisetron on days
two and three. The study investigators
could prescribe “rescue” medications
at any time as medically indicated, and
patients recorded all events of both
vomiting and rescue medication use
in a daily diary during the entire study
period. The primary efficacy endpoint of
the study was the proportion of patients
achieving a complete response, which
was defined as no emesis or use of
rescue medication, in the delayed
phase (>24-120 hours after the initiation
25
Materia Medica
From Page 25
Table 1. Comparison of the currently available neurokinin-1 receptor antagonists.12-14
Aprepitant /
Fosaprepitant
(Emend®)
Dosage form
Dosing
Half-life
Metabolism
Drug
interactions
Generic form
Oral
Intravenous
150 mg x1 or
115 mg on day 1, 80 mg
on days 2 and 3 or
125 mg on day 1, 80 mg
on days 2 and 3
9-13 hours
Substrate of CYP3A4
Inhibitor of CYP3A4
Inducer of CYP2C9
Numerous
Yes, but not yet
available
of chemotherapy) in cycle 1.7
In this study, patients who received
rolapitant experienced a 71 percent
complete response in the delayed
phase, as compared to 62 percent
in the control group. This difference
was statistically significant (odds ratio
1.6, 95 percent CI 1.2-2, p = 0.0002).
Across the entire 120-hour risk period,
significantly more patients treated with
rolapitant had a complete response
than did those patients receiving
placebo (62 percent vs 53 percent, OR
1.4, 95 percent CI 1.2-1.8, p = 0.0012).
Conversely, the results showed no
difference between the groups in complete response during the acute phase
only. Rolapitant was well-tolerated,
and the incidence of adverse effects
was similar between the groups, with
fatigue, constipation and headache
most frequently reported. The authors
26
Netupitant
(a component of the
combination product
Akynzeo®)
Rolapitant
(Varubi®)
Oral
Oral
300 mg/0.5 mg
palonosetron x1
180 mg x1
80 hours
180 hours
Substrate of CYP3A4
Inhibitor of CYP3A4
Moderate inhibitor of
CYP2D6
Numerous
Few
No
No
concluded that adding rolapitant to a
5-HT3 antagonist plus dexamethasone
improves CINV control in the delayed
phase for patients treated with either
moderately emetogenic chemotherapy
or regimens that contain an anthracycline and cyclophosphamide.7
The second study examined the
effectiveness and safety of rolapitant in
preventing CINV with highly emetogenic, cisplatin-based chemotherapy in two
global, randomized, placebo-controlled
phase III trials. This study used the
same inclusion criteria as the study
previously discussed and enrolled
1,089 patients. All patients in the study
received granisetron at 10mcg/kg and
dexamethasone 20mg prior to cisplatin-based chemotherapy, and were
randomly assigned to receive either
placebo or rolapitant 180mg. Dexamethasone was then administered at
8mg twice daily on days two through
four. Patients could be prescribed “rescue” antiemetics at the study investigator’s discretion, and patients recorded
emetic episodes and use of rescue
medication in a diary as discussed in
the first study. The primary endpoint
was the proportion of patients achieving a complete response, which was
defined as no emesis or use of rescue
medication, in the delayed phase (>24120 hours after the initiation of chemotherapy) in cycle 1.8
The results of this study revealed
that a significantly greater proportion
of patients in the rolapitant group had
a complete response in the delayed
phase than did patients in the placebo
group (pooled analysis 71 percent vs
60 percent, OR 1.6, 95 percent CI 1.32.1, p = 0.0001). Patients who received
rolapitant also had a statistically greater
Materia Medica
complete response rate throughout the
overall study period (69 percent vs 59
percent, OR 1.6, 95 percent CI 1.2-2.0,
p = 0.0005). Adverse effects were minimal in both groups, and were similar
to those discussed in the first study.
The results of this study suggest that
rolapitant is effective in managing CINV
in patients treated with highly emetogenic, cisplatin-based chemotherapy
at up to 120 hours after initiation of
chemotherapy.8
Place in therapy
The potential advantages and
disadvantages of rolapitant compared
to other NK-1 receptor antagonists are
listed in Table 1.
The National Comprehensive Cancer Network (NCCN) Clinical Practice
Guidelines currently list rolapitant as
a first-line agent for the prevention of
CINV in highly emetic chemotherapy
regimens, along with other NK-1 receptor antagonists such as aprepitant
and fosaprepitant. The guidelines state
that an NK-1 antagonist, 5HT3 antagReferences
1. Jordan K, Jahn F and Aapro M. Recent
developments in the prevention of chemotherapy-induced nausea and vomiting (cinv):
A comprehensive review. Ann Oncol. 2015;
26(6): 1081-90.
2. Navari RM. Prevention of emesis from
multiple-day and high-dose chemotherapy
regimens. J Natl Compr Canc Netw. 2007;
5(1): 51-9.
3. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology.
Antiemesis v2.2015. Available at www.nccn.
org. Accessed December 9, 2015.
4. Wilhelm S. Nausea and vomiting. In:
Chisholm-Burns MST, Wells BG, et al (eds).
Pharmacotheray Principles and Practice,
Second Edition. New York: McGraw-Hill
Companies, Inc.; 2010.
5. Navari RM. Pharmacological manage-
onist and corticosteroids should be
used together as prophylaxis in highly
emetogenic chemotherapy regimens.
Rolapitant also is recommended as an
optional third agent in combination with
corticosteroids and 5-HT3 receptor antagonists as prophylaxis in moderately
emetogenic chemotherapy regimens.3
Rolapitant’s specific place in therapy
has yet to be determined, as it has not
been directly compared to other NK-1
receptor antagonists or combined with
any 5-HT3 antagonist other than palonosetron. Likewise, long-term safety data
and robust clinical data are lacking.
Finally, the cost of this new agent may
be prohibitive, especially when compared to the anticipated availability of a
generic form of aprepitant.
Conclusion
Rolapitant is a novel NK-1 receptor
antagonist that adds an additional option for the prevention of chemotherapy-induced nausea and vomiting. In two
clinical trials, the combination of a 5-HT3
receptor antagonist, dexamethasone
ment of chemotherapy-induced nausea and
vomiting: Focus on recent developments.
Drugs. 2009; 69(5): 515-33.
6. Hesketh PJ. Chemotherapy-induced
nausea and vomiting. N Engl J Med. 2008;
358(23): 2482-94.
7. Schwartzberg LS, Modiano MR,
Rapoport BL et al. Safety and efficacy of
rolapitant for prevention of chemotherapy-induced nausea and vomiting after administration of moderately emetogenic chemotherapy
or anthracycline and cyclophosphamide regimens in patients with cancer: A randomised,
active-controlled, double-blind, phase 3 trial.
Lancet Oncol. 2015; 16(9): 1071-8.
8. Rapoport BL, Chasen MR, Gridelli
C et al. Safety and efficacy of rolapitant for
prevention of chemotherapy-induced nausea
and vomiting after administration of cisplatin-based highly emetogenic chemotherapy
and rolapitant demonstrated superior
efficacy in the control of delayed CINV
and overall CINV. Its long half-life and
prolonged receptor binding means that
only a single dose is necessary during
each chemotherapy cycle, and its lack
of cytochrome P-450 3A4 drug interactions offer an advantage to patients
on potentially interacting medications.11
Rolapitant already has been incorporated into national guidelines, but further
studies and more clinical experience
will be necessary to clearly define the
most effective use of this new agent.
Mr. Scott is a doctor of pharmacy
candidate at Duquense University Mylan School of Pharmacy. Dr. Fancher
is an assistant professor of pharmacy
practice at Duquesne University Mylan
School of Pharmacy. She also serves
as a clinical pharmacy specialist in
oncology at the University of Pittsburgh
Medical Center at Passavant Hospital.
She can be reached at fancherk@duq.
edu or (412) 396-5485.
in patients with cancer: Two randomised,
active-controlled, double-blind, phase 3 trials.
Lancet Oncol. 2015; 16(9): 1079-89.
9. Hesketh PJ, Bohlke K, Lyman GH et
al. Antiemetics: American society of clinical
oncology focused guideline update. J Clin
Oncol. 2015.
10. Barbour SY. Corticosteroids in the
treatment of chemotherapy-induced nausea
and vomiting. J Natl Compr Canc Netw. 2012;
10(4): 493-9.
11. Olver I. Role of rolapitant in chemotherapy-induced emesis. Lancet Oncol. 2015;
16(9): 1006-7.
12. Emend [prescribing information]. Whitehouse Station, NJ; Merck & Co., Inc: 2015.
13. Akynzeo [prescribing information].
Woodcliff Lake, NJ; Eisai Inc.: 2015.
14. Varubi [prescribing information].
Waltham, MA; TESARO, Inc.: 2015.
27
Practice Management
Nine strategies to get employees
talking during one-on-ones
“How are things?” you ask.
“Good,” she replies. Then silence.
“So … what’s the biggest challenge
you’re facing here at work?”
“Normal stuff, I guess.” More
silence.
“Like what? What are the kinds of
things demanding your attention and
effort these days?”
“Nothing out of the ordinary.”
Does this exchange sound familiar?
If you hold regular one-on-one meetings with employees (and research in
employee engagement makes it clear
you should), then you’ve probably gone
up against the no-talker. Or the oneword-answer-giver. What’s a dedicated,
invested leader like yourself to do? You
genuinely care about your employees’
ideas, opinions and challenges. How
can you involve and engage them if
they won’t talk? Here are nine strategies to get the conversation going in
one-on-one meetings:
Ask Why or How questions.
Open-ended questions (not “Yes”/“No”
questions) are the lifeblood of any
conversation. Questions that start with
“Why” or “How” by their nature require
an explanation. Plan to have several
ready to go – the more specific the
better. If it helps, make a list that you
keep handy.
Wait. Silence is uncomfortable for
some. Get over that. Don’t give in to
the compulsion to fill the space. If you
ask a legitimate, sophisticated question, and get a one-word answer, stay
silent. You’ll be surprised how often the
employee will start talking again. Often
28
Joe Mull,
MEd
what comes next is the kind of meaty
answer you desired initially.
Start by asking for advice. Try
opening with this: “Hey, I’m really glad
we were scheduled to meet today.
I’d love to get your advice on something. I’m trying to figure out …” Then
describe a challenge you’re facing, a
question you’re pondering, or any other
issue in which employee perspective
could be helpful.
Share a personal story. If you
open with some variation of “How are
you?” most of the time your counterpart
will ask a similar, general question.
Answer it by sharing something you
did that weekend or that happened that
morning, then use it to pivot back to
them. Like this: “I’m good … I’m tired,
though. My daughter has been sick
and I was up with her several times last
night. She insists that she’ll only get
better if she can sleep in her bed with
ALL of her Barbies. At 3 a.m., I finally
gave in! What’s the cold and flu season
been like in your house?” The personal
story fosters a more human connection
between the two of you, and the pivot
to asking about their circumstance
gives them a low-risk way to ease into
the conversation.
Ask for specific feedback. Ask
about processes, systems, atmosphere, or even your performance.
Some questions can be broad (for
example: “If you could change anything
about the way things work at the front
desk, what would it be?”), while others
can be very specific: “How can we
tweak our holiday scheduling process
to make it fairer to everyone here?”
Offer a different communications
vehicle. People who prefer introversion – people who prefer to take in and
process information before responding
or deciding – will often shine when
given just a bit of space to ruminate. If
you’re not getting much from someone
during your meetings, restate how
much you value their thoughts/feedback/ideas/opinions, then invite them
to follow-up via email, text, leaving a
note, or “dropping in.”
Thank and tell after. Any time one
of your reluctant participants DOES
give you advice, feedback, or an opinion, be sure to circle back to them later
(perhaps a few days after your meeting) to thank them and explain how it
helped you. This is the “I was thinking
about what you said; here’s how it really helped me” strategy. Do this with all
employees, as it is proof of their value
and influence.
Ask for more. Despite your best
efforts, you may have to come right
out and ask the employee to get more
verbally involved. Example: “Jim, I really
value your insight, but I’m not getting
much from you when I bring up things to
discuss. Can you give me a little more?”
Be ok with it. Not every one-on-one
has to be a profound, in-depth, professionally satisfying discussion. In fact,
Practice Management
some people just aren’t talkers. Assess your approach. If
you’re asking thoughtful questions, are demonstrating a
sincere interest in the person across from you, and if they
appear engaged in all other parts of their job, then accept
that this person is just less verbal than others.
And a BONUS strategy (which actually brings our total
to 10):
Give out a question or two ahead of time. Giving
employees a heads up on something you plan to ask at a
one-on-one may result in a more robust conversation.
Research suggests the most effective one-on-ones
are those in which the agenda is set and led by employees. That doesn’t relieve you of the responsibility to plan
and prepare for one-on-one meetings. In some cases,
you have to work a little harder to create an easygoing
dialogue. Try out the strategies listed here and there’s a
pretty good chance you’ll get the gab going.
Joe Mull, MEd, is president of Ally Training & Development. He teaches front-line health care leaders how to be
better bosses. He can be reached at [email protected].
Patient-Centered Care,
Close To Home
Anton Plakseychuk, MD, PhD, Associate
Director of The Bone and Joint Center
at Magee-Womens Hospital of UPMC,
now provides orthopaedic services
at UPMC Downtown.
Anton Y. Plakseychuk,
MD, PhD
Orthopaedic Surgery
Our multi-million-dollar,
state-of-the-art healthcare facility.
Every day, we provide healthcare to more families in their homes than
just about anyone. Whether you’re recovering from surgery, disabled
or just need a little help to maintain your independence, our trained,
experienced caregivers will come to your house and take care of you.
On a part-time, full-time or live-in basis. We’re Interim HealthCare®,
and we provide healthcare for the people you love. Give us a call.
Dr. Plakseychuk received his medical degree from the
Kazan State Medical University, Russia. He completed
orthopaedic surgery residencies and fellowships at the
University of Pittsburgh School of Medicine, Carnegie
Mellon University, and the Kazan branch of Illizaov Center
in Russia. Dr. Plakseychuk is board-certified and an expert
in hip arthroscopy (labral repairs), hip resurfacing, hip
replacements (minimally invasive direct anterior approach),
partial and full replacements of knee, shoulder, and ankle,
and revision surgeries in difficult cases.
For information or to schedule an appointment,
call 412-641-8609. Dr. Plakseychuk sees patients
at UPMC Downtown and in Oakland.
The Bone and Joint Center
at Magee-Womens Hospital of UPMC
UPMC Downtown
Heinz 57 Center, 5th Floor
339 Sixth Ave.
Pittsburgh, PA 15222
1789 S Braddock Ave.
Pittsburgh, PA
(412) 436-2200
www.interimhealthcare.com
BCD-CMI-10538_bone_joint_plakseychuk_3-625x9-75_ACMS.indd 1
29
12/9/15 10:25 AM
Legal Report
W
When is a physician
an ‘agent’ of a hospital?
hen a patient dies unexpectedly
in a hospital setting, and there
may be some indication of negligence
by a physician, plaintiffs’ lawyers try
to target as many deep pockets as
possible. Not only will they sue the
physician responsible for the patient’s
care, but increasingly they also will sue
the hospital itself. This is even more
likely if the lawyer failed to identify and
name the responsible physician within
the two-year statute of limitations. If
the physician is directly employed by
the hospital, there could be separate
liability under the doctrine of respondeat superior (Latin for “let the master
answer”) which makes an employer responsible for the actions of its employees performed within the scope of their
employment. But what happens when
the physician is not an employee?
A recent Pennsylvania Supreme
Court case overturned a lower court
decision and held that a hospital could
be separately liable for medical errors
made by a non-employed physician
staff member who was called to
respond to a medical crisis. In Green
v. Pennsylvania Hospital, the patient,
Joseph Fusco, came to the hospital’s
emergency department with shortness
of breath, rapid breathing and wheezing. He spent 10 days in the ICU on a
ventilator. In an effort to wean Fusco
from the ventilator, he was given a
tracheotomy. Later that day, a nurse
noticed he was bleeding from the tracheotomy site and an emergency team
30
William H.
Maruca,
Esq.
was called to attempt to identify the
cause and restore his airway. Among
the team was an independent otolaryngologist, Dr. Nora Malaisrie, who
allegedly misplaced a breathing tube
into his thorax instead of his trachea.
The error was corrected, but not in time
to save Fusco.
Fusco’s estate brought a malpractice suit against the hospital, the nurse
and the anesthesiologist, but not Dr.
Malaisrie, the ear, nose and throat
(ENT) specialist. Court filings indicate
that the estate’s medical experts did
not identify Dr. Malaisrie’s negligence
as the cause of Fusco’s injuries until
after the statute of limitations had expired, which is the reason Dr. Malaisrie
was not named individually as a defendant. As a result, the estate sought to
hold the hospital vicariously liable for
Dr. Malaisrie’s alleged negligence. The
trial court tossed the vicarious liability
count, and concluded that no reasonably prudent person in Fusco’s position
would be justified in believing that the
care he was receiving from Dr. Malaisrie was being rendered by the hospital
or its agents. This holding was upheld
by the Superior Court, leading to the
appeal to the state Supreme Court.
This counter-intuitive result was
based on an interpretation of the Pennsylvania Mcare Act, which the state
Supreme Court has rejected in favor
of a more common-sense approach.
The Mcare Act states that a hospital
may be held vicariously liable for the
acts of another health care provider
through principles of ostensible agency
only if the evidence shows that “(1)
a reasonably prudent person in the
patient’s position would be justified in
the belief that the care in question was
being rendered by the hospital or its
agents; or (2) the care in question was
advertised or otherwise represented
to the patient as care being rendered
by the hospital or its agents.” The law
specifically states that evidence that
a physician holds staff privileges at a
hospital shall be insufficient alone to
establish vicarious liability.
The lower courts placed the burden
of proving “agency” on the plaintiffs.
The trial court noted that the estate did
not present any witnesses to testify
regarding “how the agency structure of
the hospital was set up regarding ENT
physicians . . . in the Hospital’s facilities,” and did not present any testimony
“as to how Dr. Malaisrie presented
herself as to agency, or whether a
reasonable patient would believe she
was an agent of the hospital.”
The Pennsylvania Supreme Court
took a different approach. Citing its
own opinion in the landmark case of
Thompson v. Nason Hospital (which
Legal Report
is well-known for establishing hospital
liability for negligent credentialing), the
court quoted: “hospitals have evolved
into highly sophisticated corporations
operating primarily on a fee-for-service
basis. The corporate hospital of today
has assumed the role of a comprehensive health center with responsibility
for arranging and coordinating the total
health care of its patients.”
The Supreme Court rejected the
hospital’s reliance on the limitations of
the Mcare Act and concluded that there
was sufficient evidence to create a jury
question concerning whether a reasonably prudent person in Fusco’s position
would be justified in the belief that Dr.
Malaisrie was acting as the hospital’s
agent when she provided care to him.
The court relied in part on the estate’s
contention that Dr. Malaisrie first
became involved in treating Fusco as
part of an emergency response team at
the hospital; Dr. Malaisrie had no prior
doctor/patient relationship with Fusco;
and Dr. Malaisrie rendered emergency
treatment to Fusco at the request of
the hospital, and not at the request of
Fusco or his family.
The hospital did not dispute that
upon discovering unexplained bleeding, the nurse (a hospital employee)
paged anesthesia and ENT to come to
the ICU. In such situations, the Supreme Court held that when a hospital
patient experiences an acute medical
emergency, and an attending nurse or
other medical staff issues an emergen-
Responding
to an
Industry in
Transition
cy request or page for additional help, it
is more than reasonable for the patient,
who is in the throes of medical distress,
to believe that such emergency care
is being rendered by the hospital or its
agents, and that the determination of
whether there is an agency relationship
should be for the jury to decide.
Notably, the Pennsylvania Medical
Society (PAMED) and the Pennsylvania Defense Institute filed a joint amicus brief, and the Hospital & Healthsystem Association of Pennsylvania (HAP)
filed a separate amicus (“friend of the
court”) brief, in support of the hospital,
to no avail. While the Green decision
appears to extend vicarious liability to
Fox Rothschild’s Health Law Practice reflects
an intimate knowledge of the special needs,
circumstances and sensitivities of physicians
in the constantly changing world of health care.
With significant experience and a comprehensive,
proactive approach to issues, we successfully meet
the challenges faced by health care providers in
this competitive, highly regulated environment.
After all, we’re not your ordinary
health care attorneys.
Seth I. Corbin
412.394.5530
[email protected]
Edward J. Kabala
412.394.5599
[email protected]
William H. Maruca
412.394.5575
[email protected]
William L. Stang
412.394.5522
[email protected]
Michael G. Wiethorn
412.394.5537
[email protected]
BNY Mellon Center | 500 Grant Street, Suite 2500 | Pittsburgh, PA 15219 | 412.391.1334 | www.foxrothschild.com
Visit our HIPAA, HITECH & HIT Blog at http://hipaahealthlaw.foxrothschild.com
31
Financial Health
Don’t try to ‘beat the market!’
T
he goal of many investors and
professional money managers is
to “beat the market” by earning higher
returns than the Standard & Poor’s
(S&P) 500 index. Most well-structured
portfolios, however, are not limited to
large capitalization U.S. equities. They
also include international stocks, real
estate investment trusts (REITs) and
bond indexes that affect total return.
While a portfolio’s U.S. equity returns
should match the market, adding fixed
income (bond) investments usually
lowers return when stocks rise and vice
versa.
The S&P 500 consists of the 500
largest publicly traded U.S. companies
based on market capitalization (total
shares X price) and is most commonly
used as a proxy for the market return.
It encompasses 80 percent of the total
market and its three largest holdings
are Apple Inc. (3.7 percent); Microsoft
Corp. (2.4 percent); and ExxonMobil Corp. (1.8 percent). Small and
mid-capitalization (cap) companies are
excluded.
Although the Dow Jones Industrial average (the “Dow”) is widely
reported, it consists of only 30 large
company stocks chosen by committee.
The average is calculated by dividing
the sum of the 30 stock prices by
0.14967727343149. The denominator
is changed annually and not adjusted
for inflation. The small sample size and
idiosyncratic calculation limit its usefulness as a market proxy.
Investors can purchase stock
indexes as mutual fund shares or
exchange-traded funds (ETFs). Mutual
fund shares are priced daily at the
32
Gary S.
Weinstein,
MD, FACS
market close (net asset value) and
include embedded capital gains. The
funds can retain those gains or distribute them to shareholders as taxable
capital gains. Investors can automate
savings by electing to reinvest dividends and capital gain distributions in
additional shares. For most portfolios,
it is better to decline automatic reinvestment and reinvest cash proceeds
in portfolio indexes that have fallen in
value.
In contrast to mutual funds, ETFs
trade like stocks and are priced
intraday. Commissions must be paid
on each purchase, and dividends and
capital gains cannot be automatically
reinvested. There are no embedded
capital gains, however, and the basis
and purchase prices are the same. For
equivalent indexes, consider choosing
the share type with the lowest cost. A
good rule of thumb is to only purchase
well-established indexes sold by large
reputable fund companies.
“Total” market indexes provide
greater diversification and tax efficiency than owning a combination of large
(S&P 500), small and mid cap indexes.
They shield investors from paying capital gains taxes when small and mid cap
stocks increase in size and graduate to
mid and large cap indexes. Unlike total
market indexes, smaller indexes are
required to sell stocks no longer meet-
ing its capitalization criteria, triggering
capital gains taxes for the investor.
Some active managers repackage their funds and market them as
“indexes.” They select stocks based
on criteria such as earnings, dividend
yield, momentum, sales growth or price
to earning (P/E) ratios. Not considering market capitalization tilts these
portfolios toward smaller companies.
Compared to passive indexes like the
S&P 500, active ones have higher
expense ratios (up to 2 percent), less
tax efficiency and lower returns.
All diversified portfolios are subject
to “tracking error,” which is the difference in return between a portfolio and
its underlying index. Money managers
and endowments with a mix of asset
classes often report beating the S&P
500. A more honest way to evaluate
performance is to compare each
asset class to its underlying passive
index. For example, a 50 percent large
cap equity fund and 50 percent fixed
income portfolio should be compared
to 50 percent S&P 500 index and 50
percent fixed income of similar credit
quality and maturity. If the S&P 500
returns 10 percent and the equivalent
bond holdings return 2 percent, the
weighted return should be 6 percent
(50 percent of 10 percent + 50 percent
of 2 percent) minus the funds’ expense
ratios.
Investors seeking high short-term
gains often invest “hot money” with
high-priced funds and managers following recent market beating performance.
Because excess return is frequently
random, yesterday’s winners often
underperform and “revert to the mean.”
We will reduce your
medical office and
supply costs.
Financial Health
Disappointed investors dump their shares and switch to
new funds and managers who also subsequently underperform. Repeating the cycle increases transaction costs
and capital gains taxes while lowering returns.
The goal of every prudent investor should be to
achieve financial security rather than beating others or
the market. This is best accomplished with a reasonable
asset allocation and a diversified mix of low cost total
market indexes. If you think you can beat the market by
choosing tomorrow’s winners, realize that the odds of
consistently doing so are extremely low. The more prudent strategy is to not even try!
Dr. Weinstein practiced oculoplastic surgery in Pittsburgh for 25 years. He taught investing at Carnegie
Mellon University’s Osher program and the American
Academy of Ophthalmology. He co-authored a Retirement Planning chapter in J.K. Lasser’s Expert Financial
Planning and lectures on investing and financial planning
to physician groups.
Legal Report
From Page 31
hospitals for the negligence of their non-employed medical staff members, it is consistent with trends emerging
in other states. The impact on physicians may be limited
since physicians remain liable for their own clinical care
decisions (provided they are named in a lawsuit within the
two-year statute of limitations), but the impact on hospitals will increase their exposure. I predict that hospitals
will increase the use of liability disclaimers in admission
forms, signage and elsewhere to undercut any patient
expectations of vicarious liability. Although patients in
acute distress may not have the reasonable opportunity to
select which physicians intervene in an emergency, juries
will now get to decide whether such patients reasonably
believe the physicians providing their care are doing so as
hospital agents, and whether to hold hospitals responsible
for their mistakes.
Mr. Maruca is a health care partner with the Pittsburgh
office of the national law firm of Fox Rothschild LLP. He
can be reached at [email protected] or (412)
394-5575.
Allegheny
3 reasons
Medcare
to consult
We will reduce yo
medical office an
supply costs.
Mike Gomber
for your medical supply needs
3 reasons
Mike
1 Mike isn’t just a “sales rep.”
to
consult
is a professional consultant with
an MBA and 30 yearsMike
experience
Gomber
serving physicians.
Savings,
Service
forand
yourSolutions!
medical supply n
2
Mike will find the best solution to
isn’t just
1 Mike
your medical supply
needs,
not a “sales rep.”
a professional
consultan
just the “product ofisthe
month”
an MBA and 30 years expe
that others are pushing.
serving physicians.
Allegheny Medicare is endorsed
Mike will
find the best soluti
2 County
by the Allegheny
Medical
medical
supply needs,
Society—the only your
medical
supply
company that is! just the “product of the mon
that others are pushing.
“The best solution to your
3
medical supply needs.”
Michael L. Gomber, MBA
Medicare is endo
3 Allegheny
More than 30 years
meeting
by the Allegheny County Me
physicians’
needs
Savings, Service
and
Solutions!
Society—the
only medical s
(412) 580-7900
company that is!
Michael
L.
Gomber,
MBA
Fax (724) 223-0959
More than 30 years meeting physicians’ needs
Email:
michael.gomber
412.580.7900
Fax: 724.223.0959
E-mail:
[email protected]
@henryshein.com
A
Allegheny Medcare
endorsed by
LLEGHENY
COUNTY
MEDICAL
SOCIETY
Allegheny Medc
Savings, Service and Solut
Allegheny Medcare
Henry Schein, a Fortune 500 Company
Michael L. Gomber, M
Together to serve to provide a one-stop
More than 30 years meeting physici
solution for all your needs
412.580.7900 Fax: 724.22
endorsed by
ALLEGHENY
COUNTY
MEDICAL
SOCIETY
E-mail: michael.gomber@henrysch
Allegheny Medc
Henry Schein, a Fortune 500 Com
Together to serve to provide
ao
33
solution for all your needs
Special Report
Maximize your EHR,
maximize your reimbursement
Quality Insights offers free help with meaningful use attestation
H
ealth care providers’ meaningful use of Health Information Technology (HIT) can be a key driving force behind
making health care more patient-centered and improving
overall quality. HIT also presents opportunities to strengthen
infrastructure and data systems, enable local innovations,
foster learning organizations and eliminate disparities.
Quality Insights Quality Innovation Network is collaborating with health information technology (HIT) Regional
Extension Centers (RECs) to build on the successes RECs
have achieved, including providing services to more than
100,000 primary care providers nationwide. We provide
tools and resources, email alerts and educational opportunities to participating practices. Our goals include:
• Improving EHR adoption rates, workflows, practice
transformation, achieving meaningful use and attestation
• Increasing eligible professionals and eligible hospitals
screening and delivery of preventive services for Medicare
beneficiaries
• Improving care access and coordination for Medicare
beneficiaries
• Reducing disparities in access and utilization of health
care services for Medicare beneficiaries
Under a charter with the Centers for Medicare & Medicaid Services (CMS) to serve as a resource for health care
providers in Pennsylvania, all of Quality Insights’ services
are provided free of charge to participating providers.
Learn more about how Quality Insights can help your
practice optimize its EHR. Contact Lisa Sagwitz at [email protected] or (877) 725-9998, ext. 7714, or (412) 6557356 to get started.
About Quality Insights
As the Quality Innovation Network-Quality Improvement
Organization (QIN-QIO) for Pennsylvania, New Jersey,
Delaware, West Virginia and Louisiana, Quality Insights is
committed to collaborating with providers and the community on the Centers for Medicare & Medicaid Services’ goals
of better health, smarter spending and healthier people.
Our data-driven quality initiatives improve patient safety,
reduce harm and improve clinical care locally and across the
network. To learn about Quality Insights’ health care quality
improvement initiatives, visit www.qualityinsights-qin.org.
Free classified ad online
Place a classified advertisement in the Bulletin, and
your ad will appear online FOR FREE on the ACMS website,
www.acms.org, for the duration of your advertisement.
For information, call Meagan Welling at (412) 321-5030, ext. 105.
34
35
Special Report
A subsidiary of the Pennsylvania Medical Society
Social Media and HIPAA:
Can They Coexist Successfully in Your Practice?
by:୹Sherry Migliore, MPA, FACMPE, FACHE
Medical practices and other healthcare organizations are faced with a dilemma when it comes to
the use of social media and potential violation of HIPAA regulations. Consider the following
scenarios:
A medical practice’s employees took pictures of each other to post on social
media. In the background of one of the pictures was a patient in the waiting
area to be checked in. The patient found out about this from a friend’s daughter
and filed a HIPAA violation complaint. The practice was fined $50,000 for
violating the patient’s privacy.
# # # # #
A physician who became annoyed with a chronically late patient used her
Facebook page to vent her complaints. Other physicians also weighed in and
provided sympathetic comments. The physician had not used the patient’s name
but had mentioned personal information that could help identify the patient. An
online debate ensued. An investigation was completed and ultimately it was
determined that the physician’s statements did not represent a breach of privacy
laws. However, her actions caused a large public relations problem for the
hospital and she was disciplined by the state medical board for unprofessional
behavior.
One need only go to the U.S. Department of Health and Human Services’ website to find
numerous examples of violations of health information privacy by healthcare organizations,
including medical practices. Social media is increasingly being utilized by hospitals and other
healthcare organizations, and surveys have shown that the use of social media by medical
practices is also increasing. Its use presents both opportunities as well as challenges. As noted
by the Journal of the American Hospital Association, “social media has changed our interactions
with others, and by direct consequence, our relationships.”
Medical practices use social media for a variety of purposes. Some are using it to improve
communication with patients and to engage them by providing educational information and
health monitoring. Portals are being used for this purpose as are other types of social media.
The goal is to help patients make behavioral changes that will increase compliance and
ultimately improve outcomes.
36
Special Report
Social media is also being used by practices and other healthcare organizations for marketing
and promotional purposes.
Physician-only social networks are being used to find and share health information,
communicate with other physicians, or to disseminate their research.
Another type of social media, physician blogs, are becoming popular, but can be troublesome
due to concerns about proper de-identification of individual patients.
For the medical community, one of the most controversial uses of social media in healthcare is
physician rating sites. While they can be helpful in helping patients select physicians, they have
also been misused.
No matter how social media is being used, it’s critically important to incorporate specific policies
and procedures on this subject as part of a medical practice’s HIPAA compliance plan. The
policies should address the following issues:
x
x
x
x
x
Definitions of the various types of social media being used by the practice and its staff
Identification of who has permission to access social media from the practice’s network
Definitions of what consists of inappropriate use of social media on practice and
personal devices, both while at work as well as outside of the realm of employment
Identification of the responsibilities of employees that witness inappropriate use of social
media
Description of the penalties associated with various violations
A resource that provides examples of social media policy guidelines of healthcare and other
types of organizations can be found at http://socialmediagovernance.com/policies. The
American Medical Association has also developed guidelines for the ethical use of social media
by physicians.
Training employees on the appropriate use of social media is an important part of the practice’s
overall HIPAA training policies and procedures. There’s no point in writing policies if they’re not
reinforced and followed by the practice. Because social media, like all technology, is
continuously changing, practices should conduct security risk assessments to ensure that their
policies and procedures reflect its current use in their organizations.
There is currently an opening on the Bulletin Editorial Board for an
ASSOCIATE EDITOR. The position requires basic writing skills and the willingness to
contribute an editorial column of 500-900 words at least once or twice per year.
Associate editor terms are for two years; they may serve three consecutive terms.
Selection of the final candidate will be made by the Editorial Board and the ACMS Board
of Directors. If you are interested, please email or fax a short letter and a writing sample to
Bulletin Managing Editor Meagan Welling at [email protected], or fax (412) 321-5323.
37
Special Report
Supporting quality health care for people
with intellectual, developmental disabilities
Cheryl Pursley,
RN, CDDN
T
his year marks the 25th anniversary
of the Americans with Disabilities
Act. The most recent census data
from 2010 revealed that 1.2 million
adults had an intellectual disability
and approximately 944,000 adults had
other developmental disabilities, such
as autism and cerebral palsy (Brault,
2010). According to the Arc of the United States, an organization advocating
equal opportunities for people with
intellectual and developmental disabilities (I/DD) in all aspects of life, people
with I/DD often encounter barriers to
health care not experienced by others.
The Arc reports the barriers include:
“Access – Underinvestment in
public health and wellness targeted to
people with I/DD results in preventable
health care disparities and poorer
health outcomes.
Discrimination – Health care providers sometimes provide inadequate
or inappropriate interventions and
treatments or deny appropriate care for
people with I/DD because of professional ignorance as well as personal
and/or societal bias.
Affordability – People with I/DD are
more likely to live in poverty and cannot afford cost-sharing. For cost containment purposes, many public and
private health care plans limit access to
specialists and critical services.
Communication and personal decision making – People with I/DD may
have difficulties communicating their
38
needs and making health care decisions without support. Their decisions
may not be respected and implemented by health care providers and, where
applicable, surrogate decision makers”
(Life in the Community, n.d.).
Pennsylvania regulations
Many people with I/DD live in
community residential group homes
governed by Pennsylvania regulations.
The capabilities for providing health
care in these group homes differ from
those in nursing homes or private
homes. It is important for health care
professionals developing in-home
treatment plans to recognize the
capabilities of provider agencies and
understand the rules by which they are
governed.
Medical knowledge
In many cases, people providing
care in residential provider settings do
not hold professional licenses or certificates; they generally learn caregiving
skills on the job. Furthermore, most
community homes do not have nursing
services or oversight. A nurse at a provider agency is generally considered
a coordinator of care and may or may
not provide direct care to the individual,
based on agency practices. Contact
the agency representative regarding
the ability of nursing to provide direct
care. If nursing care is required, a referral to home care may be necessary.
HIPAA
HIPAA regulations allow the disclosure of protected health information to
provider agency staff for the purpose of
treatment – the provision, coordination,
or management of health care and
related services among health care
providers. HIPAA compliance education is provided to provider agency staff
upon hire and annually.
Insulin administration
By regulatory requirement, group
home caregivers are not permitted to
administer insulin without training from
a Certified Diabetic Educator. If insulin
is required, alert the provider agency
ASAP to determine if staff has had
proper training.
Medications
Group home caregivers are not
permitted to administer any other
injections, IV fluids, or IV medications.
Contact the agency representative
concerning such medications and the
availability of nursing staff to perform
these procedures. Also, all OTC medications and treatments (e.g., moisturizing agents) require a written physician
order with specific instructions for use.
Physician orders for PRN medications must include specific dosages
(not a range) for specific symptoms, to
be administered within a specific time.
Provider caregivers cannot choose
when to administer medications for
orders reading “every 4-6 hours.” Likewise, they cannot choose how much
medication to administer for orders
reading “between 10-20 ml.” Group
homes cannot accept orders for PRN
psychotropic medications.
Tube feedings
Group home caregivers are not
permitted to administer or maintain
tube feedings without prior education.
Contact agency representative regardBulletin / January 2016
Special Report
ing tube feedings and the availability of
nursing staff to perform these procedures if caregivers have not received
required education. If possible, caregivers should receive instruction during
the individual’s hospitalization, prior to
discharge.
Medical supplies
Contact the person’s insurance
company or homecare agency to arrange for medical supplies required to
continue a person’s care at home (e.g.,
dressing supplies, catheters, bedside
commode, oxygen, etc.). Note: Group
homes are not equipped with wall
suction or oxygen.
Compliance
A person with an intellectual and
developmental disability maintains the
right to refuse treatment. Caregivers
in provider agencies cannot compel a
person to comply with treatment; they
are not permitted to restrain a person
for the purpose of medical treatment.
Tools
Specialists in the I/DD field have
developed tools to assist health care
professionals to provide quality care for
people with I/DD.
The Developmental Disabilities
Health Care E-Toolkit (http://vkc.
mc.vanderbilt.edu/etoolkit/) is a project
of the Vanderbilt Kennedy Center for
Research on Human Development, the
University of Tennessee Boling Center
for Developmental Disabilities, and the
Tennessee Department of Intellectual
and Developmental Disabilities. The
toolkit includes forms and information
that address health care issues specific
to people with I/DD, such as:
• Cumulative Patient Profile (http://
vkc.mc.vanderbilt.edu/etoolkit/wp-content/uploads/CumPatientProfile.pdf)
– This form is to be completed at the
initial visit and updated at subsequent
visits to document relevant information,
such as decision-making capacity,
special needs and communication,
current concerns, and current and past
medication records.
• Today’s Visit Form (http://vkc.
mc.vanderbilt.edu/etoolkit/wp-content/
uploads/TodaysVisit.pdf) – This form
includes a checklist for changes noted
in the individual, such as swallowing,
mobility, or bowel routine. Sections of
this form (e.g., Caregiver Needs and
Advice to Patient and Caregivers) promote dialogue between the physician
and the caregivers.
• The Behavioral and Mental Health
Issues section (http://vkc.mc.vanderbilt.
edu/etoolkit/mental-and-behavioral-health/) provides information on possible triggers for behaviors displayed
by people with I/DD and whether
psychotropic medications should be
prescribed.
• Other information about communicating effectively, informed consent,
specific syndromes and disorders
specific to people with I/DD also is
available.
An article from the World Psychiatry
Journal entitled “International guide
to prescribing psychotropic medication for the management of problem
behaviours in adults with intellectual
disabilities” (http://www.ncbi.nlm.nih.
gov/pmc/articles/PMC2758582/) is an
evidenced-based international guide
providing guidance for prescribing psychotropic medications and assessing
their effects in adults with intellectual
disabilities.
A 2008 joint position statement of
American Association on Intellectual
and Developmental Disabilities (AAIDD) and The Arc affirmed, “For the
first time in history, Americans living
in the 21st century will experience
millions of people with intellectual and/
or developmental disabilities living
into their ‘senior’ years.” In 2010, the
National Task Group on Intellectual
Disabilities and Dementia Practices
(NTG) was formed to examine information specific to people with I/DD and
dementia, their families, caregivers
and organizations supporting them, to
develop recommendations for services
and practices for better support (Background and History of the NTG, n.d.).
The NTG is comprised of experts
in the field of intellectual disability, with
members from the American Academy of Developmental Medicine and
Dentistry (AADMD), the Rehabilitation
Research and Training Center on Aging
with Developmental Disabilities and the
American Association on Intellectual and
Developmental Disabilities (AAIDD).
In April 2013, the NTG published
“Guidelines for Structuring Community
Care and Supports for People with
Intellectual Disabilities Affected by
Dementia,” reflecting the developing
nature of dementia and defining actions
that should be implemented. The NTG
embraces the staging model accepted
for practice among general dementia
supports. The staging model describes
dementia in stages – from the pre-diagnosis stage (early signs of cognitive decline recognized) through the early, mid
and late stages (Guidelines, 2013). The
NTG developed the Early Detection
Screening for Dementia (NTG-EDSD),
a tool to assess changes in cognition
and functional abilities in people with
I/DD. The NTG-EDSD is available at
www.aadmd.org/ntg/screening.
Special Needs Units (SNU)
Many individuals with I/DD living
39
Special Report
From Page 39
in southwestern PA have insurance
coverage through one of four Managed
Care Organizations (MCOs). Each
MCO health care plan has a Special
Needs Unit (SNU) to assist members
with I/DD, providers, nurses, and/or
caregivers to resolve issues or concerns involving a plan of care prescribed by a physician, such as obtaining approval for equipment or required
medications not covered by insurance
plans and addressing concerns with
health care providers or entities.
SNU contact information for Managed Care Organizations in SW PA:
• Coventry Cares Health Plan SNU: (866) 427-9721
• Gateway Health Plan SNU: (800)
642-3550
• United Healthcare Community
Plan of PA SNU: (877) 844-8844
• UPMC Health Plan/UPMC for You
SNU: (800) 463-1462
Educating individuals with I/DD
Educating individuals with I/DD
about their health care may require
specialized support to reinforce understanding. Methods for effective communication include:
• Teach the information in a quiet
room; minimize distractions.
• Speak directly to the individual
while caregivers observe.
• Speak clearly and slowly.
• Be patient; only raise voice if the
person has a hearing impairment.
• Allow 15-20 seconds for absorption and comprehension of information.
• If no response, call the person by
References
1. Brault, M. (2012). Americans with Disabilities
2010. Retrieved 2015, from http://www.census.gov/
prod/2012pubs/p70-131.pdf.
2. Life in the Community: Health Care. (n.d.).
Retrieved 2015, from http://www.thearc.org/whowe-are/position-statements/life-in-the-community/
health-care.
3. Health Care for Adults with Intellectual and
Developmental Disabilities: Toolkit for Primary Care
Providers. (n.d.) Retrieved 2015 from http://vkc.
mc.vanderbilt.edu/etoolkit/.
4. Aging: Joint Position Statement of AAIDD and
The Arc. (2008). Retrieved 2015 from http://aaidd.
org/news-policy/policy/position-statements/aging.
5. Background and History of the NTG. (n.d.).
Retrieved 2015 from http://aadmd.org/NTG/history.
6. Jokinen, N., Janicki, M.P., Keller, S.M., McCallion, P., Force, L.T., and the National Task Group
on Intellectual Disabilities and Dementia Practices.
(2013). Guidelines for Structuring Community Care
and Supports for People With Intellectual Disabilities Affected by Dementia. Albany NY: NTGIDDP
& Center for Excellence in Aging & Community
Wellness. Retrieved 2015 from http://aadmd.org/
sites/default/files/NTG-communitycareguidelines-Final.pdf.
40
name and repeat the information.
• Rephrase information to reinforce
understanding.
• Divide information into easy-to-understand segments, and teach one
segment at a time.
• Ask for a return demonstration to
confirm comprehension.
Closing thought
I/DD can present unique challenges
for health care professionals. Actions
that address those challenges can
enhance the health and lives of people
with I/DD.
Ms. Pursley is a health professional
with APS Healthcare, Southwestern
Pennsylvania Healthcare Quality Unit
(HCQU). She can be reached at [email protected].
Humanities in Health Conference
University of Pittsburgh, April 7, 2016, University Club
The humanities are vital to an informed and
engaged society. We must value their impact
and embrace their role in other disciplines.
As part of the Provost’s year of the humanities initiative, this one day conference on
humanities in health will:



serve to enhance the visibility of
humanities in medicine
highlight teaching & research collaborations between the humanities & health
discuss opportunities to allow the
conversation to continue past the end of
the conference
Contact: Dr. Soudi at [email protected]
Or visit :
http://www.linguistics.pitt.edu/
humanitiesinhealth/
Organizing Committee: Abdesalam Soudi, PhD; Judy Chang, MD; Shelome Gooden, PhD;
Scott Kiesling, PhD; Jeannette E South-Paul, MD
Hosted by: Departments of Linguistics; Family Medicine; Obstetrics, Gynecology, &
Reproductive Services
Special Report
2016 Medicare fee schedule:
Here’s what you need to know
Pennsylvania Medical
Society
T
he final rule detailing how Medicare
will reimburse physicians in 2016
was issued by the Centers for Medicare and Medicaid Services (CMS) on
Oct. 30, 2015. With your practice and
family responsibilities, we know you
don’t have time to read and analyze
the 1,358-pages to figure out how
your reimbursement may be impacted next year. That’s another value of
your Pennsylvania Medical Society
(PAMED) membership. We have you
covered with what you need to know.
PAMED’s experts are continuing
to analyze the final rule, but, at first
glance, here are some of the items
that may be of particular interest to
physicians:
Advance Care Planning – The rule
finalizes a proposal for separate payment for two advance care planning
services provided to Medicare beneficiaries by physicians and other practitioners. The Medicare statute currently
provides coverage for advance care
planning under the “Welcome to Medicare” visit available to all Medicare
beneficiaries, but they may not need
these services when they first enroll.
Establishing separate payment offers
providers and beneficiaries greater
flexibility in using these services.
Incident-To – In an effort to clarify
“incident to” requirements, CMS reiterates the supervising physician is
More on Advance Care Planning
Advance Care Planning Services
The 2016 Medicare Fee Schedule allows for payment for Advance Care
Planning Services. Although advance care planning was available in the past,
it was only covered when included with the IPPE. Most beneficiaries were not
likely to discuss advance care planning at the time of that visit. This enhancement will allow for greater flexibility for scheduling advance care planning
services for both beneficiaries and providers.
CMS defines advance care planning as a face-to-face meeting with the patient, family members, and/or surrogate for “the explanation and discussion of
advance directives such as standard forms (with the completion of such forms,
when performed), by the physician or other qualified health professional.” CPT
code 99497 is used for the first 30 minutes, and then add-on CPT code 99498
for 30 minute increments thereafter.
An advance directive is a document appointing an agent and/or recording
the wishes of a patient pertaining to his/her medical treatment at a future
time should he/she lack decisional capacity at that time. Some examples of
written advance directives include, but are not limited to, Health Care Proxy,
Durable Power of Attorney for Health Care, Living Will and Medical Orders for
Life-Sustaining Treatment.
CODING AND 2016 REIMBURSEMENT RATES
Name
Code
99497
Philadelphia
Area
$90.56
Rest of
Pennsylvania
$83.91
Advance care
planning; first 30
minutes
Each additional
30 minutes
99498
$78.72
$73.33
the physician who bills for “incident to”
services. In a conversation with CMS’
subject matter expert, PAMED was
told the rule “is intended to clarify that
the ordering physician or other prac-
titioner and the supervising physician
or other practitioner DO NOT need
to be one and the same. Rather, the
proposal is intended to clarify that the
41
Special Report
From Page 41
physician or other practitioner who
bills for the ‘incident to’ services must
always be the supervising physician or
other practitioner.”
Modifications to Physician Quality Reporting System (PQRS) – If an
individual eligible professional (EP) or
group practice does not satisfactorily
report or satisfactorily participate in
PQRS for 2016, a 2 percent negative
payment adjustment will apply to
covered professional services furnished by that individual EP or group
practice during 2018. There will be 281
measures in the PQRS measure set
and 18 measures in the GPRO Web
Interface for 2016. Also, as recently
authorized under the Medicare Access and Children’s Health Insurance
Program Reauthorization Act of 2015
(MACRA), CMS is adding a reporting
option that will allow group practices
to report quality measure data using
a Qualified Clinical Data Registry
(QCDR). The 2018 PQRS payment
adjustment is the last adjustment that
will be issued under the PQRS. Starting in 2019, adjustments to payment
for quality reporting and other factors
will be made under the Merit-Based
Incentive Payment System (MIPS), as
required by MACRA. Physician Value-Based Payment
Modifier – In the final rule, CMS
finalized the following provisions
related to the value-modifier:
• To apply the Value Modifier to
non-physician EPs who are Physician
Assistants (PAs), Nurse Practitioners
(NPs), Clinical Nurse Specialists
(CNSs) and Certified Nurse Anesthetists (CRNAs)
• To use CY 2016 as the performance period for the CY 2018 Value
42
Modifier and continue to apply the CY
2018 Value Modifier based on participation in the PQRS by groups and
solo practitioners
• For groups of ten or more EPs
– Continue with maximum upward adjustment of +4.0 to be multiplied by an
adjustment factor (to be determined at
conclusion of the performance period)
and a maximum downward adjustment
of -4.0 in CY 2018
• For groups of two to nine EPs and
solo practitioners – upward adjustment
of +2.0 multiplied by an adjustment
factor and a maximum downward
adjustment of -2.0 in CY 2018
Physician Compare – The final
rule continues the phased approach to
public reporting on Physician Compare. CMS will continue to make all
2016 individual EP and group practice
PQRS measures available for public
reporting. All CAHPS for PQRS measures for groups of two or more EPs
who meet the specified sample size
requirements and collect data via a
CMS-specified certified Consumer Assessment of Healthcare Providers and
Systems (CAHPS) vendor are available for public reporting. In addition, all
Accountable Care Organization (ACO)
measures, including CAHPS for ACOs,
are available for public reporting. CMS
also is finalizing the following proposals:
• To include Certifying Board, and
specifically add American Board of
Optometry (ABO) Board Certification
and American Osteopathic Association
(AOA) Board Certification.
• To include an indicator on profile
pages for individual EPs who satisfactorily report the new PQRS Cardiovascular Prevention measures group in
support of the Million Hearts initiative
• To continue making individual-level QCDR measures available for public
reporting, and, new to 2016, to publicly
report group-level QCDR measures
• To publicly report an item (or measure)-level benchmark derived using
the Achievable Benchmark of Care
(ABC™) methodology.
• To include in the downloadable
database the Value Modifier tiers for
cost and quality, noting if the group
practice or EP is high, low, or neutral
on cost and quality; a notation of the
payment adjustment received based
on the cost and quality tiers; and an
indication if the individual EP or group
practice was eligible to but did not
report quality measures to CMS
• To publicly report in the downloadable database utilization data for
individual EPs.
CMS is not finalizing the proposal
to include a visual indicator on profile
pages for group practices and individual EPs who receive an upward adjustment for the Value Modifier. CMS
is, however, finalizing its proposal to
publicly report an item-level benchmark for group practice and individual
EP PQRS measures using the ABC
methodology. The benchmark will be
stratified by reporting mechanism to
ensure comparability and reduce the
interpretation burden for consumers.
The benchmark will be displayed as
a five-star rating on Physician Compare. CMS will conduct analysis and
stakeholder outreach around the star
attribution methodology prior to public
reporting in 2017.
PAMED will monitor any developments and will continue to review the
final rule and provide information on
any changes that could impact your
reimbursement.
NOR C AL
G RO U P
O F
CO M PA N IE S
GUIDE
GUARD
ADVOCATE
MEDICAL PROFESSIONAL LIABILITY INSURANCE
PHYSICIANS DESERVE
Offering top-tier educational resources essential to reducing risk,
providing versatile coverage solutions to safeguard your practice and
serving as a staunch advocate on behalf of the medical community.
Talk to an Agent/Broker about NORCAL Mutual today.
© 2015 NORCAL Mutual Insurance Company.
nm0634
NORCALMUTUAL.COM | 844.4NORCAL

C M S Bulletin - Allegheny County Medical Society

Transcription

Similar documents

I`m helping to end MS by participating in the 2016 Jayman BUILT MS

Print Balloon Mascot - Allegheny Valley Bank

The Board of Directors of Qatar Fuel (WOQOD) is pleased to invite

5 `S` Training Program at ABV-IIITM, Gwalior on 21.07.2016

Porky Expo Flyer

Sept 30-Oct 2, 2016 Nov 4-6, 2016 @Camp Tadmor

4 star ALOE HOTEL, PAPHOS

the Guidelines for the registration on

Ticket plus hotel packages for the Chelsea Flower Show 2016

loyola institute for ministry on-campus open house thursday, may 12